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Advanced Art of Cosmetic Surgery Thomas M. DeWire, Sr., MD, FACS Specializing in Cosmetic Plastic Surgery |
Body Contouring |
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| Breast Implant Massage After Breast Augmentation |
| Technique of Breast Implant Massage after Breast Augmentation to Prevent Implant Capsule Contracture or Firmness: | ||
| The commonest mechanical complication of Breast Implant Augmentation is the development of a foreign body scar Capsule Contracture. There are certain techniques that I apply to greatly limit the likelihood of this problem, leading to a higher percentage of excellent results following Implant Breast Enlargement Surgery. Whenever any material is inserted into the body, be it suture, metal (such as a total joint), plastic, or silicone, the body will respond with a non-specific reaction of scar formation to try to wall off the foreign material with a scar covering. Ordinarily the body will try to limit as much as possible the size of this scar, and thus completely exclude the material into the smallest possible space. Scar formation cells have special characteristics that facilitate this normal biological behavior, but there are ways to limit the scar response by appropriate techniques both before, during, and after breast implant surgery. First, it is very important to limit any compromise to wound healing capacity. Thus it is important to maximize blood and oxygen delivery to the healing wounds by quitting smoking several weeks before surgery. Second, it is important to limit potential germ contamination at the time of surgery by adequate pre-op hygiene, including a thorough shower the | morning of surgery (most soaps are germicidal, so most will do fine), and avoiding shaving the armpits (for trans-axillary technique) for ten days 'til the morning of surgery to prevent ingrown hair abscesses in the surgical field. A strong anti- bacterial prep is done at surgery with strict avoidance of germ contamination at the time of surgery. Third, during surgery, I avoid incision approaches to the submuscular space that necessarily cut through the breast tissues, since they are known to harbor bacteria within the normal breast tissue ducts, and when contaminants on implants, will lead to a vigorous scar capsule formation, causing firm capsule contracture about the implants. Fourth, I create an oversized submuscular pocket, significantly larger than the implant size (primarily above the implant) at the time of surgery to create a much further distance to close in before scar can cause a visible, or palpable, firm scar capsule contracture. Fifth, early and vigorous post-op massage of the implants, fully displacing them throughout the entire oversized submuscular pockets is used to keep them wide open, and thus the implants soft, freely moveable, soft to the touch, and natural-appearing to the eye. See below | |
Photos After Augmentation Revision Surgery:
| Case 1: A 35 year old is seen 3 months after release of bilateral implant capsule contractures along with size upgrade to achieve a full "D" cup at 5'4" and 120 lbs. Implants are placed in the sub-muscular position for the natural look, while avoiding wrinkling in a thin patient. |
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Mentor round smooth saline implants: 425cc filled to 425cc Left and 450cc Right due to asymmetry. Inframammary approach to allow internal breast lift to correct serious bottoming out of the original result See Augmentation Revision page (Links below) |
| Yellow area represents the oversized implant pocket developed at the time of the breast implant placement. |  |
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| Blue overlay represents the implant in the oversized pocket in the sub-muscular space. |  |
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This photo represents the technique of massage of the breast implant, displacing it out of its normal position, up into the excess pocket space above, allowing the pocket to stay widely open, and usually preventing any scar capsule contracture from forming. |
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| The same photos showing the appearance of the breast as the implant is displaced. An animation of this process is displayed below. |  |
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I see all patients back a few days post-op to start the massage, and then every few days until mastery is demonstrated. Initially I like to move the implants every 2-3 hours, for a few days, then 2-3 times a day until about 3 weeks, and then once a day forever. The process takes a few minutes of well invested time. |
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| Maps to Office | Thomas M. DeWire, Sr., MD, FACS | E-Mail Dr DeWire |
| Advanced Art of Cosmetic Surgery | ||
| 3974 Springfield Road | ||
| Glen Allen (Richmond), VA 23060 | ||
| 804-290-0200 |
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| ©Copyright 1997-2008 Advanced Art of Cosmetic Surgery: Thomas M. DeWire, Sr, MD, FACS Revised April 02, 2008 11:07 PM |
