Breast Augmentation with Breast Implants remains the most popular cosmetic plastic surgery. Three to four-hundred-thousand women have Breast Augmentation each year in the US alone. It is the safest and most effective means of enlarging the breasts available, but even FDA approved devices, like Breast Implants, need touch-ups from time-to-time.
Do I Need Breast Implant Revision Surgery?
The following Breast Implant Revision Surgery Video originally aired on the San Francisco Bay Area‘s news Station, KRON 4. It reviews Breast Augmentation Revision Options and describes some of the most common breast augmentation revisions. Multiple before and after pictures are included as examples.
Breast Augmentation Revision Surgery Video
Breast Implant Deflation
The introductory photo for the video above shows deflation of this patient’s left breast implant. For Saline Breast Implants, loss of the breast implant’s shell integrity results in complete deflation and loss of breast augmentation. Replacement of a deflated breast implant can be done with minimal downtime. It is also a good time to consider if your breast implants are the right size, profile or style (saline vs silicone), as there is no better time to replace both implants. In situations like the above, it is extremely helpful if you know what type and size of breast implants you have.
Breast Implant Revision – Bigger
The most common reason for Breast Augmentation Revisions is to go bigger. This is especially common after pregnancy with preexisting breast implants as shown above.
The above Breast Implant Revision Before and After Pictures show two common reasons for revision. The first, and the most common, is to go larger. The second, and often seen after pregnancy with preexisting breast implants, is to correct breast tissue sagging off the breast implants.
This patient has already had a Breast Augmentation Mastopexy, also known as a breast lift, using breast implants for additional volume. The larger the preexisting breast tissue volume, the more likely the breast is to sag. This is true with or without breast implants. She desired larger breasts and a perkier appearance. A larger Breast Implant provides both additional volume and support for her breasts.
Breast Implant Revision – Smaller
The above Breast Augmentation Revision pictures demonstrate the correction of bottoming out.
Sometimes, the breast implants are too large to be supported. The before picture, in the above Breast Augmentation Revision Before and After Pictures, demonstrates what happens when breast implants are too large, even with a breast lift. Over time, the Breast Implants have over-stretched the skin of the lower breast and moved down the chest. The previous breast lift (mastopexy) scar is red and irritated, and the nipple is riding high. This patient presented with a desire for correction of the shape of her breasts, and also wanted to be smaller.
The after photo shows the results after the mastopexy was revised and the breast implants were replaced with smaller, lower profile, Breast Implants. The mastopexy scar looks less irritated. The distance between the nipples and the bottom of the breast is reduced to normal. The new breast implants are smaller, but maintain the width of the breast to preserve cleavage.
Breast Implant Revision Surgery Consultations
With the popularity of Breast Implants it is not surprising that Breast Augmentation Revision Surgery has become its own specialty. If you have breast implants which are:
too close together
too far apart
deflated or leaking
not supporting your breast tissue
then give my San Francisco Bay Area Plastic Surgery Clinic a call at (925) 943-6353. With 20 years of experience, I will give you up-to-date options that are personalized to your unique situation. Previous operative reports and your before and after pictures help, so bring them with you, too.
SanFranciscoBreast.com has been completely updated. This update includes new content, and it is artfully illustrated with new breast enhancement videos and more before and after pictures. In addition, the fresh content is wrapped in a new skin, improving navigation for the small screen and the desktop alike.
New Breast Augmentation Information
The site includes new pages featuring the most requested Breast Enhancement Procedures. For example, the Breast Augmentation Information has been exploded into a dozen detailed pages including:
The Breast Lift section includes details about five main options for Mastopexy. There are also pages dedicated to the combination of Breast Lift using Breast Implants and Areola Reduction.
Breast Reduction for Women and Men
Options for Breast Reduction for Women are also reviewed, as several techniques have evolved during the 20+ years I have been in practice. Breast Reduction for Men, also known as Gynecomastia Reduction, is covered with attention paid to the causes and the most current treatments available.
Specialty Breast Procedures
A section on the often overlooked details of Breast Enhancement is also included. San Francisco Breast’s Specialty Breast Pages include:
Inverted Nipple Correction
Other Congenital Breast Abnormalities
A Plastic Surgery Web Site Dedicated to Breast Enhancement
I have tried to create an all inclusive Breast Enhancement site designed to provide detailed information about the many Plastic Surgery options available for Breast Enhancement, whether that be Breast Enlargement, Breast Reduction or Breast Reshaping.
While the San Francisco Breast web site in meant to provide information, it is just a starting point. The Internet cannot take the place of a thoughtful, in-person consultation with a qualified Board Certified Plastic Surgeon. If you would like to schedule a private, personalized consultation appointment call (925) 943-6353 today. My San Francisco Bay Area Plastic Surgery clinic specializes in helping you obtain the best possible results.
Breast Augmentation adds volume, while Breast Lifts reshape. What happens when you put them together? You get Cosmetic Plastic Surgery that can enhance both breast volume and shape.
Total Breast Enhancement – Breast Aug and Breast Lift
Sometimes a Breast Implant or a Breast Lift alone is not enough to get the results we want. The combination of Breast Augmentation with a Breast Lift, or Augmentation Mastopexy, is used when breast sagging is combined with a loss of breast volume. Board Certified, San Francisco Bay Area Plastic Surgeon, Dr. Joseph Mele, discusses the nuances of Breast Augmentation Combined With Breast Lift on this episode of Body Beautiful, a live television show dedicated to the latest in Cosmetic Plastic Surgery news for the greater San Francisco Bay Area.
Everyone knows that Breast Implants make breasts bigger. It’s a simple concept. Adding volume behind the breast tissue, often behind the pectoralis muscle, enlarges the breasts you have. While the size of the breast changes, the shape does not. It simply inflates the skin you have.
Breast Lifts Make Breasts Perkier
Breast Lifts (Mastopexies), on the other had, are all about breast shape. Lifts do not make breasts bigger or smaller. Breast Lifts reshape the skin envelope. Mastopexies reposition the nipples/areolae into a more attractive position and reduce the amount of breast tissue that sags below the IMF (inframammary fold).
Breast Augmentation Lift Consultations
The subtleties of the procedures, whether considered separate or together, are beyond the scope of one San Francisco Plastic Surgery Blog post, though you will find other posts on the topic here and on my other web sites. But rather than learning everything there is to know about both, why not learn about the aspects of the procedure that apply to your body?
Breast Augmentation Lift Consultations are the best way, and really the only way, to get the information specific to your needs. They focus on your breasts and your goals. You won’t waste time learning about options that won’t do what you want, and you will learn what to expect from the procedures that are most likely to help you.
If you would like to schedule a personalized and private Breast Enhancement Consultation, call my office today at (925) 943-6353. Get specific information that is tailored to address your needs, not generic information meant for the masses.
The Mommy Makeover combines the most common body shaping procedures, breast augmentation and tummy tuck, into one, maximum result, breast and belly shaper.
The Mommy Makeover is one of my favorite combos. The ability to reshape the damage done to a woman’s body after childbirth or weight loss, in a single operation, makes it one of the most satisfying Cosmetic Plastic Surgery procedures.
What Is A Mommy Makeover?
The Mommy Makeover is not a specific procedure, but rather the combination of breast and belly enhancement performed in a single operation. Breast Enhancement may include Breast Augmentation, Breast Lift, Breast Augmentation with a Lift or Breast Reduction. It all depends on what needs fixing. Belly Enhancement is usually a Tummy Tuck; however, for the patient who needs less, Mini Tummy Tucks or Liposuction may be the procedure of choice.
Mommy Makeover Video Presentation
Recently, I had the opportunity to discuss Mommy Makeovers with the San Francisco Bay Area television audience. Body Beautiful airs on KRON 4, the San Francisco Bay Area’s News Station. The Mommy Makeover features the best and the latest in Cosmetic Plastic Surgery. This week, the spotlight is on Mommy Makeovers.
Mommy Makeover Video
More About Mommy Makeovers
The Mommy Makeover Video segment featured above reviews many of the available options and outcomes of the procedure for several of my patients. Additional Mommy Makeover Videos are available here, on the San Francisco Plastic Surgery Blog, and on my main site’s Mommy Makeover Video Page.
Mommy Makeover Consultations
When you are considering a Mommy Makeover, be certain to consult with a Board Certified Plastic Surgeon. Call (925) 943-6353 today, to schedule a private, personalized Mommy Makeover consultation in our San Francisco Bay Area Plastic Surgery Clinic.
Learn the latest plastic surgery news on the Bay Area’s News Station’s, KRON 4’s, Body Beautiful with Dr. Mele.
Getting ready for today’s live show with Janelle Marie. Body Beautiful airs at noon (June 7, 2017) on the San Francisco Bay Area’s News Station, KRON 4. Tune in to hear the latest plastic surgery news. Today’s topics include:
Breast Augmentation Lifts (Augmentation Mastopexy)
Brazilian Butt Lifts (Fat Grafting to the Buttocks)
Thigh Lifts (Thighplasty)
The previous post has more details about the topics to be covered. If you are reading this after the show airs, segments from the show will be posted on the San Francisco Plastic Surgery Blog.
EDIT – The first Plastic Surgery Video segment on Mommy Makeovers is up and live right here: Mommy Makeover Video.
The Mommy Makeover is the most popular, and one of the most satisfying, combination cosmetic plastic surgery procedures. With the ability to reshape the breast and flatten the belly, the Mommy Makeover is the procedure of choice to rejuvenate the female form after pregnancy or weight loss.
This Wednesday, June 7, 2017, I will be on the San Francisco Bay Area’s News Station, KRON 4’s Body Beautiful. The show airs live at noon. As usual, the discussion is focussed on the latest Cosmetic Plastic Surgery News for the San Francisco Bay Area.
Body Beautiful Plastic Surgery Topics
This week’s half-hour television show discusses Cosmetic Plastic Surgery of the Body. Planned topics include:
The Mommy Makeover Before and After Pictures that leads this post demonstrate the most popular combination cosmetic plastic surgery. By combining Breast Augmentation and Tummy Tucks, the two areas the often sag after pregnancy, the breasts and the belly, are both addressed. Of course, the procedures can be performed without having had children. The term Mommy Makeover was coined because of the frequent request from mommies to repair the damages of pregnancy on their breast and bellies. Another common situation in which Mommy Makeovers are performed is significant weight loss.
EDIT – The first Plastic Surgery Video segment on Mommy Makeovers is up and live right here: Mommy Makeover Video.
Breast Augmentation Mastopexy (Breast Implants with Breast Lifts)
Breast Augmentation remains the most popular single plastic surgery procedure. Breast implants can provide volume, and as many as 40% of patients also benefit from a breast lift. Breast lifts can improve breast shape in ways the Breast Augmentation alone cannot.
Breast Augmentation is still one of the most frequently performed cosmetic plastic surgery procedures, but what happens if the breasts are saggy, or the nipple is very low on the breasts? Breast Augmentation in these situations may provide larger breasts, but not necessarily perky ones. As many as 40% of Breast Augmentations combine some sort of Breast Lift. The most common reasons for this are low set nipples or saggy breasts due to excess skin.
Additional procedures can also be added to correct other breast problems, Fine details of the breasts that are often targeted for improvement are: Areola Reduction, the improvement of Breast Asymmetry, Breast Implant Revision for women who had Breast Implants before pregnancy and Inverted Nipple Repair. Breast Reduction, perhaps paradoxically, can also be combined with Breast Augmentation Mastopexy when heavy lower breast tissue is distorting the shape of the breasts.
Brazilian Buttocks Lift
The fastest growing procedure is the Brazilian Butt Lift. The procedure takes fat from areas where it is not desired and repurposes it, to enhance the shape of the buttocks.
A newer body procedure is allowing Board Certified Plastic Surgeons to shape an area that traditionally has been difficult. The Brazilian Buttock Lift (BBL), allows us to remove fat with Liposuction and reuse it to enhance the buttock contours. Pioneered by Brazilian Plastic Surgeon, Ivo Pitanguy, the procedure allows for customized augmentation of the buttocks, and shape that is more pleasing to the eye than Buttocks Implants can provide.
Thigh Lifts in the SF Bay Area
The Thigh Lift is used most often after weight loss. Excess skin and fat from the inner thigh is removed to reduce the size of the thighs and tighten the skin.
Thigh Lifts are one of the less frequently performed cosmetic plastic surgery procedures. The numbers have risen in response to Bariatric Surgery and the massive weight loss associated with it. As weight is lost, the thigh skin that is stretched during weight gain becomes loose. As the volume of the thigh decreases, so does the support that the extra fat provides the thigh skin. As a result, the skin can hang like drapery. The Thigh Lift removes this excess skin, and helps to tighten the thigh, especially the upper, inner thigh.
Watch Body Beautiful June 7, 2017, on KRON at Noon Wednesday
If you are interested in learning more about any of the above procedures, I have provided links in this post, and I encourage you to watch me live on KRON 4, this Wednesday at noon. Segments from the show will be posted here, on the San Francisco Plastic Surgery Blog, in the coming days. So if you miss the live show, you can still catch up here or on my local San Francisco Plastic Surgery Web Sites.
Internet education can be very helpful, and it is the goal of the San Francisco Plastic Surgery Blog; however, because information on the Internet is designed to apply to the general population, it is generic in nature. Medical advice cannot be giving without the personal contact that an in-person consultation appointment provides. To get “brand name” plastic surgery information, tailored to your specific needs, call my San Francisco Bay Area Plastic Surgery Clinic today, at (925) 943-6353, and schedule an appointment to get your personal, Board Certified Plastic Surgery information.
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%.
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.
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.
Dr. Mele and Body Beautiful host Janelle Marie in the KRON 4 Bay Area News studio.
Board Certified San Francisco Bay Area Plastic Surgeon, Dr. Joseph Mele, MD, FACS, will be discussing cosmetic plastic surgery, live at noon today (8 March 2017) on KRON 4. Topics include:
Breast Augmentation (breast implants)
Gynecomastia Reduction (male breast reduction)
Arm Lifts (brachioplasty)
Chin Augmentation (chin implants)
But you never know what will come up on live television.
Tune in or DVR us at Noon Today
If you have the chance, tune in today at noon and get the latest plastic surgery news, live, on your television. If you are reading this too late to tune in, don’t worry. Segments of the show will be posted to the San Francisco Plastic Surgery Blog and to my web shortly after airing.
You can check out past episodes here by selecting “Videos” in the “Search By Category” drop-down menu in the margin, or on DrMele.com.
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.