by Terrye Tebbetts
Question ~
My surgery was march 24 and my implants started right under my collar bone, and have barely dropped at all!!!! I have gone to 4 post op visits and he says not to worry but reading everyone elses posts it doesnt seem to happen to others. My Dr is a VERY sought after board certified plastic surgeon here in Houston so I dont think he messed up. I massage them every hour and do the lift and drop thing every hour also!! I know I am a completely neurotic person anyways, but I am terrified they are not going to drop!!!!!! Anybody else’s implants take FOREVER to start to drop????
Answer ~
All of the notes in this thread are right on in encouraging you to be patient with your implants – on average, it takes 4-6 weeks before you even begin to like what you see in the upper part of the breast, three months before you can really start to figure out what new cup size you will be and 6-9 months before they start to feel like they are yours.
The real tragedy here is that you were not aware and prepared for this ahead of time. That is why we tried very hard to tell it like it is in our book, The Best Breast 2, so that patients – regardless of the surgeon you use, will have a better idea of how to prepare and what to expect when it comes to your breast augmentation surgery.
You can read more about recovery and the advances that allow better, more refined 24 Hour Recovery experiences at www.thebestbreast.com.
I have always thought that if it is a surprise to a patient….then it is a problem. Knowledge is so empowering for each of you as you decide to enter this new world of breast implants!
I hope this helps – patience is your best friend right now!
Terrye
Question -
I was wondering who had which kind of silicone, and the pros and cons you have noticed? I am 100% getting silicone but my surgeon offers both. I do not meet with him until May so I wanted to hear from women who have them.
Answer -
I have been off the boards for a bit so forgive my delay in repsonding to your request and this question. You have asked a very important question that all women considering silicone should ask. I think the confusion surrounding silicone implants today is a huge issue for patients – and it is really sad because the manufacturers and surgeons have chosen to muddy the waters.
So let’s go back and get a handle on what is what. In the early 1990′s they took silicone breast implants off the market. They were reintroduced back into the market in November of 2006 with dramatic advances and changes that made the FDA say – this is a good produce and they deserve to be available to everyone again. In a very basic sense – here are the changes – they increased the amount of fill per implant shell which helps protect the integrity of the shell long term (helps it pass the tilt test – see www.thebestbreast.com for more info on the tilt test) and they increased the viscosity of the silicone gel – they made it thicker, not “form stable” but thicker – thus the new names – cohesive and memory gel. By thickening the gel, gel bleed through the shell is lower and thus capsular contracture rates for the device improved. These implants are widely used today and require no enrollment in a study. Any ps can use them.
While the old silicone implants were off the market, Mentor and Allergan both started studies on more form stable gel implants – or “gummy bear” implants. These studies are still in force today. They require a 10 year committment from each patient. Dr. Tebbetts participated in both studies so we have patients that have the Mentor CPG and the Allergan style 410. In fact, I have the 410 and have had them for almost 10 years now. These implants are shaped, not round. They are textured for positioning purposes and the gel is thicker – it is not solid but more form stable than the cohesive or memory gel products. The style 410 is also adequately filled to prevent any type of shell folding. Very few surgeons can use these products. There are only 150 participating surgeons in the Allergan study nationwide.
You will find a host of [B]opinions[/B] about which silicone implant is better than the other. But there is not a lot of [B]science[/B] yet as the information is still closely held by the manufacturers and the FDA.
I think the most important fact for all of us to realize going into breast augmentation is that NO implant device will last forever. The decisions we make pre-operatively will directly effect how long our results will last. So it is important to understand all the issues and information about the devices, but more importantly, understand how to work with your ps to determine which device is ultimately best for you and will offer the least amount of risk to your breasts and body long term.
For example, if you are dead set on a gummy bear because you love the idea of the more form stable gel, yet you are paper thin with no tissue chosing this implant will put you at MORE risk for a malpostioned or rotated implant. So you get what you think is a better device but then have a football looking breast on one side and a normal one on the other – that then requires another operation. So see, it is about taking the best of all the parameters and then fitting them with the best choices of implant shape, filler and shell type, pocket location and size and incision location.
The number one reason for reoperation in BA is not for device failure or longevity. The number one reason women have a reoperation in BA is for SIZE exchange – either they get something too big that damages their tissue or they get what their body really needed but get greedy and want bigger. There are clinical ways to avoid the pitfals of deciding size ( go to http://www.thebestbreast.com/articles.php for sizing information).
The moral to this long dissertation is that you can research and choose what you think to be the best, latest and safest product but if it is used incorrectly – if it’s too big for you, you are not a good candidate for it or there is not enough soft tissue coverage (pocket location) for it – then is it really the Best for you?
Good results are a product of looking at the BIG picture for your BA – not just one aspect of it. I hope this helps you and your ps look at all the little specific details of YOUR body and YOUR case so that you can both make the best decisions for you together!
Terrye
Filed under: Other
Dr. Tebbetts just returned from Venice with some pretty amazing photos of Carnivale…..
http://www.youtube.com/watch?v=Ev4oePqOSVw
Enjoy!
Terrye
Dear Terrye,
Hello. I just wanted to check in with the office. Today is my six week point and I want to make sure I am good to move on without restrictions. I believe I can now….swim, tan, anything else? Can I wear an under-wire bra, or should I wait three months for that. Also, when would you like me to come back into the office for a follow up?
I also just wanted to tell you how wonderful everything has gone! I am still amazed that I had implant surgery and that it was only six weeks ago! I have had no problems at all. My kids didn’t even know that I had undergone major surgery. I was able to pick up the two year old right away and simply side tracked the question with my 3 and half year old. It was so easy! Both my husband and I are very pleased with the results! Dr. Tebbetts is a genius and so very talented. My scar is minimal and my size is perfect! I never imagined, in my last 15 years of life as I dreamed about a chest, that it would be this easy and perfect! I feel very blessed to have found you, Dr. Tebbetts, and the rest of the staff! I guess I should be thankful for Google as well, since it lead the way:) You all really are making dreams come true in the most realistic and natural way possible! I want to tell everyone about it….but then don’t want to reveal my secret to perfect strangers!
That is my summary. All is great, tightness almost gone, no pangs of pain. They look great and are starting to feel like mine!
Answer -
Thank you so much for your wonderful note! I am so happy for you and can’t wait to hear how your trip goes too!!
Yes, you can do anything at this point – although tanning is never a good idea due to it’s skin cancer risks! But being outside with sunscreen or a spray tan might help you get through your trip???
You can wear an underwire if you want – but please still be mindful of the incision and just be sure it isn’t rubbing. And if you can come back for your 6 month visit for pictures – that would be awesome!
Thank you again for catching up with us – we look forward to seeing you soon!!
Terrye
by Terrye Tebbetts
We just received this letter this morning from Dr. Tebbetts’ publisher in London. Elsevier Publishing submitted Tebbetts’ Augmentation book for surgeons to a very special publishing awards competition. And his book won honorable mention, which according to the publisher is really amazing….she likens it to being in an Academy Award race! See her note below and a link to the announced winners:
Dear John and Terrye, I hope you are both well and that your daughter is doing well too – she must be really growing up fast now.
I’m thrilled to tell you that Augmentation Mammaplasty won a honorable mention at the Association of American Publishers Prose awards yesterday. This is the equivalent of the academic publishing Oscars and to win anything at it is virtually unheard of – so I am very proud and pleased and I hope you will be too. It’s a real coup – normally around 500 books are entered for the Clinical medicine section alone!!!
We’ll be sure to mention the award in our marketing for the book, on our website, at Amazon, etc. The link to the award site is here:
http://www.proseawards.com/current-winners.html
by John B. Tebbetts, M.D.
Today, the FDA released the results of its lengthy and detailed investigation and analysis about a possible association between breast implants and an extremely rare type of lymphoma called ALCL. This investigation by the FDA has been ongoing for almost a year, as experts from the FDA and other medical disciplines reviewed all available information in the medical literature, compiling all published case reports in the medical literature.
According to the FDA’s report, the FDA is “exploring a possible link between breast implants and ALCL. “ ALCL is an extremely rare type of lymphoma of the immune system that can occur anywhere in the body, but has been found in 34 women worldwide who have breast implants, out of an estimated 5-10 million (FDA numbers) of women who have had breast implants.
The FDA’s report states:
1) “Because the risk of ALCL appears very small, FDA believes that the totality of evidence continues to support a reasonable assurance that FDA-approved breast implants are safe and effective when used as labeled”,
2) “ALCL is lymphoma—not cancer of the breast tissue”, and
3) “If you have breast implants, there is no need to change your routine medical care and follow-up.”
The vast majority of the reported cases of ALCL in breast implants occurred in patients who developed very large collections of fluid (seroma) around their implants more than 6-12 months following their augmentation surgery.
In my 30 year clinical experience with breast augmentation, treating thousands of patients, I have seen only 4 cases of seroma or fluid collection more than 12 months following surgery. None of those cases had ALCL. Two of the 4 cases developed low grade infection years after augmentation, with the specific cause undetermined.
Any mention of any type of tumor associated with breast implants understandably causes concern to any breast augmentation patient. My job as your surgeon is to evaluate the scientific evidence available, and provide my patients with my best evaluation of the evidence available. Exceedingly rare conditions occur in medicine, so constant vigilance; clear thinking, relying on science instead of opinion, and honestly communicating with patients are the principles that guide my practice.
Until there is more information regarding ALCL, what it really is, and what association between ALCL and breast implants can be proved scientifically, I recommend two things to my patients:
1) I agree with current FDA guidelines. If you do not have large fluid accumulations around your implants, or a breast mass that you can feel, you should be aware of information about ALCL, but not change anything about your current follow up or treatment. If scientific evidence changes, I will keep all my patients updated, and our recommendations may change based on that evidence.
2) If, for any reason, even if it is not based on scientific evidence that any physician should follow, your breast implants become a source of concern that outweighs their positives for you, you can elect to remove your implants. In the absence of medical evidence that documents a medically, scientific valid reason to put you through a surgery to remove your implants, I cannot recommend removal of implants as something that is medically necessary. Nevertheless, I understand that when your concerns, after consideration, outweigh any benefits you may have from breast implants, you may elect to have your implants removed.
I currently have an article under peer review in the most respected professional journal in plastic surgery, Plastic and Reconstructive Surgery Journal that outlines detailed diagnosis and management suggestions for surgeons of options for addressing late fluid collections in breast augmentation. The peer review process is essential and time consuming, and I will keep patients and colleagues updated on the information in that manuscript as the process continues.
The FDA’s summary report is here: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm240000.htm
The more detailed and comprehensive publication by FDA of their analysis is here:
by Terrye Tebbetts
Question ~
hi. i read your book and am wondering what the best way to remove the two ugly scars i have under my breasts. I had breast augmentation done a year ago and have dark keloid scars. I like my new boobs but hate the scars. what is your suggestion? pls let me know.
…desperate in nyc
Answer ~
I am sorry to hear about how your incisions healed but really glad that you like your new additions otherwise!
Scar revision is always a catch 22 – to revise it, you have to open up the communication with the implant pocket (which increases risk of infection and possible implant removal) and the incision now has to be LONGER than the first one if done surgically. And again, remember, how you heal is genetically influenced (and people in the middle of the skin color range don’t heal as well (ie Asian, Hispanic, light African American) – you want to be really fair or really dark to get the best out of your genetics on that one and you obviously can’t change that!
Often people try to inject true keloid scars with steroid to thin them down – but that is fraught with problems here too as you don’t want to thin the skin and risk implant extrusion!
Honestly, if they are under your breasts……I would just stop messing with them and stressing over them and enjoy your breasts – because there is no good – predictable – safe option for revision.
I am sorry there is not an easy way to change what bothers you. But when in that situation, you always have to really see if something can be predictably done to fix it and if so what risks does it carry – - then weigh the risks and benefits to see if it makes sense – here, I don’t think it does.
by Terrye Tebbetts
In this month’s Plastic and Reconstructive Surgery journal there is a new article from Dr. Tebbetts and Dr. Steve Teitelbaum on the subject of High Profile breast implants and the controversy that surrounds them. Since they seem to be a topic of conversation on almost every breast implant forum and just a big a source of confusion, I thought it might be helpful to share with you what surgeons are sharing with each other.
High and Extra High Projection Breast Implants: Potential Consequences for Patients
John B. Tebbetts, M.D., Steven Teitelbaum, M.D. Dallas, Texas; and Santa Monica,Calif.
Summary:
Plast. Reconstr. Surg. 126: 2150, 2010.) All breast implants can potentially have deleterious effects on patients’ tissues. Limiting negative tissue consequences and potential uncorrectable deformities requires that surgeons be aware and educate patients regarding potential consequences of various implant designs. High-profile implants have been available for decades, and during the current decade, extra-high-profile implants have become available, but no valid peer-reviewed and published studies have compared the potential tissue consequences of these designs to those of other breast implant designs. Valid comparative studies are exceedingly difficult to perform because of the number of variables that must be addressed to establish valid comparative cohorts. Nevertheless, the potential occurrence of negative tissue consequences from high- and extra-high-profile implants in primary breast augmentation and breast augmentation reoperation cases is well known to experienced aesthetic breast surgeons. This article addresses potential negative effects on patients’ tissues of high- and extra-high-profile breast implants used for breast augmentation. This Special Topic article is not structuredor intended as a scientific article. It is written as a Special Topic and not an Editorial at the editor’s request. The cases presented are selected examples to illustrate potential clinical eventualities. The rate of occurrence of uncorrectable tissue deformities relates directly to surgeon and patient awareness of the potential consequences of implant selection decisions and requests. To minimize risks of negative tissue consequences for patients, surgeon awareness, patient education, and optimal implant selection decision processes are essential. (Plast. Reconstr. Surg. 126: 2150, 2010.)
You can read the paper and see the photos of the complications here http://www.thebestbreast.com/news/downloads/pubs/High__and_Extra_High_Projection_Breast_Implants_.43.pdf
By Terrye Tebbetts
Today a very exciting thing happened for patients considering breast augmentation! A California surgeon who tries very hard to emulate Dr. Tebbetts’ style of breast augmentation and 24 Hour Recovery (R) techniques was able to get national television to pay attention!! Dr. Ash Ghavami studied under Tebbetts in Dallas and has tried to translate our 24 Hour Recovery (R) techniques into his practice and for his patients in California. We have many surgeons that visit and say they do….but, do they? As a patient you will still need to ask the hard questions to see if you are getting a 24 Hour Recovery. How are size decisions made? How long does the surgery take? Will there be special surgical bras, bandages or drains or bruising or pain meds? How long has the ps been doing it? Can you talk to at least 3 patients who have had a 24 Hour Recovery (R)? What is their published (or verifiable rate) rate of capsular contracture? There are so many ways to ferret out – scam vs real improvements! Asking about your recovery ahead of time will give you tremendous insight into what to expect post-operatively – in the first 24 Hours and for your life time!
There are two chapters on recovery in The Best Breast 2 to help you sort through these issues….remember you can call it flash recovery or rapid recovery, but if it does not afford you the same advances that are scientifically proven with 24 Hour Recovery (R) - what is the benefit of a new name?? As Shakespeare had Juliet explain, ”What’s in a name? That which we call a rose by any other name would smell as sweet.” But it still has to be a rose, not a petunia or a daisy…… 24 Hour Recovery either is or it isn’t, consumers, patients, must determine the validity of the rose.
I am just so proud that someone got the word out that there is a better way – that surgical advances exist in breast augmentation that will allow patients to change their bodies in a ways that they cannot do through their own efforts….safely and efficiently. When you can truly produce a 24 Hour Recovery (R)- it allows you to do something for yourself and let no one notice – you don’t have to take time away from your family or your profession – you get to treat YOU for a change. And in the process, we have shown with Dr. Tebbetts’ patients that when patients truly have a 24 Hour Recovery (R) - they have a lower incidence of capsular contracture- – - 36% to 1.5%!! This is a tremendous clinical advance for the surgical community and for patients.
When Dr. Tebbetts published his works in 2002 – - over 8 years ago – - he did so because he wanted ALL patients to have a better experience. We applaud the surgeons who strive for a better level of care and results for patients. But as a patient, you must always be the educated consumer and be sure you get what you are asking for.
After 12 years of standing on my soapbox and wondering why television perfers to show the blood and gore of Dr. 90210…….I am thrilled that 24 Hour Recovery (R) has finally triumphed and gotten, at least a tiny bit of the attention it deserves! Thanks Ash.
Filed under: Breast Augmentation, Other, Recovery Experiences, Size Issues
by Terrye Tebbetts
I don’t have the luxury of knowing this lady’s entire situation; however, when someone says, “Anyone with Silimed implants? I am going to UK for a consult. I have had terrible problems with breast augmentations,” my stomach aches for her. The moral of this story is – it is rarely the product – the implant’s fault. Implants don’t do anything until the patient and surgeon make them do something, so without really good education preoperatively to make good decisions with your ps, you can end up in a ton of trouble. The worst part is, there is no easy fix – - like a new implant or new product. Once you damage tissue – you have damaged tissue. That is why making quality, knowledgable decisions ahead of time are so important.
Here is my answer……
I am sorry you have had problems, but remember, and I don’t know your situation, but in general, it’s not the implant that causes the problem and it is rarely a certain type of implant that can fix the problem.
A beautiful, natural breast that is least likely to cause risk of reopeation is one that is the right size for you – one that does not push the tissue to places it has never been before.
Even though Dr. Tebbetts was instrumental in developing shaped implants – shaped implants are not what make a pretty breast – an implant that is the right size is what makes a pretty breast – no matter the shape or filler.
I know Silimed’s big push in the US has been with shaped implants – I would not pursue a shaped implant in any secondary case. A round implant will be better for you if you have had multiple reoperations.
Now, if Silimed has a round product – then yes, I believe it is worth looking into as they are a really good company that hopefully will gain US market share when the FDA makes a move on approval of new implants.
If you are interested in what we have done to help patients avoid reops in the future, you can read more about the process of good preop decision-making at www.thebestbreast.com
I hope all turns out well for you this time!
