Gummy Bear Implants What are they really?

Dr, Franco: Hi team. Welcome back to “Plastic Surgery Untold.” I’m Dr. Johnny Franco also known as Austin Plastic Surgeon. And so we have our celebrity cast with us today we got one “Celebrity Anesthesia.”

Travis: Hey guys, what’s up?

Dr, Franco: We got the Austin’s most beautiful man, G-Berto.

Gilberto: Buenas tardes.

Dr, Franco: And then we have the privilege of having Sarah, who’s a lifestyle blogger and influencer. You can follow her at “Delivering Motherhood.” She is not only a lifestyle blogger, influencer, but you’re also an OB nurse as well.

Sarah: That’s right. Hey guys, happy to be here.

Dr, Franco: Which I think is super exciting. And one of the reasons we had her on is that this is…kind of she sees this from two angles from one being a nurse, and the other part is just from her lifestyle, blogging that she does on, I guess sort as your second, third, fourth job because you’re a mother as well?

Sarah: Right, yeah. I can’t stay busy enough basically.

Dr, Franco: Tell us a little bit about you because we actually kind of met online doing a lot of, as you and I both being influencers we’re trying to get “Celebrity,” and G-Berto, to become influencers like ourselves. But in our celebrity you know, influencers club we met once and have become friends since then. And so tell us a little bit about you and what your blog talks about.

Sarah: So I am a born and raised Austinite so I’m a mom of three beautiful…

Dr, Franco: Oh, you’re like one of the five left.

Sarah: Exactly, one of the very rare so I like to slip that in there. I was actually born here and haven’t left which is obvious why. And then I have three girls, I’m a twin mom, so I’ve got twins that are five, I have a two-year-old. And then like you mentioned, I’m an OB nurse so I get to help deliver babies for a living. And then we’re almost a week out so I just had a breast augmentation surgery which is kind of what we’re covering today so yeah, kind of the hot topic of the day.

Dr, Franco: So you got the trifecta there because you see people starting their lives, you also influence people because you basically share a lot of your life with people. Because as we were talking about earlier, I follow you online, I watched some really cool stuff that you guys do. You do a pretty uncensored version of stuff. One of the things that I thought was absolutely hilarious…and for people that don’t know, “Celebrity’s” wife is actually a fashion blogger if you will so you guys have a lot of competition in common. And as most people probably don’t know you guys are actually a little bit of rivals. And one of the things that I thought was so funny is that your husband and “Celebrity” were exactly the same. Because, when you came by the office, he was taking 1,000 pictures, you only scolded him three times saying, “That’s not a good angle,” which I thought was hilarious. And then we were taking a picture and you’re like, “That’s not my good side.” And we had to switch sides to make you happy. But that’s cool. And I was like, “Oh, I wanted to put like “Celebrity” on FaceTime just so he could see that he’s not alone in the world.

Travis: I’m not the only one suffering.

Dr, Franco: Maybe you guys should start like a celebrity husband like, support group.

Travis: I’m open to that.

Sarah: I already mentioned this to Dusty and he’s convinced that he is the best husband photographer but I [crosstalk 00:03:24.278].

Dr, Franco: Oh damn. “Celebrity Husband” what do you think…

Sarah: I’m sure he [crosstalk 00:03:28.039].

Dr, Franco: …about that?

Travis: Shots fired.

Dr, Franco: We’re gonna have to have him on the…

Travis: We might have to have a celebrity husband off.

Dr, Franco: That would be kind of…

Sarah That would be fun.

Dr, Franco: Sarah, can we arrange this? Can we figure something out and we’ll do a little Instagram competition between celebrity husbands? Can we…?

Sarah: We need to maybe like an Instagram Live. I mean, Travis as long as you take at least 27 photos every time. We need, you know, we need a lot to work with. That’s how [inaudible 00:03:59.233]

Travis: At minimum

Dr, Franco: I don’t wanna give away the challenge…

Travis: You can to go through three or…

Dr, Franco: I don’t wanna give away the challenges yet because this needs to be a surprise. What we do is between you, me, and G-Berto we need to come up with three challenges that are unknown to the celebrity husbands, and then we’ll pick a weekend day and we’re gonna have like a little celebrity husband challenge off.

Travis: It’ll be like a little celebrity husband decathlon.

Dr, Franco: Oh, I like this.

Sarah: [crosstalk 00:04:23.688].

Dr, Franco: …some exciting things to come. Well, let’s catch up a little bit what everybody’s been doing since last week’s podcast. Sarah got some new titties. Gilberto, anything you got going on some new calves anything?

Gilberto: No new calves just been going to the park a lot just trying to get outside a little bit. It’s starting to get a little warmer so you know, trying to enjoy the outdoors but not melt in this incredible heat that we’ve been experiencing.

Dr, Franco: You’ve been working on your tan or anything?

Gilberto: No, I’m in dermatology, John. I have to wear my sunscreen every day. So, no, I’m not working on my tan.

Dr, Franco: Okay. “Celebrity Husband” anything besides doing some anesthesia, keeping people comfortable?

Travis: Keeping people comfortable. Outside of the OR, we’ve been working a lot as you know and everybody in the plastics world has…

Dr, Franco: Just to put that into perspective, you just came back from a vacation last week.

Travis: Okay, I knew that was coming. Yes, I did.

Dr, Franco: I guess…

Travis: But before I was out of town, we were working quite a bit. We have a backlog of cases at the surgery center and we’re pumping them out, we’re trying to get everything done as much as we can.

Dr, Franco: So all of you that haven’t been able to get on the schedule yet, please direct all your messages to your trendy therapist celebrity anesthesia’s personal admin.

Travis: Yeah. Outside of the OR, I’m still training for the half marathon so I’ve been doing that. Mary is finally, @yourtrendytherapist, that’s my wife, shameless wife plug number 9,076. She is actually hopping on the bike now so she is riding around with me for the runs, so that’s been fun.

Gilberto: [crosstalk 00:06:08.826].

Dr, Franco: Can we organize like a big group outing to do, because you know at Coda [SP] you can take your bike out and ride around Coda.

Travis: Let’s do it.

Dr, Franco: So maybe when Sarah is healed, can we get a big group out and do like…maybe we could do a little fundraiser or something and do a bike-a-thon around Coda?

Travis: I like it let’s do it.

Gilberto: We can do it on Tuesday nights.

Dr, Franco: Tuesday nights. Oh gee. Are you allowed to come out on Tuesdays?

Gilberto: I used to ride my bike out there when I was training for a triathlon.

Travis: Very cool.

Dr, Franco: Well let’s jump into… This episode is gonna be talking about Gummy Bear Implants because I think one of the hardest part of breast augmentation is deciding what implants, what kind of implants, and what size. And so, you know, we could talk about all that focusing on the actual implants themselves. You know, the anesthesia part is easy because of people like “Celebrity Anesthesia,” and we’ll circle back to that and he’ll remind us some of the stuff he’s talked about on episode number six of anesthesia and the ERAS protocol and some of those things that we’ve accomplished in terms of making recovery a little bit easier. But one of the most common questions we get is what breast implant should I get? And then to follow that up is what is a gummy bear implant? And Sarah talk to me a little bit your thoughts of trying to decide what implants and questions you had in your mind and maybe we’ll kind of go through that process a little bit to walk people through how you kind of came to a decision?

Sarah: Yeah, absolutely. Being a nurse, I feel like I automatically was thinking, well, what’s the safest for my body? You know, health-conscious. I have heard in the past, maybe saline is safer, you might think that just because it’s, you know, basically like saltwater. But then I knew just from watching a lot of what you’ve already put out there that the gummy bear implant being a highly cohesive gel, you can get a more natural look than the saline but having a safer implant, and you’ll be able to explain this better than I can, but to where even if something were to happen to the implant, somehow it broke or ruptured, it still stays in one spot so you don’t have to worry about it kind of leaking out all through your body. So yeah, just kind of watching what you had put out there and asking, you know, questions with you at our pre-op consult, I was able to realize that was the best way to go.

Dr, Franco: And that’s honestly one of the things that’s been a little harder for us is we used to have every implant under the sun out on just display for everybody to touch, feel. We had them in our waiting room, we had them in our exam room, we’ve had them, you know, in our coordinator’s office. And we’ve started to limit it a little bit just because, you know, obviously for patient safety, we wanna make sure that things aren’t being touched by a million people. But no question, when you can feel the difference between a saline and gummy bear you can really tell the difference. And to your point, gummy bear is not a true brand, it’s not a true thing. It’s a nickname that the implants came to, because when you cut the implant in half, it looks like a gummy bear candy and that’s where the nickname came from. And so it’s kind of interesting, but to your point, you know, the fear was in the past was if the plan was to rupture, like a saline implant, it would just deflate, you got a flat tire on one side. It’s saltwater, your body absorbs it, you know, kind of the end of it. With the gel, the silicone, you know, is still there. I think one thing that a lot of people forget in terms of safety is even saline implants the shell of the implant itself is a silicone shell, so it’s not like you’re not having anything inside at all. And I’m gonna try and show you guys here. So for those of you that don’t follow us on YouTube as well, if you wanna see what I’m talking about, you can jump on here. But I’ve got a saline implant here. And so, you know, one of the thing that’s kind of cool is the saline implants always tend to have a little bit more firmness. And if you could hear me drop that, I mean, that fell like a rock where you know the little feather of this gel implant is much softer. Because with the gummy bear implants I like to say you can get fullness without firmness, and I think that’s a super cool entity. Because especially for our moms most of the time, you can correct me if I’m speaking out of turn here Sarah, but a lot of moms want to restore the fullness that they had. They’re not necessarily looking to porn star it up but they also don’t wanna feel so deflated. They just wanna get back to where they were. Or a lot of moms actually like some of the fullness that they had when they were pregnant, engorged during breastfeeding and some of those things.

Sarah: Yes, absolutely. After breastfeeding all three of the girls I knew I needed some help. And I’ve seen you hold up the gummy bear implant like kind of sideways and…

Dr, Franco: Not the one I dropped.

Sarah: Is that the one you dropped? No that one.

Dr, Franco: I dropped the saline that’s why you heard the thud.

Sarah: So when you hold it sideways it just looks a lot more natural. Yeah, just like that. So yeah, it’s the way to go. It doesn’t feel like you have a water balloon, you know, up in your boobs, so I love it.

Dr, Franco: And even from the head of the bed I think “Celebrity” you’ve made comments a lot, the difference between the saline sizer or the gummy bears, just some of that nice natural slope. Because the gummy bears are so much more compressible when we put them under the muscle you don’t see as much of that overly round coconut type look. And being at the head, you know, a captain of our ship here you see that all the time?

Travis: Absolutely. And for those of you guys that…and the three people that exists in America that don’t watch your stories every day, we’re in the OR, and we set patients up and we insert a saline sizer and we actually fill it up with air just because it saves time during the case. But we will fill it up with air and it basically takes the same shape as that saline sizer and it actually looks much more augmented, much more fake, much more less round and smooth. But when we actually put in the real silicone implant, it looks much less dramatic, it’s got a much more natural and smooth shape.

Dr, Franco: And I think Sarah brought up…you know, basically, there’s different types of silicone implants. And so there’s the highly cohesive, which is what we’d call the fifth generation of implants and most of the implant companies are actually moving to that. So I think in the next four or five years you won’t even have an option of doing a silicone implant that’s not a type or gummy bear type implant. And it’s pretty interesting because when stuff… And one of the things that kind of makes it better and better for patients is each company tries to one-up each other right? Because everybody wants something a little bit better. So now there’s even different degrees of gummy bear implants, right? So there’s like the highly cohesive and then there’s like highly cohesive plus. And so you know…then Allergan thought that wasn’t enough to have two choices so they have three levels of cohesive gel. And so it’s kind of interesting how things evolve and in the end, keeps giving patients more and more options which I think is a plus when there’s competitiveness to get better, much like G-Berto and “Celebrity Husband” have a competition of who does the best quote of the day. And our quotes have gotten progressively better I would think.

Travis: It’s the innovation and competition.

Dr, Franco: Some of the other benefits, you know, and not so true sometimes for some of our younger moms or 20-year-olds, but definitely some of our older patients. One of the other reasons that we switch out a lot of saline implants to the gummy bear implants is something we call rippling. And I don’t know if you saw this on your research, Sarah and those who are watching on YouTube, you can see this, those that are listening I’ll try and explain it. But you can see here, I’m holding up a saline implant, you can see the edges and the rippling is basically where the water balloon basically turns the corner you could just see the edges of that. And in the old days, one of the things that people used to do to decrease that rippling in the saline implant was overfill it. So if you had a 420cc implant, they may put 440, 450cc’s in there. The trade-off obviously is just like any water balloon that you overly fill, the more you fill it, the harder it becomes. And that’s what gave some of the people that overfilled round, fake hard look that I think scares a lot of people from getting their breast augmentation is because they just don’t wanna be overly fake. They still wanna be able to do the PTA meetings, they still wanna do the…I think somebody told me she was the head of the… What’s it called when you pick everybody up all the kids from school? You can tell I don’t have kids.

Sarah: Like the buses? I don’t know.

Dr, Franco: No, but…

Travis: Carpool.

Dr, Franco: The moms drive the bus now?

Sarah: Oh, carpool.

Dr, Franco: The carpool.

Sarah: There we go.

Dr, Franco: Sarah, I can tell you got your pulse on the carpool.

Sarah: Yeah, I have to get on the carpool. I’m not.

Dr, Franco: She said she was the head of the carpool so she said she couldn’t look overly fake picking up all the kids, so I thought that was priceless.

Sarah: Yeah, I actually had somebody drunk message me when I started talking that I was doing this and they asked specifically about the type of implant and their main concern was the rippling. So that must be something that’s more well known with the saline and why we’re obviously getting away from that.

Dr, Franco: And “Celebrity” and you do a lot of…because the majority of the cases that you do are for plastic surgeons. And so you’ve probably seen a lot of that over the last couple of years of switching from saline to silicone implants.

Travis: I would say it’s less than 5% of the breast augs that we do are putting in saline implants at this point.

Dr, Franco: But you see a lot of people taking salines out and replacing them?

Travis: Oh, yeah. A lot of breast exchanges or implant exchanges are going from saline because they either have rippling or they don’t like that look of being extremely round and not soft, and then they transition to a much softer better gel implant.

Dr, Franco: G-Berto, thoughts you have about the new gummy bear implants as we used to operate a lot together?

Gilberto: Yeah. No, I think the science is really interesting behind it. You know, clearly it’s the wave of the future and it does, you know, give a more natural outcome to the appearance of the breast. On a personal note, you did the surgery on my girlfriend a few years back and she had the same gummy bear implants placed at the time. So, you know, I’ve seen what they look like both from the assisting surgical side and from, you know, the other side of the equation so I think you know they’re really impressive.

Dr, Franco: There are so many things I wanna say right now but “Celebrity” keeps shaking his head no at me so I’m gonna pass because “Celebrity” has given me the devil stare of don’t do it, don’t do it right now. You do have an ally even though you guys are “rivals.”

Travis: “Rivals”. We’re rivals. Okay.

Dr, Franco: But I think the other thing that’s kind of cool about the gummy bears…and this is definitely a misnomer and I actually saw this on TV probably about a month or two ago where there’s just a misunderstanding, because for some reason people think gummy bear breast implants have to come in shaped implants and that they don’t have them in round. And that is just not true, you know. And I think, Gilberto you’ve seen them, Travis, you see them all the time. Sarah, you’ve seen them in our office and felt them. And so I think that misnomer came because the very first gummy bear implants were a shaped implant and that was what first came out when I was actually in residency back in like 2005 right before silicone came onto the market as a whole. Because as most people know, with any kind of FDA approved device, they’re in trials for a long time before they actually come onto the market. And so the very first gummy bear implant was a textured shaped implant but it’s not true anymore that that’s the only gummy bear implant on the market anymore. And just something I think it’s important because some of the bad press came from textured implants. And sometimes when we hear gummy bear people think that the implants have to be textured. Do you guys mind if we touch a little bit on that since it made so much news and so forth? And I don’t know if you guys ever saw that. I know you guys are busy, “Celebrity” traveling the world, and G-Berto, you know, ridding the world of skin cancers and making some luscious lips and I don’t know if you have time for TV.

Gilberto: No, I remember hearing about this. Yeah, let’s talk about it.

Dr, Franco: Because one of the things that was on the news, one of the companies did recall their textured implants. And shaped implants are typically textured because that’s what keeps them from shifting and moving, you know. I think most people don’t realize that textured shape actually make up about less than 5% of the implants in the United States as a whole anyway. The smooth round implants is the number one implant in the United States for probably the last 10, 15 years probably farther back than that, but I’m not that old. But over my career, it’s always been the number one implant used, and so it’s a very small percentage of implants. And the idea is that, that there was some Velcro action and then that friction was causing something called ALCL, a low-grade lymphoma and so that’s why they got pulled off the market. But the majority of the implants are smooth implants and that’s what we continue to use. And so that’s the idea and hopefully, that makes sense.

Gilberto: Yeah, absolutely. Wanna make sure that patients are safe and well educated.

Dr, Franco: [inaudible 00:20:06.813].

Sarah: I have a girlfriend that did the…must have been one of the very first gummy bears because it was shaped, it probably was textured, I’m not certain, but it sounds like it was. And it ended up flipping and she switched to the same kind that I have now. She got them taken out, replaced, went to the smooth round. It sounds like it was one of the very…it was about 10 years ago so it must have been one of the very first ones.

Dr, Franco: And that’s one of the reasons the… And I think the shaped, you know, have a much bigger role in breast reconstruction and those type of things. I think in the aesthetic breast aug, you know, they tend to have been a little less common for a couple of reasons. One, if they shifted, moved then people need to be revised and that can be, you know, more out of pocket cost which can be hard for patients. Two, there was actually a great study that was done and they looked at 100 patients, half of which had had the teardrop-shaped implants, and half that had had the smooth round new gummy bear cohesive gel. Okay. And what…this was all judged by plastic surgeons. What percentage of the time do you think the plastic surgeons could choose which implant they had?

Travis: I’m gonna say [inaudible 00:21:18.949].

Dr, Franco: And this was…

Sarah: A lot.

Dr, Franco: …plastic surgeons evaluating these pictures.

Gilberto: Fifty?

Sarah: Like 80%.

Dr, Franco: Fifty percent of the time.

Sarah: Okay, I was thinking probably pretty easily.

Dr, Franco: No, they couldn’t tell. So 50%. So 50% means that you were basically…you were guessing…

Sarah: You’re guessing, yeah one or the other.

Dr, Franco: …at that point. And some of that comes to the point that “Celebrity” brought up earlier with the new gels, you know, especially if they’re under the muscle and they get compressed, they already have that teardrop. And you can…for those of you following us on YouTube, you can already see, you know, how that gives a compressed look and that already has a teardrop and standing up is in that natural position that most women are gonna be in, you know, for the majority of the day when people are seeing them and to that type of look. And then the nice thing is… Because one of the things that we talked about in the office was finding this realm where you can dress them up dress them down. And I feel like with the new gummy bear implants that range is a little bit bigger because, again, you can get some fullness without firmness. And I thought about that this morning as I was exercising and that’s gonna be my new term for the week, fullness without firmness.

Sarah: That describes it perfectly. Yeah, absolutely. I wanted, you know, if I wanna be able…

Dr, Franco: If you notice “Celebrity” nor G-Berto are willing to give me a compliment on that great line, but they’re stingy so that’s cool.

Gilberto: So many things I wanna say right now.

Travis: Same.

Dr, Franco: Fullness without firmness.

Travis: Trying to keep this PG.

Sarah: [crosstalk 00:22:45.284].

Dr, Franco: Sarah, as we continue our dual podcast here, go ahead, and please continue.

Sarah: I don’t know. Now, I got off track. What were we…

Dr, Franco: You were talking about fullness without firmness?

Sarah: Yes. Oh, yeah while we were talking about sizing in the office and just like what you said, dress them up or dress them down. I can feel sexy in a swimsuit or I can feel professional at work, you know, without having to change anything literally, [crosstalk 00:23:12.192]

Dr, Franco: Which is important if you’re driving the carpool.

Sarah: Exactly, yeah. Or you’re a nurse. You don’t have to… Oh, that could go the wrong…

Dr, Franco: I think plastic surgery nurses may be outside of that because…

Sarah: That’s what I was about to say.

Dr, Franco: …I think that’s a little bit of a different category.

Sarah: You’re right. Yep, that could go the wrong way too. All right.

Travis: No, I do totally agree with you, Franco, on that. I mean, it is a much softer, much more full look without giving you that overly projecting, super round in your face “Baywatch” Pamela Anderson 1990s kind of look. And that really…it does allow you to dress them up and dress them down like you said because you’re not stuck in that high tight position 24/7.

Sarah: Right.

Dr, Franco: The other kind of cool thing about the gummy bear implants now is that they come in all sorts of different sizes and profiles. So, you know, there’s a couple of different ways that we get to what’s the right implant for each person, you know, and Sarah can jump in here anytime she wants. But we actually do a sizing system in the office. And I think which pictures are great because it gives me an idea of what…you know, terms like natural, full, subtle, mean a lot of things to a lot of people. And G-Berto could be all over the map with what natural is to him. But for the rest of us, you know, it’s usually in more of a moderate range. But you wouldn’t be surprised at what people bring in as natural. And so make sure that we have the same reference point because there’s times people will bring in a picture and they’ll have a size that they’re sizing on that they like. They bring the picture I’m like, “Hey, those are both nice, but they ain’t the same.”

Sarah: Yes. I will say that that was recommended to me to bring some pictures of something that I like, something that I don’t like, and I think that was maybe the number one most helpful thing other than actually trying them on. Because your input, I was really appreciative and that helped me decide. We were picking between three different sizes, you knew what I wanted to look like in the end. And of course, we’re talking about, you know, a different amount of volume or ccs and everybody is starting with a different amount, right, in their tissue. So if I bring in a picture of this is kind of what I wanna look like in the end then you were really able to tell me, and as we were trying on the different sizes, this is probably where you wanna be.

Dr, Franco: And I love trying on the implants themselves because, you know, a 300cc implant on you, on G-Berto, on “Celebrity Husband,” you know, it’s gonna be different on everybody. And so gives you a real feel for what it’s gonna look like.

Sarah: Yeah, and that’s the fun part.

Dr, Franco: It is the fun part. I tell people, it’s like taking a test drive, you know, just take them for a stroll.

Travis: Well I think…

Sarah: My husband kept telling everybody we went “Boob shopping this week.” I’m like, “Yes, we did.”

Travis: That’s great. I think…

Dr, Franco: He’s moving into husband number one. Is there a way…just like G-Berto lost the name Austin’s most beautiful man, is there a way that Travis could lose “Celebrity Husband” and…

Travis: Not a chance.

Dr, Franco: ….and Dusty could take that? I mean, I…

Travis: I already patented it.

Dr, Franco: …know we’re on the bench right now losing “Celebrity Husband” title.

Travis: Oh, man.

Sarah: I don’t know.

Gilberto: I thought I lost Austin’s most eligible bachelor. Who said anything about losing most beautiful man?

Dr, Franco: Greg took it. I think gossip…

Gilberto: [crosstalk 00:26:29.858].

Dr, Franco: …Greg took most beautiful, man. Huh?

Gilberto: Greg took most eligible bachelor.

Dr, Franco: Maybe we need to refer to the video.

Gilberto: Which video is this? Are you having clandestine meetings with Greg?

Dr, Franco: Yeah, we’ve been talking about you. He’s like, “How can I dethrone G-Berto?” But I like how you saved “Celebrity Husband” from losing his title. That’s good. You guys are banding together today. What’s going on?

Travis: That’s right. The quote artists have to stick together. No, I did wanna point out one other thing, and Sarah, you can probably…I think you’ll agree with where I’m coming from here. I think people when they come in, especially pre-op, and they haven’t tried any implants on, they have this idea of cc’s or a number in their head. And they say, “Oh, I want 350s,” or “I want 400s,” or “I want 500s.” That means tons of different things to everybody. And once you see what a 350 looks like with the tissue that you already have in place, and depending on what profile you’re gonna go with or base diameter or whatever, that changes the look completely.

Sarah: Yeah, absolutely. I really didn’t know until I tried them on. So like I said, that’s the fun part. You get to go in the office, put them on with a little tank top and see you’re adding to what you already have, you know, and just see what works best for you.

Dr, Franco: Can I tell you my favorite? And please don’t take, anyone who’s listening who did this, I’m not trying to be rude. But my absolute favorite is when somebody comes to the office and says, “I want the implant that’s gonna give me a C cup.” And I’ll be like, “Well aren’t you a D cup now?” And they’re like, “Yeah.” And I was like “So we’re gonna put a C cup implant in and make you smaller but put in an implant?” They’re like, “Yeah,” I’m like, “Okay.”

Travis: That’s not how this works.

Sarah: I don’t know how that works. Are we talking…? Yeah, that doesn’t add up.

Dr, Franco: Yeah, it happens. But I think to “Celebrity’s” point is just that, you know, I think this is where a good consultation and spending a little bit of time is super, super helpful to make sure that we’re on a good page about what we can or can’t do. Because, sometimes people bring in wish pictures and I’ll just tell them, “Hey, I can’t do that, you know. That’s just not in our cards.” And I think better to do that and be disappointed at the office than be, you know, disappointed. $6,000 later…

Sarah: After surgery.

Dr, Franco: …you know, six weeks later time off, hubby’s time off and, etc.

Sarah: Absolutely.

Dr, Franco: Sarah, if you could leave us with like…and not leave us because we still got a lot more show to go but leave us on this segment. If you could leave five points for people who are thinking about breast augmentation and picking implants, or the process, what are five little golden nuggets you could do? And if you can only come up with three we’ll let “Celebrity” and G-Berto come up with one too.

Sarah: Okay, perfect. I was like, oh, man five. Okay. Number one is do your research as far as picking your wish pictures. I really do think that’s most important. Have a, literally a physical photo, this is what I like and this is what I don’t like because I think that’ll be super helpful for you. Another one is plan for your recovery. I think the best thing… I’m only a week out and everything is going great for me so far. But the best thing that I did was I set up time off work, I set up childcare. You know, if you can plan to really rest and relax then you’re gonna recover faster. And then lastly…

Dr, Franco: Can I put an asterisk by that? Because that’s true not just for our breast aug patients, but any of our surgery patients. If you do a little time to give yourself a chance to recover, you’re gonna do so much better. We see people just sabotage themselves and I’m like, “Please, please, please take a little time and it’ll save you and get you back in so much faster if you can just do a little time.”

Sarah: Yeah,. And then the last thing that I’ll say is I love…and I think we might talk about this later. But the medication regimen that y’all prescribed is awesome. And if you’ll just stay on top of that, your pain is gonna be so well controlled, and then you’re gonna find that you don’t even need that many narcotic pain medications. So just really staying on top of your medication schedule, your recovery is gonna be so much easier and quicker too.

Dr, Franco: We’ll circle back to that because we are gonna come to anesthesia and I think some of those are some great points and “Celebrity” actually helped me come up with that regimen. So “Celebrity” if you don’t mind just holding on…

Travis: I love hearing that by the way…

Dr, Franco: …for one minute and we’ll circle back to that.

Travis: …it’s awesome to know that that’s going well for you.

Sarah: Yeah. It’s been a really good experience overall.

Dr, Franco: G-Berto, any nuggets for our fans listening out there or people?

Gilberto: I think one thing that is also important is…and I don’t know how it is now especially, you know, given the way things are with COVID and restricting too many people being in the office during consultations and such. But I think having somebody there to go with you to listen for certain points and such that maybe, you know, you may not remember you can have somebody there to be your backup essentially. You know, because there’s a lot that goes on during these consultations, a lot of information that gets passed back and forth and you may not catch everything, you know. And so having someone else there, a second set of ears to kind of just catch all the information and kind of tie it back to one another I think is important. But again, I don’t know how that works now, you know, given the current situation of things. Has it changed much for you guys in the office?

Dr, Franco: It has a little bit. We only allow people to at most bring one guest. What we have seen a lot of people doing is Facetiming or putting somebody on speakerphone so that they can listen. Sometimes they’re just doing it from their car and so forth or sometimes they’re at home with the kids because they trade-off. So 100% you need somebody involved with that. So no, no, I agree.

Gilberto: That’s a great one.

Sarah: That’s a great point.

Gilberto: That’s kind of [inaudible 00:32:31.524] of planning you know, for your procedure.

Travis: If I could piggyback on what G-Berto said there. Having a caretaker lined up that’s actually gonna help you when you get home as well and pick you up from the surgery center or be there at the end of your surgery because we go over all the discharge instructions with them, again, at day of surgery when we’re discharging the patient. So Sarah, was it your husband I’m assuming that picked you up?

Sarah: Yeah, absolutely.

Travis: We went over everything with Sarah’s husband right after because, you know, I’m married too, I totally get it. Everything is written down. I’m not gonna be able to catch everything in that moment. But you want responsible ears and a responsible party there with you. It’s gonna help when you get home too.

Dr, Franco: And I’m the most responsive plastic surgeon in America.

Sarah: You are, you absolutely are.

Travis: You heard that folks, call him day or night.

Sarah: Yep, any time 1:00 a.m.

Dr, Franco: I’m only…[crosstalk 00:33:34.705].

Gilberto: [crosstalk 00:33:34.927].

Dr, Franco: …all-time record is 72 text messages during one surgery. We had some like six-hour surgery, 72 text messages in a six-hour period. So if I don’t respond, you guys can hit me up again because I might have missed one of the 72. But…

Sarah: So you’re saying you’re really popular.

Dr, Franco: I mean, 68 of those were my mom asking me why I hadn’t called her back…

Sarah: [crosstalk 00:34:01.976].

Dr, Franco: ….but I didn’t wanna say that but since you’re gonna call me out on the podcast, that’s cool Sarah appreciate it.

Sarah: I’m just kidding.

Dr, Franco: Before we jump to anesthesia, and I really truly don’t know the answer to this, I’m not trying to do a plug for myself. How did you go about doing your research in terms of, you know, picking a plastic surgeon or doing some of that? Because that’s something we’ve talked about a little bit on the show and it’s easy for, you know, G-Berto, “Celebrity” and myself to be like, “Hey, you know, you need to look people up, you need to do your research.” But what did you truly do?

Sarah: Okay. So, naturally, I used Google. I mean, I Googled and then I being an influencer on Instagram, I spent a lot of time on Instagram. So I actually found you on Instagram. And then you put your surgeries obviously right out there so I watched your, you know, how you do everything. I’m not gonna lie. I actually had my surgical techs that I work with, they watched y’alls surgery and they were like, “He’s really good. I really like how he does everything.” So I was pretty thorough. I looked up all the reviews, and then I had people watch your surgeries. But yeah, really just the internet, Internet searches, you were easy to find on there, and then being all over Instagram, you know, you’re pretty active on there. So kind of a combo of all of those.

Dr, Franco: Kind of interesting to hear an OB nurse and surgical tech say that because, you know, we tend to be the most judgmental in our own field about skills and stuff. And it’s funny because you never know what you remember from your training gets, you know, beaten into you. And I still remember our chairman, because he’d always be like, he’s like, “Why is there blood in the field? He’s like, “What if somebody walks in?” And this is the days before Instagram? He goes “What if one of the ortho guys walks in and he sees this mess?” He be like, “Damn, this was orthopedic case,” he’s like, “You can’t be that you’re a plastic surgeon. This has gotta be clean.” I will never forget that that has been beatdown. And so G-Berto and anyone who’s been there knows that I’m like a blue towel king because if there’s one little spot that I’d be like, “No, no, we have to put a blue towel down. Can’t have this mess in case somebody walks in.”

Sarah: Yeah. I think it looks like y’all do an impeccable job so I was very impressed.

Dr, Franco: Let’s talk about impressed let’s go on to a “Celebrity Anesthesia” who impresses us every day with his skills and knowledge in quotes. As we alluded to a few times here and if you listen to our podcasts religiously, thank you, but “Celebrity” did help me come up with our ERAS protocol for those of you that don’t know he actually trained in Duke. And so I know some of you may not know that because you may have missed, you know, all of our episodes. But he actually was part of the process where they first helped develop some of this. And so we’ve brought a lot of this into our practice. He was actually going to give a talk to all the plastic surgeons in Austin about ERAS and pain management and because of COVID, that’s been put on hold. But hopefully, we’ll get that done in the fall because you are really willing to share that knowledge with everybody else in town, which is only to benefit patients.

Travis: Yeah, I mean, I’m a huge believer, I’m all in on the low narcotic train. I think narcotics definitely have their place in surgery, and I use them when I need to. But anytime I can get by without having to give patients a ton of opioid-based pain medication we really try to do that. And the way we’ve been successful with doing that is by using other pain alternatives, besides just narcotic medications, we call that multimodal analgesia.

Dr, Franco: And I think the one thing to your point here is, it’s not like they’re not getting anything. Because sometimes people get scared that “Oh, I’m not gonna get narcotics I’m not gonna get anything.” That’s not true and that’s not what we’re doing. The idea is that, at some point, you get side effects from medications, the lower doses you do, typically the lower side effects that you’re gonna get. And so the idea is that you’re doing a lot of things at low threshold where they’re not gonna get to the side effects of a lot of these things.

Travis: That’s very true. And there’s tons of research coming out showing that preventing pain is not just hitting one single pathway, and opioids only hit one single pathway. So if we’re able to use a handful of medications that happen to not be narcotics to hit a bunch of different pain pathways, we can help alleviate patient’s pain a lot better. There are also a couple of things that narcotics have in common like increasing nausea profile, making people feel just crummy. There’s also…I mean, there are several side effects. So if we can alleviate and like Dr. Franco said, keep that number low or use less narcotics we’re winning.

Dr, Franco: No, I think…And then Sarah, I think basically touched on earlier, but you also helped me with the protocol that patients do on their own. Because there’s the stuff you do behind the blue curtain, which I feel like is a segment we need to do coming up soon but behind the blue curtain because there’s more behind the blue curve than crossword puzzles and in video games but …

Travis: And trading stocks. No, that’s exactly right. We have a pre-op regimen of medications that patients take preventatively. And then postoperatively we have another allotment of medications that patients are given in a time schedule to take them that are not just narcotic medications. And they will help prolong that decreased pain time.

Dr, Franco: Because a lot of people…I’ll tell you one of the biggest complaints we get…and I get it because I’ve been at pharmacy and it’s extra money and everything else but we do prescribe a lot of medications. And Sarah is a nurse, I mean, you probably had two different gut feelings about this. Like one damn this is a long list, but two hopefully you like, thought there was a rhyme and reason for it.

Sarah: Yeah, absolutely. Actually being a nurse, I am a big fan of medication, right so, I just know that it is helpful. And so I was excited to learn you know, y’all have meds for muscular pain, meds for you know, nerve pain, meds for inflammation and swelling. So we’re covering several different pain points for you, you know, and then also the narcotics for just regular pain, you know. So the combo of all of those has allowed me I can speak personally to really decrease the need for the narcotics as I’ve gotten several days out from surgery, I’m hardly having to use them.

Travis: Which is exactly you know, the point of the regimen that we came up with. So that’s awesome to hear.

Sarah: Yeah, it’s working well.

Dr, Franco: And so I hope people are listening, you know, the better you are about taking these the day before, taking them the morning of, and then the day after. Getting on top of that at the beginning then you can get off the narcotics and that’s what typically keeps people from getting back to work and back to life because you’re nauseous, it becomes this cycle and then you’re really not on top of it. It’s really made a big difference for those that have stayed on top of it. So I appreciate you bringing that up, Sarah.

Sarah: Yeah, and I will say one other thing that y’all do really well is there was like three different things to help with nausea and I did not have one ounce of nausea the whole time. So…

Travis: It must have been your CRNA.

Sarah: So congrats to y’all that is obviously working very well so I’m proud of that.

Dr, Franco: It was so funny because she goes “Oh, I get Rob the body instead of “Celebrity Husband.” She’s like, “At least I’ll have some sweet dreams.” I’m like “We won’t tell Dusty we’ll tell him you were already under anesthesia when you said that. ”

Sarah: Y’all have to tell me if I said anything weird.

Dr, Franco: Maybe we’ll tell you about the things you said offline because this is a family show.

Sarah: Okay, deal so good.

Dr, Franco: “Celebrity” anything else about anesthesia that we should touch on? Because we do do some local anesthesia on the skin as well to try to get decrease some of that pain in terms of the incision. You know the incision tiny little baby.

Travis: Yeah, it’s a small incision to begin with, and then also you always put a little bit of local anesthetic at the skin. Another thing, I always talk to patients before we roll back and tell them “Look, what you’re gonna experience after breast augmentation, more than pain from an incision is pressure and heaviness and tightness in your chest.” And that’s because we’re putting something in a pocket that does not exist at the moment. We’re gonna create that pocket, then we’re gonna stick an implant inside that pocket that’s gonna stretch. That stretch sensation manifests itself with pressure and a lot of tension in your chest. And that happens 99% of the time after breast augmentation. Patients wake up “I definitely feel the pressure not much pain but it definitely feels like a little bit of pressure.”

Sarah: Yeah, I’d agree.

Dr, Franco: And that’s why playing with the different meds I think really helps because some people…

Travis: Absolutely.

Dr, Franco: …do better with a muscle relaxant, anti-inflammatories than the true pain meds because the pain meds don’t really get rid of that tight pressure sensation to the same degree.

Travis: Absolutely.

Dr, Franco: Can we do a little something called fact or fiction?

Sarah: Let’s do it.

Dr, Franco: Fact or fiction you’ve never invited me on your new boat.

Sarah: Well, that’s fact but I just got it out of the shop so you gotta give me a chance.

Dr, Franco: Fact or fiction you and yourtrendytherapist have been rivals for a long time.

Sarah: That’s fiction. Mary and I…I haven’t gotten to meet her in person, but I need to. Actually I think the Austin bloggers are really good about working together, supporting each other we’re not rivals.

Dr, Franco: Fact or fiction you don’t even follow her.

Sarah: I do follow her I think, okay, I’m not sure but that I need to check.

Dr, Franco: We may have to fact check is fact or fiction.

Travis: [crosstalk 00:44:13.469].

Sarah: I’m gonna have to check on that. I have definitely Instagram stalked her though because of y’all’s podcast.

Dr, Franco: This is what I’m gonna say. I’m not gonna say it’s a little weird or a little part to the rival. But be interesting that you stalked her, but don’t follow her because that’s..

Sarah: I think I do follow her.

Dr, Franco: That’s like Gilberto’s girlfriend checking on all the exes. She’ll check her Instagram to make sure they’re…

Travis: You’re not gonna follow him.

Dr, Franco: …mentioning Gilberto, but she ain’t gonna follow them.

Sarah: Okay, well, you better believe I’m gonna make sure I follow her right after because I don’t.

Dr, Franco: Fact or fiction you have the world’s greatest celebrity husband that does all your photos?

Sarah: That’s a fact.

Dr, Franco: Damn the gauntlet has been thrown boom, damn.

Travis: [crosstalk 00:45:03.488].

Sarah: [crosstalk 00:45:03.274] He’s very well really trained. He’s been very well trained.

Dr, Franco: So, good maybe “Celebrity Anesthesia” come train with you for a little while, and that way he can get his game up for Mary, or would that not go well in the rivalry?

Sarah: Hey, I’m here to help however I can help.

Gilberto: The celebrity husband, boot camp.

Travis: Celebrity husband boot camp.

Dr, Franco: Sarah, you see you could add a fifth job you could start the celebrity husband boot camp.

Sarah: Why not? Let’s bring it on. Bring it on.

Dr, Franco: Let’s do a little segment called behind the bogey. Maybe a little…what’s a little nugget Sarah, that you could tell us about your experience with breast aug that most people wouldn’t know or think about? Is there anything that you can…a little nugget or something you can share that people wouldn’t know?

Sarah: Let’s see I’m trying to think.

Dr, Franco: If not, I’ll jump in and help you.

Sarah: Yeah, I don’t know, maybe that it’s a really simple procedure. Like I was really surprised that it took maybe an hour or less for the surgery and you go home within a couple of hours. I was just pleased with it’s like…

Dr, Franco: Just because it doesn’t take a long time doesn’t mean it’s not phenomenal.

Sarah: Absolutely, absolutely that’s not what I’m saying. But how about convenient like, it’s just a pretty convenient thing you don’t have to be there the whole all day. I’m happy that I didn’t have to be under anesthesia very long and you get to leave pretty quickly. So yeah, it’s easy. Easy but very effective way to change [crosstalk 00:46:49.594].

Dr, Franco: Would you say efficient,

Sarah: Efficient absolutely.

Dr, Franco: You see, I’ve told you guys I’m efficient. I’m just efficient. You know what’s another kind of golden nuggets in terms of implants is I think most people don’t realize that we try to never touch the implant. And so, you know, it’s in several boxes so the nurses show me the box…And I’ll have the video that process it’s actually kind of cool. So the nurses like confirm the implant, they open that sealed box and then inside the tech takes another sealed box, it’s reopened. And so they open up the third sealed box with the implant, we put in a box position and then we actually dump the implant into the killer [SP] funnel. And along with that, I change my gloves we already have the sterile field, we re-prep the skin, have sterile gloves on. I re-change my gloves again and before the implant just to dump it into the funnel and then it goes from the funnel straight in. And the funnels used for the implant not to touch the skin. And so I don’t think people realize how many extra steps we take and that’s after the pocket’s been washed out with triple antibiotic solution, betadine solution, and a new thing we call phase one, which is a anti detergent for the inside. Just all to prevent infection, prevent capsular contracture, and make sure that this easy process is all done efficiently.

Sarah: Efficient, not easy.

Travis: It’s just a breast implant.

Sarah: I knew about the funnel, but I didn’t know about all the steps so I think you should definitely record that. I think that’d be super interesting to watch.

Dr, Franco: Okay, yeah, because I don’t want people thinking that it’s simple.

Sarah: Okay, you’re gonna give me a hard time about that I’m sorry. Efficient [crosstalk 00:48:35.235].

Dr, Franco: Can we do a quote of the day since we smashed the sky is the limit and found out that there were footprints on the moon on the last episode?

Travis: I’m turning it over 100% to Gilberto, on this one I can’t even compete anymore.

Dr, Franco: Sarah, did you know the “Celebrity Husband’s” favorite saying was almost like sky is the limit and then on the last episode, which I’m sure you listen to Gilberto comes in and says, “How can the sky be the limit when there’s footprints on the moon?” I was like, damn just like that.

Travis: I know just like that my crown was gone.

Sarah: Okay, I’m ready for this.

Dr, Franco: Any words of wisdom a little quote of the day for us?

Gilberto: I got one yeah. Let’s see here. Here’s one from…

Dr, Franco: You just happen to have one boom, boom.

Gilberto: Just happen to have one right here. Here’s one from Mahatma Gandhi. It says, “Live as if you were to die tomorrow. Learn as if you were to live forever.”

Travis: That’s a thinker. That’s good.

Dr, Franco: That’s a little bit…

Sarah: I like it.

Dr, Franco: …more intense than footprints on the moon I’m not gonna lie.

Gilberto: You know, it’s just [crosstalk 00:49:44.496].

Dr, Franco: That hits a little close to home just post COVID right now. Gilberto is an intense man, okay. Yeah, I’m gonna…I usually go around…

Sarah: [crosstalk 00:49:59.212].

Dr, Franco: …the room and ask what that means to everybody. Sarah, would you like to take that?

Sarah: You know, sounds like I need to really do some learning. Think on that like, I’m gonna live forever absolutely.

Dr, Franco: “Celebrity?”

Travis: What did you say Gilberto?

Gilberto: I was just gonna say…Go ahead.

Travis: No, I mean, I thought that was just saying if you’re given that opportunity to learn, you need to take it and whatever you get out of something, use that for the rest of your life and use it to change your life for the better. Because if you could live forever, I mean, you’re gonna have all the time in the world to use it.

Gilberto: Yeah, I think for me, just taking it at face value it’s like, live as if you were to die tomorrow, take every advantage of life that you have live for the moment essentially. But on the flip side of that, you know, always keep learning, always keep striving, always keep working hard and grinding you know, and, this…

Travis: Would you say sky is the limit?

Gilberto: No, I wouldn’t, because, you know, there footprints on the moon.

Sarah: Of course not.

Gilberto: But I think I think this quarantine time has given a lot of people opportunities to take on new challenges and learn new things that they probably wouldn’t have had time to do otherwise. So it’s just like, always be learning something new just move forward.

Dr, Franco: I also think it makes you think about and be like all the dreams or things that you’ve said, hey, you know, next year, I’m gonna go to college, next year, I’m gonna apply for that new job, next year, I’m gonna start that project. And I feel like if anything, this quarantine, the COVID everything else that has happened this year, which has been an interesting year, to say the least, I think pushes people like hey if you’re gonna make a change in your life, if you wanna make a change in the world, like [crosstalk 00:51:53.320]…

Sarah: Why not now.

Dr, Franco: …rather than later you never know what tomorrow is gonna hold for sure. So I appreciate, G, that’s a great time to [inaudible 00:52:01.482]. I know, I’m giving you a hard time but I think super, super important for people to think about. Any closing statements from anybody, last thoughts around the horn? That’s an ESPN reference Sarah, just so you know.

Sarah: Thanks for that. No, I don’t know I’m excited to keep y’all updated on the rest of my recovery. So you can…you know, you mentioned earlier, that y’all can find me at “Delivering Motherhood,” I’m gonna be sharing…You know, I’m a week out, I’ll share an update and then we’ll share you know, a month and then a few months so we can see the changes. But yeah, I’m excited to see where it goes from here.

Dr, Franco: So Sarah’s Instagram handle is @deliveringmotherhood. She also has a website blog so if you wanna catch up on some of her past things, you can actually look her up and her website is actually the same at deliveringmotherhood correct?

Sarah: Yeah, that’s it.

Dr, Franco: And it’s super cool her Instagram does a little bit of everything. She gives some shots of her as an OB nurse, she also sends a lot of stuff with her kids at the beach, and so forth. And so kind of cool to just get caught up on what life’s about and I can’t wait. So we’re definitely gonna make this happen we’re gonna have the celebrity husband challenge off and so Sarah and I will…

Sarah: I’m excited for it.

Dr, Franco: …talk offline. And don’t wanna give away all the nuggets I got my head because I want them to walk into the challenge unprepared. Maybe we can’t involve Sarah. Maybe Gilberto and I gotta come up with this because I’m not gonna say that Sarah will give her hubby a little bit of unfair advantage but I feel like there might be.

Sarah: Okay, I get that.

Travis: It’s on.

Gilberto: Third-party unbiased you know, we gotta come up with these [inaudible 00:53:42.934].

Travis: They’re unbalanced.

Dr, Franco: And I feel like Gilberto and I are pretty fair you know, we never get worked up, we never get out of control. So I’m sure this will be super reasonable challenges.

Travis: Totally.

Dr, Franco: Well, I wanna thank everybody for listening to “Plastic Surgery Untold,” the greatest podcast in the world as voted by us. So I also wanna thank producer Donald who does all the back work who unfortunately doesn’t get seen on here because we’re on Zoom. And so I am hoping just so you guys know who are listening hopefully, within the next week or two, we will be in our new office. We are building out a new media room so hopefully, we will be in our new media lounge by our next taping. So that’s my goal, that’s my hope. I’ll see you guys. Thanks, everybody. Thanks, Sarah.

Sarah: Thank you, bye.

Travis: See you guys.

Gilberto: Bye, Sarah.

About The Author

Dr. Johnny Franco
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