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Topic: Miscellaneous Kathy: I had my BA on September 7th. I went under the muscle. When does the soreness and tightness let up? Dr_Deane: Usually takes about a month Del: I am curious if you have ever seen success in treating staph infection without removing the implant?Dr_Deane: if infections are "early" sometimes implant removal is not necessary. It's tricky to treat the infection but it can be done. Del: Thank-you that helps! Dr_Deane:can I ask questions also? Dr_Deane:what's the single most important thing you're looking for during the consultation? Lisa: To feel comfortable and at ease with the Dr and staff Kathy: being comfortable with the surgeon Del: Bedside manner and sense of capability of the surgeon Del: How long can you expect your implants to last these days? Dr_Deane: Deli, the implants should last forever
Kathy: forever, that's the first time I hear that Del: Really, so the 10 year replacement theory is just that! BARB: Forever...coolI can deal with thatDr_Deane: Yep, the implants are very well made, but we can't stop age and time, so the breast shape may change Kathy: so what's all this I hear about wear on the implant Dr_Deane: wear from what? Kathy: well, like aging Heather: Forever? I have never heard that before.All the pamphlets from Mentor tell you they are not lifetime devices. I will say that makes me happy though! Dr_Deane: The manufacturers will only give you ten year guarantees, but I have only rarely heard of implants deflating or rupturing Lisa: Dr. Deane--Do you put your patients all the way out for surgery? Dr_Deane: Lisa...all patients are asleep Dr_Deane: What do you all think about advertising from doctors, and what is acceptable?
Kathy: advertising? Candy: I don't like to see a Dr. advertised in too many places.That's just me, I'm in L.A. Cleo: I agree BARB: advertising is ok as long as it doesn't sound like some sort of circus caller Lisa: Yes I feel that advertising is acceptable if done tastefully Sez: I wish more DR did.I can't seam to find one around here Kathy: I don't see any advertising for surgeonsDr_Deane: Sez, where are you? Candy: and all the Doctor's that aren't board certified seem to advertise in this one paper Melissa: I have heard advertising on the radio, and they advertise sales, etc...I feel neutral about it BARB: LOLMelissa Sez: Iowa BARB: I've hear that one too Kathy: to me it would seem like the DR wouldnt be as good, like a cheap sale or something, but thats just me WebMaiden: I'm a marketing grad, so my opinion is probably biased! Melissa: You know who, Barb...?:-) BARB: two for one BARB: how much for just one?? WebMaiden: I hate when I see the wrong type of marketing like Howard Stern and Ophra have both had uncertified surgeons on their show. I do not agree with that. Kathy: the only advertising I see is in yellow pages Heather: I know of only 2 plastic surgeons in Vermont and that is why I'm going to Canada.I think I will be the only women in my county with implants! Cleo: buy one get one free? Dr_Deane: I think that most patients can tell when the marketing is out of hand Dr_Deane: Bravo WebMaiden WebMaiden: because people trust them (well, they trust Oprah) Candy: Oprah?I'm surprised BARB: Cleowe have one here that does the buy one get one free WebMaiden: I think docs need to advertise somewhat so patients can find them. Lisa: I think that advertising would help those that are broad certified to get their cLisaentials known.. WebMaiden: It does seem like non-certified docs advertise more than the certified. Dr_Deane: A surgeon near me advertises a "free implant" Lisa: Does that mean you only pay for one implant? WebMaiden: I've gotten to the point where I can almost tell if the PS is cert. or not before looking it up Sez: how could he do that WebMaiden: I bet the free implant PS is not certified Cleo: I'd be hesitant even if he was...or she Dr_Deane: No WebMaiden believe it or not, he advertises no charge for the implants! Lisa: Gimmicks make me wonder "Why?" Cleo: well...where the heck is he? WebMaiden: Is he certified? Dr_Deane: yes Sez: he has to have the cost somewhere WebMaiden: NY, where else??? lol WebMaiden: Hmmm, I'd still be weary! Lisa: I'll bet there are hidden costs there? Dr_Deane: yes Lisa, he makes up the cost in other ways WebMaiden: Yea, in the operating room, something is cheap! Candy: Are surgical tools reused?Or does each patient get her own set for the surgery? Dr_Deane: Girlie, surgical tools should always be sterilized before each case. They are generally stainless steel and reused. Candy: thanks Lisa: My husband was joking at the consultation today and wanted to know if we could save some money and not have anesthesia?Dr_Deane: another question: did anyone's surgeon use computer imaging? Candy: no, I'm still pre op Dee: no Sez: this is really helping me learn more I'm such a chicken. Lisa: I was kind of disappointed that mine did not Cleo: but it was a poor pic and didnt turn out too well WebMaiden: I have only seen one doc use it for a BA and she stated it was only a guideline Candy: I know Jill's does WebMaiden: Other docs that have PC Imaging have stated they do not use it for BAs
Dr_Deane: I ask because I don't yet......the software is not good enough yet. Cleo: how was it Heather? WebMaiden: Did Dr. V use it for your BA, I knew he had it WebMaiden: I agree Dr. D WebMaiden: If you find something that is good enough, let me know Lisa: I think it would be great to help determine what size you really want WebMaiden: I'd like to get something like that for the site Cleo: that would be great! Dr_Deane: there is one thing that I have heard of It is a 3D camera, costs $15000 WebMaiden: Did U C it in Plastic Surgery Products Mag? Dr_Deane: Web, it was at the ASPS meetingIncisions/Placements/Size/TypeDezzie:i have a question Dr_Deane:yes? Dezzie:when you get a trans-ax incision is it always done completely under the muscle or partially Dr_Deane: the transaxillary incision is just a type of approach. Once under the skin, the surgeon can do whatever he wants. Dezzie:thank you Lisa: Dr. Deane- I am a mammographer and I am considering BA. I went for my consult today....I am curious to know what approach you like the best?I am leaning towards a round implant under the muscle Dr_Deane: I always get a preop mammogram, even if the patient is young. Dr_Deane: My favorite approach, after fifteen years, is a submuscular implant, usually round and smooth. I have lots of experience with anatomic and gel, and will use these if the patient desires. Lisa: Do the gel implants image better? Dr_Deane: there's no difference in imaging between the gel and saline Candy: Which incision do you use the most? Dr_Deane: I like the inframmary most (75%) but will also do periareolar (25%). Crystal: what's the limit to how small an areola can be and still fit the implant thru it? Dr_Deane: An areola only needs to be large enough to allow a 3-4 cm incision along the lower half. Crystal: have any of your patients lost sensitivity in the nipple after going that route? Del: Do you have many patients lose sensation from transax incisions? Dr_Deane: Del---I used to do transax incisions but try to stay away from them because of nerve problems Lisa: DR Deane..Does having BA affect self breast examination? Dr_Deane: No not at all. I tell patients that it may even help the breast self exam because now the breast is on a little "water bed" which makes feeling the breast tissue easier. Kathy: DR Deanewhen does the sensation come back to the nipples? I hope it won't be numb for a long time Dr_Deane: Kathy---what type of incision did you have, etc? Kathy: i have crease incision, round, smooth Dr_Deane: Kathy---how long after surgery? Kathy: 12 days Dr_Deane: Kathy, be patient Kathy: ok... Cleo: my future ps thinks about 420 will take me to a D...at 5'11 135 lbs is that right to you? Dr_Deane: Cleo, depends on how much breast tissue you have now, but sounds right Cleo: I'm a 34 b...he says I have good shape and tissue Cleo: just too darn small :D Dr_Deane: Cleo, sounds good Cleo: I think so too...thank you Heather: Dr. Deane- I wear a 36C now, I am 5'8 (almost) and weight about 155# how many cc's do I need to think about to become a Medium D-going under muscle? Dr_Deane: Heather, at least 300 Kathy: DR, do you use Mentor or Inamed (formerly McGhan) implants? Dr_Deane: Inamed (formerly McGhan) only Lisa: Dr. D--what is your opinion of the oil implants that are being tested now and what about the new silicone that will not bleed? Dr_Deane: Lisa, oil is experimental and has been mentioned for years Del: Have you used Becker 50? Dr_Deane: Don't use Becker Dr_Deane: I really think that Inamed (formerly McGhan) has the best quality, but always remember that implants are business for the manufacturers Dr_Deane: Want an example? Kathy: please Heather: Yes! Dr_Deane: You understand the importance of having a board certified plastic surgeon doing the surgery, right?A board certified plastic surgeon, we feel, provides "gold standard" care and technique.Did you know that implant manufacturers will sell the implants to gynecologists, dermatologists, any doctor? Kathy: no.... Dr_Deane: yes Cleo: thats criminal' Crystal: anything for a $ Dr_Deane: I have a real problem with this WebMaiden: I have a problem w/ that too, Dr. Deane Dee: Yes, unfortunately some of us do know that and feel it's wrong Lisa: I know how reps work...it does not surprise me BARB: kind of like selling gas and a lighter to a arsonist Kathy: what does that mean though Candy: I didn't think about it like that, if they don't have any implants they couldn't do the surgery Cleo: does overfill help prevent rippling? Crystal: what's the purpose for overfilling Dr_Deane: Does everyone understand how implant fill is determined? Heather: No, not really. Lisa: no...please explain Dr_Deane: Let's say that you and your surgeon have decided on a Inamed (formerly McGhan) round smooth saline implant 270 cc Dr_Deane: The manufacturers' recommended fill volume is 270-300cc Dr_Deane: which means that the surgeon has the option of filling up to 300 cc Kathy: is it always 30cc overfill? Kathy: I went 390-420 Lisa: is there a max on how much it can be filled? my surgeon over filled my 325 to 400 Dr_Deane: He can, if he wants, fill to beyond 300 cc but the company does not recommend it and reserves the right to back out of their "guarantee" Crystal: ohhhhhh Dr_Deane: usually 30 cc with Inamed (formerly McGhan) Kathy Dee: KitKit the 30cc is not considered overfill...it's filling within range Kathy: I see Dr_Deane: Dee is right Kathy: so then I'm not overfilled??? Heather: This might be a weird question, but do you sit your patients up on the table to see how the breast falls? A nurse who worked for a plastic surgeon said he did this. Dr_Deane: So, "overfill" is relative and you should ask the surgeon about the range of fill Dee: KitKat I have 300 o/f 340...I have 10cc overfill Cleo: good question Heather! Dr_Deane: I sit the patients in a modified position during the case Lisa: I have 75!! is that bad???? Cleo: I wondered that too Kathy: wow, I didnt know that Heather: I always knew you were a smart girl Dee!;-) Candy: What is considered too much overfill? Lisa: Dr. Deane, is 75cc's overfilled in a Mentor 325 bad? Dr_Deane: Lisa...I'm not familiar with your implant and it may be fine Lisa: ok. thank you Dee: Lisa...if you're filled to 400cc, you're 25cc overfilled Lisa: 325 to 400 Heather: Dr. Deane, The swelling does not occur immediately does it-like when you are still on the table-Can you tell about how the breast will look later? Dr_Deane: not sure what you mean Heather Dr_Deane: I usually can see what the patient will be like during the surgery when she's sitting upright Candy: Do you place the implant completely under the muscle? Dr_Deane: Candy, the implants are never completely under the muscle in augmentation Dr_Deane: The recovery is always longer with a submuscular placement of any type Dr_Deane: can I ask a question? Kathy: sure Dee: sure Sez: sure Dr_Deane: what is the groups feeling about gel implants? Is there pressure to get them? Fears about them? Dee: are you talking about 'regular' silicone gel or the new cohesive gel WebMaiden: I have done a great deal of research, which can be found on the site. I feel they are safe, but sounds like they can be a mess to clean up if not the cohesive Candy: I love the way they feel, but am still wary of them Heather: I haven't heard much about them Dr_Deane: I mean the very latest best gel Kathy: I don't really know much about it, but if my implant ruptured I'd feel safer with something that absorbed into my system like saline.I'd be nervous with gel Dee: The Cohesive's by Inamed (formerly McGhan) that do not bleed? WebMaiden: They have less problems w/ rippling too Lisa: I wish I could get gel implants Dr_Deane: Thank you for your answers WebMaiden: Everyone on the forum that has gotten any type of silicone so far, has been EXTREMELY pleased Dr_Deane: We provide gel for study group (Inamed (formerly McGhan) ) BARB: I would love gel if they could get me the same size and could go trans ax Dr_Deane: They can go transax with gel BLS Lisa: I thought that get could only be used for replacement purposes that you had to have saline first BARB: 700CC?? Dr_Deane: no BLS! BARB: ok Dr_Deane: Yes, Lil Lisa, studygroup: 1. previous failed saline 2. previous gel 3. reconstruction 3. congenital problems WebMaiden: We've had a few go from saline to silicone & they like the silicone better Dr_Deane: WebMaiden I agree Dr_Deane: Eventually (when I'm not sure) all will be gel. WebMaiden: I can feel the difference outside the body, I have felt 1 set of silicone in, but couldn't tell the difference Dee: Have you had any patients with the Inamed (formerly McGhan) Cohesive 410's? BARB: Have they considered a gel that is adjustable yet? WebMaiden: A lot depends on the person. Dr_Deane: Agree WebMaiden. Dee: no patients with that implant yet. Dr_Deane: BLS, gel adjustable would be very hard to do Crystal: DR D...is there any difference, medically speaking, in doing a BA on a transsexual as opposed to a genetic female Dr_Deane: Yes Crystal Dr_Deane: It's complicated Crystal: it sure got quietBottoming Out/ CC/ Rupture~DeflationKathy: how early on can you tell if you are bottoming out? Dr_Deane:It usually is seen within the first month or so. Del: What is your opinion regarding massage? Dr_Deane: Massage was something we did in the gel days to prevent contracture. It mostly is not done anymore, not because it's bad but because it probably doesn't do much. Kathy: What percentage of your patients have gotten capsular contracture? Dr_Deane: I have never had a capsular contracture Heather: Why do so many surgeons recommend massage? Dee: Wow...is that with any type of implant that you've used? Dr_Deane: Never a contracture with gel or saline Heather: That is incredible! Dr_Deane: Maybe it's because almost all my implants are submuscular Dr_Deane: Remember, no one really knows what causes contracture, but we each have our theories. Lisa: what is your theory? Dee: So, Dr. Deane...I caught only part of what you were saying...you don't have your pts do massage do you have them take any type of vitamins, etc? Dr_Deane: My theories about what prevents contractures: submuscular placement, meticulous dissection (no blunt dissection), no bleeding, certified operating room conditions,..... Dr_Deane: I don't have patients do massage any longer, because I don't feel it's necessary. Dee: My PS has the same theory... Cleo: so you feel submuscular helps? That's what my ps said also Dr_Deane: Yes...it also is great for women who are thin Dr_Deane: because you get the best upper breast contour and can avoid what I call the "Tory Spelling" look. Cleo: DR D...what about bottoming out? doesnt a bra help prevent that? Dr_Deane: No, bottoming out is really dependent on the type of technique and placement, etc Cleo: ahhh...learn a little each day:-) Sez: I was told that you have to have your implants redone every 5 years do you tell your patients? Dr_Deane: Sez, that's not right Sez: I was hoping not I've had 3 different friends go to the same Dr. and told the same thing Dr_Deane: why does he say that it's necessary? Cleo: change doctors Sez: I think I will I haven't had my ba done yet. Heather: How many surgeries have you performed? And out of that how many patients have had to have their implants replaced? Dr_Deane: Heather...I haven't tallied the number, but it's most of what I do, since 1986. I have replaced implants in about a dozen patients, to make them larger mostly. Heather: That is really fabulous! Cleo: that sounds like a very good track recordCaring for your scarsCandy: What do you recommend to use on scars to help healing? Dr_Deane: I usually use silicone gel strips (very thin) on the incisions for 3-6 months. Patti: What about the scar on the nipple? Patti: Mine are on the inner ring..inside Candy: Have you had many patients w/ incisions that keloid? Dr_Deane: I have had one patient with a keloid. Cleo: are keloids primarily seen in darker skinned women? Candy: How do you handle keloids?Which incision was it? Kathy: (what is a keloid?) Dr_Deane: Cleo, keloids are mostly in Asian, African-American, sometimes South American Cleo: thats also me, sorta Dr_Deane: Kathy, a keloid is a type of scar which grows out of proportion to the wound boundaries Kathy: thanksHeather: Gee, I was hoping you weren't going to say that!:'( BARB: oh man I better wear my bra 24/7 then...LOL Patty: Is there any type of breast lift that leaves minimal scars or no "lollipop" scar?(Benelli lift? SAMBA?) Dr_Deane: Patty, Benelli and SAMBA are still being "tried". The scarring depends less on the actual technique and more on the surgeon's own skill!! Patty: would you recommend either of them? Dr_Deane: No
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