![San Diego plastic surgeon Dr. Katerina Gallus and her scrub tech Bri on the episode of their podcast "All the B's" where they chat about capsular contracture [Breast Implant Buzzkill Capsular Contracture]](https://restoresdplasticsurgery.com/wp-content/uploads/2025/06/ALL024-1-1024x576.jpg)
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Did you catch Doja Cat’s breast implant mishap? Because capsular contracture affects some women with breast implants, Dr. G and Bri discuss the not-so-glamorous side of breast augmentation: what capsular contracture is, why it happens, and how it can be prevented or treated.
Motiva implants are getting a lot of attention lately for their lower reported rates of capsular contracture. Hear Dr. G’s take.
Trending stories:
Buzzfeed, Lindsay Lohan Addressed Comments About Her Changing Appearance
DailyMail, Brad Pitt shows off bold new buzz cut while out in LA
Capsular Contracture & Motiva-related stories:
DailyMail, Doja Cat suffers plastic surgery disaster as she begs fans not to notice
Medical Marketing and Media, Meghan Trainor challenges breast implant stereotypes in Motiva’s campaign
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. I’m Dr. Kat Gallus and you’re listening to All the B’s, the unfiltered plastic surgery podcast with myself and Bri. Hey Bri.
Bri (00:16):
Good morning.
Dr. G (00:19):
Good morning to you. So today we’re talking about breast implant complications, the one that’s known as capsular contracture, which hopefully you never have to learn what that is, but if you do, it happens about one in six to one in 10 cases of breast augmentation, and it happens when you have a breast implant in place and your capsule that normally forms in is thin and filmy starts to contract and get thickened and hard and can distort the implant. We’re going to cover that in a sec. First, we want to discuss whatever’s new with celebrities. Speaking of topical is Lindsay Lohan because we’ve talked about her on the podcast already about her new look and how her face looks amazing at 38 or 40 and whether or not she had a facelift and apparently she’s saying no.
Bri (01:19):
Okay, so
Dr. G (01:21):
Please.
Bri (01:21):
I woke up this morning, the first thing that popped up was a Lindsay Lohan saying she attributes her new younger appearance to chia seeds and lemon water. And I was like, this bitch did not, okay? And then she quoted, when would I have time to get a facelift? And they’re like, all the time in the world, you don’t act, love you Lindsay Lohan, but you don’t do anything. I mean, she’s a mother, but
Dr. G (01:48):
She has time to take to run off to Dubai, which we know she’s done to get a bunch of derm procedures. So I feel like maybe she didn’t have a deep plane facelift. If that’s the case, it’s hard to know, but she’s done everything up to that, you know what I mean? Lasers, probably threads, she cops to having tried Morpheus but didn’t really like it. Her skin was so thin and she doesn’t have a lot of fat. Clearly filler, probably Sculptra. I mean, come on.
Bri (02:26):
It’s just so Martha, it was Martha Stewart, right, that attributes her young appearance to horseback riding. She’s like, well, I put olive oil in my juice in the morning. No, Lindsay, that is not why you look the way you do.
Dr. G (02:39):
To be fair, I think it’s Jennifer Lopez that says the olive oil, but she said chia seeds.
Bri (02:46):
Oh yeah. But I read this article, she that
Dr. G (02:47):
Choke that down
Bri (02:48):
That said she puts olive oil in her juice.
Dr. G (02:50):
Oh, she does? That’s disgusting. Yeah,
Bri (02:54):
And if chia seeds made me look like that, I’d be bathing in them. So
Dr. G (02:57):
Yeah, I eat chia seeds in my yogurt and I don’t get facelift results. What the fuck?
Bri (03:06):
I just can’t.
Dr. G (03:09):
It’s just disingenuous to say that it’s her healthy living, which I know is part of it. She’s definitely cleaned up her act and is doing better, is probably sober and drinking lots of water, but come on.
Bri (03:24):
Yeah, there’s no way that’s just
Dr. G (03:27):
Lemon water.
Bri (03:28):
Yeah, absolutely not. Absolutely not. She’s like a whole new person. It’s like Chris Jenner saying she didn’t get a facelift.
Dr. G (03:37):
She’s just, I think Steve Levine’s already copped to that facelift, although in true dissident fashion, my sister thinks she looks awful, is not impressed by Chris Jenner’s facelift, thinks she looks like Michael Jackson or a man or I think it’s because in one of the clips she’s wearing that oversized blazer. I’m like, she hates her hair. I was like, wow, okay. Got to have her come on the podcast.
Bri (04:03):
I can totally envision the way your sister’s saying that too. Right? Her sister’s like her twin. It’s really funny when they’re both in the office and they both roll their eyes the same exact way. I can go on a whole tangent.
Dr. G (04:16):
Yeah. So anyway, yeah, not impressed with that facelift. I think Steve Levine’s probably crying inside.
Bri (04:22):
I thought it was good. I thought she really looked younger.
Dr. G (04:25):
I thought she had a lot of filters in place, which to be fair, so does Lindsay Lohan, but
Bri (04:31):
Right. Yeah.
Dr. G (04:33):
Okay. Well, speaking of updates that have nothing to do with facelifts, how about the Taylor Swift subpoena for the Blake Lively lawsuit.
Bri (04:44):
I’d be so pissed.
Dr. G (04:46):
They’ve already rescinded the subpoena. They said, just kidding, we don’t actually want to do that. But I guess according to them, they were just concerned because Blake Lively was already texting Swift to publicly side with her.
Bri (05:03):
She should know better than that. I feel like Blake has, or no, Taylor has tried really hard to keep this appearance of being this perfect good girl. And then the last thing I’m sure she wanted to get in Blake’s drama.
Dr. G (05:18):
Yeah, she doesn’t do drama. Yeah, no.
Bri (05:22):
Yeah, absolutely not.
Dr. G (05:24):
Burned another bridge. God, is it March? I mean, as soon as the P Diddy trial ends, we can roll right into this one. Honestly.
Bri (05:32):
I know. It just keeps getting worse and worse.
Dr. G (05:36):
Okay. All right. That’s a quick update in case anyone’s following because I feel like that’s their goal is to keep it front of the news until their trial starts in March of 2026.
Bri (05:49):
Right.
Dr. G (05:50):
Am I right?
Bri (05:51):
Otherwise people are going to forget about them in their movie.
Dr. G (05:55):
I guess at the end of this article it says that the movie made an S ton of money. It made quite a bit of money in the end, even though it was a sucky movie. Yeah, it definitely made a profit. So it is working out for them. Of course, they’re going to blow all that profit on lawyers for these stupid suits, but I feel like it maybe cost 50 million to make and made 250 million or something like it did well.
Bri (06:24):
I’m so surprised
Dr. G (06:26):
Here, It Ends With Us, was a box office hit according to whom? 351 million worldwide despite a 25 million budget, none of which was spent on Blake Lively’s outfits during the shoot.
Bri (06:42):
Absolutely not.
Dr. G (06:43):
Those were thrifted.
Bri (06:45):
Those were terrible. And they said, didn’t she triple her budget for outfits? And she still looks like that.
Dr. G (06:51):
Yeah.
Bri (06:52):
I just think that I feel like this movie maybe got popular after the lawsuit.
Dr. G (06:56):
Yes, that’s what I’m saying.
Bri (07:00):
Because I didn’t even know anything about this movie, which is kind of sad because for the message, it’s supposed to be portraying something so close to a lot of people’s hearts. I didn’t even know it was about domestic violence until way after the fact. It’s about Blake’s haircare.
Dr. G (07:16):
And flowers
Bri (07:20):
And bad outfit choices.
Dr. G (07:22):
Oh my God. Okay, well let’s talk about someone we have positive things to say. Brad Pitt got a buzz cut while out in LA and looks good.
Bri (07:36):
I haven’t heard a lot about Brad Pitt. Definitely good with the buzz cut. Men if you’re listening. Cut your hair.
Dr. G (07:46):
A shockingly short buzzed haircut spotted behind the wheel. I think he looks great. He doesn’t look like a, I don’t know.
Bri (07:55):
Is he dating anyone?
Dr. G (07:57):
I don’t know actually. I think he’s been laying low lately. He had time for a facelift. I’m just going to throw that out there and did fine. You could see there’s that little patch of non hair bearing skin in front of his ear, which is weird. Yeah, he looks awesome. Props.
Bri (08:15):
He looks good. Just like Ben Affleck in The Accountant 2. Slay.
Dr. G (08:21):
Slay. Yeah. And he’s 63 he looks like honestly amazing.
Bri (08:26):
He does. It’s the lemon water and chia seeds. Oh, right. But he also rides horses.
Dr. G (08:33):
I feel like he’s just like Ben Affleck. I don’t know that Brad Pitt, if somebody wants to call in and let us know or comment, I feel like he might be a smoker. I know Ben Affleck smokes. What’s her face smokes. Jennifer Aniston’s a smoker.
Bri (08:51):
Really?
Dr. G (08:51):
Yeah. A lot of these people shockingly are,
Bri (08:53):
She doesn’t believe in Botox either, right?
Dr. G (08:56):
No, I think she does.
Bri (08:57):
Oh, okay.
Dr. G (08:59):
But yeah, they’re all like have to go get their oxygen facial so that they can counteract the chain smoking.
Bri (09:07):
I always love all these people that are anti Botox, anti filler, but then they do have all these other gross habits and it’s like just get the Botox.
Dr. G (09:17):
Right? Yeah, put the cigarette down, get the Botox. And then speaking of somebody who cops to plastic surgery all the time, Kim Kardashian fans are convinced she could be eyeing political career at the White House, all caps, after an inspiring post. I mean, honestly, at this point anybody can be president, so go for it girly.
Bri (09:47):
She could be the new attorney at the White House.
Dr. G (09:49):
She could do anything.
Bri (09:50):
New press staff.
Dr. G (09:52):
Do we all get free skims if she becomes president?
Bri (09:55):
Oh my God, that would be USA. Nothing says USA like skims. She also already has the Olympic collection ready to go.
Dr. G (10:03):
Right. Let’s do it.
Bri (10:06):
So where is she wanting to be in the White House?
Dr. G (10:09):
I don’t know. First of all, just like everything else, it gets twisted in the comment section. They think graduation from law school is a step. She did not graduate from law school. Full stop. She graduated from a law program and which is basically following a lawyer around until you meet the requirements to take the bar, I guess. But no, I love how they keep saying graduation from law school. She did not graduate from a named credited law school. I could follow around.
Bri (10:46):
I’m going to follow you around and then I’m going to be a plastic surgeon.
Dr. G (10:50):
Yeah. She chose a rigorous program registered with a California state bar building on 75 college credits to complete a four year curriculum that’s stretched to six.
Bri (11:05):
I just didn’t even know that was a thing.
Dr. G (11:07):
I feel like
Bri (11:08):
They really thought you had to go to law school, all these people paying all this money to go to law school and you can just shadow someone?
Dr. G (11:14):
I don’t know. Only if you’re Kim Kardashian and you have six years to chip away at it. I mean, she works, believe me. I get it. She’s pretty busy, but I don’t think she wants, I mean, I don’t think she wants to go.
Bri (11:27):
Is that really what she wants to do?
Dr. G (11:29):
I doubt it. I don’t understand.
Bri (11:32):
You don’t think they can film in the White House?
Dr. G (11:36):
I mean, maybe we need to bring a reality TV show to the White House. That might be the way to do it .
Bri (11:41):
Now that would be gold if anybody’s listening and that can make that happen.
Dr. G (11:47):
Yeah, see, it’s called Reading the Law a four year law office study program, and then she still needs to pass the bar exam, which if you’re going to pick states where it’s freaking hard to pass the bar, this is it. California is incredibly difficult and so is
Bri (12:08):
She hasn’t even passed the bar?
Dr. G (12:10):
No, she can’t. She’s just now qualified to take it. So good luck, sweetie.
Bri (12:16):
You do you Kim K. You are fabulous and you have skims, so it’s fine.
Dr. G (12:24):
Yeah, you have something to fall back on. So that works.
Bri (12:29):
Anyway, vested in this journey through the bar exam.
Dr. G (12:33):
I mean, it’s taken her six years to get this far, so she’s pacing herself.
Bri (12:37):
At least she’s doing something besides just living off the money she’s made. She’s starting businesses doing law or watching law.
Dr. G (12:48):
Yeah, I don’t think she strikes me on the little bit I’ve seen of her on her reality show as someone who doesn’t chill ever. Right? I mean, she’s always going.
Bri (12:59):
It’s like she watched all the seasons of suits and then all of a sudden I was like, I’m going to be a lawyer. I kind of thought that for a second too after the season two. I was like, I’m going to go to law school.
Dr. G (13:11):
So you can wear cute clothes. That’s all I did on watching that show.
Bri (13:14):
I just want to look like Donna and have little pencil skirts and cute dresses, and I also want to be in a high rise and I want to come down. It has to be a high rise. Otherwise I don’t want it.
Dr. G (13:25):
You can’t be a lawyer in San Diego. I feel like there’s no,
Bri (13:29):
Okay, only New York City or Chicago or wherever it was based
Dr. G (13:34):
Big glass buildings.
Bri (13:34):
A bunch of hot lawyers. Not that I would look.
Dr. G (13:37):
Just FYI. I believe it was filmed in Toronto, but
Bri (13:41):
You know what? I just went to Canada and it was amazing so I could go to Canada.
Dr. G (13:46):
Okay,
Bri (13:47):
Yeah,
Dr. G (13:47):
You just winter in San Diego maybe?
Bri (13:50):
Oh yeah. I can only go to Canada for a couple months though to fulfill my law dreams
Dr. G (13:55):
To just walk around the glass building.
Bri (13:58):
And get lunches and dinners.
Dr. G (14:01):
Yeah. Oh my God. I mean, it sounds good. I love that.
Bri (14:06):
I love that too.
Dr. G (14:08):
All right, let’s move on to cap con. So cap con is short for capsular contracture, which is when the capsule around your breast implants starts to thicken or harden. And speaking of celebrity news, I mentioned this on her Instagram, Doja Cat has pretty bad cap con right now. In the left breast, it appears she was at the iHeart Radio’s Wango Tango something event, and she even though it’s like a week after the Met Gala where she wore a shirt that covered up her chest. In this one, she wore a very low cut dress and you can absolutely see that the left implant is kind of trying to go up and in up to her collarbone, which is interesting. It usually goes the other direction. It usually goes towards your armpit, but whatever.
Bri (15:04):
I just think you can’t wear that. She looks phenomenal. The dress is so pretty, but you can’t wear that and then tell people not to comment on it.
Dr. G (15:14):
I know she could have worn, she could have worn something low cut, but then had a strap across the top. I feel like you could have found a dress that would’ve maybe masked it a little bit.
Bri (15:27):
Yeah, I love the confidence.
Dr. G (15:28):
But she also is somebody who does not give a shit. So I’m sure she doesn’t care. She had a breast lift. She’s claimed to have had a breast reduction. But anyway, with the breast lift, she has that vertical scar. And I always point out, I saw her in concert, she had a white shirt on. She got all sweaty and you could see through right to her breast scars, and I was like, oh, okay. She doesn’t care.
Bri (15:57):
We love that.
Dr. G (15:58):
But this is problematic because cap con can happen for a number of reasons. I think the most common reason is we don’t know. A lot of times we don’t know what’s causing it, which sucks because a lot of the things that we claim to cause cap con, for example, smoking, I know in the past she vaped, I don’t know if she smokes anymore. It’s not great for your vocal cords. We know that cigarette smoking or nicotine use or whatever is associated with an increased risk of cap con, but quite commonly it’s in one breast. So why isn’t it not affecting both breasts if you’re smoking, so whatever. So that’s one reason that you can easily deal with. If you have cap con, another common reason, which is probably your best scenario is implant rupture. So maybe that’s what’s going on. If she has an implant rupture, that silicone exposure, the capsule breaking down or gel bleed, all of that can cause inflammation and then that gives you capsular contracture. That’s usually the best scenario because you’re going in there and you’re solving the problem, you’re getting rid of the ruptured implant, putting a new implant in, dealing with the capsule, and then your odds of having recurrent cap con are lower than if you’re like, I don’t know why I have cap con on. What are we doing differently? It’s kind of a bummer.
Bri (17:24):
Right? So is that the only option starting from least invasive, we can go on meds, but does that actually help?
Dr. G (17:33):
The meds sometimes slow things down or help a little bit, especially if you catch it early. So I usually do that preventatively. So if someone like her showed up with cap con and we were operating to fix it, I put them on doxycycline, which is an antibiotic that has anti-inflammatory properties and singular, which is, weirdly is an asthma medication, but also has anti-inflammatory properties and they stay on the doxy for a month and the singular for three months. And we think that helps. Vitamin E has also been tossed around as helping with cap con, but there legitimately are no studies that show that it’s effective. So I don’t bother to put people on that. If she showed up like this, I would not think singular and doxy is going to change anything there that’s too far gone. It’s really distorted.
Bri (18:29):
So essentially there’s no warning signs to if a patient’s going to get cap con?
Dr. G (18:35):
No. So there are some things that we think make a difference but haven’t been proven. So there was a thought that being submuscular reduced your risk for cap con versus under the breast tissue. Using a textured implant may or may not reduce your risk of cap con, but nobody has textured implants anymore, and then not going in through the areola when you put the implant is supposed to reduce the risk of cap con. But plenty of people had peri areolar incisions and do just fine. So that leads to the theory that it’s a biofilm, that it’s not an infection, but there’s residual bacteria or biofilm on the implant and that is causing the inflammation. In which case there are things we do when we put the implant in to reduce that. You know all of those things, right?
Bri (19:28):
Oh yeah. We change all our gloves 5,000 times. We use a Keller funnel so that you never actually touch the implant. We wash out the pocket really good, stay clean. She puts in her suture beforehand so she’s not there messing around by the implant. All the good stuff.
Dr. G (19:47):
And your favorite thing is big little pop, right?
Bri (19:50):
Oh yeah, I prepare the implant. So it’s this really, really loud pop. So we don’t take the full cover. So when the circulator hands me the implant, instead of peeling off the top, so all those contaminants or whatever’s in the air gets in, we just make a small little pop, which is incredibly loud and it scares everyone every single time I do it. And then we just clean it a little bit, let it simmer.
Dr. G (20:18):
Right. We add a little bit of Betadine solution, the implant comes sterile, but it’s in a little container with a wrap on top. And so we make a hole in that, put the Betadine solution in there, let it marinate, and then when it’s time to open the implant container, if you will, we do that slowly. And since it’s already broken the seal, it doesn’t suck whatever particles are in the air into that. So yeah, that’s super important. And Bri has learned to warn us before she makes that pop.
Bri (20:51):
I do. I just like to make sure everyone’s awake.
Dr. G (20:56):
It’s how anesthesia knows. We’re almost done when we get to the second pop.
Bri (21:01):
Yeah, I think he likes it. He’s like, oh, we’re about to close.
Dr. G (21:07):
So yeah, so all of those things are an effort to decrease any contamination. Oh, we also put Tegaderm, so little occlusive dressings over the nipples at the start of the case after we’ve prepped and draped the patient. So everything we do is to reduce any level of contamination at the time of insertion. Now does everybody do this? No, I mean you should. Well, the most egregious, well, no, I’m not going to say that. I was going to say the most egregious thing I’ve heard of is reusing the Keller funnel, but
Bri (21:41):
That’s crazy to me.
Dr. G (21:43):
Not the most egregious thing. So some people will take that stupid funnel that’s like 125 ish dollars per whatever. So we use it to put the implant in. It’s like I always tell the patients it’s a really expensive pastry bag, the kind you use to frost something.
Bri (22:01):
Like if you got a Ziploc and then you cut the hole out the bottom.
Dr. G (22:04):
Yes. And then you have some weird coating on the inside that gets activated with water so that the implant slides through and into the pocket and nobody’s touching it. So some people don’t use the funnel at all. They just shove the implant in there with their little fingers.
Bri (22:19):
It’s just I’ve worked for surgeons before that do that and not only does it take such a long time to get that implant in that little hole, it’s a pain in the ass. I mean, I don’t understand it. You’re all touching the implant.
Dr. G (22:34):
Yeah, you’re touching. I mean you have new clean gloves on, but the implant is touching the outside skin.
Bri (22:39):
Except for ones that don’t change their gloves.
Dr. G (22:41):
Oh, that’s right. Some people are just cheap, man.
Bri (22:44):
Yeah, they just wild, wild west over here.
Dr. G (22:47):
Just shove it in.
Bri (22:48):
Yeah,
Dr. G (22:49):
So that’s why I think the cap con rate that’s quoted in the literature is high because everyone’s approaching it from different levels of anal, I think, right? So some people are like, I’m not going to change my gloves. I’m just going to jam this implant in through the incision. We change the gloves, like you said, 5,000 times, I use the Keller funnel to put it in. Then some people are like, oh, I use a Keller funnel. But then they fail to mention that they use it, they rinse it out and then they sterilize it and then use it again, which is I think defeats the purpose, but whatever.
Bri (23:24):
People do that with a lot of things and I’m so surprised and I’m like, that’s so gross.
Dr. G (23:30):
It’s just cheap. It’s $125, just whatever.
Bri (23:34):
And I feel like I’m very cost, I order everything in this office. And I feel like there are some things where she’s like, I need another stapler. And I’m like, no, no, you don’t get one.
Dr. G (23:44):
But if it has to do with patient safety or improved results, then we don’t skimp on that ever. If it’s for my convenience.
Bri (23:53):
Suck it. Oh, is that easy for you?
Dr. G (24:00):
Oh no, forget it. So alright, so those are all the things we do interoperatively to decrease the risk of cap con. But like I said, not everybody does that. So I’ve seen people not rinse the pocket out with either. We use Dilute Betadine, some people use triple antibiotic irrigation. Some people use the pool water, AKA phase one, which is a hypochlorous acid solution, which is why it smells like the pool.
Bri (24:28):
Straight, like chlorine.
Dr. G (24:31):
Those are all options. I think you just have to use something. But again, I’ve been places where they’re like, oh wait, what you want dilute Betadine and triple antibiotic irrigation? Oh, Dr. So-and-so never does that. I’m like, okay, well he’s not doing this case, so can you go grab that stuff? That’s why I like having my own OR so that we know what we’re getting honestly. Those are some risk factors. We know that if you have bleeding afterwards that can cause cap con. It’s also pretty rare. And then some sort of infection. I mean there is a theory that if you have dental work and you see the implant potentially with bacteremia that you could create cap con. But again, these are all theories and we don’t really know what’s what. So way back in the day it was recommended that you take antibiotic prophylaxis if you had a dental cleaning or a root canal. But now most people don’t do that. There’s just an over prescription of antibiotics in general. So I think we try to avoid it.
Bri (25:38):
But if you get them, finish them.
Dr. G (25:41):
That’s right. Don’t just take two days worth and move on.
Bri (25:46):
Alright, so if somebody gets cap con, are they like what’s the rate that they’re going to get it the second time?
Dr. G (25:53):
So again, I tell people I don’t know. It’s higher than if you never had it. It’s better, like I said, if the implant is ruptured because then we have a valid reason for the cap con and we can assume it’s not some weird biofilm juju that we can’t maybe get rid of. So I think those people have a better chance as long as the silicone hasn’t spread everywhere, you have a better chance of getting that out. Cleaning up either the pocket or making a new pocket and then putting a new implant in. I think people run into trouble. I treated a friend of mine who no longer has her implants in, but I think she had implants placed, had a postoperative bleed, had that dealt with, then got cap con, then had them exchanged, got cap con again, then had somebody deal with her capsule, but then put the same implant back in.
(26:51):
So that never works. So then I made a neo pocket and then put an implant in and she did great for a really long time and then she got super sick and the implant ended up infected. It was wild, it exceeded the implant, then they had to take ’em out. So yeah, not great if you go down that pathway. So who knows what’s going on with Doja Cat, maybe it’s ruptured, but if it’s a chronic problem, it’ll be hard to take it out and get a new implant. One of the other things you can do if you have somebody with chronic cap con, again, it’s expensive, which probably isn’t Doja Cat’s problem and not proven in the literature, is to wrap the implant when you put it back in. So you get all the capsule out, you get the old implant out and you put the implant back in and then you either wrap it or anteriorly cover it with AlloDerm or an ADM or a mesh. And that’s thought to kind of interrupt the process and keep it from giving you recurrent cap con. And I have done that once for a patient. She had, I can’t remember if she had cap con to start. I think she did. And then I changed her implants out and she looked great and she’s like, well this one’s a little lower. So I took her back and raised it. Then she got cap con.
Bri (28:12):
Ugh, that sucks.
Dr. G (28:13):
So then I took her back and what I ended up doing was using instead of human ADM, which is a cellular dermal matrix, so someone’s dermis is just processed, it’s like cadaver skin for lack of a better word. You can use something called stratus, which is a little bit cheaper option and it is pig skin dermis. And then so you put that in as a kind of interrupter and the best place to put it is between the implant and anteriorly where the nipple sits. And a lot of times if you’re looking, when we’re taking out implants and ones that are encapsulated, I think we did this last week when that patient had the capsules from old saline implants, the thickest amount of scar is kind of around where the nipples is, where it’s sitting on top of things. So if you can kind of disrupt that, that can help. And she did fine afterwards for the millionth surgery.
Bri (29:16):
Do you like using AlloDerm? I don’t think I’ve ever seen you use it. All I know is every time you go and you go, oh, it’s fucking AlloDerm in there.
Dr. G (29:24):
Oh yeah. Yeah. So it was more common before we had mesh. And it is, it’s thick. It gets incorporated, but it’s definitely not your own tissue and it doesn’t get replaced per se. It’s more of a scaffolding that sits there and then you can just see it. And we did just take out of somebody who, but she was a recon patient. So it’s commonly used in breast reconstruction patients to cover the, now they make a ravioli out of that stuff, put the implant in there and then put the implant into the pocket.
Bri (29:58):
Oh, interesting.
Dr. G (30:00):
So that’s called pre-pectoral breast reconstruction. And that’s kind of how it’s done. Now, if you just put the implant in there under the mastectomy skin flap, it won’t have enough support. And we’re seeing a lot of malposition and maybe some cap con with that, but better than if you didn’t use it. That’s not my lane anymore. I just know that that’s kind of what’s trending. So it’s super expensive to use a full wrap of AlloDerm. So people started using the mesh stuff, which I use a lot. So either Durasorb or Tiger mesh or GalaFLEX, it’s still expensive but not as bad as human tissue in terms of mesh. And it breaks down over time because it’s made of suture like material, and so your body breaks it down, replaces it with its own collagen, and that can sometimes help counteract cap con.
Bri (30:55):
We love that.
Dr. G (30:56):
I think for Doja cat, depending on where that implant is, you probably either have to do a full capsulectomy, which is get all the capsule out, which is kind of painful, put a new implant in, and then usually you have to close the space down with some mesh. Or we do something called a neo pocket where you just get on top of the capsule, you get the implant out, and then you push the capsule down so the whole space is shut off and then you put the implant in on top of that. So those are your two options for creating a new pocket.
Bri (31:30):
So would you only do that if the capsule was really pretty thin? Or can you do that with any thickness? I know we taken out some capsules that look a little rough.
Dr. G (31:41):
Yeah, yeah. I mean if the capsule is calcified, you can’t do that. You can’t leave it in there, feel it. It’s nasty. So it has to be a relatively, it can be thickened, but it just needs to be smooth. And sometimes you can use that to work with you, so you only create the space you need. We’ve done that before on somebody who had malposition. So there’s lots of reasons. I mean, you can have lots of problems with your implant, right? Over time you can have malposition, you can have capsular contracture. Those are the two common issues. You can have rupture, and then you can just decide you want a size change.
Bri (32:18):
Now does cap con happen, does it always happen right away or can it happen over years or when does?
Dr. G (32:25):
We used to quote 2% per year, but I think it varies per brand. And again, you’re talking these 10 year studies where you have, everybody’s putting them in. So for example, Sientra only sells to plastic surgeons. Motiva only sells to plastic surgeons. But Mentor and Allergan, the other two makers of implants, you can be an OB GYN in Dallas or a general surgeon in San Diego. And if you’re putting implants in, you can put those implants in. So who knows what those guys are doing in terms of technique.
Bri (32:59):
That’s why I have Allergan.
Dr. G (33:03):
Oh, right. Yes. You had that general surgeon, right? Isn’t that who did it?
Bri (33:06):
I don’t even know what he was, maybe a, god knows what, but it was cheap. Only had to get ’em redone three times.
Dr. G (33:17):
Right? And it wasn’t Mexico. So you’re already, your bar is low.
Bri (33:22):
Exactly. Exactly.
Dr. G (33:25):
So yeah, so when you’re talking about cap con rates, you’re talking about all comers and there’s so many little factors, that includes everybody and who’s putting them in and what technique are they using? What are the patient risk factors? What incision did you use? I mean, I think it’s a really hard number to quantify. So most people just follow their own cap con rate, which I think my office is pretty low.
Bri (33:50):
It’s all my cleaning.
Dr. G (33:53):
Right? So So I think that’s important to figure out how many times are you taking people back for capsular contracture and if there was an issue, which isn’t very often.
Bri (34:06):
So are there warning signs that people can look out for to see if they’re going to get cap con?
Dr. G (34:12):
Oh, right, your original question. Yeah. So a lot of times the implant will start to feel stiff and won’t move around as much. I have patients that worry about that in the early stages, in the first few months. And usually that’s just related to stretching. And the other thing is now when I put an implant in, it’s a pretty tight pocket because we don’t want malposition. I don’t want the implant in your armpit. I don’t want it out on your side of your chest wall. So I’m not giving it a lot of room to move in. I’m not having you do massage. So it’s kind of staying where it needs to stay. That’s the reason for that. But then people start freaking out because they’re like, it doesn’t really move around. So do I have cap con? No, it’s locked in there. It’s like a fingers in the glove, kind of hand in glove, fingers in the glove. What am I talking about? Hand in glove situation?
Bri (35:05):
I don’t know either one. So that’s fine.
Dr. G (35:07):
But you want a tight fit so that you don’t get malpositioned. So my patients tend to come in and be like, I’m concerned, I have cap con and then I take a look at ’em, I’m like, you’re fine.
Bri (35:18):
And then they want to start massaging it and moving it all around, which is
Dr. G (35:23):
It’s fine.
Bri (35:23):
Right off the bat?
Dr. G (35:24):
Not right away. Yeah. I mean at a certain point you’re not going to hurt anything.
Bri (35:30):
Would that affect the pocket if you massaged it right off the bat, moving it around? Right. That’s what I would assume.
Dr. G (35:36):
Yeah, you’re stretching things out. So I tell people not to do that. It takes a few weeks for the capsule to form. So after four weeks, sure, I guess you can move it around or massage it. The contracture could happen right away, very unlikely or 10 years later. The thing is we don’t know.
Bri (35:59):
So speaking of cap con, I know there’s a new implant out: Motiva.
Dr. G (36:07):
Oh, right. So Motiva people are starting to say that it, well, they’re quoting a very, very low cap con rate, like 1%. And the other companies are quoting high tens, or not high tens, but high single digits and some double digit rate of cap con. The thing is with Motiva, you have five year data. It’s recent. So you’re assuming that the people who participated in the study know what they’re doing and are doing all the things that we mentioned before with the funnel and the incisions and pocket locations, those are submuscular implants. For the record, those are dual plane placement. But people are extrapolating that and saying, okay, well it has this low five year rate of cap con, so I’m going to put it in the sub glandular plane and tell patients that they’re not going to have cap con. And you’re like, you can’t say that.
(37:06):
It’s not a magic implant. It’s nano textured. So it’s supposed to create a thin capsule based on some studies, but if you spit in the capsule, it’s going to get infected and you’re going to get cap con. So don’t tell me it’s not, like I said, it’s not magic. You still probably need to use a funnel. I think people are pushing to go sub facial or sub glandular. We don’t know that that doesn’t impact the cap con rate because that’s not what was studied with a Motiva implant. And like I said, it’s not magic. So if somebody had recurrent cap con and I might consider trying them with a Motiva implant just to see as one other maneuver, like I said, you can’t make that claim. And the company is not trying to, I just think people then push it as such. They interpret the data how they want.
Bri (37:58):
So do you really think Motiva what, they are, nano textured. You think that’s a whole lot different than the textured implants that got or for mostly recalled?
Dr. G (38:09):
Yeah. I mean the Allergan textured implants that got recalled were pretty, they called macro textured. They were more textured than even the ones that are still in the market that no one uses, which is the mentor version. It was called salt loss texture. So it was a pretty big imprint into the shell of the implant to make that texturing. And that has not gone well, got recalled for the incidence of ALCL. Right? So the breast implant associated lymphoma, still low risk, but it was a potential risk factor. There have been no cases of ALCL with the Motiva implant. So I think that’s probably going to pan out as being okay, like a smooth implant. It’s acting like a smooth implant. It’s softer and has more integration of the shell with the inner silicone in there. That’s like a gummy bear consistency. So one of the thought processes is that it has a less risk of gel bleed, which we hate when I take out those implants and people are like, I want ’em out. I’m not doing well. And we get in there and it’s not ruptured, it’s just sticky. That’s what we call
Bri (39:21):
Super sticky.
Dr. G (39:22):
Yeah, that’s gel bleed. Nobody wants that. I see that more commonly with a certain brand of implants that I’m not going to name. And then somebody mentioned at a conference that even a different brand for the different cohesivity might have more gel bleed, but I haven’t seen that substantiated anywhere. So gel bleed’s a whole other problem. It definitely can cause cap con and it’s just in general not great for you. So if you can avoid that with this implant, that might be a reason to use it. The other reason is that because it’s cohesive and cohesive with a shell, it has more projection CC per CC than the same implant in a different brand, allegedly. And so what people are finding is that they’re getting more oomph for the ergonomic version of this implant and that you have to factor that in. Yeah, it looks bigger because it’s not like it’s just sitting, it just has more projection.
(40:25):
So you know how I don’t like to jump into things right away and just put a bunch of Motiva implants in and then wait to see what happens. I’m waiting for people to figure out exactly what’s the best way of doing it and making sure that the rate of cap con stays low. If it’s low and there’s no gel bleed, then sure, maybe I’ll transition to that. It’s a more expensive implant. And also the data you’re doing now is, like I said, is comparing it to data from 20 years ago where we were doing things differently. So we learned from that, changed things and now we’re testing a new implant. It’s not apples to apples, but nobody wants to, those are what we call two market studies. So those studies were done so that you could get the implant to market. No one wants to redo that study cuz it’s expensive. Right? So no one’s going to redo an Allergan cap con rate study because people are already using the implant period.
Bri (41:29):
Yeah. It’s also hard to switch over when like you said, your rate of cap con, knock on wood, is really low. So really, if you’re doing all the right things and putting in the implants, why would you change over?
Dr. G (41:45):
What am I gaining there? I need somebody to show me that it’s going to, it’s a value added.
Bri (41:51):
Maybe you guys just need a better scrub tech to prepare your implant
Dr. G (42:00):
And then you’ll have no problems no matter what you’re using. So we don’t know that any type of implant is more associated with cap con than the others. Textured implants are supposed to have a lower rate of cap con, but it never got proven. And like we said, are mostly off the market. So unless you’re in Europe, then you can put whatever in. They use polyurethane coated implants, which is kind of bananas.
Bri (42:26):
I don’t even know what that is, but it sounds wild.
Dr. G (42:28):
Yeah, it doesn’t sound great. They don’t put crap in their skincare. You’re not allowed to have any weird ingredients, but you can put these crazy implants in.
Bri (42:38):
What was the implant with the tracking device? Wasn’t there a Motiva something or a knockoff Motiva?
Dr. G (42:44):
Yes. Motiva hasn’t brought that to market in the us, but in China they have an RFID device. So like a tracking device in the implant that you can scan.
Bri (42:55):
For all the husbands out there that want to know where your wives are, your wife’s tits.
Dr. G (43:00):
Oh my God.
Bri (43:01):
I follow my investment on an app.
Dr. G (43:04):
Yeah, I don’t think you can. It’s not like Find your phone.
Bri (43:07):
Genius. It’s like air tagging the boob.
Dr. G (43:11):
Right? That would be crazy. Yeah, just talking about it, you’re like, this is never going to go down in America. But in China, the reason they did it is because people were pushing a fake Motiva implant, which is crazy. So a counterfeit implant. And patients wanted to know that they got the real thing and not the counterfeit, not the dupe. And so one way of doing that was after the surgery, you could have your implant scanned and it had this tracker device in there that showed you like a microchip really, that showed you that you had the true official Motiva. I was like, if we’re at the point where you’re concerned, I put a dupe in there. I’m not really sure that you should trust what, okay.
Bri (43:58):
The dupe la boo boos.
Dr. G (44:01):
Yeah. That’s crazy.
Bri (44:04):
Yeah, that’s insane.
Dr. G (44:06):
Luckily there’s no fake implant market here, so I don’t know. There’s no, I don’t even know, I don’t think it exists here. I don’t think you could get a implant from.
Bri (44:17):
I don’t even know where I would get at, Amazon. Just kidding.
Dr. G (44:24):
Probably. We could probably look.
Bri (44:26):
Yeah.
Dr. G (44:27):
Yeah. So that’s the scoop on the different types of, if you have cap con and it continues to progress, it gets worse and worse, it can become painful. So if Doja Cat leaves hers alone and it keeps contracting, it can get cold, it can get hard. Usually the dinosaur egg phenomenon is after 20 years of watching it.
Bri (44:51):
Yeah.
Dr. G (44:52):
And those are generally the older implants, right?
Bri (44:55):
Oh yeah. They’re like rock solid in a shape that I’ve never seen before. Calcified, they’re popping a boulder out of a small incision.
Dr. G (45:06):
Yeah, they’re pretty gnarly. And they have usually a ruptured seventies, eighties style implant in there that has a motor oil consistency for the silicone. So it would be everywhere. Very inflammatory.
Bri (45:23):
Yeah, it’s a hot mess. So if you leave cap con alone, it’s never going to get better.
Dr. G (45:31):
It does not resolve on its own ever.
Bri (45:33):
Okay. It’s just there.
Dr. G (45:35):
Yep. Bummer. I know. That’s why I think my patients are always concerned. Am I getting it? And I know because when I had my implants put in too, I was like, wake up. Am I getting it? Every little thing for the first few months, and then after a while I’m like, no, I’m not. I just need to calm down. But it gets in your head, you’re so worried about it.
Bri (45:57):
My girlfriend and I got ours done together, and she was very concerned about it, and she was asking anybody prescribed singular, she was doing all these things and neither of us got it. I wasn’t super worried. I didn’t have at that time a lot of information. I was like, oh, cap con, whatever. I’m fine.
Dr. G (46:14):
I know. I feel like sometimes informing the patient is, plants things in your head. And then I know it’s almost worse than it is not. Right. Is it ruptured? Am I going to have any of these problems? No, probably not. We just need to let you know. Yeah. So Meghan Trainor had Motiva implants put in, which,
Bri (46:37):
Oh, I didn’t know that.
Dr. G (46:39):
Yay for her. Yeah. Not a huge fan of Meghan Trainor for no specific reason except that she bugs me. It’s just the music. I don’t know why she’s challenging breast, she is such a pick me. What are you challenging? What’s her experience? She had a lift with, she had kids and then she had a lift with implants, and she acts like she’s the first person to ever do that.
Bri (47:03):
What’s the stereotype with implants?
Dr. G (47:07):
I don’t know. Safety? I don’t know what her issue is. A taboo topic. Okay.
Bri (47:17):
Is it taboo still?
Dr. G (47:19):
I don’t think so. Maybe not in Southern California. That’s why I’m like, what? No one cares. She became the subject of headlines bashing her decision. Oh. Because she was basically doing a commercial for Motiva, but okay.
Bri (47:34):
Yeah. I don’t, think she just needed to stay relevant for a hot second, just get the implants and be like, woo.
Dr. G (47:44):
I got new boobs now.
Bri (47:47):
Yeah.
Dr. G (47:48):
She’s pro body positivity and she’s so authentic. Is the implication that other women that have implants aren’t? I don’t.
Bri (47:56):
Just because they don’t have Motiva?
Dr. G (47:58):
Or they don’t have kids or they have kids or, I don’t know. I, I do think there’s a reputation for women with implants to be a specific type, but that’s a cliche because when we see women with implants all day long, and it’s everybody.
Bri (48:18):
And women who you don’t think have implants that have implants, I have so many girlfriends that have the smallest little implants in because they don’t want anyone to know and nobody knows.
Dr. G (48:28):
Right? You don’t have to have giant implants.
Bri (48:32):
You don’t have to go
Dr. G (48:33):
Whatever you want to do. If you just want to fill out the upper pole, if you want to add a little volume, if you want to fit differently and clothes, all of those things are reasoned. Same reason you might want a breast reduction. Again, maybe it’s just so in it. I just don’t see it as a taboo situation. So I don’t feel like she’s this master trailblazer.
Bri (48:52):
Right.
Dr. G (48:53):
In her defense, she’s not attributing her new boobs to chia water.
Bri (48:58):
Chia seeds, and lemon water. That’s good.
Dr. G (49:02):
So she’s owning it.
Bri (49:04):
Yeah.
Dr. G (49:06):
We’ll give you a point for that.
Bri (49:08):
Exactly. But you deduct a point after owning it for your taboo stereotyped.
Dr. G (49:14):
Yeah. Those of us with implants are offended. Yeah. I do remember doing an IG live about implants, and someone was like, what do you know? You don’t even have them? And I was like, so cool. Thanks.
Bri (49:27):
That’s crazy. You’re like, so you’re saying I’m natural.
Dr. G (49:32):
Okay. Sounds good. Wow. So anyway, that is the wrap on cap con. I think we’ve answered all the questions that most people commonly have about capsular contracture and breast implants. I think the one thing we did skip over is what’s the recovery from the second surgery? And it’s different. It depends.
Bri (49:59):
You think your recovery is harder the second time you get it revised?
Dr. G (50:03):
I think it’s just different. I think generally speaking, if you have cap con, I’m having to do something to the capsule, and that can be painful. The pressure of expanding the pocket with an implant is gone. So you don’t have that stretch that you have from the original breast augmentation. So in some ways that’s less painful. But the second part of me making sure that the new implant is in a good location usually involves mesh and a bunch of internal suturing. And that can be uncomfortable. And I really need you to take it slow for six weeks. So we want ’em to lock in the new position and not have any issues. So even if you feel great, I need you to take it easy for six weeks. And sometimes it is a little bit more uncomfortable if there’s a malposition or anything that we’re correcting at the same time to smooth out in terms of discomfort. But that initial, when you feel like you got kicked in the chest after the original augmentation, that’s way better because you’re not on that stretch.
Bri (51:05):
Yeah, I can attest to that. I haven’t had cap con. But the first surgery is always the worst.
Dr. G (51:12):
The first is the worst, but you also want to take the second one just as seriously as the first, so you don’t jack it up.
Bri (51:19):
Yeah, don’t do that. I did that.
Dr. G (51:23):
Yeah. I mean, so many people have done that.
Bri (51:25):
Popped those sutures.
Dr. G (51:26):
Yeah, I know. None of us want to slow down.
Bri (51:31):
I know.
Dr. G (51:32):
So if you have questions about capsular contracture, if you’re concerned about your implants, please reach out to us. You can like and subscribe below or put your comments in there and let us know what your questions are and we can address them later if we didn’t cover it today.
Bri (51:50):
And if you’re Ben Affleck or Brad Pitt, you can also slide into the dms.
Dr. G (51:53):
Right? Tell us your thoughts.
Bri (51:56):
We just want to know.
Dr. G (52:00):
So I think it’s time to scrub in.
Bri (52:02):
And we’re scrubbing out. Slay.
Dr. G (52:07):
Nailed it. 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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