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Dr. Jay M. Pensler Chat Transcript
Dr Pensler has entered the room. Dee: Hi Dr. Pensler Dr Pensler: hi Dee: how are you at typing? Dr Pensler: ok Dr Pensler: fair Dee: okay...well let's give it a couple of minutes and hopefully more women will show up Dr Pensler: I peck away with two fingers Dee: lol...hey as long as you're a good surgeon, that's okay :-) Dr Pensler: I can use ten fingers at that Dee: THAT's GOOD :-) BARB: and sometimes you wish you had more than ten for that too I bet BARB: I know sometimes I could use about 3 more arms Dr Pensler: I have good help BARB: that's good BARB: do you have your own surgical team that you work with or do you just get who's scheduled by the hospital? Dr Pensler: I perform 95% of the breast augmentations in the office so I have a fixed team there BARB: oh ok cool Dr Pensler: in the hospital its a bit more random BARB: I'm trying ton convince my PS that he needs his own surgical RN Dr Pensler: it is quite good because we perform 150 -200 breast augmentations a year so everyone is on the same page Dr Pensler: is on that is BARB: yeah I think that is a very good idea Dee: Okay, well I put a notice on the forum and Dezzie is arguing with her 3 y/o and will be here momentarily along with Nicole, lol! Dr Pensler: its helpful I usually don't need to ask for anything it is typically ready Dee: So, Dr. P -- which incision site do you prefer? Dr Pensler: a common question Dr Pensler: sorry about the spelling Dee: lol...that's my first ? in these live chats Dee: don't worry about spelling...we edit the transcripts and usually can figure out what you Doctors are talking bout Dr Pensler: I perform 1/3 trans ax. 1/3 periareolar and 1/3 inframamary Dee: Pench and Carlisle can you give us your Forum membername from the forum please Newbie: I am seventeen and will be getting an breast augmenation done the day after Christmas what do I need to know? Dr Pensler: I tell people its like picking a red or black sports car Dee: You have LOTS to learn and research there Peach Dee: PLEASE don't go into it not knowing... Dee: where are you located? Newbie: Houston TX Newbie: I have a wonderful doctor Dee: who is the doctor? Newbie: I have an asymmetry case...Dr. Cheney Dee: well you can ask Dr. Pensler who is our guest PS tonight some questions. Dr Pensler: breast augmentation under 18 is a special situation Newbie: yes Dee: what size are you on each breast? Dr Pensler: as you may know implants are approved for people over 18 and for use via trans axillary,periareolar and inframamary incisions by the FDA Newbie: an A on the right and a large c small d on the left Dee: However, Dr. P --- if she has what's considered a birth defect it can be done under 18 right? Dr Pensler: correct Dezzie: Dr. P have you ever done a periareolar incision on a darker skinned person and the scar did not heal well? DR Pensler: yes Dee: Peach...what is Dr. Cheney's first name and is he in Houston also? Newbie: Michael Cheney I believe and yes he is in Houston Dezzie: can it be fixed or are stuck with it? Dr Pensler: but a more common situation would be an inframamary incision with a problem Dezzie: meant say is the patient stuck with it DR Pensler: I have used steroid injections DR Pensler: it works well typically but requires a series of injections Dezzie: yikes=-O DR Pensler: I use a needless injection system called Madajet DR Pensler: the steroid is injected with lidocaine DR Pensler: people with keloid formation complain more about the itching than the injections Dee: Dr. P - what is your CC rate? DR Pensler: the injections stop the itching Newbie: the reason they are going to do the surgery is because I was on a medication that stopped everything from growing and Its something that depresses m DR Pensler: 3-5% Dee: I understand that Peach...we've had a couple of almost 18 y/o or just over 18 women on the forum having a BA because of assymetry DR Pensler: I have peole massage it seems to help but it is a tough problem Dee: What do you think of the TUBA procedure? DR Pensler: if there is severe asymmetry you should feel a lot better after Newbie: I hope so DR Pensler: I think its presently not allowed by the FDA Dee: Peach, are they going to implant only 1 side or do a reduction on the large side and then implant both? Newbie: implant both sides.. and a lift on the bigger side Newbie: I want to go up a cup size to a D Dezzie: What kind of treatment do you recommend for your patients that get CC? Dee: Dr. P --- can you clarify that for us please? Because if it's severe and considered a birth defect then it is allowed under 18, right? DR Pensler: when the FDA(Federal Food and Drug Administration) changed the status of breast implants from experimental to permanent they said no to tuba Dee: ahhhh...okay, I didn't realize that's what you were answering, lol Dee: Ummmm...then WHY are there so many doctors whether certified or non-certified doing TUBA then? DR Pensler: yes if its a congenital problem under 18 should not be a problem although there are no written guidelines saying that it is ok DR Pensler: I have done breast augmentation under 18 (17) for asymmetry but one needs to be sure the larger breast is not still enlarging Newbie: that's what my doctor said Newbie: it has been the same for 4 years Newbie: and definitely stopped with the medication I was on Dee: Catz...jump in with a question :-) Nicole: Hey everyone! Dee: hey Nicole BARB: hi Nicole DR Pensler: I used to do tuba I think its technically ok but the FDA specifically said not for individuals under 18 and not through the umbilicus Jessica: LOL hi everyone Jill: hi Nicole BARB: Hi Jessica Dee: gotcha...Dr. P Nicole: Hello Dr. Pensler! DR Pensler: hi Dee: What do you do if any thing to try and reverse CC before you have to do surgery? DR Pensler: if you perform a tuba today the surgeon puts himself/herself at risk DR Pensler: there is no magic bullet first of all Dee: I agree Dr. P...there's a doctor out in CA that's lost a couple of patients this year from doing that procedure DR Pensler: cc may be helped by massage so I try and get all of my patients to massage Dee: Do you do trans-ax blind or endoscopically? BARB: hey you took my question Dee: I guess I can type faster Barb...neener, neener, lol DR Pensler: also if there is a lot of imflamation post op I think those patients are at higher risk for cc so I have a low threshold for placing them on antibiotics Dee: ok Dee: any specific type of antibiotic? Newbie: do they really insert a urinary catheter when they do the surgery?:-( DR Pensler: I used to do virtually the entire operation via the endoscope now its only about ten percent DR Pensler: irtuaaly that is DR Pensler: sorry about the spelling DR Pensler: I use either ceftin of I there is a lot of inflamation cipro Jessica: how soon can you tan after a BA? Or can you ever tan nude again? DR Pensler: the situation with tanning and scars is that the scars hyperpigment if they are not mature Jessica: how long tell they are mature? DR Pensler: so you need to keep the uv off of them either by staying out of the sun or with sun block until they are whie and mature DR Pensler: variable Jessica: ok..thanks DR Pensler: may take four to twelve moths BARB: little bandaids BARB: that is what I use when I go to the tanning bed DR Pensler: months Jessica: good idea :-) DR Pensler: or zincoxide works well BARB: I have trans ax and my incision is maybe 3/4 inch BARB: so it isn't too hard to cover DR Pensler: long or wide BARB: yes I have tried the zinc oxide too BARB: long DR Pensler: ;-) BARB: I really have to look for my incision now DR Pensler: my nurse thinks trans ax incisions are the best BARB: this nurse thinks so too BARB: lol Dee: I like my crease incision :-) BARB: so how long do you tell people to abstain from sex post-op? DR Pensler: any incision if it heals well is great DR Pensler: I usually don't put ant restrictions on that BARB: ok just wondering because some PS do DR Pensler: I tell proplr re activity if it hurt cut back a bit BARB: mine said 6 weeks ummmm I did not make it that long Newbie: how long before I can drive? Nicole: Don' drive at day 3! BARB: first of all can you drive now??? LOL Nicole: it will hurt! Nicole: lol BARB: just kidding BARB: yes at day 3 it WILL hurt DR Pensler: it depends on how you feel Jill: nicole would know Nicole: I know McDonalds didn't appreciate me driving all up on their curb cause I couldn't turn the wheel.... DR Pensler: I have had people go out to dinner the night of surgery and others stay in bed for days BARB: LOL they now have 3 windows at THAT McDonalds... Nicole: lol Nicole: Dr.Pensler...sorry if this had been asked, but have you used the cohesives yet? Dee: Dr. P - do you participate in any silicone studies? DR Pensler: I am in mentor and McGahan silicone studies DR Pensler: cohesives? Dee: Inamed (formerly McGhan) Cohesil style 410 Nicole: the cohesive gels DR Pensler: I though you meant some sort of glue Dee: they are in a study right now...they are the thick non bleed gel Dee: lol BARB: hey glue would work no CC no muscle spasms BARB: might look funny though DR Pensler: I put a pair of McGahans in last week but honestly I'm not sure which type I used BARB: Have you used the new Mentor high Profiles yet? Nicole: oh...ok DR Pensler: I put 4x as many mentor gels in and 8x McGahon saline in Dee: why is that? DR Pensler: gee my spelling really deteriorate when I try to type faster Dee: LMAO...don't worry about the spelling DR Pensler: I like the McGahan guarantee better for the saline Dee: yeah, but for $125 with mentor you can have better than Inamed (formerly McGhan) ...I'm not biased since I have Inamed (formerly McGhan) and wouldn't trade them for Mentor's DR Pensler: why do I keep spelling Inamed (formerly McGhan) with an extra a DR Pensler: I think also than the Inamed (formerly McGhan) implants are slightly thicker and more stable less likely to rupture Dee: BARB: Have you used the new Mentor high Profiles yet? DR Pensler: but there is no data to that effect Dee: gotcha DR Pensler: no I like the low profile implants BARB: for what reason DR Pensler: the old silicone implants were all "high"profile DR Pensler: and the low profile implants look a lot better not like cherry pets on a board so to speak Dee: Hi Buster...what is your Forum membername? DR Pensler: cherry pits Dee: glad you clarified that because I wasn't quite sure what cherry pets were, lol DR Pensler: If you look in old plastic surgery textbooks or articles you can see what the high profiles look like Nicole: Yeah, but haven't the new ones changed? DR Pensler: the key issue is the dimensions of the implant Nicole: I thought they just provided more projection and weren't as wide. And also better for people with tiny ribcages. DR Pensler: that determines the look Nicole: ribcages DR Pensler: that is how they are trying to sell them Hope2: I don't mean to interrupt.. ..I have a question about the pros/cons of various incision types DR Pensler: but if you look at the difference in projection with the low profile implants at typical sizes there is not a big difference in projection Dee: ask away Hope, lol Hope2: Thx ... First, are PS trained in all incision types? BARB: typical sizes such as less than 400cc?? DR Pensler: I tell people incision choice is like choosing between a red and black sports car DR Pensler: even up to 500 BARB: oh ok I wouldn't be satisfied with 500 DR Pensler: no not al surgeons are trained in all incisions Hope2: ha ha so a car salesman can sell any color thus a PS should be able to perform any incision but may have a preference? DR Pensler: you have to decipher the spaces there sorry DR Pensler: its not a problem unique to plastic surgery DR Pensler: If you have a hernia repair the surgeon will choose between a number of repairs Hope2: I'm debating between inframamary and trans ax... I'm fearful of loss of sensation and cc. I'm looking to go under the muscle with an inconspicuous scar... do you have any preference DR Pensler: for instance at the university I am at I do not think anyone else does transaxillary incisions Hope2: is trans ax THAT rare? DR Pensler: and as I do the majority of the BAs in the office it is quite possible that a resident may not see one done Nicole: I like the areola! Dee: Hope...IMO, loss of sensation can happen with ANY incision including trans-ax DR Pensler: I think the most common is the inframamary second periareolar them transax Dee: I have crease was numb on the bottom half of both breasts and at 4.5 months sensation was coming back and is completely back at 10 months on the left and 50% on the right Hope2: I've seen numerous areola incisions and have always noticed the scar. I know inframamry scar is most pronounced but seems least visible unless you lift up the breast (from those I've seen anyhow) Trans ax intrigues me DR Pensler: correct any incision can result in loss of sensation Dee: Hope, that is IF you have a PS who can place the incision correctly. Some end up with them too high on the breast...mine are perfect :-) Nicole: I think it all depends on the patients skin and the surgeons skill. DR Pensler: 4th intercostal nerve supplies sensation to the arela and nipple BARB: Hope your PS really has to know what he is doing during dissection or you will lose sensation no matter where the incision Jill: my incisions are perfect too & I have all sensation back :-) Hope2: got it.. so how much more skill is needed to properly place implants trans ax vs inframmary? Nicole: Mine are even more sensitive now. Hubby likes that! Jill: lol BARB: I never lost sensation and they are more sensitive too Jill: mine too Dee: Well, ladies...we have time for one more question for Dr. Pensler Hope2: my friend is more sensitive too.. I'll take that ! :-) DR Pensler: well if no more burning questions good night to all Hope2: since infram is most commom, does that mean its the "easiest" to do? DR Pensler: I think so Hope2: thx Dee: Thank you Dr. P... DR Pensler: particularly if one makes awide incision DR Pensler: welcome soory about the spelling Hope2: so for the ladies on .. how many aereola? infram? trans ax? Special thanks to Dee for arranging our chat & for editing the transcript. Copyright©2005 |
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