Plastic surgeons there are using a thick, gel-like substance, Macrolane, made of the same chemical compound as the familiar Juvederm.

It’s made by the same Swedish firm that makes Restylane.

Injected deep into the breasts, Macrolane breast enhancement really is an augmentation without the knife. Of course, this procedure has its plus and minus features, too.

Upsides include:

• Recovery is nil

Walk in, have a one to two hour procedure, walk out

• It looks good

Macrolane is said to provide substantial volume and provide a smooth appearance to the breasts without lumps or bumps

• Few risks

The risks of general anesthesia and surgery (infection, scarring, broken implants) are gone.

The downsides are:

• Not approved yet for U.S. use
• Effects only last one to two years (British doctors include yearly “top-offs” to maintain the look.)
• Not for those allergic to hyaluronic acid
• Women who have the procedure are monitored

Many women now in their 40s and 50s who had breast augmentation while younger no longer want large bosoms and often have surgery for smaller implants.

If those women can afford to go back every two years for Macrolane, they would not have to worry about explants surgery later on.

Explore Plastic Surgery, the most excellent blog of Indiana board-certified plastic surgeon Barry Eppley, M.D., says injecting Macrolane is “very much like injecting jello.”

Dr. Eppley compared breast augmentation before and after pictures of both implants and Macrolane. His opinion?  “Macrolane fares poorly compared to breast implants.”

For a preview of coming attractions, here’s a British You Tube segment, below.

The segment starts with a low cringe factor as the surgeon uses a tiny syringe to inject what is probably a pain killer.

That thicker, foot long instrument he puts into the patient’s breasts is not a needle but a blunt end canula, a thick, hollow tube that injects the Macrolane jell deep into the breasts. (Watch the Macrolane breast augmentation.)

Dr. Eppley says Macrolane will probably be used in the United States soon.

But the real danger he sees: the stuff is so easy to use, more untrained hands may take advantage of “quick and cheap” factors to produce shoddier breast augmentations.

While the vast majority of breast enlargement patients were happy with their surgical outcome, breast surgery is like any other surgery: even in the best of hands, unforeseen complications can crop up.

So what are the signs a woman might notice in herself that something has gone wrong after breast augmentation?

Warning signals include:

• Changes in nipple sensation

Several invasive cosmetic plastic surgeries – like breast enlargement and liposuction – can leave the skin in the treatment area with a slight numbness. It’s almost always temporary because the nerves grow back.

• Fever

A high fever can be more serious because it may indicate an infection. Other signs of infection include redness around the incisions. If you notice that in your incisions, you should call your surgeon right away. If he or she is a board-certified plastic surgeon, that doctor will have seen – and treated – all the possible complications.

• Muddy mammograms

Tell your radiologist you have breast implants; sometimes, one or both implants can obscure the X-rays. But additional pictures from different angles can be taken.  Ultrasound or magnetic resonance imaging can also be done.

• Hardness of the breast

The natural healing process can form scar tissue that surrounds and squeezes your implants in varying degrees. That can cause the breast(s) to feel tighter than normal. Your surgeon needs to evaluate it sooner rather than later.

• Changes in breast size

If a breast looks like it is deflated, it could be because the implant has leaked. For a saline implant, the filler leaks harmlessly into the body. Your doctor needs to know because surgery may be required to replace it. The good news? Many implants have warranties.

• Sickness after surgery

The best way to prevent nausea after your procedure is to make sure you have a board-certified anesthesiologist.(Tip: use a little doctor slang and ask your surgeon who the “gas passer” is going to be. They’ll both be charmed by your insider knowledge!)

The best way to handle complications: discuss them before surgery with your surgeon and ask the doctor who would beresponsible for what treatments in case one of these rare complications rears its ugly head.

Massage.com is offering a peek at a March article in the print edition of Massage Magazine. It tells how massage therapy was found to reduce both short and long term pain and anxiety in cancer patients with bone pain.

That is some pain!

And, according to Medical News Today, massage may help ease pain and anxiety after major surgery. Of course, major pain is not often a part of plastic surgery, but massaging definitely helps.

Massaging can help make sure that you end up with the best possible results after your breast augmentation.

Some plastic surgeons use massage therapists who perform a type of rub-down, known as  manual lymphatic drainage before and after surgery. That massage is said to reduce swelling, pain and bruising that may result from some cosmetic and reconstructive procedures.

One Florida plastic surgeon even combines massage with liposuction and claims better results.

But for breast enhancement, the massage is different and you don’t need a specialist; you can do it yourself.  What’s more, you may protect your investment in a new, attractive bust line.

In some cases after surgery, the body will try and wall off a breast implant because your immune system sees the implant as a foreign invader.

When that happens, scar tissue surrounds the implant and squeezes it, causing the implant to feel hard. Known as capsular contracture, the condition also allows the enhanced breasts to look distorted and uneven.

Capsular contracture is the most common complications and leading causes of breast revision surgery. It happens more often when the implant is place atop – and not under – the patient’s chest muscle.

But if the patient has quit smoking (read a post about smoking and plastic surgery) and gone through the proper  de-contamination routine with germicidal skin washes just before surgery, she vastly decreases any chances of capsular contracture.

And if she performs a suggested massage routine on herself for several weeks after the operation, she increases the chances of having a natural looking bust line.

See a demonstration of the breast implant massage.

Why?

For starters, here are some of the unexpected detours a typical breast augmentation can take. Even in the best of hands, a small (less than one percent) number of cases may experience any of the following conditions:

• Bottoming out

In this scenario, the breast implant has not been placed in the chest pocket correctly and falls to the bottom of the breast, causing the nipples to point up. It’s difficult to fix and usually requires a breast revision specialist. Plus, the cost is usually equal to twice the original cost of the breast enlargement.

• Capsular contracture

Sometimes, the body’s natural reaction to a foreign body – like a breast implant – is to wall it off with scar tissue. It’s one of the most frequent complications.

Capsular contracture can squeeze the implant and breast, making it hard to the touch. Implants placed under the chest muscle have less contracture, plus really skilled surgeons know how to place two-thirds of the implant under the muscle, with one-third over that muscle.

• Implant rupture

Although uncommon, both saline and silicone breast implants can leak if they are ruptured. In the case of a saline implant, the affected breast will collapse. A rupture of a silicone implant is harder to detect because the contents inside are a cohesive silicone gel. Either way, an additional surgery will be required.

• Change of mind

The most frequent reason for another surgery following a breast augmentation is because the patient sees the final result and wants a larger bust line. (About 10 percent want a smaller implant.) A well trained surgeon can give you good advice because he or she knows how to rate various factors – like the base diameter of the patient’s breast, shoulders, hips and general body build – to recommend an implant for a breast size that best flatters you. The board-certified surgeon will also consider your profession and culture in recommending a final size for your bust line.

Have you ever considered breast augmentation?

Two plastic surgeons in Virginia and Maryland noticed a slightly different way to administer pain killers. It made that is making a large impact in a first study on 200 patients.

Dean Jabs, M.D. and Franklin Richards, M.D., like most other board-certified plastic surgeons, are very observant and noticed that most liposuction patients have very little pain afterwards.

So why not have the same technique for breast enlargement patients?

In liposuction, the treatment areas receive large injections of a medication to lessen bleeding – but that medication, lidocaine, is also a potent pain killer.

When performing a breast augmentation, the standard procedure for many is to make a pocket – for the breast implant — under the large chest muscle, the Pectoralis major.

Part of creating that pocket involves making incisions in the chest muscles. And that’s what creates a lot of recovery pain for patients, even though “pain pumps” are often put into patients’ chests before they wake.

Narcotics are available, but the side effects can be unpleasant.

The surgeons thought a better way might be injecting long-lasting pain relief into the chest muscles before creating the implant pocket. Additionally, they used another long acting anesthetic, Marcaine, in any muscle that had to be cut.

Soon, recovery room nurses were asking the doctors what they were doing differently. Breast implant patients treated with the pain medications at the start of the procedure were found to be more comfortable in recovery and leaving sooner. (Read more about the breast augmentation pain relief study.)

The physicians then compared 100 patients who received the new treatment with another 100 similar breast augmentation patients who did not have the extra medications.

Women treated with the extra measures went home sooner, used less pain medication while recuperating, had less nausea and were more comfortable during recovery.

What’s your experience with pain killers?