RE: I'm new-thanks

October 7, 2002

Wow, I just measured my scars underneath. The left one is 5 inches, the right almost 6. But I didn't have that much boob skin to begin with--I did get stretch marks when I got milk in--I went almost to a D cup with milk, then back down to my normal size, an A, but with all that extra skin.

My impression was that the large scars I have now are mostly from the en bloc explant with lift. , (and I know you can't say this for sure, but I'll ask it anyway), do you think these size scars would be normal for an anchor lift if I had never had implants?

Patty

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 8:52 AM

Subject: RE: I'm new-thanks

Bonnie: That is correct. The smaller the skin resection, the smaller the horizontal compenent. It is mathemathical. .

-----Original Message-----From: Heer [mailto:idagirl@...]Sent: Monday, October 07, 2002 11:45 AM Subject: Re: I'm new-thanks

I was nothing but skin, if you have looked at my photos here on the site you can see I was very saggy and just skin with nipples hanging down before implants. My breasts are not firm at all, they are still smoshy, but they are perky and sit up where they should be

----- Original Message -----

From: Bos@...

Sent: Monday, October 07, 2002 9:48 AM

Subject: Re: I'm new-thanks

I'm lost again--where does this 3rd scar fit in? Again, I'm just going by my daughter's anchor mastopexy--her incision went around the areola, vertically down and about a 1-1/2 ro 2 inch area horizontally under the breast. . .??? I would think that the amount of skin to be removed would decide the width of the bottom of the anchor and therefore horizontal incision, but maybe I have this wrong in my mind. . .i,e. the more to be removed the longer the horizontal incision. I can't feature a need for an anchor if there isn't a lot of extra skin, but in her case, there was--she had very, thin stretchy skin and of course she cannot be the only one with this type of skin. There was a time a plastic surgeon would assess the skin and advise the patient of the potential things that may be encountered as a result of it. . . Bonnie Bonnie Bonnie

October 7, 2002

That does seem big, I mean what I don't get is that he did the vertical lift so why would you need that big of a scar underneath too? The vertical ones are pretty long themselves, I would think long enough to do an en bloc, right? Weird, anyhow, I don't think you could have been much saggier than I was so again, not sure why you had to have those extra scars. However wasn't your implantation through the crease? This could be part of why he reused them, my implants were put in through the nipple so it made sense to use them again.

oh well, who really knows, all I know is that I did what needed to be done, I had saggy boobs and stretched out big ugly nipples that needed to be smaller for my smaller breasts.

hugs

C

----- Original Message -----

From: ~*Patty*~

Sent: Monday, October 07, 2002 10:27 AM

Subject: Re: I'm new-thanks

Wow, I just measured my scars underneath. The left one is 5 inches, the right almost 6. But I didn't have that much boob skin to begin with--I did get stretch marks when I got milk in--I went almost to a D cup with milk, then back down to my normal size, an A, but with all that extra skin.

My impression was that the large scars I have now are mostly from the en bloc explant with lift. , (and I know you can't say this for sure, but I'll ask it anyway), do you think these size scars would be normal for an anchor lift if I had never had implants?

Patty

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 8:52 AM

Subject: RE: I'm new-thanks

Bonnie: That is correct. The smaller the skin resection, the smaller the horizontal compenent. It is mathemathical. .

-----Original Message-----From: Heer [mailto:idagirl@...]Sent: Monday, October 07, 2002 11:45 AM Subject: Re: I'm new-thanks

I was nothing but skin, if you have looked at my photos here on the site you can see I was very saggy and just skin with nipples hanging down before implants. My breasts are not firm at all, they are still smoshy, but they are perky and sit up where they should be

----- Original Message -----

From: Bos@...

Sent: Monday, October 07, 2002 9:48 AM

Subject: Re: I'm new-thanks

I'm lost again--where does this 3rd scar fit in? Again, I'm just going by my daughter's anchor mastopexy--her incision went around the areola, vertically down and about a 1-1/2 ro 2 inch area horizontally under the breast. . .??? I would think that the amount of skin to be removed would decide the width of the bottom of the anchor and therefore horizontal incision, but maybe I have this wrong in my mind. . .i,e. the more to be removed the longer the horizontal incision. I can't feature a need for an anchor if there isn't a lot of extra skin, but in her case, there was--she had very, thin stretchy skin and of course she cannot be the only one with this type of skin. There was a time a plastic surgeon would assess the skin and advise the patient of the potential things that may be encountered as a result of it. . . Bonnie Bonnie Bonnie

October 7, 2002

:

I am happy with my PS. The only thing that irks me is for revisional work he charges a (small) fee. But that's the policy at the University. That's the way the ball bounces.

LM

October 7, 2002

:

Hi. My doc told me the same thing Feng told you. I guess it comes down to differences in *styles* and philosophy. While there are no guarantees when it comes to the result of surgery, one betters their chances being picky about their doc. Why take unnecessary risks!

LM

October 7, 2002

:

Hi. What is the "Bevel Cut"--it does sound fascinating? I too would have been one over.

LM

October 7, 2002

Oooh, too bad, I don't have any and Hiatt never took any. Oh well, can't change it anyway.

Patty

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 9:09 AM

Subject: RE: I'm new-thanks

Patty: I would have to see your preop photos. .

-----Original Message-----From: ~*Patty*~ [mailto:fdp@...]Sent: Monday, October 07, 2002 12:27 PM Subject: Re: I'm new-thanks

Wow, I just measured my scars underneath. The left one is 5 inches, the right almost 6. But I didn't have that much boob skin to begin with--I did get stretch marks when I got milk in--I went almost to a D cup with milk, then back down to my normal size, an A, but with all that extra skin.

My impression was that the large scars I have now are mostly from the en bloc explant with lift. , (and I know you can't say this for sure, but I'll ask it anyway), do you think these size scars would be normal for an anchor lift if I had never had implants?

Patty

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 8:52 AM

Subject: RE: I'm new-thanks

Bonnie: That is correct. The smaller the skin resection, the smaller the horizontal compenent. It is mathemathical. .

-----Original Message-----From: Heer [mailto:idagirl@...]Sent: Monday, October 07, 2002 11:45 AM Subject: Re: I'm new-thanks

I was nothing but skin, if you have looked at my photos here on the site you can see I was very saggy and just skin with nipples hanging down before implants. My breasts are not firm at all, they are still smoshy, but they are perky and sit up where they should be

----- Original Message -----

From: Bos@...

Sent: Monday, October 07, 2002 9:48 AM

Subject: Re: I'm new-thanks

I'm lost again--where does this 3rd scar fit in? Again, I'm just going by my daughter's anchor mastopexy--her incision went around the areola, vertically down and about a 1-1/2 ro 2 inch area horizontally under the breast. . .??? I would think that the amount of skin to be removed would decide the width of the bottom of the anchor and therefore horizontal incision, but maybe I have this wrong in my mind. . .i,e. the more to be removed the longer the horizontal incision. I can't feature a need for an anchor if there isn't a lot of extra skin, but in her case, there was--she had very, thin stretchy skin and of course she cannot be the only one with this type of skin. There was a time a plastic surgeon would assess the skin and advise the patient of the potential things that may be encountered as a result of it. . . Bonnie Bonnie Bonnie

October 7, 2002

My PS lifted big granny-like boobs (D) with a vertical. I suppose for the abnormally sized women.....yikes.

LM

October 7, 2002

Sorry Bonnie, you confused me--

I did not have implants when lactating. I had my kids and breast fed them before I got implants. (I waited to get implants till I was done-- I would never put my kids in potential harm's way!)

But I am confused by what you said, so I don't know if this is what you thought!

Patty

----- Original Message -----

From: Bos@...

Sent: Monday, October 07, 2002 10:07 AM

Subject: Re: I'm new-thanks

--that's what I pictured. . .I'm wondering now if we are all on the same page. . .are you saying that your explant was performed entirely between the nipple and the crease with no horizontal incision? If so, I haven't ever heard of that. Could it be that your horizontal incision has faded or is so small as not to be noticed? It seems you didn't have your implants very long, so your skin probably didn't give out much. Where was your incision for implant? Bonnie

October 7, 2002

My allergies are to prolene and vicryl sutures, and because the sutures that were placed in my chest after my open heart surgery caused a SEVERE infection which led to sepsis, my being admitted to the ICU and fighting for my life, I don't know of any doctor who would risk his/her license or reputation by putting dissovable sutures in me. And I wouldn't let them. And the 2 surgeons who operated on me after my heart debacle refused to attempt it, and this was my neurosurgeon and Dr. Huang. She normally doesn't do a subcuticular suture, but after talking to me and reading my med records, she absolutely said she was not going to take a chance with any dissolvable sutures. I think the statement you made that the much longer lasting dissolvable sutures are not going to result in allergic reactions is incorrect and misinformation. This may be a "blanket" statement for the majority of people, but not everyone. I had titanium placed in my neck for my first surgery. This is supposed to be something that no one reacts to, and yet I did. Plus, in people who do have allergies to sutures, the last thing they need in their body is a longer lasting suture to invite infection and allergic reaction. Plus, once someone has an allergy to a particular kind of suture, they are at higher risk to have hypersensitivity reactions in the future, which you should be taking into account when you do your H & P. I'd much prefer to go to a MD who will err on the side of caution and not take any risks. e ----- Original Message ----- From: Dr. Kolb Sent: Monday, October 07, 2002 5:33 AM Subject: RE: I'm new-thanks Most plastic surgeons use internal dissovable and external permanent or paper tape if needed on the breast. Some older plastic surgeons use permanent subcuticular (pull-out) if the patient has reaction to Vicryl or Dexon. Most of the longer lasting dissovable sutures are not going to result in allergic reactions. The worst scars I have are in protein deprived ie bullemic or alcoholic patients so patient factors are often important. . -----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 12:41 AM Subject: Re: I'm new-thanks Bonnie, You're right in that it really is not a matter of internal dissolvable sutures vs external sutures that makes a scar good or bad. It comes down to technique and expertise, as well as type of suture used. I will say again, that internal dissolvable sutures will almost always have a better aesthetic result than external scars; however, if you get a surgeon who is meticulous in his/her technique, one can have all external sutures and have very faint scars, which fade over time to become barely visible. Since I cannot have dissolvable sutures, (as I found out with my heart surgery), my neurosurgeon was the first surgeon after that debacle to have to find a suture I wasn't allergic to and which would not produce a horrible or even large scar. He is a meticulous surgeon anyway, since he often deals with facial trauma and brain trauma, and has to cut the face and scalp. He used 2-0 PDS running subcuticular sutures on my neck, and my scar is barely visible. And working in a trauma hospital, I have seen multiple traumas come in and their face has essentially been reduced to mush. A ps operates, uses hundreds of sutures, and that persons face is just like new. And on the other hand, I've seen other ps' whose technique sucks and I'm suprised they even have a clientele! So, suturing technique is probably the most important factor in how a scar will turn out. Sure, it's always better to have dissolvable sutures, but if the surgery is too big, or the pt is allergic, or there's another reason they can't be used, external sutures can be used, and a very good, acceptable aesthetic result can be obtained. I am living proof. I also had foot surgery done for a neuroma. This was an orthopedic surgeon, so I figured I'd be butchered, but this man was so meticulous in his suture technique, that you can't even see the scars now, and in fact, I have to actually pull the skin taut to see the scars, otherwise they are invisible. And there are just some areas and surgeries where you can't use dissolvable sutures or subcuticular sutures. e ----- Original Message ----- From: Bos@... Sent: Sunday, October 06, 2002 6:47 PM Subject: Re: I'm new-thanks I think it may not be a matter of external or internal stiches-- HOW it is stitched can make a difference. Example, when I was only 22 I had a mole removed from my face and the surgeon put eleven external stiches in a tiny little space--I can't even find a scar or the area itself, although I know it has to be there. He said the more stitches, the fainter the scar. My ex had an auto accident whereby his neck was ugly with scars from a barbed-wire fence; when these were removed it was restitched with over two hundred external stitches and one can barely see the lines (same doctor) In addition, I would think one's particular skin and pigment color has something to do with scarring. For instance, I'm told that darker skinned people show scarring more than lighter skinned people. Bonnie I'm still confused re the anchor vs. vertical scarring-- is there not a scar from the nipple down to the bottom of the breast and then across the bottom in both cases? Bonnie

October 7, 2002

I didn't know--there was just so much controversy over silicone gel, and I have always been of the mind that God's way are infinitely better than man's. He knows best how to make babies, and I wasn't going to do anything to alter the conditions under which they were to be formed! I mean, common sense tells us that putting something into your body is going to change the way it functions in some way, even if it is on a microcellular level...and that is how babies start out.

So, yes, in the back of my mind, I knew when I got implants that I was changing my body, and that it may not be as safe as the doctors claimed. I had absolutely no idea now bad it was though until it actually happened to me. I think that we can all say that.

Patty

----- Original Message -----

From: Bos@...

Sent: Monday, October 07, 2002 11:10 AM

Subject: Re: I'm new-thanks

That is what I thought--that you had implants while lactating. . . So the stretching occurred due to the pregnancies and lactations (and aging skin) and you filled the "extra" with implants? That's what a lot of women do. . . So you thought implants were potentially harmful even when you got them? My daughter was told (I was there) AFTER implantation, not to breast feed. . this was in 1989. . . Bonnie

October 7, 2002

You got it....

That's why we are here : ) And we will try to reach anyone else we can through the media.

Patty

----- Original Message -----

From: Bos@...

Sent: Monday, October 07, 2002 12:37 PM

Subject: Re: I'm new-thanks

"I had no idea how bad it was until it actually happened to me" Wish this could be publicized over and over somehow for all those women who are taking the risk. . .just so they have this fact well fixed in their minds. Bonnie

October 7, 2002

I got my implants in May 1997. Everyone was saying they were safe. I heard nothing bad about saline, but still, in the back of my mind, there was that little nagging thing that made me wonder...

Yes, it has made me a better person but I wouldn't recommend others taking this path!

----- Original Message -----

From: Bos@...

Sent: Monday, October 07, 2002 12:35 PM

Subject: Re: I'm new-thanks

Oh--don't know when you got implants. . .so the controversey had got underway already. . .it appears to me that you had a life lesson and learned from it whatever it was you were supposed to learn. It may not seem so, but I consider your experience ultimately positive in the whole big scheme of things--in the words of my attorney's paralegal, "It could have been worse." It's real doubtful you will need to be presented with the same lesson again. . .(a personal philosophy) Bonnie

October 8, 2002

Martha:

Hi.Are you married? I'm 29 and single and to be quite blunt not very experience with men. I had what many would be considered a lovely body until my PS butchered me putting in/taking out my implants. As good as it was to be explanted, I think it's important to get good results as well. My disfigurement has impacted on my sexuality and self esteem.

I agree with . When you're my age (or any age) and unmarried (or married) whatever, you want good results--and your health too.

I'm glad things went well for you.

Take care and keep those quotes coming.

LM

October 8, 2002

Amen!

October 8, 2002

Explants are a whole different ball of wax than regular mastopexies and reductions as the blood supply is different to the nipple. If not careful one could have a partial or total nipple necrosis as Jenna did due to this situation. Pneumonthorax is also a possibility as we are very close to the pleura. One patient called to say she had an undiagnosed pneumothorax from an explant that was diagnosed after her airplane trip home from another surgeon. Like with anything there is a learning curve. I have had th good fortune not to have either of these complications but it does make me very cautious as I know that other experienced surgeons have had these potentially serious problems. .

-----Original Message-----From: perlesetlacet@... [mailto:perlesetlacet@...]Sent: Monday, October 07, 2002 4:10 PM Subject: Re: I'm new-thanks :Hi. My doc has been a PS since 1997. He's younger and new school. He's done MANY mastopexies and reductions (I saw many photos), and reconstructive breast work on women with cancer pediatric plastic surgery, maxillofacial, and burn victims. He does not do as many breast augmentations and explants as there is not as great as a demand in his practice. He is more in the reconstructive side of plastic surgery than just the "cosmetic" side of it.Take care,-Marie

October 8, 2002

e: I have never had an allergic reaction to PDS or Maxon sutures in any of my patients but I agree it could occur. But remember that my patients are on an immune program prior to surgery so many of their allergies are resolving. If one is not on such a program, I agree that multiple allergies are possible. Prolene is a permanent suture that is similar to nylon so what kind of sutures did Huang use? We will often test patients prior to surgery to determine allergies then use NAET to eliminate them. Have you considered NAET? We are going to be interviewing the doctor who developed this technique on the radio show this month. You might want to read her book. Her name is Dr. Devi. Have you had your platinum levels tested as multiple allergies can be associated with this toxicity and there is a protocol for detoxification of platinum at www.templeofhealth.ws . I believe our clinic is very skilled at the treatment of the multiple chemically sensitive patient as we are trained in holistic medicine. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 2:43 PM Subject: Re: I'm new-thanks

My allergies are to prolene and vicryl sutures, and because the sutures that were placed in my chest after my open heart surgery caused a SEVERE infection which led to sepsis, my being admitted to the ICU and fighting for my life, I don't know of any doctor who would risk his/her license or reputation by putting dissovable sutures in me. And I wouldn't let them. And the 2 surgeons who operated on me after my heart debacle refused to attempt it, and this was my neurosurgeon and Dr. Huang. She normally doesn't do a subcuticular suture, but after talking to me and reading my med records, she absolutely said she was not going to take a chance with any dissolvable sutures.

I think the statement you made that the much longer lasting dissolvable sutures are not going to result in allergic reactions is incorrect and misinformation. This may be a "blanket" statement for the majority of people, but not everyone. I had titanium placed in my neck for my first surgery. This is supposed to be something that no one reacts to, and yet I did. Plus, in people who do have allergies to sutures, the last thing they need in their body is a longer lasting suture to invite infection and allergic reaction. Plus, once someone has an allergy to a particular kind of suture, they are at higher risk to have hypersensitivity reactions in the future, which you should be taking into account when you do your H & P.

I'd much prefer to go to a MD who will err on the side of caution and not take any risks.

e

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 5:33 AM

Subject: RE: I'm new-thanks

Most plastic surgeons use internal dissovable and external permanent or paper tape if needed on the breast. Some older plastic surgeons use permanent subcuticular (pull-out) if the patient has reaction to Vicryl or Dexon. Most of the longer lasting dissovable sutures are not going to result in allergic reactions. The worst scars I have are in protein deprived ie bullemic or alcoholic patients so patient factors are often important. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 12:41 AM Subject: Re: I'm new-thanks

Bonnie,

You're right in that it really is not a matter of internal dissolvable sutures vs external sutures that makes a scar good or bad. It comes down to technique and expertise, as well as type of suture used. I will say again, that internal dissolvable sutures will almost always have a better aesthetic result than external scars; however, if you get a surgeon who is meticulous in his/her technique, one can have all external sutures and have very faint scars, which fade over time to become barely visible. Since I cannot have dissolvable sutures, (as I found out with my heart surgery), my neurosurgeon was the first surgeon after that debacle to have to find a suture I wasn't allergic to and which would not produce a horrible or even large scar. He is a meticulous surgeon anyway, since he often deals with facial trauma and brain trauma, and has to cut the face and scalp. He used 2-0 PDS running subcuticular sutures on my neck, and my scar is barely visible. And working in a trauma hospital, I have seen multiple traumas come in and their face has essentially been reduced to mush. A ps operates, uses hundreds of sutures, and that persons face is just like new. And on the other hand, I've seen other ps' whose technique sucks and I'm suprised they even have a clientele!

So, suturing technique is probably the most important factor in how a scar will turn out. Sure, it's always better to have dissolvable sutures, but if the surgery is too big, or the pt is allergic, or there's another reason they can't be used, external sutures can be used, and a very good, acceptable aesthetic result can be obtained. I am living proof. I also had foot surgery done for a neuroma. This was an orthopedic surgeon, so I figured I'd be butchered, but this man was so meticulous in his suture technique, that you can't even see the scars now, and in fact, I have to actually pull the skin taut to see the scars, otherwise they are invisible. And there are just some areas and surgeries where you can't use dissolvable sutures or subcuticular sutures.

e

----- Original Message -----

From: Bos@...

Sent: Sunday, October 06, 2002 6:47 PM

Subject: Re: I'm new-thanks

I think it may not be a matter of external or internal stiches-- HOW it is stitched can make a difference. Example, when I was only 22 I had a mole removed from my face and the surgeon put eleven external stiches in a tiny little space--I can't even find a scar or the area itself, although I know it has to be there. He said the more stitches, the fainter the scar. My ex had an auto accident whereby his neck was ugly with scars from a barbed-wire fence; when these were removed it was restitched with over two hundred external stitches and one can barely see the lines (same doctor) In addition, I would think one's particular skin and pigment color has something to do with scarring. For instance, I'm told that darker skinned people show scarring more than lighter skinned people. Bonnie I'm still confused re the anchor vs. vertical scarring-- is there not a scar from the nipple down to the bottom of the breast and then across the bottom in both cases? Bonnie

October 8, 2002

My statement that most of the longer lasting sutures are not going to result in allergic reactions is medically correct. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 2:43 PM Subject: Re: I'm new-thanks

My allergies are to prolene and vicryl sutures, and because the sutures that were placed in my chest after my open heart surgery caused a SEVERE infection which led to sepsis, my being admitted to the ICU and fighting for my life, I don't know of any doctor who would risk his/her license or reputation by putting dissovable sutures in me. And I wouldn't let them. And the 2 surgeons who operated on me after my heart debacle refused to attempt it, and this was my neurosurgeon and Dr. Huang. She normally doesn't do a subcuticular suture, but after talking to me and reading my med records, she absolutely said she was not going to take a chance with any dissolvable sutures.

I think the statement you made that the much longer lasting dissolvable sutures are not going to result in allergic reactions is incorrect and misinformation. This may be a "blanket" statement for the majority of people, but not everyone. I had titanium placed in my neck for my first surgery. This is supposed to be something that no one reacts to, and yet I did. Plus, in people who do have allergies to sutures, the last thing they need in their body is a longer lasting suture to invite infection and allergic reaction. Plus, once someone has an allergy to a particular kind of suture, they are at higher risk to have hypersensitivity reactions in the future, which you should be taking into account when you do your H & P.

I'd much prefer to go to a MD who will err on the side of caution and not take any risks.

e

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 5:33 AM

Subject: RE: I'm new-thanks

Most plastic surgeons use internal dissovable and external permanent or paper tape if needed on the breast. Some older plastic surgeons use permanent subcuticular (pull-out) if the patient has reaction to Vicryl or Dexon. Most of the longer lasting dissovable sutures are not going to result in allergic reactions. The worst scars I have are in protein deprived ie bullemic or alcoholic patients so patient factors are often important. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 12:41 AM Subject: Re: I'm new-thanks

Bonnie,

You're right in that it really is not a matter of internal dissolvable sutures vs external sutures that makes a scar good or bad. It comes down to technique and expertise, as well as type of suture used. I will say again, that internal dissolvable sutures will almost always have a better aesthetic result than external scars; however, if you get a surgeon who is meticulous in his/her technique, one can have all external sutures and have very faint scars, which fade over time to become barely visible. Since I cannot have dissolvable sutures, (as I found out with my heart surgery), my neurosurgeon was the first surgeon after that debacle to have to find a suture I wasn't allergic to and which would not produce a horrible or even large scar. He is a meticulous surgeon anyway, since he often deals with facial trauma and brain trauma, and has to cut the face and scalp. He used 2-0 PDS running subcuticular sutures on my neck, and my scar is barely visible. And working in a trauma hospital, I have seen multiple traumas come in and their face has essentially been reduced to mush. A ps operates, uses hundreds of sutures, and that persons face is just like new. And on the other hand, I've seen other ps' whose technique sucks and I'm suprised they even have a clientele!

So, suturing technique is probably the most important factor in how a scar will turn out. Sure, it's always better to have dissolvable sutures, but if the surgery is too big, or the pt is allergic, or there's another reason they can't be used, external sutures can be used, and a very good, acceptable aesthetic result can be obtained. I am living proof. I also had foot surgery done for a neuroma. This was an orthopedic surgeon, so I figured I'd be butchered, but this man was so meticulous in his suture technique, that you can't even see the scars now, and in fact, I have to actually pull the skin taut to see the scars, otherwise they are invisible. And there are just some areas and surgeries where you can't use dissolvable sutures or subcuticular sutures.

e

----- Original Message -----

From: Bos@...

Sent: Sunday, October 06, 2002 6:47 PM

Subject: Re: I'm new-thanks

I think it may not be a matter of external or internal stiches-- HOW it is stitched can make a difference. Example, when I was only 22 I had a mole removed from my face and the surgeon put eleven external stiches in a tiny little space--I can't even find a scar or the area itself, although I know it has to be there. He said the more stitches, the fainter the scar. My ex had an auto accident whereby his neck was ugly with scars from a barbed-wire fence; when these were removed it was restitched with over two hundred external stitches and one can barely see the lines (same doctor) In addition, I would think one's particular skin and pigment color has something to do with scarring. For instance, I'm told that darker skinned people show scarring more than lighter skinned people. Bonnie I'm still confused re the anchor vs. vertical scarring-- is there not a scar from the nipple down to the bottom of the breast and then across the bottom in both cases? Bonnie

October 8, 2002

The nicotine patch will make blood constriction worse so it will have an

adverse effect. It can be for both but is more critical for the mastopexy.

I have had nipples turn pale when patients have had multiple surgeries but

have not lost any yet. It is sometimes a risky business. I try to review

op notes prior to surgery to find out which surgical planes were used in

previous surgeries. One cannot assume anything. .

-----Original Message-----

From: JHH7 [mailto:rogerlh@...]

Sent: Tuesday, October 08, 2002 12:13 AM

Subject: Re: I'm new-thanks

Hi Dr. Kolb,

I am intrigued by what you said about the blood supply. Is that for the

lift part following the explant or for the explant itself? How does

nicotine (patch) effect this/ if it does?

Thank you.

J~

----------

> From: Dr. Kolb <drkolb@...>

>

> Subject: RE: I'm new-thanks

> Date: Monday, October 07, 2002 11:01 PM

>

Explants are a whole different ball of wax than regular mastopexies and

reductions as the blood supply is different to the nipple. If not careful

one could have a partial or total nipple necrosis as Jenna did due to this

situation. Pneumonthorax is also a possibility as we are very close to the

pleura. One patient called to say she had an undiagnosed pneumothorax from

an explant that was diagnosed after her airplane trip home from another

surgeon. Like with anything there is a learning curve. I have had th good

fortune not to have either of these complications but it does make me very

cautious as I know that other experienced surgeons have had these

potentially serious problems. .

-----Original Message-----

From: perlesetlacet@... [mailto:perlesetlacet@...]

Sent: Monday, October 07, 2002 4:10 PM

Subject: Re: I'm new-thanks

:

Hi. My doc has been a PS since 1997. He's younger and new school. He's

done MANY mastopexies and reductions (I saw many photos), and

reconstructive

breast work on women with cancer pediatric plastic surgery, maxillofacial,

and burn victims. He does not do as many breast augmentations and explants

as there is not as great as a demand in his practice. He is more in the

reconstructive side of plastic surgery than just the " cosmetic " side of it.

Take care,

-Marie

October 8, 2002

Show me the data. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Tuesday, October 08, 2002 12:21 AM Subject: Re: I'm new-thanks

I beg to differ with you on that.

e

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 9:12 PM

Subject: RE: I'm new-thanks

My statement that most of the longer lasting sutures are not going to result in allergic reactions is medically correct. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 2:43 PM Subject: Re: I'm new-thanks

My allergies are to prolene and vicryl sutures, and because the sutures that were placed in my chest after my open heart surgery caused a SEVERE infection which led to sepsis, my being admitted to the ICU and fighting for my life, I don't know of any doctor who would risk his/her license or reputation by putting dissovable sutures in me. And I wouldn't let them. And the 2 surgeons who operated on me after my heart debacle refused to attempt it, and this was my neurosurgeon and Dr. Huang. She normally doesn't do a subcuticular suture, but after talking to me and reading my med records, she absolutely said she was not going to take a chance with any dissolvable sutures.

I think the statement you made that the much longer lasting dissolvable sutures are not going to result in allergic reactions is incorrect and misinformation. This may be a "blanket" statement for the majority of people, but not everyone. I had titanium placed in my neck for my first surgery. This is supposed to be something that no one reacts to, and yet I did. Plus, in people who do have allergies to sutures, the last thing they need in their body is a longer lasting suture to invite infection and allergic reaction. Plus, once someone has an allergy to a particular kind of suture, they are at higher risk to have hypersensitivity reactions in the future, which you should be taking into account when you do your H & P.

I'd much prefer to go to a MD who will err on the side of caution and not take any risks.

e

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 5:33 AM

Subject: RE: I'm new-thanks

Most plastic surgeons use internal dissovable and external permanent or paper tape if needed on the breast. Some older plastic surgeons use permanent subcuticular (pull-out) if the patient has reaction to Vicryl or Dexon. Most of the longer lasting dissovable sutures are not going to result in allergic reactions. The worst scars I have are in protein deprived ie bullemic or alcoholic patients so patient factors are often important. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 12:41 AM Subject: Re: I'm new-thanks

Bonnie,

You're right in that it really is not a matter of internal dissolvable sutures vs external sutures that makes a scar good or bad. It comes down to technique and expertise, as well as type of suture used. I will say again, that internal dissolvable sutures will almost always have a better aesthetic result than external scars; however, if you get a surgeon who is meticulous in his/her technique, one can have all external sutures and have very faint scars, which fade over time to become barely visible. Since I cannot have dissolvable sutures, (as I found out with my heart surgery), my neurosurgeon was the first surgeon after that debacle to have to find a suture I wasn't allergic to and which would not produce a horrible or even large scar. He is a meticulous surgeon anyway, since he often deals with facial trauma and brain trauma, and has to cut the face and scalp. He used 2-0 PDS running subcuticular sutures on my neck, and my scar is barely visible. And working in a trauma hospital, I have seen multiple traumas come in and their face has essentially been reduced to mush. A ps operates, uses hundreds of sutures, and that persons face is just like new. And on the other hand, I've seen other ps' whose technique sucks and I'm suprised they even have a clientele!

So, suturing technique is probably the most important factor in how a scar will turn out. Sure, it's always better to have dissolvable sutures, but if the surgery is too big, or the pt is allergic, or there's another reason they can't be used, external sutures can be used, and a very good, acceptable aesthetic result can be obtained. I am living proof. I also had foot surgery done for a neuroma. This was an orthopedic surgeon, so I figured I'd be butchered, but this man was so meticulous in his suture technique, that you can't even see the scars now, and in fact, I have to actually pull the skin taut to see the scars, otherwise they are invisible. And there are just some areas and surgeries where you can't use dissolvable sutures or subcuticular sutures.

e

----- Original Message -----

From: Bos@...

Sent: Sunday, October 06, 2002 6:47 PM

Subject: Re: I'm new-thanks

I think it may not be a matter of external or internal stiches-- HOW it is stitched can make a difference. Example, when I was only 22 I had a mole removed from my face and the surgeon put eleven external stiches in a tiny little space--I can't even find a scar or the area itself, although I know it has to be there. He said the more stitches, the fainter the scar. My ex had an auto accident whereby his neck was ugly with scars from a barbed-wire fence; when these were removed it was restitched with over two hundred external stitches and one can barely see the lines (same doctor) In addition, I would think one's particular skin and pigment color has something to do with scarring. For instance, I'm told that darker skinned people show scarring more than lighter skinned people. Bonnie I'm still confused re the anchor vs. vertical scarring-- is there not a scar from the nipple down to the bottom of the breast and then across the bottom in both cases? Bonnie

October 8, 2002

Which platinum test did you have? .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Tuesday, October 08, 2002 12:30 AM Subject: Re: I'm new-thanks

I have had all the tests done that everyone recommends on this site. I don't have any platinum, I don't have yeast. I will ask Dr. Huang what type of sutures she used on me. It was similar to what my neurosurgeon used, but much finer and smaller (he used monofilament nylon). I have not heard of NAET. What is it?

e

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 9:18 PM

Subject: RE: I'm new-thanks

e: I have never had an allergic reaction to PDS or Maxon sutures in any of my patients but I agree it could occur. But remember that my patients are on an immune program prior to surgery so many of their allergies are resolving. If one is not on such a program, I agree that multiple allergies are possible. Prolene is a permanent suture that is similar to nylon so what kind of sutures did Huang use? We will often test patients prior to surgery to determine allergies then use NAET to eliminate them. Have you considered NAET? We are going to be interviewing the doctor who developed this technique on the radio show this month. You might want to read her book. Her name is Dr. Devi. Have you had your platinum levels tested as multiple allergies can be associated with this toxicity and there is a protocol for detoxification of platinum at www.templeofhealth.ws . I believe our clinic is very skilled at the treatment of the multiple chemically sensitive patient as we are trained in holistic medicine. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 2:43 PM Subject: Re: I'm new-thanks

My allergies are to prolene and vicryl sutures, and because the sutures that were placed in my chest after my open heart surgery caused a SEVERE infection which led to sepsis, my being admitted to the ICU and fighting for my life, I don't know of any doctor who would risk his/her license or reputation by putting dissovable sutures in me. And I wouldn't let them. And the 2 surgeons who operated on me after my heart debacle refused to attempt it, and this was my neurosurgeon and Dr. Huang. She normally doesn't do a subcuticular suture, but after talking to me and reading my med records, she absolutely said she was not going to take a chance with any dissolvable sutures.

I think the statement you made that the much longer lasting dissolvable sutures are not going to result in allergic reactions is incorrect and misinformation. This may be a "blanket" statement for the majority of people, but not everyone. I had titanium placed in my neck for my first surgery. This is supposed to be something that no one reacts to, and yet I did. Plus, in people who do have allergies to sutures, the last thing they need in their body is a longer lasting suture to invite infection and allergic reaction. Plus, once someone has an allergy to a particular kind of suture, they are at higher risk to have hypersensitivity reactions in the future, which you should be taking into account when you do your H & P.

I'd much prefer to go to a MD who will err on the side of caution and not take any risks.

e

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 5:33 AM

Subject: RE: I'm new-thanks

Most plastic surgeons use internal dissovable and external permanent or paper tape if needed on the breast. Some older plastic surgeons use permanent subcuticular (pull-out) if the patient has reaction to Vicryl or Dexon. Most of the longer lasting dissovable sutures are not going to result in allergic reactions. The worst scars I have are in protein deprived ie bullemic or alcoholic patients so patient factors are often important. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 12:41 AM Subject: Re: I'm new-thanks

Bonnie,

You're right in that it really is not a matter of internal dissolvable sutures vs external sutures that makes a scar good or bad. It comes down to technique and expertise, as well as type of suture used. I will say again, that internal dissolvable sutures will almost always have a better aesthetic result than external scars; however, if you get a surgeon who is meticulous in his/her technique, one can have all external sutures and have very faint scars, which fade over time to become barely visible. Since I cannot have dissolvable sutures, (as I found out with my heart surgery), my neurosurgeon was the first surgeon after that debacle to have to find a suture I wasn't allergic to and which would not produce a horrible or even large scar. He is a meticulous surgeon anyway, since he often deals with facial trauma and brain trauma, and has to cut the face and scalp. He used 2-0 PDS running subcuticular sutures on my neck, and my scar is barely visible. And working in a trauma hospital, I have seen multiple traumas come in and their face has essentially been reduced to mush. A ps operates, uses hundreds of sutures, and that persons face is just like new. And on the other hand, I've seen other ps' whose technique sucks and I'm suprised they even have a clientele!

So, suturing technique is probably the most important factor in how a scar will turn out. Sure, it's always better to have dissolvable sutures, but if the surgery is too big, or the pt is allergic, or there's another reason they can't be used, external sutures can be used, and a very good, acceptable aesthetic result can be obtained. I am living proof. I also had foot surgery done for a neuroma. This was an orthopedic surgeon, so I figured I'd be butchered, but this man was so meticulous in his suture technique, that you can't even see the scars now, and in fact, I have to actually pull the skin taut to see the scars, otherwise they are invisible. And there are just some areas and surgeries where you can't use dissolvable sutures or subcuticular sutures.

e

----- Original Message -----

From: Bos@...

Sent: Sunday, October 06, 2002 6:47 PM

Subject: Re: I'm new-thanks

I think it may not be a matter of external or internal stiches-- HOW it is stitched can make a difference. Example, when I was only 22 I had a mole removed from my face and the surgeon put eleven external stiches in a tiny little space--I can't even find a scar or the area itself, although I know it has to be there. He said the more stitches, the fainter the scar. My ex had an auto accident whereby his neck was ugly with scars from a barbed-wire fence; when these were removed it was restitched with over two hundred external stitches and one can barely see the lines (same doctor) In addition, I would think one's particular skin and pigment color has something to do with scarring. For instance, I'm told that darker skinned people show scarring more than lighter skinned people. Bonnie I'm still confused re the anchor vs. vertical scarring-- is there not a scar from the nipple down to the bottom of the breast and then across the bottom in both cases? Bonnie

October 8, 2002

It is an allergy elimination technique based on the acupuncture meredian system. Dr. Devi has written a book on it. Many patients with difficult allergies such as you have with suture have been helped. The theory is interesting as we may develop allergies when we have a particularly negative state when we are exposed to something. This can be undone energetically. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Tuesday, October 08, 2002 12:30 AM Subject: Re: I'm new-thanks

I have had all the tests done that everyone recommends on this site. I don't have any platinum, I don't have yeast. I will ask Dr. Huang what type of sutures she used on me. It was similar to what my neurosurgeon used, but much finer and smaller (he used monofilament nylon). I have not heard of NAET. What is it?

e

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 9:18 PM

Subject: RE: I'm new-thanks

e: I have never had an allergic reaction to PDS or Maxon sutures in any of my patients but I agree it could occur. But remember that my patients are on an immune program prior to surgery so many of their allergies are resolving. If one is not on such a program, I agree that multiple allergies are possible. Prolene is a permanent suture that is similar to nylon so what kind of sutures did Huang use? We will often test patients prior to surgery to determine allergies then use NAET to eliminate them. Have you considered NAET? We are going to be interviewing the doctor who developed this technique on the radio show this month. You might want to read her book. Her name is Dr. Devi. Have you had your platinum levels tested as multiple allergies can be associated with this toxicity and there is a protocol for detoxification of platinum at www.templeofhealth.ws . I believe our clinic is very skilled at the treatment of the multiple chemically sensitive patient as we are trained in holistic medicine. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 2:43 PM Subject: Re: I'm new-thanks

My allergies are to prolene and vicryl sutures, and because the sutures that were placed in my chest after my open heart surgery caused a SEVERE infection which led to sepsis, my being admitted to the ICU and fighting for my life, I don't know of any doctor who would risk his/her license or reputation by putting dissovable sutures in me. And I wouldn't let them. And the 2 surgeons who operated on me after my heart debacle refused to attempt it, and this was my neurosurgeon and Dr. Huang. She normally doesn't do a subcuticular suture, but after talking to me and reading my med records, she absolutely said she was not going to take a chance with any dissolvable sutures.

I think the statement you made that the much longer lasting dissolvable sutures are not going to result in allergic reactions is incorrect and misinformation. This may be a "blanket" statement for the majority of people, but not everyone. I had titanium placed in my neck for my first surgery. This is supposed to be something that no one reacts to, and yet I did. Plus, in people who do have allergies to sutures, the last thing they need in their body is a longer lasting suture to invite infection and allergic reaction. Plus, once someone has an allergy to a particular kind of suture, they are at higher risk to have hypersensitivity reactions in the future, which you should be taking into account when you do your H & P.

I'd much prefer to go to a MD who will err on the side of caution and not take any risks.

e

----- Original Message -----

From: Dr. Kolb

Sent: Monday, October 07, 2002 5:33 AM

Subject: RE: I'm new-thanks

Most plastic surgeons use internal dissovable and external permanent or paper tape if needed on the breast. Some older plastic surgeons use permanent subcuticular (pull-out) if the patient has reaction to Vicryl or Dexon. Most of the longer lasting dissovable sutures are not going to result in allergic reactions. The worst scars I have are in protein deprived ie bullemic or alcoholic patients so patient factors are often important. .

-----Original Message-----From: e Rene [mailto:e_Rene@...]Sent: Monday, October 07, 2002 12:41 AM Subject: Re: I'm new-thanks

Bonnie,

You're right in that it really is not a matter of internal dissolvable sutures vs external sutures that makes a scar good or bad. It comes down to technique and expertise, as well as type of suture used. I will say again, that internal dissolvable sutures will almost always have a better aesthetic result than external scars; however, if you get a surgeon who is meticulous in his/her technique, one can have all external sutures and have very faint scars, which fade over time to become barely visible. Since I cannot have dissolvable sutures, (as I found out with my heart surgery), my neurosurgeon was the first surgeon after that debacle to have to find a suture I wasn't allergic to and which would not produce a horrible or even large scar. He is a meticulous surgeon anyway, since he often deals with facial trauma and brain trauma, and has to cut the face and scalp. He used 2-0 PDS running subcuticular sutures on my neck, and my scar is barely visible. And working in a trauma hospital, I have seen multiple traumas come in and their face has essentially been reduced to mush. A ps operates, uses hundreds of sutures, and that persons face is just like new. And on the other hand, I've seen other ps' whose technique sucks and I'm suprised they even have a clientele!

So, suturing technique is probably the most important factor in how a scar will turn out. Sure, it's always better to have dissolvable sutures, but if the surgery is too big, or the pt is allergic, or there's another reason they can't be used, external sutures can be used, and a very good, acceptable aesthetic result can be obtained. I am living proof. I also had foot surgery done for a neuroma. This was an orthopedic surgeon, so I figured I'd be butchered, but this man was so meticulous in his suture technique, that you can't even see the scars now, and in fact, I have to actually pull the skin taut to see the scars, otherwise they are invisible. And there are just some areas and surgeries where you can't use dissolvable sutures or subcuticular sutures.

e

----- Original Message -----

From: Bos@...

Sent: Sunday, October 06, 2002 6:47 PM

Subject: Re: I'm new-thanks

I think it may not be a matter of external or internal stiches-- HOW it is stitched can make a difference. Example, when I was only 22 I had a mole removed from my face and the surgeon put eleven external stiches in a tiny little space--I can't even find a scar or the area itself, although I know it has to be there. He said the more stitches, the fainter the scar. My ex had an auto accident whereby his neck was ugly with scars from a barbed-wire fence; when these were removed it was restitched with over two hundred external stitches and one can barely see the lines (same doctor) In addition, I would think one's particular skin and pigment color has something to do with scarring. For instance, I'm told that darker skinned people show scarring more than lighter skinned people. Bonnie I'm still confused re the anchor vs. vertical scarring-- is there not a scar from the nipple down to the bottom of the breast and then across the bottom in both cases? Bonnie

October 8, 2002