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Dr.
Scott A. Brenman Chat Transcript
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10/15 Dr.
Scott A. Brenman from Philadelphia,
PA.
Chat has been edited by Dee for easy reading.
Visitors names have been changed for their
protection.
Note: These answers are the opinions of
the doctor. |
Andrew:
Doctor I have read some disturbing information about saline implants...
is it true that some doctors inject antibiotics into the saline as they
are filling them up in surgery?and can this cause fungus to grow inside
the implant and be potentially harmful to the consumer?
Dr. Brenman:
While some surgeons may do that, the implants become a "delivery device"
and they are not approved for this
Andrew:
I have saline implants and I am concerned
Andrew:
ok
Andrew:
so this act is illegal?
Mo:
good evening all...
Dr. Brenman:
I do not know about the legality of this, but I believe it may invalidate
the manufacturers warranty on the implant
Dee:
Amanda...PS's
are known to flush the pocket with antibiotic as well as soaking the
implant prior to insertion
Dee:
Dr. B...are you
skilled at all incisions or do you prefer one over another and if so
why?
Dr. Brenman:
yes that is true and is "approved"
Dee:
Dr. B...my PS
does that and feels it helps against CC in case any bacteria should
enter during surgery...sounds good to me :-)
Dr. Brenman:
I generally prefer the peri-areolar incision for its optimal healing
and control of the pocket but I performed the incision selected by the
patient
Mo:
Dr. B, good evening.
Do you prefer under or over the muscle? why?
Dee:
what do you think
of TUBA?
Dr. Brenman:
invariably I am now performing submuscular placement as it conceals
the edge of the implant, reduces rippling and prevents or at least delays
bottoming out
Dee:
hey Melissa you
newbie boob girl, lol
Mo:
I have areola incision
and it has healed wonderfully
Dr. Brenman:
I have never performed the TUBA procedure though I have watched it done
and am intrigued by its potential. I have seen one very serious complication
from it however.
Mo:
what kind of complications
on TUBA?
Dee:
what is that Dr.
B?
Hailey:
I have sub
muscular, and have developed an area that you can see a definition of
where the breast tissue is and the implant. I'm 7mo post op... does
it eventually fill in?
Dr. Brenman:
the complication which I was called by the ER to treat required emergency
surgery for a liver perforation- a very unfortunate complication
Dee:
OMG
Ms. Nomer:
very scary
Dr. Brenman:
where is that defined area, Hailey?
Mo:
Dr. B. I have a
lump of scar tissue under my areola. I'm 16 weeks post. I'm told to
massage. Should it soften? I know you may not be able to tell w/o seeing/feeling
it.
Hailey:
toward the center around the edges
Hailey:
the crease area
Bunnie:
Hello Dr B. My name is Bunnie I had a Benelli Lift with implants I be
believe they are 325 filled to 340 I had the procedure done in January
of this year, areola, but my scars are raised and still kind of pink
and sore .
Dr. Brenman:
Are you sure it is scar tissue and not the valve from the implant?
Melissa:
:-) I think I will
do just that Barb! Good night
Barb:
nite
Barb:
take it easy
Bunnie:
Is there anything I can do to reduce the scars, I am hispanic and skin
is of medium color.
Mo:
yes it's scar tissue...
Dee:
Was the doctor
certified who performed that TUBA?
Mo:
it's about the
size of 1/2 inch wide by 1 inch long
Dr. Brenman:
I would continue with massage and be patient. Your surgeon may consider
a very careful steroid injection for the scar, Mo
Mo:
thanks, dr. b.
Bunnie:
I have started using a product called Scar-Guard have you heard of this
product? If so what do you think about it?
Dr. Brenman:
scars following a mastopexy can be troublesome, especially in a patient
of color. I recommend silicone sheeting for hypertophic scars and am
now using ScarGuard which has steroid, Vit. E. and silicone in a liquid
Dr. Brenman:
Yes, persist with the ScarGuard
Dr. Brenman:
No, the surgeon who performed the TUBA was not board-certified
Andrew:
Dr. what is the percentage of women that have complications from breast
implant surgery? Also have you ever treated a patient that has had some
type of fungis growing inside the implant?
Dee:
ARGH...that's
what I figured!
Bunnie:
Thanks, the silcone sheeting where do I get them? Is there anything
else I should be using? Also My breasts are still pretty firm, how can
I get them to become softer?
Dee:
how much fill
do you have bunnie?
Bunnie:
I believe they are 325 filled to 340
Mo:
sleeping on my
softened them once ok'd by ps
Mo:
mine
Bunnie:
I can't really remember.
Dee:
how far post-op
are you?
Bunnie:
I started sleeping on them 2 days after surgery that is the only way
I can sleep. On my stomach.
Ms. Nomer:
Is ScarGuard available
by prescription only?
Bunnie:
Got them done in Jan 19,01. No I order
scar-guard through the 800 Number
Dee:
ummm, I would
think they would have softened...
Mo:
DR b... how often
do you perform BA's?
Dr. Brenman:
silicone strips are available in the drugstore now. The firmness almost
a year after your augmentation mastopexy may be the normal firmness
of saline implant or a mild case of capsular contracture.
Bunnie:
I guess I am just used to my breast the way the used to be I was a large
c small d before the surgery, but since I had my lift the told me it
was best to put an implant in there.
WebMaiden:
Dr. B, do you use any silicone implants?
Bunnie: I mean most people don't realize I
have implants because I had large breast before they just look firmer,
they have dropped nicely, I don't know if it is because I had enough
skin
Dr. Brenman:
I perform on average 2-3 breast augments a week with substantially more
during the late winter and early spring as you can imagine
Barb:
Have you done any BA's with the new Mentor High Profile Implants yet?
Bunnie:
Oh yea is it normal to have sharp pains in your breast especially around
the aeriola? Is it just the nerves?
Dr. Brenman:
I used silicone implants exclusively in the mid eighties to early nineties
and really liked them except for the high rate of contracture associated
with them. I now used them for the majority of breast reconstructions
and for women fitting in the Inamed (formerly
McGhan) Adjunct study criteria
WebMaiden:
Why do you think the cc rate is higher
w/ silicone?
Dr. Brenman:
while unproven, I believe it is due to micro gel bleed which you can
notice if you feel a silicone implant (outside the body) and rub your
fingers together- they're slippery!
Andrew:
that is scary
WebMaiden:
When I spoke to Mentor at the ASPS show
they stated they were making the shell 4 times thicher to deter the
bleed.
Dee:
what do you think
of the new Inamed (formerly McGhan) Cohesive Implants?
Dr. Brenman:
A thicker shell may be necessary, or returning to the double lumen implants
of the past with an outer adjustable saline layer.
I have not used the cohesive gel implants yet but they are supposed
to be more firm than a liquid gel implant, just less of a problem if
they leak. I know they are very expensive which certainly is an issue
Dee:
yeah, they go
for $995 EACH
WebMaiden:
Yikes
Bunnie:
Hey is it normal to have sharp pains in the aerola area, it feels like
pins, once in a while it will be really sharp, Is it just nerves regrouping?
Jill:
wow$
WebMaiden:
Dr. B, who much were implants before
the 1990s scare.
Pare :
i have a question,if you dont mind me changing the subject? what will
happen if you don't wear the bandage across the your chest?
Dr. Brenman:
$200 each for silicone implants if I remember correctly
Bunnie:
wow. Hey DR B what is the average cost for a benelli lift w/implants
Dr. Brenman:
periodic sharp pains are normal and temporary. If you sensation have
been diminish it is likely that the nerves are "waking up", the neuropraxia
is resolving
WebMaiden:
Do you use the strap?
Pare:
ace bandage
Dr. Brenman:
In my practice,comprehensive costs for an augment mastopexy including
surgery, implants, hospital and anesthesia may run about $6500, more
or less
Bunnie:
If I wear a good supporting bra all the time, and do not breastfeed
when I have children I will not have to have the procedure done again
will I. I know with age my breast will sag, but not to the extent were
I will need surgery
Dr. Brenman:
The "strap" is useful if the implants appear to be sitting too high
after a few weeks. It helps reduce upper pole fullness by directing
the implants down into the pocket
KT:
DR b? I had surgery about a year and a half ago.,,.. can I ask you a
question?
Jill:
you & me both!
Bunnie:
If I keep massaging will my implants get softer, and if I take Vitamin
E will that help, I am sorry if I sound stupid, but I didn't tell anyone
I was getting implants I just told them I got a lift. Like I said before
my
Dr. Brenman:
It is really unpredictable what will happen to the breasts after pregnancy.
Most women lose some volume, but others may enlarge, especially if their
weight stays up.
KT:
my doc said none of those things mattered
Bunnie:
breast dropped beautifully, just a little firm, so far no one has questioned
me
KT:
hello? dr. b?
Dr. Brenman:
Go ahead KT!
KT:
I had surgery a while back and I am wondering if I go and have it a
third time (yea, I know that sounds bad) but if I do am I gonna do further
damage to my nerves even though I have hardy any sensation left there
anyway
Dr. Brenman:
clearly each time you have surgery the risks of nerve injury go up,
especially of you are going much larger and require enlargement of the
pocket
Pare:
why does it burn when you use it? that is why I only used it a day
KT:
not going bigger... got c's now and im happy with that... but they are
under my muscle and I don't think the doc cut enough muscle and so they
flex like a guy's pecs do and I hate that!
Dr. Brenman:
Is that the strap?
Pare:
im just concerned because my ps does not have me massaging
KT:
so all I wanna do is have the muscle cut more or have them back on top
of the muscles
Pare:
yes the strap
KT:
not to mention they are really firm now and I don't like that much either
Dr. Brenman:
KT- nerve injury is still a potential problem that your surgeon will
discuss with you, I am sure
KT:
ok but my question is can they really get worse if I cant feel them
now?
Bunnie:
DR B, is it strange that about 5 months after I had rippling, I called
my PS and she said there was nothing she could do, I am now 11 months
post and the rippling I had in the one breast does not ripple or at
least I can't see it..
KT:
bunnie did you have much tissue to begin with?
Dr. Brenman:
Pare- likely you were feeling the effect of the implants descending
downward through early scat tissue, which is very uncomfortable. I prefer
manual gentle compression of the upper pole. Sometimes it is necessary
to reposition th
Jac did I
miss it?
Bunnie:
I don't really know I am very thin but have always had pretty large
breast depends on my weight in my early 20's I was a DD than late 20's
D and thirties
Dr. Brenman:
the implants if they do not drop, especially very large implants
Dee:
Faith it's still
going on
Jac *smiles*
wonderful...
KT:
you were a dd before surgery?
Bunnie:
Large C or small D, guess all the up and down made me sag so that is
why I had the lift and implants put in how do I know if I had alot or
a little tissue?
Pare:
Dr. Brenman-so the burning will go away?
KT:
if you were c or d to begin with then you had plenty of tissue
KT:
I didn't ... I was barely an a and so I saw a lot of rippling too
on the sides and tops-
so are yours above the muscle?
Dr. Brenman:
Pare- I would expect improvement but it may take up to a year, sometimes
longer
Pare:
wow,I don't think I could handle wearing it that long.
Bunnie :
Oh Does tissue mean skin, I told you I am really stupid when it comes
to this, when I went for my consultation I just asked for the smallest
ones. I have my implants under the muscle.
Pare:
Dr. Brenman-do you think its weird that my ps is not having me massage?
everyone else is. I never heard anyone say they didn't
Bunnie:
KT did you have you surgery through the aeriola? If so do you have scarring?
Dee:
I don't massage
:-)
Jill:
I know a few with smooth
that don't have to massage
Jill:
Dee for one :-)
Mo:
I do massage
Bunnie:
I massage
Pare:
im concerned because I thought you massage to soften them up. Wow they
are some out.lol
Dee:
lol...only PLAY
massage, lmao
Dr. Brenman:
Massaging is helpful to a small degree with submuscular implants, moving
your arms effectively massages the implants
Pare:
lol
Jill:
:-)
Bunnie:
So are you saying that Massage dosen't make them softer?
Pare:
oh thank you very much that takes a load of my shoulders. I didn't want
to walk around with hard twins
Dr. Brenman:
It can help but I really believe the muscular action of arm motion is
at least as effective. This does not apply to implants above the muscle
Bunnie:
Hey has anyone that has had a ba gotten the aeriola reduction, I don't
know if it is because of my scars but my nipples look so big, I can't
stand them maybe if the scars were reduced they would look better, I
am embarrassed because of my nipples, the
rest of the breast look great.
Dr. Brenman:
areolar reduction may be recommended by your surgeon of the starting
size is above normal and the selected implants are large
WebMaiden:
Thank you Dr. B for you time and if
anyone is interested in learning more about Dr. B you can go to ../brenman/
Special
thanks to Dee for arranging our chat &
for editing the transcript.
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All About Breast Augmentation and Breast Implants Plastic
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