Life After Breast Implants: What To Expect

Dr. Houssock (00:05):
You are listening to another episode of Perfectly Imperfect. Hi Val.

Val (00:12):
Hi Dr. Houssock.

Dr. Houssock (00:13):
How are you honey?

Val (00:14):
I'm great.

Dr. Houssock (00:14):
Welcome to the Perfectly Imperfect podcast.

Val (00:17):
Thank you for having me. Glad to be here.

Dr. Houssock (00:19):
Those of you who are watching on video, we have this awesome new setup. We hope you love it.

Val (00:25):
I do.

Dr. Houssock (00:25):
Val loves it.

Val (00:26):
I love it.

Dr. Houssock (00:27):
Val and I were, well all of us before we had this setup that we have in right now, we were sitting in different rooms right across the hall from each other and this is all, we're all growing. A lot of this stuff takes some growth and podcasts are one of the many things where you have to grow and figure things out. So we're very, very excited to be sitting across from each other.

Val (00:50):
It feels right. It just feels right.

Dr. Houssock (00:53):
She's actually a little too far from me, to be honest with you. I'm normally very close to Val when we're working side by side, but that being said, this is much better than staring at a screen and pretending like we're chatting.

Val (01:03):
You just put me in a room.

Dr. Houssock (01:05):
Yeah, just lock her in the room. So now we're in the same room. This topic, I feel like we say this a lot, but Val and I is very near and dear to us because we both have experienced it. So we are talking about life after breast implants and I think it's a great topic for so many reasons. I think one of the reservations about getting breast augmentation is am I really going to like him after I'm nervous? Once I do it, what's it like? Am I going to enjoy them? What do I need to know? And then not just the hard and fast rules, which of course we'll go through, but just generally how have they integrated into our lives? Right?

Val (01:48):
Right. Big change.

Dr. Houssock (01:49):
Yeah, I mean it's a big thing and doing any aesthetic procedure is a big life-changing thing in the sense that much of what we do, maybe not breast augmentation per se, but some of what we do is permanent. There's no going back. And while maybe technically augmentation is not one of those, it's still a very big deal. Comes with pros and cons. And I think sometimes some of it you just kind of learn on the fly. So because we've both been through it, it's very easy for us to talk about it in a personal way but also in the professional way.

Val (02:23):
Absolutely. Right. Definitely.

Dr. Houssock (02:25):
So how about you Val? Let's start with when you had yours done, how long did it take you to feel like they're, you didn't notice they were your boobs, they're not just something crazy that you had done. When did it kind of hit you like, oh, I actually don't even notice them anymore?

Val (02:41):
I would say it probably took me a good six months to really start to feel like they were a part of me. And not to go too much into detail quite yet, but I'm under the muscle. And so Dr. Houssock is above the muscle, so we'll talk about that in a little bit. But the recovery is also different. And I feel like with me going under the muscle, it definitely took some time for them to settle naturally them to not really impact my exercising them to sit naturally and close. So they definitely were very high and tight at first, but I would say about a good six months for sure, it took me to really feel like they were a part of me.

Dr. Houssock (03:21):
And that's about right when you think., and the reason why she mentions it, it does matter. If you are under the muscle, you have to keep in mind that the pec muscle, which is the muscle that we place these under the pec major muscle, pec minor stays on the chest wall, on the rib cage, and then the pec major is what is lifted to place the implant. And so if a patient has them placed there, we literally are on your rib cage looking at the floor being the rib cage and the ceiling being the pec major. And it just so happens that because of that plane and the fact that the muscle is getting affected, everything stays a little higher, tighter, square at first because what you're seeing from the outside is the pec muscle. The pec muscle has been for a lighter word, it's traumatized. So when you have an implant place under the muscle, the pec has swelling, everything's kind of tight, it's crampy. And so at first your implants really sit pretty high. Generally speaking, when they're placed above the muscle, you still are going to have swelling, you're still going to have some tightness and even some highness, but it isn't at the same level as those who get them under the muscle.

Val (04:31):
I agree.

Dr. Houssock (04:32):
So one of the things that I talk about, because for my patients, for the most part, unless I'm doing a lift, they do go sub glandular or above the muscle. There is a little bit of a speedier fluffing, if you will. We call it fluffing. I have no clue where that came from, but that is in the world. We call 'em dropping and fluffing. I guess the ideas are like a pillow and you're like fluffing it up, but they're not fluffy. But that's the concept. They take longer to fluff when you go under the muscle. There's nothing in the end the results. If you were to see somebody who's above the muscle or below the muscle, it's really hard for you to tell once they're all done. But they do take longer to settle. So Val saying six months isn't so shocking. I would say mine was closer to, I feel like they're really mine, it was a couple of months, maybe two to three months, they felt like they were a little bit more like myself. And again, mine are above the muscle. So faster recovery with how they feel and fluff.

Val (05:33):
I also was at that time of my life doing a lot of CrossFit. So the surgeon that did my surgery did say that I had a very thick

Dr. Houssock (05:42):
That matters.

Val (05:42):
Pec muscle.

Dr. Houssock (05:43):
That matters.

Val (05:45):
And she said to me, she's like, Val, it's going to take some time for them to really settle, for sure.

Dr. Houssock (05:51):
Yeah, for sure. And that does matter, man. Is it hard to get underneath that pec muscle when you are somebody who has a really well-defined it actually sometimes even limits what size we can put in. But anyway, so that's one of the initial when do you feel normal? And honestly, I would tell you just to really broad spectrum, it can take up to a year. Any surgery takes time to settle. There is no immediate gratification operation in the world. I get crazy when people talk about these speedy recovery, fast recovery. I want you going out to dinner the next night. And that honestly drives me nuts because I think it's a marketing ploy and okay, I'm glad you could go out to dinner, but also thank God you didn't trip and fall because you're on medication. I'm not one of those who's going to tell you I want you living your normal life in 48 hours. That's not happening. Sorry.

Val (06:45):
You need that recovery. Yeah, give your body that time.

Dr. Houssock (06:47):
Don't think that. And there's no surgical skill that can make your healing faster that you would be out to dinner that night and be fine. I am telling you, it's crazy. But anyway, so there's going to be a time period of healing, and I usually tell patients to be out of your basic day-to-day for at least a week if we're doing just a simple breast augmentation and then it's four whole weeks in my hands for if you are trying to get back into major heavy lifting, heavy sweating and honestly.

Val (07:19):
But it flies. It goes by so fast,

Dr. Houssock (07:21):
Doesn't it? Talk about that Val.

Val (07:23):
It really does.

Dr. Houssock (07:24):
You're told four weeks of no exercise, right? What's your first thought on that?

Val (07:28):
I was bummed. I was super bummed, I was getting married. I was in the best shape of my life. I had just finished RP strength, shout out, RP change.

Dr. Houssock (07:39):
I don't know if they could do that. If they haven't. They haven't sponsored us.

Val (07:45):
So I lost all this weight and I was feeling really good about myself. And then I had to take a break for four weeks and I was like, gosh, I really don't want to, but I'm glad I did. It gave my body the time to take that recovery. And when I was cleared to go back to working out, yeah, it took some time. It felt a little odd at first, different doing upper body stuff, but I actually felt stronger going back after taking that.

Dr. Houssock (08:11):
Because you gave the time. Yeah totally.

Val (08:13):
I gave the time. And I feel like recovery is a big important step in building muscle and endurance and all that. So I'm glad I had that time to just really relax and take that time.

Dr. Houssock (08:25):
And it's not just the lifting and all of that. You have to keep in mind that your body only has a finite amount of energy that it can expend in a daytime. And if you are using half of it to work out, then that half that you could have been using to heal is not being used to heal your body. And so that leaves you opened up to infections, seromas longer healing times, bad scars. The more you allow your body to heal and do what it needs to do, the better the result. It's not just like, oh, as long as I'm careful I'll be, it's the energy that you're expending.

Val (08:57):
Not worth it.

Dr. Houssock (08:57):
No. You want to have the best result possible. So four weeks is not a whole lot to ask. I want you walking immediately. So I ask you to go ahead and do your walking, walk as much as you want, but you've really got to take the time to take the rest. And your body will tell you that it needs the break anyway. But at the same time, you need to kind of be smart about it. Let's talk bras. So this was fun for me. One of the things about the bras, before I had my breast augmentation, I was wearing the typical bombshell like Victoria Secret, padded, bras.

Val (09:23):
So much padding.

Dr. Houssock (09:24):
Under wire padding, so much padding. I had no idea. I thought that was just normal. I worn them my whole life. And then when I got my implants, we were in sports bras. So I have patients wear a soft supportive bra for six weeks.

(09:38):
And I remember going back at one point and being like, I'm just going to see what these bras look like. What does my Victoria's Secret bra look like now that I with implants, my implants in. So I'm like, before I throw this entire drawer away, which was like, dude, you guys all know how expensive those Victoria Secret bras are so expensive. And I had developed over the years, I didn't get my implants until I was in my thirties. So I had tons and they were nice. Beautiful. Anyway, throw it on and my boobs were in my chin. I was like, so I guess these bras are done. I guess I don't need to wear these anymore.

Val (10:12):
And how uncomfortable was underwire?

Dr. Houssock (10:14):
Oh my gosh, terrible. So what did you wear immediately after? And then what did you get yourself into as things healed?

Val (10:22):
So immediately after, it was the surgical bra that button's in the front, super comfortable, good amount of support. I did that for a couple weeks and then after that I switched into Under Armour Sports Bras.

Dr. Houssock (10:33):
Oh yeah,

Val (10:33):
Because they fit so well. They gave you good support. And after that, I haven't come back to underwire since 2018.

Dr. Houssock (10:42):
No, and I think there's two reasons why there's no, the underwire thing is kind of out now. Maybe it's the world I live in, but I don't know that underwire is even in at all anymore. I feel like all the commercials and things I see are, even if people need pushups, they're being pushed up in a different way. So somebody comment on the bottom about that. If you guys can tell me what are people who are trying to do a pushup type thing without implants, what are you guys wearing? Are you still wearing underwires? Because we haven't seen underwires in a long time. And nobody goes back to them. Nobody. We wear cute bra. Lets now, and if you want some more pushup and support, you can obviously get some more support, but your implants kind of give you what you need.

Val (11:24):
They really do. It also doesn't feel comfortable to have something digging underneath there.

Dr. Houssock (11:29):
No,

Val (11:29):
My incision actually is around my nipple, not underneath.

Dr. Houssock (11:31):
Oh yes.

Val (11:32):
So even though I don't have an incision under there to wear it underwire bra still does not feel good. So our incisions here are under the breasts in the IMF area. So the fold and everyone who has an incision there definitely says it's not comfortable wearing underwire there.

Dr. Houssock (11:48):
Yeah, totally. Not at all. So we fell upon these Under Armour bras because, and again, we're not sponsored, so if they're listening anyway, so when I had my augmentation, I was like, alright, it's just the one spot. Your incision is right at your inframammary fold. And when you think about any bra, that's a spot that it digs in. And so I don't even know. I think honestly, now that I look back, I think I went to the Under Armour warehouse sale while I was recovering. They had these seamless bras. They're called the Under Armour Seamless or the Under Armour Long line. They still make 'em. And what I love about those bras, so these are the things that I like about it. So it doesn't matter if it's Under Armour, but so if you find it, this is the kind of bra you want, we'll link to that again with no obviously advantage to that. I'll link it and we'll have it in the show notes.

Val (12:41):
We love it.

Dr. Houssock (12:42):
It's a very thin strap here, so you can still look really cute in tank tops or whatever you want while you're healing. It's on a big old thick sports bra. And the bottom part is a seamless band, about four inches or so underneath. So there's no digging. It's longer so that it kind of supports, but it still comes down in a V. It's super cute. So it really fits well underneath all types of clothings. Even cute clothing, which ultimately you just had your boobs done. You don't want anybody having to wrap up in a crazy sports bra. So I love those bras and I've never found anything as good as them for recovery. No, they don't have any buttons in the front or anything like that. But by the time you're in that, which I usually tell you something to button for the first week or two after that, you're allowed to use your arms.

(13:35):
And that's one of the things we want to talk about. How should I be using my arms when it comes to this surgery? I don't need you necessarily, I call it the, yeah, the T-Rex. I don't think you need to T-Rex it, but you do have to be careful about how much you do. And if you're going to lift your arms, which is fine, you just have to do it. I always call it doing it deliberately, meaning be slow and steady about things. Don't pull something quickly because I've worked on your pec muscle and your pec is connected to your arm. So just want to be careful. You just want to be careful. So yeah, that's bras. And then long-term, I always say by six weeks you might go braless, you may want to, and I don't care if you do,

Val (14:16):
They have great pasties out there.

Dr. Houssock (14:18):
So show off the boobs. By six weeks you can be braless. But before the six weeks I want you in a bra night and day. I think it's really important.

Val (14:25):
It feels good too.

Dr. Houssock (14:26):
It's good for support. I don't need it to be tight, but I need it to be supportive. It's soft. There's a stitch that I use right at the inframammary fold at your incision that holds your implant up while it's healing and that suture goes to the rib cage and that suture is just a suture for the first six weeks. And then by the time you get to six weeks, your body has started to heal that area where it's okay to not have so much support helping it. And that's why that's my time period for when you can go out and do I always say you want to go out one night and have a cute little dinner out and you don't want to wear a bra and it's in the six weeks.

(14:57):
As long as you're not going on a trampoline, then fine, go ahead. But be careful.

Val (15:02):
Yes.

Dr. Houssock (15:02):
Oh, trampolines remind me of bouncing and that reminds me of sex. So I have a rule about the breasts being mine for two weeks and then they can be your spouses or significant others after that. So for the first two weeks, no sexy time, no touching my work, looking from afar. And then after two weeks I do say sex is okay, but we call it the starfish. And that comes after a patient who said that. And I thought it was the best thing in the world.

Val (15:29):
It really was.

Dr. Houssock (15:30):
If you can understand and picture a starfish, that's the kind of sex you're having. You're not getting into your swings yet or anything like that. You're just having very simple, very boring missionary sex. And still those boobs are kind of carefully on limits. So still be careful with them during sex, but at two weeks I do start allowing you to massage them. So I mean listen, foreplay during play, that's fine.

Val (15:56):
Yeah, if that's, I'm seven years post op and I still massage mine.

Dr. Houssock (15:58):
Yeah, so that can be part of the mix. Speaking of sex, you're with Kevin when you got them, right? Yes, yes. So what did Kevin think of your boobs? How about, let's go through this. What did Kevin think before, during recovery and after? Let's go through that and I'll tell you Chris's thoughts on that.

Val (16:16):
So before those who know Kevin, he's very supportive, very sweet guy. That's why I married him. And he was like, if that's going to make you happy, then obviously I support that. So he takes me to surgery and before they take me back, and it's where I work at that time, and he says to the surgeon, he was like, oh, if you want to put some eight hundreds in there and slip and slips her, I think a bill or something. And I was like, shut up, go away.

Dr. Houssock (16:45):
Kevin.

Val (16:45):
And so that was the before. And then six months later I did not go big enough.

Dr. Houssock (16:56):
Oh see, he was right all along.

Val (16:58):
He was right. So I went back and he was like, alright, we doing eight hundreds this time? And I was like, no, we're just going 200 ccs higher, still supportive, still great with helping me with recovery, helped me wash my hair the first time. The first time was really hard for me to get my arms up because how tight things were. So he was super helpful with that and just being there for me. And now, I mean I joke around, I'm not doing this, but I joke around taking them out because when I was pregnant, I was pumping, they were insane. And I was like, oh my god, this is wild. He was like, are you taking them out? And I was like, I think

Dr. Houssock (17:35):
So what we've decided is that Ken is obviously a boob guy.

Val (17:37):
Yes, he is. So he is very happy with them as am I. So yeah, overall he's been supportive since day one with it. I love you bub. So thanks.

Dr. Houssock (17:48):
Yeah. It's funny, sometimes we will have partners come in and they'll be with their significant others during these consults. Sometimes they're not, it doesn't matter to us. It's really up to you and your partner. And ultimately, I always speak to both of you. If you've been invited into the room, it means your significant other wanted you there. And so I will, if you're in the room, you're part of the conversation too. I do believe they're yours too. But at the end of the day, obviously the patient makes a decision. But I think there's nothing wrong with making that decision together if that's what works for you and your family. But ultimately, like I said, the decision is on the patient and what she wants and so we'll go with that. You are part of the process and obviously we do care what you think.

Val (18:33):
Oh yeah, absolutely.

Dr. Houssock (18:33):
We may not be doing it for you necessarily, but we do care what our significant others think. And I remember when I, so I really just started dating Chris when I was getting mine done. I was already going to get them done. I think I was already thinking about it. And then we started dating and I was like, Hey, what to do? And a couple Fridays from now I need a ride from surgery, I'm thinking about getting my boobs done, what do you think? And he was like, whatever. If anybody knows my husband, he is like the most calm, collected, cool guy, just the coolest.

Val (19:07):
He's so great.

Dr. Houssock (19:07):
Yeah, he was like, okay, if you want to whatever, it's fine. So he didn't care at all. And then I got them done and then he was a great recovery nurse and took care of me. He brought the girls donuts that day and so.

Val (19:23):
Diablo donuts.

Dr. Houssock (19:24):
Yeah. God, they were good. And so he's been a good partner through it. And then I would say now it's funny because sometimes now is the time where I've noticed he actually does them. I said something about, do you think my boobs, you think my boobs are too big now? I've been through pregnancy now and breastfeeding. And so I do think they've changed quite a bit and I think they're bigger going through that process. And I was like, are they too big? And he's like, no, no, I like them. I like them. I'm like, all right, fine. So long story short, it's nice to know at the end of the day, I don't know really very many people and I can't think of a patient that has been unhappy with their breast. And that doesn't mean that breast implant illness doesn't occur. We haven't had one of our patients yet have that.

(20:13):
I think it's that rare. That's a whole different podcast. It is a thing. And so since we're talking about life after breast implants, yes, there are instances where your body might not like your implants and that can come in the form of capsular contracture, which is scarring around your implant. It can come in the form of breast implant illness, which is a lot more complicated to talk about. It's many different symptoms. It's hard for us to pinpoint, it's hard for us to study, but the way that I describe it is I think some people just don't do well with having a foreign body in their body, much like some people can't do ear piercings and that kind of thing. So that is a thing. But it is rare enough that we haven't seen it in one of our own patients and I've been in practice for eight years now, but I've seen it.

(20:54):
So it doesn't mean I haven't seen it. It's just you figure, we do hundreds of implants a year and I haven't seen any yet in eight years of my own. So it's that rare. So I like to say that not to poo poo it, I don't believe in that. I believe it is real. I do believe that sometimes things get overdone sometimes on social media. And so you have to be very careful and just have a good surgeon that you can speak to about these things. Because if I have a patient who is concerned about that and I have had patients come from other practices, again, I always say that's not because I did anything special and my patients didn't develop breast implant illness. I just think it's that rare. And when they come to me and talk to me about it, I always say the only way we're going to know is by removing your implants. As long as you've had all of the other workup that your primary care would check for the symptoms. They talk about brain fog and tiredness and different things and to make sure that there's not something else going on because there's more likely that there's more likely some other reason.

(21:54):
As long as those things have been cleared out, then the only way for us to know is to take 'em out. And it's not a surefire thing.

Val (22:01):
No, I mean it's just like trial and error.

Dr. Houssock (22:04):
Yeah. I wish we had a lab value to look at, we don't. Things that we can look out for after breast augmentation are capsular contracture, which is still rare. Depending on the implant, it's anywhere, maybe they talk, it's hard to say about 0.5 to 1%, maybe a little bit more of patients get capsular contracture. That's a scarring around the implant. How do we diagnose it? It's feel, you can feel it. It feels hard, gets tight, can actually deform the implant. Treatment for that is not scary, but it's a procedure and so we have to take you back to the, or remove the implant and the scar tissue and then put a fresh implant in. A lot of companies have warranties for that. The ones we use have a warranty for a couple of years. And then I think there's always a little bit that you can get. So there's warranties that come with the implants. So that's one thing we can diagnose pretty clearly. The other one that people worry about is rupture. So how do you know if your implant's ruptured? So saline's easy. What happens with saline?

Val (23:04):
It deflates.

Dr. Houssock (23:07):
You wake up and you literally don't have a boob. It's easy. It's like a water balloon and the saline just dissolves into your body. Not a problem. It's salt water. So you know, silicone's more complicated because it is a really cohesive gel. And when it cracks, we have implants sitting here, right here. When it cracks, it still stays in its form. And so sometimes, and many times you don't even know that you've had a rupture. Sometimes the body will respond to it and notice it and then you'll start getting capsular contracture or some discomfort. But because it's so hard to tell, because it's so hard to tell if you've ruptured, the FDA has suggested that you do keep an eye on these implants every few years with imaging. So currently, and this changes a lot. So currently you are to get a MRI or ultrasound at five years out from your implants. And then every three years after that, they used to say it had to be an MRI and now they've switched it to either ultrasound or MRI. So what I normally tell patients is if you are in that age of getting a mammogram, then every three years add an ultrasound to your mammogram. Unfortunately, you cannot see a rupture really well with mammogram. And also all images aren't perfect. So ultrasound is okay, but MRI is the best way to tell.

(24:22):
And then the other downside is that even MRIs can miss one because we had a patient recently who got an MRI thinking she was ruptured, she was ruptured on her MRI on the right side. And when we went in, she was ruptured on the left too.

(24:35):
So it didn't show the left. It was so early that the body hadn't responded yet, but they were both ruptured. So images are helpful. The most important thing to know is that the rupture in itself is not dangerous to you. It sounds really scary, like oh my gosh, I have silicone, you do have silicone floating through your body. So when studies are done on women who have silicone implants, you do have silicone in your bloodstream and that silicone can even go into the bloodstream of a unborn baby. But the dosing and the amount is so low that there is zero risk. This is important because it sounds really scary. Again, I had my implants in, Val had her implants in when we were both pregnant. Yes, that's been studied and yes, it exists in the bloodstream, but it is at such a low level that it is not detrimental to your health. So it just doesn't work that way. It's a very inert substance and it doesn't hurt you in that way, but it's ultimately a foreign body.

Val (25:28):
So get your images.

Dr. Houssock (25:29):
Yeah, so get your images. So alright, so someone's fresh out of surgery Val. Val makes the phone call to prepare patients for surgery. So they're fresh out of surgery, they leave us and they're on their way home. What are the things that they're thinking about in the first two weeks? Talk me through their recovery.

Val (25:44):
So making sure their diet's adequate because diet's important for recovery. Staying on top of pain control. So we really like our patients rotating between an anti-inflammatory, some Tylenol and their narcotic if they need it. Icing, it's going to be ice is your best friend for the first couple days. Give me at least three days worth of icing. But obviously feel free to do it longer if you need it. Taking the time to recover like we talked about earlier, super important. Making sure you have the help if you do have kids, it takes a village during recovery, so definitely get that all lined up before surgery. It also takes the stress level down on you, which can also impact your recovery. So stress is a big thing as well too. And making sure the necessary supplies at home that you might need. So Bacitracin is good to have some gauze pads just in case lining up another bra because after the one week mark you can switch into something different. So having something else like that and then just making sure that you have everything, all your prescriptions lined up, your antibiotic, anti-nausea just in case, and some good Netflix shows.

Dr. Houssock (26:51):
Yeah, no kidding. Yeah, Netflix and chill for real. Really do that. And that's really, it's about TLC, it's about TLC. Yes, you're going to have some bruising and swelling that is very normal and typical, you are going to have some soreness and I usually say it's more like a tightness. It's not pain, pain, but it's tightness. And I remember the first night waking up, the wake up and sitting up the first morning after surgery. Yes, I remember that feels so tight under the incision.

(27:18):
So that's normal and typical and pings and pangs is very normal, like nerve ending kind of things. Zings again, I remember these things like they were yesterday, like 10 days out or so. Your nipples get again, not everyone gets this, but I did and it was crazy. They're so sensitive because we've placed an implant in between the nerves. The nerves travel through your skin to the nipple and so we're stretching those nerves and so they get irritated. And my nipples were so sensitive.

Val (27:44):
Mine were too.

Dr. Houssock (27:45):
Yeah, the shower head goes on them and it hurts. It's not guys that are listening. It's not fun. No. Okay, I hear I know what you're thinking. I'm talking about sensitivity and you're like, no, no, stay away from them. It's super, it's uncomfortable and then it goes away and then it goes away. Something else that can happen around the 10 day mark.

(28:05):
And we don't talk about it that often. It's not that common, but it is very benign. It's something called Mondor's disease. And I always say that sounds terrifying. Mondor's disease. So when we cut the incision, we cut across veins and when it happens, it's higher risk for those who are very, very slim with very little body fat. When you cut across the veins, they back up and so it's okay. It's not like a blood clot. They're just very superficial veins. And so when they get cut and they get backed up, it's exceedingly painful in the vein and it can feel like literally just an absolute sharp, sharp, sharp pain at the incision site. So much so that I've had patients who have left work and they're thinking something's wrong. So it is not a dangerous situation. It can be uncomfortable. It usually happens around 10 days out and it is completely benign and the treatment is 800 milligrams of ibuprofen every six hours, just anti-inflammatory.

(29:03):
And it goes away on its own, but it can be shocking. It doesn't happen right away. It's not like, oh, I wake up and the next day I have it. It happens about a week and a half out. So if that happens to, that is a very typical thing. Obviously still check in with your surgeon because we don't know that it's that until we examine you or talk to you. So yes, it's common, but it could be other things. So let us be the judge of making sure that it's just something benign.

Val (29:27):
Yes, please call us.

Dr. Houssock (29:28):
Yes. And then after that four to six week mark, we do let you get right back into your exciting life. And I just say, live your life. I really don't give you limitations. I remember some old surgeons talking about how they never want you to sleep on your stomach again or lay on your stomach, get out of here, get out of here. You live your life, you got these implants. Live your life and if they move or something happens to them, we'll fix 'em. You're not going to ruin them laying on 'em. Stop it. Live your life.

(29:59):
Enjoy yourself. Do all the activities. I've had guys who say you can never do chest workouts ever again. Again, get out of here. Why? Yeah, just do what you want to do. One of the things we wanted to mention is if you're a bodybuilder or you do that kind of thing, or even if you're just somebody who really loves to lift it for strength, you can do it with implants these days we're putting them all above the muscle anyway, at least in my practice since 2017. So it's not going to affect your strength. It's not going to affect your pec muscle. The only thing about, you have to think about when you are a bodybuilder, you have very little body fat. So I might put you in a little bit more cohesive gel implant so that it holds the shape a little bit better. You're not going to have anything to cover it with. So that's the only thing. I would probably put you in a little bit of a stiffer implant to keep the shape. Otherwise you could get some rippling and that kind of thing because you're so fit. But you absolutely, we have Olympic weightlifters and bodybuilders who get implants all the time and it does not change their strength at all.

Val (30:53):
Just start slow.

Dr. Houssock (30:54):
Yeah,

Val (30:54):
Just listen to your body. And start slow.

Dr. Houssock (30:56):
Yep. But you absolutely can do all the workouts that you want to do. You just have to ease into all of that.

Val (31:00):
Absolutely.

Dr. Houssock (31:01):
Finally, how long do these puppies last? So the old school answer used to be 10 years. That was just somebody making up a number and we all said it because we didn't know what else to say. We see implants now that are 25 years old that are doing amazing and fine. Here is my steadfast, but very general rule, if you've had your implants and you're doing fine and you love how they feel and you love how they look and you've had them imaged and everything's fine, you can leave your implants alone, leave 'em alone. You don't have to get them taken out. There is some stipulations where I will tell you implants are so good now that your body's going to change faster than maybe the implant. So you might need to lift at some point. You might want to go smaller, you might want to go bigger.

(31:46):
The other thing that I've noticed is that some implants, even when they have not ruptured, once they get to a certain age, they start to, I've had recently where I've seen where the gel is seeping through the implant. It's not ruptured, but these guys have been in for a long time. So it starts to seep through the shell. So my new rule is maybe start thinking about it and being aware of it around 15 years out. It doesn't mean you can't have them switch before and it doesn't mean you have to get them at 15, but you want to be aware of it. You might want to touch base, you might want to just make sure that you're happy and that your imaging has been fine and that maybe even come in and see me and we just make sure that everything's going well. I've seen perfectly beautiful implants that are longer and older than that. So I have a hard time giving you a steadfast rule. So just keep an eye on.

Val (32:35):
I think that's very fair.

Dr. Houssock (32:36):
Yeah, everybody's different. Everybody's different. What else, Val? Did we miss anything?

Val (32:40):
I think we got everything.

Dr. Houssock (32:42):
I mean there's a lot to this and of course if you have questions or anything, please put them in the comments. If you've got things we didn't cover about life after implants, we definitely don't regret them.

Val (32:52):
No.

Dr. Houssock (32:53):
I don't know, I will probably always have implants. It's not even just about the size, it's about the shape. It's about what it does for me. And my boobs went through a lot going through breastfeeding and stuff, so I know they're not what they used to be. Yeah,

Val (33:05):
I actually said to Dr. Houssock the other day, I actually like mine more now than I did before I had Emmy because I feel like they just settled more naturally now and they weren't so high and tight. And yeah, like I said, I'm going to just ride 'em out as long as I can.

Dr. Houssock (33:22):
Yeah. I'm going to tell you, I'm going to shout out Eva because Eva, the director of our podcast, had to ask before our podcast if mine were real or fake because mine looks so natural. I love that. I love that. So shout out to my surgeon. I'm actually going to call it on two people. I'm going to shout my surgeon and I'm going to shout out my son because I think my soft droopiness that I now have is from going through pregnancy and breastfeeding. But yeah, the one thing I love about, and it doesn't mean you can't have a natural looking breast when you're subpectoral, but the sub glandular implant will age with you in that way, whereas it will sag with you in that way. I do, people ask about how they age, the concern, and sorry, I'm thinking about this last minute, but the concern of how they'll age. Alright, well listen, I hear you Dr. Houssock, I could have these for 15 plus years, but how are they going to look? How are they going to age? I do the sub glandular or the above the muscle for one of those reasons, and it's because of how they settle. You might argue, well, some people say, well, if they're above the muscle, do they have as much support? Well, you want support, but you also want them to age with your boobs.

(34:30):
And we don't live on the moon, I say we have gravity. So if your boobs over your lifetime are going to sag some you want your implant to also, because unfortunately with a subpectoral implant, not all, but a lot of subpectoral implants will stay high and tight, which sounds super attractive in the acute setting. But if your implants are staying high and your boobs are sagging low, you get something called a waterfall deformity or a Snoopy deformity and they just kind of fall over the implant. That does not look natural at all. So I do like how a above the muscle implant ages because it ages with your breast.

Val (35:06):
I agree.

Dr. Houssock (35:07):
So that's one other thing in just life after implants, just to think about. By the way, most importantly, it is not wrong to put an implant above or under the muscle.

Val (35:15):
Not at all.

Dr. Houssock (35:16):
It's not wrong. Please hear me. This is what I do in my practice. There are many, many, and really the whole entire generation before me, they were all subpectoral and even some of the people who are still practicing. Absolutely. That pendulum is just turning. And the reason why I think I'm a little ahead of the game is I was training at Hopkins at the time where it was getting really hot to do pre-pectoral breast reconstruction, and we were placing implants above the muscle on mastectomy patients and doing it really well. And we were finding patients were doing amazing. They had much less pain, they had all these things. It was so good for them.

(35:51):
And so when I came out into practice, I was fresh out and I was like, why would I not do this to my cosmetic patients too, who have, by the way, more breast tissue than a mastectomy patient. So I kind of came out here at an early time. So I think that's why I personally have been doing it so long, whereas it's starting to kind of catch on now because we were kind of just starting to do that in training. So anyway. Anyway, great topic. Any questions that we didn't address, please comment below and carry on Val.

Val (36:19):
Carry on Dr. Houssock.

Dr. Houssock (36:22):
Perfectly Imperfect is the authentically human podcast navigating the realities of aesthetic Medicine. Got a question for us? Leave us a voicemail at perfectlyimperfectpodcast.com. JEV Plastic Surgery is located in Owings Mills, Maryland. To learn more about us, go to JEVplasticsurgery.com or follow us on Instagram @DRCareHoussock, spelled D-R-C-A-R-E-H-O-U-S-S-O-C-K, or just look in the show notes for links. If you enjoyed this episode, please share it and subscribe to Perfectly Imperfect on YouTube, apple Podcasts, Spotify, or wherever you'd like to listen to podcasts.