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Archive for the ‘Breast Augmentation’ Category

Hard Breasts & The Dentist

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Below is a recent question from a patient 15 years post breast augmentation.  She asked a very good question and it deserves answering, but I also want to get it out to all of my patients.  It turns out that studies done by Allergan and Mentor separately show that, across the country, 7% of patients get capsular contracture (hard breasts) within the first 3 years of surgery, therefore probably related to the surgery.  Another 8% of patients get capsular contracture between 3 and 8 years post breast augmentation.  This second group of patients who get capsular contracture is related to causative situations only very indirectly associated with the breast augmentation surgical event.

 

The #1 cause of capsular contractures in this group was the dental visit.  Individuals who care enough about themselves and their appearance to get breast augmentations also care about their oral health as well.  Therefore, these individuals are the ones who get their teeth cleaned on a regular basis and their cavities taken care of immediately when they arise.  The human mouth has some of the nastiest bacteria in the world and I have heard it said that a human bite is much more dangerous than an animal bite.  Therefore, when one gets blood in his or her mouth during a dental visit, there is a route of entry for oral bacteria to get into one’s system.  Our immune system has basically one way to deal with invaders into our bodies, and that mechanism is to wall off the invader.  That happens around artificial hips, pacemakers, breast implants, etc.  The walls around these foreign bodies are called capsules.  If these capsules are thin and pliable, there is no pain on walking if you have an artificial hip or knee and there are no hard breasts if you had a breast augmentation.  However, if after these capsules form, there is a second invader such as oral flora, the body may depending on several factors start walling off your breast implants more, leading to a hard breast or pain on ambulation if an artificial hips is present.

 

The way to inhibit this second and thicker capsule around a breast implant is to eliminate for a very short period time the oral flora from your mouth by taking antibiotics one hour before the dental visit.  This wipes out all oral flora for several hours, and when you get your teeth cleaned and/or a tooth drilled with a rubber dam in your mouth and you get blood in your mouth, there is no bacteria to get into your system, and therefore your immune system is not triggered to wall off foreign bodies (i.e. to turn your breasts hard).

 

My patient’s question was, “since it has been 15 years since my breast augmentation, can I stop taking antibiotics before the dentist”.  My answer to this would be, I don’t think the problem ever goes away, and it is such a small amount of antibiotic and one goes to the dentist routinely but sporatically, and therefore the antibiotic is cheap insurance to decrease the chance of uncomfortable hard breasts and/or a second surgery which can be avoided.

 

I am not an infectious disease doctor, nor am I an immunologist, nor am I a researcher.  I am merely a “boots on the ground” every day sort of cosmetic plastic surgeon, and I can tell you from my own 36 years of experience that my patients who follow the above recommendations have much fewer redo surgeries and many few

Breast Augmentation Surgery (GRAPHIC) for Patient with Minimal Pectoralis Muscle

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(GRAPHIC)

Watch a breast augmentation surgery being performed by Dr. S. Larry Schlesinger in Honolulu, Hawaii. Dr. Schlesinger is a board certified plastic surgeon at The Breast Implant Center of Hawaii. His patient was born with what we believe was Poland Syndrome but when he goes into surgery, he finds there is a small amount of pectoralis muscle, making implants easier to place.

This breast augmentation surgery is unique in that both sides require two separate sizes in order to make them symmetrical. Dr. Schlesinger walks us through liposuction of the bra bulge, removing the pectoralis major muscle from the fifth rib, inserting saline sizers to ensure implants are symmetrical, using a no-touch technique for silicone breast implant insertion, and then suturing the transaxillary incisions.

Breast Augmentation – Tasha’s Video Story

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I feel blessed, I feel adored, and I feel very excited.

My doctor was Larry Schlesinger and I had my procedure done at The Breast Implant Center of Hawaii.

I was a new mommy and I think after I had had my daughter, I was feeling not so secure about my body and the way things fit, the way that they used to and I wanted to do it for myself.

It just so happened that one of my girlfriends had had a procedure done and I had seen breast augmentations done before but when I saw hers I just knew I had to see Dr. Schlesinger.

I feel confident. And I think that it contributed with the entire staff.

I would tell a friend that is thinking if they should jump in and do the procedure or not to do it, and to actually see Dr. Schlesinger because he will make sure that everything, all of your worries that you may have, you’re going to feel amazing about yourself afterwards and you know that you’re going to be getting the best, most luxurious experience you can possibly get.

I don’t feel like it’s just a doctor. I feel like I’m going to come see my friend. And he’s going to look out for my best interest.

Breast Augmentation Revision – What Happens If Implants Don’t Drop?

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Breast Augmentation Revision – What Happens If Implants Don’t Drop?

Why would a breast implant have to drop? What happens after surgery to get them to move where they need to? What happens if they never fall to the expected placement on the chest wall? Dr. S. Larry Schlesinger, a board certified plastic surgeon in Honolulu, Hawaii explains what happens after sub-pectoral breast augmentation, how to help them move into the correct position, and what happens if they never drop and require a new surgery.

Video transcript:
Hi, I’m Larry Schlesinger and I’m a board certified plastic surgeon from Honolulu, Hawaii. The question is: What do I do if my breast implants never settle down or as they say on RealSelf “Never drop and fluff”?

So what happens – implants are placed either through the areola, peri-areola, inframammary, or my favorite going through the armpit. And the implants in the subpectoral space are being pushed up by the muscle. What if the muscle keeps them up there or what if there’s some scar tissue that was never noticed by the surgeon that holds the implant up too high?

Very early, it’s important to wear either a bandeau or an ace wrap up here to force the implants down where you want them. And usually it’s not both, it’s just one and it’s the culprit.

It’s been my experience that about 80 percent of the time, with an ace wrap and some reasonable pressure, you can force the implants down to where you want them. However, every once in a while, it requires opening up the breast always through a peri-areolar incision because you get the most visualization. You open it up, you find out what the problem is, whether it’s a capsule, whether it’s bleeding, whatever it is and you put in a new implant. Never use the same implant because you lose your warranty and also there’s a potential danger of infection. So you put in a new implant and then you sew it back up and then always wear an ace wrap after that or a bandeau. Some kind of pressure to keep it in the new lower position that you wanted it in the first place.

Timewise, it depends on how much work you did. If you do a little bit of work then it’s a little bit of time. If you do a lot of work, then it’s a lot of time. But my best guess is on average, you’re driving your car at four days and you’re back at administrative work by five or six days, and back at physical work by six or seven days.

I’m Larry Schlesinger and I’m a board certified plastic surgeon from Honolulu, Hawaii. Aloha!

Recovery From Breast Augmentation Revision Surgery for Malplacement of Implant

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What is Recovery Like From Breast Augmentation Revision Surgery for Malplacement of Implant.

If a breast implant drops to the side or drops farther than you want it to, breast augmentation revision surgery may be necessary. Dr. S. Larry Schlesinger, a board certified plastic surgeon in Honolulu, Hawaii explains what surgery can be like and how long recovery may take.

Moving Breast Implants from Above to Below the Pectoralis Muscle?

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What is Recovery Like When Moving Breast Implants from Above to Below the Pectoralis Muscle?

Video transcript:
Hi I’m Larry Schlesinger and I’m a board certified plastic surgeon from Honolulu, Hawaii. And the question of the day is – What’s the recovery after moving from above the muscle to below the muscle?

Again, this is a trick question. When you’re implants in the pocket above the muscle, there’s always scar tissue around it whether it’s a thin fine scar or a thick scar that causes capsular contracture. At any rate, you need to go in, always from a periareolar, just around the areola, go in, take out all the capsule…and the reason for that is you want the breast tissue and the top of the pectoralis muscle to fuse. So you want to obliterate the space above the pectoralis muscle. And so that’s the first step.

Then, what I do, doesn’t have to be what everybody does, but what I do is put a drain in that pocket. The drain is not going to really drain any fluid, it’s to suck the pectoralis to the breast tissue above and that comes out through the armpit.

The drains stay in for three days. Once the drains are out, I’d say it’s about five to seven days and of course the sutures come out around the areola at about six days. And then in this situation because you’ve got a periareolar incision you want to wear a bra. I normally don’t have patients wear bras because we come from the armpit and we’re subpectoral, etc. But in this situation, you’re going to want to wear a bra and you’re going to want to 24/7.

And that’s about how much time it is for recovery when it’s pocket switching. I’m Larry Schlesinger and I’m a board certified plastic surgeon from Honolulu, Hawaii. Aloha.

What is Breast Augmentation (Implant) Revision Recovery Like for Implant Exchange

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What is Breast Augmentation (Implant) Revision Recovery Like for Implant Exchange.

 
Video transcript:
Hi, I’m Larry Schlesinger from Honolulu, Hawaii and todays question is “How long does it take to recover if you’re just changing the size of the implant?”

Well, that’s kind of a trick question. When you’re putting in a larger implant you’re going to have to open the capsule, there’s always a capsule. It doesn’t have to be contracted. But you have to open the capsule, which could lead to bleeding. You have to very often, reposition to pocket to be either bigger or smaller depending on if you’re going with a larger implant or a smaller implant. You may have to put Siri in, you may have to do a capsuloraphy or remove some of the capsule which would be a capsulectomy. So changing the size of the implant leads to many other intra operative things that one does inside the pocket so there’s no simple answer for that but let’s say you’re just going just a teeny bit more and the pocket exists, you open it up, and let’s say there’s no capsular contracture so you go into an armpit, you take out the existing implant, you put in a new implant of a slightly different size, sew up the armpit. And one can drive their car in three days and it’s a really quick recovery. On the other hand, if there’s a whole bunch of switching around and closing the capsule and so on, the recovery could be up to seven, eight, even ten days. That’s my answer. I’m Larry Schlesinger, I’m a board certified plastic surgeon from Honolulu, Hawaii. Thank you very much.

How Long Is Recovery for Breast Augmentation Revision for Capsular Contracture?

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How Long Is Recovery for Breast Augmentation

Video transcript:
Hi, I’m Larry Schlesinger and I’m a board-certified plastic surgeon from Honolulu, Hawaii.

Today’s question is What is the length of time of recovery after a capsular contracture breast implant revision?

In a capsular contracture situation, you have this capsule completely surrounding the implant and it makes the implant hard. So what you need to do, these are best perhaps only operated on through a peri-areolar incision, the bottom of the areolar complex. You go in, you take out the capsule, you take out the implant, and then at least at the Breast Implant Center of Hawaii, we put in a drain. And that drain stays for a minimum of three days.

Usually we keep an ace wrap on for a couple more days. You decrease the chance of blood around the implant which could lead to a second capsular contracture.

So the answer to the question of “How long is the recovery?” The recovery is three days for the drain, the recovery is about five to six days to start to go back to work, driving the car, etc. And how soon before you feel completely normal, and you can do anything? Usually it takes about two weeks, perhaps three but that’s about it. It’s not a huge recovery but you do have to decrease the chance of bleeding again and that would add more time to the drain and to the recovery.

I’m Larry Schlesinger from Honolulu, Hawaii and thank you very much for listening. Aloha.

Breast Augmentation Revision – What if I get The Wrong Size Implant?

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Breast Augmentation Revision – What if I get The Wrong Size Implant?

Video transcript:
Hi, I’m Larry Schlesinger and I’m a board-certified plastic surgeon from Honolulu, Hawaii.

Today’s question is what if I get a breast augmentation and choose the wrong size implants? What happens next?

Well, the answer to that question is something you should have done beforehand. Sit down with your plastic surgeon, go over the size, determine that it’s exactly what you want, try on implants and bras which we do, bring in a wish picture so the plastic surgeon understands where you want to go to and be sure you understand where you want to go to.

However, if your plastic surgeon has put in breast implants and they’re not the size that you wanted then I would call my plastic surgeon and have a heart-to-heart about what is the next step. Also, to kind of obviate this problem, whatever your plastic surgeon’s policy is, you should know it before surgery not after surgery.

Thank you very much for listening to me. Aloha.