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Oct. 1, 2026

The First Signs of Capsular Contracture After Breast Implants

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Show Notes
Transcript

Months or years after surgery, one side can suddenly feel firmer than the other, and most women assume they did something wrong.Dr. James Koehler and Dr. Vincent Gardner walk through what a mild case actually feels like, how it's graded on the Baker scale, and why some cases never get noticed until something changes years later.The leading theory is a "slime layer" of bacteria that settles on the implant and triggers chronic inflammation, which is part of why implants are more often placed under the muscle today.Treatment carries its own risk of recurrence, so Dr. Koehler explains how an acellular dermal matrix like Strattice dramatically improves the odds of it not coming back — plus what rupture, rippling and bottoming out look like, and why the "replace your implants every 10 years" rule isn't quite true.Read more about capsular contracture treatment: easternshoreplasticsurgery.com/breast/breast-implant-revision/capsular-contracture-revision

Questions answered by this episode:

What does capsular contracture feel like when it's just starting?
How much firmness is normal after breast augmentation?
What causes capsular contracture?
What is the "slime layer" theory of capsular contracture?
What are the Baker grades of capsular contracture?
When should capsular contracture be treated?
Does a capsulectomy fix capsular contracture for good?
What is Strattice and how does it help prevent recurrence?
How can you tell if a silicone implant has ruptured?
Do breast implants really need to be replaced every 10 years?

Alabama the Beautiful is the cosmetic surgery podcast co-hosted by Dr. James Koehler and Dr. Vincent Gardner, surgeons with over 2 decades of expertise in cosmetic surgery and their trusty co-host Kirstin, your best friend, confidante, and the snarky yet loveable "swiss army knife" of Eastern Shore Cosmetic Surgery.

Have a question for Dr. Koehler, Dr. Gardner or Kirstin? Record your voicemail at alabamathebeautifulpodcast.com and we'll answer it on the podcast.

Eastern Shore Cosmetic Surgery is located off Highway 98 at 7541 Cipriano Ct in Fairhope, Alabama. To learn more about the practice or ask a question, go to easternshoreplasticsurgery.com

Follow the team on Instagram @easternshorecosmeticsurgery

Watch Dr. Koehler, Dr. Gardner & Kirstin on YouTube @JamesKoehlerMD

Alabama The Beautiful is a production of The Axis: theaxis.io

Theme music: Never Need a Reason, Guy Trevino and Friends

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We do know that when patients do develop capsular contracture,

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and then we do whatever, any of those treatments like

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a capsulectomy, and we put a new implant in, there's

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a 25% chance that it's going to happen again. So unfortunately,

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you know, if you get a capsule contracture once, it

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can be a frustrating problem and it can tend to recur.

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You're listening to Alabama the Beautiful.

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I'm Kirsten Jarvis, and I'm here with our host cosmetic surgeons, Dr.

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James Kohler and Dr. Vincent Gardner. Hey, doctors.

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Hey, Kirsten. Hey, Kirsten.

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Hey. So one thing that people don't always get warned

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about when they get breast implants is that their breasts

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can change months or years after the surgery. And the

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women who feel it first almost always assume they did

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something wrong.

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So.

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We're going to talk about the first sign. What women

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notice when they call when they have signs of capsular contracture.

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What does capsular contracture actually feel like when it's just starting?

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When it's mild, the breast is just maybe a little

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firmer than usual. It's not painful. It doesn't look distorted.

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It just feels a little bit firmer. And a lot

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of times these mild forms of contracture, people don't even

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really even sometimes recognize. But As capsular contracture progresses, then

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it does become a lot firmer. And it's usually, it

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doesn't typically happen on both sides. It can, but maybe

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not at the, you know, usually one side will get firm.

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The other side may not be firm. Sometimes they'll both

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get contracted. But when it happens, like one side will

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get significantly firm and then ultimately it'll start to look different.

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And they usually start riding up and look distorted. Instead

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of looking round, they can start to look kind of

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more oblong in shape. And then when they're really severely contracted,

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they can actually be painful.

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How much firmness is normal as part of healing? And

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then when does it cross the line into something wrong?

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It's sometimes hard for the patients to judge. I mean,

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I guess, when is it problematic? Well, I guess when

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it's bothersome to the patient, but There are some patients

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that will come in, they'll be like, oh, my breast

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feels firm, but yet it's really the, you know, they

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might have chose a cohesive implant and that feels a

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little firmer than, let's say, you know, one of the,

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you know, other implants that is not as cohesive. And

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so that firmness is a bit of a subjective thing.

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But if it's changed from when the original augmentation was, well,

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then that may be something of concern.

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How long after surgery does something like this usually show up?

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Is it almost immediate or does it take months or years?

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It varies. And so that's the thing. Like sometimes, you know,

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you might see a patient, you know, three to six

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months out from surgery and they're totally fine. And they

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may think, oh, good, I'm out of the woods, you know,

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no problems, I'm set. And that may be very true,

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but capsular contracture is a cumulative risk. So The longer

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you have your implants, you know, the more chance that

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you're going to get that. So you might be fine

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for one year, five years, maybe even 10 years. And

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I've seen women go, you know, 30 years with implants

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and not have capsular contracture. But it absolutely can happen

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months after surgery. Or, you know, you may go 15

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years and then all of a sudden one side starts

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getting hard. So it's a cumulative risk. It's something that

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you don't kind of like, you know, if I didn't

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get it by this time, I'm never going to get it. No,

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you might. It just may take a long time.

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Do you find that patients blame themselves when something like

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this happens?

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Sometimes they don't notice it until something happens. Like maybe,

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I don't know, like they had some kind of accident

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or something like that. And then they just become more,

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maybe their breast is hurting and they become more aware

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of it. And then they start comparing it and they're like, okay,

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this side doesn't feel the same as the other. So

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It might have been there, but they become aware for

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some reason. So I don't know that I necessarily feel

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like women blame themselves for it. I think it's a

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frustrating problem and they just don't understand why. Like, you know,

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they were good and then now they're not. So it's

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just frustrating. But it is one of the risks of

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implant surgeries. And like I said, you know, some people

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are very lucky and they'll never develop it. And other

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people are just more prone to developing it. And it

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can be a frustrating problem to treat.

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Tell us what a capsule actually is and why does

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everybody form one?

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Well, all it is, is whenever you implant a foreign

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substance in the body, the body will form a thin

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layer of scar tissue around that foreign body. So I

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always tell patients, like if you had a pacemaker put in,

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if you went to take that pacemaker out, there's a capsule,

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a little thin layer of scar tissue that forms around

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that implanted device. So it's something that we see with

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all implantable devices, but that thin layer of scar tissue

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is normal. It's not abnormal. It only becomes abnormal when, well, there's,

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you know, we're not to get into all the technical explanation,

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but like what can happen is the fibroblasts can kind of, well,

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you can get these myofibroblasts which align in a certain way.

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And they, when they do that, the scar tissue can

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be either thickened Or even if it's not thickened, it

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can start to tighten up around that implant. And when

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it does that, that's when it starts to become firm.

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And sometimes the women feel like, oh, my implant got hard. Well, no,

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your implant's the same as it always was. The implant

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didn't get hard. It's the scar tissue around the implant,

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which is now so tight around the implant that the

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implant doesn't move freely and it makes the implant feel

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like it's hard.

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So what can make one person's capsule tighten when most

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never do?

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Well, there's a lot of factors and there's a lot

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of theories. It's sort of the whole thought process behind

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capsular contractures. It really can be multiple things that can

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contribute to it. One of the theories is this, we

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call it the slime layer theory, which is basically when

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an implant is placed into the body, there's bacteria and

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that bacteria is actually healthy bacteria, it's within our bodies.

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So inside of your breast tissue is bacteria. And one

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particular strain of that bacteria is staph epidermidis. And in

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some people that bacteria can get on the surface of

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the implant and it doesn't create an infection, but it

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creates what we call a slime layer. And that layer

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of bacteria stimulates a chronic inflammatory process, which then results

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in thickening of scar tissue. That is something that we

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do a lot of different things at surgery to minimize that.

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And it's one of the reasons why implants are more

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often placed under the muscle versus on top, because when

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implants are placed on top of the muscle, the implant

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is exposed to all of that bacteria in the ducts

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of the breast. Whereas if you go under the muscle,

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although there is contact still with some breast tissue, there's

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less exposure, so less potential bacteria. But we do things

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at surgery like irrigate the pocket out with antibiotics before

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we put the implant in. We use things like the

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Keller funnel to try to not touch the implant or

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change our gloves. And we do all these things to

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minimize any contamination that could potentially result in this, you know,

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slime layer on the implant surface. But other things like

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if you had some bleeding after surgery, like a hematoma,

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although the blood's a great culture medium for bacteria, but

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also it stimulates further inflammation. And so things that stimulate

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inflammation after surgery can also contribute to capsule contracture. So

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those are things that, especially the early contractures, it can contribute.

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But again, nobody fully, fully understands why. And certainly like,

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you know, why does it happen 15 years later versus,

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you know, not right away. So anyhow, it is It's

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a frustrating problem, but that's the theory.

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Have you ever used the term slime layer face-to-face with

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a patient?

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Yeah, I use the term slime layer. Yeah. You're kind

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of slimy, to be honest. I was going to say.

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And they used it in Ghostbusters, too, by the way.

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He slimed me. There you go. All right.

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Let's talk about... Where does the Baker scale start and

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what does each grade actually look and feel like?

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The Baker scale. So grade one is a normal, healthy capsule.

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So there is a scar tissue there, but like when

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you feel the breast, it feels soft. That's normal. So

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Baker grade one is normal. Baker grade two is firmer

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than normal. It's like when you feel it, it might

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feel different than the other side. It's a little bit firmer.

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That's something you can live with. There's some treatments, non-surgical

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treatments that your doctor could discuss with you. But anyhow,

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that's not terrible. Grade three is when it starts to

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become even tighter and it starts to distort the shape

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of the breast. So now there's a visible difference. So

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grade two, you could look at the breasts and they

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visibly may not look any different, but there's a difference

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in the feel. Grade three, it looks different. And grade

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four just means it's painful. So if it's hurting, then

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it's a grade four.

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At what point do you tell someone it's time to

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do something about it?

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Well, you know, grade four is definitely if it's painful,

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like you've got to do something. I mean, you know,

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nobody wants to live with, you know, chronic discomfort. Grade twos,

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like I said, you could probably live with. There are

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some treatments like You can use some of the leukotriene

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inhibitors like Singulair, which is FDA approved for asthma. It's

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not FDA approved for using it in capsule contracture, but

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there is scientific evidence now that suggests using that for

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a 90-day period after you have, when you develop a

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grade two contracture, that it can help. So that's something

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that you might discuss with your doctor.

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Because it gets rid of the slime.

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It doesn't get rid of the slime. It does decrease

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the inflammatory mediators, though, and it can slow the process down.

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And in some cases, it seems if it's early enough

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in the formation of your capsule, it may reverse it.

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So you can use it in a grade two because

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you could potentially be fine with a grade two. Like

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they look good. It's just it might feel a little different. Now,

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you might opt to have surgery, but the point is,

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is grade two is not terrible. Grade three, once it's

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starting to distort the shape, most women are going to

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opt to have surgery to correct the shape. And so

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the surgical treatment involves either taking the entire capsule out

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or taking part of the capsule out or sometimes not

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taking the capsule out, but making little cuts in the

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capsule to stretch the capsule. But all of the treatments,

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most people would recommend replacing the implant. Because if we

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believe that potential bacteria is a problem, we don't want

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to put that same implant back in. We'll take that out,

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we'll rinse everything out really good, and we'll put a

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brand new implant in. However, we do know that when

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patients do develop capsular contracture, and then we do any

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of those treatments like a capsulectomy, where we take all

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the scar tissue out, and we put a new implant in,

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there's a 25% chance that it's going to happen again.

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So unfortunately, you know, if you get a capsule contracture once,

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it can be a frustrating problem and it can tend

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to recur.

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Is there anything you can do to reduce the odds

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of recurrence?

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Yeah, the biggest one that we can do is the

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placement of acellular dermal matrix. So one of the products

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that I use is called Stratus. it's pig skin, but

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all the cells have been removed. It's basically just dermis.

219
00:12:37.059 --> 00:12:41.289
So it's an acellular, there's no cells, dermis, dermal, and

220
00:12:41.309 --> 00:12:44.789
it's a matrix and it's basically collagen. But once you

221
00:12:44.809 --> 00:12:48.570
take out all the scar tissue, you suture this material

222
00:12:48.629 --> 00:12:51.169
in place. And what it does is it prevents those

223
00:12:51.250 --> 00:12:55.259
myofibroblasts from aligning in a certain way to cause that

224
00:12:55.320 --> 00:12:59.940
scar tissue to contract. And it's extremely effective. I think

225
00:12:59.980 --> 00:13:04.320
in the literature, it shows like a 85% relative risk

226
00:13:04.360 --> 00:13:07.580
reduction or something like that. But like in my experience,

227
00:13:08.159 --> 00:13:11.019
I feel like I've had 100% success rate with Stratus

228
00:13:11.080 --> 00:13:14.480
when it comes to capsule contracture. Maybe not 100, but

229
00:13:14.539 --> 00:13:18.500
it's very high. I can't recall a time. So the

230
00:13:18.559 --> 00:13:23.720
unfortunate thing is, is that material is expensive. And a

231
00:13:23.779 --> 00:13:27.279
lot of people really wouldn't consider it first line therapy anyhow.

232
00:13:27.419 --> 00:13:30.990
So Let's say you had surgery and now it's three

233
00:13:31.090 --> 00:13:34.720
years later and you got a grade three contracture and

234
00:13:34.779 --> 00:13:38.899
it's distorted. A lot of doctors would do like a

235
00:13:39.240 --> 00:13:42.159
capsulectomy or one of the other treatments I mentioned and

236
00:13:42.200 --> 00:13:45.120
put a new implant in, but not put the dermal

237
00:13:45.159 --> 00:13:50.409
matrix in. However, if it recurred, most people would be

238
00:13:51.409 --> 00:13:54.350
leaning you towards trying out one of these dermal matrix

239
00:13:54.429 --> 00:13:56.549
products to try to prevent it from recurring.

240
00:13:57.480 --> 00:14:03.350
Recovery-wise, is there a difference between primary augmentation, capsulectomy, or

241
00:14:03.389 --> 00:14:04.710
capsulectomy with stratus?

242
00:14:05.730 --> 00:14:09.730
Well, yeah. I mean, a capsulectomy is, I don't know,

243
00:14:09.750 --> 00:14:14.100
I'd say it's probably on par with a primary augmentation,

244
00:14:14.899 --> 00:14:16.840
maybe a little bit more uncomfortable. It just sort of

245
00:14:16.879 --> 00:14:20.899
depends on how the capsulectomy goes. But putting the dermal

246
00:14:20.940 --> 00:14:23.700
matrix in really is, I don't consider that to be

247
00:14:23.860 --> 00:14:28.629
really any added post-operative discomfort. But If the treatment was

248
00:14:28.669 --> 00:14:32.080
just like doing a capsulotomy where we're just making little

249
00:14:32.129 --> 00:14:34.259
cuts in the capsule and putting a new implant in,

250
00:14:34.379 --> 00:14:38.679
that would not be very uncomfortable. But, you know, sometimes

251
00:14:38.700 --> 00:14:41.460
that's not an effective treatment. So a lot of times

252
00:14:41.700 --> 00:14:43.830
I find a capsulectomy is a better choice.

253
00:14:45.490 --> 00:14:48.889
So beyond capsular contracture, let's just talk about a few

254
00:14:48.929 --> 00:14:52.190
other things that could go wrong potentially like down the road.

255
00:14:52.289 --> 00:14:57.269
So maybe like rupture. either silicone or saline, how would

256
00:14:57.330 --> 00:15:01.809
someone know and does silicone behave differently than saline when

257
00:15:01.850 --> 00:15:02.350
it ruptures?

258
00:15:02.870 --> 00:15:07.139
Oh, yeah, very different. So people with saline implants, they

259
00:15:07.179 --> 00:15:09.299
call the office in a panic going, I need on

260
00:15:09.320 --> 00:15:13.600
your surgery schedule tomorrow. Because with a saline implant, it's

261
00:15:13.840 --> 00:15:17.710
just IV fluid, saline that is in your implant. And

262
00:15:17.750 --> 00:15:21.610
if it leaks, It doesn't like, usually it can, you

263
00:15:21.649 --> 00:15:24.409
can occasionally have a slower leak, but usually it happens

264
00:15:24.509 --> 00:15:28.159
pretty quickly. And so, you know, they wake up the

265
00:15:28.200 --> 00:15:30.320
next morning and they're like, one breast is half the

266
00:15:30.340 --> 00:15:33.360
size of the other. And they're like panicking because like,

267
00:15:33.419 --> 00:15:37.820
oh my God. So saline is not, you know, it's

268
00:15:37.860 --> 00:15:39.940
not one of these where I think it might be leaking.

269
00:15:40.019 --> 00:15:43.370
It's usually, it's pretty obvious. Silicone on the other hand,

270
00:15:43.429 --> 00:15:47.070
because it is a gel and your body doesn't reabsorb that,

271
00:15:47.710 --> 00:15:50.889
you could go a long period of time and have

272
00:15:51.190 --> 00:15:54.210
no idea that your implant is even ruptured. In fact,

273
00:15:54.789 --> 00:15:57.940
I remember a patient that I didn't do her primary surgery,

274
00:15:57.960 --> 00:15:59.860
but I was going to do a revision surgery on her.

275
00:16:00.340 --> 00:16:01.879
She was only like a year and a half out

276
00:16:01.919 --> 00:16:05.639
from her surgery. And I was going to redo her

277
00:16:05.700 --> 00:16:08.179
left and some other stuff. Anyhow, we planned on using

278
00:16:08.220 --> 00:16:10.700
her existing implants because they were only a year and

279
00:16:10.740 --> 00:16:14.120
a half old. When we got in there, found that

280
00:16:14.360 --> 00:16:17.779
both of her implants were ruptured. So wasn't obvious on

281
00:16:17.840 --> 00:16:21.320
exam for her, but sometimes on the exam, it can

282
00:16:21.379 --> 00:16:25.360
feel even like almost squishier than normal for a silicone

283
00:16:25.379 --> 00:16:28.379
because the shell's ruptured. And so sometimes you can have

284
00:16:28.419 --> 00:16:31.539
a contracted breast, but yet it still kind of feels

285
00:16:31.679 --> 00:16:33.730
soft and it's kind of hard to explain, but it's

286
00:16:33.769 --> 00:16:36.429
like it's, you know, the implant doesn't move, but yet

287
00:16:36.470 --> 00:16:40.470
the breast is soft. So anyhow, silicone, the only way

288
00:16:40.490 --> 00:16:43.289
you're really going to know if it's ruptured is you

289
00:16:43.309 --> 00:16:46.299
can do imaging. An ultrasound is what you know, is

290
00:16:46.340 --> 00:16:49.450
a good screening tool and it'll pick up a lot

291
00:16:49.490 --> 00:16:53.870
of ruptures. MRI is also a helpful tool, but a

292
00:16:53.909 --> 00:16:57.450
little bit more expensive to get the imaging done. But

293
00:16:57.889 --> 00:17:00.789
these things aren't even perfect. I remember one time with

294
00:17:00.850 --> 00:17:04.569
a patient that she swore her implant was ruptured. It

295
00:17:04.630 --> 00:17:06.730
had only been in for a short period of time.

296
00:17:06.819 --> 00:17:08.799
And I examined her and I said, I really just

297
00:17:08.819 --> 00:17:10.960
don't think this is ruptured. And she said, well, what

298
00:17:10.980 --> 00:17:13.569
do I do? I said, well, get an MRI. And

299
00:17:13.650 --> 00:17:16.210
the MRI said the implant was ruptured. And so I

300
00:17:16.210 --> 00:17:19.730
was like, well, I'm shocked anyhow. So I took her

301
00:17:19.809 --> 00:17:22.130
and she had no history of trauma or anything else.

302
00:17:22.759 --> 00:17:24.470
You know, I took her to surgery and I videoed

303
00:17:24.799 --> 00:17:28.359
me taking the implant out and the implant was completely intact,

304
00:17:28.480 --> 00:17:31.819
like not even a little bit ruptured. So the imaging

305
00:17:31.880 --> 00:17:34.839
is not perfect. We did replace the implant, put a

306
00:17:34.859 --> 00:17:37.839
new implant in. But the point is, is that sometimes

307
00:17:38.119 --> 00:17:41.819
ruptures can be a little difficult. The bigger concern with

308
00:17:41.839 --> 00:17:45.619
silicone implants, and this was more true for the old

309
00:17:45.920 --> 00:17:48.519
liquid silicone implants that were taken off the market in

310
00:17:48.539 --> 00:17:52.480
the 80s, is that when they ruptured, it was a

311
00:17:52.819 --> 00:17:56.539
liquid silicone back in the 80s, and it would not

312
00:17:56.599 --> 00:18:01.269
stay contained to the scar tissue, the capsule. And it

313
00:18:01.309 --> 00:18:04.019
could spread beyond the capsule and get into the breast

314
00:18:04.059 --> 00:18:07.779
tissue and form painful nodules and that sort of thing.

315
00:18:07.799 --> 00:18:10.299
And it could be really difficult to sometimes get in

316
00:18:10.319 --> 00:18:12.779
there and remove all of that. I've had to do

317
00:18:12.819 --> 00:18:16.950
that before and it's just a mess. But these newer

318
00:18:16.990 --> 00:18:19.829
implants are more cohesive. So most of the time on

319
00:18:19.890 --> 00:18:22.150
any of these implants that have been ruptured nowadays, it's

320
00:18:22.190 --> 00:18:24.730
all contained within the scar tissue and it's pretty easy

321
00:18:24.769 --> 00:18:25.430
to take care of.

322
00:18:25.430 --> 00:18:31.990
Okay, what about... rippling or bottoming out or semastia. Are

323
00:18:32.269 --> 00:18:33.750
any of those not fixable?

324
00:18:34.529 --> 00:18:37.240
No, they're all, you can do things. Some of them

325
00:18:37.440 --> 00:18:41.119
may not be completely fixable. Like rippling, unfortunately, is a

326
00:18:41.180 --> 00:18:44.880
function of your tissue thickness. And sometimes if you just

327
00:18:44.920 --> 00:18:48.130
have extremely thin tissues, even with a small implant, you

328
00:18:48.150 --> 00:18:51.759
can have rippling. But Usually most people that have rippling,

329
00:18:51.940 --> 00:18:55.359
visible rippling, usually have saline implants and the treatment is

330
00:18:55.400 --> 00:18:58.460
to switch them to silicone because they ripple much less likely.

331
00:18:59.059 --> 00:19:01.740
But if you're super thin, you can still have visible

332
00:19:01.799 --> 00:19:05.059
ripples in your breasts. Also, another patient of mine, she

333
00:19:05.079 --> 00:19:09.359
was very fit. She was like a personal trainer and

334
00:19:09.440 --> 00:19:11.779
she had like no body fat, like none. And she

335
00:19:11.819 --> 00:19:15.420
also had no breast tissue and she had implants. And

336
00:19:15.440 --> 00:19:19.609
I swapped her implants from saline to silicone. And it

337
00:19:19.650 --> 00:19:23.400
was better, but she still had rippling. She ultimately ended

338
00:19:23.440 --> 00:19:25.980
up getting pregnant and put on some weight and all

339
00:19:26.019 --> 00:19:29.059
her rippling went away. So, you know, it's kind of

340
00:19:29.079 --> 00:19:32.440
one of these things where, you know, tissue thickness plays

341
00:19:32.480 --> 00:19:36.269
a role. And yes, some of the newer, more cohesive

342
00:19:36.309 --> 00:19:39.930
implants ripple less, but they can be firmer feeling and

343
00:19:39.950 --> 00:19:42.769
you can palpate the shell a little bit more. So like, anyhow,

344
00:19:42.809 --> 00:19:45.470
some of these problems, you may just kind of get

345
00:19:45.490 --> 00:19:46.880
to a point where it's like, well, this is the

346
00:19:46.920 --> 00:19:51.240
best we can get to. Sin Mastia is generally correctable.

347
00:19:52.220 --> 00:19:53.759
Some of them are easy to correct and some of

348
00:19:53.799 --> 00:19:56.279
them can be more challenging, but basically that's when you

349
00:19:56.319 --> 00:19:59.579
end up with a uniboob because the muscle gets lifted off.

350
00:19:59.900 --> 00:20:01.809
Or sometimes it can be above the muscle in a

351
00:20:01.900 --> 00:20:05.490
uniboob because the implants are too close together. And so

352
00:20:05.589 --> 00:20:08.130
in those cases, you have to tack all that down.

353
00:20:08.150 --> 00:20:11.970
It's sort of hard to explain in the podcast because

354
00:20:12.009 --> 00:20:14.410
each situation is a little different, but there are treatments

355
00:20:14.430 --> 00:20:17.049
for that. And then what was the other thing you mentioned?

356
00:20:17.069 --> 00:20:20.670
There was synmastia. Bottoming out. Oh, bottoming out. Well, again,

357
00:20:21.230 --> 00:20:23.430
that can be a function of if your tissues are

358
00:20:23.470 --> 00:20:26.079
just not strong enough to support the size of implant

359
00:20:26.099 --> 00:20:29.700
you've chosen. And we see bottoming out much more commonly

360
00:20:29.759 --> 00:20:33.279
in these massive weight loss patients because their tissues are thinner,

361
00:20:34.900 --> 00:20:37.880
their tissues tend not to support an implant as well.

362
00:20:38.400 --> 00:20:41.079
So in some of those patients, we'll use mesh or

363
00:20:41.140 --> 00:20:43.720
other things to kind of help support it. You may

364
00:20:43.779 --> 00:20:47.539
see stuff online about people calling it an internal bra. Well,

365
00:20:47.559 --> 00:20:51.210
that's what it's a mesh. It's not FDA approved for

366
00:20:51.289 --> 00:20:55.289
breast surgery or reconstructive surgery, but it is FDA approved

367
00:20:55.329 --> 00:20:59.390
for tissue support. And so that's what's used in those cases.

368
00:20:59.470 --> 00:21:02.529
But yeah, bottoming out, the bigger the implant you have,

369
00:21:02.589 --> 00:21:05.410
the more likely you could bottom out. because there's more

370
00:21:05.509 --> 00:21:08.130
weight and sometimes it can be a function of time.

371
00:21:08.250 --> 00:21:11.210
You know, it was good at first, but then five

372
00:21:11.269 --> 00:21:13.829
years later, again, your tissues aren't supporting it. And that

373
00:21:13.890 --> 00:21:15.380
implant slowly drops.

374
00:21:16.730 --> 00:21:22.319
You had a really, really impressive semastia repair. Is that

375
00:21:22.359 --> 00:21:23.880
what you would call it earlier this year?

376
00:21:23.900 --> 00:21:25.960
Yeah, no, it was, it was good. Yeah.

377
00:21:26.660 --> 00:21:29.160
She came from another surgeon. I'd love to show her

378
00:21:29.339 --> 00:21:32.089
before and afters in this podcast because she looks amazing.

379
00:21:32.690 --> 00:21:35.170
Yeah, she had a synmastia and it was, you know,

380
00:21:35.910 --> 00:21:38.829
they're never easy to correct, but hers was one of the,

381
00:21:38.849 --> 00:21:41.339
I won't want to say easier ones, but it was,

382
00:21:41.650 --> 00:21:44.960
it went really smoothly and turned out great. So it

383
00:21:45.400 --> 00:21:48.640
can be a frustrating problem for sure. But now she

384
00:21:48.680 --> 00:21:52.579
looks like, you know, more like she has real breasts,

385
00:21:52.680 --> 00:21:53.380
not a uniboob.

386
00:21:54.769 --> 00:21:58.410
Have either one of you ever experienced a patient where

387
00:21:58.450 --> 00:22:01.750
you've tried and tried and tried and you're just like, girl,

388
00:22:01.769 --> 00:22:03.259
I think you just need to take these things out.

389
00:22:03.339 --> 00:22:05.039

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