Notice of Data Incident
August 1, 2023

Dear Patients:
We post this Notice pursuant to the United States Health Insurance Portability and Accountability Act (“HIPAA”) to inform you about a data incident involving an unauthorized release of patient Protected Health Information (“PHI”), as that is defined by HIPAA, at Gary Motykie, M.D., a Medical Corporation and Gary Motykie, M.D. (“Practice”), a covered entity under HIPAA.

PHI, as defined by HIPAA, is information that is “created, received, maintained, or transmitted by or on behalf of the health care component of the Covered Entity.” § 164.105 (a)(2)(i)(D). Information that is created or received by a Covered Entity and that relates to the past, present, or future physical or mental health or condition of an individual; or the past, present, or future payment for the provision of healthcare to an individual is considered PHI. PHI is required to be protected when transmitted or maintained in any form by a Covered Entity. Individual identifiers (including but not limited to name, address, telephone number, fax, email address, social security number, medical record number, etc.) maintained in a designated record set along with health information (including but not limited to x-rays, images, scans, physician notes, diagnoses, treatment, eligibility approvals, claims, remittances, etc.) are collectively considered PHI.

Event Description:
On or about June 6, 2023, an initial technical analysis of the Practice’s information technology network determined an unauthorized release of PHI occurred to an unknown third party. The initial analysis determined that the unknown third party accessed the Practice’s network. It was further determined that the unknown third party acquired some of the Practice’s patient’s unencrypted PHI and that party was not authorized to do so and did so in an unlawful manner.

The information that may have been accessed or acquired during this unauthorized access included:

  • First and last name 
  • Social Security Number (if provided)
  • Address
  • Driver’s license or identification card number
  • Financial account or payment card number, in combination with any required CVV code
  • Intake forms, which may include medical information and history
  • Images taken in connection with the services rendered at our office
  • Health insurance information (if provided)
Steps Taken to Address:
Upon discovery, the Practice took the following immediate steps to address the situation:
  • Computers and servers replaced
  • Network passwords changed
  • Endpoint detection, virus, and malware detection tools and software installed on workstations and server
  • Limitations concerning Internet access
  • Access controls put in place for users based on role and responsibility
  • Server policies in place
  • Device locking mechanisms
  • Multi factor authentication enabled
  • Network segregation efforts
  • Encryption of devices
  • Additional workforce training
Risk Assessment:

The Practice conducted a risk assessment to evaluate the potential harm to potentially impacted individuals. Based on that assessment, it is determined that there is a high risk of harm. It is essential for potentially impacted individuals to remain vigilant in monitoring their personal accounts and data and promptly report any suspicious activity to law enforcement or their financial institutions.

Assistance and Resources:
Starting on or about June 22, 2023, letters were mailed to patients providing the following resources to assist the potentially impacted individuals, offering at no cost:
  • two (2) years of no cost Triple Bureau Credit Monitoring/Triple Bureau Credit Report/Triple Bureau Credit Score/Cyber Monitoring services.
  • the services also include reviewing whether Information appears on the dark web and alert the individual if such Information is found online.
  • proactive fraud assistance to help with any questions in event a potentially impacted persons becomes a victim of fraud.

Steps to Prevent Future Incidents: We deeply regret any inconvenience or concern this Incident may cause. The Practice is taking numerous steps to help prevent similar Incidents in the future. We will continue to review and enhance our security measures, policies, and employee training.

If you failed to receive your letter in the mail, and/or if there is a concern your mailing address has changed since you were a patient at the Practice, please contact 1-800-405-6108 or call our office immediately at 310-246-2355 from 9:00 am to 5:00 pm Pacific time, Monday through Friday.

Capsular Contracture

A scar tissue capsule forms around every breast implant placed for breast augmentation. However, the thickness and overall size of the scar tissue capsule depends on many factors including heredity, inflammation and post-operative care and prevention. Depending on all of these factors, the scar tissue capsule can either be thin and soft or thick and hard. It is the body’s normal response to wall off or form scar tissue around any foreign body (including a breast implant) but no one is certain why sometimes the body will form a soft thin capsule while other times it will form a thick, firm capsule. If the capsule becomes very severe it can even lead to deformity of the implant and tenderness in the breast area. For this reason, capsular scar tissue has been classified from being mild to severe depending on the thickness of the capsule and whether deformity or symptoms of pain or tenderness are present.

When the scar tissue capsule begins to thicken and contract the condition is called “Capsular contracture.” The exact cause and mechanism of capsular contracture is not entirely understood but most surgeons agree that is related to inflammation within the breast implant pocket. Capsular contracture can occur as soon as 4-6 weeks after surgery and is uncommon to begin developing later than six months after surgery unless some sort of trauma has occurred to the augmented breast. Dr Motykie has seen many capsular contracture patients from around the world and he has developed many different protocols to help treat and prevent the development of capsular contracture in patients that are already prone to its development. The development of capsular contracture can be very frustrating for the patient and surgeon alike. Sometimes the perfect patient and the perfect surgery can still randomly lead to the development of a capsular contracture. It is also unknown why only one breast may develop a capsular contracture while the other breast remains perfectly soft and natural.

The first step in trying to solve the mystery of capsular contracture development is to determine the specifics of the breast surgery that lead to its initial development.  Many times a revision surgery that simply changes variables of the previous surgery can have a great impact on preventing the recurrence of a capsular contracture. One of the first variables to consider is the implant position within the breast pocket because capsular contracture occurs significantly more frequently when the implants are placed above the chest muscle as compared to be placed underneath the muscle. In order to correct this problem and decrease the risk of capsular contracture recurrence, the revision surgery should place the breast implants underneath the chest muscle. In addition, the implants should not be left above the muscle because the removal of scar tissue may thin out the breast tissue itself leading to increased implant visibility (rippling) and palpability (feeling the bag through the breast). This is one of the reasons that Dr Motykie recommends the majority of his patients to have their implants placed underneath the muscle in the first place. A second variable is the type of breast implants used in the augmentation. Saline-filled implants seem to fare better than silicone gel-filled implants whether they are inserted above or underneath the chest muscle. Therefore, if a patient has developed capsular contracture with silicone breast implants, they may want to consider switching to saline breast implants during any corrective surgery in order to help lower their risk of capsular contracture recurrence. Thirdly, since many believe that inflammation may be the identifiable culprit in the formation of capsular contractures, any technique or intervention aimed at reducing post-operative inflammation should have an impact on possibly reducing the recurrence of capsular contracture formation.

All surgeries to correct severe capsular contracture will involve some sort of interior scar tissue release that may include capsulotomies, capsulectomies, implant exchange and/or placement of dermal substitutes such as Alloderm or Belladerm.  A capsulotomy is a surgical procedure that releases scar tissue (but does not actually remove it from the pocket) that has formed inside of the breast. This allows for expansion of the breast pocket and relief of the scar tissue contraction that literally squeezes the breast implant. Dr Motykie performs this procedure in order to limit the amount of breast tissue removed during the surgery in order to decrease the risk of implant visibility and palpability after the procedure as well as to decrease the risk of bleeding which can lead to an increased risk of capsular contracture recurrence. A capsulectomy is a surgical procedure that is performed to completely remove the scar tissue surrounding a breast implant. This is a more aggressive approach to releasing capsular contracture and it is more often used in the cases of very thick, calcified scar tissue capsules and/or in the case of ruptured silicone breast implants. However, just because the capsule is removed in its entirety does not mean that it will not recur.  This is why Dr Motykie has developed specific protocols in order to help decrease the risk of capsular contracture recurrence. Dr Motykie has found that it is extremely important to evaluate every patient on an individual basis in order to determine the probable cause of the capsular contracture in order to reduce the risk of recurrence in each specific case. Most of the time, with longstanding capsular contracture, Dr Motykie recommends removal and replacement of your breast implants at the same time as your scar tissue release.

After corrective surgery has been performed, Dr Motykie has learned that a combination of post-operative preventive modalities appears to work the best in combating capsular contracture. Therefore,  Dr Motykie usually recommends a combination of modalities in capsular contracture corrective surgery that includes compression therapy to reduce post-operative swelling and inflammation, possible placement of a drainage tube to remove any inflammatory fluid form the breast implant pocket during recovery, prophylactic use of Accolate or Singuliar, an aggressive post-operative breast massage routine, prescription of anti-inflammatory medications and possible placement of dermal material such as Alloderm or Belladerm in order to help camouflage the presence of the implant

To find out more about breast surgery please contact us at 310-246-2355

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