Dr. Leland M. Deane Chat
Transcript
|
Dr.
Leland M. Deane from Garden City, NY
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. |
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 that
Dr_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 surgeons
Dr_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 meeting
Incisions/Placements/Size/Type
Dezzie: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 quiet
Bottoming
Out/ CC/ Rupture~Deflation
Kathy: 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 record
Activities/Exercise/Post-op
Care
Kathy: when
is it safe to go bowling (lol)
Dr_Deane:
The type of approach has a lot to do with activity. Submuscular implants
are always restricted longer.
Candy: Dr.
Deane do you have your patients wear and underwire bra immediately after
surgery?
Dr_Deane:
Candy---I don't use bras at all...I think that they keep the patient swollen,
and they are not needed.
Cleo: no bra?
Dr_Deane:
no bra Cleo
Cleo: thats
the first time I've heard that..i'm still pre-ba tho..
Del: Dr. Deane
is there any cure that you are aware of for the weird look the breast
takes on when you flex your chest muscles and it contorts the submuscular
implant
Dr_Deane:
Del, you have hit on a very tough problem. I have found that a partial
muscle release helps
WebMaiden:
What is a partial muscle release consist of?
Dr_Deane:
WebMaiden: a partial muscle release is releasing the lower portion of
the pectoral muscle along the sternal border.
BARB: DR with
that partial muscle release do you lose any strength..and what about recovery?
Dr_Deane:
BLS, great question.Some surgeons, ones I respect, say that there may
be some muscle strength loss with a muscle release.This is not well studied
though
BARB: Okthank
you
Del: I must
go but thank-you so much for answering all of my questions Dr. Deane,
you have been very kind, helpful and informative!
Dr_Deane:
My pleasure Del
wrog: Hi Drmy
girlfriend had implants about a month ago and she is now having severe
pains in her legs after standing on them can this be from the surgery
somehow?
Dr_Deane:
Wrogw, probably not from the implants. What does the surgeon say?
wrog: he is
kinda just blowing it off saying its probably from being off her feet
wrog: but
she is in real pain right behind her knee
wrog: she
didn't not have any problems before having surgery
Dr_Deane:
wrogw: get another opinion if it persists
wrog: ok thanks
Heather: How
long will it be before I can start lifting again?
Dr_Deane:
Heather, how long?
Heather: Yes,
before I can see lift a box of depositions? I work in a law firm
Dr_Deane:
My recovery recommendations for any submuscular: no heavy lifting for
one month. Aerobics OK at 2 weeks. Nothing over five pounds for 2 weeks,
ten pounds for 4 weeks.
Heather: This
may sound silly, but what about dancing? My surgery is on 10/5 and my
30th b-day is 10/22.
Dr_Deane:
Should be OK Heather. Happy birthday
Heather: Thank
you very much.Although I'm dreading turning 30- a grown up!
Sez: I kickbox
how long should I put that off?
Dr_Deane:
Sezz, I would wait a month.
Lisa: what
do you recommend for recovery time for sub muscular?
Cleo: not
even if done trans-ax?
Kathy: (so
how much does a full Brita jar weigh, anyone? lol)
Lisa: How
about exercising or horseback riding (My passion)
Dr_Deane:
Lisa, one of my patients "broke" horses for a living. I kept
he away for three weeks.
Cleo: ok,
this may sound odd, but I tend bar...will the repetitve motion of pulling
beers harm me?
Dr_Deane:
Cleo: probably not
Kathy: what
medication do you prescribe for after the surgery
Dr_Deane:
I usually use Tylenol #3. All patient take Arnica too, which helps with
the swelling
Kathy: This
is a weird question, but I have heard that when you go on an airplane,
the pressure on the implant changes. What exactly happens? anything in
appearance?
Dr_Deane:
Kathy, no change in appearance, no danger......remember, the cabins are
pressurized and the pressure differences are small.
Dee: KitKat...I
didn't notice a difference and I've been on a plane twice since
Kathy: lol
thanks, I was just wondering
Lisa: Dr.
Deane--Do you recommend following the same screening mammogram schedule
after BA
Dr_Deane:
Yes, yes yes Lisa
Lisa: BRAVO!!!
Cleo: DR Deane,
other than tobacco, alchohol, and ibuprofen, what else do you suggest
avoiding before a ba?
Dr_Deane:
Cleo, no heavy pectoral exercises for three weeks
Cleo: oh,
and my vice...Ginko biloba
Cleo: thanks
Dr_Deane:
not sure about that herb Cleo
Cleo: I hear
it's an anticoagulant
Dr_Deane:
possibly
Candy: I heard
the same about too much wheat grass juice
Candy: Do
women w/ implants need to take antibiotics before getting their teeth
cleaned by the dentist?
Candy: I've
heard some women do and some don't
Kathy: good
one, I never heard of that
Cleo: me either
Dr_Deane:
Girlie...good question. Strictly speaking, no, but there have been reports
of breast infections which may have been linked to dental procedures
Caring
for your scars
Candy: 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: thanks
Lifts
Heather: Is
it possible to have some sag and not have to have a lift?
Heather: Dr.
Deane, I will be having surgery in 16 days. I'm wondering if it is possible
if you get enough cc's that you can avoid a lift? I should mention I
will be going under the muscle also
Dr_Deane:
First Heather......if you have significant ptosis, then an implant alone
will only provide a little lift
Del: Dr. Deane
is the sag rate the same with implants as it would be with natural breast
tissue and does it matter whether you have silicone or saline?
Dr_Deane:
Del, great question.....the larger the implant the greater the sag, especially
with saline over 350 cc.
Heather: Dr.
Deane, saying I don't have significant ptosis, is it possible to get lift
with enough cc's and going submuscular?
Dr_Deane:
Heather, the implant will only provide a little lift
Heather: 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
Breast Surgery -> Breast Augmentation Chat Transcript with Plastic Surgeon
