Monique Ramsey (00:04):
Welcome back to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today we have Dr. Hector Salazar, one of our plastic surgeons. Welcome.

Dr. Salazar (00:14):
Thank you so much, Monique. It's a pleasure to be here, and it's always great to have these conversations with you.

Monique Ramsey (00:21):
As we've said on previous episodes, women have become more concerned about breast implant safety than cost in recent years. Breast implants are the safest medical device in history, but as we know, nothing is perfect. So we're going to talk today about what is a complication? Is there a standard definition, and have Dr. Salazar really walk us through what are maybe the top three common complications in surgery, of surgery in general, and then let's go into breast implant complications. So let's talk about surgery in general. First, what do you most want to tell patients that could happen?

Dr. Salazar (00:58):
Well, I would say that I would fully agree with you in your opening statement, first of all, with the fact that you say that patients are very concerned about safety and we're seeing more and more educated patients. And yeah, cost is probably not their main concern at this point, but we want to share with them and explain to them all the risks and benefits and definitely foresee some of the complications. The first and last idea about this podcast that I will actually share with our audience is that breast augmentation is a safe procedure. Even if you talk about going on the highway, I mean, that's risky as well, right? We never think about it that way, but breast augmentation is a safe procedure. It has its potential risks, and that's exactly what we're going to be talking about. To answer your question when we are talking about any kind of surgery in general, so things that they're always present are going to be number one, there can be some bleeding to reassure patients.

(02:06):
We never leave the operating room when there's bleeding. We're always there. We cauterize, we get everything under control, and sometimes bleeding can happen because of changes in blood pressure. That's why we always ask patients not to exercise, not to win the lottery immediately after surgery. You got to get very excited and you can get into some bleeding. Nothing that accelerates your heart rate. So bleeding is a potential complication. Very rare though, but it is a complication that potentially can be present. Something else could be infection. So anytime that you have a disruption in your skin, even like with a paper cut, you can get infected. So especially if you're doing large incisions, everything, the environment and the operating room is sterile. Everything's very clean and all of our instruments and pretty much all the culture that it's around the operating room, it's all about performing a clean surgery.

(03:09):
But despite of that fact, one bacteria can be present actually most of the time on the patient of that patient's skin, actually living on the patient's skin. And because of that disruption of the skin, then that bacteria can jump in and start creating a party over there and reproducing and getting an infection. How do we prevent all that? We prevent all that by giving patients antibiotics actually when the patient goes to sleep, but they don't see this. But then we push some antibiotics through the IV. And the other thing is we watch them very closely after surgery to make sure that if something is developing, oh, we can jump in on top and start treating that infection. So infection is another very rare complication, but it exists. Something else that could happen would be, let's say a complication is a delay in wound healing so that the incision that we make and breast augmentation, probably it goes at a little bit lower, but when we make, for instance, an abdominoplasty, as you were asking me is surgeries in general, when you make a very, very long incision, the body that is not used to create more tissue anymore, because we're not 13 or 12 years old, the body is already reached a stable economy in which the only thing that your body is replacing is the usual, right?

(04:36):
A little bit of hair, a little bit of the skin, a little bit of the mucosal lining inside of your mouth, et cetera, et cetera. So all of a sudden the body has a long incision that has to heal, and sometimes this creates a disruption in the economy of the body, and then it can take a little bit more effort to heal a particular area of that incision. So I would say those three are one of the ones that I always bring the attention of my patients to in general, I would say.

Monique Ramsey (05:05):
And anesthesia related complications. Is that something that patients need to be concerned about?

Dr. Salazar (05:11):
Let me explain to our audience the fact that number one, you're having your surgery performed at the right place. So what do I mean by that? It's not in an office. It's actually a surgical center. It's a surgical center that's certified by what we call it, I mean, the way we explain that to patients, because the certification is called AAAA certification, but honestly, that to the general population is not going to say a lot. But what that means is that our outpatient surgery center has the exact same certification that the surgery centers of Sharp, Scripps, Kaiser, outpatient surgery centers have. So that's for their reassurance. We keep up that certification, so they're having their surgery done at a real operating room, and that's important. The other thing is that the anesthesia is being provided by a board certified anesthesiologist. So board certified anesthesiologist, we work with a very tight group of mainly three anesthesiologists that have been with us for a very, very long time, and they're extremely experienced.

(06:20):
And in their previous life when they were providing anesthesia at the hospital, they were doing a lot of even heart cases. So they're very well trained. They're the real deal. It's not that it's going to be a doctor that's operating and at the same time giving anesthesia or trying to control other things. The only thing that the plastic surgeon is going to be doing is going to be focusing in the cosmetic part of the procedure, and the anesthesiologist is going to be watching them all the time that they're there. And we have two operating rooms, and those operating rooms are covered each by one anesthesiologist. It's not that there is an anesthesiologist going back and forward between the two rooms. And that's another important thing for our audience to make sure that when they're considering a center that they have that.

Monique Ramsey (07:06):
Yeah, you have your own anesthesiologist for that case.

Dr. Salazar (07:09):
Exactly.

Monique Ramsey (07:11):
And we actually have an episode or two, but for sure, one on anesthesia. And one of our anesthesiologists, actually, Dr. Steve Saltz, Dr. Lori Saltz's husband, and he's been with our group for a really long time, his same as all the other anesthesiologists that we have. And it's really, really interesting. So if that's something that you're thinking about, a little worried about anesthesia, I just want to know more about it, listen to that episode, and we will put a link in the show notes so it's easier to find. So now let's get into breast surgery and what are the most common breast surgery complications?

Dr. Salazar (07:52):
Where I want to bring the spotlight when I talk to patients about breast implant complications is number one, we can talk about capsular contracture. Number two, we can talk about implant failure or rupture. And number three, we can talk about some sort of a need for a revision or a second surgery.

Monique Ramsey (08:18):
Well, most implants, if I'm remembering correctly, go under the muscle, right? You're putting them under the muscle. So the pain is the most of the pain related to that muscle stretching?

Dr. Salazar (08:29):
Correct. Normally under the muscle, there's nothing, right? And then the muscle is going to be contracting, but now it's going to be contracting on top of something. So the way I like to create an analogy for patients is imagine that you have your keys in your back pocket, and then you sit down and you feel those keys, but then five minutes, 10 minutes later, you don't remember about those keys. As a matter of fact, you might be looking where they are, where are they? Where are those keys? And then the keys are in your back pocket because you stop actually being attentive or paying attention to the fact that they're there. Same thing with, you can talk about sunglasses or a cap.

Monique Ramsey (09:12):
They're on your head.

Dr. Salazar (09:13):
They're on your head, and where's my cap? And I'm wearing it. So when the first moment the patients start feeling those implants behind the muscle, they're going to feel some good amount of pressure. That's where the main discomfort of the surgery comes from. Then they're going to start getting more and more active. So then the muscle's going to start contracting on top of the implant, and that generates some discomfort. And they realize that that exists little by little, their brain, the muscle is going to get used to the presence of the implant. And also little by little, they're going to start ignoring the fact that they have implants and then they integrate very well into their lives. Another thing that also takes a little bit of time, and patients mention it quite frequently is that the nipples are a little bit or get a little bit more sensitive that they get even sometimes with clothing. And the reason for that is because you're pushing on the back of the nipples, and the nipple is the nipple. A complex has some muscle and a component into it, so that's the reason how it can contract, but now you're stimulating it from the inside.

Monique Ramsey (10:25):
Oh, interesting.

Dr. Salazar (10:26):
And that takes some time as well for the nipple and areola to get used to it and then be like, oh, okay, we are going back to normal.

Monique Ramsey (10:35):
Now you're talking about extra pain or sensation, but is there also ever any numbness in that area?

Dr. Salazar (10:41):
Very rarely. I would say extreme, like I can close my eyes try to remember the last patient that mentioned something like that with a pure breast augmentation and changes in sensation, either to lose some of that sensation or to become numb, it's going to be really, really rare. I mean, I wouldn't say that it even reaches 0.5% of change in sensation.

Monique Ramsey (11:06):
Okay. Well, that's good to know because there's urban legends out there like, oh, this could happen and that could happen. And so it's like we don't know. So it's good to help everybody understand if it happens, it's really, really, really rare. So you touched on capsular contracture. So what is that and what causes it, and is there a way to prevent it?

Dr. Salazar (11:31):
Okay, so capsular contracture patients also talk about as encapsulation of the implants. That's also how they mention it, or they can tell you that, oh, I saw my friend that got an implant that was tight and higher than the other one. And harder, what capsular contracture is you have. So the breast implant is a foreign body, just like any other implant that we have in our body. What could that be? It could be a hip replacement, it could be a pacemaker. So it's a foreign body that's inside of your body. It's not part of your own tissue. Also, think about it as a splinter or the tip of a pencil that was never removed or something that actually got into your body for a reason. And what happens is that your defense cells actually are going to detect that as a foreign body, as a foreign object.

(12:37):
So they'll start orchestrating a response for you to start creating a capsule around the implant. And I'm not talking about the actual shell of the implant. When I'm talking about a capsule that your body is going to create. It doesn't come, and this is very important, that capsule does not come from the implant. That's a capsule that your body starts depositing all the way around that implant to, in a way, according to your body, protect you from that foreign object, right? So you're protected. I would say the great majority of patients, more or less, the number is 90% of patients for the first 10 years, that capsule is going to remain soft, nice, pliable without a problem. Numbers vary, but anywhere from eight to 10, 12% of patients or have the risk during the first 10 years to develop capsular contracture. So what that is, think about it this way.

(13:46):
So the implant is covered by that capsule, so the implant's inside, but then your body, for some reason, in a silly way, decides to start shrinking that capsule and making the foreign object, squeezing it and making it as tiny as possible so it doesn't bother you or it doesn't hurt you. It's such a silly reaction. No, please don't help me. Don't help me that way. If you think about it, when you think about asthma, asthma, you get a little bit of dust or a little bit of pollen or something in your nostril, and then all of a sudden your bronchial tree shuts down and tries to defend you from that agent, and you're like, oh, no, please don't help me that way. We do not exactly know what triggers that response. Some studies have said, well, maybe there's a little bit and a little bit of an infection that the patient actually never realized that there was an infection.

(14:46):
Other studies say, well, no, what it is is the presence of a little bit of blood. If a little bit of a microscopical bleeding there, then the capsule can start tightening. Or we have even actually, we have seen patients that they go to the dentist, they get a deep dental cleaning, and then sometimes they come back and they come with an encapsulation of the implant, and it's like, right, it doesn't make any sense, but it's a reality. It can happen most of the time happens only on one side. So also that makes us think like, oh, I mean because nothing systemic that's happening in your body, right? Something maybe localized to that breast. So it's not that the great majority of patients, of course, as I'm saying that have breast augmentation will suffer from this. But there's a minority of patients that can experience that in the first 10 years. So we have ways to, or we actually take 14 steps in the operating room to prevent this.

Monique Ramsey (15:52):
14, 14 separate steps.

Dr. Salazar (15:54):
14 separate steps, and we do them religiously. And this has become part of our routine, starting from the prep of the patient, even switching gloves before you manipulate implants, not touching the implant actually at all, using a special funnel to put the implant in so that the implant never touches the patient's skin. Washing the cavity with antibiotics and prepping again before the moment that we are going to put in the implant. But several things that we do in order for us to prevent it. And the more and more we get studies out in regards to capsule contracture, the more things we learn and see about it. For instance, now we know that having the implant behind the gland places that patient at a higher risk of developing capsular contracture. So placing the implant behind the muscle actually protects or gives you that protection of staying away from the gland.

(17:00):
The gland has communication to the outside world for the purposes of the gland through the ducts, the gland communicates to the outside world. So we're thinking about maybe some bacteria that was jumping around the implant. So it's easier to happen in a place where you have contact to the outside world through the ducts than if you have it behind the muscle. So that's actually what we do to prevent that. Also, we have seen that if we go through the inframammary fold to the crease, if we place the implant through there, the rate of capsular contracture is lower than if we go through the areola. So that's another change or another thing.

Monique Ramsey (17:42):
Yeah, because when I started 31 years ago, nice it that everyone, the implants were put on top of the muscle most of the time thinking that's going to look the most natural, not everyone. And I remember they're smooth and textured and all over the years, then the Keller Funnel came in and all these different things. It's kind of cool to know that the technology and the way that everybody's doing the surgery has everybody's worked together to reduce that number of people to be as low as it can be.

Dr. Salazar (18:22):
And the treatment for it, if a patient gets capsular contracture or develops capsular contracture is to go in, remove the capsule so that we call capsulectomy, remove the capsule, and we take the implant, original implant, we'd take it out. We get rid of it. Because if we were thinking that maybe there was a little bit of contact with blood, or maybe there's a contact with bacteria. You know what? Let's get a fresh implant in and we put a fresh implant in, and then we go ahead and close. And immediately patients after immediately they notice a difference because the implant's not going to be riding high. It's not going to be hard or encapsulated. And even that generates some tension internally that sometimes some patients can develop some pain, but some patients actually just say like, oh, I don't know. It feels so much better. It's not hard. Oh my God, this is much, much better, much more natural. Of course. So that's a treatment to do a capsulectomy in an implant exchange.

Monique Ramsey (19:21):
And is that a pretty straightforward surgery for patients?

Dr. Salazar (19:23):
I'd say pretty straightforward. Surgery is something that has been, well-established treatment. The only thing that you have to talk to patients about is if you're going to go in, you're going to be playing the game again, you have the risk of getting capsular contracture cuz you're going to be, and any time that you go in and you exchange implants if it's for a different reason or you're going to do a lift and you're going to change the implants, you're playing their game again of having that.

Monique Ramsey (19:50):
You're hopping on the freeway.

Dr. Salazar (19:51):
You're hopping on the freeway. And actually they're aware and they know that maybe because their bodies have already demonstrated that a little bit of a, they have more predilection to do this or develop this capsules that are tight, that they can have that again. But we see a good number of patients that actually never had it, never have it back again. If there's a recurrence, a second encapsulation, then we have another treatment for them. And that's like to use an ADM or to use a mesh to hide that implant from your defense cells to hide that implant. And we can talk later about it, but we could have a complete podcast on this.

Monique Ramsey (20:44):
And we're following one of the patients that you just recently did surgery on a week ago.

Dr. Salazar (20:50):
Oh, fantastic.

Monique Ramsey (20:50):
And so her name is Tati. She's on the radio, and so she's been talking on the radio about that. I'm not giving away any secrets.

Dr. Salazar (20:58):
That's correct.

Monique Ramsey (20:58):
She had had breast implants, I think when she was maybe in her mid twenties, and she had a deflation recently. And so she then came and saw you, and I think she just had her surgery a week ago. She was back on the radio I heard yesterday, so that was Wednesday, so five or six days later.

Dr. Salazar (21:16):
Correct.

Monique Ramsey (21:17):
So when somebody has an implant rupture or deflate, how would they know? I think if it's saline, it would be really obvious, right? It's popped and it's like a deflated balloon. But what about maybe what causes that in a saline and then what in a silicone implant might be the giveaway that something's not right?

Dr. Salazar (21:38):
We can all relate to a balloon that's filled up with water, and if it doesn't matter, if you poke a very, very tiny hole in it, it's going to deflate completely sooner or later. I mean, so if a patient has saline implants and the volume that they have is still present, they can rest assured that there, that implant is not ruptured, because otherwise all the volume would've been already out little by little. And then the course of one or two days or three days, actually that saline gets absorbed by the body, filtrated by the kidneys, and you go to the bathroom and get rid of that volume. And so when you have a saline implant, the sign of deflation is, oh, look at this breast. This is the way this other one here used to look like. And right now I noticed this, that discrepancy, is that an emergency something you've got to run to go and see your plastic surgeon or go to the er?

(22:40):
I would definitely wouldn't go to the ER for that. I would go ahead, it's nothing you have to rush, but probably to go and be assessed by a board certified plastic surgeon, give us a call, give the office a call, set up an appointment within the next couple of weeks. And then we can make sure that everything looks okay and we can plan for this surgery. Again, nothing bad is going to happen with that deflated device because you had it inside of your body, you had contained water, but now or saline. But now it has been deflated and it's never a good thing to have a ruptured device inside of your body. So you can schedule the surgery as soon as possible, but without, if you have a very important thing that you have to do tomorrow or the following week, you can actually do that and then later come back and do it.

(23:34):
In terms of the silicone gel implants, a deflation, it's harder to actually detect. There could be some constant or some skin irritation or changes in the shape of the breast, or actually some contracture sometimes can also be caused by a rupture in the implant, but it's not as obvious. So if you're really concerned, the first step would be to go and visit with your plastic surgeon, then determine if it's a good idea to just observe it or if it's a good idea to go ahead and pursue an MRI or a high definition ultrasound to make sure that the implant is intact or not.

Monique Ramsey (24:19):
So they can come to you, have you do that high definition ultrasound, and can you nine times out of 10, see if there's a problem? Is it pretty obvious?

Dr. Salazar (24:33):
For the expert eye, it's pretty obvious. And we like to share that with patients, cuz it's funny, when you put out the ultrasound, everybody relates to, oh, like a baby. You're looking for a baby. And so then we start explaining then, okay, so this is your skin. This over here is a little bit of fat, the breast gland, this is the muscle, this is where the implant is, this is the shell of the implant. That's what we are looking for, that integrity of that shell. And then we look for it together and they actually are seeing the screen and everything. But yeah, I would say in terms of one way to look at the implants is to realize or to acknowledge that implants are manmade objects, as in any manmade object, they can fail. It's extremely rare for implants to rupture, especially to rupture spontaneously. I mean, patients can actually see, or some patients actually come in and they say, oh, I've already watched videos on YouTube where they ran over with a truck like an implant.

(25:40):
It doesn't get ruptured because they're quite resistant. I tell patients that when probably at our three month or six month office visit, we always go over when to be concerned about what type of trauma can actually rupture my implant. So maybe if you're riding, you're in your car, you're driving highway, God forbids motor vehicle accident, 80, 75 miles an hour, 65 miles an hour deployment of an airbag, you were wearing the seatbelt. So maybe at that point it wouldn't be a bad idea to obtain an MRI make sure that those implants are intact, but someone that I was about to walk into bathroom and someone opened the door and hit me a little bit with that door or someone, I was at a concert and they elbowed me on the breast as they were jumping, that's really not a concern for a rupture of an implant.

Monique Ramsey (26:42):
Might be sore, right?

Dr. Salazar (26:44):
Might might be sore.

Monique Ramsey (26:44):
Probably it.

Dr. Salazar (26:45):
But that's it. We're not going to run for an MRI or a high definition ultrasound.

Monique Ramsey (26:51):
Now, do you have any stories or can you remember any scenarios of some sort of event causing the rupture of any patients that you've had? Or is it more just sort of they break down over time and it could happen?

Dr. Salazar (27:08):
I could tell you that we hear all those stories, meaning patients that never had any trauma that come in that they cannot identify any moment, and the implants have been there for 15, 20 years, and yeah, they're ruptured or patients that come in. And sometimes what happens is patients get a mammogram and then after the mammogram they are looking for a better, characterized better, take a closer look at a small lesion, and then they order an MRI. And then the MRI, the MRI is really good to catch on not only those small cancerous lesions, but it's very good at catching implant ruptures. It's so good that sometimes over calls those ruptures. It's so, so sensitive it actually goes in and tells, sometimes they say like, oh, it looks like a rupture, and then the radiologist actually reads the MRI and say like, yep, it looks like a rupture.

(28:21):
You go in and maybe the implant had a little tiny fold on its own, it was folded, and sometimes that can be called as rupture.

Monique Ramsey (28:29):
Oh, I see.

Dr. Salazar (28:30):
But that's also some of the flavor that we even get, right? I mean some MRI that says like, oh, the implant might be ruptured. Most of the time that tends to happen down the road, meaning if there is a rupture, it's going to happen, it's not going to happen. I can assure you. And day one or year one or two or three tends to happen a little bit later in time. Our, the implants that we're using right now, the most modern implants, the shell of the implant, now we're not talking about the capsule that your body forms, but the shell of the implant tends to be much more resistant. So that's also reassuring. The FDA recommendation of having them exchange every 10 years has not changed, but patients should be happier that they're getting a shell of a breast implant that's much more resistant.

Monique Ramsey (29:23):
It's sort of like your phone. If you have one that's a few generations back, it doesn't mean it's not working. But the new one, if you end up after 10 years or 15 years switching out, you're getting the newest technology, right?

Dr. Salazar (29:36):
Correct.

Monique Ramsey (29:36):
I'm sure there's been improvements every time there's a new generation of implants that comes out.

Dr. Salazar (29:41):
Absolutely.

Monique Ramsey (29:42):
So now you just made me think as a woman, having had many mammograms in my life, I don't happen to have implants, but those things hurt those mammograms. Now, could a mammogram ever cause a rupture because they really smoosh you.

Dr. Salazar (29:57):
They really smoosh you. But we can go back to a YouTube video of the truck, but yeah, there's no evidence-based doc papers studies that we can getting mammograms. So it's safe to go.

Monique Ramsey (30:13):
Because you want to get your mammogram no matter what. So that's more important than, but just so we all feel assured that that's not going to be something.

Dr. Salazar (30:23):
Correct. Correct.

Monique Ramsey (30:24):
And now we talked at the very beginning about complications that can happen with any surgery, and the one that comes to my mind is a hematoma, which is when you have that bleeding happen, and sometimes it wouldn't necessarily, it could happen right out of the or, but based on your 14 steps, it sounds like that's a pretty unusual circumstance. But if people we tell don't lift luggage, if you're going on a trip, have somebody do it for you. Don't put, don't do crazy things with the weight machine because you just had implants. Because I think from what I understand is that's how you can end up having that complication is then you can get bleeding and then the one breast might get bigger.

Dr. Salazar (31:09):
What I tell my patients is that for three weeks, in reality, I wouldn't like them to be exercising at all and wouldn't like them to be carrying heavy things. And when I talk about heavy things, I make it, I mean, I bring it down to think about a gallon of milk. So you can carry a gallon milk, you can pour milk on your coffee, but that's it. No heavier than a gallon of milk. I would tell you that in my practice, it's extremely, extremely uncommon that I have postoperative bleedings. But because I tell the patients once, twice, three times, four times, do not become creative. The problem is patients, and again, and this is for patients to take note of their recovery, so they're going to feel fine probably after two to three days. There's some patients that walk in day one, it looks like we never operated on them and they feel fine.

(32:11):
We are happy for them, but we start getting a little nervous because we say, oh, they're going to try to do too much. So again, tell them the story again, have the conversation. Classic thing, as you're correctly saying, one week after they were feeling fine, they decided to go to Whole Foods, get some groceries. There was a bag that was heavier than the other ones, and when they were putting it in the trunk, I felt like a pop doc, and then it started getting bigger. So we don't want that. I mean, it's not the end of the world. It's a matter of assessing the patient, making the decision, taking the patient back to the operating room. They have to undergo anesthesia again. Again, we're in a very safe impairment, and they go to sleep. Make that small incision that we had originally. Take the implant out, take a look, take the blood out, take a look in there, find a bleeder again, cauterize it, and then clean everything and get that implant back in again, and we close up that incision. But we don't want to do that. There's no need. So just take it easy, take it easy. Binge on Netflix for those three weeks. Catch up on some good series that were pending and read some good books, chat with friends, but don't do a lot.

Monique Ramsey (33:36):
Listen to our podcast.

Dr. Salazar (33:39):
Exactly, exactly. Finish them all.

Monique Ramsey (33:41):
What else is better? So now who pays the bill when something like that happens? Is there complication insurance or if the patient's putting groceries in her car or exercising, you told her not to, there's going to be some costs involved, I would've think.

Dr. Salazar (33:57):
Right. It depends on the situation. It depends on the timing, and we always work with our patients, but it depends on timing of things. It depends on the circumstances. So we would be assessing pretty much everything on a case by case basis. And I know patients, they get very, very close with their coordinators, but for certain complications, and let me share this with you, for certain complications, for instance, like an implant rupture or sometimes capsular contracture, the implants that we use, they come with a insurance that protects them from that rupture. In what sense? The sense of if their implant ruptures, then the implant company would actually exchange that implant for them. So it said like, okay, so they're going to remove the implant that's ruptured. Here is your free implant back so they don't have to pay for the implant. That's really good. And it depends on the plans, but they have a little, some economical aid for patients because here's the deal, we have to go back to the operating room. We have to, patient have to go under anesthesia. There are going to be resources that need to be used. They're going to be to, I mean, anything starting from sutures or instruments for devices or anesthesia gas, I mean every single thing. So if it's a force, someone's forcing us, some situation is forcing us to go back to the operating room, there's going to be some cost. But of course, if it depends on timing, it depends on situations, but I would say that we always work with our patients to make their experience their best.

Monique Ramsey (35:45):
Now in general, I guess, and I don't even know if this is a question you can answer, how common are complications? Can you say one in 3000 people or one in 250 people? I mean, is there kind of any way for patients to think about it or do you have a good analogy for how small of a risk that the surgery is?

Dr. Salazar (36:07):
Yeah, no, I mean, and you can talk about different rate or different things. We've been talking about very different types of complications. If you want to individualize, if you can say how common is that a patient bleeds? Well then at that point you're probably going to be talking around anywhere from 0.5 to one to 1.5%. If you're talking about infection, maybe it's around 1% of the time, some very, very light infection that can get treated with antibiotics. So all these complications are very, very uncommon. Most of our patients come in and out and leave the operating room, and we also follow them really closely. We see them the next day after we tell them, do not worry about taking a shower. Don't worry about changing your dressings. We will do that for you the following day. And really the next day, the only reason why we're seeing them is to make sure that there is no problem.

(37:13):
We're not seeing them for symmetry. We're not seeing how beautiful the side of the breast is going to start looking. The only reason why we see them is to make sure that there is no complication, that there is no bleeding. Make sure that the incision is ready to start healing in the right way. We see them back at about a week. Same thing, we're not seeing them to assess if the volume matches perfect. The only reason why we're seeing them is to make sure that there's no infection, that there's no bleeding, that there's no collection of fluid accumulating. So I think the most important part for all of our patients to have in mind is that they will be watched very, very closely by our team and that we are there to intervene. It's not that we operate, and some patients actually, when they see that, we see them the day after surgery in a week, and then we tell them, you're going to come back in three weeks and you're going to come in six weeks or sooner if you need it. They get surprised and they're like, oh my God, I thought that was going to be my last visit. I thought day one, it is like, oh, yeah, no, it's something that we do. And I would say that's something across the board that we do at La Jolla Cosmetic to follow our patients very closely to see if there's a need for any intervention that we need to do.

Monique Ramsey (38:33):
And let's say, even though this isn't complication per se, but say you're talking about symmetry. How long should a patient, things like you say, people swell more on one side or your body is just weird, a lot of the times, however, your body decides to deal with something. So how long, if somebody's thinking, oh gosh, this side's slightly different than that side or higher or lower, when do you want them to wait for things to settle down? At what point is it three months, six months, a year?

Dr. Salazar (39:04):
The first set of pictures, we start taking them about six weeks and we never say, congratulations, here are your set of pictures fantastic before and after. The reason why we take pictures at about six weeks is because the swelling pretty much is starting to resolve. So the swelling is gone. Still, we are working with tissue that is alive, it's tissue that it's going to move, it's going to adjust. It's the way, I mean, I've told some patients that when I got this orange jacket.

Monique Ramsey (39:39):
Which is fabulous by the way, I love it.

Dr. Salazar (39:40):
Thank you. When I got it, they never told me, oh, Dr. Salazar, wait for a couple of weeks and you'll see how it's going to start cinching better around the waist and your arms are going to, because it's completely inanimate tissue. It is what it is. So that's what you're purchasing, that's what you're getting. With surgery, we work with living tissue. So tissue is going to swell up. Tissue is going to retract the implants. We live on planet Earth, there's going to be some gravity. They need to settle, they need to go to their final position. We estimate all these different things. So at about, I mean literally for the first three, four weeks to start paying attention to things you are assessing a moving target. About six weeks we start, we get a nice setup for pictures, establish a baseline. Then at about three months, we're going to have a very, very good idea about where the implants are sitting for good, what's going to be their final position.

(40:35):
The swelling is going to be pretty much done around that time. Then you move into those six months as you're saying, and that gives you a great, great idea of the symmetry of the final result. One of the things I would say, the only thing we do throughout the week is actually we measure breast all the time. Every day we start measuring and looking, and one thing that we see is that to find that woman that has the perfect measurements of their breasts, it actually, it never happens. It doesn't happen. It doesn't exist. It always tends to happen, there's one, I mean, you look at the face, right? One side of the face is a little smaller, the other side of the face is a little bit larger. Same thing happens with breasts. And one breast tends to sit a little higher, and the one that sits a little higher tends to be a little bit smaller, but all within normal anatomical differences, there are cases in which you have a severe asymmetry.

(41:36):
And we can entertain the idea of ways that we can start compensating for that. But sometimes when you have a minimal difference, it's really, really not noticeable if you are not measuring it the way we do very strictly measure the breast. So and then we set about six months, and then at about a year, we always want to see our patients especially well, we review the FDA recommendations, we remind them about certain things that they have to do to the implants and to establish a good, nice follow-up with them. Every yea we like to see them. But also because at a year, the scar, most likely of that small incision, four centimeter incision, well hidden, and very inconspicuous. But we want to make sure that we like it, that it actually has healed the right way. And that after that is going to continue healing and fading little by little up to a point that sometimes it's hard to find them. They're always going to be there, but we want to make sure that we all like them, we are satisfied with that incision, and if not, then we can go ahead and do a quick revision or a little injection of something or some action. But I would say that's our routine.

Monique Ramsey (42:49):
Well, and that's really helpful. And I think when you have your consultation with Dr. Salazar, he'll show pictures and we have them on our website as well, sort of that graduation, here's at a couple of weeks, here's at three weeks, here's six months, here's a year. Then you can kind of see, okay, because I feel like as a patient, if we know what to expect, it's a lot easier to go through it. If we go like, okay, this is what happened with this lady, and I can relax and not be worrying about every little detail. It's just going to take time. In our very immediate society, we want it all happening in perfect immediately. Right?

Dr. Salazar (43:25):
Exactly. Exactly. I purchased my iPhone and I want it to be charged ready and ready to go, even if I just opened it and unpacked it. I want it to be able to use it the entire day. And that's actually the culture that we're leaving in. But again, we have to set the tone and explain to our patients. It takes time. It's part of a process.

Monique Ramsey (43:41):
Yeah, we've been talking about complications all day, but if something happens, what position do you want to be in? Or what advice would you give to a patient?

Dr. Salazar (43:55):
So I would say, remember when we go through this consent, educated consent form decision, and all patients will go in and have this document that we are reviewing, and it's based pretty much on what we discuss with them during the consultation, but you'll see all the different complications that could happen. I mean, the reason why they're there is because they have been described most likely nothing bad is going to happen. But what I tell patients is once they're doing their research in terms of who to have the with, is I want to bring to their attention that if a complication happens, go and have the surgery done with that plastic surgeon, that you really and truly feel close to someone that will be there with you to deal with the complication. Someone that you can trust, someone that you say, okay, so he knows about these complications.

(44:55):
He can take care of them. I feel fine. I can bring it, I can bring this issue up to him, to her, and they're going to be responsible. They're going to be responding. They're going to be, they're going to work with me to resolve all this. And I feel that that's what they're going to find in all of our surgeons at La Jolla Cosmetic people that actually work hand by hand with the patient, and actually people that are knowledgeable have the experience and the heart to actually sit next to the patient, not across the table where the patient's sitting. So we have this complication, let's get going, let's start treating it. We're going to give you this, we're going to give you that. These are the different scenarios that we're going to be facing. Let's see you tomorrow. Let's see you the following day. I would normally see you in a week, but you know what? Let me watch you even closer. I want to make sure that we are heading in the right direction. So that's something that is important.

Monique Ramsey (45:55):
Yeah, so it's not just about really picking the plastic surgeon for your surgery, but thinking in the rare event something goes wrong. Do I trust them to help me through it? Do I trust them to be my partner in good times and in bad? Right.

Dr. Salazar (46:10):
Exactly. Exactly.

Monique Ramsey (46:12):
And I think I'll put

Dr. Salazar (46:15):
You put it correctly.

Monique Ramsey (46:16):
Yeah. Yeah. I'll put it in the show notes because we do have a blog post about medical tourism.

Dr. Salazar (46:25):
I was going to say.

Monique Ramsey (46:25):
And that's the thing, I think you and I have talked about that before where save a little money, I'm going over here and getting my surgery. What if something goes wrong? Where is that person? Are you going to fly back to Turkey? Or you have to think about those things. So we'll put a link to that blog post. And I think one of you and I, when we had our breast aug podcast, I think we talked about that. So I'll let everybody know that. Well, thank you so much for all this great education today. I assume,

Dr. Salazar (46:58):
Oh, I'm so happy.

Monique Ramsey (47:00):
I think, like I said, if we kind of know what to expect and we can kind of hit some of these complication topics head on, I think that's really helpful for patients to know that here are some of the things that can happen. Here's how often we might see it, almost never. But if it happens, here's how we fix it. And so I really appreciate your time today. And for everybody in the audience, if you're listening and we want to ask you a special favor, if you love our podcast, if you learn something from it, write us a review. We would love it. And if you have any ideas on other topics you would like to hear from us and any of our plastic surgeons, please let us know. And we'll have everything in the show notes, in terms of links about scheduling, our financing reviews, photos before and after photos. All of that great stuff will be in the show notes. So thanks everybody for today. We'll see you again next time.

Dr. Salazar (47:57):
Thank you so much Monique.

Announcer (48:03):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XiMed Building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @LJCSC. The La Jolla Cosmetic Podcast is a production of The Axis, T-H-E-A-X-I-S.io.