My Plastic Surgery Pet Peeve: Self-Promotion Through Fear-Mongering and Old Implant Photos

Time for a two-part rant about something in my own specialty that genuinely bothers me — and that I think is actively harming patients trying to make good decisions for their bodies.

Some plastic surgeons on social media are self-promoting by misrepresenting valid alternative techniques as dangerous and scary — particularly around breast implants. And the worst version of this involves recycling decades-old "dinosaur egg" implant photos as if they're a realistic preview of what every implant patient should expect. They're not.

Let me explain.

One of the things that's genuinely confusing for patients in plastic surgery is that you can see five different plastic surgeons and walk away with five different recommendations. That's not a sign anyone is wrong — it's a sign that plastic surgery is not like other surgical specialties.

In a lot of medicine, you have a problem, and there's a defined solution:

• Infected gallbladder → cholecystectomy
• Acute appendicitis → appendectomy

In plastic surgery, the same problem can have multiple legitimate solutions, each with its own trade-offs:

• A patient who lost weight may benefit from a tummy tuck, lipo, or both
• A breast cancer patient may be a candidate for implant-based reconstruction, DIEP flap, or hybrid options
• An augmentation patient may do well with submuscular, subglandular, dual plane, or subfascial placement

There are many ways to skin a cat, so to speak. None of them are universally right. None of them are universally wrong.

Here's where my pet peeve kicks in: there is a population of plastic surgeons who are not respectful of techniques other than the one they personally favor.

These surgeons:

• Portray completely valid techniques as dangerous and scary
• Misrepresent the actual risk profiles of legitimate alternatives
• Frame patient decisions as "choose me or choose disaster"
• Build their personal brand on scaring patients away from techniques their colleagues offer

They're not doing this because they've identified a real safety issue. They're doing it because fear-marketing works. Scared patients call their office. That's the entire point.

I find this genuinely gross.

The most aggressive version of this in my world right now is around implant-based breast reconstruction and augmentation. A specific tribe of plastic surgeons has built careers in implant alternatives — removals, flap reconstructions, and "implant-free" approaches. Many of them spend significant time on social media:

• Misrepresenting the risks of implant-based reconstruction and augmentation
• Showing the worst possible implant outcomes as if they're typical
• Framing implant choice as essentially a choice to harm yourself
• Selling their non-implant approach as the only "safe" path

Implants are not for everyone, and there are absolutely patients who do better with autologous flaps or with implant-free reconstruction. Those are valid options for the right patient. But they shouldn't be sold by trashing the alternative.

Here's a question worth sitting with:

No. You don't.

Surgeons doing implant-based work generally don't go after the flap community in this way. The traffic is one-directional. That asymmetry tells you exactly what kind of conversation is happening.

We all know complications happen with every type of surgery. Flaps fail. Implants get contracture. Open wounds happen. Asymmetry happens. Every technique has known risks. A surgeon who pretends otherwise about their preferred technique while emphasizing every risk of the alternative is selling, not educating.

This brings me to the second half of this rant — the photos that drive me especially crazy.

You've probably seen them on social media: surgeons posting horrifying-looking implants they've removed — calcified, distorted, "dinosaur egg" shells with massive long-term capsular contracture. The framing is usually some version of:

Here's the actual reality of those photos.

Those calcified, dinosaur-egg implants are typically:

• 30 to 40 years old
• Placed in the era before modern implant safety profiles
• Implants the patient was never told to monitor
• Implants the patient never received follow-up imaging for
• Implants placed during a time when proper imaging surveillance protocols didn't exist

Plastic surgeons of that era did a poor job of educating patients about long-term implant care. We didn't have great monitoring protocols. We didn't emphasize follow-up. As a profession, we honestly contributed to the problem we're now seeing the late-stage consequences of.

That's on us. We own that. And we're working to fix it.

In 2026 — with proper care — that "dinosaur egg" outcome is not what we see in current implant patients:

• We have imaging surveillance protocols (ultrasound or MRI starting at 5 years, regular intervals after)
• We have PSA-style guidance about getting implants imaged before any breast surgery
• We have primary care education campaigns so non-plastic-surgery doctors also screen
• We have evidence-informed guidance about when to replace implants
• We have techniques that meaningfully reduce biofilm and capsule formation
• We have modern, more cohesive implants that don't fail the way 1980s implants failed
• We actively educate patients about long-term care during consultation

When someone posts a photo of a long-term contracture or a calcified rupture from an implant placed in 1985 — and frames it as "this is your future" — they are:

• Showing you a result of poor education and no follow-up, not a result of inherent implant evil
• Implying that today's implants and protocols produce the same outcome
• Ignoring that no current patient should be getting a contracture like that because we have the tools to prevent and identify it long before it gets to that stage
• Using a frightening image to drive their personal practice volume

It's misleading. It's also the exact opposite of the patient education we should be doing.

Let me say it directly:

• No one in 2026 should have a long-term, untreated capsular contracture like that. It's preventable with proper monitoring.
• No one in 2026 should have a long-untreated silicone rupture. We have the imaging, the protocols, and the patient education to identify it years before it becomes catastrophic.

Those photos are the past. They are not a fair representation of where implant care is today.

I want to be clear, because I don't want this to come across as "no surgeon should ever talk about complications." That's the opposite of what I believe.

Honest patient education absolutely should discuss:

• The real complication rates of implants (capsular contracture, rupture, BIA-ALCL, infection)
• The real complication rates of flaps and other alternatives
• What proper implant monitoring looks like
• What kinds of changes should prompt a call to the surgeon
• When and why replacement might be considered

You can do all of this honestly, evidence-based, and respectfully without:

• Implying every implant patient is doomed
• Recycling 30-year-old neglected-implant photos as if they're typical
• Framing one technique as "the only safe option"
• Trashing the work of colleagues who use different techniques

The goal is informed patients. The goal is not a personal book of business built on fear.

Patients having breast cancer surgery, breast reconstruction, or cosmetic augmentation deserve:

• All of the options presented to them
• Accurate, evidence-based information about each
• Honest discussion of the risks of each option, including the one their surgeon prefers
• Respect for the validity of techniques their surgeon doesn't personally do
• The ability to make an informed decision about their own body

That's the standard. We should all be holding ourselves and each other to it.

Plastic surgery is a specialty where multiple valid techniques can solve the same problem. When colleagues self-promote by misrepresenting the alternatives as dangerous — or by recycling decades-old implant horror photos as if they represent the current reality — they're not educating patients. They're fear-marketing.

We can absolutely talk about complications. We can absolutely educate the public about implant care, monitoring, and when something is wrong. We can do all of that honestly without trashing the work of our colleagues, and without scaring patients away from techniques that, for them, may be exactly the right choice.

Patients deserve options. They deserve accurate information. And they deserve to make their own informed decisions — without being herded by fear into one practice or one technique.