Dr. Jay M. Pensler Chat
Transcript
|
Dr.
Pensler from Chicago, IL hosted a live chat in December.
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 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.
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