Ears come in all shapes and sizes. If you like your ears, Otoplasty is not for you, but if you feel your ears are too big, stick out too much or have an unusual shape, Cosmetic Ear Shaping Surgery may be just what the doctor ordered.
Who Gets Cosmetic Ear Surgery?
I discussed Ear Pinning recently here on the San Francisco Plastic Surgery Blog. The post included several Otoplasty Before and After Photos and answers many of the frequently asked questions about Otoplasty.
Otoplasty Video (Prominent Ear Reduction)
While before and after pictures do illustrate the words, for some, video provides the optimal experience. Below is a segment from my latest KRON 4, Body Beautiful show. More Ear Pinning Before and After Pictures are included, and narrated, to help illustrate what Otoplasty has to offer.
Man Boobs can affect men at every stage of life. All men are all born with them, due to the effects or maternal estrogen on the male breasts. This usually resolves in a few months, but can persist. The most common timing of Gynecomastia is during adolescence. With puberty comes hormone surges that can lead to Male Breast Development. The problem impacts about two-thirds of young men. For half these men, the swelling resolves over a year or two. For about one third of men, the breast tissue persists, and can become tender, annoying and embarrassing. Some men will not develop Moobs (Man Boobs) until later in life, and often as a side-effect of medications.
There are several ways to treat Gynecomastia, because it can present in different forms. The Gynecomastia Reduction Video below provides several examples of Gynecomastia Before and After Pictures and a narrative for perspective. This KRON 4 television segment is from Body Beautiful and supplements the information that can be found here on the San Francisco Plastic Surgery Blog and my other web sites. While I hope you find the information useful, it cannot substitute for an in-person consultation with a qualified and experienced Board Certified Plastic Surgeon.
Gynecomastia Reduction Video (Male Breast Reduction)
Male Breast Reduction Consultations
Gynecomastia affects most men at some point in their lifetime. For young teens, it is good to get checked, but waiting is usually recommended unless the problem is extreme or persists. If you have persistent male breast enlargement, and would like to schedule a private appointment, call (925) 943-6353 today, for a personalized consultation in our San Francisco Bay Area Plastic Surgery Clinic.
Breast Augmentation Revision is a specialty unto itself. It includes any Breast Implant Revision for breast implant replacement, deflation or for a change in size or style. Other reasons for Breast Augmentation Revision include correction of capsular contracture and breast implant malposition like bottoming out, symmastia (uniboob), lateral displacement and double bubble. A rare Breast Implant Complication, Breast Implant Erosion, was reviewed in last week’s Body Beautiful Sneak Peek.
Breast Augmentation Revision Video
This Breast Implant Revision Video reviews some of the most common reasons for correction and shows Breast Augmentation Revision Before and After Pictures to illustrate what Breast Augmentation Revision can do.
Breast Implant Complications corrected in this video include:
Breast Implant Deflation
Symmastia (Uniboob or Breadloafing)
Breast Implant Malposition (implants in the wrong place)
Breast Implant Erosion
Adjustment of Breast Implant Size
Breast Implant Revision Video
Breast Augmentation Revision Consultation
Breast Implant Revision covers a wide variety of procedures. If you have had Breast Augmentation, and are considering breast revision surgery to improve your results, call (925) 943-6353, today, and schedule your private and personalized consultation.
Attention Plastic Surgery Television viewers. Body Beautiful will be broadcast live on KRON4 this Wednesday, September 7, 2016, At Noon – Live. So tune-in to get the latest Plastic Surgery News, and see if I get it right on the first take.
Plastic Surgery Topics Will Include…
This week’s show will be thirty minutes packed with what’s new in Cosmetic Plastic Surgery. Topics will some of the most popular procedures here in the San Francisco Bay Area including:
Breast Augmentation Revision for…
Breast Implant Deflation
Breast Implant Exposure (Skin Erosion)
Breast Implant Malposition
Breast Implants too small
Gynecomastia Reduction (Male Breast Reduction)
Otoplasty (Ear Pinning for Prominent Ears)
Asian Blepharoplasty (Asian Eyelid Surgery)
There will be plenty of discussion and Before and After Pictures for illustration. Below is a sneak peek.
Breast Augmentation Revision
The patient below had a rare, but serious Breast Augmentation Complication, requiring staged Breast Augmentation Revision Surgery. Her breast implant nearly eroded through the skin on the bottom of her left breast. Oversized Breast Implants in small breasts with poor soft-tissue coverage are at greater risk. This is more commonly seen after Breast Reconstruction when the breast has been radiated to treat breast cancer. It is unlikely to occur in a young, otherwise healthy woman, but it did.
Breast Implant Revision: Sometimes breast implant revision is urgent. The square shape sticking out of the bottom of this patient’s left breast is her breast implant, and it’s about to fall out.
Breast Augmentation Revision Stage I – The Salvage Operation
The top row of photos are the before and after photos from the first stage of her Breast Implant Revision Surgery. The upper left photo shows that the patient’s left Breast Implant is eroding through the skin of the lower breast. It’s about to fall out, and the current breast implant needs to be removed, urgently. If the Breast Implant becomes exposed, infection quickly follows. After careful discussion, it was decided to proceed with Breast Implant Removal on both sides.
Breast Augmentation Revision – Stage I was urgent removal of the left breast implant, which had nearly eroded its way through the lower pole of the breast. It was elected to remove both implants during stage I, because replacing the original saline breast implants with smaller silicone gel filled breast implants was part of the plan to decrease the risk of recurrence.
Having one implant in and one implant out was an option, but would have left her with an almost undisguisable amount of asymmetry. Moreover, the plan was to use smaller replacement implants, to decrease the risk of another breast implant erosion. Leaving both implants out forever would also treat this problem, and completely eliminate any chance of it happening again.
Breast Augmentation Revision Stage II – Asymmetric Breast Augmentation
While the nearly Exposed Breast Implant problem was solved, there were two new problems: 1) obvious breast asymmetry and 2) breasts which are too small for my patient’s preferences. The Breast Asymmetry is two fold. The left breast is smaller than the right, and the left breast is higher and tighter on the chest wall.
Breast Augmentation Revision Surgery – Stage II. The second stage entailed lowering the left implant pocket, expanding the lower, contracted pole of the left breast and asymmetrically augmenting the breasts to decrease the size difference.
Breast Implant Revision Surgery was performed to asymmetrically increase the size of the breasts, and to lower the left breast to match the right. The initial results are shown above, just one week after surgery. An alternative approach would be to raise the right side with a Breast Lift; however, this would require additional, external scars on the right breast.
Breast Augmentation Revision Surgery – Stage II and a patient patient. As time marched on, the results improved. No additional surgery was performed after stage II. While initially the skin stretched well, the muscle was tight. Over several months the muscle relaxed and the symmetry improved, as expected.
The Breast Revision Before and After Photos above show the results after new, smaller Silicone Breast Implants were placed, and the breasts were allowed to heal. The left picture is one week after surgery. In this photo, the left breast mound is firmer, higher and more projecting, as would be expected when more stuffing is placed in a smaller pillow case.
As the breasts heal, the left breast skin and muscle relax, the left breast implant descends and her results improve. The right, after photo shows the results after a few months. A larger breast implant was used on the left, to correct the asymmetry, and while initially it may seem like her Breast Implant Problems are not completely corrected, over time, it settles down. It is a good deal better than the potentially life-threatening complication she presented with originally, as shown below.
Breast Implant Revision Before and After Photos – the left picture is how the patient initially presented. The second picture is a few months after completion of both stages (breast implant removal and breast implant replacement with pocket modifications).
Breast Augmentation Revision Consultations
Breast Augmentation Revision is considerably more complicated than primary Breast Augmentation. If you have problems with your Breast Implants, seek an experienced and Board Certified Plastic Surgeon for your revision surgery. If you are in the San Francisco Bay Area and would like to schedule a personalized consultation appointment call (925) 943-6353, today.
PS – Don’t forget to watch Body Beautiful live at noon, this Wednesday, September 7, 2016, on KRON4, the Bay Area’s New Station.
Two and one half years ago, I posted about Jean-Claude Mas and his substandard PIP Breast Implants. Poly Implant Protheses, PIP for short, had their Breast Implants banned in 2010, after it was revealed that industrial grade silicone was being used, rather than the medical grade silicone that has passed safety tests for use in the human body.
PIP’s Jean-Claude Mas Goes To Jail
PIP founder, Jean Claude Mas, loses appeal in French court, and goes to jail. Photo credit: Guillaume Horcajuelo
In 2013, Jean-Claude Mas was convicted of fraud. His sentence included: four years in prison, a75,000 euros ($86,000) fine and that he be banned for life from working in medical services or running a company. This year, a French appeals court upheld the decision.
Plastic Surgeons Blew The Whistle First
Plastic Surgeons were aware there was a problem years before the government took action, because PIP Breast Implants leaked about ten times as often as FDA approved breast implants. In fact, the US FDA refused PIP’s application for Silicone Breast Implant sales in the US.
Unfortunately, the Pre-filled Saline version of PIP Breast Implants was sold here for a short time. They also leaked at much higher rates than those seen with the other FDA approved Saline Breast Implant manufacturers at the time: Allergan and Mentor.
PIP – Cheaper Is Not Better
You have likely heard the expressions, “You get what you pay for,” and that, If something is too good to be true, it is false.” Well both these expressions apply to Plastic Surgery. It is not an area that you want to get the cheapest price.
PIP’s appeal was that they were cheap. While they claimed to be equivalent to other manufacturers, they were not. They cost less, because they were made cheaply. Industrial silicone is not the same grade or cost as medical silicone, and the company substituted industrial grade silicone for medical grade silicone for years without regulators catching on.
Jean-Claude Mas posing at his manufacturing facility. Only a few knew what was really going on with PIP’s breast implant quality control.
Plastic Surgeons complained for years that something was wrong with PIP Breast Implants, but the final straw was when the company supplying the large quantities of industrial grade silicone raised their suspicions also. Even the people selling the industrial grade silicone knew there was nothing good about these Cheap Breast Implants.
PIP Knew The End Was Coming
PIP Breast Implants manufacturing was headquartered in La Seyne-sur-Mer, France. Since they were not FDA approved, they were not subject to FDA rules, like surprise inspections. Incredulously, European inspectors had to give 10-days notice prior to an inspection. During this grace period, PIP would remove drums of industrial silicone from their manufacturing facility and quickly order the medical grade silicone they should have been using all along. After the inspection, the industrial silicone was brought out again and cheap manufacturing resumed.
When it was clear that the end was near, PIP slashed its prices further. Knowing that their inventory was going to be confiscated, they sold in bulk, and they sold quickly. PIP flooded the market with cheap “European Approved” breast implants throughout Europe and South America. In the end, between 300,000 and 400,000 women in 65 countries are believed to have received PIP implants. Europe was a major market, but more than half went to South America. Fortunately, they were not sold in the United States.
Medical Tourism – Buyer Beware
Poly Implant Protheses was founded in 1991 and shut down in 2010. It is thought that the manufacture of the Bogus Breast Implants, those made with industrial grade silicone, began in 2001.
It Is Recommended That All PIP Silicone Breast Implants Be Removed
PIP Silicone Breast Implants were never sold in the US; however, if you took advantage of cheap overseas breast augmentation early this millennium, you need to check if you have PIP Silicone Breast Implants.
Breast Implant Removal Before And After Photos: One option is to have the breast implants removed and not replaced. Another is to replace your PIP breast implants with FDA approved breast implants, the later options will also preserve the size of your breast. Be certain to ask your Board Certified Plastic Surgeon about your options for treatment.
PIP Silicone Breast Implants have a higher risk of leaking than approved models, as well as being implicated in several deaths due to systemic toxicity and several cases of induced breast cancer. If you have these breast implants, the current world-wide recommendation is to have them removed, and if you desire, replaced with approved Medical Grade Silicone Breast Implants.
If you have PIP Silicone Breast Implant’s, find an Experienced Board Certified Plastic Surgeon in your area and get the information about the benefits, and risks, of having them removed. I have removed several. The Ruptured Saline Breast Implants are easy to remove. The saline is absorbed by the body, and all that remains is the solid shell. Ruptured Silicone Breast Implants, especially those filled with the less cohesive gel, are a much bigger problem.
When Breast Implants are ruptured, the gel that fills them can migrate. Most the PIP silicone Breast Implants I have removed were ruptured. The longer the Leaking Breast Implants remain in your body, the less likely it is that all the industrial silicone gel can be removed. Like most problems, the sooner it is addressed the better the outcome. Breast Augmentation Revision is a better option. If you are in the San Francisco Bay Area, call (925) 943-6353 today.
Gynecomastia is normal breast tissue and fat in the male chest, that is often disproportionate. When large enough, it causes a feminization of the chest, and in the case above, puffy nipples. Direct excision of the excess breast tissue creates a more masculine appearance, and less embarrassment at the beach.
More men are having Cosmetic Plastic Surgery. Since starting my practice in 1997, the number of cosmetic procedures performed among men has increased over 325%, according to the American Society for Aesthetic Plastic Surgery (ASAPS). Liposuction remains the number one requested procedure; however Male Breast Reduction, or Gynecomastia Reduction, has the fastest growth rate.
How Common Is Male Breast Reduction Surgery?
In 1997, according to the American Society of Plastic Surgeons (ASPS), around 20,000 men underwent Gynecomastia Reduction. Last year, over 30,000 men did the same, representing a 5 to 7% increase from the previous year’s data. The word is out. You don’t have to live with man boobs anymore.
What Is Gynecomastia?
Gynecomastia is the medical term for enlargement of the male breast. Enlargement can as small as a lump under the areola, to large enough to look like a well endowed female breast, and everything in between.
When Does Gynecomastia Arise And Will it Go Away?
Gynecomastia Reduction: In this case, direct excision of the glandular tissue from under the areola not only smooths the chest’s contour, but also reduces the apparent size of the areolae — the pigmented skin that surrounds the nipple. The darker color is simply a result of the same amount of pigment distributed over the new, significantly smaller, area.
Gynecomastia normally becomes a problem at puberty. It is estimated that two-thirds of men suffer from some degree of breast enlargement during adolescence, and that for half of them, it persists into adulthood. If you are a young man with a new lump in your breasts, it is a good idea to have it checked by your family doctor to be certain the tissue and your hormones are normal. The best early treatment for true Gynecomastia is usually observation, as half the cases with resolve on there own within two years of developing.
What Is Gynecomastia Made Of?
Just like in the female breast, there are two tissue types found in the enlarged male breast: glandular tissue (breast) and adipose (fat). The amount and location of these tissues determines how best to treat the gynecomastia. Glandular tissue is firm, tough and sometimes painful. Adipose is soft, weak and non-tender. Glandular tissue is most often found under the nipple and areola, with a tail extending to the side, while fatty tissue is more peripheral. Both are more likely to be found in the lower pole of the male chest. Too much of either can stretch the skin to the point that extra skin may also need to be removed.
How Is Gynecomastia Treated?
Gynecomastia Reduction: Sometimes the amount of breast tissue on the chest is enough to completely feminize the chest. Liposuction, combined with direct excision of the glandular components, restored the flat chest that this young man is expected to have. Again, the reduction in areolae is due to the skin’s elastic contraction after the breasts are unstuffed.
So how do I treat Gynecomastia? The answer depends on several factors and the best way to find out what can be done in your specific case is to schedule a personal consultation appointment with an experienced, Board Certified Plastic Surgeon in your area.
For adolescents, usually the best treatment is to wait a few years and see if it goes away. On the other hand, all new lumps should be checked by your primary medical doctor to be safe. If the area has persisted for several years, and is not resolving, Gynecomastia Reduction may be the best next step.
For adults, first you must be healthy. Male Breast Reduction is an elective procedure and needs to be held to a higher standard. If treatment is safe, there are the components to breast reduction that need to be evaluated and treated: the amount of gland, the amount of fat and the amount of skin.
Glandular tissue, true breast tissue, responds best to direct surgical excision. It is tough, so the cannulas used for Liposuction often just bounce off it. Fatty tissue, on the other hand, is soft and responds well to Liposuction. Both methods reduce the amount of “stuffing” in the chest, and allow the skin to shrink.
Gynecomastia Reduction: Sometimes the skin enveloping the breasts is redundant. This man has breast enlargement and sagging from his gynecomastia and loose skin. In this case, the breast tissue and the excess skin were removed through an incision that runs along the bottom of each breast. Without this, the skin would sag further over the inframammary fold from the loss of support caused by removing the chest’s stuffing, just like deflating a balloon causes the balloon to fall over.
In most cases, the skin and the areola will shrink proportionately, to reveal the contours of the pectorals major muscles. In cases of extreme gynecomastia, or after large weight loss, the skin may be loose, and direct excision of the excess skin may be necessary. This needs to be determined at an in-person consultation.
Gynecomastia Reduction Consultations
If you are suffering with embarrassing, or painful, male breasts, treatment is available. Call my San Francisco Bay Area office in Walnut Creek, CA at (925) 943-6353 today, and schedule your private, informative consultation appointment. More information is available on line through the links embedded in this article and on my San Francisco Breast web site’s Gynecomastia Page.
The official torch of the Rio Olympics (Click picture for a close-up.)
All eyes are on Rio de Janeiro this week. Most of us are celebrating the spirit of competition during the XXXI Olympiad. But for Plastic Surgeons, despite the amazing achievements of our athletes, it may be remembered more for the passing of a single Brazilian Plastic Surgeon.
The Olympics and Northern California
Northern California in particular has a lot to celebrate. Eighty-Four of the five-hundred-fifty athletes representing the United States have Northern California ties, with seventy-six US olympians coming from the San Francisco Bay Area. An additional thirty-one former Cal (UC Berkeley) or Stanford athletes will compete for other countries.
Passing the Olympic Torch
The prelude to the Olympics is the passing of the Olympic Torch. The flame originates from Greece and is nurtured along on its trek to the current Olympic city. About twelve thousand torchbearers carried the Olympic flame across Brazil between May 3rd and August 5th, 2016.
The Olympic cauldron was lit at the Maracana Stadium on August 5, 2016. One of the torch bearers on this the final day was Brazilian Plastic Surgeon, Ivo Pitanguy. Dr. Pitanguy was as much a national symbol of Brazil’s excellence in Plastic Surgery as he was a hero for his care of many of the victims of the Niterói Circus Fire; 70% of the approximately 3000 in the audience were children. He credits this experience with teaching him that for many, physical appearance was critical to living. The day after helping light the Olympic Torch, his own light extinguished. At the age of 93, he suffered a fatal heart attack at his home in Rio de Janeiro.
At Palácio da Cidade, plastic surgeon Ivo Pitanguy hands over the Olympic torch to Gyleno dos Santos, waiter at Mayor Eduardo Paes’s Office / Photo Credit: Ricardo Cassiano
Dr. Ivo Pitanguy Philanthropist
Dr. Pitanguy was as much philanthropist as celebrity in his home country. He renovated a ward at the public Santa Casa da Misericórdia Hospital in Rio where, for four decades, he offered free treatment. He also founded the Clinica Ivo Pitanguy in Rio de Janeiro, which provides members of underprivileged communities, carriers of congenital or traumatic deformities, with opportunities for psycho-social assistance and physical repair. Since its opening, more than 50 thousand surgical interventions have been performed, as many as 1,800 operations per year, in the three surgical theaters that make up the surgical center at the hospital.
Dr. Ivo Pitanguy Celebrity
There is no doubt that Dr. Pitanguy was famous among Plastic Surgeons, but he was known for his famous friends and life away from the practice of medicine, too. He provided many a column inch for the gossip magazines. Early in my practice, I took a Breast Reduction course from Dr. Pitanguy at an American Society of Plastic and Reconstructive Surgeons meeting (now the American Society of Plastic Surgeons or ASPS). I was privileged to learn from the best.
Shortly after returning back to my San Francisco Bay Area Plastic Surgery practice, I read an article about the near death experience of Rolling Stones Guitarist Ron Wood. From the European Rolling Stone Fan Club’s web site, It’s Only Rock’n’Roll web site:
While Mick and Charlie stayed at their hotel Copacabana in Rio, Ronnie and Keith went to the plastic surgeon Ivo Pitanguy’s house on the island Angra dos Reis. Ronnie with his wife and son went on a boat trip off the island, and during the trip the engine stroke fire, and they had to evacuate the boat in a hurry. Luckily they were followed by paparazzi boats, and the boat from Jornal Do Brasil picked up Ronnie and his family. See photo etc in Aftonbladet.
On An Approachable Pedestal
Ivo Pitanguy – as he still appears on his web site.
While always in demand, my personal experience with Dr. Pitanguy at our professional meetings was that he was always ready to offer advice and share a joke. Although we met only at professional meetings, and the sum of our interactions can be measured in days, he was a great influence on my chosen profession. I thank him, and I am humbled that he so easily shared his time.
At one meeting he tells me, “You American’s are screwing everything up.” I pondered the meaning of his words, and considered the possible target of his criticism. Was it politics, finances, the ASPS? No. He spent the next fifteen minutes expressing his concern that MTV was changing the Brazilian woman’s ideal of the perfect female form. Apparently, his patients were asking for larger and larger breast implants, like the women on MTV.
Beauty ideals are cultural. They change by geography and they change over time. There is a reason that fat grafting to the buttocks is called a Brazilian Butt Lift. It originated in Brazil, and Dr. Pitanguy is credited with its invention. Perhaps, he has turned the tide back on America. Maybe, I should be concerned that he has changed the American woman’s ideal of the perfect female form. I will miss you Ivo. In your lifetime, you have passed thousand of torches and provided an abundance of light for those that will follow in your footsteps.
Prominent Ears can be a cosmetic concern for both the young and old. For the young, ears that stick out can be a source of ridicule and teasing. At older ages, it may prevent enjoying the option of short hairstyles. However, the problem can be addressed at almost any age.
How Young Is Too Young For Otoplasty?
There are two peaks in the age at which people present to have their ears fixed. The first peak is around the time that children go to school, when their parents have the means to intercede. The second, is in the 20’s, when we are financially able to take care of ourselves.
Sometimes Otoplasty sooner is better. For children, early intervention can often reduce teasing and bullying.
The youngest age that cosmetic Otoplasty is performed is age five. By five years of age, the ear is about 85% of its adult size. This makes Ear Pinning predictable. For children, Otoplasty is performed under general anesthesia. This provides the necessary level of cooperation, safety and relaxation.
Does Otoplasty Need To Be Performed Under Anesthesia?
Ear asymmetry is more common than not. Sometimes Otoplasty is needed on only one side.
For adults, Cosmetic Ear Surgery can be performed either under general anesthesia or with local anesthesia. For my patients who do not want to be awake, general anesthesia is the best option. You get some medicine through an IV, and the next thing you know, it’s all done. For patients who are less anxious, local anesthesia provides a lower cost with less fatigue and none of the occasional nausea seen in about 10% of patients.
How Is Otoplasty Performed
Ear Pinning is an outpatient procedure. The majority of the work is accomplished through an incision placed in the crease behind the ear. Thin, strong sutures are used to bend and hold the ear cartilage in its new, folded back position. As with most of plastic surgery, the goal is to achieve just enough reduction, but not too much. The amount of Ear Pinning can be modified by adjusting the placement of the sutures and by scoring the cartilage along the desired path of bending.
What Is The Recovery After Otoplasty?
The Otoplasty scar is hidden in the fold behind the ear, allowing the hair to be worn up, or even shaved off with confidence.
Recovery is variable, but most patients are feeling normal in a few days. A head dressing is required during the first week to protect the repair, especially at night. After the head dressing is removed, the ears will be swollen, but look fairly normal. At night, a head band is worn to prevent inadvertent forward folding of the ears during sleep. Vaseline is usually all that is needed to keep the incision moist and to help it heal.
“Do No Harm” is the doctor’s moto, so safety and predictability are paramount for medicine. This is especially true for elective surgery, including my specialty, Cosmetic Plastic Surgery. There are many benefits to plastic surgery, but there are also risks. Even though the risks are usually small, it is important for surgeons and patients alike to understand the risks before making the decision to proceed.
Breast Implant Associated ALCL
Breast Implant Associated Anaplastic Large Cell Lymphoma (BI-ALCL) is extremely rare, and has only recently been described. Through the efforts of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) a database was and continues to be compiled.
The typical presentation of ALCL is a large seroma (fluid collection) around the breast implant causing obvious enlargement and asymmetry of the breast augmentation.
The presentation of ALCL is fairly obvious. Since the tumor is extremely rare, the presentation is usually unilateral (on one side only). The effected side begins to collect fluid around the breast implant, causing enlargement. A sudden increase in size after breast augmentation is always worth asking your Plastic Surgeon about.
ALCL Not Associated With Breast Implants
ALCL comprises about 1% of all non-Hodgkin lymphoma. Symptoms of ALCL can include fever, backache, painless swelling of lymph nodes, loss of appetite, and tiredness. It is found in skin, in the lymph nodes, or in organs throughout the body. ALCL that appears in the skin is most often called primary cutaneous ALCL, and it typically has a less aggressive disease course than the systemic (throughout the body) types.
First Cases of BI-ALCL
Thirty-Four unique cases were described in the medical literature from between 1997 and mid 2010, and awareness was raised. Like any new disease, once physicians knew what to look for, more cases were identified.
In 2011, the FDA reported approximately 60 cases of ALCL in women with breast implants, out of approximately 5-10 million women who had received breast implants worldwide.
Since that time Plastic Surgeons and the FDA have:
Reviewed medical device reports (MDRs)
Reviewed the medical literature
Exchanged information with other international regulators, scientific experts and plastic surgery societies
Initiated a collaborative effort between the FDA and the American Society of Plastic Surgeons (ASPS) and the Plastic Surgery Foundation (PSF) to collect data through the Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma (ALCL) Etiology and Epidemiology (PROFILE Registry)
August 25, 2010 through September 10, 2015 the FDA received 258 MDRs, including the original 60 cases reported in 2011, of anaplastic large cell lymphoma in women with breast implants, with reports of three deaths. Although the MDR system is a valuable source of information, it has limitations, including incomplete, inaccurate, untimely, unverified, or biased data. In addition, the incidence or prevalence of an event cannot be determined from this reporting system due to potential under-reporting, duplicate reporting of events, and the lack of information about the total number of breast implants.
ALCL Associated With Breast Implants 2016 Update
Based on the information we currently have, the current estimate is that there have been 100-250 known cases of ALCL in women with breast implants worldwide. According to the World Health Organization, BI-ALCL is not a breast cancer or cancer of the breast tissue; it is a lymphoma, a cancer of immune cells. Women with breast implants may have a very low, but increased risk of developing ALCL adjacent to a breast implant. Textured implants may increase the risk or ALCL.
ASPS and ASAPS recommend educating breast implant patients on the risk of BI-ALCL and the early detection of symptoms. Women with breast implants are encouraged to contact their plastic surgeon if they notice swelling, fluid collections, or unexpected changes in breast shape (Figure 1).
In symptomatic patients suspicious for BI-ALCL, perform an ultrasound and send suspicious peri-prosthetic fluid for CD30 immunohistochemistry, cell block cytology, and culture. Surgical treatment is essential for the management of BI-ALCL. See Figure 2 for treatment algorithm.
Above is the current (2016) treatment algorithm for BI-ALCL. If you experience breast implant enlargement, breast inflammation, breast pain, a breast lump, a breast sore or have fluid around you breast implant, follow up with your plastic surgeon or primary medical doctor ASAP. (Click image for larger view.)
Breast Implant Associated-ALCL is very rare, and if it occurs, is highly treatable in the majority of patients. The FDA, ASPS, and ASAPS recommend that all women, including those with breast implants, follow their normal routine in medical care and follow-up, including mammography when appropriate.
The FDA as well as the Institute of Medicine (IOM) maintain that breast implants do not impair breast health or cause breast cancer, and scientific evidence continues to support that FDA-approved breast implants have a reasonable assurance of safety and effectiveness.
For centuries, attempts have been made to map the human brain. Now the roads are a lot clearer.
Trying to figure out what the different bumps on the brain do is not easy. Scientists have been classifying different areas of the brain for centuries. Maps have been based on function, anatomy, cell types, the amount of insulation around cells, neural connections, and more recently, metabolic activity during specific tasks. A few examples are shown above.
It’s All About Making Connectomes
A connectome (pronounced con-nec’-tome) is the complete description of the structural connectivity of an organism’s nervous system. In other words, it’s a map. Much headway has been made in the last decade in refining the brain’s connectome. It turns out, that our soft, squishy, three pound brains have wiring similar the Internet.
Here is the Opte Project’s 2005 map of the Internet. Each line ends on a specific IP address. This map of the Internet has been compared to complex connections exhibited by neurons in the human brain.(Click on the map for more detail.)
A connectome of the “IP addresses” of the brain. (Click on picture to zoom in.)
The picture above is from the NIH Blueprint for Neuroscience Research Website. The sphere’s represent regions of interest (ROI). These ROIs seem to serve specific functions or show increased levels of activity during specific activities.
But What Have We Learned About The Brain Lately?
This week in Nature, an article with the uncomfortable sounding title, A Multi-Modal Parcellation of Human Cerebral Cortex, increased the number of recognized, distinct areas in the human cortex from 83 to 180. This is bad news for medical students learning neuroanatomy, but is good news for brain researchers.
The study is based on brain scans of 1200 young adults. These 180 areas were consistently found within the population. When new subjects were scanned, software could detect all 180 areas correctly 96.6% of the time, and automatically identify individuals with atypical patterns for manual review. This provides researchers and practitioners alike, a new and easily reproducible method of examining the brain.
Fingerprinting Your Brain
High definition brain scans are more than just maps. They may eventually lead to the ability to “fingerprint” our brain. This would allow scientists to see the differences in each of our brains, and further help correlate the anatomy and function of brain areas. High definition brain scans will be able to map the changes that occur in our brains as we age, identifying the milestones of normal healthy development. Moreover, much like an x-ray can detect a fractured bone, the scans will also detect the early signs of brain illness and exactly where the brain is broken.
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