Eyelid surgery is a way to open tired looking eyes and reduce lower eyelid bags. It can improve your view of the world and how the world views you. An Eyelid Lift is an outpatient Cosmetic Plastic Surgery procedure that can dramatically improve the appearance of the skin around the eyes.
Eyelid Lift Before and After Pictures
Eyelid Surgery, or Blepharoplasty, shrinks the loose skin than overhangs the upper eyelid and tightens the bags often seen in the lower eyelids.
What Can Blepharoplasty Do For You?
Blepharoplasty literally means “Eyelid Shaping,” and that’s exactly what it does. If you have excess eyelid skin encroaching on your upper eyelashes, or acting like blinders blocking your vision, an Upper Blepharoplasty can help. Removing redundant upper eyelid skin not only makes you look more alert and rested, in cases of visual obstruction, it will increase your field of vision.
Cleaning Up the Upper Eyelids
Excess upper eyelid skin gives a tired look. After upper eyelid surgery, the appearance is alert and rested.
Lower Eyelid Bag Removal
The Lower Blepharoplasty can also diminish the tired look. The fat of the lower eyelid can push forward as we age and looks like the puffiness seen with fatigue. A Lower Eyelid Lift can remove the excess fat and tighten the lower eyelid, restoring a more youthful rested appearance.
Lower Eyelid Lift Before and After Photos
While upper eyelid surgery removes hooding, lower eyelid surgery removes bags. The post-operative appearance is alert, rested and still you.
What Can Eyelid Surgery Do?
The most common reasons that Eyelid Lifts are performed include:
This patient had upper and lower blepharoplasties, also known as a “Quad Bleph.”
The “Quad Bleph”
The rejuvenation of all four eyelids, two upper and two lowers, is also know as a “Quad Bleph.” The above Quad Bleph before and after photos reveal improvements in the appearance of both the upper and lower eyelids. Less upper eyelid skin means smoother, cleaner lines and that eye makeup stays put better. Lower eyelid improvements include smoother appearance and less bagging of both skin and lower eyelid fat.
Schedule an Eyelid Lift Consultation
There are a variety of techniques used for eyelid surgery. If you want more information that is specific to your needs, there is no substitute for an in-person and personal consultation appointment. Call (925) 943-6353 to take the next step toward rejuvenating your eyelids.
My favorite part about being a Plastic Surgeon is fixing stuff. I have been this way for as long as I can remember. I was one of those kids who loved taking things apart to see how they worked, and putting them back together like new, but improved. The ability to combine fixing stuff with helping people makes being a Plastic Surgeon the perfect profession for me.
Why Plastic Surgeons Like to Fix Stuff
I received the nicest email this week. A patient, who is a decade or so out from her Tummy Tuck, made my day by dropping a little note about how her Tummy Tuck is holding up. Rather than paraphrase, here are her words:
Hi there! I am a former patient who had a T-Tuck I think ten years ago. I was getting dressed this morning and still ADMIRING the work you did an how great I still look so I wanted to send you an updated “after” photo so your patients can see what really can be achieved with this procedure. I’m 56 now and I … look this good in a bikini. So, I just wanted to share this with you. If you can respond with your email address I will forward it – – and come by you have time to prove its not a fake!! ; )
The Proof is in the Selfie
Of course, I responded. And here is the proof:
Ten Years After Tummy Tuck at 56-years-not-so-old.
The Before Picture
To make her feel even better about taking care of the “work,” I sent her the before picture:
The “infamous” before Tummy Tuck picture at 46-years-old.
Plastic Surgery is a Partnership
It takes two to get a great Plastic Surgery result. At 46, my patient was in pretty good shape, but a lot can happen in 10 years. I suspected my patient was doing more for herself than getting an Abdominoplasty. When I inquired she responded with:
Well ok – I work out 6 days a week running and doing strength training also and I am in better shape now at 56 than I was in my 40’s when I had the procedure done. Here is the key – -Getting the surgery gave me a whole NEW level of confidence that inspired me to take it all to a new level! I don’t think I would have been motivated to really change my whole “lifestyle identity” if I had gotten from the surgery a glimpse of the potential I could reach. So thank you so much for everything! ; D
Make My Day
I hope you can see why this made my day. It is a privilege to be a Plastic Surgeon. Plastic Surgery is a lot of work, and it takes a lot of ongoing training, but the rewards are wonderful. Just like many of the things I took apart in my youth, my patients are not “broken.” In fact, many of them look very good without my help. While the changes we see in these Tummy Tuck Before and After Photos are physical, the changes that I often see go beyond that.
Excellent Plastic Surgery is a Partnership between the patient and the surgeon.
Improved Self Esteem?
It is often said that Plastic Surgery can improve self-esteem, and there are numerous studies that bear this out. Since most of us do not have best friends who are also Plastic Surgeons, it takes gumption to present your least favorite body part to a complete stranger. I think Plastic Surgery can remove some physical barriers, but the psyche and the body must be healthy to start with. Removing an uncomfortable physical barrier can awaken a healthy self-esteem like it did for my Tummy Tuck patient above.
San Francisco Bay Area Board Certified Plastic Surgeon
If you are considering Plastic Surgery in the San Francisco Bay Area, call (925) 943-6353 to schedule your person consultation appointment. There is a lot of information available about the many Cosmetic Plastic Surgeries I perform here on the San Francisco Plastic Surgery Blog, and the other web sites listed under “Useful Links” above. Also, feel free to ask questions via the contact form located in the column.
Facelifts, Eyelid Lifts, Tummy Tucks and Brazilian Butt Lifts (fat grafting to the buttocks) will all be discussed on this week’s Body Beautiful airing on the Bay Area's News Station, KRON4, this Wednesday at 11:00 AM (12 Dec 2014).
It’s hard to believe that I have been appearing on Body Beautiful for seven years. Doing live television is fun with a little unpredictable mixed in. The nice thing about live TV is that viewers can call in and ask questions. Since there are no retakes, the time commitment is exactly the same as the length of the show, plus San Francisco Bay Area travel time. The downside is there are no retakes, so what you see is what you get.
New Studios Just About Finished
The new KRON studio goes live in the next few days, and I hear it’s as beautiful as it is state-of-the-art, but that will be seen next episode. This week’s Body Beautiful will be one of the last shows broadcasted from the old KRON 4 studios. The current TV studio’s layout is the result of years of use. Every inch is utilized, and every wall has a purpose.
Janelle Marie and Dr. Mele getting ready for another episode of Body Beautiful – Looks like we were talking about Breast Implants that day.
The main KRON 4 studio I will use Wednesday has the Body Beautiful set, the main KRON 4 News set, a large green screen and the weather desk, the traffic desk and seating area used for interviews. In the center are the cameras which rotate around to the desired set. There are lots of cables interconnecting all the equipment on the floor and numerous lights hanging from the ceiling. Somewhere behind the green screen is the speaker that I hear your questions through. Above this is the booth where the producer and director produce and direct. The talent is top notch, and everyone is extremely nice, which helps a lot.
During the show, the phone number for KRON 4 will be broadcast. If you have questions about any of the procedures reviewed, or about Plastic Surgery in general, be sure to call in during the show. It the mean time, you can call my office at (925) 943-6353, or send me a note via the contact form in the margin. Some questions are hard to answer without seeing you, but I will do my best to get you the information you need.
Breast Augmentation remains the most popular Cosmetic Plastic Surgery procedure. With over fifty years of use, Breast Implants remain the safest and most reliable way to increase the size of a woman’s breasts.
Breast Implants have been an option for women with small breasts for over fifty years, but many myths about Breast Augmentation persist.
Ten Breast Augmentation Myths
A large amount of Breast Augmentation Information is available here on the San Francisco Plastic Surgery Blog and many other places on the Internet. Despite this, many misconceptions about Breast Enhancement still exist. Below are a few of the most common:
Breast Implants must be replaced every ten years. Breast Implants do not have an expiration date. As long as they are intact, look good and feel good, there is no reason to change them. The most common reasons for Changing Breast Implants is to change size or change from saline to silicone gel.
Breast Implants Cause Cancer or Connective Tissue Disorders. Breast Cancer is the most common cancer in women, and for Hispanic women, breast cancer is the leading cause of deaths from cancer. For all other ethnicities, lung cancer is the cancer most likely to kill you. Large studies show that your risk of cancer is the same with or without breast implants. Similarly, connective tissue disorders like Rheumatoid Arthritis, Scleroderma and Lupus are more common in younger women, but are found at the same rates in age matched populations of women with and without Breast Implants.
Saline Breast Implants are safer than Silicone Breast Implants. The FDA has approved both Silicone filled Breast Implants and Saline filled Breast Implants as safe and effective. Both have advantages and disadvantages, and these should be discussed with a Board Certified Plastic Surgeon before you make your Breast Implant Selection. Most patients who have had both types prefer the look and feel of Silicone Breast Implants over Saline Breast Implants.
Breast Augmentation with Fat Grafting is better than Breast Implants. The argument is that fat is “natural”; however, Fat Grafting of the Breasts was around before Breast Implants. Since the invention of breast implants, nothing has been shown to be safer or more effective. Fat grafting offers advantages for filling partial defects, like those seen after a large breast biopsy; however, fat is not a reliable substrate. The volume of fat transferred to the breast may not be the volume that survives. Fat grafting is unpredictable. It may take 100%, or may take 50%, and the amount of take may vary with location in the same breast. The fat will continue to change volume with your weight, and fat that does not take may disappear silently or form hard lumps that can calcify and make mammography more difficult to read. On the other hand, a precise Breast Implant volume can be selected.
You cannot breast feed after Breast Augmentation. Current recommendations are to try to Breast Feed whether you have Breast Implants or not. The breast milk is not changed by your breast implants. Incisions placed beneath the breasts (the IMF) are less likely to interfere with the lactiferous ducts ending in the nipple. Larger breast implants may be more likely to trick the breasts into thinking they are full, so lower volumes of breast milk may be produced.
Nipple sensation is lost after Breast Augmentation The vast majority of Breast Augmentation patients have no change in breast or nipple sensation after Breast Implants. Approximately 15% of women will have a change in sensation. The most common change is increased sensation, which often resolves in a few months. Decreased sensation can also occur, but is rarely permanent.
Breast Implants will Lift My Breasts. Breast sagging, or ptosis, is caused by a combination of factors. Loose skin and a low nipple position are the most common. The best treatment for breast ptosis is a Breast Lift. Sometimes, a Breast Implant will help provide additional upper pole fullness. Rarely, Breast Augmentation alone will correct a deflated breast. It requires a specific type of sagging called pseudo-ptosis (fake sagging).
Textured breast implants will prevent Capsular ContractureCapsular Contracture occurs when the pocket of scar that hold the breast implants in place becomes too tight. Texturing allows the scar to adhere to the surface of the breast implant and may reduce the risk of Capsular Contracture for some patients, but it can still occur. For patients who have had problems with Capsular Contracture in the past, switching to a textured Breast Implant may reduce the risk of recurrence. On the other hand, textured implants have a higher risk of rippling, wrinkles in the breast implants transmitted to the surface of the breast.
Darker Skin means darker, thicker scars. While the incidence of Keloids is higher in darker skinned individuals, it is still not common. A good test is to check your ear piercings. If you have a large lump of scar around the piercing, you may be at higher risk of a thicker scar, but this is true regardless of your skin type. It is how your body heals, not the color of your skin, which determines the appearance of your Breast Augmentation Scars.
Breast Implants provide Improved Self Esteem. This is something I have seen in print repeatedly. Self esteem is difficult to measure. It is clear that women often feel more confident and comfortable both in and out of clothing after their Breast Augmentation; however, it takes a fair bit of self esteem to find a Plastic Surgeon and show them a part of your body you want improved.
Breast Augmentation Facts
The Internet can provide a lot of information about Breast Implants and Breast Augmentation, but it is hard to sort through all the “facts” without years of training. After doing your online research, the best way to reach your Breast Enhancement goals is to consult a Board Certified Plastic Surgeon. There is no substitute for an in-person evaluation and consultation. Your goals and options will be explained in detail, and a safe and predictable plan constructed.
To schedule a private Breast Augmentation Consultation, call (925) 943-6353, or send me a message via the contact form in the left margin. Breast Augmentation is no myth. It is the most popular Cosmetic Plastic Surgery performed in the San Francisco Bay Area, and the United States.
For Meghan Trainor it’s, “All About That Bass.” Her song has frequently gotten stuck in my head, and apparently in many other heads, too. She has reached number 1 on the US Billboard Hot 100, and just announced the That Bass Tour which is scheduled to begin on February 11, 2015 in Vancouver, Canada and end on March 20, 2015, in Nashville, Tennessee. Not too shabby for a 20-year-old.
All About That Bass
There has certainly been more attention paid to the booty in recent years. In Plastic Surgery, the Brazilian Butt Lift continues to be a hot topic. More and more are done each year as techniques improve. However, if you look at the numbers, it’s still more about the treble.
Can’t Ignore the Treble
I like to keep things positive, so for me, Meghan’s “debut” single is all about appreciating assets rather than dissing flaws. It’s important to appreciate and admire our favorite features, but for Plastic Surgery balance is more important.
The Golden Ratio
Beauty is all about proportions. Math might not be the first subject that comes to mind when you think of beauty, but our brains are tuned to both symmetry and mathematical ratios. The most well known is the Golden Ratio. If you draw the perfect rectangle, the ratio of the sides will be the golden ratio. If the short side has a length of 1, the long side will have a length of 1.618. The number 1.618 is represented by the Greek letter phi.
Phi for Phidias
1572 engraving by Philippe Galle of Phidias’ enormous Statue of Zeus at Olympia
It was a mathematician, Mark Barr, who proposed using the first letter in the name of Greek sculptor Phidias to symbolize the golden ratio. Phidias was the creator of one of the seven wonders of the world – The Statue of Zeus at Olympia, and many of the carvings in and around the Parthenon. He used the Golden Ratio to great effect; creating beautiful sculptures of the human form.
It’s All About the Face Too
The Golden Ratio applies to the body and the face.
The Golden Ratio is not just about the body. It can be applied to the face, also. The faces above have a Golden Ratio Mask superimposed. The top row shows classic beauties going all the way back to Nefertiti (ca. 1370 BC – ca. 1330 BC). The middle row illustrates more modern beauties: Angelina Jolie, Audrey Hepburn and Marilyn Monroe. The ratio applies across nationalities as the Asian, Caucasian and African faces demonstrate on the bottom row, and applies equally as well to the male face below.
The Golden Ratio Mask applies equally as well to the masculine face.
Balance and Harmony Trumps Absolutes
The same Golden Ratio is found everywhere in nature, and not just in animals. Plants grow, and flowers bloom with the same attractive proportions. If you are considering Plastic Surgery, keeping the Golden Ratio in mind, or at least in your Plastic Surgeon’s mind, is important to obtaining optional results. Even for a simple lip plumping, the upper lip height is a 1, and the lower lip height is 1.618. We can all recognize this, and it is why when only the upper lip is augmented, the results are not as attractive. Attention to the proportions is important to a pretty, and natural, result.
For a private Plastic Surgery Consultation in the San Francisco Bay Area, give me a call at (925) 943-6353, or contact my Walnut Creek, CA, office via the contact form in the left margin.
Today is Veteran’s Day, a day honoring the men and women who have provided military service to their county. I’d like to send a personal thank you to my father, my uncle and other friends who have risked it all to protect these United States of America.
Why November 11th?
Front Page of the New York Times on November 11, 1918. Above the title it says “twenty-four pages” and the price, “two cents in the 10 miles radius of the metropolitan district, three cents within 100 miles and four cents elsewhere.”
November 11, 1918, is generally regarded as the end of “the war to end all wars,” i.e. World War I. The official end of WWI was June 28, 1919. This is when the Treaty of Versailles was signed; however, fighting ceased seven months earlier when a temporary cessation of hostilities, an Armistice, between the Allied nations and Germany went into effect on the eleventh hour of the eleventh day of the eleventh month. It was still a bloody day as 10,944 casualties including 2,738 who died on this, he final day of fighting. The last American was killed at 10:59 AM.
But I Thought it was Armistice Day
US 64th Regiment, 7th Infantry celebrate the first Armistice Day.
In November 1919, President Wilson proclaimed November 11 as the first commemoration of Armistice Day. The original concept for the celebration was for a day observed with parades and public meetings and a brief suspension of business beginning at 11:00 a.m.
It Was Armistice Day
In 1938, congress proclaimed the 11th of November a legal holiday – a day to be dedicated to the cause of world peace and to be thereafter celebrated and known as “Armistice Day.” It was a day to honor veteran’s of WWI. Unfortunately, WWI was not the war that ended all wars, so in 1954, the act was amended by replacing Armistice with Veteran’s. For the last 60 years, November 11th has been Veteran’s Day, a day to honor American veterans of all wars.
It Still is Armistice Day
The hillside near the Lafayette, CA, BART station is a large reminder that war continues to happen, almost 100 years after the end of the war to end all wars.
November 11th is still celebrated as Armistice Day in many nations. People observe one, or more commonly, two minutes of silence at 11:00 a.m. local time as a sign of respect. The first minute is for the roughly 20 million people who died in the war, and the second minute is dedicated to the living left behind. The holiday has also evolved into Remembrance Day and Poppy Day, in other nations.
How to Support Veterans
How can you support a Veteran? The five word title of this article is a good place to start. Thanking a veteran for his or her service is always appreciated. Like many of my favorite Plastic Surgery procedures, it is direct, simple and effective.
Organizations that support our troops range from local, like the Blue Star Moms in San Ramon and Danville, CA, to national, like the Wounded Warrior Project; from broad to specific, like the Navy Seal Foundation; from active duty, like the USO, to retired. There are many ways to support our Veterans, and no better day than today.
Many people have Plastic Surgery, but is it safe for “old” people? Should there be an age limit on Cosmetic Surgery? Recent research shines a spotlight on the question, and what is reveals is very encouraging.
How Old is Too Old for Plastic Surgery?
The woman above is a patient of Dr. Suzanne Noel, a French Plastic Surgeon who was doing “lunchtime facelifts” in her apartment one-hundred years ago.
How old is too old for Plastic Surgery? is a question I hear every week in my San Francisco Bay Area Plastic Surgery Office. My standard answer has always been that your health is more important than your age, and research presented at this year’s American Society of Plastic Surgeons meeting in Chicago backs that up.
Dr. Suzanne Noel, pictured above, was a gifted Plastic Surgeon and one of the first to perform outpatient surgery. Thankfully, today we use gloves. In 1924 she founded Soroptimist International Paris, the first Soroptimist club in Europe. The first Soroptimist club was founded in 1921, in nearby Oakland, California.
How Old is Old?
For me, every year “old” gets a little older. For the paper, Safety of Cosmetic Procedures in Elderly and Octogenarians Patients, the young group had an average age of 39 (+/- 12.5 years), and the elderly group had an average range of 69 (+/- 4.1 years). Investigators reviewed the outcomes of 183,914 people who underwent cosmetic surgery.
Differences Between the Young and Elderly Groups
There were some interesting differences between the young and elderly groups besides their age. There were more men in the older group (11.3% vs 6.2%), and the older group was a little heavier (average BMI 25.4 vs 24.2). There were more diabetics in the older group (5.7% vs 1.6%) and fewer smokers (3.4% vs 8.5%).
Different Folks Different Strokes
The Mommy Makeover, in this case Breast Augmentation plus a Tummy Tuck, is more often performed for younger women who are finished having children.
The two age groups also had different types of procedures. Younger women for example have more Tummy Tucks and Breast Augmentations and don’t need many Face Lifts. As expected, the elderly group had more Facial Plastic Surgery (69.2%) than their younger peers (12.0%).
Facelifts are more common performed after age 50, to reverse the sequela of aging: jowls, deep naso-labial folds and sagging neck skin.
And the Complication Rate is…
The most common complications with any surgery are bleeding (hematoma), infection and wound healing problems. The study revealed there was no difference in complications between the two groups. The complication rate for the younger group was 1.94%, while the complication rate for the elderly group was 1.84%. Even when selecting only the octogenarians, the complication rate was 2.2%, and still not statistically different from the younger group’s results. Each procedure was examined independently, and only the Abdominoplasty had a higher incidence of complications in the older group (5.4% vs 3.9%), so get your Tummy Tucks early.
Board Certified Plastic Surgeons
This study was for a group of patients operated on by Board Certified Plastic Surgeons. The selection of patients who are good candidates for Plastic Surgery includes more than the fact that someone wants surgery. It includes objective and subjective evaluations about safety and predictability. The was no data available for the number of patients who were declined Cosmetic Surgery because of health concerns. This study looked only at a group of patients who Plastic Surgeons felt were safe to have their selected procedures. It is not clear if the outcomes would be the same if another group of providers were making the selection.
If you are considering Plastic Surgery, select a Board Certified Plastic Surgeon with experience performing your desired Cosmetic Surgery. If you are seeking a Plastic Surgeon in the San Francisco Bay Area who specializes in Cosmetic Plastic Surgery, give me a call at (925) 943-6353, or contact me through the contact form in the margin.
This week, I am continuing to talk about Breast Augmentation, specifically Breast Implant Deflation. As mentioned in last week’s post about Saline Breast Implant Deflation, Silicone Breast Implant Deflation is quite different. A Saline Breast Implant is essentially filled with water. Saline is slightly salty water (0.9% NaCl) that matches the saltiness of our bodies. When saline leaks out of the implant, it is absorbed. Saline quickly disappears without a trace, and it is not dangerous.
Saline or Silicone? Saline and Silicone Breast Implants feel different, but give similar results visually.
Get to Know Your New Silicone Filled Breast Implants
Modern Silicone Breast Implants are filled with a soft, but nearly solid, silicone gel. The consistency is like a soft, “indestructible,” stress ball. The latest high strength, highly cohesive silicone gel breast implants are also form-stable. This means they maintain their shape. The phenomenon is similar to Gummy Bear candies. These soft bears can be compressed flat, and will return to there original bear shape once released. This is why the latest silicone breast implants are frequently referred to as Gummy Bear Breast Implants. The video below makes it clear what happens when there is a hole in the shell of a silicone breast implant.
Video of the Inside of a Gummy Bear Breast Implant
This Breast Implant Rupture Video demonstrates what happens to the silicone filled breast implant’s contents after massive failure of the breast implant’s shell. Even when cut completely in half, the gel maintains its shape and integrity. It is soft, but does not flow. The high strength silicone gel changes shape easily when squeezed, and returns to its original form when the deforming force is removed. High tech meets high aesthetics.
Not Your Mother’s Breast Implants
Gummy Bear Breast Implants are a giant leap forward from the older silicone filled breast implants. Breast Implants manufactured before 1985 were filled with a silicone gel that behaved more like a liquid than a solid. When the breast implant ruptured, the silicone oil/gel would migrate into the breast and cause lumps of scar tissue. After 1985, the gel was made more cohesive, and the shells were made stronger. Implants after 1994 are less likely to leak, have very little “gel-bleed” (the ability of the gel to pass through the shell like helium through a balloon), and the gel inside them is less likely to migrate. If you are interested in the older breast implants, check out the History of Breast Implants.
Who Makes the Strongest Breast Implants?
Sientra’s newest breast implant line contains the strongest silicone gel to date, yet it remains soft.
The implant manufacturer which currently has the strongest silicone gel is Sientra. Their five-year follow-up data shows zero cases of gel migration. As a Board Certified Plastic Surgeon specializing in Breast Augmentation Revisions, who has spent many an afternoon cleaning up pre-1985 ruptured breast implants, this is welcome news. This means if your modern silicone filled breast implants rupture, the gel will not immediately begin to migrate, and has a very high likelihood of staying in the pocket. But this causes a different problem, which I discuss below under “Silent Leaks”.
Silicone Breast Implant Deflation
Silicone Breast Implants Deflations should always be addressed as soon as it is medically safe. Unlike with Saline Breast Implants, delaying correction can cause more problems than just the pocket tightening, especially if you have older technology Silicone Breast Implants.
Silicone, unlike Saline, does not absorb into the body. Instead, the body tries to contain it by making a pocket of scar. For an intact Breast Implant, this works very well. The pocket surrounds and supports the implant, keeping it in the desired position. When a Silicone Breast Implant Ruptures, initially the gel remains within the breast implant’s pocket. With newer highly cohesive and gummy bear breast implants, the gel tends not to flow.
Older Breast Implants Are Messy When they Leak
For older, pre-1994, silicone filled breast implants, long term studies show that the more liquid-like silicone gel in older breast implants can migrate outside the pocket on the order of 14% per year. This means that if we follow 100 women who have older silicone gel filled breast implants that are already ruptured for one year, fourteen of them will develop gel migration outside the containment of the breast implant pocket. This gel migration may become evident as a change in shape of the breast implant, sudden softening of the implant, or lumps in the breast as the body tries to form a new pocket around the leaking gel.
Silent Silicone Breast Implant Leaks
The latest generation of breast implants have a strong, fairly solid center. The scar pocket contains this highly cohesive gel, much like the breast implants shell does, even after there is a leak. This makes it difficult to tell when the implant has leaked on physical examination. This is termed a silent leak, something that cannot happen with saline breast implants. What problems a silent leak can cause when the gel is still contained are not clear, but it is recommended to have any Leaking Silicone Breast Implant replaced before it can cause the problems outlined above. The FDA has recommended obtaining an MRI at three years, and then every two years after breast augmentation with silicone breast implants. With the data coming from the long-term breast implant follow-up studies showing reduced or no gel migration with the newest generation of breast implants, this recommendation may be modified in the future.
Breast Implant Revision Surgery
Breast Augmentation remains the most popular Cosmetic Plastic Surgery. While many women will keep their original implants for life, other will benefit from Breast Implant Revision Surgery.
If you are considering Breast Implants, or would like Breast Augmentation Revision, a Board Certified Plastic Surgeon is your best bet for a great result. If you are near the San Francisco Bay Area, give me a call in Walnut Creek, California, at (925) 943-6363, or use the contact form to the left for more information.
There is a big difference between Breast Implant Deflation for Saline versus Silicone filled Breast Implants. A deflated Saline Breast Implant is illustrated below. Since saline is water that is slightly salty (0.9% NaCl) to match our bodies, it is not dangerous and is quickly absorbed. Saline is necessary for life. The IV bag of saline used to inflate breast implants is exactly the same bag used to resuscitate people who are dehydrated.
Saline Breast Implant Deflation Before and After Photos
The dramatic asymmetry above was caused by deflation of the left breast’s saline filled breast implant. While the saline is quickly and safely absorbed, its exit rapidly returns the breast to its pre-augmentation size. The after photo shows the result after breast implant replacement surgery.
The shell of a Saline Breast Implant is strong, so they do not leak often. When they do; however, it is safe but it is not subtle. More on this below under Saline Breast Implant Deflation.
Silicone Breast Implant Deflation: More Next Week
Modern Silicone Breast Implants, while soft, are nearly solid. The latest high strength, highly cohesive silicone gel breast implants are form stable. This means they maintain their shape. The phenomenon is similar to Gummy Bear candies. These soft bears can be compressed flat and will return to there original bear shape once released. This is why these implants are frequently referred to as Gummy Bear Breast Implants. The newest silicone breast implants are filled with a gel that is unlikely to migrate, but causes a different problem with surveillance, which I will get to next week when we discuss Silicone Breast Implant Deflation.
Saline Breast Implant Deflation
Saline Breast Implant Deflation while disappointing, is not dangerous. It is rare for a saline implant to partially deflate, so the augmentation of the effected breast is lost rapidly, usually in 24 hours. While replacement is not an emergency, there are several advantages to performing the Breast Implant Replacement sooner rather than waiting.
Immediate Breast Implant Replacement
This woman developed a collection of blood (a hematoma) around her ruptured breast implant after trauma. Urgent breast implant replacement was performed before the hematoma became infected or leaked through the skin.
Reasons for Early Breast Implant Replacement include not only the rapid restoration of appearance, but early intervention prevents the “pocket” from shrinking. The pocket is the thin capsule of scar that surrounds and supports the Breast Implant. This pocket is important in preventing the breast implant from moving. Too thin a capsule will allow the implant to “bottom-out.” While too thick a capsule will compress the breast implant, making it hard. This situation is termed Capsular Contracture.
Late Breast Implant Replacement
If a Saline Breast Implant has been deflated for months, the capsule will gradually tighten around the deflated breast implant shell. The shell can fold irregularly, and these folds may become visible. Some patients even complain of discomfort from the folds poking them. After the capsule shrinks, it will no longer accommodate the replacement breast implant. To make room, the pocket is enlarged (a capsulotomy) or removed (a capsulectomy) to create a pocket of adequate size.
When a breast implant remains deflated for a long time, the skin and the pocket around the implant often shrink. This before and after picture show improved symmetry after breast implant replacement surgery.
Delayed Breast Implant Replacement may have both financial and medical causes. Looking for the lowest price in Plastic Surgery is not usually a good idea. It is alway a good idea to check with your Plastic Surgeon or your Breast Implant Manufacturer about your Breast Implant Warranty. The link provides some of the basic information, but breast implant warranties change from time-to-time, so be certain to get the latest information. If you are having Breast Augmentation, be certain to check your options. Some manufacturers offer enhanced warranties, which need to be purchased within 30 days of the initial Breast Augmentation. These warranties can be very helpful if you have a leaking breast implant as they offer not only a new implant, but money toward the surgery to replace them.
Why Delay Breast Implant Replacement?
Sometimes it is necessary to delay Breast Implant Replacement. Medical reasons include: pregnancy, active infection, breast implant exposure or untreated breast cancer. The timing of Delayed Breast Implant Replacement is guided by the clinical course. Sometimes, Breast Implant Removal is the best option. This is most often recommended for breast implant infections or in cases when the skin breaks down over the implant. The timing for Breast Implant Replacement in cases where implants need to be removed and left out is guided by both the clinical course and your desires. Usually, it is best to wait three, six or even twelve months before attempting replacement of the breast implant.
Breast Implant Repair
As you can see there are lots of options and details to consider with breast implant replacement, and we haven’t discussed Silicone Breast Implants, yet. If you need breast implant replacement, it is also a good time to address all the current breast augmentation options. Some patients will take advantage of the opportunity to switch from Saline to Silicone. Others, who have had some issues regarding asymmetry or breast sagging, will choose to take care of it simultaneously.
If you are in need of Breast Implant Repair, drop me a note via the contact form on this page, or call my San Francisco Bay Area office in Walnut Creek, California, at (925) 943-6363. More next week on Silicone Breast Implants.
Do Breast Implants cause breast cancer? At the risk of ruining the suspense, the answer is still no. Breast Cancer affects 1 in 8 women over their lifetime, and women with and without breast implants have the same risk. If your mother or sister have breast cancer your risk of having breast cancer is increased; however, only 20% of breast cancer patients have a family history of the disease. In other words, 80% of breast cancer is spontaneous.
The Best Cancer Defense is Finding it Early
Amy Robach preparing for her first screening mammogram at age 40.
Like most cancers, Breast Cancer is easier to treat if found early. Early detection means smaller tumors which are less likely to spread, and more likely to let you live a long life. If you find a lump in your breasts, get it checked out by your doctor. The only way to know what a breast lump is for certain is to sample it. Needle biopsies have come a long way, and diagnosis of a suspicious lump can be quick and easy in many cases.
What About the Breast Cancers We Can’t Feel?
The best screening test for breast cancer remains the Mammogram. New techniques can detect smaller tumors earlier, and reduce unnecessary biopsies. The current recommendation for healthy women without a family history of Breast Cancer is to get your first mammogram at age 40. Amy Robach (pictured above) learned the value of the screening mammogram when she received her first mammogram at age 40 as part of a story about Breast Cancer Screening. The test potentially saved her life by detecting a breast cancer before there was any evidence of the disease.
When to Get Your First Mammogram
The mammogram on left is of normal glandular breast tissue. The white circle in the mammogram on the right is breast cancer.
The American Cancer Society, The American College of Surgeons, The American College of Obstetricians and Gynecologists, The American College of Radiology and The Society of Breast Imaging all recommend that routine mammograms begin at age forty for women with an average risk of breast cancer. Women with a strong family history of breast cancer should have their first mammogram 10 years prior to the age that their relative was when they developed breast cancer. On the other hand, the federal government’s USPTF recommendations are to wait until age 50, no breast ultrasounds and no mammograms after age 75. Unfortunately, the USPTF’s recommendations are based on older methods of mammography, and fly in the face of the recommendations made by doctors who care for women every day. The same doctors who continue to make strides battling breast cancer.
Worldwide, there have been 71 documented cases of patients with anaplastic large cell lymphoma (ALCL) in women who have breast implants. This type of ALCL found around Breast Implants is completely different than the usual ALCL, in that it usually has a more benign course, and that removing the breast implants and their capsules has been curative with and without other treatments.
ALCL is normally found in the lymph nodes, as well as in skin, lung, liver and soft tissue, but not usually in the breast. This is a previously unrecognized, new subtype of ALCL. Cases in which ALCL developed in the breast region often involved patients who have had breast surgery, and arose in the scar tissue. Often, many years were required for the tumor to develop, and in the case of Breast Implants, a collection fluid around the implant, rather than a mass, leads to the diagnosis.
ALCL is not Breast Cancer
Anaplastic Large Cell Lymphoma
ALCL arises from lymphocytes (white blood cells), not breast tissue, so mammograms are not useful for diagnosis. Breast Implants are generally safe and studies have found no association between breast surgery and other forms of cancer. ALCL itself is also an extremely rare occurrence. Among three million breast implants, there are between one and six reported cases of ALCL.
What Causes ALCL of the Breast?
Determining the cause of ALCL is made difficult because it is so rare. While the tumor has been found associated with breast implants, it is unclear if Breast Implants are the cause, or if breast implants make the diagnosis apparent. Several mechanisms are under investigation including an abnormal immune response from the body. American, National and International Plastic Surgery Societies are raising awareness for this rare disease among their members, and are repeatedly soliciting their members for new or suspected cases, and compiling a database to help investigators get to the root of the problem. Breast implants, medical implants in other parts of the body and even dentures are being investigated for any link to this rare tumor.
Plastic Surgery and Breast Cancer
Fortunately, plastic surgeons get to help with the healing after the Breast Cancer is removed. As the results of Breast Reconstruction improve, the procedure becomes more popular. Some women, like Amy Robach and Angelina Jolie, are even electing to have both breasts removed and reconstructed. This is usually done when women are at higher risk for breast cancer in the other breast. Since genetic screening for breast cancer is relatively new, not enough time has passed to show any survival benefit to bilateral mastectomies. However, it does provide peace of mind for women who feel their breast is ticking time bomb.
Breast Implants Help After Breast Cancer
The most common way to reconstruct the breast after a mastectomy is with a breast implant. In the year 2000, 78,832 women underwent breast reconstruction, and in 2014 the number will be closer to 100,000. Millions of women have benefited physically and emotionally from these procedures. But with early detection, we can reduce the number of mastectomies performed, and increase the survival for breast cancer patients.
Breast Augmentation vs. Breast Reconstruction
New research confirms what plastic surgeons have known for years. Breast Augmentation does more for a woman than just enlarging her breasts.
Breast Implants are used three times more often for elective Breast Augmentation than for Breast Reconstruction. Breast Augmentation helps with the fit of clothing, provides high patient satisfaction and has been shown to provide significant improvement in quality of life for both elective breast augmentation and breast reconstruction after breast cancer. While breast implants do not cause breast cancer, there are risks and benefits that need to be discussed with a qualified Board Certified Plastic Surgeon. In most cases, the benefits will outweigh the risks, but the decision should always be individualized.
Breast Implant Consultations
If you are considering Breast Augmentation, and live in or near the San Francisco Bay Area, give us a call at (925) 943-6353. An in-person, confidential consultation is the best way to find out if Breast Augmentation is right for you.