Otoplasty means ear changing. It encompasses a collection of cosmetic ear procedures designed to restore or create normal anatomy. Otoplasty can also be life changing for those embarrassed by their prominent ears.
How To Correct Prominent Ears
Ears that stick out can be a source of embarrassment. It is a problem for both children and adults, male and female. This is one reason why the Correction of Prominent Ears is among the top 20 cosmetic plastic surgery procedures performed each year. The two most popular age groups undergoing correction are young children (greater the 5-years-old) and young adults, although it is not unusual to seek Otoplasty as an adult.
If treated at birth, the ear may be able to be reshaped by external splinting. The concept is simple, but splinting needs to be started in the first weeks of life, while the ear’s cartilage is still soft. Splinting not often done, as it is hard to keep the required headgear on for the months required. Even with good compliance, sometimes it is still ineffective.
Otoplasty, ear pinning, reduces the appearance of prominent ears by bringing them closer to the head.
On the other hand,Otoplasty, also known as Ear Pinning, is very effective and is the most common cosmetic ear procedure performed in the U.S. In fact, 20 to 30 thousand Otoplasties are performed in the U.S. each year.
Cosmetic Ear Surgery Video (Otoplasty)
Today’s video discusses cosmetic ear surgery also known as Otoplasty. The most common reason for Otoplasty is to reduce the appearance of prominent ears, but there are other reasons for cosmetic ear surgery. Some causes are congenital, while others are acquired.
This Otoplasty Video focuses on two of the most common reasons for the procedure. The first, and most common cause, is congenital: Prominent Ears, while the second reason is acquired: Cauliflower Ears. Prominent ears respond well to reshaping of the natural cartilage with Ear Pinning. Cauliflower ears, on the other hand, require removal of scar tissue caused by trauma.
As always, the patients in the video are included to demonstrate what is possible in selected cases. While educational, this video cannot substitute for an in person consultation with an expert. If you are considering Otoplasty, be certain to seek the guidance of an experienced, Board Certified Plastic Surgeon.
What Causes Prominent Ears?
The most common reason for prominent ears is that they stop developing before forming the final fold that tucks the ears back. Without full development of this fold, the upper half of the ear sticks out from the head rather than tucking back alongside the head. Prominent ears may also be caused by an enlarged concha or a concha which is rotated forward. The concha is the hollow in the center of the ear which catches sound and guides it into the ear canal.
How Old Do I Need To Be To Have Otoplasty?
With Otoplasty, sometimes sooner is better. For children, early intervention can often reduce teasing and bullying.
Otoplasty can be safely performed at age five or older, because the ear achieves 85% of its adult size by age five. It is an outpatient procedure which can be completed under local or general anesthesia. After surgery, a head dressing is required to protect the repair until it has healed sufficiently. After the dressing is removed, often a head band is required at night for the first three months to prevent recurrence.
What Causes Cauliflower Ears?
Cauliflower ear is caused by trauma. Like most medical problems, prevention or early intervention are preferable. Late treatment, as shown in the Cauliflower Ear Before and After Pictured above, can help; however, creating a beautiful ear is very difficult.
Cauliflower Ears are the result of blunt trauma. They are also known by the sports most likely to cause them: Boxer’s Ears or Wrestler’s Ears. If the ear is hit hard, but the skin is not cut, blood collects under the skin, separating it from the supporting cartilage. If not drained, the blood hardens, and the convex cauliflower shape becomes permanent, replacing the ear’s normal concavity and sometimes affecting hearing. The treatment involves surgical removal of the solid mass of scar left behind. Unfortunately, the skin and cartilage are often damaged, and the ear rarely looks completely normal after correction.
If you, or your child, has a problem with the shape of the ears, a Board Certified Plastic Surgeon can usually offer a solution. Be certain to find a plastic surgeon, whom is experienced and comfortable with Otoplasty. In the San Francisco Bay Area, call (925) 943-6353 to schedule a private consultation appointment and learn more about the latest treatment options available for you.
Brachioplasty removes excess skin and fat creating a tighter, smaller upper arm.
Arm Lifts and Brachioplasty
Arm Reduction is a combination of arm fat reduction and arm skin tightening. Both weight loss and liposuction reduce the fat on the upper arms, but neither tightens loose skin. Loose arm skin is a very common problem after bariatric surgery or significant weight loss and can be a source of embarrassment and discomfort for many patients. Arm Lifts or Brachioplasty improve the appearance of the arms by removing fat and tightening excess skin. The result is a slimmer upper arm which fits much better in clothing.
Arm Lift Video (Brachioplasty)
The above Arm Lift Video is from a recent segment of my Body Beautiful television show. The show airs on the San Francisco Bay Area’s News Station, KRON 4. The techniques for Brachioplasty, including scar placement and recovery are reviewed, and many examples of the procedure are illustrated with Arm Lift Before and After Photos.
What Does An Arm Lift Do?
Arm lifts allow for the reduction and tightening of the upper arm, and restore the normal arm proportions after weight loss.
Arm Lifts remove excess skin from the upper arm. The larger the amount of skin, the more dramatic and satisfying the result. The procedure is normally performed under anesthesia, and leaves a scar in the inner part of the arm. A special arm compression garment is worn for several weeks after the procedure to help ensure the best possible result.
Arm Lift Consultations
Arm Lifts are for people who have excessive upper arm skin and who are bothered when their arm does not stop waving when they do.
Arm Lifts are not the most commonly performed cosmetic plastic surgery procedures, so it is important to find an experienced, Board Certified Plastic Surgeon for your Brachioplasty. As a member of the American Society of Bariatric Plastic Surgery, I am dedicated to quality results for my post-weight loss patients. To schedule a private, informative consultation, tailored specifically to your needs, call (925) 943-6353.
Breast Augmentation with Breast Lift (Mastopexy Augmentation) and Tummy Tuck. Breast Enlargement when the breasts are sagging and the nipples are below the inframammary fold requires a Breast Lift to achieve an aesthetic result. The Tummy Tuck further enhances the breasts’ proportion by flattening the belly.
The Components Of Breast Enhancement
Breast Enhancement surgery has two aesthetic components: size and shape. Breast size is increased with Breast Augmentation and reduced with Breast Reduction. Breast shape is adjusted with the Breast Lift. There are many options for adjusting both size and shape, and today’s video is an introduction to the most versatile of all the Cosmetic Breast Enhancement procedures, Mastopexy Augmentation — the combination of Breast Augmentation and Breast Lift procedures.
Breast Augmentation With Breast Lift Video (Mastopexy Augmentation)
This Mastopexy Augmentation Video is from my Body Beautiful television show, originally broadcast on the San Francisco Bay Area’s News Station, KRON 4. It reviews the techniques and options available for different types of Breast Augmentation With Breast Lift.
Indications For A Breast Lift With Augmentation
The majority of Breast Augmentation patients do not need a lift, but here are 5 reasons why your Plastic Surgeon may be recommended adding a Breast Lift (Mastopexy) to Breast Augmentation:
Breast sagging (ptosis)
Low set nipples
Tubular breast deformity
Disproportionately large areolae
Breast Augmentation Lift – When the breasts are close to the desired size, sometimes a Breast Lift alone is all that is needed to create youthful, perky breasts. If the upper pole is empty, a small implant can be used to enhance the shape of the breasts by adding fullness to the bust line without over exaggerating the size.
Mastopexy Augmentation Consultations
When considering Cosmetic Breast Surgery, be certain to select an experienced and Board Certified Plastic Surgeon. During your Breast Enhancement Consultation, your goals for both size and shape of the breasts should be discussed. If you are happy with the shape of your breasts, and are just looking for more volume, Breast Augmentation alone is likely the procedure of choice. If your size is good, but the shape is bothersome, a Breast Lift may be the best option to achieve your desired breast aesthetic. If your goal is to both augment and rejuvenate your breasts, the combination of Mastopexy Augmentation is often recommended and may be the best choice for you.
To schedule a personal consultation appointment in the San Francisco Bay Area call (925) 943-6353.
Mommy Makeovers include breast and belly enhancement in one surgery.
No matter what shape you are in before childbirth, the postpartum physique is rarely an improvement. Pregnancy can wreak havoc on a woman’s body. Cosmetic Surgery Repairs after having children are done so frequently, there’s a name for it: Mommy Makeover. Today’s video is all about the Mommy Makeover, and its many variations.
Breast Augmentation and Tummy Tuck Video (Mommy Makeover)
This Mommy Makeover Video is from my Body Beautiful television show broadcasted on the San Francisco Bay Area’s News Station, KRON 4. It reviews the techniques and options available for different types of Mommy Makeovers.
What Is A Mommy Makeover?
The Mommy Makeover has two goals: to enhance the shape of the breasts and to flatten the belly. With pregnancy, the breasts enlarge and then often shrink and collapse. Breast Augmentation and Breast Lifting are used to enlarge and lift the breasts. On the other hand, if the breast remain too large after pregnancy, a Breast Reduction can be substituted to improve breast and body proportions. The differences and options for Breast Augmentation and Breast Lifts are discussed further here: Breast Augmentation or Breast Lift?
For the belly, a Tummy Tuck is the workhorse that dramatically improves the appearance of the abdomen by tightening the abdominal muscles and skin, and by removing excess fat. When abdominal laxity is confined to the area below the belly button, a Mini Tummy Tuck may be the procedure of choice to restore a pre-baby toned belly. Lastly, if the skin and muscle tone are good, but disproportionate fat is bothersome, Liposuction alone may be the answer. The differences between the procedures are discussed here: Liposuction or Tummy Tuck?
Mommy Makeover Consultations
If you are considering a Mommy Makeover, or its component cosmetic procedures, Breast Augmentation or Tummy Tuck, be certain to consult with an experienced, Board Certified Plastic Surgeon. In the San Francisco Bay Area, call (925) 943-6353, and schedule a personal and private consultation appointment today.
Special Announcement Regarding Textured Breast Implants From The ISAPS
As of tomorrow, the use of Textured Breast Implants will be restricted in France.
From the ISAPS:
We have been informed today that the French health regulatory authorities (ANSM) have announced the following regulations regarding breast implants, and have summarized the most important information for you. You can read the full text of their announcement here.
As a precautionary step, ANSM decided on April 4, 2019, to withdraw macrotextured breast implants and polyurethane-coated breast implants from the market, as certain macrotextured implants and implants with polyurethane-coated surfaces may be a risk factor for the development of BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma). Given the rarity of the risk to exposure to BIA-ALCL, ANSM does not recommend preventive explantation for women with these implants, due to the very rare risk of serious disease. This decision will go into action on April 5, 2019. The purpose of this precautionary approach is to prohibit the sale, distribution, use, and withdrawal of this type of breast implant in the French market.
The ANSM reiterates its recommendation to use smooth breast implants as the preferred method of cosmetic or reconstructive surgery.
Since 2011, 59 cases of BIA-ALCL have been reported in France, with approximately 400,000 implants implanted annually in the country.
In addition, ANSM would like to reiterate the importance of proper information for women who wish to receive breast implants of all types. The patient and the surgeon should jointly discuss the advantages and disadvantages of the various implants available and alternative techniques in cosmetic surgery or post-breast cancer reconstruction.
An informed consent form containing the identification of the implant surface (smooth, microtextured, etc.), its limited life span, and the possible resulting need for re-intervention and medical care, must be submitted to all women prior to the placement of breast implants.
In the case of functional or physical symptoms in a woman with breast implants (such as abundant periprosthetic effusion, increased volume, pain, inflammation, mass, ulcers, or changes in general condition), particularly in the time since the postoperative phase, the diagnosis BIA-ALCL must be taken into account and ruled out by an analysis of the periprosthetic fluid (CD-30 testing, culture, cytology, and flow cytometry).
For women with breast implants and without clinical signs on the breast, the expert group recommends an annual follow-up examination of the breasts.
The International Society for Aesthetic Plastic Surgery
While ISAPS respects the decision reached by ANSM, we would like to point out that this disease BIA-ALCL is rare and, above all, easily treatable with total capsulectomy in early stages or Brentuximab in more advanced cases. Fortunately, compared to the high number of breast implants that are performed on a global scale, there are only few deaths worldwide. We are concerned about the recommendation to only use smooth implants, as we know from evidence-based data that the complication and reoperation rates are higher for smooth implants. Through this decision by ANSM, we plastic surgeons are effectively taken back to the time when there were no anatomical implants. This will affect breast reconstruction outcomes.
We believe that this is the wrong approach and less satisfactory for our patients. It is more important to inform our colleagues, family doctors and gynecologists about the early symptoms of the BIA-ALCL and how to evaluate patients. Patients must also be informed about the possible risks and symptoms of BIA-ALCL at the time of implantation. The information here should be cautious and always show the relation of an extremely rare disease.
We hope that the decision in France will remain on a case-by-case basis and that treatment options using macrotextured implants will not be taken away from our patients and us, as this would be a huge step backwards. Current opinion indicates that macrotextured implants can be safely used when appropriate precautions are taken to mitigate surface biofilm contamination, according to published data.
Dirk Richter, MD,
The response from the European Association of Societies of Aesthetic Plastic Surgery (EASAPS)
ANSM (agence national de sécurité du medicament et des produits de santé) stated April 3th, 2019 that macrotextured and surface-coated polyurethane implants from different labels are prohibited in France.
EASAPS opinion is that this is an regrettable decision that is not based on scientific data.
We need evidenced-based and statistically convincing studies for proper patient information on adverse events and the rare disease of ALCL.
The ASPS 2018 Plastic Surgery Statistics were released this week, and they are trending up.
The American Society of Plastic Surgery has released the 2018 National Plastic Surgery Statistics. The Top 10 Cosmetic Plastic Surgery Procedures maintained their order of popularity, with the overall trend being up compared to the previous year. Below, I have listed the most popular procedures and the percentage change from the previous year.
The 2018 Top 5 Cosmetic Procedures reflect the overall upward trend.
Top 10 Cosmetic Plastic Surgery Procedures
Here are your top ten Cosmetic Surgeries for 2018:
Breast Augmentation (Augmentation Mammaplasty) – 313,735 up 4% (from 2017)
Liposuction (Liposculpture) – 258,558 up 5%
Nose Reshaping (Rhinoplasty) – 213,780 down 2%
Eyelid Surgery (Blepharoplasty) – 206,529 down 1%
Tummy Tuck (Abdominoplasty ) – 130,081 up 0.25%
Facelift (Rhytidectomy) – 121,531 down 3%
Breast lift (Mastopexy) – 109,638 up 4%
Dermabrasion – 80,697 down 4%
Neck lift – 53,571 up 1%
Breast Reduction (Aesthetic patients only) – 43,591 unchanged
The 2018 Top 5 Minimally Invasive Procedures also show growth.
The Biggest Gainer and Losers
The top 10 procedures have been pretty consistent through the years, but four procedures stand out for the large percentage changes when compared to last year.
The biggest losers:
Pectoral Implants – 700 down 29%
Buttock Implants – 946 down 28%
I am not a fan of either of these procedures, because in general, the results are not great. Moreover, with advancements in fat grafting to the buttocks, the cosmetic results for Buttocks Augmentation have improved tremendously. Unfortunately, it is still not possible to do fat grafting unless the patient has enough fat to move.
The biggest gainers:
Buttock Augmentation with Fat Grafting – 24,099 up 19%
Hair Transplantation – 23,658 up 18%
Both these procedures owe their rise in popularity to improvement in the technology surrounding them. Fat grafting has evolved from stuffing the buttocks to shaping the buttocks. Gentle handling of the harvested fat, and meticulous care in placing the fat have improved both results and safety. For hair transplantation, improvements in harvesting hairs and minimizing donor site scars have made the procedure more palatable for more men and women.
The 2018 Top 5 Reconstructive Surgeries
It’s Cosmetic But It’s Still Surgery
It’s important to remember that Cosmetic Surgery is still surgery. Popularity and trends certainly influence behavior, but as a patient, you still need to do your homework. The Internet provides a wealth of information, but the emphasis is too often quantity over quality and new over proven. While it is nice to gather generic information anonymously, Cosmetic Surgery is neither generic nor anonymous. Don’t do it on your own. If you have friends or family who have been through it, ask them. Seek professional advice from experienced, board certified plastic surgeons. The information necessary to make an informed decision should always be specific to your needs.
This ear has the typical appearance of a cauliflower ear. It is thick and irregular. The hematoma has filled the ear up to the rim of the helix and solidified. Plastic surgery was performed to remove the dense scar tissue, and restore the normal topography of the external ear.
Cauliflower Ear Correction
Cauliflower Ear is a difficult cosmetic deformity caused by a combination of trauma and neglect. Often seen in wrestlers, it is also known as Wrestlers’ Ear. During the injury, the ear skin is pulled away from the cartilage which supports it, causing bleeding under the skin. This collection of blood, known as a hematoma, further lifts the skin off the cartilage giving the typical ballooned appearance. When left untreated, the blood hardens to rock like consistency, making treatment difficult.
The Best Treatment is Prevention
The best treatment for Cauliflower Ear is prevention. Avoiding injury is always preferable to repairing an injury. Unlike when I wrestled, protective headgear is now available. Headgear can protect the ears from injury. MMA fighters do not wear head gear, and many of them end up with cauliflower ears.
The Second Best Treatment is Early Intervention
The second best treatment for Cauliflower Ear is early surgical intervention. When an ear hematoma is treated early, the outcome is much better. Evacuating the blood from between the skin and the cartilage while it is soft, allows the skin to stick back down where is belongs. Often, a conforming bolster dressing is sewn onto the ear to enforce the approximation. Early treatment not only helps keep the ear looking normal, but also prevents the pressure of the hematoma from causing additional injury to the skin and cartilage. Early intervention for Cauliflower Ear can also be considered prevention. Draining the collection of blood while it is soft, prevents it from organizing and becoming hard. Unfortunately, my patient above, did not seek early treatment.
Delayed Treatment for Cauliflower Ear
Cauliflower ear is caused by trauma. Like most medical problems, prevention or early intervention are preferable. Late treatment, as shown in the Cauliflower Ear Before and After Pictured above, can help; however, creating an aesthetically pleasing ear after this type of trauma is very challenging.
Cauliflower Ears are difficult to restore. The process is hampered by distorted anatomy and rock hard scar, which is often calcified like bone. Staged treatment is often necessary and even though improvement is likely, complete correction is not. Delayed surgical treatment for Cauliflower Ears is much more difficult and frustrating. The organized hematoma is the consistency of cement, the skin is scarred down to it and the cartilage beneath the hematoma often disintegrates from the pressure. This is what happened in the case pictured above. Fortunately, despite the trauma, he did not suffer hearing loss. Often, the swelling fills the ear hole, obstructing the external auditory meatus (ear hole) essentially forming an ear plug. You may have noticed that the ear opening in the after photo is three times larger.
In the before pictures, the interior curves of the ear are completely obscured. The skin is super-glued down to the old hematoma, making further injury more likely. Most of the cartilage of the upper ear was dissolved by the injury, so the helical rim, the curved edge of the ear, had to be reconstructed with skin, without the benefit of normal cartilaginous support. After reconstruction, the hollow of the ear is restored. The helix is clearly defined, and the ear hole is opened to its normal dimensions. The skin covering the ear is thicker than normal due to scarring from the injury, so the subtle folds of the antihelical fold and other ear curves are muted.
Hard Of Hearing
Here, the ear hole, otherwise known as the external auditory meatus, is closed. Cauliflower ear treatment often includes opening an obstructed ear hole, in addition to restoring the normal ear hollow and curves.
Sometimes the cauliflower deformity is not isolated to the outer helix of the ear. There are times when the mass extends into the external auditory meatus (the ear hole). When the cauliflower ear deformity extends this far into the ear, it plugs the ear. In fact, it is like having permanent ear plugs. In the above case, scar tissue was removed from inside the external auditory meatus. The changes above are most noticeable at the helical rim and above the ear lobe, with the restoration of the intertragal notch.
Cauliflower Ear Treatment
If you or someone you know has a Cauliflower Ear Deformity, call (925) 943-6353 and schedule a private consultation appointment. The pros and cons of Cauliflower Ear Correction will be thoroughly discussed and a treatment plan developed based on your specific needs.
Otoplasty, ear pinning, reduces the appearance of prominent ears by bringing them closer to the head.
Prominent Ears can be a source of embarrassment for many patients; however, we are happy to offer a solution: Otoplasty. It is a common cosmetic plastic surgery procedure that literally means ear changing. By bringing the ears closer to the head, Ear Pinning lets patients enjoy shorter haircuts and/or ponytails, and can be a huge confidence builder for those that worry about their ears sticking out.
The primary scar for Otoplasty Surgery is in the fold behind the ear. This hidden access allows the ear to be reshaped discreetly. Even the early scars, as shown below, are only visible from behind and only if you have short hair or wear your hair up. Many of my patients with prominent ears keep their hair long to cover them. Long hair can also make recovery easier after Otoplasty, as any postoperative swelling is well hidden.
After Cosmetic Ear Surgery, you’ll have the option of cutting your hair or wearing it up, without the ears protruding. If you live in the East Bay Area, or California’s Central Valley, summers are hot. The option to confidently wear your hair off your ears is a blessing.
Otoplasty scars are hidden in the folds of the ear. The primary scar is behind the ear. The Otoplasty Before and After Photos above show early scars. Even the early scars are well hidden, and as they mature, they become even more discreet.
In the above Ear Pinning Before and After Pictures, the ear prominence is reduced in three ways. The top of the ear is folded in, the cup of the ear is reduced and the entire ear is rotated back. The actual height of the ear has not changed, though the ears appear smaller. More details about Ear Pinning can be found on my website’s Otoplasty Page.
How Young Is Too Young For Otoplasty?
Otoplasty is used to reduce the appearance of prominent ears and to improve symmetry. The earliest the procedure is performed is at five years of age.
I am often asked by parents, “How young is too young for Otoplasty?” Prominent Ears are usually evident at birth, and are often fixed before adulthood. The ears reach 85% of their adult size by age five, and five years of age is the earliest that Otoplasty is normally performed.
There is evidence that some ear deformities can be corrected by early molding. Headgear is worn, beginning in the first few days of life, and it needs to be worn constantly for months. As you can imagine, this can be difficult to maintain in a baby. The reason early molding works is that the mother’s estrogen crosses the placenta and circulates in the infant.
Estrogen makes cartilage more flexible. In the mother, this facilitates opening the pelvis for delivery. This also softens the cartilage in the infant’s ears. By molding the ear cartilage early, the hope is that as the estrogen levels drop, the ear’s cartilage freezes in this new and improved position. This is likely the reason why splinting later in childhood has not been successful in changing the shape of the ears.
Ear pinning can be a very rewarding procedure. If you are considering Otoplasty for yourself or your child, be certain to seek the advice of an experienced, Board Certified Plastic Surgeon. Every ear is different, and several techniques have evolved to treat these differences. If you are in the San Francisco Bay Area, call (925) 943-6353, to schedule a private consultation appointment in my Walnut Creek Plastic Surgery office.
Mommy Makeovers may include Breast Augmentation, Breast Lifts or Breast Reduction combined with a Tummy Tuck, Mini Tummy Tuck or just Liposuction, depending on the areas that need improvement and the patient’s wishes.
There is no denying that breasts and bellies take a hit with pregnancy. Fortunately, there is a solution. Mommy Makeovers rejuvenate both the breasts and the belly, to help restore your pre-pregnancy body.
Mommy Makeover Options
The term Mommy Makeover comes from the frequently requested combination of cosmetic plastic surgery procedures used to restore a woman’s body after childbirth. The most common combination is Breast Augmentation with a Tummy Tuck, but variations are available when indicated.
Mommy Makeover Breast Options
The motivation for having a Mommy Makeover is the desire to restore the breasts and belly to their pre-pregnancy shape. For breast enhancement, the best procedure depends on how the breasts have changed:
Smaller Breast may benefit from Breast Augmentation.
Larger Breast may benefit from Breast Reduction.
Sagging breast may benefit from a Breast Lift.
Changes to the nipples and areolae can also be reversed.
Mommy Makeover Before and After Pictures
This Mommy Makeover included Breast Augmentation and a Tummy Tuck, the most common combination for restoring the body after childbirth.
Mommy Makeover Belly Options
Just like with the breasts, there options are available for treating the belly, depending on each patient’s needs. While the most common surgery to restore a pre-baby belly is the Tummy Tuck, sometimes a smaller operation is the better choice. Regardless of the procedure used, the best results are obtained when your weight is optimal.
Common scenarios and treatment options include:
Loose abdominal skin and muscle laxity are treated with a Tummy Tuck (Abdominoplasty)
Loose skin and muscle laxity confined to the lower abdomen may respond to a Mini Tummy Tuck.
If the muscle and skin are tight, but disproportionate fat is present, Liposuction might be the best solution.
The abdominal fat, which is removed during the Mommy Makeover, is sometimes repurposed to enhance an atrophied bootie. Fat from the abdomen can often be transplanted to the buttocks as part of a Brazilian Buttocks Lift.
This Mommy Makeover combined a Breast Augmentation Lift with a Tummy Tuck and Liposuction.
Mommy makeover Consultations
There are many treatment options for Mommy Makeovers, so it is necessary to have an experienced professional to guide your decision making. The Internet can give you an idea of what is possible; however, there is no substitute for an in-person consultation with an experienced Board Certified Plastic Surgeon.
If you have Mommy Makeover questions, call me at (925) 943-6353, and schedule a private consultation appointment. Your options will be discussed and your questions will be answered in a manner specific to your needs.
Coming Soon to a Station Near You
Stay tuned to the Bay Area’s News Station, KRON 4. Later this month, I will be starting my television show Body Beautiful with a segment dedicated exclusively to the Mommy Makeover, and more before and after pictures will be revealed.
What we know about Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is evolving. We learn more as each new case is identified. Right now, there are just too few cases to know many of the specifics; however, today I will go over the data currently available.
ASPS and ASAPS summary of BIA-ALCL in 2019
Much of this information comes from the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS). Thanks to its members voluntarily reporting and collecting information on BIA-ALCL, these US based national plastic surgery organizations have the best database on BIA-ALCL in the world.
What is BIA-ALCL?
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and treatable type of T-cell lymphoma that can develop around breast implants. BIA-ALCL is not a cancer of the breast tissue itself. It is not breast cancer, but it is found in the breast, around the capsule which surrounds breast implants.
When Does It Present?
The time between breast implant insertion and diagnosis of BIA-ALCL varies greatly. It ranges from 9 months to 27 years, with an average delay in presentation of 9.2 years.
Who Gets BIA-ALCL?
Cases seem to be concentrated in patients who have, or who have had textured breast implants. It seems to be related to the aggressiveness of the texturing and has occurred in patients with both silicone and saline filled breast implants.
When in doubt; check it out. Early diagnosis and treatment are key to curing BIA-ALCL.
After reviewing all available case series, case reports, and registries, BIA-ALCL is more common with textured implants. Textured implants are used less frequently than smooth implants. Textured implants are also used more often for breast reconstruction after breast cancer, because shaped implants are more desirable in this population and texturing is used to reduce breast implant rotation for shaped implants.
To date, no cases of BIA-ALCL have been verified in patients who have had exclusively smooth breast implants. However, it is not possible to exclude the appearance of BIA-ALCL in association with smooth implants at this time. The FDA reports that they are aware of smooth breast implant only cases; however, they warn that this information is “unverified” and potentially “inaccurate.”
The association of BIA‐ALCL and textured implants may be related to the increased surface area of the texturing; however, this has not yet been definitively proven. The variation in surface texturing among breast implant manufacturers may mean there are variable risks for the development of BIA-ALCL.
How Does BIA-ALCL Present?
The majority of patients present years after their initial surgery with one breast gradually increasing in size. The increased size is from fluid, serum, collecting around the breast implant. This collection of fluid is called a seroma. Seromas are normal right after surgery; however these seromas appears later and are thus called a delayed seromas. A few patients have presented with different symptoms such as a mass, skin rash, fever and night sweats, and lymphadenopathy.
How Is The Diagnosis of BIA-ALCL Made?
BIA-ALCL usually presents as increased breast size due to fluid collecting around a textured breast implant.
Diagnosis is based on analysis of the fluid in the seroma. Most commonly, ultrasound‐guided fine needle aspiration of the peri-implant fluid is assessed with immunohistochemistry for CD30-positive large anaplastic T-cell lymphocytes.
How Is BIA-ALCL Worked Up?
PET‐CT is performed following a positive diagnosis. Mammograms are not helpful for evaluating lymphoma, but are important for the evaluation of breast cancer. Often, a multidisciplinary team approach including, when required, an oncological breast surgeon and an oncologist specializing in lymphoma.
How Is BIA-ALCL Treated?
The treatment of BIA-ALCL is evolving. In most cases, cure is obtained by removal of the breast implant and the capsule surrounding it. Incomplete capsular resection has been associated with both recurrence and significantly lower survival. Rarely, patients may present with a mass and have an increased risk of requiring radiotherapy and chemotherapy. Treatment approach should follow international guidelines established by the National Comprehensive Cancer Network (NCCN) for BIA-ALCL, available at nccn.org.
Current treatment recommendation is for bilateral complete capsulectomy and implant removal, as a small number of women have had contralateral disease found incidentally; however, it cannot be stressed enough that the treatment is still evolving, and each patient must be individually evaluated. If you suspect you have BIA-ALCL, do not delay, and contact your plastic surgeon or primary medical doctor immediately.
Summary Statement On BIA-ALCL From The ASPS
I have included below a statement released by the American Society of Plastic Surgeons (ASPS) this week. It summarizes well what we currently know about BIA-ALCL. The ASPS has also published an 2019 online BIA-ALCL summary.
“Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of lymphoma that can develop in the scar capsule near saline or silicone breast implants. This disease is currently being investigated as to its relationship with breast implants. The family of ALCL is a rare cancer of the immune system, which can occur anywhere in the body. Based on adverse event reports, the United States Food and Drug Administration (FDA) estimates the total number of cases of BIA-ALCL to be over 450 cases.”
“It has been noted that the majority of BIA-ALCL patients have a history of a textured-surface device. An exact single-number estimate of the risk for both textured and non-textured implants is not possible with the currently available data. Lifetime risk of BIA-ALCL has been estimated at 1:1,000 to 1: 30,000 for women with textured breast implants, and BIA-ALCL risk is currently under investigation. BIA-ALCL usually involves swelling of the breast at an average of 3 to 14 years after the initial breast implant operation. Most cases were cured by removal of the implant and the capsule surrounding the implant; however, rare cases have required chemotherapy and/or radiation therapy for treatment.”
“Patients with breast implants should be followed by a surgeon over time and seek professional care for implant-related symptoms such as pain, lumps, swelling, or asymmetry. Patients should monitor their breast implants with routine breast self-exams and follow standard medical recommendations for imaging (e.g. Mammography, Ultrasound, MRI). Abnormal screening results or implant-related symptoms may result in additional expenses for tests and/or procedures to properly diagnose and treat your condition. Tests and procedures could include but may not be limited to: obtaining breast fluid or tissue for pathology and laboratory evaluation, surgery to remove the scar capsule around the breast implant, implant removal, or implant replacement.”