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.
BI-ALCL is not breast cancer. Here are some additional numbers, and some links, to keep the worry about BIA-ALCL in perspective:
The average woman’s risk of developing breast cancer is 12.5%.
The risk of developing recurrent breast cancer after mastectomy is 5-8%.
The risk of capsular contracture through 10 years is 14%.
The risk of breast implant rupture through ten years is 10%.
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.
Breast Augmentation and pregnancy, the combination is the source of many questions in my San Francisco Bay Area Plastic Surgery Clinic. The answers center around a few themes: timing, breast feeding and how breasts change.
Pregnancy brings many changes including changes to the breasts. If you are considering Breast Enlargement, or if you already have Breast Implants, and you are contemplating pregnancy, this post is for you.
Breast Augmentation and Pregnancy: Timing
If you are done having children, the timing is ideal. The dramatic changes that can occur with pregnancy and breast feeding are over, and the focus is on getting back the breasts you had, or the breasts you always wanted to have. Details like size and shape tend to change slowly with age, but may swing widely with pregnancy. Having this behind you is a big plus in the direction of predictability. Additionally, details like inverted nipples, enlarged nipples or enlarged areolae can also be addressed. The Mommy Makeover can also be discussed if your belly has been stretched and has not recovered to your satisfactionx.
If you are planning to have children whether to have Breast Augmentation now depends on how soon you plan to get pregnant. If you are actively trying to get pregnant, you should wait. Your breasts may change with pregnancy. The changes may be small or dramatic, there is no way to predict. Even from child to child, there may be variation. If you get Breast Implants, and then things change dramatically, Revision Breast Augmentation may be needed to restore the breasts’ volume or shape.
If you are planning to have children later, it may make sense to have Breast Augmentation now. If you consider the immediate gratification of the Breast Enlargement, and you feel you will have enough time to enjoy the results, before possibly needing a touch-up, then go for it. The decision is not purely black and white. Breast Augmentation Revision is not always needed after pregnancy, and Breast Implant Revision Surgery may be necessary, even without becoming pregnant.
Before: This young woman had Breast Augmentation before pregnancy. After two children, the skin of her breasts relaxed, dropping the breast tissue off her Breast Implants. After: Her Breast Implants were exchanged to adjust volume and a Breast Lift was performed to reshape and rejuvenate her breasts.
Breast Augmentation and Pregnancy: Breast Feeding
If you have Breast Implants, there is no reason not to breast feed normally. Breast Implants do not taint the milk, and in many cases, the advantage that breast milk gives your infant is significant. Breast Augmentation may decrease the absolute volume of milk produced. The exact mechanism is unknown, but the easiest way to think about it is that the breast may be tricked into thinking it is already full. The volume of the implant may inversely effect the breasts’ milk production. On the other hand, I have had many women who had Breast Augmentation in their twenties, who later went on to breast feed successfully.
If you are currently breast feeding, and wondering when you can have Breast Enhancement Surgery, it is recommended to wait until the milk has dried up for a minimum of three months. This allows the breasts to finish their post pregnancy changes, and decreases the risks of operating on a lactating breast. However, it is never too soon to have a consultation with a Board Certified Plastic Surgeon, and in the San Francisco Bay Area, there are many to choose from.
Sometimes Breast Augmentation alone is enough to rejuvenate the postpartum breasts, as demonstrated in the above Breast Augmentation before and after pictures.
Breast Augmentation and Pregnancy: Breasts Change
We touched on this a little above, but breasts do change with pregnancy. Some change very little, some quite dramatically, and sometimes one changes more than the other. If your breasts change a little, then Breast Augmentation after pregnancy will be very similar to Breast Augmentation before surgery. On the other hand, if the breasts increase rapidly in size for lactation, and then shrink, often to a volume smaller than their original size, adjustments will be needed in your Breast Enhancement. These adjustments depend on the size and shape of your breasts.
Size is perhaps the easier of the two to understand. If breast lose volume, more stuffing is required to perk them back up to the desired size. In cases when the breasts enlarge, but do not shrink back down to the original size, it may be advantageous to have a Breast Reduction, especially when the sizes are uneven. When the breasts shrink too much, Breast Implants are used to restore volume and improve both the shape of the breasts and the fit of clothing.
The shape of the breasts is determined not just by their volume, but mostly by the breasts’ skin. When the volume of the breast shrinks, but the skin doesn’t, excess sagging occurs. Breast Augmentation alone may not be enough. A combination of Breast Augmentation and Breast Lift is needed in as many as 40% of women after pregnancy. The Breast Lift is used to reshape the breast and remove the skin excess, while Breast Implants can restore volume and increase the bust.
Breast Augmentation Consultations
If you are considering Breast Augmentation, give me a call at (925) 943-6353, and schedule a private, personalized consultation appointment. It is never too early to get the facts, and there is no better way to get a plan tailored to your needs than with an in-person consultation with an experienced, Board Certified Plastic Surgeon.
Mastopexy Augmentation is the combination of Breast Augmentation and Breast Lift. When is Breast Augmentation alone enough? When is a Breast Lift the best choice? When should a combination of Breast Augmentation Lift be performed? It’s a big subject, and requires an in-person consultation for your specific needs, but some general rules for the procedures are explained below. There are many options, so be certain to consult with a Board Certified Plastic Surgeon before making the decision.
Breast Augmentation Lifts Come in May Sizes
Breast Augmentation with Breast Lift was used to enlarge the breasts, elevate the nipple and tighten the breast skin, especially the skin that hangs at the bottom of the breasts. The technique used, a horizontal breast lift, does not require the vertical scar seen in the anchor or inverted-T type breast lifts.
Breast Augmentation lifts, like the breasts themselves, come in many shapes and sizes. When the shape of the breast is good, but a larger version is desired, Breast Augmentation with a Breast Implant is often enough. When the size of the breast is good, but the breast tissue sags, a Breast Lift alone may be enough. The exception in this case is when there is no upper pole fullness, often seen as gapping of the upper bra. A small implant may be beneficial to add a bit of volume to the upper breast in these cases. When the breasts are small and saggy, the Breast Augmentation Lift is the procedure of choice.
The case above is an unusual lift in that a periareolar (defined below) and an inframammary incision (hidden in the crease beneath the breasts) were used, but there is no vertical scar. The “Horizontal Breast Lift” is great for breasts that have bottomed out or for breasts with more extreme sagging.
Breast Augmentation Lift for Tubular Breast
Smaller Breast Lifts require smaller scars. In the case above, a periareolar scar was used to reposition the nipple and reshape the breasts. Periareolar literally means “around the areola”. The areola is the pigmented skin that surrounds the nipple. While this does provide the smallest scar, it does the least. It tends to flatten the end of the breast and it is not great for reducing the size of the areolae.
The Breast Augmentation and Breast Lift combination with the smallest scar is the Periareolar Mastopexy Augmentation. An incision around the areola is used to raise the nipple and insert the Breast Implant. In the above case, the flattening effects of the periareolar lift are exploited to help reshape these tubular (tuberous) breasts.
For cases of Tuberous Breasts, flattening of the shape of the breast is a plus. It can be used to prevent the puffy nipple from sticking out like a cherry on top of a sundae. This patient’s breasts are narrow at the base, and the constriction gives a narrow, elongated, tubular breast. The Breast Implant helps to round the breast out, but it may not correct the areola when it is puffy.
Bigger Sagging, Bigger Problems, Bigger Breast Aug Lifts
For patients with severe postpartum breast involution (shrinkage), and for patients after massive weight loss, the breast volume has left the building, leaving only a loose, empty flap of skin. Breast Augmentation Lifts are the only solution to this problem. Breast Implants are used to restore the breasts’ volume, and it is combined with a Breast Lift to restore the breasts’ shape.
Severely deflated breasts, like those seen above after massive weight loss, need more volume and bigger lifts. An Anchor shaped scar was needed to raise the nipple, remove the overhanging lower breast skin and to tighten the breast skin in the horizontal direction, too.
Often, I will see on the Internet the misconception that if a big enough implant is placed, you will not need a lift. This is not true. Imagine an implant, the size of the one used above, placed under the skin of the pre-op picture. The breast would be the same size; however, the loose skin holding the nipple would hang off the end. In the above case, only a Breast Lift can correct the problems with the breasts’ shape, nipple position and excess skin at the bottom of the breast.
More Scar = Happier Patient?
The ultimate goal of Cosmetic Plastic Surgery is a happy patient. So how can more scar lead to a happier patient? It all depends on the circumstances. If a scar is not needed, then more scar is bad. I have had patients on the borderline of needing a lift elect to not have lift because of the extra scar. Some are happy with their decision of not completely correcting the sagging, and not having extra scars. Others have come back for a Breast Lift after their Breast Augmentation, and are much happier now, after the Breast Lift. Staging does make it easier to see what each procedure has to offer the final result.
The main goal of Cosmetic Plastic Surgery is a pretty result. The Breast Augmentation Lift allows for control of both the size and the shape of the breasts. The cost is additional scar. In this case, an Inverted-T scar was needed.
Above, an inverted-T Breast Lift was performed along with placement of a Breast Implant. A periareolar lift would have left the nipples low, the areolae much larger and the end of the breasts flat. A vertical lift would not have tightened the lower pole sufficiently, or coned the shape of the breast as beautifully. In my experience, the incision underneath the breasts is well hidden. By keeping its length short, the scar will hide in the shadow under the breasts.
Breast Augmentation Lift Consultations
If you are considering a Breast Augmentation, Breast Lift or the Combination Augmentation Mastopexy, be certain to consult an experienced Board Certified Plastic Surgeon. While there are advantages to combining the procedures, it is also more complicated than both procedures done separately.
If you are in the San Francisco Bay Area, give me a call at (925) 943-6353, and schedule a private comprehensive consultation. Your options will be reviewed and the best course selected to optimize you breast aesthetics.
Every Mommy Makeover includes enhancement of both the belly and the breasts. The most common combination is Breast Augmentation with a Tummy Tuck (Abdominoplasty). However, other options include:
Breast Implants with Breast Lift
Mini Tummy Tucks
Other Body Enhancements
Brazilian Butt Lift
Lower Body Lift
The combination best for you depends on what you need, tempered by safety and predictability.
Mommy Makeover Video Presentation
The television segment included below is all about Mommy Makeovers and includes many of the most popular variations. The Mommy Makeover Video includes Mommy Makeover Before and After Pictures that illustrate what the procedure has to offer.
The following video segment is from my latest appearance on the San Francisco Bay Area’s New Station, KRON 4. The show gives me the opportunity to talk about the latest Cosmetic Plastic Surgery News.
Mommy Makeover Video
Make Your Mommy Makeover Consultation Appointment
When considering a Mommy Makeover, be certain to find a Board Certified Plastic Surgeon in your area who has years of experience with the techniques currently available. If you are in the San Francisco Bay Area and would like to schedule a personalized appointment in my Walnut Creek Plastic Surgery clinic, give me a call today at (925) 943-6353.
Breast Augmentation remains one of the most frequently requested Cosmetic Plastic Surgery procedures.
Breast Augmentation remains one of the most popular cosmetic plastic surgery procedures, but what is the recovery like after Breast Implants?
Breast Augmentation – The Procedure
Breast Augmentation is simple to understand. Breast Enlargement is performed by placing a Breast Implant behind the breast tissue to increase the breasts’ volume. Of course, there is more to it than that, and it is important to seek the advice of an experienced Board Certified Plastic Surgeon, before your Breast Enhancement Surgery.
Breast Implants are placed in the operating room, almost always under general anesthesia. This provides maximal safety and predictability of the operation, especially when Silicone Breast Implants are being placed behind the muscle, or when a Breast Lift is also being performed.
Breast Augmentation Recovery Time – The First 24 Hours
After the anesthetic is given, the next thing you will know, you will be in the Recovery Room. It feels instantaneous. Your breasts will be sore and many patients feel pressure, like an elephant is sitting on their chest. Pain is present, but should be manageable. Local anesthesia is frequently placed around the Breast Implants to help with the initial discomfort. Medications will be given intravenously to make you feel better. The primary goals are to allow you to wake-up and to reduce your discomfort.
At home, prescription pain medications are often used for the first few days. Acetaminophen (Tylenol) is also safe, because it does not increase the risk of bleeding like aspirin can. Acetaminophen should be taken instead of, not with, your prescription pain medication because most prescription pain medications already have acetaminophen in them, and too much, can cause liver damage.
RICE Therapy for the Breasts
Post-operative discomfort can also be helped with RICE. The acronym RICE stands for:
REST – Not overusing your chest muscles after surgery can speed your recovery. Your Plastic Surgeon should review what precautions to take after surgery. To read a copy of my Breast Implant Instruction Sheet, click the following: Post-Operative Breast Augmentation Instruction Sheet.
Ice is Nice: Ice provides natural pain relief with few side-effects.
ICE – I cannot stress the importance of icing down after surgery. Like after any injury, ice can effectively decrease swelling and discomfort after surgery, often better than pain medication. Ice should not be applied directly to the skin, to avoid frostbite. A thin cloth should be placed between you and the ice, and the ice should be applied hourly for 15 minutes at a time.
COMPRESSION – The amount of compression will vary by Plastic Surgeon. Some surgeons recommend no support, while others bind the chest. Remember, your Plastic Surgeon will choose the method that works best for the surgery they perform. I prefer the combination of Bra and Band to keep the Breast Implants in their proper position, and to provide some post-operative support and comfort.
ELEVATION – Keeping the head elevated day and night the first few days after Breast Augmentation also helps reduce swelling and discomfort in the breasts. Sleeping on an extra pillow or two is all that is needed. If you are not used to sleeping on your back, a pillow behind the knees can help. It helps you maintain the correct position while you are sleeping and makes your back more comfortable.
Breast Implants have been an option for women with small breasts for over fifty years. During that time, the Breast Implants, the techniques and the recovery time have all improved.
Getting Back To Normal
After the first few days, your activities will begin to get back to normal. Most patients can drive by three or four days. However, if you are still sore or are taking pain medication, you should wait. By the end of the week, office work is usually doable. After two weeks, light physical activity is encouraged, and by six weeks, you should be able to return to all your usual activities.
It is also important to know that your results will vary. Good results and experiences are a product of teamwork. Choosing a Board Certified Plastic Surgeon who you are comfortable with is paramount. Doing the Breast Enhancement well is only part of my job, getting you through the recovery is equally as important to a good result.
Breast Augmentation Questions
If you have questions about Breast Augmentation, please call my San Francisco Bay Area Plastic Surgery Office today at (925) 943-6353, and schedule a private consultation appointment. While a lot of good Breast Augmentation information is available here, on the San Francisco Plastic Surgery Blog, and the links provided, an in-person consultation allows us to discuss the details specific to your Breast Enhancement.
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.
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.
Breast feeding is good for babies nutritionally and emotionally. Above is Naomi Jael, from Germany. She caused a viral sensation this week with this snap of her breast feeding her 10-month-old son at a wedding reception, though comments centered more around her public display than the virtues of breast feeding. A more supportive and more comical imitation can be found here.
A common question I get from women considering Breast Augmentation is, “Will Breast Implants interfere with Breastfeeding?” For women who are trying to reclaim their breasts after finishing having children, this is not an issue. However, if you want Breast Augmentation, and want to have children afterward, here are a few things you should know.
Is Silicone Safe For Babies?
Did you know that silicone drops are used to treat infant colic? An article from 1988, Mylicon drops in the treatment of infant colic, dosed 51 colicky infants with 0.3 ml of simethicone with each feeding. Symptoms of colic improved or resolved in 38 infants (78%) after one day and in 44 (86%) after seven days. Simethicone is an anti-foaming agent that relives bloating, and it is still available without a prescription, over-the-counter at your local pharmacy.
Safe enough to use at every feeding and up to 12 times per day. Active ingredient: Simethicone 20 mg in each 0.3ml dose.
Simethicone is a mixture of polydimethylsiloxane (PDMS) and hydrated silica gel. If you have ever taken Gas-X, you have ingested PDMS. What you may not have known is that PDMS is the same type of silicone found inside breast implants. So it is safe for adults, too. So if silicone is in breast milk it’s safe, but can it get out of a breast implant and into the breast milk?
Can Silicone Get Out of Breast Implants And Into Breast Milk?
PDMS is a silicone polymer which can be cross linked to increase its viscosity. This allows it to remain soft, yet resist flow. It is used inside breast implants, and is surrounded by a soft, solid, tear-resistant shell to further isolate it. Current breast implants are made with shells that do not allow the gel to bleed through them, though this was not always the case.
Modern Silicone Gel Breast Implants are filled with highly cohesive gel that does not flow like the oil found in earlier generations of breast implants manufactured before 1994. Implants made before 1985 have very runny filling and a high rate of rupturing.
Older breast implants, manufactured prior to 1994, did allow a small amount of gel to seep through them without a hole in the shell. It is like Helium seeping out of a balloon; however, rather than leaking out over night, it takes years for measurable amounts of silicone to be detected outside the these older breast implants. New breast implants are made with low-gel-bleed shells, which contains the internal gel, and prevents the gel from seeping through the wall. New breast implants also have high-cohesive gel centers, which do not flow like water. In the most recent long term follow-up studies, there have be no cases of the gel migration, which was seen in the older breast implants. So it is unlikely that silicone can get out of the breast implant, never mind into the breast milk.
Is Silicone Found In Breast Milk?
In 1991, before the more impervious breast implant shells were manufactured, a study measuring the amount of silicone found in the breast milk of lactating women with breast implants was published. The scientific sounding title is, “Determination of low levels of silicones in human breast milk by the aqueous silanol functionality test.”
Silicon compounds are widespread in the environment, making measurement of elemental Si in biological systems difficult. The assay was quite laborious and required 10 days to complete and measures PDMS, not elemental Si. The amount of PDMS in the milk of women with implants was not statistically different from that in water blanks or control human milk samples. The milk from women with polydimethylsiloxane breast implants contained 3.62 ppm (parts per million); control milk contained 3.40 ppm; and water contained 2.25 ppm. Moreover, this was in the older breast implants that had gel bleed, and still the levels were not statistically elevated.
Proper Breast Implant Placement Can Help Too
Surgical considerations for decreasing the risk of breast implants interfering with breastfeeding include scar and implant placement. Incisions made around the areola, may cut some of the ducts going to the nipple. I have had many patients with periareolar incisions maintain the ability to breastfeed, because most of the milk gland is between the nipple and the armpit, away from this periareolar incision; however, for patients wanting to breastfeed, I recommend using the inframammary fold (IMF) incision.
The most frequently used Breast Augmentation incisions are the periareaolar incisions and the inframammary incisions as shown above.
Placing the Breast Implant behind the pectoralis muscle can help, too. This provided an additional barrier between the breast implant and the breast gland, and also takes some of the compression off the milk gland. More pressure may trick the breast into thinking it has made enough milk, and turn off production early. Larger implants may also be more likely to decrease the amount of milk produced for the same reason.
Nipple Sensation is Helpful For Breastfeeding
Nipple stimulation is another stimulus for lactation. If you lose nipple sensation after breast augmentation, this may cause a reduction in milk production as it interferes with the normal milk let-down reflex that nipple stimulation causes. Fortunately, decreased nipple sensation is not common after Breast Augmentation.
Normal Breast Are Better For Breastfeeding
What I mean is that if you have normal breasts before Breast Augmentation, you are more likely to be able to breastfeed after Breast Implants are placed. If your breasts did not develop, you are more likely to have problems breastfeeding with or without breast implants. Other risk factors for not being able to breastfeed are: breasts that are spaced far apart, breasts which are tubular in shape or breasts that are significantly asymmetrical. If any of the above describe your pre-implant breasts, it’s possible you don’t have enough of the glandular tissue you’d need to make milk, and one study found that women with these conditions are 25 percent more likely to be unable to breastfeed and 19 percent more likely to need to supplement.
Can I Breastfeed If I Have Breast Implants?
Yes. The current recommendation for women with Breast Implants is to breastfeed. Breast Augmentation is not a contraindication to breastfeeding. While some women will make a smaller quantity of milk, there is no change in the quality of the milk produced.
Breast Augmentation Consultation
If you are currently trying to get pregnant, of plan to have a child in the next year, now is not the time for Breast Augmentation. If you are considering pregnancy somewhere in the future, or if you are done having children then now is a good time to find out what to expect. For a private, personalized Breast Augmentation Consultation call (925) 943-6353 and schedule an appointment. More information is available here on the San Francisco Plastic Surgery Blog, and my other websites, but there is no substitute for an in-person consultation, tailored to your body and your needs.