Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Alexandra McSpadden

Alexandra McSpadden, PA-C

Plastic Surgery

Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.

My Offices

Santa Rosa Medical Center
Appt/Advice: 707-566-5288

See all office information »

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Most breast implants have a silicone shell filled with saline (saltwater) or silicone gel and probably will not last forever, but if you are not having a problem with your implants, they generally will not need to be replaced.

The U.S. Food and Drug Administration (FDA) has approved the devices we use for breast implants and determined that they are safe. Research has shown that women with silicone gel-filled breast implants are no more likely to develop connective tissue diseases, cancer, or neurological disease than women without implants.

However, many women with implants can experience problems such as excessive firmness, implant leaks, or cosmetic changes. You may need an additional surgery to either remove or replace your breast implants.

If the reason for your implant is breast reconstruction or congenital breast deformities, we will manage and maintain your breast implants.

If you chose to have your implant for breast augmentation or breast lift, these are considered cosmetic procedures and are not covered by your health plan benefits. If you have breast augmentation and develop a problem with these implants, we can remove them and remove scar tissue (capsulectomy). If you want to replace your implant(s), we will refer you to one of our Cosmetic Surgery Centers.

Additional References:

Link to Diseases

There have been reports of silicone gel-filled breast implants causing health problems. Research into the relationship between these diseases and breast implants did not show a connection.

Connective tissue diseases and related disorders involve the immune system and the body's connective tissue (bones, muscles, and tendons). The theory is that when the body reacts to a foreign material (silicone gel), it produces antibodies that can cause problems with connective tissue. However, no proven link between breast implants and immune system disease has been found.

The FDA continues to require studies on silicone gel-filled breast implants, which monitor their safety and effectiveness. If new risks or unexpected problems are found, the FDA can pursue regulatory options.

Additional References:

Potential Problems

When you choose to have a saline- or silicone gel-filled breast implant, it is likely that the implant will become firm (capsular contracture) or leak and deflate over time.

  • Capsular contracture occurs when the scar tissue around your breast(s) implant tightens, causing your breast to feel firm and in some cases look abnormal or become painful.

We do not know why capsular contracture occurs. Infection, hematomas (a collection of blood outside the blood vessels, generally the result of internal bleeding), silicone leaking, and an individual's predisposition to irregular, raised scarring may be factors. It may occur soon after surgery or later.

The chance of it happening increases with time. In some cases, you may require surgery to remove the scar tissue around the implant (capsulectomy) or to replace the implant. If the contracture cannot be improved, you may need to have your implant removed.

  • Implant leakage and deflation can occur at any time with either saline- or silicone gel-filled breast implants. The main reason for leakage and deflation is wear and tear on the wall of the implants.

For saline-filled breast implants, deflation is usually immediate and results in a decrease in the size of the implant and softness of the breast. This occurs in the space of hours or days. The saline solution is absorbed by your body.

For silicone gel-filled implants, the silicone gel may be contained in the scar tissue or capsule around the implant or it may leak out. Leakage from silicone gel-filled implants occurs more slowly, so it is more difficult to identify the exact time it begins. If the gel is contained, there is usually no visible change to the breast. If the gel leaks, you may notice a decrease in breast size and a change in shape, or an uneven lumpy breast and, possibly, pain. Over time, small amounts of gel molecules will migrate to the lymphatic system in other parts of the body.

  • Breast deformity may occur for women who require multiple or repeat operations, who have recurrent problems with capsular contracture, or who need treatment of infection.
Potential complications
  • Infection can occur right after surgery or many years later. Swelling, pain, redness, fever, and pus draining from incisions are signs of infection. If you have one or more of these symptoms, you need to see us as soon as possible. It is rare for this type of infection to be cured successfully with antibiotics alone, so we often need to perform surgery to remove the implant. We may be able to replace the implant later.
  • Bleeding around an implant usually occurs shortly after the surgery to place the implant. Symptoms are a very swollen, sometimes painful, bruised breast. If this occurs, you need to be prepared to come to the Emergency Department. You will probably need to go to the operating room, as well, to have the accumulated blood removed. The implant can usually be replaced right away. If the bleeding is not addressed appropriately, it can result in skin or nipple healing problems.

Repeat Operations (Reoperations)

You may need to undergo several procedures due to problems from breast implants. Additional procedures may be needed to improve the appearance of your breast or to remove a leaking or deflated implant. There is a possibility that the results will be disappointing.

We can remove an implant with or without replacing it. Not replacing the implant can result in the breast dimpling, puckering, or sagging, so many women choose to have the implant replaced (revised).

If you had breast reconstruction or correction of congenital breast deformities, we will manage and maintain your breast implants.

If you had cosmetic breast augmentation and are having problems, complications, or unsatisfactory results, you have two choices:

  • Remove the implant permanently, which eliminates possible future problems with implants.
  • Remove and replace the implant in one or two stages. We can remove the implant, but if you elect to have the implant removed and replaced in one stage, we will refer you to one of our Cosmetic Surgery Centers.

Other types of surgical procedures that may be done in a repeat operation include:

  • Capsule procedure (capsulectomy). We remove or surgically release the scar tissue making up the capsule surrounding the implant.
  • Scar revision. We remove the excess scar tissue.
  • Repositioning. We open the original incision and move the implant.

Breast Cancer Screening Recommendations

Women with remaining breast tissue should undergo mammography as recommended. When scheduling your mammogram, let the receptionist know that you have an implant. The radiology technician can use special implant displacement techniques that require additional time but provide a better result. Always inform the radiology technician at the time of your appointment, so that care can be taken with your implant. While mammography is considered safe, a recent FDA study suggests that the risk of rupturing the implants is exacerbated by mammography. When undergoing mammography, you as the patient accept that risk.

MRI of the breast is not a replacement for mammography or ultrasound imaging but rather a supplemental tool that has many important uses, including screening in women at high risk for breast cancer. While MRI is the most sensitive test for determining if a silicone gel-filled implant is ruptured, a plastic surgeon can best determine with you the indications, need, and risks of the study.

Your Care with Me

If you are having problems that may be related to your breast implants, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together.

During your office visit, we will discuss your medical and family history and I will examine your breasts. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing an emergency, call 911 or go to the nearest Emergency Room.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 

  • At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Prepare for Your Procedure

See more Health Tools »

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

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