Wednesday, April 18, 2007

Some more words on Silicone Implants

Last week, one of our patients came in for her pre-op with her friend. Her friend had just had silicone implants at another practice and was very unhappy with her results. Not only did her implants feel very heavy and looked saggy-she was upset that nobody at that particular practice gave her information that is a prerequisite (by the FDA) and part of the consent forms for implantation of silicone implants. She was never informed that MRIs are the only measure to detect leakage and that they are recommended at certain incremental times after surgery. She was also never shown the booklet that we have to give patients before even scheduling a consultation for silicone implant surgery.

I am not saying that silicone implants are a bad choice-the are great implants for the right patients. The patient has to be led through a specific and very detail-oriented consent process in order to be educated about this type of implant. Whether you have surgery with Dr. Bednar or elsewhere for silicone implants, please make sure that you are handed a booklet that gives you all the details involved before and after surgery. If you are not handed this information, you are being denied accurate knowledge in what to expect after surgery.

Thursday, March 22, 2007

The Importance of Massaging after Breast Augmentation

Your first post-op visit not only entails removal of your sutures but we will also show you the massage technique to help you get your implants settled in your pocket. On the average, most of the settling will take place during the first 3-6 months, however, keep in mind that each individual is different. Sometimes, it can take up to 1 year for implants to finally settle down.

Let's revisit why the implants sit high in the first place. They are placed behind the pectoralis muscle (chest muscle). Basically the implants are trying to stretch the muscle out but the muscle is reluctant to give right away. So, the implants sit high and the manual manipulation (through massage) of the implants will allow the implants to stretch the pocket out and lengthen the muscle. You have to massage continually-whenever you think about it if you want to let those implants drop sooner than later. The look of an implant sitting high is really humpy and odd looking at first. At this point, also keep in mind that the implants will not reflect an accurate size-i.e. they may look smaller than they actually are because the muscle has not fully stretched out. So, please be patient and keep massaging. Also, keep in mind that this is only temporary-the frequency of massaging will help you to achieve a much more natural look much more quickly. Remember that with the textured implants you just need to massage until the implants have dropped-the smooth implants need to be always massaged. (see prior blogs). You also want to avoid wearing wire push-up bras for 1 year after surgery because as you are trying to get the implants settled in their respective pockets, the wire push-up bras are doing the opposite, i.e. pushing the implants back up. And, honestly, you don't need those anymore.

Sometimes, due to muscle dynamics, one side may settle faster than the other. Then you have to be more aggressive with the side that is lagging behind. There is a chance (1-3%) that the implants may never settle despite all the massaging in the world. This is typically due to scar tissue formation that is forming faster than the implant being able to settle in the pocket. It's called a capsular contracture. The body generates scar tissue as a response to trauma no matter what (trauma is your actual surgery). Some patients develop scar tissue faster than others-we have seen smokers in our practice with a higher rate of scar tissue formatiuon than non-smokers. When you do have a capsular contracture, Dr. Bednar will have to go back in and clean the scar tissue out which will allow the implant to drop. The recovery time is typically 1-2 days.

Tuesday, February 06, 2007

Comments on lifting children after breast augmentation

After breast augmentation, you might want to wait 2-3 days before picking up small children. The shoulder range of motion involved in lifting them at that point may be difficult to do due to discomfort. You definitely want to make sure that you have plenty of help within that time frame. You can also have someone help you in the actual lifting process and have the children sit on your lap.

Wednesday, January 31, 2007

Smoking and Surgery

I know that quitting smoking is much easier said than done. If you are a smoker-no matter if social or not-and are considering breast augmentation or any other surgery for that matter, please read the following.

Smokers have a much tougher time with wound healing-why is that? Well, everytime you take a puff, you are depleting your body of oxygen. Oxygen is a life line-it carries a multitude of nutrients that are especially necessary for wounds to heal. It takes your body 3 weeks to be at 90% wound strength. We have seen patients (smokers) who are initially doing just fine with their sutures for about 2 weeks, and then they start popping them. Your body has run out of material to heal your injury-which surgery really is-it is trauma to your body. Now, there are smokers who do not encounter any difficulties-but that is definitely not a given.

Also, consider that a long term smoker may suffer from chronic lung ailments. In many of the longer cases, you may be intubated. If your airways are not clear, that can cause serious problems during your anesthesia.

Dr. Bednar is one of the few plastic surgeons that I know who will actually listen to your heart and lungs and take your blood pressure during the initial exam. If you are a smoker and he finds that your lungs are not clear, he may very well refuse to do surgery on you. He has actually stopped performing facelifts and tummy tucks on smokers-they just don't heal well at all.

Overall, if you are a smoker you run a higher risk of complications after surgery, such as poor and prolonged wound healing and higher rate of scar tissue formation. Why would you want to risk that - especially for costly elective surgery. You want the best possible outcome, right? I know it's hard to quit-but maybe consider cutting back-or better yet-this could be your best excuse ever to stop.

Wednesday, January 24, 2007

Patient before and after photos

A few months ago, I went on a consultation for breast augmentation (will not say where) to see how this practice dealt with before and after photos. We receive many comments on our website photos (positive that is) and patients always comment that we have a plethora of before and after photos in our albums. There was not a single before and after photo on that surgeon's website (that part of the site was under construction and still is to-date). So, I was a bit curious whether I would find many in his office. Well, this is what happened-he pulled out a Sports Illustrated Magazine and showed me several swimsuit models. Mind you, I am in good shape-I work out every day but I am 42 years old and not 22. My body has held up relatively well, but I am definitely not 6 feet tall. I am 5.3. Any how, I almost could not contain myself.

The reason I am writing about this is that airbrushed photos are not reality. You need to see patients that have similar builds, shapes, whether the implants are above or below the muscle. When you come in for a consultation, we actually take a pre-op photo and have you look at that photo as a means of comparison to what is in the albums. I guarantee you, you will see someone with similarities to yourself. It is so helpful to see what the outcome could be-given your own preferences, such as size or type of implant. These photos are medical photos-they are not airbrushed-they are brutally honest. Dr. Bednar may point out certain things about your chest wall for instance that you may not have noticed so much until you see it in the photo. Therefore things are kept much more in perspective-ie your expectation can be so much better met than when being compared to a playboy bunny or a swimsuit model. I know I am not.


Thursday, January 18, 2007

Additional informative links for breast augmentation

I highly recommend the following sites for additional good and solid information on breast augmentation procedure.

Check them out and let me know what you think.

Friday, January 12, 2007

Exercising after Breast Augmentation

Happy New Year!!!

Many of our patients work out consistently and worry about setting themselves back after breast augmentation.

We do recommend not isolating the pectoralis muscle for 6 months to 1 year with exercises such as the pec fly, chest press, push ups, dips. Now, everyone is different-I have seen patients at the gym doing modified push-ups or going lighter on their weights when doing chest press. You have to listen to your body - if there is pain involved-do not continue, obviously.

What patients have to remember is that the implant will have to settle in the pocket after surgery-exercising the pec muscle will interfere with the settling process by keeping the pec muscle tight and the implant therefore high. The muscle has to relax (lenghthen) in order for the implant to settle. After the first week of surgery at your first post op visit, you will learn a massage technique to help you get the implant down-this will have to be done consistently and aggressively-there will definitely be discomfort-but it's necessary to help in settling the implant.

Here is what I suggest-start with light cardio after 7-10 days after surgery. Keep your heart rate down and time your work-out to 10-20 minutes and see how you do. Increase the time of your work-outs slowly after giving your body time to adjust. I was up to 30 min of cardio w/o breaking a sweat after 3 weeks out and kept that intensity for 2 more weeks after that and then increased intensity slowly after that. It is importanat that after your surgery, you do not break a sweat as that will cause increased swelling due to your elevated heart rate. Keep this schedule for a couple of consecutive workouts and then maybe start incorporating lighter weights, such as for arms, legs.

A lot of patients take body pump classes. Initially, you might just want to use the bar without weights and refrain from presses, dips , push ups-anything isolating the pec muscle.

Lighter weights for bicep curls - push-down triceps w/ straight bar is better than rope, you can do light leg workouts-stay with machines-that way you don't have to carry the weight plates around.

Altogether, remember-you will not lose muscle tone overnight-I was out for 2 weeks after my surgery and it took me 1 full week to get back to a semi-normal routine. Sometimes your body even welcomes the rest. I felt like I had no endurance at first-mainly due to all the pain pills that had to be flushed out of my system. I had also gained water( 5LBS) weight from the meds but the bloats went away after 1 weeks- no fun. But I went back slowly and my endurance level and strength slowly returned as well. I listen to my body and watch for changes!! You will get all the hints you need to modify your exercise routine to what you can and cannot do by taking it step by step and respecting what your body tells you.

So, no fears!