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What you’ll hear in this episode:

• How a breast augmentation surgery is completed
• The risks associated with breast augmentation surgery, and how to mitigate them 
• Debunking common myths and answering FAQs

Dr. Matthew Bindewald of San Antonio Plastic Surgery Center sits down with Dr. Ramdeen to discuss one of the most common plastic surgeries in America – breast augmentation surgery. Despite the procedure’s prevalence, it can be challenging to find reliable answers for common questions and concerns, and Dr. Bindewald is here to help.  

Dr. Bindewald is double Board-Certified and a member of the American and Texas Societies of Plastic Surgery. After earning his doctorate degree in Hawaii, Dr. Bindewald went on to practice as a military surgeon, where he witnessed reconstructive surgery change patient’s lives. This prompted him to specialize in plastic surgery. 

Transparent and honest communication with the patient is the first and most important step of any procedure, including breast augmentation surgery. Things that he will discuss with his patient include what their cosmetic goals are for the procedure, what kind of activities they do on a day-to-day basis, what type of implant (saline or silicone) they prefer, and how they’d like the incisions to be made. Dr. Bindewald takes the patient’s entire body and lifestyle into account when constructing a plan for surgery. 

Risks are also part of this preliminary discussion. While breast augmentation conducted by a local medical professional is considered very safe, it is not “without complications,” especially as the implants age inside the body. 20% of people with breast augmentation surgery need a reoperation at 3 years due to unsatisfactory size, scar tissue developing around the implants, or infection and bleeding, which is a risk incurred with any surgery. 

However, Dr. Bindewald debunks the myth that you have to change your implants every 10 years, instead encouraging women with implants to pay attention to their body. “If it’s not bothering you, you don’t need to do anything,” he explains, and tells patients to alert their surgeon if they do experience any pain or change in appearance or feel of their breast. 

Listen to the ninth episode of Apple a Day Doc Talk to hear more about the future of breast augmentation surgeries, the perils of “medical tourism,” and everything else our listeners should know about the surgery. 

Apple a Day Doc Talk is a founding_media podcast created in partnership with Dr. Khris Ramdeen.

Host: Dr. Khris Ramdeen

Guest: Dr. Matthew Bindewald

Transcript:

this is a founding media podcast if welcome back to apple and a doctor thanks for tuning in I’m your host Dr Indian and we have the special guests today here doctor Matthew been the wall thank you Matthew for coming in today thank you for having all right so we’re gonna talk about very important topic here’s breast augmentation very commonly done and I typically have a lot of patients in my practice doc that ask me questions that to be honest I don’t know the answers to so this is gonna be really valuable for me to it I thank you for coming Dr bindu wall grew up in Hawaii on the Big Island and he studied chemical engineering and pre med at the university of Colorado Denver turn to Hawaii for medical school and completed his general surgery residency in Santa Barbara where he met his wife who is also a surgeon that I know very well doctor as far as an amazing Colo rectal surgeon hopefully we can have her own soon to he then spent time in the navy as a general surgeon during his time in the military he decided to pursue plastic and reconstructive surgery after seeing its benefits first hand for a great many any then completed a plastic and reconstructive fellowship in San Antonio and now he’s in private practice he is double board certified by the American board of surgery and American board of plastic surgery and is a proud member of the American society of plastic surgeons in the Texas society of plastic surgeons all of this all of his free time whatever free time you have reached is devoted to his three wonderful children his young children and his wife

and again thank you so much method for coming we’re going to dive right in talk about breast augmentation so for stuff doctor who’s a candidate and what are the various reasons you see for patients coming to have this procedure done the thing is a great many candidates actually the number one reason is obviously somebody who was unsatisfied with the the shape of the size of her breasts and either once larger or better symmetry who is a candidate pretty much anyone who fits those criteria but also doesn’t have any medical country indication for having an operation and is there a particular age group you’re seeing that you’re operating more honors it is a very usually it’s younger women probably the most common age group would be twenties to thirties and it what is the procedure entail can you tell us a little bit about what well you can see yourself talked with me in the patient isn’t trying you know what it is that they are looking for an American style they’re looking for and you make sure that you answer other questions make sure they don’t have any reasons why you should be having the procedure receiver itself the vast majority are done under general anesthesia there are some practitioners who may elect to do that in a in a war wake setting under local maybe some sedation but I prefer general anesthesia personally most places do as well that one is that what why do you tend to prefer depends since where you’re placing the implant placement dipped the muscle it’s kind of difficult to elevate the muscle and actually divide the pectoralis muscle under Jeff under local because residents to be rather involved painful

right so and and you tend to go under the textiles lessons in the majority of cases yes so what what is your decision making process to determine similar to other belongings obviously one of them point things you take into consideration is what that patient’s preferences okay they may have a very set preference or opinion on it but also you want to make sure that you’re doing something that is safe for the patient as well since we have very very minimal breast tissue may not necessarily be possible to put it on top of muscle or in the sub glandular position so in that case if you want a quick cover W. implant flat and you want to put it below the muscle okay Beijing to have ample breast tissue begin went through you know you may have some opportunity put it on top of the muscle in patients who are critically strength athletes right you mean honestly want to be dividing part of their muscle for the vast majority of people that’s not a big deal but for certain athletes and may be an issue

that’s a very important issue in my practice because I deal with a lot of bodybuilders rain so for them yes do you find do you find that they prefer not to separate that muscle can it can it depends a little bit on what they’re made of breast tissue is like okay okay some builders are exceedingly fit in Minnesota have war breast tissue right to put an implant under and then you may have to put into muscle but you want to take in that particular activity into consideration and make sure that you’re doing is limited release of the muscles pasta okay so if they are particularly active aside from preference do you push them one way or another based on for example if they’re doing a lot of pectoralis exercises push ups things like that for those type of exercise is not the big deal okay if you’re like a competitive bodybuilder and may be a big deal but I think for that standard athlete it probably is and if you have as you mentioned adequate breast tissue be above the pectoralis other than than that is there any other reason why a woman may ask to have the implant placed either below or above a you know aside from how much breast tissue one of the other one of the big big differences in that procedure is recovery

obviously you’re looking up the cross muscle degrees long more uncomfortable and the recovery may be longer than if you’re just placing beneath the breast tissue itself what are the different recovery times for above versus below I think it really depends on the main difference in recovery times when you’re gonna be going back to doing all year this collectively really put in above the above the law school about three weeks there shouldn’t be as long as you know doing things quickly tension on the skin okay really nothing should be able to after putting it on the the most compatible way about six weeks okay and then what are the different types of implants she’s probably the two most common types all implants right now have a silicone shell instantly pretty standard it can be either smooth or textured McNabb hello that later but then it’s either second show that’s filled with saline there’s obviously is a salt and water versus a commercial it’s filled with silicone gel which maybe has a consistency more like honey and then there is B. highly cohesive silicone gel what people call a gummy bear type which is a lot more firm sometimes can be more shaped as opposed to just round okay and what are some of the reasons for choosing the different formulations well the two most common are us in this regular saline slick on gel I think the big difference between choosing which does two things is by far the silicone gel is more popular you will have a belief that it feels more like native breast tissue okay and I think for the most part that’s probably true some of that there’s a little bit us feeling empty and paying how much is filled with hawk tensely it’s filled okay but then other reasons choose one or the other with silicone implants and maybe more follow up as necessary because you may not necessarily know if there’s a leak with this problem so it’s recommended to get MRI screening

and people had silicone implants three years no okay here okay okay honestly I don’t know too many people actually go through that because a lot amorous that is there is a cost differential between the two sailing is typically less expensive okay and for the athletic more athletic patients that are are going to be doing a lot more vigorous physical activity is there one formulation you counsel they they you push more honored is another matter I don’t think it really matters or activity ones okay and then what’s the difference between augmentation and master taxi can you tell us the difference well on the patient involves adding something to the pastor I maintain it in this case come out and plans for the most part there is some augmentation with either fat injections or targets flaps which may be something that is more prevalent in the future I would say it’s still kind of a up and coming okay Mr picks itself does necessarily do anything to the volume of the breast anything to create you have a little bit of loss of polling with master pixie but it is restoring the suspension of the breast okay correct cracking ptosis of the breast got any back on the chest got it and then when those two things can be combined by the way okay and because augmentation of loan typically will not correct significant doses of the rest of it okay okay and then what what type of recovery time are you looking at when you do either one the augmentation Leicester taxi does it depend on the formulation you have I think the the recovery time is essentially saying for most of these things unless you’re putting in planet the muscle he really just dealing with breast tissue and skin is long as you’re not putting excessive amounts of stretch in that game then you should be able to pretty much all your other regular activities okay in either case you should be up walking around the day after your procedure you know if you’re working like an office job and that should be back within a couple days later he pain medications okay we’ll strenuous physical activity regardless of

what it is I usually tell people about six weeks six weeks and what are some of the company the more common type of complications you see here what should women be looking out for in terms of the employer retractions or anything that song it is not without complications right certainly true probably the single most common complications were reasons for re operation which is kind of the figure you look at when you saying whether or not this is a successful operations what is your we operate Dave rate for breast augmentation alone it’s usually around twenty percent at three years so it’s not small but so the number one causes from the operation would be for things like capsular contracture which is the body forming scar tissue around the breast which is very that is a normal process but sometimes it can be more intense in Peter Pan for distorting okay so that’s not probably number one so what would we look at as providers and as the patient what would you see on the outside to clue you in on that the person be more firm okay it may be tender or painful may be distorted usually if that’s not something that you know starts off right away it develops over years and some people who have had their implants in for twenty to forty years and they will definitely have that okay okay one of the other big reasons for it we operation would be unsatisfactory size we see that a lot and so I mean you do a lot of things beforehand as far as how yeah three different sizing math is right with the patient and saying you know what is it you’re looking for what can look are you trying to achieve okay he is trying to be on the same page beforehand I think you can eliminate some of the re operation for size afterwards mmhm and then there’s just other things that with any type of surgery there’s a risk of bleeding risk infection infection implant surgery is always a very big deal because if it’s given back to the main S. and may not necessarily be able to remain in the test and speaking of infection just to take tension here a doctor in the walls in terms of U. LA helping patients out in the hospital is an internist can we talk a little bit about travel medicine

because we do see cases from other countries that will come into our hospital it was done somewhere else can you talk a little bit about the travel aspect to the surgeries that’s not to say that her not excellent qualified surgeons outside I’m sure absolutely yep but my thoughts on medical tourism is in my opinion obviously yes of course you B. travel abroad he made to that for a variety of reasons I want the more common reasons to that is a price and you may have a great surgeon may have a great even a great facility right but once you go home you’re essentially on your own so if you have a complication the person I can be there to take care of you may not necessarily having an adequate follow up with them may not have any follow up or contact whatsoever before two and if you do end up in the E. R. with the complication who’s going who’s responsibility is it to take care of you at that point I mean if it was your surgeon is like I think that they’re gonna take care of you right they know what they did they know the anatomy real patient exactly and takes ownership absolutely so that’s the problem is is typically there is it there obviously cases where there is ownership but typically there isn’t and so you’re the patient is basically assuming the best case scenario right you go in there everything’s gonna be great and I’m not gonna need any follow up and that’s what they planned for right so questions were what is that based upon to write it source of information and saying that everything’s been great with right and so cost is a factor in so unfortunately we do see patients coming into the hospital for this and so what are some of the common types of complications that is there a common complication you see from medical tourism that you see well for this procedure in particular for particular breast augmentation personally I’m not seeing any specific to that

let me think of something that you would see in the media post operative period probably the two biggest ones would be in bleeding or infection okay and both of those can be essentially catastrophic tear cosmetic outcome if you don’t take care of them and lately what kind of things can happen because medically to you if you do not take care of the infection and you may try and treated with antibiotics and sometimes that can be successful there’s a salvage great is not successful and on the way to radically temptation is actually to remove the implant so obviously you’re not talking about returning to the operating room surgery and then it may be that you know you’re not gonna have another implant put in another six months afterwards right because what kinds of problems with scarring contraction and things and just as a side question here do you get patients coming to say Hey I know this because this but I’d noticed on this medical tourism site it’s way cheaper why shouldn’t I do that do you ever get patients that bring that up really not know who came home the people are going to travel abroad the they made up their mind is usually made up there laughs okay but I have seen patients in the ER after trips yes yes and is it mainly for implants or do you see that as a consequence of some other popular personal property procedures and extreme face lift accident with a human was in her face after returning from their trip there ought Saruman’s after abdominoplasty and tell us that our listeners what’s aromas are so in a lot of different parts to it we’re simply dividing different layers of tissue and your body’s natural response to having players divided is to fill that space with fluids on either with compression or a dream to try and prevent that from happening believe it even under the best cases you can still have a strong which is just essentially a collection okay and

this this podcast listeners here are very fitness inclined a lot of them and so I know we talked about restricted restrictions basically after surgery there really doesn’t sound like there’s any other than stretching of the skin are there particular workouts exercises movements that you say Hey if you do this you may be at risk for rupture or we’re not so much not so much richer I mean the force it takes to rupturing plant is pretty significant and you are doing something is causing your plan structure than that’s probably has other adverse effects for you as well okay that’s got to be just blunt trauma nine things okay as far as activity I think it’s important to be somewhat active immediately after surgery to cut down on your wrist applications like you know T. V. T. in the morning and things like that but as far as being active depending save it to presentation you know if it’s if you’re doing division of muscle really came back to a pretty significant activity within the first couple weeks is probably okay adequate gray in the in the other common question I get on the primary care side is that so I’ve had these implants for a couple years my ten year mark is approaching do I need to get them changed what’s your what’s your yes yes so if it’s not bothering you we do not have to do anything with her now some of them may change a little bit if you have silicone implants versus sailing in saline implants if they rupture stealing comes out and plays you know immediately you had a leak of your in plant cell cultures is what the cost reduction where implants can rupture but that silicone gel or silicone filling material may be contained within the capsule earlier than planned or capsule depressed and there may not be any definitive signs of that you may have more of a capsular contracture

so if you’re having pain or if you have been some changes in your breast I think that should definitely be evaluated in those cases of silicone implants probably MRI is the best tool forces that cheapens covered by insurance at that point but that’s probably the best tools and things like that and it’s absolutely I do not believe in taking out every ten years and won the the symptomatic breast implant that someone may be very happy with just because ten years is up right I think and can you talk about the incisions and where they are talking to typically there are several there are some that are more common probably the two most common are you from memory in through the folder the breast plate second most common is around aerial itself and said it probably makes up those two together probably make about ninety percent of all breast incisions and is that patient preference as well or is that something that you kind of calculate I think that sometimes there’s discussion to be had I personally preferred the infirmary incision thank you better access to the entire base okay depressed there may in theory be less chance of infection because you’re not necessarily going through the aerial and okay milk trucks themselves which to harbor bacteria the normal person some of the other less common would be through the excel and very uncommon is through the employers and what would be the advantage of going through the other than the cosmetic isn’t B. no scar on the breast right is there any other advantage or is it is it how much more technically difficult is that for you to do because the umbilicus well I do not do that okay people who do you do that obviously you can only use a saline implant capital entire silicone implants with the other button up into the chest and the reason I’m not a big fan of that is because dissection of the pocket and it’s completely through the belly button I think technically is rather challenging okay and the it’s so that ten to fifteen your question is just clearly answered here it’s a I want to stress it because it’s so a lot as well yeah and I’m not sure who put that out there or who that serving

okay but I think that’s absolute nonsense sort listeners can consider that myth officially busted it is not in my mind excellent excellent and how the you mentioned the different incisions that we have and we want you know around the aerial going to that effect in the mammary glands if a woman is of childbearing age and they’re going to be breast feeding is that something you counsel against or is it not does not affect breastfeeding much it in theory it should not affect us feeding me for putting through the infirmary decision or teach them a selection effect at all if you’re putting it through the aerial it may affect some by women need to understand that actually pregnancy breast feeding this can be a lot of changes to the breast and you press will change and your aesthetics may change as well right to say those things are not great things are ahead I need to understand that there will be changes afterwards absolutely and and it in terms of safety for breastfeeding or ability to breastfeed is that affected at all when you have it when you have implants it shouldn’t be this shouldn’t be okay and then cancer screening was does that affect how cancer screening is done emigrates let’s say if you’re putting them in time beneath the muscle it really should not affect how mammograms done because still all the best issues and here to the muscle if you’re putting in this adventure position may make mammograms more difficult but they can be the argues that they can do okay to let your memory for no okay beforehand that you have implants okay so so from a primary care provider standpoint it’s not something you have to go through say plastic surgery or anything like the same screening criteria okay and then it can you tell us a little bit about the B. I. A. L. C. L. issue it’s in the news and undergoing hearings right now

hello this is something that was first can discover about twenty years ago so it’s not something is relatively new what that stands for is breast implant associated anaplastic large cell lymphoma so it’s not a breast cancer but it is actually a lymphoma it arises as to how to rise from the capsule around a breast implant is barely there in the United States has been about I think to to shy of three hundred reported cases hello nine fidelity’s from that room the overall risk women with textured implants will be a lot more prevalent textured implants although prevalence Plymouth rewards is still very rare but the vast majority people who do develop this half textured implant and instead the overall lifetime risk of developing insulin hesitation plan is somewhere between one and two thousand one and thirty thousand okay so the FDA has been eating with plastic surgeons and patients in trying to come up with best practices I see there is no role for prophylactic X. plantation okay but I think it’s important that if there is changes in your breasts clit your surgeon know usually this is something that develops long after implantation okay but I think it has to be something that also has to be discussed in the informed consent for breast augmentation

absolutely yeah and how is the particular type of the in place to fluid the saline versus the No it is user type the only thing it may be different yeah says the implant texture okay smooth versus textured okay and tell the number of cases that have been linked this move it’s questionable because they haven’t really considered a verified all the information whether that was only a smooth implant case and smartglass majority are related ones are textured okay and smooth versus textures that also all patient preference or is there a reason to that choosing one or the other a person is not using the textured implants okay more if you’re using a shaped implant okay or if you’re putting in some closure position but if you putting in plant around implant under the muscle there’s no reason to even today there’s a textured implants okay and tell us if you could doctor in the wall the future trends in this realm of augmentation where’s it going one was trying to implement all the impact company out there working on that but then one thing one of the other things that people are more interested in is maybe going on vacation without an implant and there are some people who would recommend doing that with large volume of fat grafting

maybe with some external tissue expansion which is essentially like a vacuum expansion of the chest with that grafting think fat grafting is not quite there for a medication loan and he does have a role in revision of reconstruction okay but the volume that you would need to actually augment breast I think it’s not quite there yet but maybe something in the future okay so is that used much at all and just the fat method or not really crafting is huge when I use it he would use it in setting up just kind of revision okay about reconstructive breast usually more like fine tuning yes but when you talk about transfer the amount of fat that you would need to augment impressed right and trying to have that that graft it’s not as reliable is home much W. is going to remain I see behind the fat grafting does not survive may generate into oil systems okay so these are K. texture problems sinus problems so I think I think there’s some work still needs to be done because that’s being done in the medical tourism realm to the fat grafting or it’s all being that it’s a I mean you can do whatever you want a portion of the that’s one of the other things about medical tourism it’s not you don’t have to FDA or regulatory bodies right watching over you right and those things may be good things to happen regularly yeah sometimes they’re good but hit they had there’s an expense associated with it which is well worth it sell it interested close up what what are some of the are there any reservations that patients typically have misconceptions that they come in with that you have to field that’s that’s a common misconception well with respect to press him into an audition on you know doesn’t fix everything

yeah for example talking about nafta pixie putting a bit in plant in is not gonna solve trump has a lot of ptosis in her breast okay there also you know maybe other areas outside the breast itself the trimming to the deformity of the tests that they have can be scaled told for many years her alterations that can be solved with breast augmentation alone so I think it’s important that you have discussed these things with patient actually address them prior to surgery rather than trying to trust them after the Sir absolutely absolutely well thank you so much doctor been the wall that was really helpful and to me as well so they’ll be able to at least I’m really happy to bust the ten fifteen year mark that’s a big serves as he’s well thank you so much for coming by doctor been the world I like to think founding media for hosting us and thank you so much guys for tuning in see you next time the apple a day doc talk podcast team includes me Dr Reem dean producer Mariah Gosset an audio engineer Jake Wallace thank you to everyone at founding media for your support the apple in the dock talk is available on iTunes stitcher Spotify or wherever you get your podcasts you can follow me on Instagram at rain D. N. N. D. spelled R. A. M. D. E. N. M. D. or check out the link to my YouTube channel and website in the show notes thanks for listening