Saint Paul Doctors

Will my Surgeon Be More Likely to Do a Better Job on my Rhinoplasty if I'm His First Surgery of the Day or the Last?

I know it seems like a silly question but its really not. Take for example my hair stylist. I've found she does a much better job if I'm her very first client of the day. Verses being the last when she;s worked all day and tired. I know a stylist goes through a lot more clients in a day then a surgeon, so their not comparable. But i'm still wondering if it makes a difference? I've researched my surgeon and am confident in him but i'm still looking for the best possible results, as is anyone!!

Every surgeon will have his or her own answer to this question, and each of us will likely be different. Some surgeons actually do prefer their longest or more difficult cases to be first or last, since there are mental and physical challenges with each and every operation, no matter how "routine" or "easy." It just depends on how you wish to address them, and whether or not you prefer to be "done" after a hard case, or get the difficulty out of your mind so you can concentrate on the subsequent "easy" work.

In fact, I would suggest that there IS no "easy" case--each patient deserves our utmost attention to detail no matter if it's a mole removal or a lower body lift!

I've been asked this question for as many years as I have been a surgeon (31 since medical school graduation and the start of my surgical residency). And I've truthfully answered that for the first case the patient gets me when I'm "fresh." The last patient of the day gets me when I'm "warmed up." Adrenaline and focus still make me as good on my last case as my first, but I do sometimes arrive  home exhausted. It helps if your surgeon has the capacity to compartmentalize each patient's issues rather than dwell or "stew" on them, because this is one trait that could intrude on another patient's care. I compartmentalize fully between each case, but that's just me.

Ask your surgeon--he or she has been asked this before, and will have an answer ready. Then you can decide where you want to be in the rotation!

Richard H. Tholen, MD, FACS

Minneapolis Plastic Surgeon

Vibrating "Bourdonnement" 3 Years After Breast Augmentation Surgery

I had a breast augmentation procedure 3yrs ago w/cohesive gel implants. I've recently started to experience bourdonnement-vibrating/buzzing/humming in L breast-almost feels like bubbles rising. Apparently normal during post-op period, but normal 3 yrs later, all of the sudden? Mammogram a few months ago was WNL. Could the implant be bottoming out? Trauma due to overzealous boyfriend, maybe? (I hope they're not that fragile). Something more serious?? Nothing serious?? Just tell me I'm not going to end up with an embolism. They look awesome-if I do say so myself-no rippling or anything, but these symptoms are a bit unnerving

Your implant sliding against the stretched moist tissues causes a friction rub (sound) that can be felt as well as occasionally heard. This is termed "bourdonnement" and was definitively described in the plastic surgery literature: "Bourdonnement and other benign temporary breast implant sounds", Annals of Plastic Surgery, Vol 43 p589, 1999.

When this occurs this long after surgery, the sound is not related to the incompletely-healed and still-inflamed tissues. It may well indicate some new source of inflammation, possibly related to a moderate trauma to the breast tissues, perhaps secondary to bacterial contamination such as from dental work (controversial, but still a real occurrence). The inflammation that causes this sound has nothing to do with "bottoming-out" but could indeed be due to a severely overzealous breast manipulation!

You are either very good at research or have some medical background, since a friction rub heard on chest auscultation with a stethescope can be associated with a pulmonary embolus from DVT. Bourdonnement alone without any other symptoms (leg pain, swelling, shortness of breath) is NOT worrisome.  

Ibuprofen or Celebrex (prescription) anti-inflammatory medications are a good starting point. If you begin to notice firmness or soreness in the "noisy" breast, this could be an early sign of capsular contracture. See your surgeon for evaluation and consideration of a course of Accolate or Singulair and Vitamin E. Best wishes!

Richard H. Tholen, MD, FACS

Minneapolis Plastic Surgeon

Are Rubbing "Squeaky" Noises 3 Weeks Post op Normal?

I had my BA 17 days ago(sub-muscular silicone). Immediately after the surgery I noticed a lot of squeaking and popping, which I knew was normal and it went away. However, my right breast has begun making a fairly loud rubbing noise when I do my massages or when I move my arm in certain directions. It feels like the implant is rubbing on my chest wall when it moves. Is this normal this many days out? My friend jokes that I have a squeaky toy now - funny as long as it goes away! Thanks.

Your new implant sliding against the stretched moist tissues causes a friction rub (sound) that can be felt as well as occasionally heard. This is termed "bourdonnement" and was definitively described in the plastic surgery literature: "Bourdonnement and other benign temporary breast implant sounds", Annals of Plastic Surgery, Vol 43 p589, 1999.

The inflammation that causes this sound resolves as the healing process goes forward. It generally goes away in a few days to weeks, but can occasionally take longer, depending on how long your healing process takes.

Those of us who still use a stethescope for listening to patients' chests will occasionally hear distinctive sounds such as this that indicate lung/chest (pleural) inflammation that can aid in diagnosis. In your case this sound only indicates that your healing is incomplete. Best wishes!

Richard H. Tholen, MD, FACS

Minneapolis Plastic Surgeon