By Dr. Philip Richardson
Cosmetic breast surgery including breast augmentation using breast implants, breast reduction and breast lifts are elective procedures that help address aesthetic concerns and in some cases functional concerns.
Cosmetic breast surgery carries physical, financial, and psychological risks. Risks can arise from many different sources. It can range from the sourcing of unverified information on the internet and choosing an unregistered surgeon to the operating table, and they can occur at any point along your surgical journey. So, what can patients do to avoid risk when planning their breast surgery?
The simple answer is by learning as much as possible, from the right sources that are credible. Patients who are in the research phase unfortunately get coerced and confused by ‘click bait buzzwords” and become victims of unethical marketing ploys. Certain operators in the cosmetic industry know all the key buzzwords that act as ‘click bait’ to reel patients.
In this blog post, ASAPS member and Brisbane based Specialist plastic surgeon Dr. Phil Richardson, analyses common terms that are widely used in cosmetic breast surgery marketing such as “rapid recovery”, “medical tourism”, “twilight sedation” and “invisible scars” .
In doing so, ASAPS member and Brisbane based Specialist plastic surgeon Dr. Phil Richardson aims to provide you with knowledge to spot fake and potentially dangerous buzzwords enabling you to make safe surgical choices. This patient safety focus of Dr Richardson’s blog is well aligned with the ongoing patient safety advocacy activities of the Australasian Society of Aesthetic Plastic Surgeons (ASAPS).
The truth about the “rapid recovery technique”
The “rapid recovery technique” is one of the most misleading marketing tactics in the breast augmentation industry right now. Many cosmetic surgeons and even some plastic surgeons use this term to lure patients in by promising a quicker recovery time than “normal” breast augmentation surgeries.
What does this term really mean though? Well, not much. Rapid recovery really is just a buzzword surgeons use to suggest that they have some “proprietary” advanced technology that other surgeons don’t have, which is simply not true.
This misleading punchline can have patients thinking they will be back to running marathons the week after surgery which of course, is incredibly damaging. The idea that shorter recovery is a selling-point is damaging in itself as this should never be a defining factor for patients when undergoing a serious surgical procedure. Rest and recovery is the single most important aspect of avoiding post-operative complications and achieving optimal results.
Most plastic surgeons will tell their patients that it takes a full six weeks to recovery fully. During these six weeks, patients should be resting as much as possible. You should steer clear of any upper-body exertion including lifting your arms above your head and be sure to avoid getting your heart-rate up. Six weeks may seem long, but when you consider that you have undergone an invasive surgery and now have breast implants that need to settle and adjust, there’s no wonder that recovery takes time.
Each surgeon will have their own protocol as to when certain activities can be resumed throughout the 6 weeks of recovery, and you should follow their instructions closely. If your surgeon tries to sell you on “rapid recovery” or tells you you’ll be back to normal in no time, you should seek a second opinion. Disregarding the importance of recovery is dangerous and damaging.
In short, if you come across any surgeon promising a quick recovery or using their own patients as examples of women “bouncing back” right after surgery – beware, it might not happen to you. Remember, every individual is different in how they respond to a surgical procedure.
The truth about “medical tourism”
While medical tourism has been put on hold the past few years due to the pandemic, we will certainly see a resurgence of this type of offering very soon. Medical tourism refers to companies that offer packages for patients to essentially get a “free holiday” with their surgery. The surgeries are usually performed in Thailand, and are notably cheaper than any local providers. These companies use the “holiday” aspect as a selling point, and this can be attractive to patients for a number of reasons.
Firstly, many patients think that having surgery overseas is a great way to keep things private. Away from friends and family, and an excuse to be out of action for a few weeks, medical tourism provides patients with a way to have surgery discreetly. Another common appeal of medical tourism is that patients see this as a way to have a luxury recovery. They imagine that they can lay by the pool while recovering and enjoy their holiday. Of course, there are serious risks that go hand in hand with this mentality.
Medical tourism companies will match you with a surgeon. In almost all cases, you will not have a pick of which surgeon performs your procedure. There are obvious risks associated with this approach as the qualifications, safety protocol, and aesthetic results of the surgeon are completely out of your hands.
Given that these surgeons are located in Thailand there is no opportunity to consult and decide whether this doctor is the right one for you. This is a risky adventure that could leave you feeling uncertain and unsupported in the lead-up to your operation. Generally there is very little down-time between consultation and surgery which has obvious risks and implicates informed consent for patients.
There are obvious issues relating to the recovery aspect. The promise of a beautiful holiday for your recovery encourages patients to go out and about and enjoy their trip. The first week after surgery should be solely for resting, and patients should not be exerting themselves or baking in the sun. In the event of an emergency, you may need an ambulance which will incur significant costs as you are overseas.
During the recovery period you are vulnerable and at a higher risk than usual of running into health concerns. It’s important to understand that medical attention will be more difficult to acquire, less comfortable, and more costly in a foreign country.
The truth about “twilight sedation”
The use of twilight sedation is most common among cosmetic surgeons. If you’re familiar with ASAPS “Know the Difference” campaign, you would be aware of the key differences between practitioners who are not registered surgeons but continue to use the term “cosmetic surgeon” and plastic surgeons. If you’re not up to date with this information, check out the ASAPS blog on this topic. Some “practitioners” are using twilight sedation to perform breast surgery, and it’s putting patients at risk.
So, what is twilight sedation? Twilight sedation is often referred to as “conscious sedation”. This approach involves a small dose of general anaesthesia that places a patient in a relaxed, sleep-like state. In this state, patients are able to breathe on their own. Cardiovascular function is not affected either. Under twilight sedation, the patient is still able to respond, and can follow directions.
This may sound safer and less daunting because patients are not fully under general anaesthetic. The truth is, this is a much risker option and is not recommended by specialist plastic surgeons for breast augmentation, or any surgical breast procedure.
The reason a practitioner offers twilight sedation is simple. These practitioners lack the credentials to operate out of fully-accredited hospitals. Due to this limitation, these surgeons offer breast augmentation operations out of their own clinics. Such clinics do not meet the highest Australian standards of safety and hygiene of private and public hospitals, and as a result are not considered safe to administer general anaesthetic.
There are quite a few risks associated with twilight sedation. Anaesthesia toxicity is a reaction that occurs to excessive local anaesthesia. This can result in a heart attack. This is a huge risk given that twilight sedation is often not administered in a fully-accredited hospital. The patient would need to be transferred to the nearest hospital, increasing risk.
There are also risks associated with breathing under twilight sedation. Finally, if there is not a qualified anaesthetist present, the surgeon will be the one simultaneously operating and monitoring the patient. This has obvious risks for safety and surgical outcomes.
To conclude, while twilight sedation is a great option for minor procedures, it is not the optimal choice for invasive surgeries such as breast augmentation. Specialist Plastic surgeons will always recommend breast surgery be performed under general anaesthetic. Experienced specialist anaesthetists should be monitoring you during your surgery in a fully-accredited hospital for the best safety outcomes. Patients should be wary of practitioners offering conscious sedation for breast surgery, and in this case you should seek a second opinion from a plastic surgeon before proceeding.
The truth about “invisible scars”
Every patient’s dream is to have undetectable scars after breast surgery. Unfortunately, some practitioners will capitalise on this desire by compromising patient safety and overall results. It’s not common, but there are still some surgeons out there that insert breast implants through the belly button, armpit, or around the nipple. The idea of these incision sites is that they “hide” the incision and the subsequent scar. So, what’s the issue? Let’s start with the belly button.
Insertion of breast implants through the belly button (transumbilical incision) can really only be performed using saline breast implants. Saline implants are rarely used in Australia today. This is mainly due to the fact that saline implants will deflate when ruptured, and re-operation is usually desired immediately. New generations of breast implants have focused on silicone implants.
As such, the safety profile of silicone implants has surpassed saline alternatives. In addition, the belly-button incision basically means the surgeon is “going in blind” when it comes to shaping the pocket for the breast implant. There are obvious risks associated with this approach that will affect both safety and aesthetic outcomes.
More common—but still rare—is the armpit incision (transaxillary incision). This method is reserved for saline implants and smaller-sized silicone implants. Aside from what we now know about saline implants, the use of this incision for silicone implants poses its own risks. Much like the transumbilical approach, the distance from the armpit to the breast pocket limits the surgeon. The creation of the pocket is less controlled and can compromise aesthetic results. As you can imagine, the armpit incision will also increase the risk of infection due to the location of the incision.
Incisions around the nipple are another alternative that some practitioners will use to sell “invisible scarring”. Insertion through the nipple (periareolar incision) is an approach that involves incisions made around the lower half of the areola. While this technique provides some greater control over the implant pocket, there are still some prominent risks.
Firstly, this approach has a greater risk of severing the milk ducts and nerves in the nipple. This can lead to difficulty with breastfeeding, or loss of nipple sensation. Secondly, there is mounting evidence of increased risk of bacterial contamination using this approach. Bacterial contamination can lead to complications such as capsular contracture.
Ultimately, breast implants inserted through the breast fold (inframammary incision) are what the vast majority of specialist plastic surgeons use today. While there is a “visible” scar under the breast, it is generally very will hidden in the crease. The advantages of the inframammary incision are decreased risk of bacterial contamination, and greater control and precision over the breast pocket and symmetry. This leads to better safety outcomes, and better aesthetic outcomes.
To conclude, as cosmetic breast surgery increases in popularity, marketing has become a huge focus for practices operating within this highly competitive landscape. Unfortunately, some practitioners will compromise safety and aesthetic outcomes to implement marketing at all costs. Hopefully this blog post provides you with some useful knowledge to help you make better decisions and spot a gimmick when you see one.
Remember, all invasive surgery carries risks and always seek the opinion of a fully-qualified and registered specialist plastic surgeon, and conduct thorough research before undergoing any cosmetic procedure.