Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Category: Breast Implant Illness


Another side of breast implant illness : one woman’s misdiagnosis and journey back to health.

October 23rd, 2018 — 8:57am

Recently I received this email from a former breast implant illness patient.  I am sharing it with her permission but she has asked me to protect her identity.  I will call her Celeste because I love that name.  I have made no changes except for correcting a few typos.

Celeste:  I read your blog post on breast implant illness and it literally brought tears to my eyes. Tears of joy!!!!  Back up three or four years ago when my life was in shambles – emotionally abusive husband, stressed out to the max at work, sex hormones had crashed, possible thyroid issue…..but yet my family physician said I was fine according to my lab tests. I wasn’t able to see what my ex husband and stress were doing to my body at the time and so I was bound and determined to find an answer. Then I found it – the BII group on Facebook. I had found my answer so I thought. Went through the surgery and wow none of my symptoms got better! It wasn’t until my divorce was final and I was able to relax and started taking a low dose thyroid medicine and got my estrogen back to a normal level that I started to feel normal again. Long story short, I miss my implants like crazy and want them back. I’m soooooo happy to see a plastic surgeon standing behind her beliefs! I totally think it wasn’t my implants at all and more stress and hormone related. I guess I’m going to be the first trial case to see what happens. lol. Thanks for the blog. I really enjoyed it.

Me:  I am very glad you are feeling better after getting your life in order and getting good medical care. Sorry about your implants, though. Have you shared your experience with the Facebook group? I am just curious.

Celeste:  Hahahah.  To spare myself the verbal attacking that would come with it, I have not. All of my friends have implants – a good mixture of saline and silicone, and none of them have issues. I even have one older friend who has had her saline implants for 20+ years to the point one ruptured and still no issues. I don’t want to fight with 18,000+ desperate women who are looking for an answer to their issues when in reality it is probably what you said, the general human condition and life itself. My mom has a lot of allergies and it is possible that my body reacted to my silicone implants (second set), but it took several years for me to feel bad. So, doubtful in my opinion. I had my saline implants for six years with no issues. The issues of general fatigue were once again a result of stress and being on birth control most likely. When I got my silicone implants I went off birth control and my stress was at an all time high. Perfect storm imo. But we shall see what happens. I’m torn on what to get again. I loved how my silicone looked and felt, but still have a slight fear that maybe just maybe it was my body reacting to the silicone (doubtful)……

I’m sure that group has attacked you. It’s like the blind leading the blind and defintely a herd mentality. I can’t bash them too much because three years ago I was one of them – desperate for an answer……and I’m a research scientist, so no dummy either ….. I was just that desperate to feel better.

Me:  Is there any advice you would give women who like their implants but think they have breast implant illness?

Celeste:  Oh geez this is a hard one. There is so much misinformation out there that if it seems pretty far fetched, it probably is.

I lived with my symptoms for years and even had my best friend, who is also my family physician, tell me that I was super stressed and THAT was my problem. The funny thing I have learned about stress in our society is that it starts out small and slow and that becomes the new normal. Then a little more stress gets added on, then that is the new normal. The cycle continues to repeat itself until something or someone stops it. In my case I got my second set of implants (silicone), stopped birth control causing my hormones to crash because I was basically dependent on it, major stress in my marriage, and I was studying for my board exams. And I was the silly one sitting in my doctor’s office telling her that I wasn’t stressed, but yet I couldn’t sleep, felt tired and heavy all the time, my weight was increasing quickly, etc. I went on like this for six years! I’m a little stubborn, ha! Removing my implants helped momentarily because all I could do was sit around and relax. That should’ve been my huge red flag. But nope, I missed it, lol. It wasn’t until just recently that all the pieces started coming together. My hormones are finally at normal levels, my stress is down, my divorce was final two weeks ago. I am finally relaxing and it feels good! I’m still going to the gym and doing strenuous weight lifting and from time to time when I don’t get enough sleep because I’m enjoying life too much and burning the candle at both ends, guess what????? My symptoms start to come back!

For me I’m skeptical that the millions of women that have implants are walking around like zombies (basically what I felt like). I was barely functioning – getting out of bed was difficult, but I didn’t want to lose my job so every morning was a struggle and a pep talk to do it one more day. And what about all the celebrities that have butt implants, chin implants, cheek implants, pec implants (men) – all silicone. I suppose one could argue that those are different than breast implants in chemical consistency, but why aren’t they feeling awful????  I’m more of a believer of an inflammatory response to implants that are too big for the body and overtime the body starts to reject them. My last set were DD and way too big imo. I’m naturally an A, so that is a big difference. And what about all the women in the bikini industry – models and competitors??? They are fine. I’m not saying breast implants are 100% safe, but causing issues almost a decade later is something that I’m not too sure on. My implants came out looking brand new with a thin capsule and no other issues. It is interesting though, the doc that took mine out says he’s seen some stuff that he just can’t explain and the lab can’t identify what it is……so maybe there is truth to it????

With all that being said, I think my biggest piece of advise is know that the mind is very powerful and when you are desperate for an answer, almost anything can be made to fit the given scenario. I wasn’t able to take a step back and evaluate my life and see that the problems I was having were self inflicted. Stress, abuse, lack of sleep, etc. had nothing to do with my implants. After years of living like this, my body was burned out and literally quitting on me. What it needed was lots of TLC! I’m still happy I got my implants removed. That set was too big, but I wish I would’ve swapped them out for a smaller set like my first set of implants. At this point I do miss my implants enough that I’m willing to risk that I’m completely wrong about all this and get implants again……..

So there you have it.  Another side of the breast implant illness conundrum.

Thanks for reading and I would be honored if you followed me on Instagram @breastimplantsanity and @sowdermd.  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Illness, Breast Implant Removal, Breast Implants

Maximizing Follow-Up in Cosmetic Surgery Clinical Trials – Money Helps

July 26th, 2018 — 9:05am

In a previous blog post bemoaning the difficulty of good follow-up in clinical research I sort of place most of the blame on patients who blow off the follow-up  once they have their desired implants.  This was my experience with the implant study I participated in many years ago.  I had an 80% follow-up at 5 years (which was really, really high)  mostly because I pestered patients relentlessly to come back for their follow-up exams.  I have taken a bit of flack (especially from the breast implant illness activists) for my blame-the-patient stance but now there is a recent study out that supports my politically incorrect opinion.  Check this out.  It seems if you pay the patient big bucks to show up they do!  This study has an astounding 94.9% and 96.7% follow-up compliance at 5 years.  The study has another 5 years to go and my guess is that given the size of the monetary award, those numbers will also be very high.

“Maybe I will show up for my follow-up.”

Novel Approach for Maximizing Follow-Up in Cosmetic Surgery Clinical Trials: The Ideal Implant Core Trial Experience

Mueller, Melissa A. M.D.; Nichter, Larry S. M.D.; Hamas, Robert S. M.D.

Plastic and Reconstructive Surgery: October 2017 – Volume 140 – Issue 4 – p 706–713
Cosmetic: Original Articles
Background: High follow-up rates are critical for robust research with minimal bias, and are particularly important for breast implant Core Studies seeking U.S. Food and Drug Administration approval. The Core Study for IDEAL IMPLANT, the most recently U.S. Food and Drug Administration–approved breast implant, used a novel incentive payment model to achieve higher follow-up rates than in previous breast implant trials.

Methods: At enrollment, $3500 was deposited into an independent, irrevocable trust for each of the 502 subjects and invested in a diversified portfolio. If a follow-up visit is missed, the subject is exited from the study and compensated for completed visits, but the remainder of her share of the funds stay in the trust. At the conclusion of the 10-year study, the trust will be divided among those subjects who completed all required follow-up visits. For primary and revision augmentation cohorts, the U.S. Food and Drug Administration published follow-up rates from Core Studies were compared for all currently available breast implants.

Results: Five-year follow-up rates for the IDEAL IMPLANT Core Study are higher for both primary augmentation and revision augmentation cohorts (94.9 percent and 96.7 percent, respectively) when compared to all other trials that have used U.S. Food and Drug Administration standardized follow-up reporting (MemoryShape, Allergan 410, and Sientra Core Studies).

Conclusions: This trial demonstrates the utility of a novel incentive strategy to maximize follow-up in cosmetic surgery patients. This strategy may benefit future cosmetic surgery trials and perhaps any prospective research trial by providing more complete data.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Hey, thanks for reading and I really thank Drs. Mueller, Nichter and Hamas for this awesome article.  And my hat is really off to Dr. Robert Hamas who not only thought up the idea of the Ideal implant but actually brought it to market.  And Ideal only sells its implants to surgeons certified by the American Board of Plastic Surgery.  That means if your surgeon is using an Ideal implant, he/she is actually a real honest to goodness plastic surgeon, not just poseur.

And I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity. Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implants, New Technology, Now That's Cool

Capsular Contracture – the final frontier in breast implant surgery?

April 3rd, 2018 — 10:52am

Capsular Contracture 101

Anyone who knows my practice well knows that I am not a big fan of breast implants.  I much prefer fat transfer and/or breast lift to get a breast looking nicer.  But sometimes only a breast implant will get the patient the size and shape of breasts they desire.  Implants have many issues including malposition (too high, too low, too whatever), size problems (too big or too small), leaking or rupture problems.  Those issues can usually be address with revision surgery.  There is one issue that has tortured plastic surgeons and their patients from day one of breast implants decades ago.  That problem is capsular contracture.

All implants develop a capsule.  Actually it is the body that develops the capsule.  This is normal reaction to a foreign body and, yes, breast implants are a foreign body, a large foreign body.    A capsule only becomes a problem when it become thick and/or tight.  As the capsule thickens or tightens, it puts pressure on the breast implant and turns any shape or profile of implant into a sphere because a sphere is the shape that supports the largest volume in the smallest surface area, or something like that.  Geometry was a while ago for me!  Thus most badly encapsulated implant all look sort of the same – like a ball.  And they all feel hard, sometime really hard and often they are very uncomfortable.  Capsules can even become calcified in which case the implanted breasts are literally rock hard.

Capsular contracture: Looks bad, feels bad.

So what causes capsular contracture?  Good question and I hope the smart researcher who breaks the code wins the Nobel Prize in medicine some day.  A lot of progress has been made, especially in the past 10 years or so and it sure seems like inflammation is the common pathway to capsular contracture.  The most common causes of inflammation around the implant and resultant capsular contracture are 1. bleeding in the implant pocket, 2. subclinical infection and biofilm in the implant pocket, 3. leakage or rupture of silicone gel implants.  Let’s look at these a little closer.

Bleeding in the implant pocket has been known to result in capsular contracture for decades.  Plastic surgeons take a lot of care to really “dry up” the implant pocket prior to inserting an implant.  This is usually done with an electrocautery device call a Bovie.  This little gizmo allows the surgeon to zap little oozing vessels and help prevent any significant blood from accumulating around the implant.  Also, in the rare incidence of post operative bleeding around an implant, surgeons are very quick to take a patient back to the OR to “wash out” the pocket, find and treat the bleeding and reinsert the breast implant.  Sometimes a very minor bleeds can avoid a trip back to the or but in cases like these, the surgeon is on high alert for capsular contracture.

Subclinical infection and biofilm have been on our radar screen for 10 years or so.  Biofilm (which deserves it’s own blog post) is a slimy substance that is produced by certain types of bacteria.  It serves as a protective hiding place for bacteria and is resistant to antibiotics.  The most common example of biofilm is dental plaque.  Yuck.  Anyway, once the biofilm issue became well known, much more attention was paid to reducing the exposure of implants to bacteria.  We are now compulsive about washing out the implant pocket with antibiotic solution, using a no touch technique with a Keller funnel when inserting the implant, changing gloves prior to touching an implant and such.  Remember the billionaire Howard Hughes and his OCD about germs?  Well, we really go totally Howard Hughes with implant surgery!  Also, the location of incision has been shown to have an effect on the rate of capsular contracture.  Incisions around the nipple, through the arm pit or belly button have the highest rates of capsular contracture.   Incisions under the breast (the inframammary fold) have the lowest rate.  This is very likely due to a lower level of bacteria in the area of the inframammary fold as opposed to the other areas.  I use the inframammary fold incision almost exclusively for this reason and also because it allows me to see the pocket really well.

Leakage or rupture of gel implants results the in silicone gel coming into contact with the capsule and this often seems to cause inflammation and hardening or tightening of the implant capsule.  When I am going after a particularly nasty capsule, I expect to see an leaking or ruptured implant and I am usually not disappointed.  The advances made in implant construction – thicker implant shells and more cohesive gel – will hopefully decrease this cause of capsular contracture.

So that is Capsular Contracture 101.  Next up will be a blog about what can be done for capsular contracture.  Stay tuned and thanks for reading.  And I would be honored if you followed me Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

Breast Contouring, Breast Implant Illness, Breast Implant Removal, Breast Implants

What might the Cuban Sonic Attacks have in common with Breast Implant Illness?

February 1st, 2018 — 8:49am

You gotta read this from today’s Slate.com.  This will involve some heavy mental lifting so put on your thinking cap and take the time to read the entire article.

MEDICAL EXAMINER
Cuba’s Sonic Attacks Show Us Just How Susceptible Our Brains Are to Mass Hysteria
The symptoms so many Americans experienced were probably not caused by a secret weapon. That doesn’t mean they’re not real.

By FRANK BURES
FEB 01, 20185:43 AM

A few weeks after the 2016 presidential election of Donald Trump, several people working for the U.S. Embassy in Cuba fell mysteriously ill. Some lost their hearing. Some had headaches and a pain in one ear. Others reported feeling dizzy or nauseous, having trouble focusing, or feeling fatigued. Later, some would have a hard time concentrating, remembering things, sleeping, and even walking.

These symptoms were “medically confirmed,” as the State Department’s medical director Charles Rosenfarb put it, and brain scans were said to show abnormalities in the victims’ white matter, which transfers information between brain regions. The illnesses were believed by the government to be “health attacks,” carried out by a foreign power, though as Todd Brown, assistant director at the Bureau of Diplomatic Security, told the Senate Foreign Relations Committee, “investigative attempts and expert analysis failed to identify the cause or perpetrator.”

Nonetheless, investigators concluded the illnesses, which ultimately affected 24 people, were likely the result of a “sonic device.” This conclusion seems to be primarily due to the fact that some diplomats reported hearing a high-pitched noise in their homes and hotel rooms.

Despite a lack evidence for such a weapon, or any known way it could affect white matter, the sonic weapon theory proved irresistible for both media outlets and for Cuba hawks like Sens. Marco Rubio and Bob Menendez, both of whom immediately transformed the sonic weapon into a handy political weapon.

In the months following the “attacks,” new diplomats arriving in the country were warned of this sonic danger. Embassy employees were played a recording of what was thought to be the sound so they knew what to listen for. Soon, people at the Canadian Embassy in Cuba began reporting symptoms similar to what the Americans had experienced, as did a few tourists there. A husband and wife at the U.S. Embassy in Uzbekistan became ill as well. Whatever it was, it seemed to be spreading.

There is increasing recognition that these epidemics of hysteria, which usually mirror prominent social concerns, present real individual and public health problems.
With no details, no motive, and no plausible explanation for what kind of weapon this might be, doubts began to surface. The FBI investigated and reportedly found there had been no such attack (though it suggested maybe it was a “viral” weapon). Sen. Jeff Flake also cast doubts on the sonic version of events. A handful of skeptical stories began to appear amid the more alarming ones, suggesting this might be what in the past was known as, “mass hysteria,” but which is now referred to as “mass psychogenic illness,” or a “collective stress response.” (These include things like the twitching girls in Le Roy, New York, in 2011; the 600 paralyzed girls in Mexico in 2007; and the Belgian Coca-Cola scare of 1999, which affected 100 students with more than 900 others reporting a related symptom, and costing the company somewhere between $103 million and $250 million.)

Epidemics of this sort are well-known in the scientific literature. Robert Bartholomew, a New Zealand–based medical sociologist and the co-author of Outbreak! The Encyclopedia of Extraordinary Social Behavior, Mass Hysteria in Schools: A Worldwide History Since 1566, and other books on the subject, has collected a database of some 3,500 cases. While the precise mechanisms are difficult to pinpoint, and the diagnosis is always controversial, there is increasing recognition that these epidemics of hysteria, which usually mirror prominent social concerns, present real individual and public health problems.

Yet many people still assume victims of such phenomena are simply faking or imagining their symptoms. In the Senate hearings on the attacks, Sen. Rubio asked Rosenfarb whether he thought this was, “a case of mass hysteria, that a bunch of people are just being hypochondriacs and making it up?”

This was a loaded question, with Rubio deploying the term mass hysteria as a means of dismissing this possibility altogether. But Rubio’s assumption—that a mass psychogenic illness is the same as faking or hypochondria—is wrong, as was his dismissal of the idea that this might explain the illnesses in Cuba. Indeed, mass psychogenic illness is likely the best explanation for these illnesses. According to Bartholomew, if you removed the word concussion from discussion of what happened there (but left the “white matter tract” changes in its place), you’d have a “textbook case” of mass psychogenic illness, in everything from its symptoms to its spread.

“There’s no evidence whatsoever that this was caused by a sonic device,” Bartholomew says. “It is physically impossible to have brain damage caused by an acoustical device. And most of those symptoms are not symptoms of sonic weaponry.” Anxiety and nausea, he notes, can be caused by both mass psychogenic illness and acoustic weapons, but the noise would have to be incapacitating and high volume. None of the other symptoms reported in Cuba are associated with an acoustic assault.

And what’s more: “This is a small, close-knit community in a foreign country that has a history of being hostile to the United States,” he says. “That is a classic setup for an outbreak of mass psychogenic illness.”

History is filled with cases of “sounds” making people ill. In Kokomo, Indiana, locals have been plagued since 1999 by a low frequency hum, which one resident said caused, “short-term memory loss, nausea, and hand tremors.” In Taos, New Mexico, a similar sound causes resident “sleep problems, earaches, irritability, and general discomfort,” by one account. Similar hums are reported in Bristol, England, and Windsor, Ontario. In 1989, a “Low Frequency Noise Sufferers Association” was formed in London. The people reporting illness from the noise produced by wind turbines have given the phenomenon its own name: wind turbine syndrome.

Unfortunately, it is also possible to lose your hearing without being attacked by a secret weapon. The Handbook of Clinical Neurology volume on Functional Neurological Disorders lists “nonorganic hearing loss” in its chapter on “Functional Auditory Disorders,” alongside conditions like musical hallucinations, misophonia (“hatred of sound”), “acoustic shock” from a sudden noise (symptoms include “pain in or close to the ear,” tinnitus, balance problems, hypervigilance, and sleep disturbance), and others. In Germany, there is a common condition called Hörsturz, which is a sudden loss of hearing related to stress. In 1973, at a nursing school in Papua New Guinea, there was an epidemic in which students were struck deaf, among other symptoms, with no apparent external cause.

“It’s very easy to manipulate people’s physical well-being through giving them expectations about sound,” says Keith Petrie, who researched the power of the mind in relation to wind turbine syndrome. When Petrie and colleagues exposed people to both infrasound and sham infrasound (silence), they found it wasn’t the sound itself, but their expectations—or what’s known as the nocebo effect—that produced adverse physiological reactions. Witnessing another person with symptoms can create an even stronger response, as can the perceived cause.

“When we gave them a plausible, biological explanation,” says Petrie, “it increased their symptoms the next time they were exposed to sound. When we gave them a nocebo explanation—and both explanations were equally credible—their symptoms decreased.”

On the surface, studies like this make it easy to agree with the Marco Rubio line of thinking that sufferers are just faking it. But the people who were told there was a medical reason for the hearing loss are not just imagining the resulting symptoms—they are physiologically real, “medically verifiable,” and cause deep distress, even if they resolve quickly, as most do.
“People suffering from mass psychogenic illness are not hypochondriacs and they’re not all making it up,” says Bartholomew. “It is a real condition with real symptoms. It could happen to anybody.”

There is real crossover between the condition’s mental origin and physical manifestation.
Research into the nocebo effect has been hampered by the ethics of subjecting people to it, but a picture of the mechanisms is emerging. And one important factor is “abnormally focused attention,” as neurologist Jon Stone puts it.

“As human beings, we’re more prone to these phenomena than we like to think,” says Stone, co-editor of Functional Neurological Disorders. “The rate of functional symptom experiences in the general population is very high. People have these symptoms a lot and just normalize them. We’re never very far from a functional disorder.”

What were once known as conversion disorders (meaning the conversion of a mental problem into a physical one) are now referred to as functional disorders. The old terms like psychosomatic or even psychogenic imply a purely mental origin, but the current parlance reflects the more complicated picture, that there is real crossover between the condition’s mental roots and physical manifestation. A “functional disorder means something has gone wrong with the network, the connections, the pathways, as opposed to the physical structure of the brain. And when these functions go wrong, normal sensations like tiredness, dizziness, or pain can grow much worse and become persistent.

One of the findings in Cuba that reporters seized on was the assertion that victims had suffered some kind of head trauma. As Rosenfarb put it, there were “clinical findings of some combination similar to what might be seen in patients following mild traumatic brain injury or concussion.” Here, he appears to be talking about abnormalities in the patients’ white matter, but a concussion isn’t the only thing that can have that effect. White matter changes with experience and learning, and becomes more robust in response to using a given pathway repeatedly. If those pathways are related to a disorder, it may appear in “diffusion tensor imaging” scans as anomalies.

“Diffusion tensor imaging,” says Stone, “is a technique that shows abnormalities in patients not only with minor brain injuries, but also with chronic pain, anxiety, depression, you name it. This is not a mark of brain injury. It’s a mark of brain dysfunction. It’s evidence that they’re ill.”

One problem in understanding the reality of a functional disorder is that most of us, when we are ill, look for a single cause, a simple chain of events that starts with an event, or a germ, and ends with our own misery. But functional disorders don’t work in this linear fashion. They are recursive and multifactorial, a feedback loop between our expectations, emotions, and physiology. According to Mark Hallett, a senior investigator at the National Institute of Neurological Disorders and Stroke, a picture of how they work is beginning to emerge, in a sense that, “when the so-called limbic system of the brain [the part of the brain that drives instinct, mood, and emotion] is overactive, it might induce the different symptoms that arise.”

Which is to say that if we fixate on our naturally occurring experiences and feelings, they can become amplified, particularly if the limbic system is overactivated by fear and anxiety. This creates a kind of loop between mind and body that it can be difficult to get out of, and which can make these conditions difficult to treat.

“It’s very powerful,” says Petrie. And often underestimated. “From the comments I read by the physician associated with the [embassy attacks], it was interesting how he dismissed this explanation” Petrie says. “He didn’t seem to understand how easily this can happen.”

Most people don’t. That includes just about everyone involved in the Cuban attacks. Mass psychogenic illnesses are not as intuitive to grasp as cold or a flu, but they are just as serious, and should be treated as such. In Cuba, they have not been. Instead, a fixation on secret weapons has obscured a real illness with real consequences, one which can not only be “medically verified,” but which regularly afflicts people across the world, and to which anyone with a functioning brain is vulnerable.

Thank you for reading!  Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity

Breast Implant Illness, General Health, Uncategorized

More on Breast Implant Illness

November 28th, 2017 — 11:41am

If you have not read my initial post on Breast Implant Illness, I recommend you do so now.  In fact, I implore you to read it.  Here’s the link.  https://www.sowdermd.com/blog/breast-implant-illness/.

I belong to a few physician only message boards and breast implant illness has been a hot topic in the past few months.  It is interesting to see what other plastic surgeons think and especially what physicians in other specialties think about this controversial topic.  These boards encourage free discussion without anyone being shut down, banished, blocked, or slammed on social media.  This makes me grateful to be part of a group of professionals that value serious and candid discussion of complicated issues.  Here I present a few thoughts I have curated from the past several months.

Dry eye and breast implants:  Many, many ophthalmologists weighed in on this one.  The consensus is that dry eye is very common in middle aged women.  Women are 10 times more likely to develop dry eye. One doc said 80% of his female patients over 50 had dry eye.  Conditions that contribute to dry eye include previous eyelid surgery (blepharoplasty), too much screen time, and some medications including SSRI antidepressants.  Implants?  No support for that theory from any of the ophthalmologists.  My ophthalmologist, who recently did my cataract surgery, looked at me like I was nuts when I asked him about implants and dry eye.  The eye docs also reminded us that silicone products are used extensively in ophthalmology:  punctal plugs for dry eye, silicone stents for nasolacrimal duct reconstruction, silicone buckles used to treat retinal detachment, silicone oil used as a replacement for vitreous humor in the posterior chamber (eyeball), silicone intraocular lenses used after cataract extraction and finally silicone contact lenses.  WOW.  That’s a boat load of silicone.

When docs congregate is it wisdom of the crowd or groupthink?

Mold and biotoxins:  General consensus from internal medicine and infectious disease is that patients ill with systemic fungal infections should be in the intensive care unit.  None of the plastic surgeons, with one  exception, had seen a case of mold growing in a saline implant.  I added up the years of practice and it came to about 250 years.  That is a lot of experience.  One plastic surgeon who has written a book on BII seems to see mold and biotoxins wherever she looks.  She puts her implant removal patients on extensive anti-fungal therapy post-operatively.  She has extensive experience with mold and biotoxins but has not been published in any recognized peer reviewed medical journals.  Her reason for not doing so has something to do with being targeted by Big Pharma.  Hmmm.

Autoimmune issues:  There were several rheumatologists weighing in on silicone triggered illness.  Their opinions varied from no evidence whatsoever to there are some individuals who are genetically susceptible to autoimmune diseases (this is well known) and exposure to silicone may trigger the onset of disease in these individuals.  It was noted that women are affected by autoimmune disease about 4 times more commonly than men.   One infectious disease doctor thinks breast implants caused slceroderma (which is very, very serious connective tissue disorder and is usually fatal) in 6 of his patients.  He recommended checking how wide an implant patient can open her mouth to diagnose early perioral and TMJ fibrosis and scleroderma.  The rheumatologists thought that this doc was really out there.  The plastic surgeon who has written a book on BII, who is not a rheumatologist, stated that rheumatoid arthritis is caused by an intracellular mycoplasma infection and she can cure rheumatoid arthritis and scleroderma with non-conventional therapy.  None of the rheumatologists believed her.  They all wondered why she had not published her results in a peer reviewed medical journal.  Same answer.  Big Pharma.

Breast Implant Associated Anaplastic Large Cell Lymphoma:  It is rare.  It is treatable if caught early.  It is really creepy.  It is associated with textured breast implants and/or tissue expanders. The plastic surgeon who wrote the BII book stated that BIA-ALCL was the most common cause of death in her implant patients prior to 2005.    It was pointed out by several other doctors that BIA-ALCL was recognized as a disease around 2012.

Other stuff:   Many of the internal medicine docs, ER docs, pain specialists, psychiatrists and OB-gyns weighed in on so called functional and somatic disorders including fibromyalgia, chronic fatigue syndrome, pelvic congestion, brain fog, anxiety, poor memory. depression, and malaise as primarily affecting women and pointed out that the vast majority of these women with these disorders do not have breast implants.  This chatter of functional and somatic disorders made me think of the Freudian disorder of “hysteria” of yesteryear which was supposedly caused by the uterus wandering around looking for a baby.  This sort of stuff gets my hackles up a bit, being a woman and all.  One doctor wondered if there were any male to female transgender individuals with breast implant illness.   Now that is a great question.

Future research:  Everyone pretty much agreed that a large, multi-center, long term (10+ years) may help answer many questions about breast implants.  Several plastic surgeons, myself included, pointed out that the dismal long term follow-up in previous studies was in part due to patient non-compliance with follow-up.  I know this will make a lot of people angry but it is really true.  Back when gel implants were only available through studies like the one I participated in, once patients had their coveted gel implant, they were gone, gone, gone.  My follow-up for the McGahn study was about 80% which is really high because my staff and I pestered the participants mercilessly to come in for their appointments.  Once doc suggested maybe a prison study using inmates with really long sentences.  Maybe this could be Orange in the New Black meets Extreme Makeover?

Breast implants in general:  Whoa, were there some strong opinions about this.  Many, many non-plastic surgeons think any woman who gets implants is by definition is a mentally impaired bimbo.  One doc divulged that his wife was going to get implants to treat her postpartum atrophy and boy did he get an earful!  Many of the male doctors assumed that she was preparing to leave him once he had paid for her surgery!  Such cynicism.  But there was one family practitioner who has had the same set of implants for over 30 years (!) who said they absolutely changed her life.  She went from a wallflower to a confident young woman.  She even credits her implants for giving her the confidence to apply to medical school!

Plastic surgery and plastic surgeons in general:  Some of the docs think that any sort of appearance altering surgery (except for obvious reconstructive procedures) was morally and intellectually bankrupt.  This was an opinion shared by many anesthesiologists!  Weird, huh?  I wonder if my anesthesia group thinks they are slumming to work in my OR?  I guess I should ask.   Many of the male docs stated they didn’t need plastic surgery because their female partners found them totally smokin’ hot just the way they are.  Hmmmm.  Some of the docs think we plastic surgeons are a bunch of money grubbing fools.  Oh well.  I chalk that one up to jealousy.  ; )

So there you have my carefully collected and curated review of some wild times on the doctor only message boards.  You too can join a doctors only message board but first you have to finish medical school.

Thanks for reading and check out my Instagrams @sowdermd and @breastimplantsanity.    Dr. Lisa Lynn Sowder

 

 

Breast Implant Illness, Breast Implant Removal, Breast Implants

Breast Feeding and Breast Implants

June 24th, 2017 — 8:56pm

In a perfect world, women would wait until they were done childbearing and breast feeding prior to having breast implants, mostly because pregnancy and breast feeding can really change the breast.  In the real world, many young women opt for breast enhancement long before having children. I am often asked what effect childbearing will have on an implanted breast.  My answer?  Some ladies do great and some don’t.  I don’t have a crystal ball.  I do tell patients that whatever happens to their breasts, I can likely fix it!

I am also often asked about the effect implants have on breast feeding and if feeding a baby from an augmented breast is safe for the baby.  Here is what I know based on reading the literature and listening to patients for 25+ years.

In the recent “Cohort Study to Assess the Impact of Breast Implants on Breastfeeding” conducted by lactation specialists and doctors in Argentina published in the December 2016 Plastic and Reconstructive Surgery Journal (PRS Vol. 138, 1152-1159, 2016) 100 women with breast implants and 100 women without breast implants were followed from the time of childbirth through about 3 months.  All of these women received instruction and encouragement to breast feed by lactation specialists. Here’s what was found:  99 of the 100 women without implants were able to breast feed.  93 of the 100 women with breast implants were able to breast feed.  This was not found to be statistically significant.  At 3 months, more women without breast implants were breast feeding exclusively than the women with breast implants.  This was statistically significant.   The study showed no correlation in the type of implant or incision location as to the ability or inability to breast feed.  Sooo…it would appear that breast implants may impact the quantity of milk production and it may be necessary to supplement.  I have been telling my young patients for years if they will feel like a terrible mother if they are unable to breast feed, they may want to wait on that breast augmentation. I think based on this study I will change that to breast feed exclusively. I also over share with these patients that I am a lactational failure and my children (now 20, 20 and 16) have had one ear infection, 2 broken bones, one cavity, one torn thumb ligament between them and all are healthy and happy.  And I felt like a horrible mother for awhile but got over it. I also refer them to a article that appeared in the Atlantic in 2009: The Case Against Breast Feeding written by Hanna Rosen, the mother of three breast fed children.  It’s an fact filled and thoughtful look at this very prickly topic. It made this lactational failure feel a little better!

Is it dinner time?

And lately I have been questions about the safety of breast milk from an implanted breast.  I think some of this is being stirred up by the breast implant illness community which is doing its best to have breast implants banned.  One of the breast implant illness web sites has an extensive diatribe about this and there is also a recent alarmist Instagram post on this topic.  In doing a little research of the peer reviewed literature, I did come up with a paper regarding silicone gel implants and breast milk.  This paper (PRS Vol. 102, 528-522, 1998) looked at silicon levels (silicon is the element that silicone is made of) in breast milk in patients with and without breast implants and also in cow’s milk and various formulas. This study was done way back in 1997 at the University of Toronto.  The researchers looked at the milk of 15 mothers of newborns with silicone gel implants and 34 mothers of newborns without implants.  The silicon levels in the implant group was lower than the non-implant group although the difference was not statistically significant.  Now here’s the kicker. The silicon levels in cow’s milk (presumably the cows did not have breast implants although that is not stated in the paper) was over 13 times that of the mother’s milk!  Twenty six formulas were tested and they ranged from 13 times to 433 times that of mother’s mild.  The soy-based formulas had some of the highest levels!

How can this be????  Again this study did not measure silicone (the rubbery stuff made from elemental silicon).  Silicone is a big fat molecule and cannot be dissolved in solution and therefore cannot be measured.  Silicon, the element, can be measured.  And silicon is everywhere.  Silicon is the second most abundant element on  the earth’s crust, second only to oxygen.  Silicone, the man made rubbery stuff, is also very abundant in medical devices, prosthetics, pharmaceuticals and many consumer products (I love my silicone oven glove). Oh, and it’s used to make nipple shields for breast feeding moms and bottle nipples for bambino.

The other issue is the location of breast implants in relation to the milk producing glands and the lactiferous (great word) ducts.  Implants on top of the muscle sit under the breast tissue and are in contact with some of the milk producing gland but are well away from the ducts.   Implants under the muscle are not really in contact with the breast much at all.  I don’t have the imagination to visualize big gooey silicone blobs getting though the wall of an intact implant, thorough the fibrous scar capsule and into the milk producing glands and travelling out of the ducts.  I have removed a bajillion ruptured gel implants and have never seen or heard of leakage of gel from one of my patient’s nipples.

Based on this information and my intimate knowledge of the location of breast implants in relation to the milk glands and milk ducts, I would not advise patients with intact silicone gel implants to forego breastfeeding because of fear of some sort of contamination of their breast milk.  If an implant is ruptured, I think it would be prudent to bottle feed.

So there you have it, my take on breast feeding and breast implants.  Mothering is a wonderful, mysterious and complex task and sometimes doesn’t include lactation (and sometimes doesn’t even include giving birth).  I think most patients are very capable of making up their own minds about if and when they desire breast enhancement with breast implants.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implants, General Health

Breast Implant Illness Fear Mongering

May 23rd, 2017 — 10:01am

I came across a post on the Breast Implant Illness Instagram site recently that really made me really cranky.  And it made me want to holler, “STOP THE FEAR MONGERING!”

Let me walk you through this image.  Obviously it is a lady and in the upper left corner you can see her breasts which have been removed and placed on a serving tray.  Um, very edgy.  And you can see the chest width slash across her chest where her breasts used to be.

The Breast Implant Illness community is on a mission to ban all breast implants, saline and gel, for enhancement and for reconstruction.  Their modus operandi is to scare the bejesus out of anyone who has breast implants, has had breast implants or is thinking about getting breast implants.  I find their IG posts mostly rather boring especially when it is the same set of moldy and/or ruptured implants that have been posted half a dozen times already.  But this post really crosses the line.  This post implies that breast implant removal requires a double mastectomy and an incision across the width of the chest.  I have been doing breast implant removal for over 26 years and I have never, make that NEVER had to do a mastectomy or use an incision of this length.  And most of my patients look better after parting ways with their implants.  I see ladies in my office frequently with old, hard, nasty implants who have suffered with pain and tightness and embarrassment for years but have been fearful to seek implant removal because they equate implant removal with mastectomy. Disinformation like this IG post feeds that fear and is a disservice to women.

Posting this sort of rubbish must provide a certain type of person with a feeling of satisfaction and self worth.  As for me, I prefer to satisfy myself by providing careful, competent and reality based care for women seeking breast implant removal.  If you want to see what breast implant removal really entails, I have a ton of information on this web site and also my IG:  @breastimplantsanity.

Thanks for reading.  Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implant Removal, Breast Implants, This Makes Me Cranky.

Louis Pasteur and why you shouldn’t worry too much about mold or fungus in saline breast implants.

April 25th, 2017 — 9:49am

Louis Pasteur in his lab.

I have had a lot of questions lately about mold and fungus in saline impants. I have even read online that some people think formerly sterile saline breast implants can somehow get filled with germs.  When I read stuff like that my thoughts go to the great French Scientist Louis Pasteur and your thoughts should too.   Pasteur contributed many, many great inventions and discoveries.  If you drink milk or wine, you can thank Pasteur for the safety of those two nourishing beverages.  If you and your children benefit from vaccinations, you can thank him for that too.  If you have pondered the deeper meaning of stereoisomers in your organic chemistry class, thank Louis.

But enough about that stuff and lets talk saline breast implants. One of Pasteur’s greatest contributions was the debunking of the myth of spontaneous generation.  You see, way back then before microscopes, microbes could not be seen.  When  something would ferment or rot or putrefy or suppurate (I’m making myself a little sick), it was believed that the agent of this process just materialized from, well, nothing. The noxious effulia that generated the aforementioned conditions was referred to as miasma.

In a series of really elegant experiments using some custom made glass vessels, Pasteur showed that a liquid rendered sterile by heating would remain sterile unless it came into contact with something that had not been sterilized.  The infectious agent had to exist in the environment.  It just did not spontaneously generate.  He figured all of this out before even seeing those nasty little germs under a microscope.  Very smart guy.

So what does this have to do with mold, fungus or bacteria in saline breast implants?  Every reasonable implant surgeon on the planet uses a closed system to fill an implant.  The saline that goes into the implant comes from a bag of sterile saline for intravenous use, into a sterile length of IV tubing and into the sterile implant.  The saline is never exposed to the air which can harbor spores and other creepy things we cannot see with the naked eye.  No contamination means the saline in the implants stays sterile.

What about saline implants that leak from a tear or from the fill valve?  Yes, there could be some passage of fungus from the breast into the implants except that breasts don’t contain fungus.  The breast does often harbor some microbes in the milk ducts but the deep breast tissue is a pretty clean environment and the space where submuscular implants are placed is really, really clean.

I have taken out a bajillion old saline implants and have never seen one that was contaminated.  I have had a few patients who were absolutely bummed that their implants were not contaminated because they had become convinced that they were.  Yes, I know there are photos of really nasty and moldy implants out there in cyberspace and yes it is obvious that some unreasonable surgeons don’t used a closed system but I think those cases are very, very rare. Nobody posts photos of old, pristine saline implants (except me on my Instagram breastimplantsanity).  Pristine saline implants are boring.

Soooo, if you think your implants are moldy, you could be but probably are not right.  But as anyone who knows my practice, I will take implants out for any reason.

Thanks for reading and you should read up on Louis Pasteur.  The contributions he made to science are nothing short of amazing.  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Illness, Breast Implant Removal, Breast Implants, Stuff I love

Breast Implant Illness – a seasoned plastic surgeon’s humble opinion. Updated October, 2017.

February 28th, 2017 — 2:24pm
worried_1375864c

“This stuff online just scares me to death.”

Warning:  This is a long one.  A really, really long one.

I recently counted up all of my operations for 2016 and I removed more breast implants than I put in.  Last year I removed implants from 44 women. Twenty-seven of those women had removal for the usual reasons:  “I don’t like them anymore, they make me look fat, they are too hard, I finally divorced that s.o.b., I’m becoming a nun, etc.”  But 17 women had breast implant removal because they believed their implants were ruining their health.  I have gotten to know these patients (and many more from prior years) and their families, have heard their concerns, looked at their medical histories, examined them and removed their implants.

I have given this topic of breast implant illness a lot of investigation and thought.  This blog represents my opinion based of what I have read, what I have heard from patients and my colleagues, what I have seen in the exam room and OR in over 25+ years of practice.  I recently presented a paper on breast implant illness for the Northwest Society of Plastic Surgeons.

A very brief history:  Back in the early 1990’s, just when I was entering private practice, silicone gel breast implants came under intense fire for being linked with health problems, notably autoimmune diseases like lupus and rheumatoid arthritis.  This concern led to silicone gel implants being taken off the market in the United States for cosmetic purposes.  It also lead to large amounts of money finding its way into the pockets of trial attorneys, the bankruptcy of silicone supplier Dow Corning, and at least one case of a woman removing her own implants with a razor blade in a fit of anxiety.  This moratorium on gel implants lasted well over a decade.  For over ten years, the only gel implants I used were used in one of the several studies of gel implants in which I was an investigator.  Finally, in late 2006, after exhaustive analysis of many implant studies, gel implants were again approved by the F.D.A. for cosmetic use.  Interestingly gel implants remained available for post-mastectomy reconstructive use during the moratorium.  I always thought it was odd that the it was okay for patients with a history of breast cancer to have the same silicone gel implants that were deemed too risky for a healthy woman.  And I thought it was odd that the FDA was not recommending the removal of implants that were deemed unsafe for use.    So did breast cancer survivor and congresswoman Marilyn Lloyd who asked in 1992, “How scientific is the FDA’s decision that no woman should have implants put in, and no woman should have them removed?”  Good question.

Fast forward to the past few years and I start seeing women with implants who are convinced their implants are ruining their health.  About 1/3 of them have saline implants which were never taken off the market.  These breast implant illness ladies tend to be a little younger than my average breast implant removal patients.  They tend to embrace alternative medicine and distrust the medical establishment.  And they are all connected to the online breast implant illness community.  And another thing I find so odd – some ladies with all of these symptoms often look so healthy and they ask questions like “When can I go back to teaching Pilates?”,  “Can I hike the Appalachian trail two months after surgery?”, “Is it okay if I go snowboarding after a couple of weeks?”.

Many of the symptoms of breast implant illness are a vague and/or very common complaints.  Most of these symptoms have significant overlap with the most common complaints related to common health issues including menopause, hypothyroidism, depression, anxiety, general aging and the human condition.  And some patients blame conditions with very clear etiology on their implants.  A few examples include plantar fasciitis (an overuse injury of the foot seen in runners and dancers), chronic Epstein-Barr virus (cause by a ….. virus!), Lyme disease (a tick-borne bacterial infection) and dental cavities (caused by the acid produced by sugar loving bacteria).    And then there are the fringe disorders such as leaky bowel, chronic candidiasis, multiple chemical sensitivity, etc.  To quote the very smart Dr. Marcia Angell, former editor of The New England Journal of Medicine: “These much discussed but elusive disorders remain entirely speculative …. they are variously said to consist of just about every symptom imaginable in biologically improbable and shifting combinations.  Since they have yet to be objectively and consistently defined, it is impossible to study whether they have anything to do with breast implants.”  For some really good reading and a wonderful primer on the scientific method and statistical analysis by Dr. Angell, you should really check out her book:  Science on Trial:  The Clash of Medical Evidence and the Law in Breast Implant Cases by Dr. Marcia Angell This book is a decade old but its lessons are very timely.

If a patient goes to enough alternative health providers, they will eventually find one willing to take their money to tell them that they have one, two or more of these disorders and that it’s their implants that are at fault.  They may even offer $50,000 worth of testing and treatment (as reported by one of my plastic surgery colleagues). I have one patent who saw seven naturopaths before she found one who told her what she wanted to hear. Did she ever go at an actual rheumatologist for her autoimmune symptoms?  Of course not.  She could not trust a rheumatologist.  I have patients who pay hundreds of dollars for hyperbaric oxygen treatment that does not involved a pressurized capsule.  Ladies, if you are sitting in a room without an airlock you, are not getting hyperbaric oxygen!   Several months ago I saw a middle aged lady who after reading one of the breast implant illness websites was worried that her implants were causing her sleep disturbance, brain fog, low energy and general feeling of malaise.  Then she told me that those symptoms had recently resolved.  Upon further questioning, she told me her primary care doctor had diagnosed depression and had put her on an SSRI.  After a week or so on medication, she was feeling so much better.  And her implants not only looked fine, they looked great!  This lady did not have breast implant illness.  She had depression.  She needed medication and a boost in her seratonin, not an operation.  Oh, and then a few weeks ago my nurse took a call from a lady who was in a panic about needing her 10+ year old implants removed the next day before they killed her.  I was scrubbed in the OR and could not talk to her.  My nurse explained that she would need to come in for a consultation and that it may be a few weeks before I had the OR time to do her surgery.  She berated me, my nurse, the universe and then hung up before we could get contact information on her.  I have no idea what has happened to her but whoever in the BII community scared her silly about her breast implants did not do her a favor.

I regularly visit some of these breast implant illness websites and Facebook groups and Instagram and to be very honest, I find so much of the content just outrageous.  Several of my patients noted the onset of their breast implant illness after stumbling into one of the breast implant illness communities.  Is this the nocebo effect (the placebo effect’s evil twin a.k.a. the power of negative thinking)?  Maybe.  One thing I find very interesting is the number of women who have their implants removed and still feel ill months and years later.   Do they think that maybe their problems were perhaps not related to their implants?  No, they are told that even after removal of the implants and scar tissue, the fact that they ever had implants condemns them to a life of ill health as if implants somehow have thrown a biological switch from healthy to sick.  Some of these posts are just heartbreaking to read. And most of the advice being given by non-physicians has no basis in reality based medicine.  And then there is the dismissal of surgeons like me who spent their youth training in medicine and surgery (I completed my residency training at the tender age of 35), took the Hippocratic Oath and devote most of their waking hours doing their best to provide competent and conscientious care to patients.  I take it a little personally when someone is more receptive to the advice or opinion of someone on Facebook who posts photos of themselves having a coffee enema that to the advice of a fully trained and experienced plastic surgeon.  And then there are those who feel that banning breast implants and denying their access to women who either want to enhance or rebuild their breasts is somehow empowering.  Give me a break.  I get cranky just thinking about it.

Do I think breast implants can cause problems?  Oh yeah.  For a small number of unlucky patients, breast implants can be a mess.  Although implant construction has improved over the years, implants can still get hard, they can become too loose, too tight, too low, too high, too medial, too lateral, too anything.  They can develop thick scar capsules that can cause distortion and cause pain in the breast, chest wall, upper extremities, neck and back.  Implants can leak which will deflate a saline implant.  A leak or rupture of a gel implant can result in silicone granulomas of the breast and even the chest and abdominal wall.  And then there is the more recent worry of ALCL which is looking like it occurs exclusively with textured implants but the jury is still out on that one.  I sometimes see patients who have had 3, 4 or more operations related to implant problems.  And yes, I am the original surgeon on a couple of them.  And yes, if a woman has breast implants she will likely need an implant related procedure sometime in the future.  And one more thing – IMO the bigger the implants, the bigger the problems.  That’s why you don’t see any large casaba melons in my photo gallery!  And you will also see a lot of non implant breast surgery in my photo gallery.  If I can make a breast look nice without an implant, I will encourage the no-implant route.

Do my implant removal patients feel better after removal?   Most, but not all of them, do feel better.  One interesting finding in almost all of my breast implant illness patients is a tight implant capsule.  Sometimes it is very thin and fragile and sometimes it is thick and even calcified but they are always really, really tight.  That tight scar tissue can cause discomfort that can include the entire upper extremity, chest, back and even the neck.  Removal of the scar tissue capsule (a procedure called a capsulectomy) will often result in a lot of relief.  Sometimes in surgery, I think I can hear the pectoralis major muscle breath a sigh of relief as I remove the tight scar tissue.   Also, capsule formation is an inflammatory process and we all know that inflammation is the new bogeyman.  And then there is the placebo effect.  I have a deep belief and deep respect for the mind–body connection.  Some patients fret every day about their implant’s effect on their health.  After removal, they often report just feeling better all over.  Is it that they don’t have the constant worry anymore or something else?  I really don’t know.  I can never guarantee what effect breast implant removal will have on a patient’s health.  I think many of my breast implant illness patients are worried sick and if the object of their worry – breast implants- can be removed, I am happy to do that.   I will also go after every bit of the scar tissue around the implants if it is safe to do so.  And, if the breast tissue is healthy enough, I will do a breast lift at the same time if it will improve the appearance of the breast.  And there’s more!  I will consider doing fat transfer a few months later if the patient wants a little volume back and has some good donor fat.  And I have to say, I just love sending patients on their way to an implant-free rest of their lives with no worries about the need for further implant related surgery. I call this “graduation” from breast implants.

If you are looking for a careful and conscientious surgeon who will remove your implants and capsules and offer non-implant options to enhance your breast appearance, I’m your gal.  Come see me!  If you are looking for a surgeon who believes that breast implant surgery destroys women’s health, I am not your gal.  And really, would I use breast implants if my implant patients came crawling back to my office sick?

So, if you want your implants out for any reason, come on in.  I will  listen to your concerns and answer your questions to the best of my ability.  I’m not Marcus Welby but for a surgeon, I am really pretty nice (at least that what I have heard).

Wow, this was a long one.  Thanks for reading!   Dr. Lisa Lynn Sowder

If you want to follow me on Instagram, I would be honored.  Look for me at @breastimplantsanity. and @sowdermd.

 

 

Breast Implant Illness, Breast Implant Removal, Breast Implants, General Health, This Makes Me Cranky.

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