UC Davis Picnic Day 2017

Posted April 23, 2017 in About Dr. Mele, Home

The Cal Aggie Band-uh leads off the 103rd annual Picnic Day Parade.

The Cal Aggie Band-uh leads off the 103rd annual Picnic Day Parade.

Picnic Day. If you attended the University of California in Davis, you know what I am talking about. Picnic Day is a 103-year-old campus tradition and the highlight of the University’s April social calendar.

UC Davis Campus-Wide Open House

If you have not been to a Picnic Day, it is a campus-wide open house. Every college, every discipline every major has something to share, and there are a lot of them.

UC Davis is the largest campus in the University of California system. It covers the most area both in acreage and in education. The campus supports over one-hundred majors in the four undergraduate colleges: Agricultural and Environmental Sciences, Biological Sciences, Letters and Science and my alma mater, the College of Engineering.

UC Davis is also home to almost 100 Graduate Studies programs, and six professional schools: The Betty Irene Moore School of Nursing, The Graduate School of Management, the School of Education, The School of Law, The worlds best School of Veterinary Medicine and my other alma mater, the UC Davis School of Medicine.

Tradition and Innovation

This year’s Picnic Day theme was “Growing Together.” Not only did the University celebrate their 103rd anniversary, but the city of Davis also celebrated their centennial. Davis is a true college town, and both have grown together.

The Davis Town Council riding in a vintage firetruck.

The Davis Town Council riding in a vintage firetruck.

The theme also included the growth from old to new. Old firetrucks were followed by new police vehicles.

The Latest in UC Davis Police vehicles

The Latest in UC Davis Police vehicles

Picnic Day 2017

The first Picnic Days I attended were years before enrolling. My best friend had family who lived next to the campus. We would bring our bikes and ride every mile on the bike paths, and off. As a student, Picnic Day was not to be missed. Friends and family would visit and celebrate the day. It was an easy way for me to share my college and for my friends to see what the UCD campus was about. As an alumnus, Picnic Day is a way to keep in touch with my younger self.

The tradition of learning, innovation and success continues...

The tradition of learning, innovation and success continues… Here are some of the banners that hang over the Aggie basketball court from back in my era. Go Aggies!

Read More

BIA-ALCL is Breast Implant Associated Anaplastic Large Cell Lymphoma

Posted April 09, 2017 in Home, Patient Safety

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Since the last BIA-ALCL update, all the plastic surgery societies and breast implant manufacturers have responded with information sheets. I am encouraged by the free flow of information within the Plastic Surgery profession and the industry that supports us.

ASAPS by the Numbers

The ASAPS has distributed a quick summary of the numbers related to BIA-ALCL. Here are a few.

How Many BIA-ALCL Cases Have Been reported?

Of the estimated 7 million women with breast implant throughout the world, 359 reports have been filed. Since the reports can be filed by patients, physicians or manufacturers, it’s important to note the MDRs (Medical Device Reports) are not individual cases, and multiple reports may be filed for a single case of BIA-ALCL. In contrast, there are currently 139 case reports of BIA-ALCL in the literature. It is also important to realize that this is a very small number in relation to the millions of breast implant patients. Lastly, the number is expected to rise because we are learning how better to identify and diagnose patients with the disease.

Smooth vs. Textured

Of the reported cases, over 90% occurred in patients who had textured implants at the time of their diagnosis. In the US database, there is a single case of a patient with smooth breast implants developing BI-ALCL; however, they had a textured tissue expander prior to the smooth breast implant placement. Unfortunately, the other 27 cases of BIA-ALCL reported in the world databases do not include past breast implant information, so while we can say that BI-ALCL is predominantly a problem with textured breast implants, it is unknown if a case has developed in a person who had exclusively smooth breast implants. Currently, 12.7% of US patients receive textured implants. This includes both textured round and all anatomically “shaped” breast implants, and includes both saline filled and silicone filled breast implants.

How Many BIA-ALCL Deaths Have Been Reported?

Of the 359 cases reported, 9 patients have died. Two patients died from stem cell transplants, one died from development of a second unrelated lymphoma, and 6 patients died from direct extension of the tumor. Early detection is key. Of the deaths, none of them received complete surgical excision at any point in their clinical history, none received targeted therapy, and most were significantly delayed in diagnosis or receiving any treatment (1-2 years from onset of symptoms). On the other hand, 93% of all patients are disease free at 3 years follow up. BIA-ALCL has an excellent prognosis when diagnosed early.

How Do We Diagnose BIA-ALCL?

Early diagnosis is key to successful treatment, so how do we accomplish this? Unilateral (one-sided) swelling or mass should lead to a thorough evaluation. This is common in the months following your breast augmentation. The possibility of BIA-ALCL should be considered in a patient with late onset, peri-implant seroma (fluid collection). The majority of patients present on average 8 years after implantation, but range extends from 2 to 28 years.

Ultrasound imaging followed by fine needle aspiration of seroma fluid should be obtained. Collected fresh seroma fluid should be sent to a qualified lab for immunohistochemistry testing for cluster of differentiation (CD30) testing.  Anaplastic Lymphocyte Kinase (ALK) testing of the seroma fluid can help differentiate BIA-ALCL from systemic forms of lymphoma that may appear in the breast.  

Current BIA-ALCL Treatment

Most patients with BIA-ALCL are cured by removal of the implant and capsule surrounding the implant, however a small number act more aggressively and may require additional treatments. For 2017, the National Comprehensive Cancer Network defines optimal treatment which is total capsulectomy and implant removal for the majority of patients with disease confined to the capsule (35% of patients) or a resectable mass (40% of patients). Advanced disease with lymph node metastasis (14% of patients) or organ metastasis (1% of patients) may require further treatment with chemotherapy using either CHOP anthracycline based-protocol or targeted therapy with brentuximab vedotin. Radiation therapy is only reserved for locally unresectable disease.

BIA-ALCL Perspective

BI-ALCL is not breast cancer. Here are some additional numbers, and some links, to keep the worry about BIA-ALCL in perspective:

Read More

Chin Augmentation SF Bay Area (Chin Implants)

Posted April 01, 2017 in Chin Implants/Augmentation, Facial Augmentation, Home, Videos

Chin Augmentation is the most popular Facial Plastic Surgery using an implant. Temporary Chin Enlargement can be performed with several fillers, such as Radiesse, Restylane Lyft (formerly Perlane) or Juvedem; however, long lasting results are only possible with Chin Implants.

Chin Implants provide projection of the chin on the profile view. In the above Chin Augmentation before and after pictures, the Chin Implant is placed on the anterior surface of the bone, pushing the soft tissue of the chin forward.

Chin Implants provide projection of the chin on profile. In the above Chin Augmentation before and after pictures, the Chin Implant is located on the anterior surface of the lower jaw bone, the mandible, enhancing the chin and pushing the soft tissues under the skin forward.

Chin Augmentation Video (Chin Implants)

The Chin Augmentation Video below is a recent segment from Body Beautiful, which originally aired on the San Francisco Bay Area’s News Station, KRON 4. Host Janelle Marie and I discuss Chin Implants and other complementary procedures such as: Liposuction and Neck Lifts. Surgical options and the recovery period are also covered. Chin Augmentation Before and After Photos are used to illustrate the mechanics of the procedure and to demonstrate what the procedure can do.

Chin Implant Options

The most popular chin implants are made of silicone. Silicone Chin Implants are solid, firm, rubbery prostheses, which come in a variety of sizes. Variations in height, width, projection and style can be used to select the Chin Implant best suited for your chin and your goals. Since these implants are soft enough to fold, they can be inserted through a smaller incision. However, they are more likely to move or buckle over time.

Another type of Chin Implant is the Medpore Chin Implant. Medpore is a hard, porous substance that is more like bone than silicone. Medpore implants can provide larger and more stable augmentation. The soft tissue of the chin grows into it, securing the chin implant in place, so this implant is less likely to move or buckle. They are also much harder to remove and replace too. Since Medpore is not flexible, they require a slightly larger incision for placement. These implants also take a little longer to settle down to their final, post-operative size.

Chin Implant Proportions

There are certain proportions that we Plastic Surgeons try to obtain with the Chin Implant. Whether chin implant or breast implants, size, shape and location matter. For women, the ideal chin projection is just shy of the lower lip projection. For men, the goal is often at, or a little past, the projection of the lower lip. Of course, this can be adjusted, depending on your goals.

Comparing the Chin Augmentation before and after pictures of this man and the woman above, you can see that the ideal chin projection for men is larger with respect to the lower lip. Facial proportions do vary; however, in general men tend to have larger bony features than women. This is especially true of the chin and the nose.

Comparing the Chin Augmentation before and after pictures of this man and the woman above, you can see that the ideal chin projection for men is larger with respect to the lower lip. Facial proportions do vary; however, men tend to have larger bony features than women. This is especially true of the chin and the nose.

Chin Augmentation Computer Imaging can be a useful adjunct to the discussion, and can make the abstract more concrete. While computer simulation is not a guarantee of results, it is very helpful in gauging how much Chin Enlargement is enough. A patient who has had the benefit of preoperative Chin Implant Simulation is rarely surprised by the outcome.

Chin Augmentation Consultations

As you can see from this brief overview, there are several options for Chin Enhancement. If you would like to learn more about Chin Implants, and how they can be used to enhance your face, call (925) 943-6353, today. A private consultation appointment will be scheduled, and we can go over the options that make the most sense for your chin.

Read More

Arm Lift San Francisco Bay Area (Brachioplasty)

Posted March 26, 2017 in Arm Lift (Brachioplasty), Home, Post-Bariatric Surgery (After Weight Loss), Videos

Excess arm skin can be uncomfortable both physically and emotionally. The Arm Lift, or Brachioplasty, removes excess skin from the upper arm. This Arm Lift Video Presentation reviews many of the frequently asked questions and illustrates the possible results with expertly narrated Brachioplasty Before and After Pictures . All Arm Lift Before and After photos are actual patients of Dr. Joseph Mele, San Francisco Bay Area Board Certified Plastic Surgeon in Walnut Creek, California.

The above Arm Lift Before and After Photos demonstrate what a Brachioplasty can do. Excess skin is removed, leaving the arm tight, firm and with a more muscular contour.

The above Arm Lift Before and After Photos demonstrate what a Brachioplasty can do. Excess skin is removed, leaving the arm tight, firm and with a more muscular contour.

Arm Lift Video (Brachioplasty)

The Arm Lift Video below is a recent segment from the San Francisco Bay Area’s News Station, KRON 4’s, Body Beautiful. Host Janelle Marie and I discuss the Brachioplasty procedure, including the available options and the recovery period. Arm Lift Before and After Photos are used to show what the procedure can do on real patients.

As an active member of the American Society of Bariatric Plastic Surgeons (ASBPS), contouring the body after weight loss is one of my specialties. Whether you have had Bariatric Surgery, or have lost weight with consistent diet and exercise, this video has something to offer.

Arm Lift Scars

The usual Arm Lifts incision runs along the inner arm, from the elbow to the armpit (axilla). The placement options are reviewed in the Brachioplasty Video above. If you have a small amount of skin laxity, which is located close to the axilla, a Mini Brachioplasty, with the scar located in the axilla, may be possible. If your arm skin is already firm, and the problem is disproportionate fat, Liposuction alone may be your best option.

The above Arm Lift before and after pictures demonstrate how careful scar placement enhances the results. In this case, the excess skin was removed using a scar that runs from the inside of the elbow to the back of the armpit. Even with the elbow rotated backward, the scar is still hidden along the lower border of the arm.

The above Arm Lift before and after pictures demonstrate how careful scar placement enhances the results. In this case, the excess skin was removed using an incision that runs from the inside of the elbow to the back of the armpit. Even with the elbow rotated backward, the scar is still hidden along the lower border of the arm.

Arm Lift Consultations (Brachioplasty)

There are several options for Arm Rejuvenation. To find out what your Arm Lifting choices are, call (925) 943-6353 and schedule a private, personalized consultation in our Walnut Creek Plastic Surgery office. If loose arm skin is bothering you, learn what treatments are available from an experienced, Board Certified Plastic Surgeon.

Read More

Male Breast Reduction | Gynecomastia San Francisco Bay Area

Posted March 20, 2017 in Breast Reduction, Breast Reduction (Men), Home, Videos

About two-thirds of men develop breast buds during puberty, and for half of them, it does not go away. Gynecomastia, male breast development, causes fullness, feminization and often embarrassment. The only cure is Gynecomastia Reduction Surgery. Dr. Joseph Mele is a Board Certified Plastic Surgeon in the San Francisco Bay Area who specializes in Male Breast Reduction or Gynecomastia Reduction. This Gynecomastia Video segment aired live on the Bay Area’s News Station, KRON 4, and discusses the procedure and reviews examples of Gynecomastia before and after pictures.

Gynecomastia may involve just the area beneath the nipple and areolae or the entire chest. In the male breast reduction before and after pictures above, the fullness beneath the nipples was removed through a small incision placed along the lower margin of the areolae.

Gynecomastia may involve just the area beneath the nipple and areolae or the entire chest. In the male breast reduction before and after pictures above, the fullness beneath the nipples was removed through a small incision placed along the lower margin of the areolae.

Male Breast Reduction As Seen On TV

Recently, I had the opportunity to discuss Male Breast Reduction on Body Beautiful. Body Beautiful is a live show on the San Francisco Bay Area’s News Station, KRON 4. The segment is included below, and contains multiple Gynecomastia Reduction Before and After Photos, along with narration about the procedure, alternatives and recovery.

Gynecomastia Reduction Video (Male Breast Reduction)

Gynecomastia Reduction Consultations

Gynecomastia Reduction removes excess breast tissue from the male chest. Excess tissue can be removed with Liposuction or direct excision, depending on the amount, location and nature of the breast tissue.

Gynecomastia Reduction removes excess breast tissue from the male chest. Excess tissue can be removed with Liposuction or direct excision, depending on the amount, location and nature of the breast tissue.

There are several alternative operations for Gynecomastia Reduction. Common methods include liposuction, direct excision of the gland, skin reduction or a combination of each. The best method is often determined by the size, location and nature of the breast tissue.

To find out what your options are, call (925) 943-6353 and schedule a private, personalized consultation in our Walnut Creek Plastic Surgery office. If Gynecomastia is bothering you, learn what treatments are available from an experienced, Board Certified Plastic Surgeon.

Read More

Video – Breast Augmentation on KRON 4 – SF Bay Area’s News Station

Posted March 11, 2017 in Breast Augmentation, Home, Videos

According to the latest American Society of Plastic Surgeons’ Statistics, Breast Augmentation remains the most popular Cosmetic Plastic Surgery procedure in the United States.

Breast Augmentation provides fullness and support. Not only can a Breast Implant enlarge a small breast, but it can restore shape and volume to a breast that has changed due to pregnancy, weight loss or aging.

Breast Augmentation provides fullness and support. Not only can a Breast Implant enlarge a small breast, but it can restore shape and volume to a breast that has changed due to pregnancy, weight loss or aging.

Breast Augmentation on Body Beautiful

Breast Augmentation was also the first topic discussed on this week’s Body Beautiful. Body Beautiful is a live show, dedicated to the latest in Cosmetic and Plastic Surgery procedures, that airs on the San Francisco Bay Area’s News Station, KRON 4.

The Breast Augmentation Video below covers the basics of Breast Implants and Breast Augmentation and illustrates the procedure with multiple Breast Augmentation Before and After Pictures.

Breast Augmentation Video (Breast Implants)

Breast Augmentation Consultations

Breast implants come in a large variety of sizes and shapes. The best size for you is subjective; however, a Board Certified Plastic Surgeon can supply you with professional guidance in selecting the Breast Implant that will best provide the result you are looking for.

Breast implants come in a large variety of sizes and shapes. The best size for you is subjective; however, a Board Certified Plastic Surgeon can supply you with professional guidance in selecting the Breast Implant that will best provide the result you are looking for.

If you are considering Breast Augmentation or have Breast Implants and are looking for Breast Augmentation Revision, give me a call at (925) 943-6353 for a personalized consultation and specific recommendations tailored to your needs.

Read More

Top Plastic Surgery Procedures – SF Bay Area

Posted March 05, 2017 in Brazilian Butt Lift, Breast Augmentation, Breast Lift (Mastopexy), Breast Reduction, Brow Lift, Eyelid Lift (Blepharoplasty), Facelift (Rhytidectomy), Home, Liposuction, Neck Lift (Rhytidectomy), Plastic Surgery Societies, Rhinoplasty (Nasal Surgery), Tummy Tuck (Abdominoplasty), Wrinkle Reduction (Non-surgical)

The 2016 ASPS National Plastic Surgery Statistic were released this week.

The 2016 ASPS National Plastic Surgery Statistic were released this week.

This week the American Society of Plastic Surgeons (ASPS) published the United States’ national Plastic Surgery Statistics for 2016. It is always interesting to me to see how the national statistics correlate with my own Cosmetic Plastic Surgery practice here in the San Francisco Bay Area. Last year, the correlation was pretty close.

Top Ten Cosmetic Plastic Surgery Procedures

As a group, surgical procedures grew 4% from 2015 to 2016. The top five Cosmetic Plastic Surgery procedures are almost the same. Facelifts edged out Tummy Tucks for the fifth spot, but the popularity of the two procedures remains very close. Here are the top five procedures as reported by the ASPS:

  1. Breast Augmentation (Augmentation Mammoplasty)
  2. Liposuction (Suction Assisted Lipectomy)
  3. Cosmetic Nasal Surgery (Rhinoplasty)
  4. Eyelid Lift (Blepharoplasty)
  5. Face Lift (Rhytidectomy)

The next five procedures, in order of popularity were: Tummy Tuck (Abdominoplasty), Breast Lift (Mastopexy), Neck Lift (Rhytidectomy), Forehead Lift (Brow Lifts) and Breast Reduction (Reduction Mammoplasty).

Brazilian Butt Lifts Grow The Fastest

The fastest growing procedure last year was the Brazilian Butt Lift (BBL). The BBL is not really a buttocks lifts, but more a buttocks enlargement. During the procedure, fat grafting is used to enlarge the buttocks and selectively enhance its shape. The results can be quite dramatic and the resultant shape is usually much nicer than that obtained from buttocks implants.

The Brazilian Buttocks Lifts is again the fastest growing cosmetic plastic surgery procedure. Significant improvement in the size and shape of the buttocks is possible by removing disproportionate fat from other areas, the lower back in this example, and selectively inserting the excess fat into the buttocks.

The Brazilian Buttocks Lifts is again the fastest growing cosmetic plastic surgery procedure. Significant improvement in the size and shape of the buttocks is possible by removing disproportionate fat from other areas, the lower back in this example, and selectively inserting the excess fat into the buttocks.

The number of Brazilian Butt Lifts increased 26%, from 14,705 to 18,489 in 2016. The procedure was also the fastest growing procedure of 2015 when it grew 28%, from 11,505 to 14,705. In fact, for the US population, the number of BBL’s has doubled from 2013 to 2016, and shows no signs of slowing in 2017.

Minimally Invasive Plastic Surgery Procedures

Minimally invasive plastic surgery procedures grew 3% in 2016. The top five procedures remain:

  1. Botulinum Toxin Type A (Botox®, Dysport®, Xeomin®)
  2. Soft Tissue Fillers (Restylane®, Juvederm®, Radiesse®)
  3. Chemical Peels (TCA, Phenol)
  4. Laser Hair Removal
  5. Microdermabrasion

Cosmetic Plastic Surgery Consultations

If you live near the San Francisco Bay Area and are considering Cosmetic Plastic Surgery, be certain to seek out an experienced and Board Certified Plastic Surgeon in your area. To schedule a private consultation, tailored to your specific needs, call (925) 943-6353, today.

Read More

Top 100 Plastic Surgery Blogs – SF Plastic Surgery Blog

Posted March 01, 2017 in About Dr. Mele, Home

The San Francisco Plastic Surgery Blog received the Top 100 Plastic Surgery Blogs on the web award from the blog feed consolidator Feedspot. This web site picks top blogs by category year round, and this week they posted the most comprehensive list of best Plastic Surgery blogs from around the world – the Top 100 Plastic Surgery Blogs.

As the creator of the San Francisco Plastic Surgery Blog, I am humbled to be listed among the Top 100 Plastic Surgery Blogs in the world.

As the creator of the San Francisco Plastic Surgery Blog, I am humbled to be listed among the Top 100 Plastic Surgery Blogs in the world.

Selection Criteria

The feedspot panelists made their selections based on:

  • Google reputation and Google search ranking
  • Influence and popularity on Facebook, twitter and other social media sites
  • Quality and consistency of posts
  • Feedspot’s editorial team and expert review

The Best Plastic Surgery Blogs On The Planet

I am honored and humbled to be listed among the largest and most active Plastic Surgery Blogs on the Internet. Honorees include blogs from corporations, news organizations, public discussion boards, national plastic surgery societies, international blogs and a good number of Board Certified Plastics Surgeons covering the United States from coast to coast.

Thank You

Thank you.

Thank you.

Thank you to Feedspot, and its founder, Anuj Agarwal, for assembling the Top 100 Plastic Surgery Blog List, but the biggest thank you goes to you, my followers. I hope that I can continue to provide you with posts that are both informative and entertaining – nothing but the latest Plastic Surgery News. Also, thank you to my readers for the feedback regarding the new layout. Hopefully, this will make the San Francisco Plastic Surgery Blog easy to read, no matter what size screen you are using. If you enjoy this blog, tell your friends, and follow me on Facebook and Twitter.

Read More

2017 BI-ALCL Update (Breast Implant Associated – Anaplastic Large Cell Lymphoma)

Posted February 26, 2017 in Breast Augmentation, Home, Patient Safety

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.

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?

ALCL Histology

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.

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.

Read More

The American Society for Aesthetic Plastic Surgery – 50 Years and Counting

Posted February 20, 2017 in About Dr. Mele, Home, Patient Safety, Plastic Surgery Societies

This year we celebrate the 50th anniversary of one of my favorite national plastic surgery societies. Happy Birthver to the American Society for Aesthetic Plastic Surgery (ASAPS). The largest plastic surgery society dedicated exclusively to the practice of cosmetic plastic surgery and medicine.

What is the ASAPS?

As it states on their website: The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.

It’s a pretty bold statement, especially when you consider its membership includes just over 2600 of the approximately 8000 board certified plastic surgeons in the American Society of Plastic Surgeons (ASPS). Even that number is exclusive of the 100,000+ other doctors and allied professionals in the US who practice cosmetic surgery in hospitals, surgery centers, clinics, spas, hotel rooms, apartments or their cars who will to come right to your house. So what makes the ASAPS special?

ASAPS vs. ASPS formerly known as the ASPRS

ASAPS members make up one third of the membership of the ASPS. When I started my practice in 1997, the ASPS was called the ASPRS. Since then, the American Society of Plastic and Reconstructive Surgeons (ASPRS) dropped the “reconstructive” from the name. Perhaps sticking to “Plastic Surgeons” was their attempt at being more inclusive, but their more general term had unintended consequences, both internal and external.

Internal conflict was felt by many plastic surgeons who practiced primarily reconstructive surgery, especially by those members who did not see the value of elective cosmetic surgery, or at least valued it less than reconstructive surgery. This internal strife was one of the reasons the ASAPS was formed. The greatest external consequence is the categorization of Plastic Surgeons as “General Plastic Surgeons” in advertisements by doctors who are not Board Certified Plastic Surgeons as a way to denigrate my chosen profession.

Why Do We Need The ASAPS?

In reality, reconstructive and cosmetic surgery are complementary. We think of reconstructive surgery as focussing on function, and cosmetic surgery focussing on form. The truth is, the best surgery requires attention to both sides of the plastic surgery coin. Ideally, neither form nor function would be sacrificed.

The ASAPS was formed by a group of plastic and reconstructive surgeons who saw the intrinsic value of the cosmetic aspects of plastic surgery. They were ASPRS members, but saw the value in specializing in cosmetic plastic surgery, when it was not socially popular. They wanted a forum in which to discuss, at the most basic level, what works and where we need improvement and to hold themselves to a higher standard. The ASAPS mission statement puts it very well:

Recent ASAPS / ASPS History

Why do we need two American plastic surgery societies anyway? Why can’t we all just get along? Aren’t all plastic surgeons the same? As it turns out, it is rare to find any two plastic surgeons who are the same. I’m not just talking about the normal variations between humans. I’m talking about how two plastic surgeons approach the exact same problem.

Trying to get Plastic Surgeons to agree is like herding cats. There are usually many ways to accomplish the same goal, and how to get there depends on the many factors including the problem, the patient and the plastic surgeon. Annually, we vigorously debate which is the “right” procedure, or even the “right” way to do the procedure. Some of these arguments have been occurring annually, for as long as the societies have existed. Listening to these “lively” debates, sometimes I am amazed that there is even one plastic surgery society in the United States.

Even The ASPS Sometimes Wonders Why We Need The ASAPS

For the majority of my Plastic Surgery career, the ASPS and the ASAPS have coexisted peacefully. Recently, there was a unilateral move by the ASPS to absorb the ASAPS. The ASPS reasoned that we, plastic surgeons as a whole, are stronger as a single group with a single voice. The ASAPS reasoned that since almost yy ASAPS member is a dues paying active member of the ASPS, they already have the aesthetic voice. The ASPS and ASAPS have goals that, like our memberships, largely overlap. The ASAPS further reasoned that their interests are a specialized, subset of the ASPS, and that aesthetic surgery encompasses a large variety of procedures that are better served by maintaining a second independent voice. To date, the ASAPS maintains its independence. In response, the ASPS broke off what had been a cooperative relationship and has excluded the ASAPS from any co-promotions. My hope is that with new leadership, cooler heads will prevail. Both societies have something unique to offer.

Why I Am An ASAPS Member?

The American Society for Aesthetic Plastic Surgery focusses on cosmetic plastic surgery. These are the procedures that I perform for my patients every day. The vast majority of the presenters are practicing, Board Certified Surgeons who do what I do. Moreover, the majority of ASAPS members are solo practitioners, who understand the balance it takes to provide quality plastic surgery, while maintaining a cutting edge education. They, too, have experience with all the demands that running a small business requires. All these factors tends to make the ASAPS meetings useful, educational and practical.

So, Happy Fiftieth Birthday ASAPS. You were born out of need for specialization, and you still serve a very important purpose. When you say, “We are aesthetics,” you speak for me.

Read More