No surgical operation is without risk. While breast augmentation risks are low and complications are rare, they are real and should be discussed with your board-certified plastic surgeon in advance.
Bleeding and infection are complications intrinsic to any surgical procedure, and the risk is less than 3% in breast augmentation. Dr. Donaldson and Dr. Sieffert almost always avoid both through meticulous surgical techniques, but it still may happen. Infection is usually prevented with antibiotics but could lead to implant removal in extreme cases.
Minor bleeding may be simply monitored, or released if necessary. Major bleeding could require a second operation.
Measurable breast asymmetry is present in the vast majority of adult women, and this will likely persist even after augmentation. This is due to a number of factors including:
Massage and displacement exercises will often improve symmetry, but if the difference is too obvious, then a revision may be considered.
Capsular contracture is a scar tissue phenomenon in which the body interprets the implant like a splinter and attempts to surround it with a thick, firm capsule. The risk is decreased with modern implant materials and skilled techniques, but it still exists. Treatment may include a second operation to relax or remove the capsule.
Nipple sensation may increase, decrease, become entirely numb or fluctuate – but most commonly, it returns to normal after several months.
Breastfeeding is a challenge for many young mothers, but breast augmentation can make it even more difficult. Implants are likely to cause more back-pressure on the milk glands and ducts, which limits milk production and prevents full engorgement. Infants with augmented mothers can usually suckle and bond, but they often require supplements with synthetic formula to achieve full nutrition.
Breast implants are very durable, but additional operations may be necessary over the course of a lifetime. The most common reason for reoperation is to increase size. Other reasons include changes in shape or position, the desire for subsequent lifting, or the desire to downsize later in life. If you experience deflation, rippling, shifting or other side effects, you may need to replace your breast implants. It’s important to follow up with your surgeon if you suspect a problem or dislike something about the look or feel.
Although they are rare, it’s important that you educate yourself on all of the possible risks of surgery. Dr. Donaldson or Dr. Sieffert can explain the extensive measures that are taken to prevent these issues, and we can share various approaches should they arise.
Do you have additional questions about the risks associated with breast augmentation surgery?
The initial breast augmentation consultation is a truly collaborative process and a vital stage when it comes to determining if surgery is the right decision for you!
Our breast augmentation specialists will work with you directly to understand your background, solidify your goals, address your concerns and set expectations. Then, they will give you the tools that are necessary to become a savvy, sophisticated consumer who is knowledgeable about the important aspects of this procedure. Our team will explain the pre-operative, intra-operative and post-operative phases of surgery and answer all of your questions in detail.
After you have reached out to our team through the website or via a phone call, we will work together to determine the best date and time for your initial consultation. Note: All of our initial consultations are now virtual, which helps to maximize your time and schedule flexibility.
Your initial interaction with our team will last about 30 minutes and it will be all about you! You will meet with our virtual concierge Kelly Sobieski. She will connect you with two vital members of our team: Carrie Esposito who specializes in scheduling your procedure and breaking down the costs associated and Angie Scala, an experienced Nurse Practioner who specializes in helping patients smoothly navigate the highly-personal breast augmentation process. These two were hand-picked by Dr. Donaldson to handle this phase because of their pertinent expertise and rich experience.
Together, they will talk to you about everything you want to discuss surrounding the procedure. They will review your photos and take an in-depth look at the custom plan that Dr. Donaldson has created for you! This is also the time when we show you relevant before and after photos that are based on you, your age, your body type and your unique desired outcomes.
Before making final decisions, we will review your medical history to confirm your candidacy and to establish a plan for optimizing your medical conditions and overall health status. If you have reached 40 years of age, our team will most likely recommend having a baseline mammogram. Safety is paramount, and Drs. Donaldson and Seiffert often rely on referrals and follow-up appointments with other medical specialists to ensure the best possible outcome.
The final part of your initial consultation includes a detailed cost estimate and a discussion of scheduling dates and times. Carrie can help arrange for flexible financing options and payment plans. She will be happy to walk you through the payment steps and make sure you’re fully educated about the financial aspects of surgery, including manufacturer warranties. Remember: Even if you already have the cash ready, you don’t have to put it all down at once if that makes you uncomfortable!
By this time, you will know that you’re in the best hands for your procedure. Now, we get to shake hands, introduce you to our team and perfect the upcoming process.
When you come into our office, Angie or another trusted member of our clinical staff will help you choose the perfect implant size at your in-person fitting. After considering your natural shape, your goals and your measurements, we will help you try on sample implants using a specialized sizing bra. Once the appropriate “size spectrum” is determined, you get to choose what you like best! You can look in the mirror, try on different outfits, take selfies and gather opinions from friends and family, although many patients prefer to make a private, personal choice.
The friendly staff at Donaldson Plastic Surgery makes sure that patients feel comfortable and appreciated during each appointment. We are incredibly experienced when it comes to breast implants and can give you sound, expert advice. Dr. Donaldson, Dr. Sieffert and their team will also go over the different types of implants available to you and the pros and cons of each. They will let you know what you can expect from your breast surgery, including size, shape and texture.
Once you have finalized your decision, that’s when we get to set your surgery date!
We invite you to get in touch with our compassionate team of breast surgery specialists. We are on standby to help you further understand what to expect during this experience. Do you feel comfortable with the process and ready to schedule your first consultation?
Nurse Practitioner, Angie Scala, and Registered Nurse, Shruti Lemus, participated in the American Society of Aesthetic Plastic Surgeons conference in San Diego this year where they met plastic surgeons and aesthetic providers from across the nation. Presented by the industry’s top thought leaders, the seminars focused on opportunities for improvement in the art of plastic surgery.
At the conference, Angie attended Opioid-Free: A Better Way to Recovery presented by Dr. Lawrence Iteld. Dr. Iteld discussed alternative ways to achieve patient comfort and create an effective healing experience without the intensity of opioids. Her experience – combined with this new insight – inspired her to apply her advanced clinical knowledge to her Nurse Practitioner duties.
Angie has witnessed the negative effects that opioids can cause patients to endure. Symptoms like constipation, drowsiness, nausea, and decreased activity can all be caused by opioid use and create setbacks in a surgical patient’s recovery. Medical professionals across fields are transitioning to new care plans that don’t include opioids. There are other ways to minimize pain and make a patient feel at ease without the downsides.
After plastic surgery, pain relief through medication is often necessary. However, the strength of opioids can sometimes be excessive. Alternatives to opioids during post-op recovery include combinations of:
Like Dr. Iteld, Angie is an advocate for early activity and moving with purpose post-operatively to assist in a quicker and more pain-free recovery. She is also a firm supporter of homeopathic supplements and believes they should be incorporated into all patients’ post-op medication regimens.
At Donaldson Plastic Surgery, we want everyone to be the best versions of themselves, and we apply that same principle to our entire practice. Our entire surgical team is continuously educated on the newest ideas in the surgical field. We aim to provide our patients with the best experience possible through the constant improvement of our processes.
We tailor post-operative regimens to each patient depending on their unique needs. We discuss the post-operative plan with patients, so they are aware of what to expect in terms of instructions and medication. If a patient requires additional pain relief during recovery, then their plan can be altered.
Every patient’s post-op experience is different. Our patient care team will prescribe opioids only if necessary – we want to ensure you are taken care of. However, many patients have reported not needing medication after 1-3 days due to low pain levels. This is due to how meticulous Dr. Donaldson and Dr. Sieffert are during surgery. When surgeons take their time, then recovery is quicker and more easily managed.
Our surgical teams already encourage non-opioid treatments. For example, we use TAP blocks during tummy tuck surgery; this safe, local anesthetic is injected during surgery and acts as a long-lasting pain reliever. We also recommend homeopathic supplements like Arnica Montana or Bromelain tablets to help with swelling, bruising, and pain.
Your pain medication regiment is just one aspect of your customized experience at Donaldson Plastic Surgery. Your surgical journey begins with a personal consultation!
Plastic surgery is a journey that takes planning, so starting sooner rather than later is a great way to ensure your experience goes smoothly. By embarking now, you can get a head start learning more about your options when it comes to timing, financing, and recovery!
Specific surgeries will have slight differences in terms of exact recovery time expectations, but all surgeries have periods that are specific to downtime along with their own activity restrictions. Every recovery timeline will also be dependent on you. You may naturally be quicker or slower to heal than others. Our Patient Care Team is trained to understand and assist you no matter your recovery timeline!
At about one week, you will feel almost back to normal, but you must continue to adhere by activity restrictions set by your medical team.
Similar to breast surgeries, the remainder of the month is spent getting back to feeling normal with established activity restrictions.
Downtime is coupled with activity restrictions that are specific to the kind of facial surgery. The main consideration is that facial surgeries often come with swelling and bruising for the first week or two. During this time, you may want to stay at home regardless of feeling better.
Oftentimes, arm and leg surgeries will have more activity restrictions than other kinds of surgeries.
*Note: For the purpose of this article, “downtime” is time designated specifically for resting. This is the time when you would be taking prescribed pain medication. “Activity restrictions” refers to the time spent after downtime. This is when you would feel more able to complete everyday activities.
Our board-certified plastic surgeons recommend you heal in the comfort of your own home after surgery. Occasionally, they may recommend staying in a hotel or in a surgery recovery center (often if the patient lives far away), but that is rare.
Our team will prepare you to understand your post-operative care instructions and expectations, so you feel comfortable during your recovery period.
Your recovery experience is directly correlated to what happens in the operating room. In general terms, when a surgeon takes their time and is very meticulous and detail-oriented during the surgery, then recovery can be easier and quicker.
The timeline for returning to work depends on the kind of surgery and what you do at work. Some recovery times only require a long weekend, whereas some may require several weeks.
How Can I Take Time Off Work For Recovery?
Your plastic surgery clinic can submit documentation to your employer to ask for time off work:
Beginning your surgical process now is the best way to secure your specific timeline. You can book your surgery as far out as you’d like but having your consultation sooner rather than later will ensure that you have options.
To learn more about how our surgical consultation experience looks like, click here.
We invite you to call (614)-442-7610 to get on Dr. Donaldson’s or Dr. Sieffert’s schedule!
The choice to undergo breast augmentation surgery isn’t one to be taken lightly, and we admire that you’re taking the time out to do your own research! There are a lot of questions that the Internet can answer for you, but there are certain facets – such as your mindset, your unique body, your individual goals – that aren’t addressed with a simple search or even hours of digging online.
Let’s take a closer look at a few criteria to ensure you’re a good candidate for this procedure and you have full confidence before you make that next move forward. This self-reflection will help prepare you for that first call with your breast augmentation expert!
Is your confidence deflated by the feeling that your breasts are sagging, flattened or just smaller than you prefer? If so, you’re likely a strong candidate for breast augmentation surgery. This procedure can also help you readjust for weight loss, life as a mom or other lifestyle changes.
Do you feel self-conscious because one breast is smaller than the other? Is bra shopping tougher than you think it should be? Breast augmentation can help directly address the symmetry issues you are facing.
Breast augmentations are designed to magnify your natural anatomy and highlight your features. And Drs. Donaldson and Sieffert? They’re two of the best in the world at what they do. However, perfection is hard to come by, and if you already have some structural imperfections, they may still show post-surgery. Widespread nipples, stretch marks, a barrel-shaped chest – these are all features that can persist.
Individuals should be at least 18 years old before undergoing a breast augmentation. Getting this procedure done before the breast muscles have fully matured can damage long-term results. Because we look at an overall picture of health, we do not have a specific age ceiling for our patients!
“Good health” means that you have no active infections, untreated cancer or other serious medical conditions. Women who are pregnant or nursing should wait a bit longer before going through with a breast augmentation. Ideally, you are not a smoker or someone who drinks heavily.
We also work with you directly to ensure you’re in a proper mental state to make your final decision.
This is our ultimate goal: to help you become your most confident self! It is all about how you feel. Once you have fully recovered, we want you to be proud of who are and how you look in your skin. We routinely follow up to make sure you’re satisfied with your results.
We carry elements of this philosophy with us not just when discussing your goals, but also when it comes to our before and after photos philosophy. Browsing pictures of naked bodies that look nothing like yours won’t do this artistic surgical procedure justice. During your consultation, we will find before and after pictures that look closer to your body type and your desired figure!
A good breast augmentation practice will never push you down a path or pressure you to make a decision you’re not 100% comfortable with. The surgeon should discuss your personal goals with you, one-on-one, before offering a solution that will get you to where you want to be!
One of the most common compliments we get from patients is our uniquely personable approach. From the first phone call to post-op follow-ups, we truly listen to you, the individual. Your goals. Your needs. Your job. Your relationship dynamics. Your fears and your dreams.
Dr. Donaldson and Dr. Sieffert are both board-certified plastic surgeons that are at the top of the industry and at the top of their game. They get your procedure done right and have the accolades to back up their work!
Columbus, OH board-certified plastic surgeon Dr. Jeffrey H. Donaldson answers your most personal and practical questions about the mommy makeover procedure.
A mommy makeover is an umbrella term we use for any combination of surgeries that address the parts of the body most affected by pregnancy and childbirth. A typical mommy makeover may include any combination of:
Any patient who is healthy, and has those typical anatomic changes that are associated with pregnancy. Those changes might include abdominal muscle separation, extra subcutaneous fat that may have lingered after childbirth, stretched skin, stretch marks, or a deformity or overlap at the point of their c-section scar.
Some women’s breasts may have been deflated through breastfeeding, which is characterized by a lack of fullness in the upper pole of the breast, or by a lack of cleavage line. A breast augmentation can provide roundness for someone whose breast tissue has fallen lower on their chest, or they may even benefit from a breast lift. There are also patients whose breast tissue tends to grow and enlarge after pregnancy, in which case a breast reduction with a lift might be necessary.
Patients who may have enlarged labia minora or the inner lips of their vaginal area may require tightening or reduction, which is commonly referred to as a labiaplasty.
Not necessarily! The “mommy makeover” moniker is given because these changes are typical through pregnancy and childbirth, but similar changes can occur through massive weight change or weight loss, or just through our own genetics.
I recommend waiting at least 6 months from the time you finish breastfeeding to pursue any form of breast procedure. Your breasts continue to change over time, and you can see residual deflation in months and years after. It is possible to have an operation that might have been different had the breast tissue been given time to settle back into its normal state after pregnancy.
Yes — that’s a part of a routine abdominoplasty, or tummy tuck, which is a procedure usually part of a mommy makeover.
Often times during pregnancy, the rectus muscles of the abdomen (or the “six pack”) tend to spread apart. There’s a small tendon called the linea alba that brings those muscles together; during pregnancy that can stretch to the point where what used to be a flat floor is now rounded or somewhat soft, causing your abdominal muscles to separate and weaken. During a tummy tuck, sutures are used to bring the outer covering of those muscles back together and reconstruct that tendon down the middle, so those abdominal muscles are brought back side by side. Repairing this diastasis recti makes it possible to get back that nice flat core that existed before pregnancy.
It certainly depends on what kind of combination of procedures are chosen. Typically, if there is both a breast procedure and a tummy tuck, it’s usually anywhere from a week to two weeks away from ordinary responsibilities, and closer to a month to six weeks before any strenuous exercise.
Generally, it’s best for patients to be within 15 to 20 pounds of their natural realistic weight. Most people are, so as long as they’re within that zone, then it would be safe. Other than that, it’s a matter of good nutrition, good rest, exercise, and being physically and emotionally prepared for surgery.
Implant selection is a highly customized process where we discuss proportions, anatomy, goals, and desires. Most often, we use a round, smooth silicone implant of moderate or high profile. The size is generally determined by the patient’s measurements and their own goals in terms of size and shape.
It depends on what procedures are selected, but for a breast augmentation, there will be a very small fine scar, approximately one inch long that is hidden within the fold under the breast. A tummy tuck would be similarly smooth, and would run right below the bikini line above pubic area from hip to hip across the front of the abdomen. Generally tummy tuck scars are not carried out to the sides of the flanks.
Any liposuction would be done through very small, quarter-inch incisions that are well concealed. And then, of course, labiaplasty would be very minimal scarring, often completely free of any scar tissue.
Yes. However, if a patient is actively planning on having more kids, we generally counsel them to wait until they are finished. In the event that a patient would become pregnant after a mommy makeover, there may be some sort of touch up procedure necessary.
Mommy makeovers are outpatient procedures that we perform in an outpatient surgical center in the Columbus, Ohio area. No overnight is required, but for someone who lives out of state or has more complex medical concerns, overnights could always be arranged.
If a patient knows that they want to have multiple procedures, then typically we will combine anything that can be done within a six-hour time frame. That is the point at which the risk curve tends to increase with more anesthesia. There is also an advantage in terms of only having a single recovery period, and it offers small financial advantages to combine multiple procedures.
There is no right age for a mommy makeover! Anyone over the age of 18 who has had children is usually a good candidate for a mommy makeover procedure. Genetics, health history, and background all play a role.
The mommy makeover is what we are quite well-known for. A lot of patients trust us to do multiple procedures for them at the same time, and we have excellent outcomes. We consistently have patients rave about our staff, about our process, and about our results, and they tend to heal very well.
We are facing an unprecedented event in our history with the arrival and spread of COVID-19. As a result of this virus, access to medical services has been limited by social distancing requirements. In response to these changes, and for a desire to restore some sense of normalcy to our patients, the aesthetic professionals at Donaldson Plastic Surgery have turned to telemedicine as an alternative to traditional in-office consultations. We want you to know it is OK during these tough times to consider aesthetic services, both surgical and non-surgical, and that we are here to answer your questions and keep you feeling your best!
So, you have reached out and scheduled a virtual consultation with Dr. Donaldson or Dr. Sieffert. What else do you have to do to get ready? Firstly, we ask that you fill out our standard medical intake forms as instructed in your welcome email (be as thorough as possible). Secondly, you will submit a series of photographs to help your Donaldson Plastic Surgery provider create an individualized plan just for you!
In order to ensure that your consultation goes smoothly, we ask that you submit your photos through our HIPAA compliant platform, TouchMD. Soon after scheduling, you will receive a welcome email from TouchMD which includes a link to create a profile, and instructions to download the MyTouchMD application. This will enable you to submit the photos used for your appointment. The photo submission button can be found by clicking the menu button on the top right of the MyTouchMD app. We ask that you complete these submissions 48 hours in advance so that we have time to prepare for your consultation.
Plastic surgeon Dr. Michelle Sieffert has created this handy photo guide to assist you in taking quality photographs for your virtual consultation. These photos are best captured using your smart phone or digital camera.
Use these angles if you are discussing any of the following treatments: face lift, neck lift, eyelid surgery, chin surgery, otoplasty, earlobe repair, fat transfer to the face, brow lift, rhinoplasty, laser treatments, Botox, fillers, Kybella, facial reconstruction, or any other treatment related to the face or neck.
Use these angles if you are discussing any of the following treatments: breast augmentation, breast lift, breast reduction, breast reconstruction, inverted nipple surgery, nipple reduction, tummy tuck, mommy makeover, liposuction, body lift, gynecomastia surgery, male breast reduction, CoolSculpting, CoolTone, or any other treatment related to the breast or body.
While the example model in these photos is wearing clothes, we require the the treatment areas you wish to discuss to be fully visible.
Use these angles if you are discussing any of the following treatments: arm lift, liposuction, laser treatments, CoolSculpting, or any other treatment related to the arms and upper back.
Use these angles if you are discussing any of the following treatments: thigh lift, liposuction, labiaplasty, spider vein removal, CoolSculpting, CoolTone, laser hair removal, or any other treatment related to the thighs or buttocks.
The photo submission button can be found by clicking the menu button on the top right of the MyTouchMD app. We ask that you complete these submissions 48 hours in advance so that we have time to prepare for your consultation.
We are here for you! The team at Donaldson Plastic Surgery is just one quick phone call or email away. You can call 614-442-7610 or email firstname.lastname@example.org to speak to our dedicated staff about any questions you may have leading up to your virtual consult.
We look forward to helping you become your very best version of you!
The world may have slowed down, but even in these difficult and unconventional times, you still have your own ambitions and vision for yourself. Donaldson Plastic Surgery has long been an advocate for personal growth and comfort, which is why we have expanded our service offerings to include secure, one-on-one virtual consultations.
Stay at Home orders have been issued, but that doesn’t mean your personal journey has to come to a halt. In fact, you can use this down time to consult with a world-class plastic surgeon, ask any questions you may have and further understand all of your options before finalizing an official date for your procedure.
A Donaldson Plastic Surgery virtual consultation is a completely remote method of connecting patients with our providers to discuss surgical and nonsurgical cosmetic procedures. The virtual consultation format contains all of the components of an in-person consultation, including a discussion of your wants, needs and goals, along with a thorough explanation of your treatment options, the viewing before and after photos and a comprehensive walk-through of information related to scheduling and financing.
Virtual consultations are a completely discreet and secure way to discuss any concerns you may have with a trusted and highly-trained plastic surgeon. You will have a fully-clothed, one-on-one conversation with your surgeon, where you will collaborate to design a plan that is just right for you and your vision.
Everything begins when you submit a request to schedule your virtual consultation – you can also reach us directly by phone at 614-442-7610. Our team will, then, reach out within one business day to answer any questions you might have and to schedule your virtual consultation. You will receive a welcome email that includes an invite for your virtual consultation using GoToMeeting, a secure, HIPAA-compliant video conferencing platform. You will then receive a separate email prompting you to fill out and submit virtual paperwork prior to your consultation, as well as any pictures you wish to include.
On the day of your consultation, you will receive a video conference call inviting you to connect with your provider – and the virtual consult will begin! Make sure you are in a secluded space where you can discuss information freely with your provider. Like an in-person visit, we encourage you to bring any and all questions for your provider to discuss during the virtual consultation.
After your video chat, you will receive a call from our Patient Experience Director Carrie, who will provide an exact quote for the procedure(s) you discuss, as well as financing options and payment plans. She will also talk to you about the process of scheduling your surgery and answer any other questions you might have. Depending on your consultation, we may set up a time for you to come into the office for a second consultation prior to your procedure to complete your surgical plan.
Our patients include mothers and fathers, daughters and sons, all with loved ones they care about protecting and keeping safe from COVID-19. It’s our duty as healthcare providers to adapt to a new way of conducting operations and provide the best possible patient care with the tools available to us.
Our virtual consultations allow us to connect with patients in a sophisticated way, and provide a treatment plan as if the consultation was in-person. Above all else, we want our patients to know they have a safe place to turn when it comes to discussing their aesthetic options.
Performing virtual consultations allows us to be more accessible resources to our community. Especially in times of turmoil, it is important for patients to make educated and sound decisions about their bodies. Even in the midst of COVID-19, the needs of our patients do not dissipate.
We are offering virtual consultations because we want to be able to help educate our patients about their bodies and the changes they are going through, and to remind them that they are not alone. It is our privilege to walk this path together with you.
During the COVID-19 stay home order, I am offering complimentary virtual skin care consultations and analyses for any patient at home wanting to maintain or improve their skin.
At-home skin care is incredibly important during this stressful time, so it is my mission that patients know how to take the best care of themselves. I can show you which products to use, how to use them, and give in-depth explanations of the science of your skin issues to tackle them at the root. My patients are important to me, which is why I would like to offer my expertise to those at home.
Ready to discuss your personal goals with Columbus, Ohio’s top plastic surgeons and leading medical aesthetician? We’re here to make your vision a virtual reality – and it all starts when you send us the first message.
Happy 2018! There’s nothing like a new year to get you excited about all the new opportunities that will come your way!
As you start planning for the new year (and maybe make a resolution or two), you might ask yourself, “Is this the year I’m finally going to pursue plastic surgery?” Chances are you’ve been thinking about it for a while but never felt like the timing was right. So how do you know if now is the right time?
Here are a few signs that can help you identify if you’re ready to move forward with surgery.
Anytime you are making a decision about how you look, it is so important that it comes from an inner desire to boost your confidence and feel good about yourself. Maybe you’ve never liked the shape of your nose, or perhaps your face is starting to age and you want to restore some of your youthful glow.
Just remember — no one should ever make you feel like you have to change something about your appearance. If you can truly say that you are doing this for you and no one else, that’s when you know that you are ready to go on this journey.
The decision to have plastic surgery is a big one. Before you ever make an appointment, spend some time doing a little research. A good place to start is learning the basics of the procedure you’re interested in — Who is a good candidate for this particular surgery? What does the procedure entail? How long will it take to recover?
Once you have an idea of what to expect, the next thing on your list is researching local surgeons. Find out who performs plastic surgery in your area and in what procedures they specialize in. And don’t forget to vet their credentials — Are they board certified? How long have they been in practice? Do they have good reviews from former patients?
Lastly, you should be well informed about the potential risks and complications associated with the surgery. All surgeries, even small procedures, have risks. Being aware of these risks will help you know what you can do to reduce them and better prepare for the procedure.
If you’ve done your homework and feel confident that this is something you want to do, that’s a great sign you’re ready for the procedure.
The required downtime varies from procedure to procedure, and everyone heals a little bit differently. But generally speaking, you’ll need at least a week off from your daily routine to rest. That means taking time off from work, skipping your morning workout and dialing back on social outings. The only thing on your schedule should be spending some quality time with your bed, resting. Sometimes that’s easier said than done. When you have a full-time job with a busy schedule, taking a week off might not always be possible.
Part of planning for plastic surgery is planning for the recovery. Do you have some flexibility with your schedule or have vacation days saved up that you can use? If your answer to that question is “yes,” you can check that off your list!
This goes along with your recovery. After the surgery, you’re going to need a little help taking care of yourself. Having a strong support system of friends and family in place is absolutely essential to ensuring a smooth recovery. You will need someone to drive you home from the surgery center the day of the procedure, as well as someone to stay with you that night and make sure you have everything you need. And that’s just the first day!
As you continue to rest, you might need someone to run little errands for you, help out around the house and get the kids to and from school. Not to mention, you could use a little companionship while you’re stuck at home. If you have family and friends around you who support your decision to have surgery and are happy to help during the recovery period, that’s further proof that you are ready to do this.
Now that you’ve decided that you are ready for plastic surgery, it’s time to schedule a consultation! Dr. Donaldson would be happy to meet with you to discuss your needs, answer any questions you have and map out a treatment plan that will get you the results you’re looking for. Make 2018 the year that you To schedule a consultation with Dr. Donaldson, call us at 614-442-7610 or email email@example.com with the subject line “Consultation Request.” We look forward to seeing you!
On Thursday, February 8th, 2019, the Food and Drug Administration (FDA) issued a report about Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) to health care providers inside and outside of the field of plastic surgery to raise general awareness, promote accurate diagnosis, and hopefully ensure more timely treatments. Dr. Donaldson and the staff at Donaldson Plastic Surgery support and advocate the FDA’s efforts to gather and disseminate accurate information. BIA-ALCL is a rare form of cancer that has been studied extensively by the plastic surgery community for the past several years. As a practice, we strive to be a trusted resource for all of our past, current, and future patients. Dr. Donaldson has attended national presentations, stayed up-to-date with clinical reports, followed best-practice recommendations, and communicated closely with his colleagues, staff, and patients regarding this topic. Fortunately, out of nearly ten million patients worldwide who have had breast augmentation surgery, only 457 have had a confirmed diagnosis of BIA-ALCL. All of these cases have been associated with the use of textured breast implants. Dr. Donaldson has NEVER used this type of implant. We have compiled the following information to present what is currently known about BIA-ALCL, including the risks, frequency, diagnosis, and treatment of this condition.
First, we will provide a description of our typical breast augmentation surgical technique. After a small skin incision, Dr. Donaldson separates tissue to create a pocket for the breast implant. Before implantation, the pocket is irrigated with an antibacterial solution to ensure a clean environment. The implant is then opened from its sterile packaging and, using a separate pair of sterile surgical gloves, Dr. Donaldson is the only person who directly handles the implant. It is rinsed with the antibacterial solution and compressed through the incision into the surgically-created pocket. The correct positioning is confirmed, and the pocket is closed with a series of dissolvable sutures. The operation typically takes less than an hour. The healing process begins almost immediately as the body’s immune system triggers a normal “foreign body” reaction that causes scar tissue to develop around the implant. Over time, the tissue completely encloses the implant, creating a capsule that separates the implant from the breast tissue.
One of the primary goals throughout the surgery is to ensure that the skin, pocket, and implant are kept completely sterile to minimize exposure to bacteria or other contaminants. Dr. Donaldson and the entire operating room staff go to great lengths to maintain sterility through the use of “minimal-touch” and “no-touch” techniques; antibacterial solutions; nipple guards; IV antibiotics; and, in some cases, implant delivery devices that reduce implant-skin contact. It is nearly impossible to prevent every bacterium from the skin and/or bloodstream from adhering to the implant. This normal process creates a biofilm between the implant and the newly-forming capsule. The body’s immune system can comfortably handle this minimal bacterial load unless a critical point is reached where the bacterial levels are high enough to trigger a chronic inflammatory response.
If the immune system develops a chronic inflammatory response, it is usually delayed a year or more after surgery and is affected by individual genetics and immune status. A chronic inflammatory response to the implant and biofilm has been linked to capsular contracture, additional scar tissue that can be seen and felt through swelling, tightening, or firming of the breast and a change in breast shape or position. Capsular contracture is graded on a scale of I-IV, and Dr. Donaldson prefers to treat the more severe grades III and IV through re-operation with capsule release and/or implant removal and/or replacement. The risk of capsular contracture occurring is less than 5 percent.
The biofilm that develops after an implant is inserted into the breast is commonly suspected as the cause for BIA-ALCL. When a chronic inflammatory response is not severe enough or fast enough to create a capsular contracture, it may lie dormant as a mild, long-term, low-grade infection inside of the capsule. Over a 7-10 year period, this underlying condition is believed to cause an immune T-cell abnormality that then progresses to BIA-ALCL. The first symptom is usually a late-onset seroma, or fluid collection, which causes swelling of the breast, asymmetry, and/or pain. In these early stages, the lymphoma resides inside of the protective capsule and is not connected to the breast tissue.
Biofilm seems to be more problematic with textured implants. In the late 1960s, textured-surface implants were designed in an attempt to reduce the rate of capsular contracture. Early results showed promise, but ten-year follow-up studies demonstrated that the texture of the implant does not affect the rate of capsular contracture. Since then, smooth, round implants have been preferred by most plastic surgeons in the United States, while textured implants have been more popular in Europe and South America. The recent introduction of shaped, highly-cohesive anatomical implants has increased the use of textured-surfaces because these implants cannot be permitted to flip or spin.
In contrast to a round implant that can flip or spin in the breast pocket with no visible difference, movement of an anatomically-shaped implant creates an unattractive breast shape that may cause the breast to appear sideways or upside-down. The texturized surface of an anatomically-shaped implant causes the capsule to grip the implant and prevent movement within the pocket. Dr. Donaldson does not use textured implants, and he does not use anatomical implants. He exclusively uses smooth, round implants.
Of the FDA-confirmed 457 cases of BIA-ALCL, no cases with purely smooth breast implants have been reported in any series, registry, or case with a detailed history. The texture on the outside shell of an implant may hinder the elimination of biofilm-creating bacteria due to the irregularity of the surface, multiple crevices, and increased surface area. Studies show significantly more bacterial adherence to textured versus smooth implant surfaces, as well as an increased number of lymphocytes–the cells that can become abnormal in cases of lymphoma.
If symptoms arise, it is imperative to consult with a board-certified plastic surgeon. If a patient’s history and exam seem suspicious, the surgeon will order tests that look for fluid around the implant. If a seroma or mass is detected, the fluid will be sampled and/or the tissue will be biopsied. Tests will then reveal whether known markers of BIA-ALCL are present. If confirmed, the surgeon will collaborate with an oncological team to create a plan for treatment. In early-stage disease, the implant and capsule are completely removed with no need for chemotherapy or radiation. Current three-year follow-ups show that 93 percent of patients are disease-free when following this protocol. If reports of symptoms, diagnosis, or treatment are delayed, then the lymphoma may spread and become systemic. The FDA has reported 9 known deaths in the US from BIA-ALCL. None of these patients received complete surgical excision or the targeted therapy that is now recommended.
Although our understanding of BIA-ALCL has improved dramatically over the past decade, further studies are underway, which should provide additional information. The FDA’s recent announcement was intended to increase awareness and encourage more health care providers to take part in the identification of BIA-ALCL. As a practice, Donaldson Plastic Surgery records all implant information in case future evaluation becomes necessary. To date, we have diagnosed ZERO patients with BIA-ALCL. Nonetheless, Dr. Donaldson is prepared to follow the most current diagnostic and treatment protocols, including radiographic imaging, fluid sampling, and immediate removal of the implant and capsule.
Our patients can confirm that their safety and wellbeing is our top priority. We believe that all of the risks associated with plastic surgery should be discussed and properly understood. There are approximately 300,000 breast augmentations in the United States every year. Given the extremely low overall incidence of BIA-ALCL, its exclusive association with textured implants, and its excellent prognosis with timely diagnosis and treatment, we continue to believe in the safety of smooth, round breast implants and the positive impact that breast augmentation has had on our patients’ lives.
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