|
|
Surgeon
Directory  Photos
  Surgery
Loans 
Risks  Tips
- Home - Shop
 
Dr.
Paul
Silverstein Chat Transcript
|
|
10/15
Dr. Paul Silverstein
from Oklahoma
City,OK
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. |
Dr. Silverstein :
Hi Dee, Thanks for finding me. I am not a
typist, so please excuse all typos. Thanks
Dee:
Dr. S...don't
worry about typos we edit for easy reading :-)
Dee:
We have a few
people here now...Reb did you post on the forum that the Doctor is in?
Dr. Silverstein:
I'd be happy to answer any questions:-)
Crystal:
Dr. Silverstien...what advantages are there to the trans-axilary incision
compared to the other incisions?
Dee:
hey you even have
the smileys down...cool
Crystal:
he's hip(do they still say that?)
WebMaiden:
I will post the announcement now
Dee:
lol
Crystal:
he's gettin jiggy with it :-D
Dee:
nope he's typing
out his response to you :-)
Dr. Silverstein:
I have performed more than 6000 augmentations
using the axillary incisions, and it is probably responsible for my
reputation. First, it is the ideal cosmetic approach because it leaves
no scars on a beautiful breast. The axillary s
Barb:
I hear that I love mine
Crystal:
dang...you da man!
Dr. Silverstein:
Secondly, the scar in the armpit fades out
to look like the skin crease in which I place it, and is practically
invisible.
Trish:
Dr Silverman my question is I am a plus size female 5'6" 170 I am a
38c would like to be dd. Dr. recommend 525cc and another recommended
600cc + for large ribcage what's your suggestion
WebMaiden:
Hi Tammy!
Dr. Silverstein:
Third, the axillary incision place me just
behind the breast and in front of the pectoralis muscle,
Tammy:
Hello
Dee:
hi Crystal
CoffeeBar:
hi everyone
Dr. Silverstein:
Trish, I can't comment without seeing you.
It takes a lot of skin and a broad chest to hold a 600cc implant
WebMaiden:
Hello!
Dee:
Dr. S...but if
you develop CC and have to have an open capsulectomy then you end up
having a scar somewhere's on your breast right?
Dee:
What is your CC
rate?
Dr. Silverstein:
Correct. If you have a CC, I usually resect
the entire capsule, and therefore I must use an inframammary incision.
Dee:
okay...
Crystal:
Dr. S...what is the rate of capsular contraction for your patients?
Dee:
I have crease
incision because I was a pessimist and figured I'd develop CC so I might
as well start with an incision on my breast and you CAN'T see it!!
Dr. Silverstein:
Our capsular contracture rate is down to 1%,
so this doesn't not occur often
Dee:
WOW, that's great
Crystal:
way kewl
Dr. Silverstein:
You're a good healer
Crystal:
my window quit scrolling and I didn't see the question was already asked
lol
Crystal:
Dr. S...Do you recommend massaging and how soon after the surgery?
Dr. Silverstein:
another advantage of the axilary incision
is that I do not cut any breast tissue, since we are already behind
the breast. This conserves nipple sensation the best
Crystal:
woohoo!
Dr. Silverstein:
I no longer recommend massaging, but I do
start Vitamin E, 1000iu daily
Crystal:
Dr. S...what percentage of your patients later decide to go larger?
Dee:
what is your theory
on the vitamin E in regards to CC?
Dr. Silverstein:
Very few! At their 3 month post-op visit some
wish they were larger, because the skin has relaxed, but the actual
size is still good for their figure and chest dimensions
Dr. Silverstein:
Vitamin E is an antioxidant, and we feel it
suppresses firbrocystic changes that cause an inflammatory reaction
leading to CC
Dee:
okay
Dr. Silverstein:
In many women (>60%) vitamin E and cutting
down on caffeine will alleviate premenstrual breast pain typical of
fibrocystic condition
Crystal:
Dr. S...will you go as big as a girl can hold or are you strict as far
as what you think looks proportionate?
Barb:
Crystal are you saying my boobs are too big?? LOL
Crystal:
not at all, lol
Barb:
ok then
Crystal:
i want some just like them, maybe bigger, lol
Dr. Silverstein:
I try to compromise with the patient. Stuffing
implants that are too large leads to folding and scar capsules, aside
from a very unnatural look. The breast should not rise higher than the
armpit crease, or it looks like it has a s
Candy:
Is their anyone who isn't
a candidate for the transax. incision?
Dr. Silverstein:
shelf on top )will hold a coffee cup
Dee:
lol
Dr. Silverstein:
I haven't found one. If a girl already has
a scar from another breast surgery, I will generally use it instead
of making a new incision.
Danni:
Is it true that if you had transax incision and there is a need to go
back in you'd have to go another way
Dr. Silverstein:
Not necessarily. It depends why I have to
go back.
Candy:
Have you ever seen any
transax. incisions keloid?
Candy:
Is it difficult to use
silicone sheeting in the underarm area?
Dr. Silverstein:
Yes, but very rarely, and they have always
responded to injection with triamcinolone and/or excision and remaking
the scar
Dr. Silverstein:
Keloids in a non keloider are generally due
to an ingrown hair
Dee:
Danni...I asked
a similar question before you came in...here it is: Dr. S...but if you
develop CC and have to have an open capsulectomy then you end up having
a scar somewhere's on your breast right?
Dee:
Dr. S's response:
Dr. Silverstein
:
Correct. If you have a CC, I usually resect
the entire capsule, and therefore I must use an inframammary incision.
Dr. Silverstein :
Yes, it is not easy to use silicone sheeting
in the axilla
Danni :
Can you ever wax again under your arms. How long should you wait
Dr. Silverstein :
Yes, you may wax under your arms. I advise
waiting one month after surgery. Also we use alot of laser hair removal
(alexandrite laser) to remove the hair so that neither shaving nor waxing
is necessary
Trish :
Dr.S I am a diabetic does that pose any special problem getting implants
Dr. Silverstein :
NO. As long as your diabetes is under control,
there should be no problems for such a short operation. We do use perioperative
antibiotics to prevent the possibility of infection,
Barb :
Do you require your patients to stop taking birth control pills prior
to surgery?
Dr. Silverstein :
NO. I only advise stopping all aspirin and
ibuprofen products 2 weeks before surgery, because they are blood thinners
and can cause post-op bleeding.
WebMaiden :
Does anyone else have a Q for Dr. S?
WebMaiden :
Dr., are you in one of the silicone studies?
Barb :
what about those who take products containing ephedrine?
Dr. Silverstein :
I'm surprised no one wants to argue saline
vs. silicone
WebMaiden :
A lot of the women are looking to get silicone
Crystal :
silicone wins!
Dr. Silverstein :
Ephedrine doesn't bother me.
Dr. Silverstein :
Yes, I am on the silicone Adjubct Study, and
the Mentor CORE silicone study
Jill :
I love my saline :-)
WebMaiden :
Ok, we need to add that to your page, along with the 6000 trrans ax
BA stat!
WebMaiden :
Jill, have U felt silicone?
Jill :
yes I did at my plastic
surgeon's office
Dr. Silverstein :
I also favor silicone because of no rippling
and longevity. Saline implants will all leak sooner or later. The 5
year leak rate is close to 10%. I have replaced more than 180 leaky
implants
Crystal :
Dr. S..when do you think the silicones will be available for everyone?
Jill :
they did feel good
Dee :
Dr. S...what do
you think of the Cohesil from Inamed (formerly McGhan) ?
Dr. Silverstein :
In the next 2 years, when the 5 year core
data is all reported. I am doing more than 90% silicone implants now
through he adjunct study for women with a little ptosis, asymmetry ,
or chest wall deformities
Jill :
when I need a redo I will
probably go for the cohesive gels
Dr. Silverstein :
I think the cohesive implants from Inamed (formerly McGhan)
are too stiff and feel unnatural. But I like the shells.
Jill :
really?
Dr. Silverstein :
Yes, and they are heavy, too.
Jill :
ugh that doesn't sound
good
Dr. Silverstein :
The purpose of the cohesive gel is to prevent
migration of gel in case of implant rupture. This has not been a problem
for me since 1990.
Dr. Silverstein :
If you take a gel implant and cut it in half,
nothing will run out. It is not liquid!
Crystal :
Dr. S... do you think they will ever make an adjustable silicone implant?
or am I just dreaming
WebMaiden :
Good Q Crystal!
WebMaiden :
Hello Deli
Deli :
Hi there!
Dr. Silverstein :
There is a Mentor implant that has silicone
on the outside and an inner lumen os saline that can be filled like
an expander. That's the closest there is to an adjustable silicone implant.
Deli :
Otherwise known as Delveen
Deli :
I have those
Nikki :
Dang!
Deli :
Becker 50's
Crystal :
is it available in the studies yet?
WebMaiden :
Hello melissa!
Nikki :
Talk about a full
house!
Melissa :
Hello!
Nikki :
Hey everyone 8-)
Dr. Silverstein :
They are nice, aren't they? especially in
someone with a significant asymmetry
Deli :
Yes they feel very real
Barb :
hey Nicole I am over her in the hot tub just listening come on in...LOL
Jill :
delveen you like yours?
Deli :
Yes they are terrific
Deli :
I used to have saline
Deli :
Very expensive though
Melissa :
I should be studying
for my test tomorrow but I decided to come here instead, LOL
Dr. Silverstein :
Yes, they are more expensive than standard
implants
WebMaiden :
Deli, R yours the adjustables?
Deli :
My insurance paid because this was Breast Cancer reconstruction.
Nikki :
***Nikki jumps in
the tub with Barb***
Deli :
Yes I have ports in right now and they kind of bug me because they sit
right on my ribs
Deli :
Its kind of like laying on a lego
Dr. Silverstein :
The ports are temporary
Barb :
ouch I know how legos feel when I step on them
Jill :
how long do you keep them
in?
Crystal :
what's the maximum they can go up to with those?
Kat :
hi
Deli :
Yes, they will come out once he fills to where they need to be but I
have to wait for them to settle completely first, had them done June
20
WebMaiden :
Kit, I was just about to invite U!
Dr. Silverstein :
until the ideal size and symmetry has been
achieved
Kat :
well here I am, the party
can start now LOL
Deli :
Well it depends on the size of implant that is chosen I have up to 600
on one side and up to 700 on the other
WebMaiden :
Kit, Dr. Silverstein is with us tonight
Dr. Silverstein :
That's not unusual in reconstruction after
mastectomy
WebMaiden :
He has done over 6000 trans ax BAs!
Kat :
hello Dr. Silverstein
Deli :
So right now I am at about 520 and 620, that means I have about 70 cc
to play with
Dr. Silverstein :
HI, welcome
Crystal :
heehee..to play with lol
Barb :
oh now crystal stop it
Deli :
Yep, and I plan on playing with it all
Barb :
in here it is called massaging
Crystal :
woohoo!
Deli :
I had my first BA trans ax
Jill :
what size will you be
delveen?
Deli :
I still have a lot of numbness though. Is this common?
Deli :
I should be a 36dd
Jill :
woohoo :-)
Dr. Silverstein :
where is the numbness. It can last a year
on the inside of the arm
WebMaiden :
Dr. S., about how many silicone implants have you done?
Deli :
I earned every inch of them too!
WebMaiden :
Before they were banned and now
Deli :
The numbness is around the bottom of the breast
Dr. Silverstein :
More then 5500 silicone since 1974
Deli :
I had my trans ax done over 2 years ago
WebMaiden :
Wow
Dr. Silverstein :
Numbness after 2 years will not go away
Deli :
That sucks! Is it because of nerve damage
Dr. Silverstein :
How's nipple sensation, or is that gone, too?
Deli :
when they were inserted?
WebMaiden :
Dr. S, Y do U think breast reconstruction patients have higher rates
of complications?
Deli :
It's gone on one side
Dr. Silverstein :
reconstruction patients tend to have more
CC's
Deli :
I had the numbness before my breast cancer because I got implants and
9 months later found the breast cancer
Dr. Silverstein :
I'm sorry
Deli :
Thank-you, but I still have breasts so I am smiling
Dr. Silverstein :
Hang in there~:-)
Deli :
You bet
Candy :
Do you use Mentor or Inamed (formerly McGhan)
implants?
Dr. Silverstein :
Almost exclusively Mentor
WebMaiden :
I'm finding a lot of docs prefer Mentor and have less problems with
Mentor
Dr. Silverstein :
The company os also more responsive tot he
doctors problems and suggestions
Dr. Silverstein :
pardon my spelling
WebMaiden :
I wish they would stop selling them to non plastic surgeons
Deli :
Doc, I also got a staph infection after my reconstruction which took
3 months to get rid of, do you think at a month post antibiotics that
I can say that I am in the clear?
WebMaiden :
We'll fix the typos later!
Barb :
I think you should have board certification before you could get them
Dr. Silverstein :
I do too. Most of the complications I see
are from non board certified faker/s
WebMaiden :
Exactly
Candy :
I wrote to both companies
about that and never got a direct answer
Crystal :
like those dentists don't make enough money, they have to try to fix
boobs too
WebMaiden :
It would be to the implant maker/s advantage not to sell them because
then the studies would have less complications!
Dr. Silverstein :
After infection, I wait 6 months before reinserting.
Candy :
just an automatic response
type answer
WebMaiden :
You go Girly!
Candy :
thanks =)
Deli :
I never had mine removed they finally had success treating it with ancef
WebMaiden :
I hope to try to do something one day, since we have a lot of women
on the forum maybe *someone* will hear us roar!!!
Dr. Silverstein :
The companies claim they could be sued for
not selling to any MD or DO. Personally I think it's BS
WebMaiden :
Yesh!
WebMaiden :
That's crazy
Dr. Silverstein :
What do you mean. "Yesh"? What are you drinking?
Candy :
What's a DO?
Dr. Silverstein :
Doctor of Osteopathy
WebMaiden :
I only invite certified docs to be on our site, Y can't the implant
companies do the same!
Dr. Silverstein :
I appreciate that, and that is why I accepted.
Candy :
Why would a DO need breast
implants anyway?!
WebMaiden :
I'm saying "Yesh" because I can't believe the impant companies give
that answer!
Deli :
First they tried rocephin followed by the anthrax drug which didn't
work, Finally they tried ancef and it worked so it seems. I'm just a
little nervous to pronounce that it is finally gone.
Dr. Silverstein :
Basically it comes down to selling more implants
- the proverbial "bottom line".
WebMaiden :
Girly: A "DO" does "medicine" differently.
WebMaiden :
Yep
WebMaiden :
That's too bad. I put women's health first
Dr. Silverstein :
Ancef is a great drug. Did your breast get
a CC?
Deli :
Nope everything there is fine
Deli :
And I had radiation too
Dr. Silverstein :
Great!, Consider yourself cured.
Deli :
Thanks Doc! Thats a load off my mind
Dr. Silverstein :
Also consider yourself lucky. Radiation alone
can cause CC
Candy :
do you have your patients
wear an underwire bra immediately after surgery?
Deli :
Yes, I know, My brother is a nutritional Dr and gave me a lot of stuff
to take to combat the effects of it all and it worked.
Dr. Silverstein :
NNNNOOOOO! I recommend not to wear underwires
because they cause irritation at the inframmary crease, which frequently
has to be lowered to accommodate the implant
WebMaiden :
I agree
Candy :
That's what I thought
too
Dr. Silverstein :
I;m glad we a free
Dr. Silverstein :
I mean, agree
WebMaiden :
My doc said no underwire for 6 weeks
Jill :
my plastic surgeon feels
the same no underwire for 6-8 weeks
WebMaiden :
and I even had a areola incision (which I hate, I wish I went trans
ax, but he wasn't experienced with them)
Dr. Silverstein :
That's fine and understandable
Deli :
I've never worn an underwire unless it was for only a few hours. I agree
that underwires put undo stress on the crease
Crystal :
how often are your post op visits for checkups?
WebMaiden :
Crystal, you may want to inquire if he has a different schedule for
out-of-town patients.
Deli :
Thanks Dr. for you insight and information, you have been most kind
Dr. Silverstein :
I see my patients at 24 hours, 7 days, 14
days, 3 months, and yearly. I do not charge for office visits, and encourage
them rather than making diagnoses over the telephone
Candy :
Wow, I may have to fly
out to Oklahoma!
Crystal :
oh I'll be able to make it there
Dr. Silverstein :
Out of town patients stay overnight, then
return in 10 days, and 3 months or a year, and we communicate by phone
or e-mail
Dr. Silverstein :
C'mon down!
WebMaiden :
Well, it's 10 and I'd like to thank Dr. S for his time!
Deli :
Goodnight everyone!
Crystal :
awwwwww
Dr. Silverstein :
It's been fun, thanks for inviting me, And
good luck to you all
Dee :
Thank you Dr.
S
WebMaiden :
A copy of this chat will be made available at IMPLANTFORUM.COM sometime
next week.
Crystal :
thanks for showing up DR S!!
WebMaiden :
There will be a link to it from the chat page and Dr. Silverstein's
page
Dee :
along with the
last 2 weeks too, LMBO!
Jill :
thank you it was very
informative
WebMaiden :
For more on Dr. Siliverstein see www.implantforum.com/silverstein
Special
thanks to Dee for arranging our chat &
for editing the transcript.
If you are interested in being
a guest speaker/, please contact Rebecca.
Copyright©2006
All About
Breast Augmentation and Breast Implants Plastic Surgery Resource by
Rebecca.
All Rights Reserved
|
SURGEONS:
