Hey there, it's your old pal Josh. This week's curator of s Y s K selects, and this week I've selected how breast implants Work. Uh. It's a pretty great vintage episode. Has it all science, pop culture, history, surgery, all sorts of weird stuff. And this episode is the origin of when I realized that Chuck says the word tattoo really oddly. So enjoy it. Take care to two. Welcome to Stuff you Should Know Reroomhouse Stuff Works dot Com. Hey, and welcome to the podcast. I'm Josh Clark, and there's Charles W Chuck Bryant, and Jerry's over there. So you got the three MUCHA shows together was well, Chaos and Muchacha. Is that right? Is Muchacha a girl? It makes sense to be probably that's generally how worths right, Yeah, but I also may have just made up a word in Spanish that it could be a snack food. Anyway, this is stuff you should know, and we want to extend a extra hearty welcome to all the additional twelve year old boys who are listening to this one. We want to apologize in advance for disappointing you, because you're going to be sorely disappointed, and I would like to insert a quick c a okay for myself. Um, we're gonna be talking about breast implants, and I'm gonna try not pepper the show with my own opinions because we have the to each his own decree here, And I'm just gonna go ahead and say out front, I'm not into it. I wish people would just learn to love themselves. But I get it, And if someone feels better to do something like this, then then that's fine. No judgment here. Yeah, Um, who are we to judge? Yeah, it's gonna be tough in the parts about like the string Uh what was that one called the string implant? It's dead and gone, yeah, but still we got to cover it. Well, you might hear some derision in my voice, a little like, but again, if a string implant is what uh, those women wanted to feel better than, then you have to go to an underground doctor to get it. Now, Well you do now, Yeah, And of course we're gonna you know, it's not just like just augmentation, like you know, mastectomes and men can get breast in plants. So we're gonna cover the whole gamut. Yeah, you're given a lot away here. People know the whole the whole farm. People know. People are gonna they're not gonna want to buy the cow because you just gave them all the milk. Hey, this, this milk and the cow are both free anyway, so let's do it. That's my little c o A. That was good chick. Thanks. Um. We are talking breast implants, and we are going to explain everything there is to know about breast plants. Breast same plants, not breast plants. That's a it's a subtropical species of carnivorous plant um that looks like a breast. Oh is that where it gets his name? Um? Anyway, I want to have I have a little intro. So, um, have you ever heard that in France the perfect breast fits into champagne glass? I have not heard that. So you told me this and I was like, what are you talking about? I thought that at first two And she's like, no, we're not a flute, you dummy, a coupe. Because I was, I was saying that very odd of banana. It's a weird. Yes, it would be a little weird if that were the case, but as champagne coup. So she looked it up and was showing it to me. And while we were UM, while we were looking at that, we found another axiom that was possibly even more true that in America. Somebody commented underneath this, in America, the of a breast cloggs a toilet doesn't fit into a champagne coop. It cloggs a toilet. That's an axiom, it is according to this comment or who made it up. I did not know that. I I think the commenter made it up as a joke, okay, and it was a pretty funny joke if you ask me. I thought I was going to get a bigger response from you, but I'll live with what I got. Um. The point is is, if in America that is the standard breast so big that they clogged toilets, that's a pretty high bar to set, especially naturally, which is probably why some women turned to breast implants. Yeah, and speaking of America, it seems like a good place for that. Um. They topped the list in the number total number of breast implant operations. UM. But if you want to go per capita, there number five and the first four are Brazil, Greece, Italy, and Colombia. Per capita, which is to me, what matters per capita. Sure, obviously we have the most because we have more people, right than in those other countries. I am surprised that we're number five. I would think we'd be higher than that. You know, it's number ten per capita. Of course, what is that, right? Yeah, they're like comfortably in the middle. Although no, that's still pretty high towards the top. Although I guess it would be about in the middle if you just did industrialized countries. So anyway, there's my stat that's a great stat. I've got another one for you, Chuck Um. Breast implants was the number one elective surgery in two thousand twelve in the United States. In two thousand eleven it was LiPo, but breast implants breast augmentation. Um beat it out in two thousand twelve. I don't know how many, probably by a nose, because in two thousand eleven it was three hundred thousand and change LiPo sections, and in two thousand and twelve there are three hundred and thirty thousand, six hundred and eighty one breast augmentation surgeries. In two thousand twelve, according to the Wall Street Journal, you know that was a rhino plastic sat that would have been a great joke by knows By. You know, yeah, I bet that's on the top five. Oh, I guess so sure. In fact, I bet that's number three. There's several ways to find out, should we know, Man, this thing is all too a rocky start. I'm just guessing. Okay, So let's talk breast implants. For before we talked implants, Chuck, we should probably talk about well, you want to talk about the history of him. Yeah, that's a good place to start. So apparently a guy, a doctor named two doctors named Frank Garrow and Thomas cronin Um came up with the idea. And Garrel specifically squeezed a plastic blood bag one day and remarked how much it felt like a breast, right, and that was um circu Yeah, And so he had the That apparently was the quote unquote aha moment like, hey, we should do this. So they tried it out on a dog named Esmerelda and uh and not obviously, you know, they were just inserting it into a body. They weren't like, hey, let's give this dog boobs. You know, they have always wanted to see what boobs look like kind of dogs. So they wanted to just see if it worked, and it apparently it took enough to where they're like, hey, I think we can try this on a person. Yeah, Esmerelda chewed at our stitches, so they had to remove it after a couple of weeks. But I mean that they were they were. It was definitely an improvement on um, what had been an innovation among Japanese prostitutes during World War Two because American gis again boobs that calged a toilet um. They apparently the Japanese prostitute said, Hey, these guys like big boobs, let's give him big boobs. Let's steal some medical grade silicone from the docks of Yokohama. I thought it was sponges that that was something. They also they self injected silicone directly into their breasts, which apparently worked, but it also gave them things like gang Green thinks the silicone rot At the side of injection. There was a lot of hematomas, very bad news stuff, but there was a It showed this desire to increase breast size, and these guys in the early sixties came in to deliver that's right. Uh, and they did it in it's sort of a weird way. There was this woman named Timmy Jean Lindsay in nine two, a mother of six in Houston, Texas, and she had to too of a rose vine on her breasts that her boyfriend talked her into. Broke up with a boyfriend and was like, I kind of really don't want this anymore. Went in to get the two two removed and she had to change to wino forever exactly, And um, why are you saying to huh? I always said that it's tattoo to too. No not I mean no, okay I And if you say it like that again to each his own, if you want breast implants, fine, if you want to say to too, fine, But I couldn't just sit here and pretend like I didn't notice that you were saying too. I've said that plenty of times and be ignored me. So are you sure? Yeah? Alright, alright. So anyway, she went in to get the tattoo removed. No, no, go back, go back to to two. I feel too guilty when you say tattoo to get it removed and umo, and she said that, Um, they said, hey, we got this new thing called breast implants. Would you like to try it? And she said, well, my ears stick out too much. If you if you pin my ears back some, I'll let you use me as a guinea pig. Basically, she knows how to bargain. Yeah, and that's what happened. That's the first breast implants were sort of a bargain like that. She went from a bead cup to a seat cup. That is correct. And um, this is at a time when women wore pointy cone braws and stuff like that. It was there was a big emphasis on big boobs. Maryland was big. They had false ease, even like the padded braws. Yeah, so there was, I mean, this desire to increase your bus size and to do it permanently. It was there and it just kind of took off like a rocket ever since then, ever since that the first procedures. The problem is there were all sorts of lawsuits associated with it too, especially because they were using medical grade silicone. Uh that's derived from silicon, which is a mineral that apparently makes up about four of Earth's crust, mixed with oxygen to create silicone, which is was originally a trade name of this medical grade silicon gel um created by GE and the early implants would rupture, and there were a lot of lawsuits against some of the manufacturers, specifically DOAO, who shell out like three billion in UM in payouts in just like the course of a decade. Yeah, and well, so you might as well go ahead and let the cat out of the bag. They finally FDA said, actually they they put a voluntary moratorium. They were like basically asked, can you stop making them in doctors? Can you stop using them? Except in certain cases? Yeah, Like there was inconclusive studies. Basically they never found like hard proof that it could cause illness, but um, it was enough, I guess in conclusion to say maybe we shouldn't push on with us. Yeah, because the when the when the implant ruptures and it's silicone, the body absorbs the silicone, and they're like, just there, Well, what happens to the body after it absorbs the silicone will happen, right, So, since no one knew, they created that moratorium. In two thousand and six, the FDA finally said, there's no evidence that this is bad, so you can go back to silicone. And now silicone implants make up of the you can get them without any special cases. Now, even in two thousand six they lifted the moratorium. Got you because for a while it was just like, um, if you had a mastectomy or um, if you were willing to if you're willing to be part of a study going on five to ten years um. And the reason why silicone was so popular, and the reason actually they looked at the band ultimately, aside from the fact that they never found any, um, real provable medical problems from it, is that it's apparently far superior to the alternative, which is sailing filled bags. Yeah, they say, apparently the silicone feels better, looks better. It's just look, it's more natural looking. Apparently it moves. Oh my god, I can't believe I just did that. Uh, the in the sailing is just kind of like a water filled implant. Yeah. Should we tell everybody Josh just talking with his hands, that's all. Um. Yeah, so this is not a video podcast, So that's okay. Alright, So silic is back. I don't I don't think I knew that back in a big way. Se Man. That's a that's that's a significan again, amount of three hundred and thirty thousand. Um. So let's talk about before we get into like how breast implants work and how they're inserted and all that kind of stuff, let's talk about the breast itself. Um, the anatomy of the breast as it Well, apparently you can break a breast down into two different and by the way, only women have breasts. Men don't have breasts. Um, But you can break a breast down into two separate parts. There's the structural component and then there's the epithelial component. That's right, and that produces the milk. Uh. Structural component is um ligaments, fatty tissue. Um. There are there is muscle, but not actually as a part of the breast. It's behind the breast exactly. Yeah. And there's a there's a ligament that kind of works to to keep the breasts suspended supported called the Cooper's ligament. Yeah. I looked into that guy, by the way, what is he like? He was He was just very big on describing anatomy in the you know, mid eighteen hundreds, and he's got a lot of stuff named after him, a lot of diseases, a lot of body parts, Cooper's ankle, Cooper's ligament is one of them. It's just the ankle, but he pointed it out exactly. Um, But yeah, that is is They kind of called these muscles in the ligaments sort of like a natural brazier to help keep the breast up. UM. And then there's the milk producing in delivery system. Milk production and delivery system, it's the epithelial component. You've got UM. Apparently fifteen to twenty five lobes are what they're called um and they're arranged kind of like a flower around the center of the breast. So if someone says your breasts are like a flower, they're they're complimenting your lobes exactly, and that's anatomically correct. UM. You can still smack them in the face though if you want to. Yeah. The lobes can further be broken down into lobules, which are kind of like clusters of grapes, and there's a lot of these um per lobe, right uh. And then at the end of the lobules there's dozens Each lobule has dozens of bulbs and that's where milk is produced. That's right. They're connected to ducks called the lactiferrous sinus, and that carries the milk to the nipple. Of course, the nipple surrounded by the areola, which is that dark tissue around the nipple at the front of the breast. And there you have it. It's breast one on one. That's the breast, and then behind it you've got the pectoral muscles, the major and the minor pictorialis uh and then the rib cage behind that. So that's the anatomy of a breast. That's right, got it? Yeah, they are since we're talking size. Obviously with augmentation UM it is not a scientific thing, but you generally go by brass eyes. How they're manufactured is by a diameter and inches around the rib cage under the breast, and then the old letter indicating the cup size. So in other words like uh a A or double A all the way up to it says in the article double D and beyond like some fantastical like alright, so now I understand the breast ambrass eyes. Yeah, and by the way, it's hereditary. Probably if you look at your mom and your grandmm, it's probably what you're what you're heading towards um later in life. Right, there are things that you can do to to impact your breast size, positively or negatively, depending on your opinion. Sure, weight yeah, um, some things that you can control like um, menstruation, menopause, pregnancy, all effect breast eyes and guys hear a lot about and actually girls to hear a lot about this if you have a girlfriend or a wife. Yeah, but just becomes a common topic of conversation when you live with somebody for long enough. Breasts. Yeah, I mean there're a thing. They're there, they are there. Um, that's a T shirt, it's a movie. So check. Now that we have the anatomy of the breast, um, let's talk about breast implants themselves. Yeah, the actual thing that has implanted. Some people might not know this. I thought everyone knew, you know, has has seen them before. But it's not has felt them, has slept with them on their pillow. It's not. Uh, it's not just like an an injection or something. It is and there's not a pill you take. It's an actual physical Who thought it was a pill. There's one dude out there that thinks it's a Bill Todd. It's not a pill. Uh. It is an actual uh sack. It is an elastomer shell, which is an elastic polymer shell and it is uh generally these days they are empty at first and it's in in they're not full, although it depends, well, it depends on what you're after all. Well, you have the empty kind that they usually roll up when inserting, which we'll get into, or you have the um pre filled, which are not pre filled to their final destination. Yeah, and they're there. Um, they're like a certain size. They can get to a certain size. I think those have fallen out of favor somewhat, but I'm sure. Well, yeah, mostly they're they're not pre filled these days. Well there's a lot of benefits to not having pre filled again, which we'll get into a little bit. But okay, um, the size then would not have to do with what they're already filled with, but what they're finally going to be filled with. And it's usually mentored measured in cubic center leaders right, Yeah ccs ccs and one cup size um for every hundred and seventy five to two hundred ccs. And I guess this is where we should talk about the rice test. Okay, um, if you want to know what your breasts are gonna look like, or if you're a man who always wanted to know what it would look like if you have breasts you style, you can um do something called the rice test. That's right, they apparently this is the best way to tell um. You cut a twelve inch length of panty hose, although they say you can use like baggies or whatever, but panty hose is probably the most realistic. Tie not in one end, and then use a chart um which you can find online, to basically fill with rice to estimate what you will look and feel like. For instance, about a half a cup is a d c cs of volume. About point six is a D fifty season on up and you can find the chart online. Just under three cups seven ccs. That's a lot. That's three cups of rice um. And remember it doubles in your stomach so you'll feel full. Uh So they say they recommend to like, uh, put in a sports bra where that wear it around, exercise in it, run errands, do whatever you normally might do to get the look in the feel of like, hey, this is what I'm gonna look and feel like? And you know, should I continue? Should I not? As too big? Are they too small? As the grocery store clerk who's checking you out. They're fine, ma'am everybody. Well, they also say you can use water, um, instant mashed potatoes and oatmeal instead of rice. I could see instant mashed potatoes being really good, because aren't they like flaky it's flaky potatoes. I could see that rice is that's I mean, that's hard. Yeah, that's true, but you should call it the instant mashed potato test. I think that's why they didn't. So anyway, that's apparently how you uh, and it's obviously you want to work with your doctor two um kind of like singles. Remember that movie when Bridget find It goes in for breast implants and Bill Pullman essentially talks her out of it. I forgot that part. Yeah, but you're gonna do that. You're gonna work with your doctor on appropriate sizing. Yeah, it's not gonna be like weird science, you know, where you just like click on the mouth until tremendous and large, um with some eighties graph behind it. But you want it. You just want an appropriate size for your frame basically, because not only just for looks, but for you know, can you support it with your body frame? Well? Yeah, that weight, not just that, I mean not just like the extra pressure that's gonna be put on your back and shoulders and all that, but I mean like your your skin itself may have trouble supporting the breast implants, which is definitely something to consider as well. Yeah, and this article says generally they come in three sizes, but there that's just not true. There's like four and fifty sizes. Well, I like this article is right, and I think in two thousand three or four, and I mean it's definitely breast implant breast augmentation surgery has increased by leaps and bounds since then. Um, I've seen up to four and fifty different varieties and I think that's combinations of shape, size, that kind of thing. But yeah, there's a lot of different sizes. Um, mainly the sizes again it has to do it's measured in ccs. The shape. There's still typically just two shapes that I ran across. Yeah, there's round and then there's a tear drop, which is also called contour. Yeah. Yeah, and basically one the round. I guess it depends when you're talking to They can be more popular in that there fuller and uh, there's more cleavage and there's more lift, but they don't look as real. The tear drop shape mimic the anatomy of a natural woman's breast. More so, some women might favor those if you want to look more natural. Right, Um, but round is the most commonly used, I believe. Well, I don't know if it still is. I take an issue with that, Okay, I think that's a two thousand three statement. Um. Again, though it has to do with what what shape you choose, you know, not just what you want how you wanted to look. But I mean the surgeon needs to have some input here too. Yeah. And if you get a good surgeon, they're gonna guide you in the right direction. You know that. That's their part of the job. It's not just to perform the surgery. It's the consultation and advice and all that good stuffy um. And since they're plastic surgeons, to look good doing it. Yeah, And if they're not doing that, that means it's a bad plastic surgeon. Did you see Rob Low in Liberacia? Man? Well is there are some real decisions made for his character and his look and this well that's what that guy looked like, Is that right? Yeah, yeah, I look at my ps. He was creepy looking. I will, I will is he still alive? Because I'm so sorry for what Chuck just said. I don't know, um, but yeah that was plastic surgery. Gon'm bad for sure. Yeah. Uh. Texture is another decision that you're going to have to make in addition to shape and size and um. Basically there's smooth and there's textured and um. Each has their pros and their cons um textured implants. We should say when you when you have breast surgery, something UM that's gonna happen is scar tissue is going to develop no matter what. Anytime you introduce foreign object into your body, your body basically defends the rest of your body against it by forming scar tissue around it and basically compartmentalizing it. UM. And in the case of breast augmentation surgery, this is called a capsular contracture. And it's gonna happen. Don't be freaked out if it happens, because it's gonna happen. It's just the degree to which it happens could become problematic. Right. And there's there's post post implant surgeries that can take place to remove some of the excess scar tissue if too much happens or your breasts become too hard as a result. But you're right, it is going to happen. And um, some implants have been created to I guess, make the most out of this. Textured implants are designed so that the scar tissue basically grips the implant and holds it in place. Yeah. And I also got the idea too that less scar tissue will form because it sticks to the implant. I guess the body just thinks, Okay, this is working. My job is done exactly. Um. There are some drawback the texture and implants. Apparently they're not quite as realistic in their movement. Look feel that kind of thing, yea, and they're more likely to rupture too, yes, which is not good. Smooth implants. Um. They actually will move around inside the capsular contractor the scar tissue sac that um that develops um, which is good for look field. It's much more natural. The problem is is that since they can move around, if you have something like a if you choose a contour or tear drop shape breast implant, if that thing flips upside down, your breast looks to forb Now you have a problem, yeah, or it can cause something called rippling, which we'll get into the problems that can arise later on. Um, And there's this lady in Akron actually, Ohio, it's probably good time to mention that she is trying to develop a breast implant that actually, um well, it can accomplish a lot of things. Is she calls it the breast implant of the future. It can emit basically the drugs that they give people, orally she is trying to build into the implant itself to emit these drugs naturally. And she thinks one day breast implants can be can actually detect cancer cells if her researches. You know, if she gets to that point, if I have the funding, especially she's looking too many but the breast implant in the future, I just need the fund But um yeah, she's she's she's working hard to try and reduce things like the inflammatory response and scar tissue, building it into the breast implant itself, which is pretty cool, I think. And then Chuck, we kind of already talked about it. But another choice is whether you're gonna have pre filled or unfilled or also known as expandable that's right, umpt. Yeah. The spectrum Expandable is sort of like a test drive almost where you have the implant put in, there is a three part valve system in your armpit where you actually can fill and release and extract some of the sailing or I guess silicone. I don't know if they can do that for silicone. I know they can, can it's Joel, I think you can. Yes, Well, basically it's like a test drive. They put it in and they can make them larger or smaller through your armpit until you're satisfied. It's kind of like doing the rice test, but a couple of steps further more than a couple because you're out there walking around saying what do you think? Yeah, and you've got a port in your armpit right, But then after you say this is it? This is the right size, they removed the port. So obviously there's a bunch of choices, and you, the patient, the person who is getting the breast implant, have a lot of things to decide. But then once you've decided all that, it's up to the surgeon to make some another series of decisions. And we'll get into the procedure right after this message. Alright, so back to it. Let's talk surgery. Huh yes, UM, all right. The most important thing they say with the breast implant is not all the other decisions you've made up into this point. It really is. It's the skill of your surgeon with the placement of the implant. Yeah, because that's where things will generally go wrong. And there are three choices, uh, subglandular, sub pectoral, and submuscular. And again, like with everything else, their advantages and disadvantages to all three. Um. Sub glandular is behind the mammary gland in front of the muscle. Um, it's the least complicated. You're going to get out of there and recover quicker. Um. It's if you're athletic. It's probably has some advantages, but um, you have an increased chance for that capsular contractor we're talking about. You might be able to see it sometimes, which is not good. Yeah. And it's more vulnerable because it's just kind of right there behind the skin. Plus also there's um, very little besides the ada post the fatty tissue holding it in place. UM, so it can produce that rippling thing, which is a sagging that produces basically UM what's that called, like on your skin when you when you gain weight and then lose it. I don't know, stretch marks. Oh yeah, it looks kind of like that, but I think they're deeper, okay. Um sub pectrol's next subpectrol is so you remember at the back between the ada posts, uh and the chest wall, you've got your two pectoral muscles. Um, the one in front the bigger the two. The pectorialis major um is goes in front of the implant, and the pectorialis minor goes behind it. So it's sort of sandwiched in the middle there. Yeah. You you have to cut the muscle, put the implant in between them, and then lay it back down. Yeah, and it is. Um. It's gonna reduce the risk of that capsular contractor and the rippling, which is good. Uh, but of course your recovery time is gonna be a little bit longer. It's gonna be a little more painful. Anytime they're manipulating muscle, it's gonna be pretty painful. There's gonna be more swelling and stuff like that. Um. The implant can also kind of droop. There's still a risk that it's gonna pull down because there's it's held in place more than it is with the subglandular um, but less than the submuscular. This is if you want your implant to not sag, you want to go with the submuscular. The third type, Yeah, that is behind fully behind the chest muscle wall and um. It has some great advantages, like it doesn't get in the way of mammograms, which is a big deal. It's a big consideration for sure. Yeah, silicone and salien implants um placed in front of or between the muscles can mess with mammograms. And you need to tell by the way. I'm sure you probably know this if you have breast implants, but you should always tell your doctor, you know, if they don't know when you go to get a mammogram, because they have different eaters and techniques that they can like work around and stuff. Yes, so those are the three types of three implant locations. Yeah, and the recovery for the last one is even longer, but has the same complications as a subpect rule, anytime you have to in size muscle and manually adjust it, you're gonna have a recovery time involved. That's true. Man, it's gotta hurt. Um should we talk about. We've got to talk about the polypropylene real quick, just because even though it's not around anymore, the string implant, Yeah yeah, it was developed by a guy, a doctor named Dr Gerald W. Johnson. And um, the quote from this article says it was designed to yield extreme, almost cartoonish breast sizes. And um it basically the pop polypropylene um absorbed fluid over like constantly over time, and the breast never stopped growing. And um it has been banned since two thousand one by the f d A. And although they say it was very popular among adult entertainers for a while. And um, yeah it's this is where I get a little judge. It's really weird looking. Oh you saw pictures. Yeah, and uh, I don't get it at all. Is it cartoonish? Yeah, very much? So yeah, um it's okay. That's my only judgment. Yeah, recent judgment is I don't get that one. Researching this article, I wanted to be like, I'm researching breast implants. I'm not agreed. People walk by your desk. Um, so chuck, let's talk. Let's talk procedure. We're we're in the operating room. All the decisions have been made. Uh, preop has been done, prep um, and the surgeon is going to start by making an incision. And um, there's really basically four types of incisions that are favored among breast on augmentation procedures. Yeah, you've got the peri areolar, which is apparently one of the most common ones. But to me, it's seems spectacularly has It's like there's a lot of room for complications. You think, yeah, what they're doing, I look this up. The the article isn't through this justice. The incision is made at where the areola, which is where the it's the brown tissue that surrounds the nipple. Okay, so um, it's it's where the areola meets the regular um colored pigmented skin of the breast um. But the whole areola is cut and pulled out and then the um the using a sterile sleeve wrapped around it. The implant is put in through that hole in the front of the breast and then unrolled in the sleeve is removed. Um. But you're going around the milk ducks and the all of the epithelial system of the breast. It just seems like you're you're exposing some really important stuff. Um to a lot of potential damage, you know, either mechanical or through infection or whatever. It just don't see much reason aside from the fact that it uh it's very difficult to see the scar because you're doing it where the pigmentation changes, so it's hard to see that difference in that that scar. Yeah. Well it also allows for more precise placement of the implant. I see that, and um, I think it's you know, there's there surge surgeons doing this. It's not you, So I know it freaks you out, but I think it's the most common for a reason. Um, that's one. Yeah, but that allows for subglandular, subpectral uh, and submuscular placement. So that's the other advantages. You have all your options open. Yeah. Um, there's also the inframamary fold incision. This one makes sense. Yeah. That also allows for all three um placement types. And that is that is just under the breast, So the scarring is you know, not as visible obviously. Yeah. Usually it's where the creases. Yeah. The big disadvantage to this one is if you are going up so much in in cup size. Um, if you're going up a lot, the surgeon is going to have to create a new crease for your breast, and when making that incision, since you want the incision underneath the breast, the breast hidden by the breast um, he has to guess where that breast is going to hang now and make the initial incision accordingly. Yeah, that's when it's work there, well, not guess work, but because that makes it sound like well education, that looks good. Well now he has to be like, where is this going to forecasting? Yeah? Educated, yeah, very educated, guess so. Um. Then there's transaxilary incision, which is through the armpit. Yeah, there's no breast scarring at all obviously. Um, it's more of a challenge because placement is pretty difficult. Um, they use an endo scope and that is not the most Uh, that's not the strangest place. No strange places. Through the old belly button, the TUBA incision, you can actually get a breast implant through your belly button. Yeah, and apparently you can get a lot of surgeries through your belly button. I think maybe that's why it's there. Um, maybe that's it's the new port. Yeah. Um. TUBA stands for transumbilical breast augmentation. Then that's a tuba incision, the belly button incision, and um, basically they cut into the navel at the top at the ridge and then go they burrow all the way up to each breast, so it makes a V through your subcutaneous fat like Charles Bronson in The Great Escape. Yeah, and then yes, and then they use um uh an end of scope to basically tunnel their way through and see that they're going the right way, and they push the implant up through there and inflated. Yeah. Yeah, that sounds like guesswork. Yes, but apparently that's the one that has the least complications. Yeah. There are a lot of limitations though, Um it requires an inflatable implant. Obviously, you can't go through the belly button with one that's already inflated. Um. It can only be used for subpectrol and submuscular And if there are complications, and it seems like there are, I don't want I don't know if I should say often, but it's not rare to have complications and have to go back and have um what they call a revision surgery. You cannot reuse that incision. No, they're gonna have to make um transaxillary, periariolar or inframamary fold. Yeah, if they need to go back in again. And um, apparently it's pretty rare, Like, not a lot of plastic surgeons even try this one. I think it takes a lot of skill. And even though the comp occasions, the post stop complications are minimal compared to the others because you're subcutaneous fat and your abdomen apparently heals very easily. Um, just getting there is kind of a problem. So let's say your doctor's ready, you got the first incision. Um, what's up next? Uh, well, you've got your incision, and so they have to cut a path through that tissue um, depending on which one you use. They're either gonna work with the muscle or they're not. And they need to separate and create a little pocket for it to sit in. You know, they don't just stuff it in there. They need to create a space and they have to figure out where that pocket is best going to be, depending on the size, shape, everything of the breast implant. Again an educated guess, yes, And you've seen some surgery nightmares with breast augmentation, and that's like Dr Quack, you know, Dr Nick it's good about there. UM. Sometimes UM mast up master PEXI, which is a breast lift, is performed at the same time, or you can just have that on its own if you just want a breast lift. But sometimes it's used with augmentation in order to get everything in the right position and you want, you know, the breast to be pointing in the right way, and you want the nipples in the arrow aerial is to be in the proper place and not looking off to the left and the right up or down. Some surgeries require that you reposition the nipple depending on how big the implant is going to be. Yeah, and man I saw with some mastectomy surgery. Sometimes they can completely remove the areola and nipple and replace it onto a uh augmentation or yeah, I guess with a periolar incision, if you're taking that whole thing off, you know, I guess you could move it to another place. What they can do UM sizers can aid in positioning, and that's sort of like it's attached to a tube. It's an implant attached to tube, and that's that's almost like a live rice test, Like you don't go home with that. They just put it in there. And mid operation. Yeah, and see what it looks like, not the final implanted, temporary and then they pull that out once they say all right, that's a good placement for this, so just let me do it for real. Um. And then so if you have pre filled implants, you have to make a larger incision of course, and then you fill those up to their full um volume. And I think prefilled textures textured is even the largest. That's the biggest incision you're gonna because you know, yeah, you also have to make room for this ridged implant that's already pre filled um. And either way you're gonna have to either top off or totally fill up this the implant once it's in there, top it off. That's pretty much what it is, So chuck um, we're talking augmentation. It's elective surgery, plastic surgery. And a lot of people think like plastic surgery is called plastic surgery because it's artificiality, right, But actually it's derived from the original Greek plastic hosts, which means uh, artificiality. It means to mold or shape something's plastic, it's pliable. Yeah, and that's what that's what plastic surgeons do say, mold or shape things, including breasts. It's it's like you said, it's not just making the cut and jamming the thing in there. They have to um, basically reconfigure what the the anatomy of the breast to to accept this new um. Yeah yeah, um. And it does take a certain amount of skill, but that's that destruct me as interesting. Yeah. They call it plastic surgery, and it's not all just augmentation doesn't always mean you're making your breast larger. There's also reduction mammoplastic, which is breast reduction. If you feel like you're too big and you have back problems or for any other reason, you can get breast reduction. We already talked about the mast aplexi, which is the breast lift, and that's when they actually remove skin and rejoin it to lift it up. It's pretty simple. Actually, I wouldn't want to perform it, I'm saying, but in uh, what's the word concept, it's pretty simple, right, um. And then breast reconstruction UM. A lot of times, if your breasts have been removed for mostectomy or damaged and you know, because of some accident or something, they can actually reconstruct your breasts in a realistic fashion, right, and uh, we said women aren't the only are the only um humans that have breasts, But there are um electric procedures for men who want to bulk up their pecks called pectoral implants. And what did you watch Entourage? Johnny dropped like, I don't think he got him, but he wanted caffeine plants at one point. I've heard of those. Yeah, caffe implants. Uh yeah, pec implants. Come on, Um see I can judge guys. What are you doing dudes? So well, well, well that's we'll see what we're doing. Um. The arm it's done with an armpin incision. It's a lot like the trans axillary breast implant, thank for women. And they go in there and lodge it behind the peck muscles to just kind of bulk them up to stick them out further. Um, and there you go, all of a sudden, you are Charles Atlas. Yeah. Or you can have reduction as a man too, if you're Bob from Fight Club. Yeah, yeah, that's right. Um kind of because because maastia, um, it's usually hereditary. It can be as a result of your diet, but basically it's when guys end up feeling like they have boobs and I feel like or do yeah, and it's it's an embarrassing thing. I'm sure. So you can get that removed. It's basically um bypo suction just under the nipple, right, And if it's the result of a glandular disorder, they'll probably just take the glands out while they're there. And usually it takes more than one surgery, but it can be corrected. What if insurance covers that? I don't know. Does insurance cover any kind of plastic surgery? I don't know, I don't I bet you wouldn't cover that because it's still cosmetic, you know, I don't know. I mean, I think you probably have to show the medical problem, right, but I think you can if you show that you're suffering from it psychologically, it might fall under it. I don't know. We'll find out, because I'll bet you an insurance claims adjuster writes in and tells us that's my prediction. And you know what, I was judging on the peck implants for there maybe uh cases I don't know about where guys have sort of like malform chest or something and they just want to look normal. Yeah, I was talking about the guys who are like still judging hit the gym man, do h some bench press? You know, you want to increase your packs. So yeah, push ups. Let's talk. Let's give me sit on your back and do pushops one one handed mershell walker style. Yeah. Supposedly he never lifted weights. Did you never know that? No? Yeah, he never lifted weights in his life. Everything he had people sit on and do push like two thousand push ups a day and stuff like that. It was all either isometrics or like chin ups, push ups, pull ups. Uh, rolling a attractive tire exactly old school. Let's talk risks, man, because this is uh, this is first of all, it's surgery. So there's always an attendant risk with any kind of surgery where general anesthesia is used. Right, it sounds like a disclaimer. Well, it's true. I mean surgeries. Surgery is risky. Um. Well, anesthesia is risky. Um. There's also infection. Anytime you're cut open, there's a risk of infection. But then breast augmentation surgery comes with its own attendance set of risks that are um, they vary from definitely gonna happen, like the capsule contractor Yeah, this scar tissue to extraordinarily rare like semastia. Yes, did you see this? I did? It was I had no idea that it could happen. Semastia is basically where your breasts joined together as the result of an augmentation surgery and you have one mega breast. Yeah. Um, I have seen something that make braziers now, like post surgical braziers and try and yeah that try and prevent that. Um. But yeah, I've never heard of that either. I guess they so after surgery, do they just kind of gravitate towards one another? Um? Actually, I'm not sure. It just says it. It's it's a mistake. So it's not like some just bad you know, bad fortune. It's actual surgical mistake. You get to own a portion of the doctor's office that But yeah, the implants lift off the tournam and grow together. So um, I guess the scar tissue grows together in that case. That's my guess. It's kind of like a unibrow made of breasts. But apparently it's fairly hard to correct, is the big problem. Yeah, that's that's pretty sad when you go in to try and make yourself look better. And you feel bad about yourself already maybe and then you end up like with something like this. But these are risk you need to know about, you know. And that is the opposite of the total recall, which is three breasts. Yeah, remember that I forgot about that man. That was a great movie. I wonder if they put that in the remake because that was one of the sort of goofy signature moments of that goofy movie. Yeah, that was you know, it's a Philip K. Dick novel. Yeah, I wrote like all sci fi basically. Yeah, pretty much any sci fi movie ever was written by Philip K. Dick. Did you know that he believes he was possessed by an angel later on in his life? Really, yeah, he came to he he believed that he was possessed by a benevolent spirit that basically took him from being like a complete shlub, drug addict loser who still wrote great novels to just becoming like a person with a fairly normal, orderly life. Uh, he cleaned himself up. He attributed it, all of it to this possession that said, this happened and that was the rest of his life. They should make a movie about that guy. I'm just kind of surprised they haven't, but someone does. Eventually he's here and then because it was my idea. Yeah, you can't just say that every time. It's got to be like your idea, a good idea, not obvious memories. And I know everyone agrees with shark, but that's like saying they should make a modern movie on Charles Darwin. Right, I made that up right, you can't do that. I'm not going to support your lawsuit against two ever makes the Philip K. Dick movie because now you're having a depressing effect on innovation. Yeah, you're right, I apologize everyone, alright. So bottoming out, let's get back to the risks. Um. Bottoming out is when the implants sit too low, the nipple rides too high, and that is a result of another mistake. Basically, they cut out too large of a pocket, so it sits down too low. It is correctible though again with a revision surgery. Yeah, there's a humatoma, which is basically blood collecting and pulling around it um. It can be painful, requires drainage, sometimes can be lumpy. Yeah, we talked about mammography being interfered with by breast implants, which is a problem, but I guess they're kind of there is technology then that you came across that, Yeah, as long as they know, but it can you know, it can hide cancer growths and X rays and you know, it's uh, it definitely has something to consider, especially if that's something that runs in your family. Yeah, um necrosis, which anytime you hear that word necros in anywhere, you're headed for bad times. That is tissue death. That is pretty rare, but it's really serious and it usually results in removal of the implant. And like sorry, sorry, you know you can't have breast implants large large scars, permanent scars. It's bad news. Um. Again, the breast implant canter rupture. Apparently most implant manufacturers offer warranties for the breast uh, the implants themselves. You gotta fill out your little card right and you also mentioned like what magazines do you like exactly? Um, but there are a lot of things you can do to void said warranty. Yeah, probably, like leaning on fences is against the warranty. Just things like that, like you you have to once you get your warranty from what this article. As this article paints it, you. Um, basically, you have breast implants down. You have to be cognizant of that or else you they are at risk of rupturing. Yeah, they're not indestructible. Um. Did we talk about s roma? That is just a collection of fluid, pretty minor and they can usually just drain that with a needle. Yeah, and then uh, we covered both semastia and rippling, and those are the risks and you've got to consider all that stuff because it happens, and it's probably your worst nightmare. Some of that bad stuff happens. So I think you kind of hit upon it pretty well earlier. Um, he said, if you're gonna do this, you need to know all the risks. You should be fully informed if you're gonna make a decision like this. But if you make that decision, go for it. And in singles, Bill Pullman completely talks right of it. And basically it's like tells her how beautiful she is and how she doesn't need that kind of thing, and it's like the sweet camera and chrome moment. He wasn't into each his own. He was turning down money and a potential client trying to get a date, which he did not get well. I imagine Bill Pullman is pretty well off. Uh yeah, he probably was. Uh what do you think Secret Life of Walter Mintie is gonna be good? Or no? The trailer looks awesome. It does look also, it looks really really cool. But I mean, I've been fooled by trailers before, Chuck. I know, I've been waiting for this movie for a long time. They were gonna make it with Jim Carey, like fifteen years ago. I could see that he would work one of my favorite stories. So I'm a little bit apprehensive. But it looks good. Who wrote it? It's right there? Man, jeez, I can't even think of it. It's not It wasn't. Oh, Henry wasn't it was Why did you bring this up? What led you to that? Uh? You're talking about singles and I thought that Ben still Head directed singles. Yeah, those reality bites. Yes, yeah, yeah. And it's taken me like a lot to remind myself you're not talking about swingers. Oh right, so all those movieses? What a waste? Um, if you you got anything else, I don't have anything else. Oh I have one more thing. Apparently, um. Breast implants were linked to suicide and increased risk of suicide, um after a certain amount of years of having them. But this it just popped up in two thousand seven and it was found in one study and everybody it made the news cycle and then just went away. Yeah, and that's all. I didn't get a real accurate stat but the woman, an accurant acron that's still in the breastand Plan of the Future, estimated that about fifty thousand out of four hundred thousand that are performed per year do require like half complications and require revision surgery. So that's an eighth that's probably significant surgically speaking. I want to say also about the suicide think, just based on my knowledge of news and journalism and stuff like that, if it just popped up once and you can't find anything else, and all the reports on it or stories on anything are all within a week of one another, five years ago, six years ago there, and there's no follow up whatsoever. It wasn't a thing. Uh okay, Well, let's breast implants. If you want to learn more, there's a really extensive in depth article on the site, including flash animations of the different types of incisions. Yeah, you can type breast implant into the search bart how stuff works dot com and it will bring that up. And since I said search bar, it's time for message break. Uh and Chuck take us out with some listener mail. Hum all right, James Thurber by the way Secret Life nice. Um, all right, this is from Todd and okay, see and this is about vulture vomit. Hey, guys and Jerry. I just finished listening to the podcasts and Vultures. It reminded me of the story. A couple of my buddies were going to college at in m s u Go Aggies, that's New Mexico State. They were driving through the desert north of Las Crucis. I've been there myself actually, when they came across a small wake of vultures eating some road kill. Two of the vultures flew away the truck approach, but the third was just a little too slow. The poor bird cannonballed into the windshield, which instantly shattered into tiny glass cubes. The vulture's head punched through the windshield while the rest of them stayed outside. The vulture instantly puked all over the inside of the truck while my buddy screamed in the truck. Fish tale to a halt in the middle of the highway. Will that guy painted one heck of a picture just now? When they jumped out of the truck, the vultures wings were covering most of the wind shield. As it struggled to get free, they ended up having to pry it's head out of the windshield the handle of a shovel, and believe it or not, it managed to fly away. Aside from a leg that was dangling and apparently injured, it appeared to be okay. I don't know if that Thanks for the ride, lady. Uh Now, I wasn't there, so I can't promise that the story happened exactly as it was told to me, but I can confirm that the interior the truck smelled like a buzzard barth two months later. Keep up the great work. You're one of my favorite shows. Always happy when the episodes pop up on my phone, which is every Tuesday and Thursday. He hasn't He's not good at recognizing pattern. He should not be surprised. Oh there's another one. It seems like this happens every two days. I'll let my card down and it's Thursday. Hey, uh so that's Todd from Okay. See, thanks Todd, you were not the Todd that I was talking to earlier about the pill. That was a fictional Todd. But how crazy would that be if that Todd did think that breast augmentation surgery was carrying out by PILs. Weird. Weird right back and let us know what you're Todd from Okay, se agreed. Uh. You know, we always love to hear follow ups about our episodes. You can tweet them to us on Twitter. Our Twitter handle is at s y s K podcast. On Facebook, we're at Facebook dot com slash Stuff you Should Know. UM. You can always send us an email to Stuff Podcast at Discovery dot com, or, like we say in the beginning of episodes, now join us at our home on the web, Stuff you Should Know dot com. For more on this and thousands of other topics, visit how Stuff Works dot com