The Mommy Makeover is the most popular, and one of the most satisfying, combination cosmetic plastic surgery procedures. With the ability to reshape the breast and flatten the belly, the Mommy Makeover is the procedure of choice to rejuvenate the female form after pregnancy or weight loss.
This Wednesday, June 7, 2017, I will be on the San Francisco Bay Area’s News Station, KRON 4’s Body Beautiful. The show airs live at noon. As usual, the discussion is focussed on the latest Cosmetic Plastic Surgery News for the San Francisco Bay Area.
Body Beautiful Plastic Surgery Topics
This week’s half-hour television show discusses Cosmetic Plastic Surgery of the Body. Planned topics include:
The Mommy Makeover Before and After Pictures that leads this post demonstrate the most popular combination cosmetic plastic surgery. By combining Breast Augmentation and Tummy Tucks, the two areas the often sag after pregnancy, the breasts and the belly, are both addressed. Of course, the procedures can be performed without having had children. The term Mommy Makeover was coined because of the frequent request from mommies to repair the damages of pregnancy on their breast and bellies. Another common situation in which Mommy Makeovers are performed is significant weight loss.
EDIT – The first Plastic Surgery Video segment on Mommy Makeovers is up and live right here: Mommy Makeover Video.
Breast Augmentation Mastopexy (Breast Implants with Breast Lifts)
Breast Augmentation remains the most popular single plastic surgery procedure. Breast implants can provide volume, and as many as 40% of patients also benefit from a breast lift. Breast lifts can improve breast shape in ways the Breast Augmentation alone cannot.
Breast Augmentation is still one of the most frequently performed cosmetic plastic surgery procedures, but what happens if the breasts are saggy, or the nipple is very low on the breasts? Breast Augmentation in these situations may provide larger breasts, but not necessarily perky ones. As many as 40% of Breast Augmentations combine some sort of Breast Lift. The most common reasons for this are low set nipples or saggy breasts due to excess skin.
Additional procedures can also be added to correct other breast problems, Fine details of the breasts that are often targeted for improvement are: Areola Reduction, the improvement of Breast Asymmetry, Breast Implant Revision for women who had Breast Implants before pregnancy and Inverted Nipple Repair. Breast Reduction, perhaps paradoxically, can also be combined with Breast Augmentation Mastopexy when heavy lower breast tissue is distorting the shape of the breasts.
Brazilian Buttocks Lift
The fastest growing procedure is the Brazilian Butt Lift. The procedure takes fat from areas where it is not desired and repurposes it, to enhance the shape of the buttocks.
A newer body procedure is allowing Board Certified Plastic Surgeons to shape an area that traditionally has been difficult. The Brazilian Buttock Lift (BBL), allows us to remove fat with Liposuction and reuse it to enhance the buttock contours. Pioneered by Brazilian Plastic Surgeon, Ivo Pitanguy, the procedure allows for customized augmentation of the buttocks, and shape that is more pleasing to the eye than Buttocks Implants can provide.
Thigh Lifts in the SF Bay Area
The Thigh Lift is used most often after weight loss. Excess skin and fat from the inner thigh is removed to reduce the size of the thighs and tighten the skin.
Thigh Lifts are one of the less frequently performed cosmetic plastic surgery procedures. The numbers have risen in response to Bariatric Surgery and the massive weight loss associated with it. As weight is lost, the thigh skin that is stretched during weight gain becomes loose. As the volume of the thigh decreases, so does the support that the extra fat provides the thigh skin. As a result, the skin can hang like drapery. The Thigh Lift removes this excess skin, and helps to tighten the thigh, especially the upper, inner thigh.
Watch Body Beautiful June 7, 2017, on KRON at Noon Wednesday
If you are interested in learning more about any of the above procedures, I have provided links in this post, and I encourage you to watch me live on KRON 4, this Wednesday at noon. Segments from the show will be posted here, on the San Francisco Plastic Surgery Blog, in the coming days. So if you miss the live show, you can still catch up here or on my local San Francisco Plastic Surgery Web Sites.
Internet education can be very helpful, and it is the goal of the San Francisco Plastic Surgery Blog; however, because information on the Internet is designed to apply to the general population, it is generic in nature. Medical advice cannot be giving without the personal contact that an in-person consultation appointment provides. To get “brand name” plastic surgery information, tailored to your specific needs, call my San Francisco Bay Area Plastic Surgery Clinic today, at (925) 943-6353, and schedule an appointment to get your personal, Board Certified Plastic Surgery information.
The 2016 diagnostic algorithm for BI-ALCL, shown in the flowsheet above, is still the recommended treatment. If you experience breast implant enlargement, breast inflammation, breast pain, a breast lump, a breast sore or feel like there is fluid around your breast implant, follow up with your plastic surgeon or primary medical doctor ASAP. (Click image for larger view.)
It’s been about six months since the last San Francisco Plastic Surgery Blog ALCL update. Recently, more information on the subject has become available, and it is about to be published. Two articles stand out. The first is from the United States, and the second is a global review of what is known to date. Both were recently e-published, ahead of print, in the American Society of Plastic Surgeons’ (ASPS) journal, “Plastic and Reconstructive Surgery.” Here are the latest facts…
What is BI-ALCL?
Breast Implant Associated – Anaplastic Large Cell Lymphoma (BI-ALCL) is a T-cell lymphoma that arises around breast implants. It is an extremely rare tumor, which makes it difficult to study; however. earlier data suggests that it is primarily associated with textured breast implants.
The Latest Plastic Surgery News
The first article by Doren et al, entitled: United States Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma, reviews all cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BI-ALCL) in the United States since the first documented case in 1996 up to and including cases reported in 2015. The study is retrospective, so it is not an ideal study for determining the incidence of the disease; however, it’s the best guess we have to date, and the conclusions seem fair. Although rare, all cases of BI-ALCL with adequate history have involved a textured breast implant. The incidence and prevalence of BI-ALCL was determined based on a literature and institutional database review of BI-ALCL cases and textured breast implant sales figures from implant manufacturers’ annualized data.
2017 United States BI-ALCL Data
One hundred pathologically confirmed BI-ALCL cases were identified in the United States. Mean age at diagnosis was 53.2±12.3 years. Mean interval from implant placement to diagnosis was 10.7±4.6 years. Forty-nine patients had breast implants placed for cosmetic reasons, 44 for mastectomy reconstruction, and seven for unknown reasons. Assuming BI-ALCL occurs only in textured breast implants, the incidence rate is 2.03 per 1,000,000 person-years (203 per 100 million), which is 67.6 times higher than that of breast ALCL (3 per 100 million; p<0.001). Lifetime prevalence was 33 per million persons with textured breast implants.
2017 Global BI-ALCL Data
The second article by Srinivasa et al, entitled: Global Adverse Event Reports of Breast Implant-Associated ALCL: An International Review of 40 Government Authority Databases, reviews all federal database submissions relating to BI-ALCL in 37 countries representing the majority of breast implant markets worldwide with available adverse event reporting. Database queries were performed for Australia, Brazil, Canada, China, Columbia, Japan, Mexico, National Competent Authorities of the European Member States, New Zealand, South Korea, and United States. Demographics, device characteristics, pathology, treatment modalities, and outcomes were assessed when available.
The United States MAUDE database included 459 entries in total for the search terms “Anaplastic” and “ALCL” as of September 2015. Excluding for duplicate entries, the MAUDE database had 258 unique cases of BI-ALCL of which 130 had pathologic markers performed. Implant surface was textured significantly more than smooth (50% vs. 4.2%, p=0.0001). Treatment, when reported (n=136), included explantation (n=125, 91.9%), chemotherapy (n=42, 30.8%), radiation (n=25, 18.4%), and/or stem cell transplant (n=9, 6.6%), and 5 deaths were reported. For the 40 countries queried, 340 unique cases were reported for lymphoma associated with breast implants.
They concluded that worldwide federal reporting of BI-ALCL has significant limitations in providing data regarding clinical history, treatment, and oncologic follow up. Country-specific total implant and textured implant sales data is needed in order to determine critical incidence and prevalence analysis. Detailed BI-ALCL patient registries such as American Society of Plastic Surgeon’s PROFILE and centralized tissue banking are necessary in acquiring accurate complete data for sound decision making. The good news for American’s here is that the American Society of Plastic Surgeons are leading the way in accurate and appropriate reporting.
What To Do If You Think You Have BI-ALCL
The most common presentation of BI-ALCL is a collection of fluid that occurs around your breast implants years after surgery. BI-ALCL is not the most common cause of these late seromas, but sending a sample may be the fastest way to make the determination. Other presentations include a mass attached to the capsule, tumor erosion through the skin, regional lymph node involvement, or sometimes it is discovered during revision surgery. Risk estimates ranged from one in 500,000 to one in 3 million women with implants.
The typical presentation of ALCL is a large seroma (fluid collection) around the breast implant causing obvious enlargement and asymmetry of the breast augmentation.
If you suspect there is a problem with your Breast Implants, whether related to BI-ALCL or not, contact an experienced Board Certified Plastic Surgeon in your area. If your original Plastic Surgeon is still in practice near-by, this would be the best place to start. They have your clinical information, and a head start in the investigation. If you have moved, or your plastic surgeon has retired, try to get a copy of your medical records. This will help your new Plastic Surgeon get to the facts much faster.
If your are feeling that your Breast Implants are too big, like the bowling balls Holly Madison is holding at the Bowling For Boobies Fundraiser in Hollywood, CA, it might make sense to have them reduced or even removed. About 1% of women who get Breast Implants have them removed at some point in their life.
Breast Implant Removal is not the most popular Cosmetic Plastic Surgery procedure. In fact, for most of my Breast Augmentation patients, Breast Implant Removal is unthinkable. Longterm plastic surgery statists show that only about 1% of women who get Breast Implants have them removed. Sometimes it is elective; sometimes it is medically necessary.
Why Have Breast Implants Removed?
Breast Implant Removal Before and After: This patient has great breast skin elasticity, so she has no skin sagging after her Breast Implant Removal. Breast Implant Remova surgery is just as personal as Breast Augmentation surgery, and the reasons for it vary. Only 1% of all Breast Augmentation patients have their Breast Implant removed.
While it is not common, there are many reasons for Breast Implant Removal. Since Breast Implants are used for both an elective and reconstructive procedure, the reasons for Breast Implant Removal can also range from elective to required.
Elective Reasons: Changes in one’s personal physique preference, body image and physical changes associated with weight, pregnancy or aging can all lead to a desire for less breast augmentation. Elective reasons For Breast Implant Removal include:
Breast Implants were placed at a young age and things have changed
Increased breast size after pregnancy
Increase in breast size associated with menopause
Planning to get pregnant and don’t want breasts to have a head-start in getting stretched out
Breast Implants are just no longer desirable or wanted
Required Reasons: Required reasons for Breast Implant Removal is more common for Breast Reconstruction patients than for elective Breast Augmentation patients. Reasons include:
Breast Implant Deflation (In most cases the Breast Implant is replaced rather than left out)
Breast Implant Infections
Breast Implant Exposure
Other severe complications of Breast Implants where the pocket needs to be reconstructed
Uncommon forms Breast Cancer treatment which include Hyperthermia
How Are Breast Implants Removed?
Breast Implant Removal Before and After Photos: Larger implants and less native breast tissue increase the desire for a Breast Lift after Breast Implant Removal Surgery. This patient above had large volume breast implants, small natural breast tissue volume, but good skin tone and nipple placement. She elected not to have a Breast Lift.
Uncomplicated Saline Breast Implant Removal can be performed under local, local with sedation or general anesthesia, depending on the motivation and tolerance of my patient. Silicone Breast Implant Removal is more often performed under general anesthesia. The reason for the difference is in the filling.
Saline Breast Implant Removal
Saline Breast Implants are filled with water essentially. The implants can be opened, the contents suctioned out and the implants’ silicone shell can be removed without fear of spillage through a small incision. While many saline breast implants were placed via a peri-areolar incision, they are often removed via the infra-mammary fold incision (IMF) to decrease the risk of dimpling at the areolar incision.
Silicone Breast Implant Removal
Silicone Breast Implants are filled with silicone gel. Unlike a Saline Breast Implant, it is sometimes difficult to know before surgery if a silicone breast implant is ruptured. Even MRIs are only 90% accurate. If your silicone breast implant is ruptured, more needs to be done than just remove the implant, so your surgeon will want to have the option, and this is more easier on you, and your surgeon, under general anesthesia. This is especially true of breast implants manufactured before 1994. These can have free silicone gel in the pocket around the implant, even without being ruptured due to “gel bleed.”
After Breast Implant Removal Will I Need A Breast Lift?
Breast Implant Removal Before and After Pictures: The patient above wanted her Breast Implants removed because she felt too big. She also has some bottoming-out of her breast implants. Her breast implants were removed and a special, inferior-pole lift was performed to reduce the amount of skin hanging below her nipple and to move the native breast tissue that she had back up under the nipple.
This is question that can only me answered with a Plastic Surgery Consultation. In general, the larger your implants and the smaller your natural breasts, the more likely you are to need a lift. An option that is always available though is to have the Breast Implants removed, allow the breasts to heal and then evaluate if a lift is beneficial. While this means two operations, it also means that you can make the decision to lift or not to lift without having to guess what your breast will look like without breast implants.
Recovery After Breast Implant Removal
Recovery after Breast Implant Removal is usually pretty quick. Most patients are wearing a firm, jog-type bra immediately after surgery to help the breast implant pocket seal and heal. Light compression provides decreased swelling, increased support and decreased discomfort after surgery. In cases where full capsulectomies are performed, or when free silicone needs to be removed, more surgery is required, so the recovery would be expected to increase proportionately with the amount of additional work required.
To schedule a Breast Implant Removal consultation, give my San Francisco Bay Area Plastic Surgery Office a call at (925) 943-6353. We are centrally located in the SF East Bay city of Walnut Creek, CA.
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.
“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.
Breast Implants are used both to provide a larger bust and to augment the natural contours of the breast. The primary goal is to improve body proportions and the fit of clothing and bathing suits. Breast Implants can help when the breasts have always been small; however, the loss of breast volume after childbirth is another common reason for Breast Augmentation.
Breast Augmentation On Television
Below is a Breast Augmentation Video. It contains Before and After Pictures of Breast Augmentation with narration. Breast Implants and Breast Enhancement, including primary Breast Augmentation, Breast Augmentation Revision and the treatment of Capsular Contracture are illustrated and discussed on KRON 4, the San Francisco Bay Area’s New Station. The show is Body Beautiful, and many video segments are available here on the San Francisco Plastic Surgery Blog and Dr. Mele’s YouTube Channel. Just click on Videos under categories in the margin or the YouTube logo.
Breast Augmentation Video (Breast Implants)
Breast Augmentation Consultations
Breast Augmentation is a very personal decision. If you have always had small breasts, or your breasts have shrunk due to pregnancy, weight loss or even age, Breast Implants may be an option. To learn more, schedule a private consultation appointment with a Board Certified Plastic Surgeon in your area. If you are near the San Francisco Bay Area, give me a call at (925) 943-6353 to get all your questions answered.
Breast Augmentation remains the most popular cosmetic plastic surgery procedure year after year. Breast Implants enlarge small breasts, whether you were born with small breast, lost breast volume with weight loss or your children have sucked the life out of your breasts. Capsular Contracture can interfere with good results, but before I explain what Capsular Contracture is, I need to discuss Breast Augmentation and normal healing.
How Do Breast Implants Stay In Place?
During Breast Augmentation surgery, the Breast Implants are carefully positioned. A pocket is made, often behind the pectoralis major muscle, to the dimensions required. The size of the pocket is determined by the dimensions of the breast implant used, and the implant is determined by your anatomy and the amount of augmentation desired.
What is the Breast Implant Pocket?
Breast Augmentation depends of the formation of a proper Breast Implant Pocket for the best results.
After Breast Augmentation surgery, your body will naturally form a pocket, lined with collagen, that encapsulates the breast implant. Ideally, the capsule is tight enough to keep the implant from moving, but not so tight that the augmentation feels hard.
With Breast Implants, Size Matters
The size and shape of the Breast Implant is important to get the optimal breast shape. Your cosmetic result is determined by a combination of a good plan, good surgery, good healing and little good luck doesn’t hurt either.
A Good Plan is formulated before surgery, during your consultation appointment. It should be tailored to your anatomy and your goals. Good communication is critical. It takes teamwork to get a good result, so the best way to start your Breast Augmentation journey is with an experienced plastic surgeon whom with you communicate well.
Good Surgery is only possible after a good plan is agreed upon. Just like the consultation, there is teamwork involved with the surgery, too. As the patient, you have to prepare yourself properly before surgery, and after surgery, you need give your body time to heal and adjust to the breast implants. The surgeon is responsible for the actual Breast Augmentation procedure. While exact results can never be guaranteed, choosing an experienced, Board Certified Plastic Surgeon maximizes the predictability and safety of your procedure.
Most patients have Good Healing. The majority of healing is how your body responds to the procedure. Following your surgeon’s postoperative instructions and cooperating with their aftercare helps improve your outcome. Each surgeon will have individual variations in care, depending on the technique they use, their experience and most importantly, you. The Internet is unlikely to provide you with a better plan, so any knowledge you receive online, even from the San Francisco Plastic Surgery Blog, should be discussed with your surgeon prior to implementation. Even if you are my patient, I will construct a specific plan for you. Given the specifics of your situation, I will adapt your surgery to you, rather than the generic Internet breast aug patient.
The Breast Implant Pocket
When it comes to great results, the Breast Implant Pocket is second only to selecting the proper implant in importance. The proper breast pocket supports the breast implant and protects it. The pocket needs to be both in the proper place and of the proper size. A pocket in the wrong position means your implant is in the wrong position, but the size of the pocket matters equally.
With Breast Pockets, Size Matters Too
A pocket that is the wrong size will diminish your results. A pocket that is too large results in a implant that moves around too much. The implants in a pocket that is too large may fall under your armpits when you lay down, or bottom-out when you stand.
When the Breast Implant Pocket is too big, the breast implant does not have sufficient support. The result is breast implant malposition with Bottoming-Out when standing. A capsulorrhaphy was performed to close the lower pocket and increase the breast implant’s support.
A pocket that is too small squeezes the implant, and makes it immobile. A tight pocket makes the breast implant feel hard and may over time move the implant away from its ideal position. When this happens it is called Capsular Contracture.
So, Capsular Contracture is when the normally helpful breast implant pocket becomes too tight. It is one of the most common reasons for Breast Augmentation Revision. Unfortunately, it is also one of the most unpredictable problems associated with Breast Implants.
Capsular Contracture results in a compressed breast implant that looks, smaller, feels harder and in the worst case scenario hurts. A capsulectomy and breast implant exchange was performed to provide this patient with softer, larger, painless breasts that look and feel better.
Treatments for Capsular Contracture vary with the problems it is causing. Thin, tight capsules can often be opened by dividing them with a Capsulotomy. Thick, tight capsules may require complete removal with a Capsulectomy. Sometimes replacement of the breast implant is recommended, and sometimes ADM patches are recommended, to help prevent recurrence of the Capsular Contracture.
If you are considering Breast Augmentation, or if you have breast implants and are considering Breast Augmentation Revision Surgery in the San Francisco Bay Area, give me a call at (925) 943-6353. A brief consultation appointment is usually all that is needed to review the details of your case and to formulate a plan that makes sense for you.
Breast Augmentation remains on top of the list as one of the most popular Cosmetic Plastic Surgery procedures year after year. With hundreds of thousands of women receiving Breast Implants every year in the United States, it is no wonder that Breast Augmentation Revision has become its own area of specialization.
What is Breast Revision Surgery?
Breast Revision Surgery is any surgery on the breasts to repair or improve the appearance of a previous Breast Augmentation. The urgency ranges from completely elective to an emergency. It can be caused by aging, pregnancy, changes in weight, changes in goals or changes caused by the breast implants themselves. Some of the more common reasons for Breast Augmentation Revision Surgery are covered in the video and text below.
Breast Implant Revision Surgery Video
Below is a segment from a recent Body Beautiful appearance. This video about Breast Implant Revision Surgery first appeared on the San Francisco Bay Area’s New Station, KRON 4.
Breast Augmentation Revision Surgery Video (Breast Implant Revision)
Breast Augmentation Revision to Change Breast Implant Size
There are many reasons for Breast Implant Revision Surgery. Changing size is one of the most common, and usually the desire is to Enlarge Breast Implant volumes. After pregnancy, weight loss or aging, the breast may shrink. Increasing the size of the Breast Implants may be all that is needed to restore both breast shape and confidence. Sometimes, however, the goal is to Decrease Breast Implant volumes, and rarely, Breast Implant Removal is desired. When downsizing or removing the Breast Implant, it may be necessary to perform a Breast Lift to obtain the best possible results.
Breast Implant Revision for Capsular Contracture
Hardening of the Breast Implants occurs when the normal scar pocket that holds the implant in place becomes too small. The tight pocket squeezes the Breast Implant causing firmness, increased projection, decreased diameter and sometimes discomfort. The medical term for this is Capsular Contracture. Most of the time, the breasts can be softened with release (capsulotomy) or removal (capsulectomy) of the capsule as an outpatient procedure.
Breast Implant Revision for Deflation
A deflated Breast Implant needs to be fixed. Breast Implant Replacement is most common, though sometimes a patient will elect to remove her Breast Implants instead. For Saline Breast Implants, the diagnosis is simple. The breast will quickly return to its non-augmented size. The body quickly absorbs the saline, and it is eliminated as easily as when we drink extra water.
For Silicone Gel Filled Breast Implants, the diagnosis is harder, because the gel is not absorbed. New, highly cohesive breast implants, have an extremely low risk of gel migration, so the gel most often stays in the capsule and maintains the breast fullness. Often, an MRI is needed to diagnose a leaking silicone gel implant, but even this is only 90% accurate. If an MRI shows that your silicone breast implant is leaking, it should be removed and, if desired, replaced.
Breast Augmentation Revision for Malposition
Breast Implant Malposition means the implant is in the wrong position. It can be too high, too low, too medial (to the center) and too lateral (to the side). Often, the capsule requires modification in these cases to encourage the Breast Implant to stay in the proper place. Implants that are too large, or soft tissue (skin, breast of muscle) that is too thin, can make management more difficult. Breast Implant Malposition is one of the items discussed on the Breast Revision page of DrMele.com.
Breast Augmentation Revision Surgery Consultations
There are many reasons for Breast Implant Revisions. If you are considering surgery to improve the results of your Breast Augmentation, be certain to seek a Board Certified Plastic Surgeon with years of experience, like Dr. Joseph Mele.
To schedule a personalized Breast Revision Consultation call (925) 943-6353 today.