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The internal bra isn’t really a bra, rather it’s a supportive dissolvable mesh used to hold breast tissue in place as it heals from breast surgery, allowing your body to build its own collagen around it.
Dr. G & Bri cover:
- Can you really stop wearing a bra after internal bra surgery?
- What’s the deal with pig skin vs. mesh for internal bras?
- Does the mesh stay in forever, or does it dissolve over time?
- How much does adding mesh bump up the price tag?
- In what situations is mesh necessary?
- What types of breast surgeries can include mesh?
- What’s a “double bubble”?
- Can you feel the mesh at all?
- Can you see the mesh over implants?
- What’s the buzz about the new Motiva nanotextured implants?
- Does mesh change the recovery process?
- Dr. G’s preferred mesh brand, DuraSorb vs. GalaFLEX
Trending stories
Dazed, We are about to enter the ‘Undetectable Era’ of beauty
Internal bra-related stories
Daily Mail, Women in their 70s no longer need to wear bras thanks to £6,000 de-sagging ‘internal bra surgery’ which involves pig skin
Harper’s Bazaar, A Better Kind of Breast Lift
Transcript
Dr. G (00:02):
You are listening to another episode of All the B’s with me, Dr. G and my scrub tech Bri. Alright, welcome back to All the B’s. We had the best gift ever.
Bri (00:12):
Best gift.
Dr. G (00:13):
From Eva for our Diet Coke, I won’t call it an addiction, maybe a love.
Bri (00:23):
It’s an addiction. The first step is admitting.
Dr. G (00:26):
Which we got monogrammed Diet Cokes, Diet Coke T-shirts.
Bri (00:35):
This will live forever, forever in a glass box in my house. Personalized Bri, Diet Coke. I mean I don’t think there’s anything better.
Dr. G (00:46):
There really isn’t. It was a spectacular
Bri (00:49):
Best gift.
Dr. G (00:49):
And surprising gift. Yes, that we appreciate
Bri (00:53):
Diet Coke for life. If you’re listening, Diet Coke sponsor us.
Dr. G (00:58):
Speaking of Diet Coke for life. Before we get started with Daily Mail headlines, it’s hard not to chit chat about The Secret Lives of Mormon wives. And I think they call that Mormon beer because they drink Diet Coke also continuously through the show. But they do add coffee creamer to it, which is disturbing on so many levels.
Bri (01:21):
And so many types of different syrups.
Dr. G (01:25):
Yes, they add syrup.
Bri (01:26):
Did you see that?
Dr. G (01:27):
Yes.
Bri (01:28):
Protein, coffee or protein Diet Coke is also trending. Not sure how I feel about that. Would you try it?
Dr. G (01:36):
I don’t think I can do it.
Bri (01:36):
I don’t think so either.
Dr. G (01:38):
I mean why mess with perfection? Just leave the Diet Coke alone. I don’t even like it on ice.
Bri (01:44):
And they don’t just pour a little bit of creamer. It’s like a little bit of Diet Coke with their creamer.
Dr. G (01:51):
Yeah, it’s like a f@*# up root beer float. Why? Right. Instead of ice cream you’re gonna use creamer, instead of root beer, we’re going to do diet Coke. Why? It’s an abomination.
Bri (02:02):
Don’t do it. And they say they have it like six days a week.
Dr. G (02:06):
Yeah.
Bri (02:07):
That cannot be healthy.
Dr. G (02:08):
So let’s go to some other headlines, preferably ones that don’t have anything to do with P Diddy.
Bri (02:16):
We could do a whole podcast just on P Diddy.
Dr. G (02:20):
We have questions.
Bri (02:22):
Many questions, comments and concerns.
Dr. G (02:26):
So let’s see, first article, right The undetectable era. Do you know who that is, Bri?
Bri (02:34):
I do. I was just wondering why the word undetectable was in there.
Dr. G (02:40):
So this article was about the undetectable era of beauty, meaning that Christina Aguilera’s recent appearance in which she looks 23 again, but she doesn’t
Bri (02:52):
Snatched.
Dr. G (02:52):
doesn’t look obviously done. I don’t know. She looks like a filter honestly. Right?
Bri (03:00):
She does look like a filter. Everything looks perfect and blurred and her jawline and her nose and her, she has zero wrinkles. I don’t think she has a pore.
Dr. G (03:11):
Yes.
Bri (03:13):
I don’t know if undetectable is the word I’d use, but it is perfectly done.
Dr. G (03:18):
Right. So she doesn’t have stigmata of plastic surgery, in that she doesn’t have an overfilled face or overfilled lips or her nose looks good. It doesn’t look scooped out. Her eyes look bright and tight and not fox eyed or eyebrows are good. Everything looks good.
Bri (03:41):
Yeah.
Dr. G (03:41):
It just looks almost unreal in the fact that she looks so good with no obvious signs. She is skinny AF, which
Bri (03:48):
Amazing
Dr. G (03:49):
GLP-1s for the win is. I mean, that has to be it, right?
Bri (03:54):
I think she came out and said she wasn’t. did she or no?
Dr. G (03:58):
I think she did because I mean otherwise you really need to get your trainer or nutritionist out there and be celebrating them.
Bri (04:07):
Right? Don’t gate, keep please.
Dr. G (04:10):
Yeah,
Bri (04:11):
She looks amazing. She looks, she did a total 180.
Dr. G (04:16):
Yeah, she looks really good and everyone’s like, well what is this going to mean for beauty standards and mental health? First of all, I’d like to see an unfiltered picture of her, which we don’t have. So what does she look like without the filter? But I mean she does still look good, but maybe she looks less like an avatar without the filter. And then yeah, she does look good without looking super weird. So there was somebody else in this article that they commented on who also looked really good that didn’t overdo it. I can’t remember who it was. Not Megan Fox for example.
Bri (04:49):
I was going to say, don’t say Ariana Grande.
Dr. G (04:52):
I think it was actually, but she’s still really young anyway, so she also looks good, but made up, done up. They definitely look like they’re having work done, but it’s not super bizarre.
Bri (05:06):
She claims to have had no work, Ariana Grande. She says she has not had a rhinoplasty and I looked very heavily into both photos of her nose and there’s no way she has not. She also says she has not had Botox or filler in four years. Homegirl also does not have a single wrinkle on her face.
Dr. G (05:26):
Right.
Bri (05:26):
So I’m not sure.
Dr. G (05:28):
I mean, I feel like there’s always workarounds, right? So maybe she has a liquid rhinoplasty. I didn’t have rhinoplasty, but somebody used filler in my nose and that’s accomplishing what I want it to do. Or there are some not commonly used treatments that are not Botox that maybe she means she’s using Xeomin. You know what I mean? I feel like there’s so much telling, not omitting the truth, but yeah, I mean she looks cute there. She’s just, if you lose a little weight and you pull the hair back even tighter, I think you look a little different. She’s just younger there. She has a fuller face. She’s younger and now she’s definitely more sculpted, which is fine, I guess. I think she looks cute. She looks adorable. Her nose looks definitely smaller. Honestly, she looks like she’s had buccal fat pad removable, which she’s not denying, right? I can’t imagine she’s like having a facelift. Not yet, but I’m open. She’s not dismissing cosmetic surgery in general. It’s just you could do Ultherapy, you could do non invasive skin microneedling, you could be doing pretty intense facials. There’s a lot of things you can do and still say I’m not doing Botox or fillers, so I take it with a grain of salt. Looks good though.
Bri (06:56):
I need to be doing the facials she’s doing. And beauty standards are so hard because plastic surgery is so widely accepted nowadays, but at the same time it’s like you have to be natural and you don’t want to talk about it. And it’s, my daughter sits in front of her mirror and she is applying skincare five times a day and she’s nine. And I’m like, I don’t think this is okay.
Dr. G (07:21):
Yeah, it definitely is influencing a lot younger and younger children so that they’re more concerned about their skin, which I don’t mind if as long as it includes sunscreen. If you’re nine and you’re interested in some skincare and sunscreen’s part of that. Cool. Yeah, it’s just I do think being kind of obsessed with your image is a tween thing to do, but also there’s a kind of a point where it just becomes too obsessive. Speaking of people’s facial transformations, I think Barry, I can never say his last name. I think it’s Keoghan or something like that.
Bri (08:00):
I can only think of one thing in one scene if you know what I’m talking about, every time I see him or hear his name. And that will never change
Dr. G (08:09):
If you know, you know.
Bri (08:11):
Yes.
Dr. G (08:12):
It was Saltburn, right, was the movie?
Bri (08:13):
It was Saltburn. I can’t say anything else, but I can’t look at him any differently. That is him.
Dr. G (08:22):
I would just say again, he’s just aged. What? Show a picture of someone who’s still baby faced in their early twenties and now they’re older and they lost the baby fat. I don’t know. He has some wrinkles. He has less fat in his face. I feel like his nose looks exactly the same. And I think the other thing that you tend to discount, even with the Ariana pictures, they’ve had 10 years of media training in between these pictures. So they know the perfect angle to hold their face. And in the first picture it’s way more candid. It’s an image of Barry just sort of, he’s not even looking directly into the camera. The second one is what my 12-year-old would call his smolder. It’s so carefully crafted look, and they are careful about presenting that. So I think it’s just a totally different angle. lighting, all of those things can really make a difference. And I don’t think he looks dramatically different. I don’t know.
Bri (09:31):
Me neither. He needs some sunscreen.
Dr. G (09:33):
He does. That was my comment. I couldn’t look past the fact that his skin, he really needs to wear some sunscreen.
Bri (09:40):
He needs the IPL.
Dr. G (09:41):
Get off that sun damage because you look at his forehead closely and there’s lots of hyperpigmentation and that is not going to go well. So that’s my advice.
Bri (09:50):
He’s too young to have aged.
Dr. G (09:52):
Skincare, all those freckles. Yeah. Great, your jawline looks 28, but your skin’s going to be 45 shortly and he was so pale, what happened?
Bri (10:05):
Look at his skin. Wow, that’s, he’s totally changed. He does have really good cheekbones.
Dr. G (10:11):
Yeah, he has good jaw structure and he just lost his baby fat. But yes, he needs to go back to the sunscreen for reals. That’s all I’ll say about that.
Bri (10:19):
He’s giving me like penguin vibes. Have you seen the show? The Penguin?
Dr. G (10:26):
Okay. All right. Let’s see what else we got. He looks great, but it’s really about how he’s posing honestly at this point. So moving on. Alright, what’s our next article?
Bri (10:40):
The internal bra, some topics. Women in their seventies no longer need to wear bras thanks to the de sagging internal bra surgery, which involves pig skin. Thoughts?
Dr. G (10:55):
Oh God, this article, I mean, women in their seventies no longer need to wear bras. Not true. Please wear a bra no matter what your age is or what surgery you do, you should support your breasts. I mean, you can not wear a bra for some part of the time, maybe in a certain dress, but gravity, we live on a planet with gravity. So the point of a bra or a camisole or some sort of light compression is just to help fight gravity. So anytime you have implants or heavier breasts and they’re pulling down a little bit, just support them with a bra. And then the internal bra surgery, we were just talking about this at our national meeting, the increased use of mesh or pig skin. We can talk about the different types of internal bras, but that it’s actually a misnomer. It’s there to support your breast tissue while it heals and creates its own collagen.
(11:58):
It is not some anti-aging process. So after this procedure is done, your tissues are going to age and sag over time just like it normally would. Maybe less quickly if you’ve added the support of the internal bra. And there’s a lot of different reasons you might use an internal bra, but I don’t know. I think it’s getting hyped and I think it’s important in certain cases, but I don’t think it’s the just put internal bra everywhere and everyone’s breast problems are going to be solved. Now with regards to pig skin, that’s just one of the options. It’s called Stratus. It’s a pig derived dermis that’s been like de-natured and stripped of any cells. So it’s essentially a scaffolding. It’s a little less expensive than using human dermis as you can imagine. So for a cosmetic revision surgery, breast surgery, we often would use the pig skin, it stretches a little bit.
(13:03):
Now we have an alternative, which is bio absorbable mesh, and there’s three currently, well, four currently on the market that are available. They are not FDA approved for internal bra surgery if that’s not a CPT code associated with that. So it’s off label use, so this mesh, which is often used for hernia or abdominal wall support. So I in my practice, I use the mesh. You don’t really need the pig skin just because it’s more expensive and often doesn’t offer what I need, which is less stretching. But you can definitely see that the internal bra supports the tissue, your own tissue, and then it eventually breaks down or gets incorporated depending on which kind you’re using. And then it helps those who have either aging skin or deflated skin or a larger implant or an implant. There’s lots of indications for it, but I would not say, oh yeah, and then you’ll never need to wear a bra. It’s a little aggressive.
Bri (14:13):
Does it stay for life or it just absorbs over time? It’s not something you can take out later?
Dr. G (14:19):
So yeah, it should, it’s not something you can remove later, ideally, unless someone’s not done the job properly. So instead of pig skin, when you use the human dermis, a lot of that scaffolding has been used in breast reconstruction. And so we’ll use either mesh or a human derived dermal scaffolding, also known as an ADM to support the implant when you place it in a mastectomy pocket. And then that plus your mastectomy skin incorporates your own body lays in collagen, elastin, blood vessels, and then slowly breaks down either the mesh or the skin dermis that’s been put in there and then it should be gone or fully incorporated. In certain cases, if it doesn’t adhere or doesn’t stick to your own tissues, it will literally just float around. And so that was a huge problem with implant-based breast reconstruction. If somebody had fluid collecting in that pocket, you needed a drain, then it can’t stick to your tissue and it can’t incorporate.
(15:29):
And so it just sits there and floats around until they get an infection and then you have to go back in and take it out. So you definitely need a drain when you’re using the skin substitutes. When you’re using the mesh, the nice thing about the mesh is you don’t need a drain, and as long as you also have that next to your own tissue, it incorporates pretty quickly. So one of the controversies about, does it go away, is there are some surgeons that take these little pieces of mesh, GalaFLEX is one of the more popular options out there, and just shove it in the pocket and say it gets incorporated and they don’t suture it in place. You’ve done surgery with me. This is kind of the painful part is suturing that in place around the implant or around the breast tissue and making sure it’s secure, making sure it’s in the right place, making sure it’s carefully approximated to the tissue. But some people feel like, oh, that’s just extra work. You will be fine. It’s fine. So they shove it in there.
Bri (16:33):
It’s fine.
Dr. G (16:35):
And then at this conference, people presented cases where they had to go back in after somebody else had done that. And my friend Danielle Leblanc, who’s in Fort Worth, Texas talked about basically pulling up these little rolled up cigarettes of mesh, because the mesh didn’t stick where it was supposed to stick. It kind of rolls up on itself as the implant is moving around and then it just sits there and it’ll take several decades for that to break down. Instead it creates a foreign body reaction. And when you go back in there to redo the surgery, there’s this little rolled up mesh cigarette that’s just floating around. So moral of that story is in general to take that mesh, which is supposed to support the lower pole of the breast, secure it to the inframammary crease, which is the crease at your breast where the bottom of your breast sits, and then secure it either laterally or medially so that it provides an internal sling. It’s like a demi cup bra. That’s the idea behind doing this. And I guess most of us would recommend fixating it to something and not letting it float around.
Bri (17:46):
I can’t believe anybody even lets it float around, just watching what we do in the OR. I was like, there’s no way it would just be a waste of mesh.
Dr. G (17:55):
It really is. It’s shocking to me. But there are several actually pretty prominent plastic surgeons who swear by just shoving it in there. One of their arguments is that they’re putting in such an enormous breast implant or whatever that there’s no space for it to float around. But a lot of things we do in plastic surgery, like closing in layers, we’ve talked about the diastasis repair and abdominoplasty, I close in two layers. When I did breast reconstruction, I often put in two drains in case one of ’em didn’t work. A lot of what we do is belt and suspender because you don’t want to have to go back and repeat what you did and leave nothing to chance, especially on elective cosmetic surgery. So I just don’t know why you wouldn’t do the little bit of work upfront. But like I said, not everybody does that.
Bri (18:45):
That’s crazy. So the mesh, you do not have to have implants to have mesh in? You can just have your own breast tissue, you can have implants. It’s pretty universal?
Dr. G (18:57):
So yeah, so I don’t put mesh in every breast lift I do again. So now again, at the same meeting that we just had, our national conference, somebody who is in the Orange County area puts mesh in every breast case. And I was like, I’m sorry, did I, what? I was like, do you have mesh in your coffee right now? What’s going on with the mesh? And that’s the thing is there are always people who will take on something like this full force, and I think it’s great good for them because he’s going to put mesh in everything and by listening to him speak and learning from him over the next several years, we’ll figure out what the true indications are because we’re going to put it in everyone. After a while you’ll figure out who doesn’t need it. So he puts it in every primary breast augmentation where I can honestly say I’ve never put it in any primary breast augmentation, that means somebody that is getting implants for the first time and doesn’t need a lift, he says it’s like an, he’s doing everything he can to support that implant and give you a longer longevity with your surgery. Which is, I guess you could make that argument, but in my experience, 99% of people don’t need that extra help. But again, this is where the differences lie, right? He’s in Orange County, they tend to put larger implants in on average. So if you are supporting a 600 cc implant, then maybe, yeah, you want to add a little mesh in. If I’m putting my average size of 300, 350 cc implants proportional to that patient and in line with what she wants, they don’t really need a mesh to support it. And then the other big trend is doing subfascial breast augs, so putting it under the breast tissue and not under the muscle.
(20:50):
A lot of times if you’re going to do that, people are, that’s trending, it’s becoming more and more popular because then the muscle doesn’t move and your implant doesn’t move. So animation issues, however, now you have to deal with the downside of doing it subfascial. So more implant visibility and less support for the implant. So one way you get rid of the support problem is then you add mesh. One way you get rid of the implant visibility problem is that you do what we call a composite breast augmentation and you add some fat transfer to the upper pole. Again, most of my patients are pretty happy with their submuscular or partially submuscular breast implants. So that is a one operation versus doing a breast augmentation that then requires mesh and fat transfer, and you’re making what was relatively a simple operation, more complicated.
Bri (21:42):
So what if you have no breast tissue when you do a subfascial implant, can you see the mesh? Is there ever a time where you’re like, oh, that’s it? If you’re just skin on implant.
Dr. G (21:56):
Yeah. So then you’re like, what’s the implant or what’s the mesh incorporating with? Right? So it’s one end of it is sitting against the implant, which isn’t going to do anything. The other side is on your skin, that needs to be incorporated. And so it’s interesting, GalaFLEX, one of the major producers of this P4HB mesh has their regular mesh and then mesh light, which is a thinner version because then that way you break it down faster. They also have a version that has a rim around it that I used a couple of times. Well, that little rim is easy to manipulate the mesh because it holds its shape, but you can feel it along, it’s almost like having underwire, but in your actual breast, like you can feel internal underwire. And so patients would be like, when’s this going to dissolve? I’m like, two years?
(22:45):
So yeah, you can feel it, so I started cutting it off and then they made the mesh without the plastic rim on it, which it was still dissolvable, but it’s not mesh anymore, so it takes a lot longer for that to dissolve. So for thin people, yeah, you’re going to be able to feel that mesh until it gets incorporated. And that again, I will echo my sticking to my guns about suturing it in place because then it’s set tight and right as we like to say.
Bri (23:16):
Tight and right.
Dr. G (23:17):
And it’s not folding or wrinkling because then they’re going to feel that as well. Nobody wants to feel a wrinkle inside their breast where the mesh is starting to wrinkle up like a bedsheet that’s not pulled tight.
Bri (23:31):
So is there anyone that you would say no, I will absolutely not put mesh in you? What would be the ideal candidate for somebody that wants mesh?
Dr. G (23:40):
I think the best people, so for breast revision surgery, so a patient comes in and she’s already had an augmentation and we’re revising it for some reason, downsizing, upsizing, one implant’s too low or too lateral. Any kind of malposition mesh is great because our previous techniques were to just internally suture the pocket and it just didn’t last long enough. It just doesn’t stay. And the implants to go back to where they were, so if there’s malposition, mesh is perfect for that. And I’ve used it in patients who are like, yeah, I have the, what we call, can you explain to everybody what a double bubble is? Do you know what that is?
Bri (24:22):
I don’t think I’ve heard of that.
Dr. G (24:22):
Oh, okay. That’s when you see at the bottom of the breast, you see the implant and then another bubble of breast tissue. So you have the implant
Bri (24:34):
Like when it bottoms out, kind of?
Dr. G (24:37):
Yeah. But then you can see almost, you see where the implant is and then you see where the breast tissue is above that. So it looks like a double bubble from the side.
Bri (24:49):
We don’t want that.
Dr. G (24:50):
Nobody wants that. So now you got to get the implant back up underneath the breast. Here’s an example of it actually on the screen. So one way to handle that is to put mesh in to secure everything in the right place. So that will support it, because just doing some internal sutures inevitably doesn’t last long enough. So that’s a great reason. If the implants sliding out to your armpit, then when you lay down and it’s like trying to make a break for it, then definitely mesh.
Bri (25:22):
Come back here.
Dr. G (25:23):
Yeah, definitely mesh to secure that. So it is really good for implant malposition. I love it for that. For patients that have had massive weight loss or significant weight loss rapidly, which is becoming more and more trendy with GLP-1s, then supporting your tissue, which might not have the same elasticity as that person who’s coming in, who’s 22 and never had kids, right? They have no stretch in their skin, so they’re going to support the implant. If you’ve had kids and your skin has been stretched out or you lost weight and your skin has been stretched out, or you have a lot of sun damage or whatever it is, then mesh is a great way of helping your body add collagen and elastin to the party and support your skin a little bit better. So it’s awesome for that, which is why I use it in breast lifts or reductions where they have maybe a little bit less, they’re laxer skin, so it holds up longer and lasts longer.
Bri (26:22):
And what mesh do you prefer to use in the OR? Or is it patient dependent?
Dr. G (26:28):
No, it’s not patient dependent, I don’t think. I mean, people are, I think the biggest thing to talk to patients about is if you’re going to use a dermal substitute like the pig or human dermis or a mesh that’s made up of some suture material. In the same way, I wouldn’t offer them, what suture should I close with? We’ve got this for you. So I did a lot with GalaFLEX and now I use DuraSorb, and they’re both very good and equivalent. There’s some subtle differences in the stretch dimension, but it really is, they’re very similar. There’s something else called tiger mesh that I have, not my gotten my
Bri (27:13):
Ooh.
Dr. G (27:13):
I know it’s not printed or anything. It’s not like cheetah printed. I don’t know what I imagined.
Bri (27:18):
So fabulous.
Dr. G (27:23):
I have not tried that particular mesh. And then there’s another one that I did try that’s Ovitex, which is like, it’s the Goldilocks of mesh. Like, do I want to use pig skin? Do I want to use something that’s suture based? Oh, I know, we’ll put the two of them together, and then you have one side is actually pig bladder and the other side is a mesh. I tried it.
Bri (27:49):
What would be the benefit of that?
Dr. G (27:50):
I don’t know. I just.
Bri (27:51):
Sounds better.
Dr. G (27:55):
I don’t know. I mean, I do love plastic surgery, the field, because there’s always innovation and people are always trying different things. And it really mesh itself has helped tremendously because with the removal of textured implants off the market, they also remove textured tissue expanders, which were critical for breast reconstruction. So now you have a smooth tissue expander. So it’s basically a deflated implant that you put in a woman who’s had a mastectomy and then you inflate it in the clinic over time. Well, if that’s smooth, it’s just floating around. Those used to be textured. So now they’ll wrap them in mesh and put them in so that it sticks a little bit better. So it’s a way of working around the fact that we don’t have textured implants available.
Bri (28:45):
When you put mesh in, does it change the recovery at all?
Dr. G (28:49):
No, I think it’s actually great because prior to that, when I would just do internal suturing, you’re like, don’t move. Don’t move your arm. You’re always afraid that
Bri (29:01):
I did that. I did the, I sutured my pockets on the outside because I had one that also wants to run away. And the second day I felt so great, and I’m just moving around it all here is a pop. And I was like, oh shit. Yeah, popped the stitch.
Dr. G (29:19):
Yeah. So it’s really hard to be a human being and use your arms after just relying on some sutures. And the number of breast revision surgeries I’ve done where you go in there and you can see, sometimes people would use permanent sutures hoping that that would last longer. And you can just see them just laying there, not doing anything. They’re just sitting there. So I think it’s really great for that. I mean, you still can’t go hang gliding afterwards or what was?
Bri (29:49):
Base jumping?
Dr. G (29:51):
Base jumping? No, you should not go base jumping period. And look it up if you don’t know what it is. Our anesthesiologist didn’t know what it was, but I did have a patient who we did revision breast augmentation, put the mesh in. I have all these patients that are like, can’t wait to work out again. I was like, just hold. They just text me and I’m like, Nope. And they’re like, I knew that’s what you were going to say. Yes, you have to stay still for four to six weeks and let everything incorporate. And then she’s like, what about repelling? And I’m like,
Bri (30:25):
Girl, what?
Dr. G (30:26):
Repelling? No. Where are you repelling, like where?
Bri (30:29):
Where are you repelling from?
Dr. G (30:31):
I don’t know.
Bri (30:32):
And why?
Dr. G (30:36):
I don’t know.
Bri (30:37):
We get that. It’s so many odd requests to do things right after surgery. It’s like when they decide to do everything they wanted to do, it’s like, oh, I’m going to have surgery and then I’m going to go do this
Dr. G (30:49):
Repelling, and literally repelling and paragliding have both been requests to me from after different surgeries.
Bri (30:56):
Skiing the first week.
Dr. G (30:58):
Skiing. Oh yeah. Because boyfriend’s going to hold the skis. Don’t scuba diving. Not even scuba trained, but that’s okay.
Bri (31:05):
No, yeah, don’t go in the water with your incisions not healed either.
Dr. G (31:10):
Yeah. So I’m waiting for the base jumper to let me know.
Bri (31:17):
So after the four to six weeks, patients are generally pretty satisfied with having mesh?
Dr. G (31:23):
They might still feel it or it feels tight. I mean, it’s not going anywhere. You still need to stay in a bra, but it definitely locks everything down. It’s great. If you put it where you want it, it’s not going to go anywhere, and people behave for four to six weeks after surgery.
Bri (31:41):
That’s the hardest part.
Dr. G (31:42):
It really does stabilize everything. And so I’ve been really, really happy with using mesh. I think that has been a game changer for revision breast augmentation. And then the other great use of it I’ve found is in patients where I’m doing either a breast reduction or a breast lift after significant weight loss, and they have that kind of saggy skin with stretch marks that tells me their collagen and elastin is not quite up to par. You do have to change your technique a little bit of how you do that procedure. I like a superior pedicle, and I switch it to a central pedicle often if I’m doing that so that I can get, again, good contact with the mesh to the breast tissue and make sure it’s going to incorporate and sit where I want it to. But we’ve gotten some very nice results using that on patients who otherwise would look great on the table. But then a couple months later you’re like, oh, it’s all stretching out again.
Bri (32:39):
So to clarify, you can use mesh with a breast lift, breast aug, breast reduction, fat transfer? Pretty much almost any breast procedure can be combined with mesh. There’s nothing that’s contraindicated with mesh.
Dr. G (32:54):
Correct. Yeah. We love that. I mean, I guess that’s why people are putting it in their coffee.
Bri (33:00):
Mesh for the win. So when you’re getting mesh, what does it add to the procedure? Is it a lot more?
Dr. G (33:08):
Yeah, that’s a great question actually. So it does add cost to the procedure. Again, I asked my co-panelists who puts it in everything, how he addresses that because he doesn’t give the patients the option to not use the mesh.
Bri (33:23):
That’s crazy,
Dr. G (33:24):
He talks them into it. But again, he’s a little farther north than us, and so his price point, he just wraps it into the cost and it’s more expensive. But yeah, it costs more money to use this product. It can be anywhere from $800 to a thousand dollars for a piece of mesh. So you’re now adding that, and that’s what I’m paying. So that’s a cost that needs to be added to the surgery. So sometimes people are, if I’m on the fence about whether they need it or not, I’ll say, hey, this is the option. This is your surgery with mesh, this is surgery without mesh. If they really need it, if we’re doing a malposition or something that I think needs it, then I’m just like, I’m not going to do it without the mesh. This is going to be the cost because you’re just going to six months or a year from now, you’re just going to need the surgery again. And that over time is going to be way more expensive. So yeah, it definitely adds cost to your procedure. And again, that’s why for a primary breast augmentation, if you don’t need it, I’m not really sure what you’re gaining. You’re adding OR time and you’re adding the cost of this, what we call a consumable, but for patients who it’s going to benefit, yeah, it’s definitely worth it.
Bri (34:35):
You’ll never see me hold something tighter in the OR than something that has a consumable price. I’m like, don’t drop the mesh.
Dr. G (34:44):
That is so true. Yes. Nothing is more expensive than dropping a thousand dollars piece of mesh or even $150 Keller Funnel, which we used to put the implants in. You just cry a little.
Bri (34:56):
That wasn’t me though.
Dr. G (34:58):
I know it wasn’t you.
Bri (35:01):
I have not dropped one of those yet, knock on wood.
Dr. G (35:04):
So yeah, that’s the funnel that we used to do a no touch technique to insert the implant into the pocket, and they’re a consumable cost. And when you drop one, that’s it. There’s no five second rule in the OR, so you got to get another one.
Bri (35:18):
I tried to use that at home the other day, and that didn’t work either. Like five second rule is not a thing anymore.
Dr. G (35:25):
No. One of my kids, when they were in elementary school, they all had to do science projects and some kid in their class did the five second rule tested it, which was amazing.
Bri (35:37):
That’s a great idea.
Dr. G (35:38):
Yeah. So anyone with kids, that’s a good project to do.
Bri (35:41):
I want to know his results.
Dr. G (35:42):
They were a little daunting, actually.
Bri (35:45):
I wonder what my orange chicken on the floor the other night was.
Dr. G (35:47):
Yeah, don’t culture that. So yeah, so I think I forgot what we were talking about. Oh, the Keller funnel, dropping things on the floor. Yeah, you don’t want to drop the mesh. It’s a thousand dollars mistake. And then same with the Keller funnel, which is a much cheaper mistake, but still painful. Yeah. Got to keep things away from gravity. Gravity is not our friend in general.
Bri (36:09):
It is not. I was going to say, sometimes we see who drops the most stuff. I can tell you right now, it’s Dr. G.
Dr. G (36:22):
I know. Okay. So
Bri (36:23):
She just likes to excel in everything she does.
Dr. G (36:27):
Right. So sometimes what is least expensive to drop, like a lap pad or a sponge or something like that. Yes. Sometimes that hits the ground. And what can you do?
Bri (36:43):
Just keep count.
Dr. G (36:45):
I’m focused on the surgery. I can’t be responsible for keeping things. If you’re listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restoresdplasticsurgery.com or follow us on Instagram @restoreSDplasticsurgery. If you enjoyed this episode, please share it and subscribe to All the B’s on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.
About Restore SD & Dr. Katerina Gallus
As the Director of Restore SD Plastic Surgery, board certified female San Diego plastic surgeon Dr. Katerina Gallus has over 20 years of experience helping patients enjoy head to toe rejuvenation with face, breast and body procedures. After a successful career as a Navy plastic surgeon, Dr. Gallus founded her San Diego plastic surgery center, Restore SD Plastic Surgery, with the intention of creating a welcoming space for anyone seeking cosmetic enhancement.
Restore SD Plastic Surgery offers popular facial rejuvenation procedures like facelift & neck lift, facial fat transfer, nanofat grafting and rhinoplasty; breast augmentation with implants, breast lifts or breast reduction; body contouring procedures such as tummy tuck, liposuction, mommy makeover, and Brazilian butt lift (BBL), as well as non-surgical aesthetician services, BOTOX, dermal fillers, laser treatments, and weight loss injections.
Dr. Gallus and her highly-experienced aesthetics team are here to help you look and feel your best! To schedule a personal consultation, please contact us online or call our office at (858) 224-2281 today. We proudly serve the San Diego and La Jolla areas.
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