Breast augmentation capsular contracture prevention is one of the most critical aspects of the surgery, as suggested by renowned Beverly Hills plastic surgeon Dr. Tarick Smiley.
Capsular contracture, which is manifested by deformed, painful breasts, is caused by tightening of the scar capsule around the implant.
Under normal circumstances, the scar capsule around the implant remains thin and flexible. However, chronic inflammation possibly due to implant contamination or low-grade infection is believed to trigger the overproduction of collagen fibers that leads to this complication.
While there are countless ways to prevent or minimize risk of capsular contracture, Dr. Smiley says certain steps are of particular importance.
- Stop smoking at least three weeks leading up to the surgery and about a month afterward.
Smoking results in constricted blood vessels, which in turn impedes with blood circulation. For this reason, smokers are significantly at increased risk of poor healing, infection, and skin necrosis.
- Make every effort to minimize implant contamination during surgery.
Dr. Smiley only performs his operations in accredited outpatient or ambulatory surgery facility to ensure that patient safety and sanitation standards are met.
To further reduce risk of contamination, he ensures that all the medical staff adheres to strict sanitation protocols (hand-washing, medical gloves, etc.); irrigates the implant pocket with antibiotic fluids; and uses Keller Funnel, which is also referred to as no touch breast augmentation technique.
Keller Funnel is a pouch-like device that allows the surgeon to perform implantation without actually touching the implants, which greatly reduces risk of contamination and capsular contracture.
The implants are poured directly from their sterile packaging and into the conical mouth of Keller Funnel whose narrow tip is positioned into the incision. The pouch is then squeezed to propel the implant toward its pocket.
The Keller Funnel also ensures there is no contact between the implant and the breast skin, which is believed to harbor staph bacteria closely tied to capsular contracture.
- Lifetime breast implant massage
It is typically advised to begin breast implant massage, or to be more accurate, implant displacement exercise, about a week after surgery. It will only take a few minutes 2-3 times a day for three weeks and then once a day for the rest of the implant’s life.
The goal of breast implant massage is to prevent the scar capsule from becoming inadvertently constricted and thick, leading to more natural looking and softer results.
Breast augmentation capsular contracture prevention may vary from surgeon to surgeon, therefore Dr. Smiley suggests all patients to adhere to the specific instructions of their doctor.
The no touch breast augmentation is a surgical technique in which the implantation process is done with a Keller Funnel, a device closely resembling that of a baker’s bag. With its tip inserted into a small incision, it is squeezed successively to propel the implant toward its pocket.
While the surgeon holds the Keller Funnel, the nurse pours the implant from the sterile packaging directly into its wide opening. Once the implant is properly loaded, the surgeon squeezes and propels it into place. Simply put, no one actually touches the prosthesis.
Photo Credit: Kellerfunnel.com
One of the benefits of the no touch breast augmentation technique is the perceived reduction of capsular contracture rate.
Capsular contracture is a copious formation of scar tissue around the implants. While a thin flexible capsule-shaped scar is a normal part of recovery, implant contamination at the time of surgery is believed to trigger the over production of collagen bundles (scar tissue).
Low-grade infection during the initial healing stage may also cause capsular contracture.
In its late stage, capsular contracture causes breast deformity and pain and thus it requires surgery in which the copious scar tissue is removed together with the implants. Replacement might be done simultaneously, while some doctors recommend waiting for a few months to ensure complete healing of the breast pocket.
Aside from minimizing the risk of capsular contracture, the no touch breast augmentation offers other benefits; hence, it has become a favorite technique of celebrity plastic surgeon Dr. Tarick Smiley who has posted Snapchat videos to demonstrate the method.
The use of Keller Funnel can reduce the length of incision by almost half, making it easier to hide scars at the areola’s border, parallel to the submammary fold, and inside the armpit skin crease, says Dr. Smiley.
Furthermore, the implantation process via Keller Funnel reduces the force by up to 95 percent (the finger insertion method uses about 27 lbs. of force, while the no touch just requires 0.64). This results in less trauma around the skin incision and thus promotes favorable scars, he adds.
And with reduced force, Dr. Smiley says implant stability is preserved as well.
The shorter surgical time is another key benefit of Keller Funnel. According to surveys, more than half of surgeon-respondents reported 10-20 minutes reduction in their procedure time.
Reducing the amount of liposuction bleeding is one of the key elements to make the procedure safe and to promote quick recovery. Leading Los Angeles plastic surgeon Dr. Tarick Smiley explains his guidelines on how he can significantly reduce blood loss during surgery.
- Careful patient selection
This is arguably the most critical step to make any elective surgery a safe endeavor. Certain medical conditions such as hypertension and diabetes are closely linked to increased bleeding at the time of surgery and severe postop bruising; hence, liposuction should never be attempted unless these are well under control through lifestyle change, diet, weight loss, and/or medications.
- Discontinue the use of drugs and supplements that thin the blood a few days or weeks before liposuction.
Aspirin and aspirin-like products, ibuprofen (and other similar non-steroidal anti-inflammatory drugs), and a gamut of herbal supplements and vitamins are known to increase bleeding and postop bruising. A good rule of thumb is to discontinue their use about a week prior to surgery.
- Inject the fatty area with epinephrine prior to fat removal.
The liposuction cannula is a flexible hollowed tube that removes the unwanted fat. To make the process “gentler” and more efficient, Dr. Smiley injects tumescent fluids (which contain epinephrine) into the fatty area before fat extraction.
Epinephrine is a drug that allows small blood vessels to constrict, leading to significantly less bleeding and bruising. In fact, it results in up to 90 percent reduction in blood loss compared to the “dry” technique in which no tumescent fluids are injected into the fatty area.
To further reduce liposuction bleeding, Dr. Smiley waits for the epinephrine to take its full effects (around 8-10 minutes) before removing the fats. Inexperienced doctors, meanwhile, commit the mistake of suctioning too soon (perhaps they don’t like “idle time”) even though complete vaso-constriction is not yet achieved.
- The use of microcannulas, as opposed to large cannulas
Microcannulas have a narrow hollowed body, allowing Dr. Smiley to remove smaller bits of fats. Large cannulas, meanwhile, suction fats in bigger chunk and thus they can cause increased risk of skin asymmetries.
Furthermore, microcannulas allow for gentler liposuction—i.e., less bleeding and surgical trauma.
The liposuction abdomen results are supposed to look natural, which is demonstrated by smooth skin surface, natural position and appearance of the navel, and preservation of the natural valleys and contours. For this reason, it is critical to maintain a thin layer of fat after surgery, as opposed to removing it altogether.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted Snapchat photos depicting impressive liposuction abdomen results. The female patient had about 4 liters of “unwanted” fat removed from her frontal abdomen and flanks, leading to a more feminine silhouette.
Dr. Smiley rarely performs a highly isolated form of liposuction in the abdomen (example: lower abdomen only) due to the natural diffusion of unwanted fat. To achieve a smooth and natural silhouette, the celebrity plastic surgeon almost always treats the four quadrants of the abdomen and occasionally includes the flanks to achieve optimal results.
He believes that the optimal amount of fat to be removed will largely depend on skin shrinkage. Failure to take into account this “key anatomy” can lead to skin surface irregularities and less natural contour.
To further achieve smooth results, Dr. Smiley may perform simultaneous fat transfer in the abdominal area, which is particularly helpful in revision liposuction to correct dents caused by a previous surgery.
Aside from meticulous patient selection and careful surgical execution, the quality of postop care will also influence the final results. For this reason, Dr. Smiley recommends the use of compression garments for several days to weeks, depending on the extent of surgery, skin shrinkage, among others.
Compression garments prevent the formation of large seromas (fluids) that when left untreated can harden and cause bumps. Simply put, their correct use promotes quick drainage, which is also the key in good healing.
The correct use of compression garments can also prevent deviation of the navel. While the problem is quite uncommon, some doctors have noticed this “phenomenon” that is usually not apparent while the patient is still on the operating table.
Some surgeons suggest that the deviation of navel, which for some reason almost occurs to the right side of the abdomen, might be caused by the closure of compression garment. Once the surrounding fat is removed, the stalk of the belly button may slightly shift as the patient tightens the garment toward her right side.
To prevent deviation of the navel, the use of compression garments with zipper and hook on both sides is highly ideal. To further minimize the risk, some doctors also apply supportive padding over the belly button for 1-2 weeks following surgery
Large buttock implants are difficult to “define” because of varying factors such as soft tissue coverage, butt dimension prior to surgery, and body frame. For this reason, a 450 cubic centimeter (cc) might be too big for a petite individual, but for someone taller (and with broader hips) this could be a good size.
Buttock implants come in different sizes, from 190 cc to 690 cc. While custom implants can be ordered larger, they always come at a higher price and a higher risk of complications as well.
Photo Credit: Sientra.com
To avoid a gamut of complications and achieve the most natural results possible, the general rule of thumb is to measure the actual dimensions of the butt cheeks and the soft tissue coverage. According to anecdotal reports provided by Los Angeles plastic surgeons, the most common butt implant size range is 400 cc to 550 cc.
It is important to use implants whose size and shape is within the anatomical boundaries of the buttocks. Failure to adhere to this rudimentary principle can lead to increased risk of wound healing problems, palpability, inadvertent implant malposition, and of course the eventual need for a revision surgery.
Using disproportionately large buttock implants can result in too much tension on the wound, thus increasing the risk of healing problems. Also, it is important that the implants are positioned beneath or at least within the gluteal muscle, which is noted for its strength and thickness.
While the under-the-muscle placement can limit the implant size, many surgeons today still prefer this technique because it lowers the risk of complication and provides a more natural look compared to placing it above the muscle, with only the skin and tissue supporting the implant.
Without the thick gluteal muscle, the skin is exposed to the wear and may eventually lose its elasticity, leading to implant palpability and inadvertent displacement.
On the other hand, placing the implant above the muscle allows for bigger augmentation, which is not really an ideal option for patients who are naturally thin or whose soft tissue coverage is limited.
Aside from the issue of size, the shape is also critical. Butt implants these days come in round, teardrop, oval, and “oval bubble” to deliver the patients’ desired results.
Travel for tummy tuck requires advance planning to avoid risk of complications, particularly relating to deep vein thrombosis. The problem with long travels (by plane or car) is the prolonged immobility, which could lead to blood clot in legs and more serious problems such as pulmonary embolism.
Inland Empire plastic surgery experts explain the basic guidelines to make travel for tummy tuck a safe endeavor.
- Wait at least a month before traveling by plane.
Many surgeons suggest postponing long flights for at least four weeks to avoid blood clots. Furthermore, staying within the immediate vicinity of the doctor’s office will allow him to monitor and ensure that his patient is healing nicely.
- Possible use of low-dose blood thinner.
Should the patient need to travel by plane sooner than ideal, some doctors recommend a low dose of blood thinner (aspirin) to reduce risk of deep vein thrombosis. “Waiting” nonetheless remains to be the best option.
- Perform light activities such as walking.
Most out of town patients can travel by car around two weeks postop. However, certain precautions are needed to prevent or at least reduce the risk of deep vein thrombosis. The general rule of thumb is to take several stopovers to stretch and walk around.
Good blood circulation through light exercise is one of the best defenses to prevent deep vein thrombosis. Furthermore, it can minimize the effects of narcotic painkillers such as constipation and lethargy.
- A capable adult must always accompany the patient.
Travel by plane means rushing from one airport to the next with a heavy luggage in tow. It is important to avoid strenuous activities, bending from the waist, and over exertion for 3-4 weeks to prevent complications. For this reason, it always makes a sense to bring a friend or family member along when traveling for plastic surgery.
Also, driving is inadvisable when under narcotic painkillers, which cause poor coordination and drowsiness. Just to be safe, patients must have someone to drive them home.
- The patient should build good rapport with a local primary care physician.
Travel for tummy tuck requires advance planning, which typically includes finding a local primary care physician ideally before to the operation. He may be the one to order a pre-op physical exam and fax its results to the plastic surgeon to rule out any medical condition.
The local primary care doctor will also monitor the patient for up to 2-3 months to ensure the latter is healing nicely.