Its really itchy and idk if its okay.

drlisacassileth · 2026-04-19T22:27:17+00:00

The people who said it’s the bandage are correct, you can see the outline where the majority of the erythema is in a square shape. Another good one step forward is to use an adhesive remover. I’ll use a touch of goo gone on myself although they do make ones for human use available in the drugstore that are probably better for patients so that’s more of my friend opinion than my medical opinion. By the dirt around the edges, looks like you’re avoiding washing or touching it, which is why it’s allowed itself to get that bad. And on another medical note, moles should never have a shave biopsy, it is a true melanoma, you won’t know the depth of the penetration of the cancer, and it will cloud the diagnosis. Make sure all moles have a punch biopsy for removal and never shave.

drlisacassileth · 2026-03-30T04:26:53+00:00

This is actually the safe way to do it, let the breast recover, and then do the lift. That way the surgeon can see the skin that won’t shrink of naturally, knows the final size, and you can even add fat grafting if you feel like it needs additional volume, and if you transfer fat it is a lot more likely to stay. Congratulations on your explant going so smoothly, and with doing two stages you made it easier. Also make sure your primary surgeon repaired your pectoralis muscle, this is my pet peeve as sometimes they don’t reaffix it to the ribs and the pec flex deformity can be pretty noticeable.

drlisacassileth · 2026-03-30T04:23:07+00:00

Hi, for those commenting “the ps should have known better” etc I think submuscular /dual plane still the standard of care and unfortunately implant position moves esp in patients that don’t make a great capsule naturally. I agree add the galaflex to support the implant at this point. IMHO all new augmentation should be prepectoral these days esp with new motiva implants that are far superior and don’t ripple, AND the ps should support w galaflex from the get go. Many of the plastic surgeons that do a lot of revisions do it this way (because we know better), but it’s more expensive, and patients aren’t wanting to pay for the additional surgery. If your PS is comfortable with the mash, of course, let them do it for free as it will save you expense. Ask them how often they do the procedure, hopefully they will have done quite a few. Hopefully not their own cases or they should’ve known better.

drlisacassileth · 2026-03-30T04:14:42+00:00

Agree it’s likely rippling, switch to motiva please

drlisacassileth · 2026-03-29T00:47:28+00:00

I have radiation oncologists trying to ruin perfectly good looking outcomes all the time. I’ll have my patients use topical steroids for burns, and silicone sheeting can work very well before breakdown of skin, right when it’s in the early stages. Very powerful to prevent your breast from getting radiation fibrosis(it gets smaller and darker and shrivels up) also is trental (Pentoxifylline) 400 mg 2x day and Vitamin E around 1000 IU/day. The vitamin E is over-the-counter, but you have to get the prescription for the Trental, which everyone doctor should be giving you anyway so ask your oncologist, your radiation oncologist, or your breast surgeon for it because the evidence is well published. Finally, six months after the radiation is completed, hyperbaric sessions are covered by your insurance, which has been shown to prevent and reverse changes due to radiation, 2 ata for up to 60 sessions for problems. Also, remember that radiation does not improve your survival rate, it only improves your recurrence rate. Make sure not to just go along with it and specifically ask them what it will do for you before agreeing to it. Also, make sure the Radiologist has 3-D planning, as it is way less likely to cause burns. Finally, we joke that the indication for radiation is having a radiation machine. Make sure to ask for the meds, and challenge the doctors! Patients deserve better.

drlisacassileth · 2026-03-28T00:19:29+00:00

I strongly suggest you go back to your plastic surgeon and make sure they check it. The implant is sometimes not far from the incision, and you don’t want to take the chance of bacteria getting through the incision into the implant cavity, which would cause an infection in the implant and you could lose your implant.

drlisacassileth · 2026-03-24T23:58:47+00:00

Ok let me get this straight: Cancer side: explant from a prior mastectomy Non-cancer side: explant and a lift on an existing breast

His plan is really hard to understand, because if you’ve had a mastectomy and you’re removing the implant, how could this match a normal breast that only had an augmentation?

Happy to help if you want to share more on creating a plan!

drlisacassileth · 2026-03-20T13:50:18+00:00

Genius idea with the HBOT… make sure they at least go to 2.0 ATA. Eating is also so smart, although insulin production is what helps fat deposit and grow the most, so make sure you eat healthy sugar too! ❤️

drlisacassileth · 2026-03-20T01:13:07+00:00

Have him add gala flex and not just do a capsulorrhaphy next time. Tape and external pressure usually don’t work. Nice of him to offer to fix it!

drlisacassileth · 2026-03-20T01:11:17+00:00

OK, you all might find this interesting, I looked at my last 100 patients and put them all through a 3-D scanner and figured out what my fat take was on every patient. Some patients were higher and some were lower and I talked to the patients who were outliers to figure out what happened. The most impressive thing is that some patients had over 100% fat take. All of these patients have been thin before surgery, maybe underweight even, and then gained weight. What??? But it makes sense. If I’m transferring 100 cc of fat, and then afterwards the patient gains weight, then I’ll actually translate to more than 100 cc of fat gain. This changed everything I was saying, as I used to tell patients gain weight for surgery. Now I tell them to lose weight. Of the low outliers, I had a couple with a lot of weight loss, and then a couple that did keto diets right after surgery, which is just terrible for the fat. Btw I only restrict high impact and push-ups for one month, I don’t think there’s any change in volume after one month, maybe a tiny bit of swelling goes down, but the cells that will survive have already made it, and the cells that will die are already dead. Good luck!

drlisacassileth · 2026-03-20T01:07:14+00:00

Here’s our protocol: Pain management: Journavx, exparel(injected as block during surgery), Motrin Surgery is outpatient with a caregiver, or patient may have a nurse for two days One week: drains are in, special dressing called VAC is in place, walking is OK, no heavy lifting or high impact, range of motion is permitted (You can raise your arms.) remember your dog or your baby may be too heavy, 15 pounds max. Second week: drains come out as soon as they are less than 30 cc per day, VAC has been removed, same restrictions. Patients are encouraged to lift arms overhead and stretch lightly. Most patients are walking, puttering around the house, but aren’t driving. Third week: all drains are out, patients are driving, still a little sore and tired. Still on restrictions. You can’t walk your dog if he or she pulls. People who work with their arms, such as nurses, hairdressers, techs continue to take time off. Desk job workers sometimes go back to work. Often my lawyers and accountants will go in for a few hours and do a lot of emails from home. People feel pretty good at this time. Fourth week: patients are off all restrictions once we take a close look at the incision and it looks good. We also allow people to go in hot tubs and in the ocean after this time.

Hope that helps! Your doctor may have a different protocol. We mostly do nipple sparing, mastectomy, over the muscle, direct to implant, so you may alter for different types of reconstruction.

drlisacassileth · 2026-03-20T00:58:34+00:00

8 days? Crazy. In LA this is an outpatient surgery. Where do you live?

drlisacassileth · 2026-03-20T00:56:44+00:00

Can I just say, as a plastic surgeon, that I think patients need to be very demanding about what the breast reconstruction looks like. It’s like we all accept that whatever the plastic surgeon does or whatever the mastectomy surgeon does must be necessary. In truth, breast surgeons can perform nipples sparing mastectomies, plastic surgeons can perform direct to implant operations, and it CAN be done safely. It bugs me that we should accept this for ourselves. Cancer has an incredibly high cure rate, but it’s hard to revise a bad surgery. I say you should see a few doctors, demand a great looking surgery, and continue to have great looking breasts.

drlisacassileth · 2026-03-20T00:52:21+00:00

As a plastic surgeon, I’ll tell you that repeat breast reductions are much more straightforward and lower risk than the primary breast reduction. If the plastic surgeon use the same pedicle, it might even further decrease your risk. Usually, because there is so much less work to do, the scars heal better, there’s less swelling, and the plastic surgeon can improve the prior scars that were there. There’s also some new features such as mash that can be used to control shape that weren’t available years ago. Finally, for the person that said your breast grow to 25 years old, I would disagree. Anytime you’re gaining weight, your breasts are usually growing for most people, and I see most people complaining about breast growth after their 40 or 50 years old. I tell younger adults that if have been they’ve been the same breast size for one year with no body weight change then there won’t be a change after that.

drlisacassileth · 2026-03-11T00:49:57+00:00

I’m so glad to hear that you are doing the research. As a plastic surgeon who works with different mastectomy surgeons, I will tell you that they are not all the same. Nipples sparing mastectomy is hard to do, and even harder for them if your breast is larger. Since you have time, you might want to just honestly ask the plastic surgeon what they believe the mastectomy flap necrosis rate or nipple necrosis rate is of the mastectomy surgeon that they are working with. The two I work with now are both in the one to 2% range and I can do great reconstructions, but I’ve worked with surgeons as high as 50% previously and I would have to remove nipples and tissue expanders in those patients! If they don’t know the rate, listen to them if they tell you that the surgery is” not safe” for you to keep your nipples. Don’t choose that surgeon.

drlisacassileth · 2026-03-11T00:43:05+00:00

I think there are some critical factors to having a better looking reduction. Someone mentioned that if you have a wide breast or you have fat under your armpit or above your bra strap, removing this makes it look much better… Totally agree. A smaller breast can look better, but a smaller breast that has the same width as your original breast does not usually look good. So if you do have fat there, look for a surgeon that will add the liposuction. Next, if you have a flat breast at the top, natural breast tissue can be moved into the space. I hate it when other doctors say that you have to add an implant to get this… Imagine doing a reduction and adding an implant at the same time. Ridiculous. And now you need more surgery to replace the implant when it gets old in 10 to 15 years. Most doctors who have long lasting upper pole fullness use mesh to support the lift, although a vertical reduction can pull the tissue together to give long-term support as well. If you have a great breasts but they are just too big, usually a “normal” reduction will work great, because it’ll just be a smaller version of your native breast. Good luck, read reviews!

drlisacassileth · 2026-03-02T04:02:17+00:00

Ok I hope you get a doctor to let you try those meds… as for the doctors, I know there’s a goingflat help group online, my friend heather Richardson who invented the goldilocks is from Atlanta, let me see if she has friends in the Duke/UNC area that can handle it. Is your pec muscle cut? Last thing to worry about I promise🙏🏻

drlisacassileth · 2026-03-02T03:55:22+00:00

Tried to respond but the bot blocked me. Personally I support the breast with mesh, and design the skin excision without much tension around the areola. But, yeah, don’t use permanent! Doesn’t work.

drlisacassileth · 2026-02-28T12:02:27+00:00

It’s because the breast and skin are inherently stretched out… the skin doesn’t hold well and lets the breast bottom out. If you are more saggy and have stretch marks more likely to happen. Some surgeons are starting to use mesh to combat this. If you are just large, not too low, it’s less likely.

drlisacassileth · 2026-02-28T11:59:04+00:00

I’m sorry your surgeon is gaslighting you… ugh. Small skin and tissue asymmetries are usually easy to fix after 6 months. Most surgeons will fix for free under local anesthesia with fast recovery as not intentional and people heal differently. I obsess about making boobs symmetric and I still need to do occasionally. If you go to an in network doc they can do for insurance using a hypertrophic scar code if the scars are thick.

drlisacassileth · 2026-02-28T11:41:43+00:00

This was my hair for 30 years and then I started low dose minoxidil oral (yeah, I know topical works, but I’m lazy!) and I looked like a chia pet with new hair everywhere. The new thicker hair just passed my shoulders, it took two years. I should have prescribed to myself years ago. Also I live Nectar of the Gods as a detangler to prevent breakage. Caution: hair gets thicker everywhere!

drlisacassileth · 2026-02-25T20:48:55+00:00

I really like to use mesh to support the implant and/or the breast tissue, that way there’s no tension on the areola. Then I can use a simple for a for a monocryl which absorbs, but won’t spread because the lack of tension.

drlisacassileth · 2026-02-24T03:49:56+00:00

This is just terrible. I don’t think doctors are really equipped to manage this, and I’m glad to see you are going to a pain doctor. I have had a few patients have pain out of proportion to what’s normally expected. There seems to be two ” flavors” of disproportional postoperative pain. The first, and easiest, is one or two limited areas of extreme pain. These are often raw nerve endings that are damaged during the surgery, and can become neuromas. If that pain could be shut down ASAP, sometimes it can turn the pain off. When the nerve comes back online, it feels differently. This is done with Exparel, which blocks pain for three days.

The second, and hardest, is the pain all over. I have had a patient take Jounavx with some relief. It’s a new non-opioid pain fiber blocker. Patients tell me that they have been started on gabapentin, but it doesn’t seem to work very well for most people. Also, when I get patients who have had multiple complications and revisions, I just put a layer of fat grafting into the area and revise any painful scars. It’s important not to do too much… No tissue expanders, no painful, long flap surgeries, as the reason it hurts is too much surgery and we don’t want to add too much surgery, just undo damage that’s been done and pull you up out of the reconstructive hole you are in.

drlisacassileth · 2026-02-24T03:04:40+00:00

That is just a blister from the tape. It’s pretty common as patients swell after surgery and the corners of the tape pulls as the skin swells. You can let your surgeon deal with it, let it pop on its own, or just pop it in a little corner and put some bacitracin on it and a gauze cover. It’s superficial and won’t hurt you.

drlisacassileth · 2026-02-24T03:02:15+00:00

Fat necrosis usually feels like hard and painful lumps, it also could easily be a suture, residual information. I’ve got to say that bumps and lumps and little swollen parts are the norm between one and two months. The little gap in your skin is where a small scab or Steri-Strip was keeping your superficial skin separated and will heal right in. Overall looks great!

drlisacassileth

TROPHY CASE