Tuesday, October 27, 2009

Why Postoperative Breast Implant Massage is Important!


about massage for breast implant

October 27, 2009 9:46 AM | Breast Augmentation

I am 5 weeks postop and I had a lift with silcone gel implants and was told I did not need to massage them . Is there a reason I was told this?


Doctor/Professional Answers (1)


Plastic surgeon
San Francisco, CA
United States

Why Postoperative Breast Implant Massage is Important!
October 27, 2009 10:16 AM
After a breast augmentation, we teach our patients to massage their implants each day in order to ensure that they stay soft and mobile, with the most natural results.

Implants can be placed under the pectoralis major muscle ("submuscular" or "subpectoral"), or on top of the muscle and under the breast tissue alone ("subglandular").

Sometimes, surgeons feel that having the implant under the muscle will do some of the massaging motion just by normal muscle movement and that massage of the implants by hand is not necessary.

In Plastic Surgery, there are few absolutely right or wrong answers. What I teach my patients is that implant massage helps to create a "pocket" that is larger than the implant itself. This will facilitate the implant to move around naturally inside its pocket and have a natural shape and motion, like a normal breast.

Implant massage also functions to some extent as a breast self-exam. Two studies of women with breast implants found that in those women who developed a breast lump, it was found earlier if they regularly massaged and felt their implants - which could be life-saving!

I recommend women massage their implants for a few minutes each day, for the rest of their life! After the scar tissue has completely healed and softened (by one year), massage could simply consist of lying on your tummy or rolling with your breasts against an exercise ball.

The purpose is to ensure the implants move around within their space and that the scar tissue does not contract around the implant ("capsular contacture").

There are videos on implant massage on my website you could refer to for reference: CLICK HERE TO VIEW THE VIDEO.

Ask your Plastic Surgeon what their normal postoperative routine is and to demonstrate what you should be doing.

Karen M. Horton, MD, MSc, FRCSC

Sunday, October 25, 2009

What to expect after routine liposuction: What is normal?


i had lipo to my hips and back area 4 days ago. i was really surprised that i had no drainage from the lipo. i went home an hour after surgery.

i was expecting drainage from the lipo. i had nothing! not one drop. is that normal? i do have severe bruising. i also weighed myself, i now weigh more than before my surgery. is all this normal?


After routine liposuction, it is normal to expect the following signs and symptoms:

1. Bruising - despite the use of "tumescent" solution, some bruising is normal. This will take 2-3 weeks to resolve.

2. Swelling - most MDs recommend the use of compression garments that help keep the swelling under control and feel protective while you are swollen. You can expect to wear your garment for up to 6 weeks.

3. Water retention - seen as weight gain. Stop weighing yourself! Give yourself at least 6 weeks for the majority of the initial surgical swelling and water retention to be processed by your kidneys, and to be eliminated.

4. Fatigue - you will not feel like yourself for at least a few weeks after liposuction. Your body is busy recovering from surgery; you will not have the usual energy to perform all your usual activities during the daytime. Ensure you have some helpers to assist with your activities of daily living, child care, house work, tasks around the home, etc. Be sure to take as much time as you realistically need off work!

In addition, as long as the amount of tumescent solution injected was approximately at a 1:1 ratio to the fat removed (known as the "superwet" technique), you will not likely drain from the incisions. Most Plastic Surgeons perform this technique, as it enables accurate evaluation of how much was is being removed during surgery, enables a smooth contour, and avoids blood loss during the procedure.

Get some rest and remember that any surgery is an "injury". You need to allow your body to heal, and to deliver the building blocks needed for healing in the form of healthy nutrition, lots of restful sleep, and a positive attitude.

Happy healing!
Karen M. Horton, MD, MSc, FRCSC

Sunday, October 18, 2009

Karen M. Horton, MD answers: Sacramento Tummy Tuck doctor recommendations


I live in Oregon but I am spending 3 months with a friend in Sacramento. I have been searching the internet for a quality doctor in Sacramento, CA to perform a tummy tuck. This will be the biggest surgery of my life and I want quality work. Any success stories out there?


Karen M. Horton, MD
2 seconds ago

A tummy tuck is a wonderful procedure and one of my very favorite operations to do!

For women who have completed childbearing, an abdominoplasty makes up the abdominal portion of a "mommy makeover".

For anyone considering surgery, my advice is always this:

Do your research and homework before deciding on a Plastic Surgeon!

The internet is often a good start, but word of mouth and referrals from other doctors is also a good source of information. Think about how you found your dentist, a realtor, your childcare giver, a plumber... You will be trusting your body to this person! Do your 'due diligence'.

Following your online research, visit a number of surgeons in person - bring a list of questions with you, and bring a friend to act as another listener and objective observer. Ask to see before and after photos - both of the best results, but average results. Ask to speak to former patients about their experience with the doctor.

There should be a "good fit" between you and the physician - in terms of personality, aesthetic goals for the procedure, office staff atmosphere, etc.

Often, making the trip outside your immediate area is worth it. If you don't find someone directly in your town, consider going to a larger cosmopolitan area for treatment. You will probably stay overnight in the hospital or surgery center after a tummy tuck, and you are usually seen 3-5 days after surgery in the surgeon's office for your first follow up visit.

I see many out of state patients for surgery. I recommend my out-of-town patients stay in the near vicinity (within a 3 hour drive) for at least 2 weeks before traveling home.

Best of luck to you!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

Wait to have breast augmentation surgery until your health is stable


Breast implants safe after thyroid ablation?

I'm 31 years old and a mother of 3 children. After the birth of my last child, I got Graves Disease. I tried for remission on an anti-thyroid drug, but I did not obtain it.

I'm scheduled to have my thyroid ablation on Nov. 6th. I'm also scheduled for breast augmentation on Nov. 23rd. I'm very excited about both procedures. Is it safe for me to have surgery after the ablation? And, I will be using the IV sedation with the augmentation which is only about 45mins. Will my hormones react to anesthesia?

Enough3 in North Myrtle Beach

A: Wait to have breast augmentation surgery until your health is stable

Karen M. Horton, MD

Congratulations on your decision to have breast augmentation! As long as it is done for the right reasons, in an appropriate candidate, and by a Board-Certified Plastic Surgeon, and at the appropriate time, breast augmentation is a wonderful procedure with fabulous results!

However, when you are actively treating any complex medical condition such as Graves Disease (overactive thyroid), you should postpone elective surgery until your medical situation has stabilized.

Radioactive ablation of the thyroid can have a short-term surge of thyroid hormone release, followed by a longer period of hypothyroidism (low thyroid) when your natural thyroid hormone decreases.

I speak from personal experience: it can take up to a year or longer for the full effect of the thyroid ablation to be complete. During this time, you will need to take increasing doses of thyroid replacement until your own thyroid has completely stopped working or its production of hormone is stable. Your mood, energy level, metabolism and other body systems can undergo major swings.

The thyroid gland controls your metabolism and nearly all your organ systems. I would strongly advise against having a surgical procedure while you are being treated for this condition.

Ask your Endocrinologist about how long you should wait before undergoing elective surgery.

Best of luck to you, and take care of your health first!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

Breast Cancer In Young Women May Be Hereditary

Many women presenting to my office for breast reconstruction do not actually have breast cancer.

Many of them have a strongly positive family history for breast and/or ovarian cancer, and upon testing, they may learn they carry the BRCA gene. They may wish to have prophylactic (preventative) mastectomy and reconstruction to lower their risk of developing breast cancer.

Read the article below on hereditary breast cancer from the latest FORCE publication:

WHAT is hereditary cancer?

Breast cancer can result from changes in genes called "hereditary mutations." These gene changes can be passed down from the mother or the father to daughters or sons and cause cancer to run in some families.

The genes most often associated with hereditary breast cancer are called BRCA1 and BRCA2.
Changes in these genes can increase the risk for breast, ovarian, and other types of cancer.

If you have had breast cancer at age 50 or younger, you are more likely to have a BRCA mutation if you have:
  • had ovarian cancer
  • breast cancer in both breasts
  • a relative with ovarian cancer at any age
  • a relative with breast cancer at any age
  • a relative with male breast cancer
  • a relative with pancreatic cancer
  • a relative with prostate cancer
  • Eastern European Jewish (Ashkenazi Jewish) heritage
Women with “triple negative” breast cancer (one that is negative for estrogen receptors, progesterone receptors, and Her-2/neu status) may be more likely to have a BRCA1 mutation.

WHAT is gene testing and how would it affect me?

If you are a young woman who has been diagnosed with breast cancer, you can take a blood test (or a genetic test using cells swabbed from the inside of your cheek) to find out if you carry a BRCA gene mutation.

Cancer genetics experts include genetic counselors, risk assessment counselors, geneticists and other physicians with advanced training in genetics and hereditary disease. Before gene testing, you should talk with a genetics expert to learn if your cancer may have been caused by a BRCA mutation, and to help you and your family members decide if gene testing is right for you.

(I usually refer my patients to their breast surgeon or an oncologist to determine whether genetic testing is appropriate for them).

Learning that your breast cancer is hereditary may change treatment or follow-up recommendations. If you test positive for a mutation, each of your children and siblings has a 50% chance of carrying the mutation. Aunts, uncles, nieces, nephews, and cousins may carry the mutation, too.

If you test positive for a mutation, your risk for a second breast cancer and other cancers may be
increased. If you test negative for these mutations, your risk for additional cancers depends on other factors. A genetics expert can help you better understand your risks for additional cancers.

The cost for gene testing can vary depending on which test is ordered. The cost is usually covered for young women diagnosed with breast cancer, either in part or in full, by insurance carriers.

WHERE can I learn more about hereditary cancer?

Experts in cancer genetics can help you understand hereditary cancer and provide you and your family with information about your cancer risk. They will:
  • review your family medical history to assess and explain your risk for cancer
  • describe the benefits and drawbacks of gene testing and discuss whether you are a candidate for testing
  • order the appropriate test if you choose to proceed with gene testing
  • assist with insurance coverage of testing
  • interpret gene test results and explain what they mean for you and your family
  • discuss how to manage your cancer risk and refer you to experts for follow-up care
If you are a young woman with breast cancer, please talk with a genetics expert and your doctor about gene testing for a hereditary mutation!

To find an expert in your area, or to receive support and information visit www.facingourrisk.org or call the helpline at (866) 288-RISK (7475)

Women who develop breast cancer before age 50 are more likely to have one of these gene changes than women who develop breast cancer after age 50. There are options available for you and your family members to lower cancer risk and to detect cancer at an earlier, more curable stage.

Friday, October 16, 2009

Busted! Fifteen Bodacious Facts About Boobs - DivineCaroline

Busted! Fifteen Bodacious Facts About Boobs - DivineCaroline

Although breast cancer is a serious health threat to women, boobs shouldn’t only conjure up thoughts of mammograms, mastectomies, and medical issues. Breasts as we know them are unique to the human female body, and there are many things that most people don’t even know about them. In honor of National Breast Cancer Awareness Month, check out these crazy, fascinating, and downright weird things you may not have realized about boobs.

  1. Human females are the only mammals whose breasts are visible at all times throughout maturity. Most animals, such as dogs, cats, and lesser primates, display swollen or enlarged mammaries only when they are pregnant or nursing their young; their breasts recede when the offspring are weaned. Evolutionary biologists think that humans’ permanently displayed breasts are intended to confuse potential mates about women’s reproductive status.
  1. In Greek mythology, the universe was created when the god Zeus tricked his wife, Hera, into breastfeeding his half-human son Heracles. According to the legend, when Hera realized that the suckling infant was not her own, she pushed him away and the drops of spilled milk became the Milky Way galaxy.
  1. There’s no such thing as a perfectly symmetrical set of breasts. All breasts have differences, but most discrepancies are simply too tiny to be noticed. For reasons unknown, the left breast tends to be larger than the right.
  1. Two million women in the United States have breast implants. The average age at which a woman gets implants is thirty-four.
  1. In early 2009, Sheyla Hershey of Brazil was awarded the Guinness World Record for having the largest set of breasts. After nine surgeries and more than a gallon of silicone, her breasts are a size 38KKK.
  1. Women who get breast implants are at least three times more likely to commit suicide, a risk that increases with time. As the August 2007 Annals of Plastic Surgery reported, it’s unlikely that silicone toxicity causes the correlation. It’s more probable that women who undergo breast augmentation are more apt to have an underlying psychiatric problem that predisposes them to suicide. (Most women seeking breast augmentation are good candidates. The best candidate for surgery is a woman who is mature, with realistic expectations, a supportive support network and who has done all of her homework! See a Board-Certified Plastic Surgeon for more information).
  1. Contrary to popular legend, the brassiere was not invented by a man named Otto Titzling. Although women have worn chest-binding garments for exercise at least since the time of the ancient Greeks, the modern bra was invented by a French woman named Herminie Cadolle in 1889. The word brassiere—denoting an upper-body harness with straps—has been in use since at least the seventeenth century. It wasn’t until the 1920s that the term referred to a garment that supports the breasts.
  1. At Hong Kong’s Polytechnic University, students can major and get a degree in bra studies.
  1. Sleeping on one’s chest can change the shape of breasts over time, stretching the skin and leading to sagging. Experts recommend that women sleep on their side with their breasts supported by a pillow. (This is debatable)
  1. Wearing a bra to sleep does not lead to breast cancer. (The main risk factor for any woman is family history.)
  1. Breasts contain no muscle tissue, so there’s no exercise that can change their shape. The only way to make breasts look firmer or perkier is to exercise the pectoral muscles underneath the breast tissue.
  1. Men can lactate, too. It’s exceptionally rare, but since men possess mammary glands just like women do, they have the capacity to produce milk. When male lactation happens, it’s usually because of hormonal treatments for diseases like cancer.
  1. According to the American Surgeon, up to 6 percent of the population has extra breast tissue, a condition called polymastia. The excess tissue usually exists in the armpit, although in rare cases, extra breasts may also appear on the neck, face, back, buttocks, vulva, thigh, or even foot and may be fully functional for nursing. The development of extra nipples without breasts is a condition called polythelia.
  1. “Breast ironing” is a practice in Cameroon in which young girls’ developing breasts are beaten and flattened with heavy objects to prevent their emergence. Usually performed by mothers and older female relatives, the procedure is intended to ward off men’s unwanted sexual advances, as well as to prevent early marriage.
  1. According to lingerie manufacturers, the average American woman’s bra size has increased in the past ten years, from a 34B to a 36C.

A woman’s lifetime risk of developing breast cancer is about one in eight, and the likelihood is higher for women who smoke, are obese or inactive, or have a family history of the disease.

It’s no secret that people—both men and women—are obsessed with breasts. But far from being simple lust objects, they’re actually surprising, versatile, and highly individual parts of a woman’s body. This October, do yours a favor and do a breast self-exam to make sure they stay healthy and beautiful for years to come.

First published October 2009
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Monday, October 5, 2009

Breast Cancer Picture Book - A Year of Treatment

See the video link in this blog post for for a very special photo album created by one of my patients.

She shares with each of us her personal journey through bilateral (double) nipple-sparing mastectomies, implant reconstruction, with later chemotherapy and radiation.

She shows the transition through the various stages of her treatment, to the final few shots of her being active on vacation and living with lymphedema.

Thank you for sharing these intimate and very special memories with us!

Saturday, October 3, 2009

DIEP flaps give breast cancer survivor a second chance at her prom!

Tori is a tragically young breast cancer survivor who traveled from South Dakota to California for her bilateral DIEP flap breast reconstructions.

After recovering from mastectomies, chemotherapy, radiation, and finally delayed reconstruction, she is loving life with her handsome husband and enjoying her new figure!

I am so proud of her.

Congratulations, Tori!