Episode 9: Secondary Breast Surgery: How do we Rebuild?

Special Guest: Dr. Scott Haydon


Special Guest: Megan Parken


Dr. Franco: Welcome back, team, to “Plastic Surgery Untold.” I’m Dr. Johnny Franco, also known as Austin Plastic Surgeon. And I’m excited to have our celebrity guest, Dr. Scott Haydon, joining us today to talk about breast revisions and secondary breast surgeries. Just so you guys know, it’s not just revising all of our own surgeries. We do a lot of good work around Austin in helping others and so forth. But we also have our usual suspects with us, formerly known as Austin’s most eligible bachelor, one Gilberto Saenz.
Gilberto: Formerly.
Dr. Franco: Formerly. And then we also have Megan “Blue Check Mark” Parken.
Megan: Hey, guys.
Dr. Franco: Also known as Just Megan. And then, of course, celebrity husband who’s got to catch us up on a lot of thrilling adventure since our last cast.
Travis: Oh, yeah. Oh, yeah.
Dr. Franco: But before we get to all the gossip and treachery and other mishaps, Dr. Haydon, let us know a little bit about you and why you’re known as Westlake’s most famous plastic surgeon.
Dr. Haydon: Well, thank you for having me. I was fortunate to grow up in the Austin area, attended Westlake High School and then University of Texas. Went away, did my training, and then came back in 2002. So I’ve been practicing here in Austin for about 18 years and I’m proud to do what I do.
Dr. Franco: And I don’t think a lot of people know, we actually operated at one of the same surgery centers. And that’s how we, I think became pretty close. And we actually pretty frequently discuss cases with each other to go over things.
Dr. Haydon: Absolutely. And I think that’s very important because with plastic surgery, people who listen to this podcast, there’s not only a whole lot of topics and procedures, but there’s a whole lot of different techniques and ways to do things. And I think that one of the things about it is knowing different ways to do things so that for certain patients you can give them the best procedure and have the best outcome with the fewest risk of needing revisions.
Dr. Franco: Exactly. But before we get into that cliffhanger, I think some people have been blowing up my DM about trying to catch up on a few things. And so, you know, the question is always whether to start with Travis’s world travels or why Gilberto’s not the most eligible bachelor in Austin anymore. So, can you catch us up where you’re at? You were just “taking stuff slowly,” quotation marks for those of you listening, with your new love endeavor. Where does that stand right now?
Gilberto: I mean, I think we’re still moving slowly and just kind of…
Dr. Franco: Well, what does it mean?
Gilberto: I mean, I don’t know. It’s like, you know, we’re just getting to know each other again.
Dr. Franco: Does that mean like you’ve bunt it and you’re still running to first base, or what’s going on here? Can we say that? Is this a PG [inaudible 00:02:29]?
Gilberto: [crosstalk 00:00:27] bases out.
Travis: [crosstalk 00:00:27].
Dr. Franco: I thought this was a family show. Well, nothing new has happened? Last time you guys were just Netflix and chill and Megan was unhappy that you don’t actually take her out into public and you just order donuts all the time.
Gilberto: No, that’s not even true.
Megan: How did Valentine’s Day go? That was kind of the last thing that was going on.
Dr. Franco: Yeah. Catch us up. Little Valentine’s. What’d you guys do for Valentine’s?
Gilberto: Okay. So Valentine’s I asked her what she would like to do. I had intentions of making plans to go out to dinner and, you know, the grand, you know, endeavor and whatnot, and…
Dr. Franco: But were these offers made on the Thursday before Valentine’s Day?
Gilberto: No, no, no, no, no, no, no.
Dr. Franco: Okay. I’m just clarifying.
Gilberto: They were made weeks in advance, but I kind of wanted to get, you know, her idea of what she wanted to do, you know, what she felt comfortable doing or whatever. And I asked her and she’s like, “Honestly, I just wanna get, like, pizza ordered in and just hang out.”
Dr. Franco: That sounds like a trap, Megan.
Megan: No, I don’t think so. Again, I think Valentine’s Day is a little overrated. So I think, you know, just spending time together and being at home, and then…
Gilberto: I will say this…
Dr. Franco: But that’s smart by Gilbert because he kept it on the DL. That’s why he’s not out in public. He’s not showing this off. It’s like, “Damn.”
Megan: But he did ask. So if she really wanted to, she would have said she wanted to.
Gilberto: And I would have made plans. But I will say that I did surprise her with tickets to a show for an artist that she really, really likes.
Travis: There you go.
Megan: That’s thoughtful.
Dr. Franco: So you should have a pizza and a show. Basically, Netflix and chill again.
Gilberto: [crosstalk 00:03:54].
Dr. Franco: You’re consistent. Okay. So where…
Gilberto: I mean, if anything, I’m consistent, I guess.
Dr. Franco: So, this is going well, would you say, or where are you at?
Gilberto: I think it’s going well. Yeah, I think it’s going well. I mean, we’re just enjoying our time together.
Dr. Franco: I mean, to the point where we can officially say you’re no longer Austin’s most eligible bachelor? Because I feel like it can only go slow so long before you’re taken off the list. Is this…
Gilberto: I mean, I guess. Yeah, I’d say…
Dr. Franco: Wow. Wow…
Travis: You heard it here first, people.
Dr. Franco: …it’s official. Official. Okay.
Gilberto: I mean, yeah, I’m giving up the crown as Austin’s most eligible bachelor.
Dr. Franco: Well, if you think that you deserve the crown, hit us up and maybe we’ll have to crown a new most eligible bachelor. So boom, boom, boom. We’ll see what happens. Travis, talk to us a little bit. Last time you were I think gonna go skiing, do something, little adventures. How’s that going?
Travis: Not well. To answer concisely. We went skiing. We went to Breckenridge, Colorado with some friends. We had a great time for the first 24 hours we were there. Second 24 hours…
Dr. Franco: You guys were just taking it slow.
Travis: Just taking it slow. Mary was doing a lesson, a ski lesson with one of her friends. They were out on the slope.
Dr. Franco: And Mary, for people who’re listening for the first time because…
Travis: Yeah, that’s my wife.
Dr. Franco: …they’re just Dr. Haydon’s fans…
Travis: That is my wife.
Dr. Franco: …Mary is your wife and also known as Megan’s nemesis.
Megan: No. No.
Travis: Not exactly nemesis, but they’re both in the same influencer space.
Dr. Franco: Fighting over that space.
Travis: That’s right. My wife, @yourtrendytherapist, if you wanna check her out. She was out with one of her friends. They were skiing. It was late in the day. They were on a steep blue. She was doing really well with the lessons. He decided to take her to something a little bit more treacherous. They were heading down the mountain. She got all wrapped up in her skis, tumbled down. I get a call, I’m on the other side of the mountain. I answer. I’m on the chairlift going up. “Hello?” “Hey, where are you?” She’s like, “I’m in the back of the sled. I’m heading down.” I’m like, “Whoa, whoa, whoa. What?” And she’s like, “Yeah, I’m in the back of the sled. The ski patrol is taking me to the bottom. I think I broke my leg.” I’m like, “Are you joking?” She’s like, “No.” So anyway, I race over to the other side of the mountain and go down to the bottom. She ends up having an ACL avulsion, a tibial avulsion fracture. We get back to Austin. Week later, she has surgery. She is now non-weight-bearing on her leg for six weeks. So it’s been rough at our house, at the Osborne’s.
Dr. Franco: This is why you’re still married. Because I would have been like, “What am I gonna do right now? I might as well take a few more trips down the mountain. You know, by the time she gets an X-ray, somebody sees her. There’s not really a lot for me to do right now.”
Travis: I love that when we got home, one of my buddies, first question was, “Well, did you ski the third day?” Like, “Dude, no, I’m not gonna ski the third day. Like, dude, she’s just gonna hang out in the…she’s gonna hang out in the cabin anyways.”
Dr. Franco: I agree. There’s not much to do. No much to do.
Travis: He’s clearly not married.
Dr. Franco: Scott, what about you? What’s going on in your life? I know with three kids, didn’t you just recently go to like a world cheerleading competition?
Dr. Haydon: I did. I’m an official cheer dad. I don’t do all the face painting, but…
Dr. Franco: Love some hair time?
Dr. Haydon: …I’m very knowledgeable about it. Yeah. I don’t go through many cans of hairspray. I was at Nationals watching the Westlake High School cheer team, and my daughter’s a sophomore. So, it was pretty fun.
Dr. Franco: And how did they do? Didn’t they do rather well?
Dr. Haydon: Well, they won last year. They were national champs. And she was a freshman. And she was determined to win every year, but they did not win this year. But they got to Nationals. So that’s pretty cool.
Dr. Franco: I mean, that’s pretty amazing, though. I mean…
Travis: Impressive.
Dr. Franco: …I don’t think people realize just to get to Nationals…
Dr. Haydon: My oldest daughter was a cheerleader and she actually cheered her first year at Texas and…so my wife has been going for seven years. And I’ve never gotten to go because I was taking Ella, my littlest one, to cheer competitions that same weekend. So I’m sitting there streaming it on my phone, watching it at Disney, and this year, I finally got to go. So [inaudible 00:07:39].
Dr. Franco: That’s awesome.
Gilberto: That’s really cool.
Dr. Franco: Megan, what about you? I think you’ve been traveling the world a little bit…
Megan: I have.
Dr. Franco: …and doing some pant lines or something like this.
Megan: Yeah, I opened my vintage denim company. So I’ve been selling, and we’ve been doing kind of custom stuff through Instagram. It’s been a little crazy, though, kind of going back and forth.
Dr. Franco: Just so you guys know, we’ve all gotten a free set of denim. And so you will be seeing that a little bit later of the…
Megan: Custom fitting.
Dr. Franco: …four of us in skinny jeans. And so…
Gilberto: [crosstalk 00:08:02].
Dr. Franco: …you know, you may or may not wanna turn off the video section for that, but…
Megan: But yeah, I’ve been working on that and just kind of trying to figure out how to do it all myself, basically. Maybe trying to hire my sisters in when she wants to help. But, I mean, [crosstalk 00:08:14].
Dr. Franco: So is this for men and women? Is this just a women’s line? Because…
Megan: Oh, yeah, it’s men’s and women’s.
Dr. Franco: I mean, so I’m not gonna say that we probably should have a pair to try out, but, I mean, you know, but maybe, but maybe.
Dr. Haydon: No cut-offs.
Dr. Franco: No cut-offs. I mean, I think I would look…
Dr. Haydon: I wanted the cut-offs.
Megan: It is about to be spring. It’s all right…
Dr. Franco: Travis does love some Capri jeans. Do you have some Capri denims? He would…
Travis: They’ll probably fit me, like, regular.
Dr. Franco: Well, listen. See, I know people wanna get into it and hear some of Dr. Haydon’s expertise. Let’s jump into it. Let’s talk a little bit about secondary breast surgery and a little bit of revision-type surgery stuff. Do you maybe just wanna tell us a little bit what we’re talking about, what’s encompassing in that? Because I think sometimes people get confused that revision means that somebody necessarily had a problem. But that’s not always the case.
Dr. Haydon: Sure. No, very much so. A lot of times…well, first of all, there’s a lot of different breast surgeries that we do. Some involve implants, some involve lifts, some are reductions. And sometimes we combine, we do a lift and an implant, for example. And so just the natural aging process, the skin gets thinner, we lose our elasticity. We may lose or gain weight. Women, with their breast in particular, when they’re younger in their 20s, 30s, etc., it’s largely a glandular structure. As they get older, it becomes replaced a lot with fat. And so the makeup of the breast changes. And so if someone has had surgery, for example, in their 20s or 30s, and now it’s a decade or 2 decades later, they’re gonna obviously have some changes that occur. And so revision surgery is really a lot of times to address just natural changes that have happened. When we operate on people, you know, we make it very clear that we’re not doing anything that necessarily is setting them up for additional surgeries. But we do make it clear that, you know, in the future, as you age, you know, your body may change.
Dr. Franco: And I feel like a lot of natural secondary surgery stuff is, you know, people will get an initial breast surgery may be in their 20s, have kids, and then after they’re done having kids, send the last child to college or something, they come in for either the mommy makeover or something else. And the breasts maybe have fallen after weight loss, breastfeeding children. And that tends to be a ton of the secondary breast surgery stuff I tend to see.
Dr. Haydon: Absolutely. And I think that, you know, women’s outlooks change, the way they perceive themselves change. And so somebody, for example, who’s younger in their 20s. you know, they may want larger implants, for example, and they want a larger breast and they want to look a little bit differently, perhaps, than they do when they’re in their 50s. And that, you know, I’m not putting every woman in the same category, but, by and large, that happens a lot. So we’ll see somebody, for example, that had fairly large implants placed when they were in their 20s and then now they’re in their late 40s, just like you said, they’ve had children, breastfed, etc., and now they really don’t want quite that volume, and they wanna be a little bit smaller. Austin’s a very fit town, as, you know, you’ve talked about on the podcast a lot. And a lot of our patients in this area, they wanna run. They wanna exercise. They wanna go to the gym. They still wanna look cute, and they wanna be able to wear their workout outfits, but they don’t wanna be as heavy and full, you know, with their breasts.
Dr. Franco: Do you mind if we jump into some few specific stuff? Because one of the ones that I see a lot of people coming back for is actually just wanting to switch from saline to the new cohesive gummy bear implant. And most of the time, they wanna change that. The other thing that I see most commonly is people wanna change their implant sizes. And so maybe we can talk a little bit about those two and how you address that or if you’ve seen that in your practice as well.
Dr. Haydon: Sure. No, I think that a lot of the people for, like you said, that have had saline implants, they realize now that the newer implants just look and feel so much more natural. And they didn’t have that option, perhaps, at the time. And when it was, you know, 20 years ago, they felt like it was not as safe an implant. And so they defaulted to saline. And maybe their surgeon was even the one that suggested that because there was a time where, you know, in the mid-90s and late-90s, people were not doing silicone because of the scare. Well, we’ve figured out that now the technology has changed, the shell of the implant is so much more durable. It doesn’t break. We don’t get ruptures like we used to, but most importantly, the gel on the inside is very cohesive, like a gummy bear, so it doesn’t leak out [crosstalk 00:12:33].
Dr. Franco: And that’s where the nickname came from, gummy bear. And I think people get confused, right, because if you would actually cut these highly cohesive gels, the gel sticks together, where the nickname gummy bear came from.
Dr. Haydon: Absolutely.
Megan: And to break it down for people that aren’t familiar, a saline implant does not have a gel inside of it. Correct?
Dr. Franco: Saline does not have a gel inside of it, but I think a lot of people forget that both saline and silicone implants have a silicone shell. And so sometimes, and this is where, as Dr. Haydon was talking, it’s our job to educate people about this because sometimes people just don’t want any silicone in their body. And then, you know, it’s a little bit of a conundrum because there is still the shell which is made of that same silicone.
Dr. Haydon: Yeah. And I think one of the great things about people who come in that have saline implants is that we have the ability to deflate their implants in the office. Because, as I was mentioning before, if it’s 20 years later, a lot of times women don’t really know what native breasts they have left. And so with a tiny little stick, you can put a little bit of local anesthetic, make the skin numb, put a little needle in there and you can aspirate all the fluid out very safely. And then women get an idea of what their actual breast is like. Then they can decide maybe I want a little smaller implant. Maybe now I just want a lift. Sometimes we’ll combine doing a lift with fat grafting for those that really don’t need the volume that the implant would provide.
Dr. Franco: And I think this is super interesting because I think a lot of times when people think of revision or secondary, that it’s because somebody had a problem or something, but that’s not the case for the vast majority of secondary breast surgeries that we see. Some of this is just time and age. And it’s interesting because a lot of people, and this is where the benefit of coming to a board-certified plastic surgeon that has a lot of experience in this because a lot of times they don’t know. They know where they wanna get to, they don’t know the best road there. And this is where deflating the implant, some of these little tricks in your back pocket really help guide patients. Don’t you think that’s what separates, you know, going to an experienced surgeon or not?
Dr. Haydon: Yes. I think, you know, again, you can’t be sort of a one-trick pony. You’ve got to be able to do a lot of different things.
Dr. Franco: We tell that to Travis all the time in terms of anesthesia, it’s like, you know, just put them to sleep, wake them up. Same thing every day.
Travis: That’s right. That’s me. The one-trick pony.
Dr. Haydon: But another thing that I think, in particular, is in terms of technology and tools. We have the Vectra system, which allows patients to have a picture taken. And a simulation is then done where we can show them, with various implants, kind of what they would look like. We can show them what the lift would look like. A lot of times people get concerned about the scars, for example. And a lot of times when you’re doing revision surgery, you need more exposure. You’re oftentimes doing a lift, and they’re kind of not sure why they have to have additional scars on their breast. And so it’s important to be able to understand and communicate that to people. So not only the software that the Vectra shows, but also just before and after pictures to show them what the scars look like and how they do fade and, you know?
Megan: And just for like a terminology sake. So if you’ve had a breast augmentation and you come back to do something else, is that, by definition, a revision, or how does that fall under what category?
Dr. Franco: I mean, that’s why we use the term “secondary.” A lot of times it’s a secondary. And revision is kind of broad because we definitely have people who come in and say, “Hey, I love my breasts. My friend has gummy bears. They feel so much better than mine.” Because one of the knots with the old saline implants was that they were just really hard and firm. So there’s not technically anything wrong, you know, it’s just, there’s a lot of times nothing wrong with my iPhone. I just want the newer one.
Dr. Haydon: Well, and I think the other thing about the saline implants that people also don’t understand is that there is a higher capsular contracture rate with saline implants. And that expression “capsular contracture” means that the normal scar tissue that the body forms around the implant, because your body says, “This is a foreign body,” it’s not part of you, we’re gonna put a scar tissue around it. We call that a capsule. So whether you have a pacemaker, a permacath, no matter what you have, artificial knee, etc., your body is forming that scar tissue. And it’s only when it becomes abnormally thick or firm that you develop a contracture. That process takes place over months to years. And so women don’t often understand that this firmness that they have is not normal. But it is more seen in saline implants than it is certainly with the newer generation of the silicone gel gummy bear implants.
Dr. Franco: And I think people get confused because they think all capsule is bad, but that’s not true. I mean, you need some capsule to hold that implant in place, or you have the lateral displacement and it’s the exact opposite. You’re coming back to us and we’re trying to do some internal bra stuff, some different messed stuff. And then there’s even some cool things that I’ve learned from you in terms of doing some various messed stuff for either supporting an implant or to prevent capsular contracture. Correct?
Dr. Haydon: Yes. And I think that, you know, we used to, just like with antibiotics, you know, we sometimes would save the biggest guns for the worst cases. And now we’ve found that if we treat people aggressively with antibiotics with bad infections, we really have a lot better chance of getting them well more quickly. And I think that when we started looking at the breast cancer reconstruction world and we were using various things like AlloDerm, what we call dermal matrices, that has now been used on the cosmetic side. And so I’m much more likely to use a dermal matrix mesh-type insert if someone has had a capsular contracture on a new implant. So for example, we know if we put the implant behind the muscle, our contracture rate should go down. We know that if we have the newer silicone gel implants, our contracture rate should go down. And we know if we don’t use a very big size and a huge implant, again, our contracture rate should go down. If you’ve done all those things and you developed a contracture, you’ve kind of…you know, you’ve got bad luck.
And so I’m much more aggressive about saying, “Look, I really think that you’re better off doing this.” Because one thing that does not get discussed is it’s expensive to have a revision. And I think the take-home of this thing today should be, get it done right the first time because this is not just a short-term thing. This is a long-term thing. And you don’t want to go in because your girlfriend had 550cc implants and you’re this tiny little thing and now you’ve got these implants. You are not going to age well with those implants. And so it’s very important that you have the discussion with your surgeon, that you’re very realistic with your expectations, and then you feel like the surgeon is comfortable with what you want to do as well. If somebody comes in with pictures and says, “I want to look like this,” I’m like, “No, I don’t feel like I can give you what you want.” And that’s my out.
Dr. Franco: And this is one of the things that we’ve talked about social media before, is that I think sometimes people have these unrealistic expectations from these pictures. And while I think they’re great for exactly this conversation of what they perceive, because I’ve definitely had people bring pictures of, “I want something super subtle and natural.” And then it’s right off of a porn site. I’m like, “Damn, those are nice, but that ain’t subtle.” And so, I mean, how do you feel social media has changed kind of people’s perception of what a “normal” breast looks like?
Megan: Definitely. Yeah. And even to get into it, you know, to have photos that maybe aren’t completely representative of what that actually looks like. I mean, it’s so easy now to manipulate photos and stuff. It’s difficult to bring in a picture and say, “This is what I wanna look like,” and then have that applied to your own body and also just in the real world as well.
Dr. Franco: G-Berto’s brought a lot of pictures off his Tinder app before he was taken off the market. And we’ve had some discussion of different, you know, pros and cons of breast stuff. We should have had you bring some of those for Dr. Haydon today.
Gilberto: I wish I would have prepared better.
Dr. Franco: But I guess you had to…but you had to get rid of your apps now that you’re taken off the market. So I…
Gilberto: Clearly. Clearly.
Dr. Franco: …also would have had something to show you, you know? I think that’s kind of…because I don’t wanna lose the point that you brought in about where patients sometimes have this idea that you can just do an extremely large implant in place of a breast lift. And I feel like that’s another place where I do a lot of breast revisions, where somebody went somewhere, it was cheaper to just get a breast aug. They avoided the “scars,” again, in quotation marks, by just getting a huge implant. Do it for about a year and now they don’t have the breast look that they wanted. They got implants that are too big. They’re too heavy. They’ve led to some problems, and…
Megan: They have to do it all over again.
Dr. Franco: …now they’re paying to do it all over again.
Travis: And I think we’ve spoken about this a couple times on the podcast, too, about doing something right the first time, making sure that you’re with a board-certified plastic surgeon and finding somebody that is going to be open, honest, and candid with you as a patient about what you can expect. What are my options? What can we look at, you know, moving forward together? It’s like you said. It’s expensive to have a secondary revision or a secondary breast surgery instead of just having it done right the first time because maybe somebody led them astray with, “Oh, you don’t need a lift. You just need monster implants.” Not always the case.
Dr. Franco: What do you typically tell patients when they come in and they’re afraid of a lift? Because one of the things that…I like to show them before and after pictures. And maybe you guys do a little bit better job in Westlake than we do at our practice. But it’s hard to get people to come back just for post-op pictures outside of three to six months unless they’re coming back for a separate procedure. Most of the time at that point people feel pretty good, and we’re a little bit of a distant memory for them. Because I don’t think most people realize incision scars get better for a full year, especially on the breast and tummy tucks and those things.
Dr. Haydon: Yes. I think that what we try to do in terms of the educational process is when we take pictures, we particularly look at the lateral view. We indicate to people that the crease or the inframammary fold that’s underneath the breast is sort of what our landmark is with regard to where the nipple position should be. We explain that that’s the bottom shelf of where an implant would sit. And so when that implant goes in, if the nipple position is below that crease, then they’re going to have a lot of fullness at the top. The breast is gonna basically hang off of the implant. So you’ll hear people talk about snoopy deformity or the waterfall effect, which is where the breast kind of falls off the implant. And so when they understand that part, and again, particularly I think the Vectra 3D imaging is helpful because they can see themselves and not just a before and after of somebody else that looks like them. So I think that that’s one of the things that goes along with it.
But again, when someone comes in, perhaps they don’t really appreciate why you’re explaining to them that they now need an implant in addition to their lift. Because a lot of times people have just had this deflation of their breasts, and they really don’t have enough substance underneath there to shape the breast once you lift it. And so a lot of people, particularly in my practice, I mean, I take care of a lot of moms, basically. And so they wanna be conservative. They wanna look natural. Which again, like you said, the word “natural” to some people is really different. But they…
Dr. Franco: Blue Check Mark Megan may have a completely different natural appearance. I mean, it’s like, DDDs are not natural? I thought that’s like baseline. That’s like, DDD is the new B. It’s like…
Dr. Haydon: Being able to explain to somebody how you measure their base diameter of the breast, and that the implant basically has to fit that diameter, then they kind of get to understand. I tell people it’s like shoes. If you wear a size six, you can’t wear a four, and you can’t wear an eight. You can kind of cheat half sizes. But a lot of my patients don’t want the look of too big and too full. And once you explain to them, “Look, let’s just say I normally do 350 with a lift. I’m gonna put in 250 on you. I’m gonna do 30% less than I ordinarily would do.” And you show them that implant, and then they get it. Then they kind of understand, “Okay, well, I’m not gonna be that mom that walks into, you know, parent-teacher conference and everybody’s like, ‘Good, Lord, who did that?'”
Dr. Franco: And we’ve even had patients in my practice that wanted a little bit more over-the-top look. And sometimes you have to be upfront and like, “Hey, if that’s really your end goal, either one, that’s not something I’m ever comfortable doing,” or two, sometimes we have to break stuff into stages. And I’ve had people break it up where we’ll do either just an augmentation or just a lift and then come back and do the implant, again, for a safety thing. And while I would consider that a secondary surgery is not a revision because we have a plan and the plan is not to kill your nipple, not to cause a bad problem. And while it may be a pain in your butt, it’s saving a lot of pain in your life.
Can we talk a little bit about rippling because I feel like that’s another area where we tend to do a secondary surgery where people maybe got a saline implant 10 years ago. I think as they’ve aged, and you touched on a little bit, the skin changes, they maybe lose some of that nice glandular tissue they had that was covering the implant and then now how you treat that when somebody comes in and they’re super thin and fit because of Austin and…is there something they can do?
Dr. Haydon: Well, I think that that is one of the things inherent to saline implants in particular. It’s not that we never saw it with silicone gel, but one of the good things about the saline era was that we learned that we started putting things underneath the muscle. We learned that by doing that, there was less visibility. And we also learned there was less capsule formation and contractures. What we also found, however, is that there is no muscle out laterally. And particularly, you know, there’s this expression people have now called side boob. And in particular…
Dr. Franco: Is that a hashtag thing, Megan?
Megan: Yeah, that’s a trend, actually.
Dr. Franco: It’s a trend?
Megan: Mm-hmm.
Dr. Franco: It’s a good one or a bad one?
Megan: There are certain clothes that people wear specifically to show, like, side boob cleavage. They say side boob is like the new cleavage.
Dr. Franco: What?
Gilberto: Is this still a thing? Because I remember, like, a few years it was.
Megan: Yeah, it was big a few years ago.
Dr. Franco: Have you seen this on Tinder or no?
Gilberto: I mean…
Megan: A few years ago it was bigger. Yeah.
Gilberto: …I can neither confirm nor deny.
Dr. Franco: Or Craigslist. How about Craigslist?
Gilberto: Yeah, I don’t do the Craigslist thing.
Travis: Not anymore.
Gilberto: Not anymore.
Dr. Franco: Not anymore? Can we not talk about it?
Gilberto: I was so ready for that.
Dr. Franco: So tell us about the side boob. This is a thing now or I…
Megan: Yeah. I mean, [crosstalk 00:26:57].
Dr. Franco: Do you get a lot of requests for side boob?
Dr. Haydon: I think that yes. I think that people want…I think people want that look. And just like anything, I mean, what you choose to wear can either enhance it or cover it. I mean, I would tell you that probably just as much as side boob that underboob is probably one of those things, too…
Megan: That is now.
Dr. Haydon: …that there’s certain tops that people definitely want that sensual look.
Dr. Franco: But underboob is a slippery slope because there’s underboob and then there’s down boob. And there’s a really fine line between.
Dr. Haydon: Yeah, we’ll call it crease and lower pole. Yeah. But no, I think, again, back to your point about the saline is one of the nice things about the new silicone gel implants is that they don’t ripple. And in a very thin patient, for example, where there is a thin layer between where the skin is and where the capsule starts for the implant, I mean, that sometimes is millimeters. And so it is something that by putting in a new-generation silicone gel implant, you can really take away that rippling effect and give them a lot better look.
The other thing about it is that the saline has a tendency to collapse a little bit. And the newer implants maintain their volume and their shape better without the expense of being hard and firm. Because in order to prevent the saline from rippling, you would overfill it. Well, everybody knows what a water balloon feels like when you put more and more water in. It becomes tense. And that’s not what a natural breast feels like. Most women that we take care of, I mean, people don’t know they have implants just feeling them. I mean, I’ve been told by tons of my patients that their OB-GYN was like, “My God, I didn’t know that, you know, implants could be this soft.”
Dr. Franco: Can you confirm Dr. Haydon’s statement, are not his patients, Gilberto?
Gilberto: I mean, with my own personal experience you mean?
Dr. Haydon: Not as a PA, but just the bachelor part.
Gilberto: I confirm.
Travis: Ex. Ex-bachelor.
Dr. Franco: But wouldn’t you say, too, that with the new gummy bear cohesive, it gives you a little bit more room to play, like you were saying earlier, in terms of sizes, because with the saline, I feel like the threshold of going up and making somebody very coconut firm-looking was very low. With the gummy bears, you get a little bit more room to play with some of those sizes.
Dr. Haydon: Absolutely. And I think that the other thing is that you maintain that upper pole better with a prettier shape and not that big, round kind of fullness that looks very unnatural. Particularly, again, in somebody who’s 40, 50 that has breastfed, had children, etc., they’re gonna start to lose some of that volume. And just with the newer implants, putting them in there really kind of helps maintain and shape that pole. Because, you know, a lot of women, you know, you tell them, “Look, you don’t have to wear a bra if you don’t want to. You can wear, you know, certain dresses, tops, etc.” And they’re so excited about that. They’ve been tied to bras their whole life. And you just tell them, “Look, I don’t have to put a big implant in. I can put one that fits you, and I can show you what it’s gonna look like.” And then there’ll be like, “That’s the coolest thing.”
Gilberto: Do you find that there’s a specific time that women prefer to have this secondary breast revision done, like a time in their life or after a certain event or something?
Dr. Haydon: I think most of the time it’s once they figure out they’re not gonna have children anymore. You know, and I think that just plastic surgery is so much more talked about. And, you know, they’ve got a girlfriend, they get online, they look at Megan’s stuff [inaudible 00:30:24]. But I think that that’s typically the deal. So I would say, you know, kind of late 30s, early 40s is when…and you know, that’s a good question that people ask a lot of times, it’s like, “How do I know when the right time is?” Well, I think that once you have what I would call the surgical findings, meaning you come in for something and I think I can fix it, the younger you are, the better your skin is gonna be, the better quality you have, and therefore, the better outcome you’re probably gonna have. You know, obviously, hoping everything gets done right. And then you get to enjoy it more. I mean, we’re not talking about facelifts today, but when people come in and say, “Well, my mom had her facelift done when she was 70. So I’m gonna get at 70,” I was like, “Why would you wait till you’re 70? I mean, you have such better skin when you’re in your 50s, you know, and we can do that.”
But getting back to the breast part, women often times are…they’re worried about having implants at a young age and whether it will affect their ability to breastfeed, the shape and size of their breast, etc. I mean, if you’re in your 20s and you have breast implants, I feel like the implant really helps maintain and preserve the shape of the breast more so than letting your body go through the normal changes without an implant because it keeps the fullness, it keeps things kind of pushed out a little bit. And so I am very much of the mindset that if that’s what you want at a younger age, there’s really no reason to not do it for fear that, you know, [crosstalk 00:31:51].
Megan: And like you said, I mean, even to the point of, you know, with clothing, that can be a very emotional thing for women. I’m sure this entire journey can be pretty emotional, but to have that confidence feeling like you can wear whatever you want and feel good about yourself, like, that shouldn’t be something that you save till later in life if it’s something that you wanna do now.
Dr. Haydon: Yes.
Dr. Franco: And I think secondary surgery, people have done their research. And so they’re definitely emotionally involved. And Instagram, YouTube, all those things, RealSelf, other stuff, really, patients come in, I feel like a different perspective. I feel like when I first started practicing, people just came in and said, “Oh, I feel like my breasts are pointing down or something.” Now they’ll come in and say, “Oh, I want strattice. I want some mesh. I want this.” And then it’s our job to kind of, “Hey, yeah, you’re a good candidate for this,” or, “No you’re not.” And I would say probably, you know, at least a good 20% of patients that come in for breast revision, secondary something, I tell them, yeah, she looked really, really good and there’s not much I’m gonna do for you. And sometimes they just need to hear it from someone because there’s also a limit to what we can do.
Dr. Haydon: Yeah. Absolutely. No, I think that, you know, like you said, it’s when people come in and you have to listen to them and see what their goals are, what their objectives are, and what bothers them. And I think you’re exactly right. You know, surgery can’t cure everything. And patients will be very disappointed if you do a surgery and you know that they’re not gonna get the outcome they wanted and then that’s a difficult…that’s the difference between an explanation at the beginning before the surgery and what we would refer to as an excuse after the surgery.
Megan: And being transparent, I feel like, can kind of cancel a lot of that out.
Dr. Haydon: Totally.
Dr. Franco: What about from an anesthesia perspective? Do you guys do anything different for this type? And I know this is an all-encompassing term, but do you treat this differently than you would a breast aug?
Travis: Well, since you pointed out before, I am a one-trick pony. I didn’t forget that. Anyway. No. Actually, when patients come in for a secondary or revision, it’s nice because I can ask that patient how their experience was the first time. Did you have nausea afterwards? How was your pain? How did you tolerate it? How were the next couple of days after surgery? How was your recovery? Those things I start to clue in on things that they say, “Oh, I was nauseous. Oh, I had pain here. I had pain there.” Doing education at that point. If it was pressure or if it was really pain. Did they have, you know, huge implants in a very tiny patient when they had it first done? Those are all things that I listen out for. And then we always try to do like low narcotic techniques, new stuff that’s trying to reduce our amount of opioids that were used on these patients to reduce effects and nausea profile and everything. So it’s nice because it gives me a little bit of a baseline.
Dr. Franco: I think it’s interesting that the low narcotic stuff has really become a huge push for all of us. And then in terms of recovery, I know this is a broad question because depending on what they have done, but I feel like sometimes in my patients, the breast revision surgeries, the recovery, not in terms of discomfort because I actually feel that like in terms of pain, it’s less when they’ve already had an implant under the muscle and we switch them out. But sometimes if we do do some type of capsulorrhaphy or internal bra or put some mesh, I do tend to limit some of their activity a little longer to let that stuff sit. What do you typically do?
Dr. Haydon: Yeah, I think that’s a good point. I think that when you’re revising something, then it’s indicative that there was something that happened and stretched, etc. So you’ve got to give that a little more time to heal. And so yeah, I probably would be more on the three to four-week side instead of a two-week, you know, side in terms of when I would, you know, let somebody go back to activity.
I think, though, speaking to the anesthesia part of it, you know, I’m much more aggressive to recommend using Exparel during that surgery because Exparel is a long-acting local anesthetic. And you guys have talked about it on the podcast before, but, you know, for those who don’t really understand it. So the dentist uses something called Lidocaine, typically. Lidocaine is something that will last for a few hours. Exparel is a long-acting local anesthetic and it will last for, we’ll say three to five days. But I think the importance of Exparel is that you’ve got to put it precisely where it’s gonna help. You’ve got to do it as an intercostal block, you’ve got to do it sort of in the thoracic bundle, and then you’ve got to do it sort of along that serratus edge, and then where your incisions are going to be. If you just squirt it in the pocket or haphazardly, you know, put it into the subcutaneous tissue, it’s not effective. But if you precisely inject it, then those patients really get a lot of relief and have to take a lot less narcotics. Because, to your point, when patients have a bad experience with nausea, they’re scared to death about taking medication. And if you can reduce the amount of narcotic, not only might they not have nausea, but they’re not gonna have constipation, and they’re not gonna have those issues that every narcotic has. It’s just some patients are just more sensitive to it.
Megan: And are there certain things that patients should be kind of worried about or nervous about as far as safety goes when having a revision?
Dr. Haydon: You know, biggest risk of having any surgery is bleeding and infection. Those risks are, you know, 2% to 5%. So those are very low. I think that as long as patients, you know, follow the directions, they don’t try to do too much. Again, typically my patient is the mom who, you know, I have to say, “Look, you can’t be supermom. You’re not gonna be able to drive carpool for probably 7 to 10 days. You’ve got to have somebody to go to the grocery store for you, you know, for probably that first week or so.” But, you know, as long as they don’t try to rearrange all the closets while they’re, you know, during their downtime, or as long as they’re not, you know, trying to rearrange the pantry, etc., then I think most patients have, you know, a good outcome. But I do feel like you’ve got to really, you know, make sure that you protect, like you were saying, Johnny, you’ve got to protect your repair because there’s a reason you’re repairing it.
Dr. Franco: Is there any kind of top three take-home points you’d like to send to people before we do a little one of my favorite sections called fact or fiction, which we’re going to…your office staff was kind enough to send us a few questions for you?
Dr. Haydon: Thanks. My take-home is you obviously go see a board-certified plastic surgeon. I think you have realistic expectations. When I have conversations with people about implants, I’m almost scientific to a fault when I’m explaining diameters and why I choose certain implants because I really want that patient to understand why I’ve chosen that size for them and why I feel like this is not only a short-term but a long-term commitment. And I wanna set them up for a great result. And I want to have a low revision rate so that, again, they’re not, you know, coming in every 5 to 10 years to fix something.
Dr. Franco: I think those are great points because breast revision especially, you need somebody that’s gonna take you through that journey, you know? And sometimes it’s a process.
Dr. Haydon: Oh, it can be.
Dr. Franco: It can be a real journey.
Dr. Haydon: It’s so much easier to do it right the first time. And like you were pointing out, I mean, the revisions that I do, not usually your patients, Johnny. And they’re fortunately not my patients. They’re other people’s patients. But it’s not necessarily because something was done wrong. It’s just because that patient has aged, their body has changed. And, you know, we wanna do as many things on the front end to reduce that.
Dr. Franco: I love it. I hope today has been helpful because I feel like there’s a lot of people out there that maybe don’t know where to go or when to go. And so I think we hit on some good stuff.
Gilberto: I feel like I learned a lot.
Travis: Yeah, [crosstalk 00:39:28].
Dr. Franco: Well, that’s what I’m talking about. You sounded very pensive today.
Gilberto: I know.
Dr. Franco: You did.
Gilberto: [crosstalk 00:39:31].
Dr. Franco: But let’s do a little fact or fiction. And if you guys have any questions for Dr. Haydon, please jump in. But we’ll jump into a few fact or fiction. You only listen to Texas country in your OR room for 14 hours a day, 3 days a week.
Dr. Haydon: That is fact. I’m a big Texas country guy. And so I really enjoy Parker McCollum, Cody Johnson, Cody Jinks, those guys.
Dr. Franco: Because Travis has told me when you have these marathon surgery days, because obviously, you’re a very popular surgeon here in town, that there’s only so many Texas country artists. And so you may recycle a few over the 14 hours.
Dr. Haydon: I know all the words, I can tell you that.
Travis: I can attest. I can attest to this, on a couple marathon days.
Dr. Haydon: So we’ll switch it up and Sometimes there will be non-Texas country, but it’s still country.
Megan: Still country.
Dr. Haydon: Still country.
Dr. Franco: And then fact or fiction that you’ve had one pair of boots that are your, like, lucky surgery boots.
Dr. Haydon: That is true. When I was a surgery…let’s see, no, I was in college, and then when I was a surgery resident, they’d gotten so worn out that one of my surgery staff told my wife that he thought my boots were HIV-positive. So she immediately went to the Red Wing store and bought me a brand new pair. So that would have been like 1995, and I still wear that pair every day when I operate.
Dr. Franco: I feel like once you get your system, it’s hard. Fact or fiction. This is general. Surgeons don’t like change. When we have a system, it just like…
Travis: I can 100% attest to that. [crosstalk 00:41:00]
Dr. Haydon: I am the most easy-going person at the surgery center, but I do not like change. I mean, they’re like, “Can we use this or that one?” I’m like, “Yeah, sure.” And they’re like, “Well, what if we do that?” I’m like, “No, come on. You know, we don’t do that.”
Dr. Franco: I feel like that’s a fact or fiction for Travis…
Travis: Oh, for sure.
Dr. Franco: …that Dr. Haydon is the most easy-going.
Travis: Oh, he is. He is very easy-going.
Dr. Franco: I get reminded that by the nurses and techs all the time, how much Dr. Haydon is more…
Travis: Dr. Franco, you know how laid-back Dr. [inaudible 00:41:26].
Dr. Franco: I feel like I’m told that on a daily basis.
Travis: Maybe.
Dr. Franco: Dr. Haydon, I appreciate you answering a few questions for us. Can we put you on the fire one more time? We do something called Behind the Bovie. And so I don’t think I gave you a heads-up on this, but if there’s something you could tell people that happens in the operating room or in a surgery consult or anything in kind of a behind-the-scenes look that people probably don’t know that we do to either help prepare them or to make the surgery a success.
Dr. Haydon: I think the markings are probably things that people don’t understand. And so I really try to be specific with patients as to, for example, how high I’m gonna lift the breast. When we do a breast lift, sometimes people think it’s just the nipple we’re lifting, but really you’re lifting the entire breast. And so I’ll put the marks on and then I’ll explain to them during the consult what I’m gonna do. And then the day of the surgery, I’ll let them know, “Look I’m gonna do all these markings with you.” And I draw on my monitor during the consult where the markings will be. But I tell them, “The day of the surgery, I’m gonna do these markings with you on you, and you’ll have every opportunity to ask questions.” So I think that’s helpful.
Dr. Franco: That’s kind of cool. Maybe one of these days on the IG we’ll actually do some live markings stuff. Because I don’t think people realize how much of a, we almost say plastic surgery is an art. But wouldn’t you agree that there’s a lot of like math and science and very specific? I mean, I actually will take my ruler and level on there sometimes because I just…I think if you’re not off in the very beginning, the old saying of measure twice, cut once couldn’t be any more true for breast surgery.
Dr. Haydon: I agree. I agree. It is a little disconcerting sometimes when you do bring the level out and just to try to get patients to understand like their inframammary folds and their creases are really like 2 centimeters off. And that’s what you’re trying to do is you’re trying to make it perfect.
Dr. Franco: And there’s only so many things we can control. And then, can we do a little quote of the day? And I think there’s a quote off going between G-Berto and Travis. There was something there that…G-Berto didn’t love the fact that Travis took his quote last time. And so I heard a rumor that you may take this section away from Travis today.
Gilberto: I’ve got some quotes.
Dr. Franco: Oh, just happened to have some.
Gilberto: I happen to have some.
Travis: That’s good. That’s right. I’m just stroking the one-trick pony.
Gilberto: Can we do that?
Dr. Franco: Yeah.
Megan: [crosstalk 00:43:40].
Dr. Franco: Give us a quote here and then maybe we could see how this applies to Dr. Haydon and his life and practice.
Gilberto: I think this one would apply really well since…
Dr. Franco: It seems like you have a plethora of them there.
Megan: He came prepared.
Gilbert: Yeah. No, just given the fact that you guys, you know, go through so much training and everything, I like this one by Steve Jobs. It says “If you really look closely, most overnight successes took a long time.”
Dr. Franco: Boom. I really like that. I mean, go ahead and get first crack at it.
Dr. Haydon: Well, I was gonna say there’s a…Jim Collins wrote a book called “Good to Great.” And he talks about companies that transition from competing at a market level to being, you know, 3 to 15 times market level, and there’s not one event, technology or otherwise, that put them there. And I think, like you said, with us, we have so much training and we learn the techniques and we have those tools so that when a particular patient comes in with a particular finding, we now know how to address that. But we may not have ever done that particular case, but we have the background and the knowledge to safely do it.
Dr. Franco: I absolutely love it because I think people think that, oh, even though someone’s so young or there’s something that’s happening, like, they don’t realize how much goes in the background. And you can talk about this all the way back to shadowing, residency, med school, all sorts of training. I think you were at UT Southwestern, which is probably considered one of the, maybe to say in a nice way, one of the most difficult residences in the United States. Is that fair?
Dr. Haydon: I think that’s fair.
Dr. Franco: But I don’t think people realize how much stuff goes into things before, like, it actually comes in. I’m sure the blue checkmark didn’t come easy. You’ve been working on this for a long time.
Megan: I mean, I think that just applies to success in all ways. I mean, people oftentimes see that you have success, but maybe they don’t take the time to think about what it took to actually get there, and all the steps you had to make.
Travis: I think also we live in this social media Instagramable, you know, world right now where everybody is only taking pictures of things they accomplish…
Megan: Exactly.
Travis: …or things that go well or things that go great, but they’re not taking pictures of the sleepless nights, the studying, the missing parties, the missing birthdays, all that.
Dr. Franco: They’re going to bed at 9:00 to be there at 5 a.m. for Dr. Haydon’s cases?
Travis: Exactly.
Dr. Franco: Okay.
Megan: And even kind of bringing that back to like an instant gratification idea, which again also kind of applies to social media, I think with surgery, too, people maybe see these looks that they want to have and they don’t think about maybe you have to have a revision, you have to go through a journey to get there. And it is a process. But once you heal up, you’ll probably look great and be happy with it.
Dr. Franco: I’m gonna go on a limb and say this may be the best quote we’ve had. I’m not trying to throw the gauntlet down for one Travis and say you may need to bring the thunder on…
Megan: It applies to [crosstalk 00:46:18] many things.
Dr. Franco: …the next cast, but…
Gilberto: I mean, I’ve got some others.
Dr. Franco: …yeah, that’s a good one.
Megan: [crosstalk 00:46:23].
Gilberto: I’ve got others.
Travis: You’re demoted.
Gilberto: I like this section of the show. So I don’t know, maybe I…
Dr. Franco: Well, I think we’re just about out of time, but I definitely want to spend a special thank you to Dr. Scott Haydon for joining us, taking time out of his life to come join us. And I know they can follow you on your Instagram @drhaydon. And you film a lot of surgeries. You also do some stuff for your med spa, covering over some other things as well on your Instagram.
Dr. Haydon: Absolutely.
Dr. Franco: And then what’s your website if people want to check stuff out?
Dr. Haydon: It’s just drhaydon.com. It’s H-A-Y-D-O-N.
Dr. Franco: Well, we’re obviously going to be covering some more topics in the near future. But I want to thank all of you guys for listening. Stay tuned. We’re gonna do some more med spa stuff. We have some injectable things coming up in some future episodes. I also wanted to ask all of you, if you like our cast, tell people about it. You can download it on iTunes. You can download it anywhere where you get your favorite podcasts. So please subscribe, please pass it on to somebody, we would greatly appreciate it. And thank you again to producer Donald, i.e. tall gamer for keeping us moving and helping us. So thank you, guys. Appreciate it.
Gilberto: Thank you.
Dr. Haydon: Thank you.

About The Author

Dr. Johnny Franco
Episode 8: Dermal Fillers (Re-Volumization and Finishing Touches)Episode 10: Jawline is the New Lips


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