Your Questions
Your Questions
Q : Dr. Eppley, I have had silicone gel implants for 31 years and am still very pleased with them. I am presently 65 years old and in good health. I regularly had mammograms every two years until five years ago. At that time, the place where got my mammograms asked me to sign a disclosure form stating that I would not hold the clinic or technicians responsible if one or both of my implants as a result of the test. This was alarming to me and I walked away without the mammogram and have not had one since!
I realize that foregoing mammograms is foolish. My doctor encourages me to have it done even though I have shared my fear. Is there a better way to examine the breast with silicone implants other than a mammogram? My breasts are small and when the paddle compresses them, it does feel like the implants could burst especially since they are such old implants. How do we know that the bag that encloses the silicone will not leak or burst? I’ve also had an ultrasound but they said that is not a good substitute and will not detect cancer cells.
Dr. Eppley, if you have any suggestions or answers to these concerns, I would certainly appreciate hearing from you.
A: Your fears about rupture of breast implants with mammograms is understandable, particularly in light of their age. While today’s breast implants have improved shells (the bag containing the implant filler) that are known to be resistant to the compressive forces of mammograms, the physical characteristics of implants thirty years ago are undoubtably less so.
I have seen breast implants of this age before on removal and most of them are either ruptured or no longer have any identifiable shell remaining. (meaning it has completely disintegrated)At thirty-one years of age, it is very likely that your breast implants are already ruptured or the shell is no longer intact. Even in asymptomatic, capsular contracture-free breasts, old breast implants will often, if not usually, not be intact.
That being said, I think your concern about breast implant rupture should not outweigh the potential benefits of mammography. Mammograms are still the simplest and most cost-effective screening tool that exists for breast cancer detection. An MRI of the breast can be done but it is more sensitive to look at whether breast implant rupture exists than to detect breast cancer.
Dr. Barry Eppley
Q : I am scheduled for facelift surgery and want to do everything to shorten my recovery and have a good result. I have read about the medication Arnica which is supposed to reduce swelling and bruising. I bought some Arnica montana to take 2 weeks before surgery and 2 weeks after and what I found was pills that dissolved on your tongue and should be taken every 30 minutes. Is that how I should take them?
A: Arnica, known more formally as Arnica Montana, is a herb extract from the mountain lily flower. It has been used for medicinal purposes for hundreds of years and remains popular today. It is used in the non-drug treatment of muscle aches and to reduce inflammation. In plastic surgery, it is used with the primary intent to reduce bruising. It can be applied topically as a cream or ointment to a bruise or can be taken orally to either prevent or treat bruising. Its effectiveness is more than a medical myth and clinical studies have shown its value. It has not known harmful effects when taken in homeopathic doses.
Oral arnica is what is recommended for elective cosmetic surgery. Because of the visibility of the face, I always recommend to my facial surgery patients that they take it several weeks before and after surgery. It comes in homeopathic doses which are usually given in C units rather than milligrams like prescription drugs. Arnica tablets can usually be gotten in doses of 15C, 30C and 60C. There are no proven differences in anti-bruising benefits to any of these doses. They are to be taken by placing several tablets under the tongue (sublingual) and letting them dissolve at a frequency of four times per day.
Dr. Barry Eppley
Q: I am wanting to get liposuction and a tummy tuck and I have learned that it is quite expensive. Do people generally pay cash, out right? What financing options are available?
A: Elective cosmetic plastic surgery is not inexpensive and many people considering it do require some financial assistance. While the concept of financing plastic surgery was once rare, it is not quite common. I have read estimates that in 2000 the number of patients that financed surgery was 5%. Today that number is closer to 40% and growing. For these patients, financing could be the only means to afford their desired plastic surgery procedures.
Most, if not all, plastic surgeons are very familiar with a patient’s request to finance their surgery. This is an everyday event in any busy plastic surgeon’s practice. While the plastic surgeon’s office can assist and guide you through the financing process, plastic surgeons do not directly loan money for surgery. Nor do they work out a payment plan so that one can have surgery and then pay out off the plastic surgeon over time. That requires a financing company or back (not usually the best) to work with you to develop the loan amount, interest, and a repayment schedule. Most plastic surgeons are signed up with financing programs that allow you to directly apply to and get very quick responses. Like a car or appliance purchase, you need to think about making monthly payments over a given period of time
There are a large number of companies offering plastic surgery financing. In my Indianapolis plastic surgery practice, we use Care Credit and My Surgery Loans, for example. But there are many other options out there that offer medical loans. Simply google the term ‘plastic surgery finiancing’ and a plethora of them will appear. These medical loans are not necessarily based on the procedure you are considering but on a dollar amount. You can then select the procedure you want to have, and depending on your credit ratings, you could be granted different interest terms.
When considering financing plastic surgery, there are three (and potentially four) costs that you need to be aware of. These include the surgeon’s fee, operating room charges, the anesthesiologist’s fee (if general anesthesia is used), and implant charges. (if some form of an implant is being used) Make sure you know all of the fees that will be required of your procedure so you don’t inadvertently get a loan that is not adequate. Your plastic surgeon should give you an estimate (quote) for all the costs of your procedure. Get a consultation and written quote before you ever finance. Do not take the estimated costs off of a website or some verbal exchange.
Lastly, like all financial and legal documents, double check the agreement terms, interest rates and re-payment time before signing at the dotted line.
Dr. Barry Eppley
Q: Dr Eppley I have had my lower eye bags and lids done and also had a MAC facelift with liposuction to my neck all at the same time. I now have two eyelids that are different and am not pleased with the result of my lower neck. I went back to see the surgeons yesterday and they said they would have to do the two eyelids again but can’t do the neck any better. I am 65 years old and after reading your article about a low horizontal neck lift I wonder if this is would nto work for me. That procedure has given me hope but I can’t trust my previous surgeons to do it.
A: The MAC facelift, like all forms of limited facelifting, is a great procedure for the right patient. The right patient for it is one that doesn’t have a significant neck problem or a lot of loose neck skin. These limited facelifts are primarily jowl reducing/smoothing procedures with some minor improvements in the neck area. Those improvements are helped through the use of neck liposuction, but the key to getting a good result is that the neck skin must not be too loose.
When one has a more significant neck issue, a full or more traditional facelift procedure is more appriopriate. This is a much more powerful neck procedure. One of the problems with these limited facelifts is that they get used in patients that really should have had a more complete necklifting procedure. As a result, they can often be disappointed with the neck result. I suspect this is what has occurred in your case.
Once can always have a secondary more complete facelift done to improve your neck result. Having had a MAC facelift does not preclude that. Saying that ‘no more can be done’ suggests to me that they are either unwilling or incapable of doing a more complete facelift procedure.
A low horizontal neck lift is always an option and certainly is simpler and easier than reverting to a complete facelift. As long as one can accept a fine line scar in a low neck crease, this could be an option worth considering. That could even be done local anesthesia.
Dr. Barry Eppley