Breast Implants and DRAINS – nothing good comes from drains in a primary breast augmentation

Posted on January 22, 2012 by pastiche1

by Terrye Tebbetts

I saw this question on the forum and I think it deserves more attention – the use of drains in a primary breast augmentation is really 30 year old surgical technique – archaic!  Better surgical alternatives have been published and proved by John B. Tebbetts, M.D., plastic surgeon in Dallas, Texas, in his renowned 24 Hour Recovery series in Plastic and Reconstructive Surgery Journal.

Question ~

Hello! This is my first time posting anything on here (or any other website) so I hope I’m doing it right! My BA is scheduled for Feb. 7. I had my pre-op with my doctor yesterday. I’m SO EXCITED and nervous. Wish it would just get here so I can stop thinking about it! One thing I wanted some info on though, is anyone of your doctors planning on using drains? I know alot of people with BA’s and none of them have had drains. My doctor said I will have them for a couple days. I trust my doctor and am going to do whatever he says. Just wondering if anyone else had them. And…how bad are the drains? Doesn’t sound very fun. Thanks!!!

Answer ~

I know you got a few personal accounts of recovery with or without drains which is a good reference for how you might feel and what it may be like, but I thought you might like to have  a clinical peek at the use of drains.

In a primary breast augmentation – how the pocket – the space for the implant to sit – is dissected will determine whether or not drains are needed.  If the pocket is blunt dissected – the tissue is simply torn – that creates a lot of trauma – bleeding and fluid in the pocket  – - no surgeon wants blood and fluid between your tissue and the implant surface, so if that environment was created during the dissection process, then it has to be corrected during your recovery.  Blood and fluid in the pocket increase risks – risks of seroma, infection and capsular contracture.  To correct it drains are placed to draw the fluid out, sometimes compression garments are used too (surgical bras, or bandages or straps).

In today’s world of breast augmentation, in a primary breast aug (nothing else like a lift etc going on), there is NO need for drains.  Instrumentation and surgical techniques exist that allow the surgeon to precisely dissect the pocket – leaving a very dry surface of tissue for the implant to meet.  Having this dry environment eliminates the need for bras, bandages and drains and has facilitated our 24 Hour Recovery process that allows patients to return to normal activity the afternoon of surgery.  But most importantly, in the absence of blood in the pocket, our capsular contracture rate has dropped to 1.5%.

If there is a better alternative that will eliminate drains, investigate that alternative.  As with everything else, there is a time and place/need for the use of drains.  Primary breast augmentation is not one of them!

 

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.

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Breast Augmentation Article Announced

Posted on January 21, 2012 by pastiche1
by Terrye Tebbetts

I was recently interviewed for an article that is to appear on www.implantinfo.com  – they wanted to share tips on how to prepare for a breast implant surgery.  From choosing a surgeon, to choosing the type of implant, to preparing for recovery, I think we tried to cover it all.  Here’s a link to the press release……

ImplantInfo.com and Co-Author of The Best Breast Team
Up on Breast …

PR Web

She has a tremendous amount of clinical experience and currently serves as
patient educator for Dr. John B. Tebbetts. She is passionate
about educating …

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.
Posted in Back to the Basics, Breast Augmentation, Choosing a Surgeon, Recovery Experiences, Size Issues | Tagged , , , | Leave a comment

Breast Implant Size – Here we go again

Posted on January 13, 2012 by pastiche1

By Terrye Tebbetts

This week, several women have asked me to send them the High Five Measurement sheet because they are unsure about how their plastic surgeon determined size during their consultation.  Dutifully, they are measuring their breasts and sending me the numbers and I then try to help them get an idea of what size range they will be in (since the measurements may not be exact – it is just to be in the ballpark.  When Dr. Tebbetts measures the breast and applies the forumla of High Five, you get and exact amount of fill and it is correct for that breast – - other surgeons can do it too – it is just when you try to do it on your own, it may not be exactly right).  So it may not be exact, but it will allow them to see if the size they are dreaming about is even close to what their bodies will allow safely.

The real sizes and the expectations have been all over the map!!  I guess we have grown accustomed to be able to order up anything we want!  For example, the High Five System put one in the 270 cc range, and she was thinking 450 cc – almost double what she can really have!  Some have been closer – the system says 270 – they are thinking 325 – but still, reality has to be balanced with expectations in order to get a pretty, safe breast augmentation with the least risk of reop long term.

What blows my mind, is that when I asked most of them what their surgeons recommended for size – that was all over the map too!  And when I asked, did they measure – I got mostly no’s and one yes, but then he told me to go home and do the rice test and tell him what she liked!  REALLY???

Breast augmentation is an operation that will change your body forever.  Once it is messed up – - it is really messed up and very difficult to fix.  The number one reason it gets messed up is SIZE – either too big of an implant and all it’s associated weight problems or they get the right size and then get greedy and go bigger.

There is a correct amount of fill for each breast that simply fills the emptiness – makes your breasts bigger, firmer and adds projection.  If you push tissue  – you create problems.  If you fill it, you get pretty and natural and least likely to cause you problems and reoperations and more money long term.

I am not sure how a surgeon or patient can get the “correct amount of fill” for each breast if they do not measure the breast, apply the High Five Forumla and then – - and here’s the hard part – - honor the breast and the body it is attached to!

Rice bags in BRAS are a horrible indicator of what your BODY, your BREAST is calling for.  Great indicator for wishing and causing reops but terrible for planning operations.  Yep, I think we all need to rethink the subjective methods and honor our bodies!

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.

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Greatest Myths Blog Published in Australian Magazine

Posted on January 11, 2012 by pastiche1

by Terrye Tebbetts

I just got word that a publication in Australia, The Cosmetic Beauty Directy, took a blog I recently wrote about the Myths in Breast Augmentation and put it in their Definitive Guide to Breast Augmentation.  It is an adaptation of an editorial Dr. Tebbetts published 10 years ago in Plastic and Reconstructive Surgery Journal and then how the state of the same issue has either evolved or stayed the same in today’s world of breast implants – a 10 year perspective/report card on the subject – are we really doing better than we were 10 years ago ( here’s a link to the start of the blog series   http://www.thebestbreast.com/blog/2011/10/10/the-greatest-myths-in-breast-augmentation-myth-1-bigger-is-better/).  They tell me a link will be up soon on their website, but if you live there, it is already on the newsstands.  I know I have communicated with several ladies on here in the past that were from those countries – just thought you guys might want to know about this resource.  It is really nice to know that the breast augmenation recovery advances we have made in Dallas, Texas are reaching Down Under!

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.

Posted in 24 Hour Recovery, Back to the Basics, Breast Augmentation, Choosing a Surgeon, Recovery Experiences, Size Issues | Tagged , , , , | Leave a comment

Breast Implants ~ what causes rippling?

Posted on January 7, 2012 by pastiche1

by Terrye Tebbetts

I recently joined a conversation between several women about what causes rippling in breast implants and was amazed to find all focused on the filler of the implant.  The debate was whether saline breast implants wrinkled more than silicone.  Although filler should be considered, there are several other significant factors that effect rippling.  One lady in particular described herself as a fairly slight woman of 115 lbs, wearing a 34AA now and had not had any babies – so no stretch to her breast envelope yet - – for her and all like her, it is important to remember that it is not just the filler of the implant that you must consider.

There are two basic types of rippling – 1.  Caused by ANY implant that is underfilled  – saline or silicone – the more underfilled they are the more the shell collapses and thus the rippling.  2.  Traction rippling – again – ANY implant that is too big – too heavy for you, will put excessive weight on your tissues and cause the pulling or traction rippling that is so very common in thin women with big implants and then they bend over……we have all seen it and it isn’t pretty and traction rippling is entirely preventable!!!  You avoid it with wise, well thought out implant size choices before surgery.

This young woman of 20 years and her plastic surgeon are planning on using a  425 cc breast implant.  I would ask that surgeon seriously about the risks of traction wrinkling and rippling with those implants in your body.  It would just be nice to know if that choice of size (let alone filler) will present a significant risk of deformity.  If so, backing off the size and weight will help reduce that risk – -  being willing to adjust expectations ie not being able to safely attain the size you dream about, but in the end having breasts that will still be bigger than they are now and prettier sans the rippling effect!

Once faced with reality, most patients will consider adjusting and balancing their expectations – honesty goes a long way.  No one goes into breast augmentation surgery wanting a disaster or a re-do!  This particular patient’s final comment was something to the effect of, “I am just trying to get my money’s worth.”  This is a concern most all women have when they look into breast implants, but getting value out of your choices and being happy with your result, you may find, comes in lots of different forms other than SIZE!

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.

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Before and After Photos of Breast Augmentation

Posted on January 3, 2012 by pastiche1

by Terrye Tebbetts

Before and after photos have always been a part of plastic surgery – a way to judge the quality of the result.  But with the advent of the Internet, suddenly the role of photos in plastic surgery are changing……

“I went to what I thought was going to be my last consult and really liked the doctor except for one thing. Not only did he not have ANY before and after photos in the office( he says bc patients and their husbands don’t want pics of their boobs on the net) which doesn’t make sense to me bc why would they care if there are pics on a site intended for breast aug and PLUS no one would ever know it was them anyways. I can see how there would be some…maybe even quite a few paranoid pep. that would object but you would think at least 30% or so would consent right??
I know that having no pics is a red flag and I’m wondering if anyone else experienced this? The previous doc I went to had only 4 or 5 photos on the site but had a whole book in the office for me to look at. ”

Dr. Tebbetts and I are a classic example of the photo dilemma.  We don’t publish photos on our website, but have them in our book and a large book of before and afters in our office for patients to look at if they would like to.

The main problem with photos is that patients will use them to “shop” for their result.  You look for some one that is about your age, your height, your weight, had the same number of babies and you see if you like their result…..or if you have an implant size in mind – you look at before and afters with that size and decide if it’s right for you.  This type of “shopping” is dangerous – - because no matter how much that lady sounds like you, she isn’t you and her result has nothing to do with you and your body, your breast tissue and your ps.

Before and after photos should be used to see and review a large body of work of the surgeon you are interested in – you may like some and hate some – but all the afters should be an improvement to the befores!  Use photos wisely and they can be a tremendous help to you as you chose a surgeon – giving you an added layer of comfort in your choice.

Bottom line, all surgeons should have photos to show you – they may not publish them in a book, or on the net, but there should be some for you to review.

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.

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High Profile Breast Implants – the new wears off, now what??

Posted on January 2, 2012 by pastiche1

by Terrye Tebbetts

I received this email from a lady who is experiencing a very common dilema.  Several years after getting breast implants and at the time deciding that BIGGER is better and going for it all – big implants and High Profile implants – she is now realizing that they are too big and “get in the way”.  I think the thing that disturbs me most is all the angst surrounding size – because I live in the John B. Tebbetts, M.D. world of the High Five Measurement System, there is never any angst about what size breast implant to chose for a patient – never – because the patient’s body choses the size – it is the correct amount of fill EVERY time!  Read on….

“I have 425 high profile implants now that I had placed
with a full lift almost 6 years ago.
They are way too big for me and i don’t like the fullness at the top of
my breast.  I am very active and these
just get in my way.  Also I’m having a
hard time with wearing certain clothes as most everything I try on is way too
tight across my chest yet fits great everywhere else.

I am scheduled for revision surgery and
have chosen 300 low profile implants.  My
concern is the diameter of the 300 low as it is 12.6cm and the diameter of the
implants I have now is 12cm.  Therefore will my new implants be too wide for my frame.  Also I’ve heard low profile implants have a “droopy” look over time.  What is your opinion of low profile implants? I do want a natural looking implant and yet everything that I’ve found on the internet says that most PS don’t use the low implants much.

I don’t see much of a difference between the high and the moderate as far as projection which is why I chose the low (my PS did give me the option of 339 cc moderate profiles).  I should mention these are silicone implants.  I was also thinking about going with the 270 low profile as the diameter is comparable to what I have now (12.2).  The reason my PS chose the 300 over the 270 was to improve my cleavage. Can you please give me your honest opinion?  I want to make the right choice. ”

Living and dying by the measurement system has been the saving grace that keeps me sane in this business – I think it makes the decision to have breast implants for our patients much easier and comfortable, safe and enjoyable because they are not worried that they made the right decision – - their body made the choice.

Although you have implants now and it will be a bit more difficult, it would still be helpful to try to get a few of the measurements from the sheet.  I am copying Krystin on this note, when our office opens again tomorrow, she will email you the High
Five Sheet.

How did your current ps come up with 300 or 339?  Do you know what the base width of your breast is now?

High profile implants can be really dangerous to the breast tissue over time because of the pressure they put on the tissue (the extra force) – - they are more narrow than most implants so that they can concentrate the volume and thus the pressure outwards.  So I am not surprised the others recommended now are wider – what we are missing is the width of your breast – - if the implant chosen is wider than your own breast – you will see implant edges.

Nothing makes cleavage – - – the space between your breast is call the intermammary distance – the area over your sternum – if it’s
4 cm wide – it will always be that – -implants should NEVER be used to try to
close that distance – doing so creates symmastia (one big una-boob) that is not
surgically correctable.  Take having more
cleavage off your wish list and buy a really good bra!

What makes a pretty natural breast is an implant that is
the CORRECT amount of fill for your breast envelope – - you don’t like the
425′s because they are too big (producing too much upper fullness).  Getting a natural look this time around, will
mean simply filling the empty space.
It’s not so much about profile – it is about the correct amount of
volume.

Until we have measurements all we have is conjecture ……and more angst!

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.

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Breast Implants and Rice Bags ~ planning surgery in a dream world

Posted on November 19, 2011 by pastiche1

by Terrye Tebbetts

I offer to share our High Five Measurement sheet with anyone who is actually interested in determining breast implant size based on what their tissue will allow.  I recently received a request from this young lady and gladly sent her the sheet, then got this note back from her….

Hi Terrye,

I have just had my first consultation.  I go on the 2nd of December for my
sizing and pre-op.  At that appt. my surgeon told me to use bags filled
with rice in a bra.  I am to bring them to the next appt
so she could look at those and get a pretty good idea of what to
use.  I am sure she will measure then too.  Or at least I would
hope.

Thanks so much!!

If a surgeon is asking you to bring in BAGS of RICE from home to your preop appointment to determine size – - I doubt that surgeon is going to consider using clinical, objective measurement systems like the High Five System to plan your operation.  The bags of rice stuff in your bra tell them what you want and they are simply, most likely going to give you what you want with no consideration for what your body will safely allow you to have.  Pushing tissue to a desired size is asking for trouble in the long run.  Yes, you will temporarily get what you want but sooner or later the weight of what you asked for will start to succumb to gravity and time and then you will find yourself back in the operating room.

Breast augmentation is a surgery that will change your body forever.  Isn’t it time we started treating it like a medical procedure again and not a new hair cut?  Seeking surgeons that will treat you like a patient and less like a client will ultimately hopefully yield not only a result that meets your expectations – your wishes, but will also respect your tissues.

Where is the medicine in plastic surgery?

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.

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Mammograms after Breast Implants – a personal experience in Dallas

Posted on November 18, 2011 by pastiche1

by Terrye Tebbetts

Today I went for my second annual mammogram with implants so while it is fresh on my mind, I wanted to share it with you ladies. I was supposed to check in at 3 pm with my mammogram scheduled for 3:15 – but I was a tad bit late, so I checked in at 3:15 and I was in my car headed to carpool pick up at school at……wait for it……3:45!! I swear it took longer to fill in my new insurance information on the in take forms than it did to do the actual views! Thank you so much, Tammy, my tech, for taking such good care of me!

Since I have implants, they had to do 8 views instead of 4. I asked Tammy if they still called them Ecklund views and she said yes but most commonly they use the term “push back” views with patients. She did the push back views first – I promise you – no pain – no discomfort! I love the new digital machines!! Then she did the regular views and honestly – the only one uncomfortable in that series is where they try to get a view up in your axilla (under your arm) to view the lyph nodes and even it did not hurt it was just uncomfortable for about 2 minutes.

She also explained that you get more radiation on a flight from Dallas to LA than in a mammogram. And with this new technology she did not even have to wear a protective vest and yet stayed in the room with me the whole time – and all the other women she had done mammogams on all day long.

Bottom line – do not fear a mammogram – physically it is not bad – - although we will always fear the unknown – but with the advances made in breast cancer today – - and with early prevention cures are possible. So it is better to know than to be in the dark – - with or without breast implants.

In our practice we require all patients who want to have breast implants that are over 30 years old to have a baseline mammogram so that when they hit 40 and need to go every year, they have a great baseline for comparison and to send it to their OBGYN as well as to us. Some surgeons don’t but because Dr. Tebbetts was a general surgeon before he was a plastic surgeon, he feels it is really important to have that baseline – - to be sure the breast you augment is healthy but also so that once that patient needs regular mammograms, there is a base line comparison that is available to the radiologist.

I will be the first one to admit, that even though I know, I was nervous – flipping though magazines I never would want to read while sitting there in the wierd poncho cover deal……but in the end it is worth it and it is not bad at all!

 

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.

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Breast Augmentation Recovery in Dallas

Posted on November 15, 2011 by pastiche1

by Terrye Tebbetts

I absolutely love getting these kind of notes from patients! Who wouldn’t? Here’s another 24 Hour Recovery Experience…..

Hi Terrye!

I just wanted to write and check in! I’m at just over 7 weeks post-op, and have stuck to the instructions given to me. I have had no complications, and my breast augmentation recovery has been amazing, especially compared to everyone else I know who has had a breast augmentation. I am extremely happy with my size and results, and am SO happy that I took the time to research and go to Dr. Tebbetts! It has been an amazing experience- I almost wish I could do it all again!

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