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
by Terrye Tebbetts
Question -
Hi my name is Megan I am a stay at home mom with a 4 year and a 2 year old. In Sept 2011 I’m getting Breast augmentation. I have decided on saline gel, smooth, round, and arm pit incision. I am currently an a cup and going to a full c small d. I need advise I will have my surgery done on a Friday morning, and my husband is off until Monday morning to help me. Does anyone have advise on my recovery with the kids? How hard will it be not picking them up or making lunch on the week after the surgery?
Answer #1 -
Hi megan, I had my surgery on 1/20 and I also have 3 small kids (8, 6,3). My 8yo and 6yo are in school and my 3yo goes to daycare (my husband and I both work full time). I was off for a week after my surgery and I needed everyday! The problem wasn’t the pain or picking up the kids. It was that I got tired a lot easier than expected. The pain meds will automatically make you tired and a combination of swelling and heaviness made it worse. I think you may need some additional help for a few more days just so you can nap and rest when you need to.
My Answer ~
Megan -
There are better ways to do this operation and recover from it! You should read about 24 Hour Recovery on our web site at www.thebestbreast.com – - if your kids weigh less than 35 lbs….you can be picking them up the night of surgery and driving the next day.
And on the size note, please don’t make your decision about changing your body based on something that doesn’t exisit…..CUP SIZE. There is NO medical definition for it – don’t change your body based on it!!
You are welcome to email me at TTebbetts@plastic-surgery.com if I can help you!
Terrye
Filed under: Back to the Basics, Breast Augmentation, Recovery Experiences, Size Issues
by Terrye Tebbetts
Thursday is our patient day with Tebbetts and today was a big one! We had a lot of out-of-town patients who had traveled to Dallas to have surgery this week. You can plan and screen and do the best you can do wanting to help someone, but in the end…it is all about the relationship the surgeon has with his or her patient.
We are in Dallas. This lady came from San Antonio – not far – but still….and when it all came down to it….there are other things going on in her life right now that emotionally inhibit her ability to go through this process like a normal patient. I hate to see this happen and it doesn’t happen very often. But when it is all said and done, what is most important is that your surgeon is on the exact same level as you are and that the two of you “get it!”.
Tebbetts measured this patient and was moving on with a normal consult today, but something wasn’t right. After a lot of time, he left the consult room and recommended that she wait. When I went in to talk with her, she said, “You have a very perceptive husband.” I said, “Really?” She said, “He just simply looked me in the eye and said, “What’s going on here?”" After many tears and simple truths, this patient has other life issues to deal with and resolve before having surgery. Dr. Tebbetts – at that point in time, became more than just her surgeon.
I have worked with him and been married to him for 21 years now and he never ceases to keep amazing me. He did what was right today – for her and for us. Good judgement, basic human kindness never goes out of style and is always in everyone’s best interest.
Having someone who you can trust and believe no matter what is priceless in any situation. ‘nough said. I am grateful.
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
I have enjoyed being back on the forum this week and I know that so many of you are looking forward to your surgery or are excited because you just had it – - all that is so good and sharing the experiences with others is so helpful to all that read the posts here.
However, and I know I will get chastised for being the bad guy again, but here goes, because all who think about this surgery and are living through the recovery must understand that you cannot truly evaluate your result and how you feel about it and how it will age and weather time with you for quite awhile after surgery.
A three week opinion vs a three month or three year opinion are entirely different. Immediate post op responses are wonderful in terms of the surgical experience and how your recovery was – I love for my patients to write about what they did the night of surgery or that weekend after surgery – a two to three day experience of how they can get up and how they use their 24 Hour Recovery time helps others understand the new level of what recovery can be.
But when, as new, fresh patients, we render a three week opinion about size and how it looks or ages – I think we are in dangerous territory. It is too soon for you to know and truly see what will happen.
There are time lines post op that can guide you through very important mile stones. 4-6 weeks – they are too high, tight swollen and big, Three months is the mark where you can really find a good bra – your new “cup size”, 6-9 months before sensation and nerves get back to normal, and a full year before your biggest risk of CC is gone. Most PS won’t even take post op pics until you are 3-6 months post op (patients will take them and document their progress – but clinically speaking we need 3-6 months).
I just think it is very important to know and understand that although you may have a great recovery – be it called 24 Hour or rapid or whatever – 3 weeks, 6 weeks, 3 months even is too soon to truly know and understand what is going on in your breasts and your result. It takes time.
500 cc at 3 weeks will not be the same as 500 cc at three years. High profiles at three weeks will not be the same as three years – trust me. So keep sharing experiences but understand, the timelines make a huge difference as to how you see your result and what you are going through. This is kind of like the tortoise and the hare …. go slow – like I tell patients, we don’t want this to be good for you for just the first 24 Hours – but good for you for your life time! Results that are good for your lifetime require educated, knowledgable decisions that will reduce your risk of reoperation long term.
Immediate feedback is like immediate gratification - – - – think about that one for a minute.
I hope this perspective can help as experiences are shared.
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!
by Terrye Tebbetts
If you have been toying with the idea of getting breast implants, but just aren’t sure how to approach the subject with your Hubby or Sweetie….get them involved too! Give him a copy of our book – The Best Breast 2. Let them know you are doing your research and working hard to make the very best decisions you can make to have an amazing result that will last as long as possible for both of you. I promise you, when they know it can be an easier more predictable surgery than what they have heard their buddies wives go through…..they will be so much more at ease and supportive of you!
The idea of 24 Hour Recovery to husbands is just amazing! After all, when Momma is sick and can’t do what she does….the whole household suffers, right? They worry about you. About you having an elective procedure, that you really don’t have to have. They worry about having to do for you what their friend had to do for his wife (take over carpool, cook, clean, baths, help her go to the bathroom (I am not kidding)). So if they can understand that it is possible for you to have breast implants and be up and showered and ready to go out to dinner and all he has to do is DRIVE……he gets a lot more excited and supportive of your new venture! It is fun to watch the guys get involved, ask questions and see how much they enjoy being your “coach” and bossing you around to get your arms up every 30 minutes the night of surgery!
Listen, it can’t hurt – the more everyone knows about breast implants and breast augmentation, the better the entire experience and result will be. And you can tell him, “Yes, honey, there are pictures in the book!”.
P.S. The Best Breast 2 is a great item to put on your Christmas list – easy to wrap and a great way to start the conversation!
by Terrye Tebbetts
Question ~
Worried about Ellipse lift being ‘enough’ and need reasurance…
surfing around another forum with an area just for ‘lifts’ I was saddned to see how many girls were not happy at all with their lifts and how they felt they did not get the ‘upper poll’ fullness at all and still had to wear a bra to have any fullness…
I want nice full perky boobs again and I’m just hopping that an Ellipse lift with my breast augmentation will be enough to keep the girls looking nice.
My nips are right even with my crease…maybe a speck above (point straight forward) and I fill out a 34C bra…just looks like I have absolutely no meat in the upperpole area when my bra is off (think breast bone!) ugh!
BTW, my PS is sure I’ll look great with just a little nipple raise with my breast augmentation…he does not think I look that saggy and thinks the other lifts would be overkill for me…
I just can’t help but be a bit scared I’ll end up with the “saggy globe” look…
I want that upper fullness so so much! My dream is to be able to wear a tube top or spaghetti straps and look AWESOME…
Am I dreaming the impossible dream?
Do boobs with any pre-op sag at all have no chance in achieving that wonderful ‘fullness’???
I’m just a bit blue today wandering if my dreams of the perfect pair will set me up for disappointment…
Terrye ~
Ok – this is NOT rocket science…..sorry ladies, but the truth needs to be out there…..am implant will go to the BOTTOM of the skin envelop it is given to go to…in a breast that needs a lift to begin with….even if you add an implant, it is not likely to be perky and firm and lifted. Upper fullness is ELUSIVE – now that is not to say that a breast that truly needs a lift will not benefit…it is just that you have to be sure that you understand what it will do and what it won’t do.
Also – please, PLEASE, understand that doing an breast lift or mastopexy at the same time as adding an implant is like doing two seperate OPPOSITE operations…..one makes the skin envelop smaller, the other bigger…..go figure!
I am happy to discuss on any level…email me at TTebbetts@plastic-surgery.com or call me at 214-220-2712
The bill of goods, the promises made to women who need a lift are very frustrating to me… you need to come to grips with your own tissue and its limits. It can be better but maybe not what you dream of….better that you understand that now than AFTER a failed procedure.
Response ~
We come here for support, and those of us who have our surgery schedualed have chosen a surgeon because we feel comfortable and extremely confident in him/her to take good care of us…
All these minor freak-outs are so normal for all of us…remember…most of us here are doing this for the very first time and it’s not only my first BA but my first major surgery EVER so of course I have emotions that bubble up and it’s nice to have a place to vent them and simply get support…not judgment…
Let me remind you that I am getting an Ellipse lift…not an extensive lift…a cressent of skin will be removed to simply lift the nipple/areola up a very small distance…I couldn’t imagine it being extensive enough to warrent 2 seperate surgeries…after all, it is the only cut I will have and he will use it just as the normal peri-areolar incision to actually place the implant through…
Like I said…I have complete faith in my PS…I just appreciate a place to pick through and come to terms with all these various emotions running through my head…
Final Answer…Terrye ~
Can we talk soon? Please call me when you have time…214-220-2712 – we are on Central time. I think you misconstrued my post and I would like the opportunity to explain – emails and forum posts don’t allow a way to truly convey your sincerity and knowledge.
I stand firmly behind my beliefs that even if you need an ELIPSE of skin removed, your tissue is genetically telling from them beginning AND UPPER fullness is the elusive treat that most women pursue, never get and instead deal with endless reoperations.
So I get the nerves and gitters that all patients go through – that is normal….seeking solice from others who may not have found their way out of the woods yet is the equivalent of telling your kids yes all the time. What I post on here may not always be what you want to hear, but I speak from 21 years of experience in dealing with patients and helping them avoid reoperations and additional costs. And please uderstand, I don’t expect to have all of those I post to come to Dallas – - – that is not why we wrote the book, or I spend time here with all of you. We want to see women avoid the pitfalls we have spent our careers FIXING—–balancing what you want with what you can have is a BIG deal in this operation.
If you like you ps (whom I know very well and respect) discuss the real time, realistic reality of upper pole fullness in any breast, let alone one that needs ANY kind of lift to begin with. Ask him and ask for reality not marketing, sign up, let’s go stuff…..look at your consents….in a breast that needs an elipse lift, and a 400 cc implant….what is he warning you about in terms of long term stretch and reop?
Like I said and I admit – perhaps a bit harshly – this is not rocket science….we all come into this operation with the tissue and experiences we were BORN with and we WALK instead of float. Now – I have been honest with you about your upper pole fullness goal….has your ps done the same? That is all I am asking…that we all be realistic.
by Terrye Tebbetts
Question ~
Just curious … Does you know which implant profile is best to achieve the upper pole fullness? Mod, Mod+, or High Profile? I so desperately want upper boobie fullness!!!
Answer ~
It is not about the implant or the device. All implant patients want upper fullness, but what you get, depends on what you start with. If your ps is measuring your breasts and applying the High Five System, then you will be filling the empty space and not pushing the tissue to where it has never been before, in doing so, the upper breast will be very blended and natural – not fake looking.
An implant MUST go to the bottom of what we give it to go to and begin filling from the bottom up. So if you are 20 yrs old, no babies and flat as a board now….you will have a ton of “upper boobie fullness” (because there is no where else for the volume of implant filler to go). If you are 30 something and had some breasts, then nursed a couple of babies, there is more stretch and further down for the implant to go before it can start heading north.
One of the key measurements in High Five is the amount of APSS (anterior pull stretch) – you can kind of sort of do this at home….grab the areolar above the nipple and pull straight out as far as the tissue will allow you to pull, watch the skin “tent” above the nipple, where that tenting goes is about (and remember, I said “about”) where you will get your upper fullness.
There is no magic here – the empty skin has to be filled, if you fill it and don’t push it, it look natural but is still full in the upper breast. If you push it and put in too much implant, it is temporarily fuller and faker in the upper breast, but….guess what? The implant is heavier than it should be and will stretch faster and all of the sudden your “upper boobie fullness” is down around your knees before you know it.
I can email you a High Five Measurement sheet for you to do at home, but at least the APSS test will show you where the skin tents! TTebbetts@plastic-surgery.com
by Terrye Tebbetts
Recently, I received a link to some new reviews of our book and wanted to share them with you. It is so nice to hear from members of our industry, surgeons and patient advocates, who find the information we have put together is beneficial and helpful to patients!
*THE* reference guide for Breast Augmentation Surgery – Rebecca Kidder – SC
I’m a plastic surgery patient advocate and have received nothing but good reviews on Dr. Tebbetts, the author/surgeon. He really knows his stuff when it comes to breast augmentation!
If you’re planning on surgery, you will spend a few thousand dollars, so the small cost of this book is an excellent investment and could help you avoid bad plastic surgery or an unqualified surgeon.
Even if you’ve done your homework, you’ll still learn from this book. It’s well-laid out to find what you need quick and lots of diagrams to help you understand sizing and implant options.
Surgeon review ~
I am a plastic surgeon who does a lot of breast augmentation, so it is with some authority that I can say that Dr. Tebbetts has contributed more to breast augmentation than any other plastic surgeon in the world. Do a search for scientific articles on breast augmentation, and his name comes up more than all other plastic surgeons combined!
In The Best Breast 2, he distills and translates those articles into understandable English for patients. I ask all of my patients to read it before their consultation.
They say it is a quick read and easy to understand. They all comment that the book is organized intuitively, with important subjects written in bold. Though it has a lot of information, the prose is succinct and can be read quickly. At times it seems repetitive, but I suppose that is necessary so that the chapters can be read independently of one another. Also, the repeated information is critical for patients to know, so it is probably good that certain points are emphasized.
When patients read it before their consultation, the visit is very sophisticated and highly productive. The Best Breast 2 fully informs them about each of the choices that they will need to make about their surgery. I am thrilled when I do a consultation with someone who has read The Best Breast, as we can have a discussion on a very high level, and spend our time discussing the important subjects as well as subtle nuances that are possible with the surgery. I don’t have to waste everyone’s time correcting common misunderstandings, and the patients know the important issues upon which to focus, the critical decision they have to make, and always ask the most insightful questions.
These patients make better decisions about their surgery. Better decisions means a better operation, less pain, faster recovery, and a better likelihood of having the long-term result that they wanted.
No book or website holds a candle to the quality and presentation of the material in The Best Breast 2.
If “All philosophy is a footnote to Plato,” and “All psychology is a footnote to Freud,” then “All that is known about breast augmentation is a footnote to Tebbetts.” Let the doctors peruse his original scientific papers, but if you read The Best Breast 2, you’ll understand breast augmentation better than 99% of plastic surgeons.
