botched

Courtesy of E online

As a follow up to my previous post on the E! show, Botched, and my review of episode 6, I’m going to provide further insight into the issues in episode 7 that they couldn’t touch on due to time constraints. I’ll point out potential alternative treatments and highlight some of the psychology with these complex patients. So here goes…Botched, season 1, episode 7!

Uneven Alien Breasts

Salina was unhappy with her natural flat chest and had a breast augmentation in 2004. Based on the photos after the first surgery, her cleavage was quite wide but the breasts did appear round, symmetric and an appropriate size for her body. However, she was very unhappy and wanted a revision. Her boyfriend thought they looked fine but not Salina. So she returned for a revision 10 years later when she had the money and after the revision, they were uneven and worse than after the first procedure.

Now she was ready for her consultation with Dr. Dubrow. He was very clear that she had a difficult problem and even an operation that went really well may not give her the result she was hoping for. During the revision procedure highlighted in this episode, she was found to have implants that were over 500cc in size which is way too big for her body size. Apparently, her doctor during her second surgery took out reasonably-sized implants and replaced them with enormous implants. Bigger implants are almost always NOT the answer!

I find that many plastic surgeons often think the best way to fix a breast implant problem is to go bigger and sure enough, in this episode, they put in slightly larger silicone implants! In my opinion, re-adjusting her breast pocket to improve symmetry was appropriate but larger implants will stretch out her new breast pockets over time and she’ll eventually have the same asymmetry problem. Things may look great on the OR table at the end of the procedure but, in time, she’ll need another revision unfortunately.

Anxious Tummy Tuck

Cristina had a tummy tuck and ended up with an infection afterwards that added to her poor result. The infection she had was MRSA (methcillin resistant staphylococcus aureus!). You could hear them referring to ‘mersa,’ which is just MRSA pronounced as a word rather than an abbreviation. Dr. Dubrow kept referring to the bacteria as potentially being a flesh eating bacteria but for accuracy, flesh eating bacteria is typically from streptococcus bacteria, not MRSA. That’s important because the antibiotic regimen is different.

She was also unhappy with how bloated her abdomen still looked. During a tummy tuck, the 6-pack muscles are tightened together to make the abdomen appear less full. The problem with some patients is that they have too much “visceral fat.” This means that rather than having a lot of fat under the skin (which can be treated with liposuction), their fat in inside their abdomen, around their intestines.

Visceral fat can’t be removed because that would require cutting fat away from the intestines, which isn’t safe. So while you can redo her abdominal wall tightening during a second procedure, the fat around the intestines will still be there and her bloated abdomen won’t ever be as flat as she wants without some good old-fashioned weight loss to reduce her visceral fat.

Interestingly, during her revision on this episode, they didn’t even address the abdominal wall tightening. In fact, they did her procedure under local anesthesia and sedated her but did not use general anesthesia. The reasoning for this was bizarre. The patient has a great deal of anxiety so instead of removing her anxiety by putting her “totally out” during the procedure, they kept her awake so that “she could feel in control.” This makes no sense to me. And as expected, she was anxious and complaining of pain from time to time during the procedure. There must be more to the story behind the scenes that we’re not aware of.

Consequently, the reason they couldn’t address the abdominal wall tightening was because she wasn’t under general anesthesia. Due to the pain associated with tightening the abdominal wall, the patient must be completely out and under general anesthesia to tighten the 6-pack.

Lacey Gone Wildd

Lacey wants triple Q sized breasts! Going from 3500cc to 5000cc (that’s 5 liters!) in each breast. In each episode, the show highlights at least one patient that has an unreasonable request and they turn down that patient. And needless to say, this is the patient that they turned down!

As with most patients, even if the doctor won’t do their operation, they are determined and will find another doctor to do their procedure. This patient was no different and made it clear that she would continue on her quest to get 5000cc breast implants.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.