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At a cost of $1500 to $2500, this seems unreasonable to me, especially since the chance of finding a broken implant when nothing else seems wrong is less than 1%. These studies are recommended by the FDA at three years after surgery and every two years after that. The mainstay of evaluating breast augmentation patients for the integrity of their silicone gel implants has been MRI. Due to the very cohesive nature of the newer silicone gels, this вЂњbrokenвЂќ implant may not leak gel very far away from the shell. The surveillance of silicone gel breast implants is important, since routine mammography and physical examination may not be able to detect a small tear in the implant shell. By utilizing these вЂњNo TouchвЂќ techniques in breast augmentation, I can offer my patients a rapid return to daily activities and a nice, soft, and natural result. Glove powder is removed before touching the implant as well. This funnel-shaped, lubricated sac allows for the smooth introduction of the implant into the pocket, reducing stress on the shell wall and completely isolating the implant from the skin. We use the Keller Funnel to help place silicone gel implants through the areolar approach into the pocket.

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I will glue a plastic-wrap-like dressing over the prepped area of the incision in the crease so that the implant never touches the skin while it is being placed. Some foreign bodies, like the powder on surgical gloves, have likewise been implicated in being causative of capsular contracture.ДЇor these reasons, it seems prudent to me to lessen the contact of the implant and the skin, and prevent glove powder from touching the implant prior to its placement in the pocket. In this biofilm state, these bacteria can cause more inflammation to the naturally-occurring scar that forms around an implant. The premise is that small amounts of bacteria that live in the ducts of the breast can gain access to the fluid that naturally occurs around an implant and form into a biofilm. The вЂњNo-TouchвЂќ technique helps in reducing possible contamination of the implant and the pocket during the procedure. Most people go back to work in a few days. We tell our patients that the recovery is one to two days and that they can return to regular activities within a week. If the implant is improperly immobilized by a poorly fitting bra, however, it may not allow the implant to access the bottom of the pocket as the pectoralis relaxes and gravity allows the implant to drop. If the pocket is made correctly, no bra is necessary to immobilize the implant. The incisions are almost completely sealed off from the outside for 24 hours. I place a waterproof dressing over the small incision and allow for immediate bathing. We tell our patients to stretch their pectoralis muscle but donвЂ™t exercise to the point where extra blood flow will add to the swelling of the area. If a muscle is sore, resting it makes sense, but immobilizing it makes for more stiffness.

None of these modalities are based on solid scientific principles.

I do not believe in placing a lot of restrictions on lifting, bathing, stretching, or the wearing of fancy post-surgical bras. The philosophy of the surgeon also matters a lot. Using ultrasound guidance, after you are asleep, I now place a long-acting numbing medicine to relax the pectoralis major muscle, resulting in fewer spasms and pain in the early postoperative phase. This has significantly reduced bruising, pain, and recovery for my patients. I have used a forceps electrocautery device for 20 years that allows for grasping and coagulation of small blood vessels prior to dividing them so that no blood enters the space where the implant will be placed.