I began my surgical residency training in 1984. Many of the plastic surgery operations performed when I began my training are still current today. It is the very nature of plastic surgery to improve and re-design surgical procedures, always looking for a way to perform a procedure with greater safety, achieve better, more natural, longer-lasting results with less downtime. How has breast augmentation improved over time?
Breast implants have been around since the 1960’s. Breast implants consist of a solid silicone shell, filled with either saline (salt water) or silicone gel. For decades, surgeons have been able to achieve wonderful, natural results with breast implants. Unfortunately, the postoperative period was marred by pain, often described as feeling like a truck ran over your chest. Ugh! Quite frankly, with a recovery like this, it is simply amazing to me that breast augmentation has consistently been the most common cosmetic surgical procedure performed in this country! I think that the willingness to undergo a procedure that causes so much agony is a testament to the emotional fortitude of today’s woman in the quest for a more beautiful, balanced and sensual shape: a desire to feel more confident within one’s own skin.
Let me digress a little about my experience with surgical training. I completed a five year general surgical residency with an additional year of surgical research, a two year residency in plastic surgery, a one year fellowship in hand surgery and a one year fellowship in microsurgery. Pretty good training, and I am very proud of it. This totaled ten years of training after graduation from medical school until I returned to my native Long Island to begin my practice (the average plastic surgeon trains 5 – 7 years). And through all this training, literally thousands of operations performed, the majority under the tutelage of master surgeons, I cannot remember one single discussion, either in the operating room or out, relating to how to perform an operation in such a way that a patient will feel less pain, recover with less downtime. Unbelievable! We were just taught that during anesthesia the patient will perceive no pain, so you can handle the tissues any way you want, because the patient will not feel it.. We learn about how to give post-operative pain medicine to our patients, how to put in local anesthesia in the wound at the end of surgery to give a few extra hours of pain relief. The drug reps would show us literature that their little pain pill works better and longer than the competition’s pain pill. We could not have missed the point any more!
I went into practice in Stony Brook, Long Island in 1994, and began performing breast augmentations then. I would say that my patients experienced pain and downtime about average to those of my colleagues. Unfortunately, for the majority of those that perform breast augmentation, little has changed today. Some surgeons inject local anesthesia in the wound for a few hours of pain relief, some perform nerve blocks, implant thin tubes called catheters to inject pain medicine into the implant pocket, place electromagnetic coils around the breasts, and the like. The local anesthesia wears off in a few hours. The catheters and coils add another encumbrance to wear and make the patient uncomfortable. How can you recover when you are sent home with gadgets and gizmos all over your chest? Elastic bandages and wraps? Whew!
Fortunately, there is a better way. If surgeons would only learn how to perform an operation without causing so much tissue trauma as to result in all that postoperative pain, recovery would be so much better. If the surgeon could look at an operation and understand which maneuvers are not associated with significant pain after surgery (i.e. the incision) and which maneuvers are associated with pain after surgery (the dissection of the pocket for the implant), and then determine how to perform the maneuvers associated with pain in such a way as to not result in as much pain and downtime after surgery..
That is exactly what I have accomplished. I have to give credit where credit is due. In breast augmentation, these principles were pioneered by Dr. John Tebbetts in Dallas. I was most fortunate to be a direct benefactor of the wealth of his wisdom, having been taught these techniques by him personally several years ago. My augmentation practice on Long Island was literally transformed overnight. Via the internet, I also get many out of town referrals as well. I will give you opinion and I will give you fact. My opinion is that I think my augmentation results are very natural and my patients are very pleased with their results. Now for the facts. Whereas the three year revision rate for breast augmentation is around 25%, mine is just a few percent, mostly due to issues out of my direct control such as an occasional saline implant deflation or a capsule contracture. The best part is the recovery! My patients awaken from surgery with far less discomfort than I previously saw. Since changing my surgical technique in 2004, I have not seen a single patient who could not put her hands up high over her head while still on the stretcher in the recovery room. 92% of my patients take nothing stronger than ibuprofen (Advil) for discomfort, if anything at all! 86% resume normal activities of daily living, including driving (no strenuous exercise!) the next day, with many going out the same day as their augmentation to dinner, shopping and the movies, just to name a few things they do. I just love hearing from the patients on their first post op visit about all the things they were able to do right after their surgery.
You can read more about this on my web site https://www.epsteinplasticsurgery.com/breast_augmentation_information.htm and see before and after photographs of our patients at https://www.epsteinplasticsurgery.com/procedures-breast.htm#baug
