Just when you think you have found the perfect surgeon to perform your breast augmentation, decided on the perfect size, committed to paying the bill for it, you realize that your surgery is going to be where?  In the back office??  Hmmm, maybe that is why it was cheaper than the other quotes? Oh no, the questions just start cramming your brain with worry – is it a real OR, are there emergency back up systems, is my surgeon allowed to take his patients to big hospitals if something goes wrong, who will be responsible for my anesthesia, why doesn’t my surgeon use a real surgery facility, who inspects this place????

A wonderful patient advocate friend of mine brought this issue to light today and I think it deserves to be spotlighted here too…

http://www.ljcsc.com/plastic-surgery-center-accreditation

“Some surgeons who are not certified by the American Board of Plastic Surgery and who are not permitted to do breast augmentations in a hospital , will try to do the surgery in their office instead. If you are considering using a surgeon who is planning to do the surgery in his office, make sure that the reason is not… that he/she is not permitted to do it in the hospital.    Ask them for the name(s) of a hospital where they are permitted to do “Breast Augmentations” (not just surgery in another specialty). Also… Check with the medical staff office of the hospital(s)  that he/she  “actually has privileges”    to do breast augmentations there .  If not…. find and use  another PS.

Those that   do have their  own “Accredited Operating Facilities”  at their own facilities   are set up just as  hospital  operating rooms with  recovery rooms, the properly trained staff and  Licensed Anesthesiologists. Some others ,  well…possibly may not be.

This matter is of the utmost  importance for your well being.  Remember if a licensed MD / surgeon in another fiield  of medicine/surgery,  can do BA surgeries and  legally so.  That does not make it  safe. They “must”  be able to perform  Breast Augmentations  in  a hospital…. even if they have their own private  Accredited Operating facilities.    Make sure, who  ever you use  has hospital affiliations/privileges… for doing” Breast Augmentations”. ”

Thanks Patty – for keeping us all honest and for always looking out for what we don’t know that we need to know.  There are so many deeper issues in breast augmentation than simply deciding on size – yet these more important issues aren’t as glitzy and fun and they don’t get the attention they should!

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.

Through the years, there have been major improvements in implant design and safety.  There have been significant advances in breast augmentation recovery – ie 24 Hour Recovery – being able to return patients to full normal activity the day of their surgery is a huge advance for patients and surgeons!  Enormous strides have been made in surgical techniques – precise dissection that allows no bleeding during surgery.  How to determine size – the High Five System – finds the perfect size breast implant for each patient every time.  But have we done anything to help patients manage expectations?  Dr. Tebbetts and I have tried through our patient education efforts resulting in our book , The Best Breast.  It was written with patients in mind so that if they know what surgeons know – then we can all make better decisions.

Despite our best efforts, the strange phenomenon, thought, theory or fantasy pervades our specialty – breast augmentation – that you can order up any size breast you want, any shape breast you want and bigger is better!  Read this post from a forum that I found today….”My surgery is in less than 2 days and I am not even remotely scared. I foresee that changing when I arrive at the surgery center. The only thing I’m thinking about is that I have chosen too small of a size…shaving off 25 cc’s less than I originally chose (not that much I know)…bringing me to 375cc. I understand the High Five Method and how it’s important to not go too big for your body type but I’m am so anxious about waking up and thinking…”that’s it? I will barely be a C”. I guess I should just chill out about it and wait and see how things turn out. I will sincerely miss running for awhile but will not miss wearing an “A” sports bra. I might just burn it. Ha.”

What are her expectations exactly?  Does she even really know what she is expecting?  What in the world is a “barely C cup”?  What if the got the bigger implants – would 25 cc jump her into the dream cup size she has in mind?

First, let me just say it and get it off my chest – shame on any surgeon who tells you everything you want to hear or promises you anything you want!  They took a Hippocratic oath for goodness sake!  And shame on any patient who thinks they can order up their new breast like it was a WhatABurger order!

We all have certain attributes and limitations we bring to the table – the OR table – that is. Are you forty, had 3 babies, nursed them all and about 15 lbs over weight?  Do you have thin, stretchy tissue and tons of stretch marks?  Or are you the one that has always felt more like a boy and that God missed you when handing out the good “boob” genes?  All breasts have a certain parameters – width, stretch, amount of tissue, placement on the chest wall etc.  Breast implants must work within those parameters – they cannot change them.  Honestly, breast implants really do just make you a bigger version of what you are now.  Which is something you cannot do on your own any other way – there is no way to diet and exercise your way to a fuller firmer breast!  So breast implants certainly have a wonderful role to play in the scenario – they can do something for you that you cannot – understanding what they can do, and understanding your limitations goes a long way to making you happy with your end result.

An augmented breast is fuller, firmer, more youthful and bigger than what you started with, right?  Then why torture yourself agonizing over whether 25 cc’s will determine your happiness with your result?  A breast that is full and firm is pretty and safe.  When a breast is pretty, do you really care if it’s a full C or a barely C?  You shouldn’t – a pretty breast is a pretty breast that you couldn’t get without that implant.  Patients should be honest about their expectations – but should be rational and logical about the limits they bring to the operation.  Surgeons should be honest with patients about what they and the breast implants can do given the limits the patient brings.  And BOTH parties should NEVER utter the word cup size ever again.

When you get to the place in your life where you have done all you can do to be the best you you can be, but your breasts still really bug you – then looking into breast surgery is a good option.  When you reach a comfort level with your research and your choice of surgeon where you believe – anything is better than what I have now – - then you can really effectively communicate with your surgeon and the two of you can make good decisions and plans to get you a beautiful result you will LOVE and be happy with long term.  Balancing expectations is always a challenge – but there is a balance that can be achieved between what you want and what your body will allow you to have.  Finding that balance makes happy patients who don’t care what cup size they wear!

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.

The High Five Measurement system was published by John B. Tebbetts, MD – it is a system that has produced the lowest reoperation rate in breast augmentation ever published.  It is a system that fills the breast – it doesn’t push it.  When tissue is pushed to new places where it has never been stretched before….problems can occur and revisions – reoperations become more likely to daunt the patient throughout the course of their lives.

What I am hearing from women on several Internet forums now is that some plastic surgeons have realized the that the importance of measurements has been brought to light and that patients are asking for High Five during their consults – - so they do a few measurements for the patient and the patient believes that they got High Five – - then they will ask the patients to either try on sizers – stuff their bras, or they will ask the patient if they think it’s big enough etc.  When this happens…….it means the measurements meant NOTHING to the surgeon and therefore mean nothing in terms of planning the operation for the patient!

When the High Five formula is used and applied, it yields the correct amount of fill for that patient’s tissue.  The correct amount of fill is always right – it give the patient an increase in breast size that is least likely to cause the need for reoperation long term.  It gives the patient a result that is pretty and natural.  It gives the patient confidence going into surgery because she knows her body chose the size.

Where Tebbetts’ measurement system truly shines is that it takes all the worry away when deciding what size is best for a first time augmentation.   Once you can get your mind around letting go of cup size and all the other normal things women and surgeons talk about, the measurements truly give you peace and comfort – because it is your body deciding what to use – and therefore it is ALWAYS perfect for you.

The hard part is when a surgeon measures a few things – ie base width – but never gets all the measurements and applies the High Five Formula.  They measure but then still guess.  If they measured you and applied the formula there would be ONE correct amount of fill for you – period.  If they measure and then still let you have input or say for you to try on sizers….then the measurements meant NOTHING and you are still planning your operation based totally on subjective/relative things that mean something different to each person.  A woman recently posted on implantinfo.com that she was told that her surgeon would use 375 and she woke up with 500′s – really???  That never, ever needs to happen and won’t happen in a world of clinical decisions.

If you are having a breast implant – you are having surgery – surgery should be planned based on clinical, objective criteria for your safety and ultimately your long term happiness.

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.

I am always amazed when I hear these types of stories, yet I shouldn’t be – because unfortunately it happens all the time.  A woman decides to have breast implants – goes into it not fully knowing and understanding all the issues and all of the sudden is entertaining the idea of operation number FOUR…….this is a prime example of why balancing what we WANT with what we can REALISTICALLY have is so important.  Having breast implants can be a wonderful experience – a change in your body achieved in no other way possible….but there are limits.  Understanding those limits and having a plastic surgeon that will be honest with you about those limits is the key to a happy ending.

Question -

I think this is pre-op? I have hated my saline from day 1. I got them done 4 years ago and tried 2 revisions. Nothing made me happy, I was a barely A and got 420cc saline. Awful- barely a C and it sucks trying to find a bra. I have a wide chest and pretty much ZERO tissue. They look like tennis balls sticking out. They kept sliding out of the pockets so my ps stitched the pockets down. They suck, very ripply, don’t move, can’t be pushed up for sexy cleavage. I’ve had 3 other consults. I’m 5″5, 135. Runner, & kickboxing girl. I was looking into Moderate Plus Silicone after visiting my ps yesterday. I’m not sure what size to get.
ASAP, I’m going on a cruise to Mexico next month.

Answer -

I think the most important thing whenever having surgery – whether it is your first surgery or your fourth – as this would be for you, is to honestly outline what you expect to get from having surgery.

Above you mention that they are not big enough, yet you have zero tissue and what you have now look like tennis balls, the size of the implant and over dissected pockets let them move too much, they are showing visible rippling, they don’t move (so this can be from capsular contracture)……which of these things bothers you most and what are you hoping to correct if you have surgery?

I also get the impression that you are hoping that simply by changing from saline to silicone these issues will get better – is that what you are thinking now?

I am really sorry that you have had to go through so much with implants – but before you jump into any more surgery – I would encourage you to be honest with yourself about what you expect and find a surgeon who will be honest with you about what he or she can fix.

For example  – 420 cc saline implants in a thin, no tissue, runner type is enough to cause the stuck on look, the rippling (from traction (weight) as well as the saline filler) and an implant that is too big can add to the over dissected pockets and allow excess movement…….so if you are trying to solve those problems with a BIGGER implant – - you may find yourself in an even bigger pickle.

Define what you hope to fix – what you WANT out of this next operation.  Then meet with the surgeon again and make him or her address those issues specifically and give you an estimate – based on their experience – of how successful they have been at correcting the issues that concern you.

We only get so much tissue in life – destroying it is not an option.

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.

A relatively new breast implant manufacturer recently recieved approval for a new breast implant device to be sold in the US – it is still unclear when they will be available to patients.  Dr. Tebbetts is anxious to be able to review their 3 year data that the FDA used to approve the devices – should be interesting stuff in the world of plastic surgery!  The two main US breast implant companies – Allergan and Mentor – have been trying to get FDA approval for their new breast implants for over 10 years – but still no approval for them.

Press Release ~
Sientra® receives FDA approval of its Silimed®-brand portfolio of round and shaped silicone breast implants

Santa Barbara, CA — Today, Sientra announced that it has received FDA approval of its portfolio of Silimed-brand silicone breast implants.

“We are elated to receive FDA approval of our flagship portfolio of silicone breast implants,” said Hani Zeini, founder and chief executive officer of Sientra. “This represents two significant milestones. Namely, for the first time in 20 years, Sientra has successfully broken the existing duopoly in the U.S. by offering surgeons and patients a new choice. And today, Sientra becomes the first and only company in the U.S. to provide a full portfolio of commercially-available breast implants, including shaped implants in addition to standard round implants.”

Until now, and in contrast to the rest of the world, the only approved breast implants in the U.S. market have been round implants with no other choices for surgeons or patients. Sientra now fills this gap by offering an innovative portfolio of breast implants, including shaped implants, with a broad selection of sizes, profiles, projections, and implant surfaces.

Mr. Zeini also emphasized, “The rigorous FDA regulatory approval process, coupled with Silimed’s 33-year successful worldwide manufacturing record, provides assurance of safety, quality and reliability to surgeons and patients in the U.S. when choosing from Sientra’s portfolio of silicone breast implants.”

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.

Recently on one of the implant forums, a lady was wondering if it was strange that her plastic surgeon did not require lab work before surgery.  Her message made me realize what I have suspected for a long time – surgeons have “dumbed down” breast augmentation surgery so much – they have made it so cosmetic – that it is losing it’s clinical boundaries – -and that my friends, is a very slippery slope!!

I made the point on the forum that lab work before surgery is very important to the safety of this entire experience.  The ladies started thinking and realizing that this is very true and then started to figure out how they could get lab work done on their own – - wait a minute – on their own?!?!?  Ok – we have established that the surgeon they chose is NOT taking the best, safest care of them and yet they were still going to use that surgeon – making it ok by getting the lab work done on their own???  So you get the lab – who is going to evaluate it?  Is the surgeon who did not order the lab going to pay any attention to what you get on your own??

So here’s my response and challenge to the ladies on the lab work issue -

ok – I know this won’t be 100% popular but if WE (discount the fact that I work in plastic surgery and just pretend I am a well informed patient like you guys) know that we should have lab work done and if it is NOT even on the PS’s radar……don’t go behind his or her back and do their job for them!!  Find a truly wonderful PS that is THINKING and a PS that lives for surgery and all that it entails.

I think so many get off on the “it’s cosmetic” “we do Botox too” thing that they slight the clinical side – I don’t know if they do it because they don’t want to scare you off or if they do it because the have just gotten flippant – - it can’t be because of cost because lab work is CHEAP to clinics and surgeons….

If you are going to have surgery – then certain lab work applies – if you are over 30, AAAA says you should have a mammogram, if over 40 an EKG also and everyone has to have a set of blood work (Comp met panel, CBC w/diff and platelets, HIV and pregnancy) – Dr. Tebbetts, Dallas based plastic surgeon and 24 Hour Recovery expert,  also requires an MRSA nasal swab  – you can be a carrier for MRSA and not know it – it colonizes in the nose and if you are in hospitals or nursing homes all the time, you are certainly at more risk.

I harp all the time on here about how surgeons should prepare you for what you are about to go through and help you with understanding your recovery etc – - and yet – you guys still chose the “best doc” in your area, let him operate on you and then come on here and have a million questions that that surgeon and his staff should have answered for you.  This board can supply some support – thank goodness – but it’s a shame because it should come from the people you PAID to take care of you.

Caring for your safety CLINICALLY is another story – - if we know we need safety and preop lab to help us be safe – if your ps isn’t calling for it – why do it on your own and still use that ps???  There are clinically motivated, thoughtful surgeons out there – you may have to do a bit of research.  But this is so important – - please don’t settle.  Why pay them to care for you if you are doing all the research, support and clinical carefulness on your own??

I think this is a huge topic and I am so glad it has been brought to life and to the attention of all here.  Remember, no one needs a breast implant……we WANT them – it is elective – therefore every risk we face is multiplied 10 fold.  Don’t settle for mediocre care – -especially in an elective procedure.  There is more to this than simply choosing the size you want to be – - and I love that this topic brings all the considerations to light!

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.

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.

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. ]]> http://www.thebestbreast.com/blog/2012/01/21/breast-augmentation-article-announced/feed/ 0 http://www.thebestbreast.com/blog/2012/01/13/breast-implant-size-here-we-go-again/?utm_source=rss&utm_medium=rss&utm_campaign=breast-implant-size-here-we-go-again http://www.thebestbreast.com/blog/2012/01/13/breast-implant-size-here-we-go-again/#comments Fri, 13 Jan 2012 00:52:02 +0000 pastiche1 http://www.thebestbreast.com/blog/?p=1616 Continue reading →]]> 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.

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.