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Plastic Surgery Blog

Plastic Surgery Blog

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Boob Greed: How Big is "Big Enough"?

"Bigger is better." This is an old slogan that has sticking power and has even filtered into the general public's ideas about breast implants. Are bigger breasts better just because they are bigger? How big is too big? Can you have too much of a good thing? At Bancroft Feldman, it's our professional opinion that, yes, some implants are too big for ...
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Mammograms and Your Breast Implants

Mammograms are a part of life for middle aged women whether they have breast implants or not. Women with breast implants, however, often have questions about how their implants may complicate having a mammogram or even wonder whether those implants compromise their breast - and best - health. Breast Implants Do Not Cause Breast Cancer The good news...
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Allergan’s new Inspira Soft Touch Implants

This last January, Allergan announced a new breast implant option in their NATRELLE® line of breast implants: the Inspira Soft Touch implant: "Now, the INSPIRA® line of breast implants helps physicians to better meet diverse, patient-specific needs based on available breast tissue and desired outcomes." This line of implants was very popular with d...
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Should I Massage My Breasts after Surgery?

Yes, absolutely. Dr. Feldman advises his patients to massage their breasts as an important part of their post-surgical care.

Why? For a number of reasons, but primarily because regular massage will reduce the risk of capsular contracture. Capsular contracture is the result of the body’s immune system reacting to foreign objects placed within it and occurs when the collagen-fiber capsule shrinks, tightening and compressing the implant. In layman’s terms, it means scar tissue forms around the breast implant that, if left untreated, can cause the breast to look and feel wrong. Frequently and vigorously massaging your new breasts will help them to avoid this type of healing irregularity, as well as to remain soft and natural feeling. This is because massage will move the implant around within the breast pocket and help maintain its dimensions. Regular massaging of your breasts will also help:

Reduce muscle spasm and skin tightness

Fine tune your result

Reduce dry skin and lower chance of stretch marks when combined with a moisturizer

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No Advantage to Using Anatomical Implants in Breast Augmentation

There are many different breast implant choices available today in terms of size, shape, and width. It can be a bit intimidating to decide which one is best for you. However, according to a recent study, patients can rule out anatomical implants as being aesthetically superior to round implants. “There’s no advantage to using anatomical implants in breast augmentation given their considerable disadvantages compared with round implants,” said David A. Hidalgo, MD, clinical professor of surgery, Weill-Cornell Medical College, during a presentation last month at Plastic Surgery The Meeting.

 

What are anatomical implants? They are implants that are shaped or contoured instead of round. Sometimes they are also called teardrop breast implants. They were initially used for breast reconstruction surgeries, but over time women began requesting them for elective breast augmentation as well. Unfortunately, anatomical implants come with a number of disadvantages. They are more expensive, more difficult to insert, are less firm, pose potential health risks, and have been known to rotate after placement. All teardrop implants have textured shells, in fact, because they need to adhere to the tissue in the pocket the surgeon makes for them in the patient’s body. If the implant doesn’t adhere correctly, it can flip or rotate in that pocket and make the breast look deformed. This can only be corrected with more surgery.

 

In order to determine whether there was a difference in the appearance of anatomical implants vs. round implants. Dr. David Hidalgo and Dr. Andrew Weinstein conducted a level 1, randomized controlled trial during which they implanted one round and one anatomical implant in the breasts of 75 women who had previously not had breast augmentation. They took photographs of the implants with the patient sitting fully upright, then replaced the anatomical implant with a round one, and completed the surgery. The average implant size, for both types, was 278 cc.

 

Following this, plastic surgeons were asked to weigh in on the appearance of the implants via an online survey. In 36.4% of the cases, the surgeon reviewers reported no observable difference between the appearance of the anatomical implant and the round implant. In 35% of cases, the surgeons reported not knowing which implant shape was producing the more aesthetically pleasing shape, and in cases where those reviewers believed they could identify implant type, they were only right 27% of the time.

 

Given the results of this survey, in accordance with the numerous disadvantages associated with using anatomical implants, Drs. Hildalgo and Weinstein argued against the continued routine use of anatomical implants in breast augmentation.

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How to Make Your Breast Implants Last Longer

The patients we see at Bancroft Feldman are so passionate about their bodies and excited to have the opportunity to eliminate flaws and improve themselves aesthetically. Breast augmentation - and all plastic surgery - is an investment in yourself and how you present yourself to the world. It would make sense, then, that anyone who’s had surgery would want to maintain that investment and do whatever they can to make sure their breasts remain beautiful for as long as possible.

What are those things? Here are six tips we advise our patients to do that will limit stress on your body and keep your breasts perky and soft.

Let your breast tissue fully heal before you begin to exercise again - While exercise is important for both health and fitness, it takes time to heal from any surgery. You need to take that time - all of it. Make sure to follow all of the guidelines Dr. Feldman gives you after your procedure. You will ease back into activity that way without risking damage to your breasts, and  you’ll thank yourself later when your breasts look good and you are fully healed and strong again.

Always wear a bra with good support - We’ve talked about how important wearing the right bra is after your surgery, but it’s also important to continue to support your breasts after you’ve healed in order to avoid unnecessary sagging over time. You will need to have your new breasts sized and purchase a bra that lifts or pushes your breasts up - so your skin doesn’t have to do that work. Purchasing a tight bra is not what you want either. The bra you buy should keep your implants in position effortlessly so they stay where they are supposed to be at all times. The more you support them, the longer you will want to show them off.

Massage your breasts - If you want to have soft breasts that feel natural, you should take the time to massage them, ideally every day.

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Removing or Replacing Old Breast Implants

For decades scare-tactic articles about breast implants have proliferated in the news and media, linking them to cancer or other dire health consequences, including autoimmune diseases. Over the last four decades, research and patient experience have proven breast implants to be safe, but that doesn’t mean that they will last forever and never have to be removed or replaced. As with anything else, breast implants have a lifespan, and a patient may find herself ready for new implants under certain circumstances, although this often occurs years or even decades after the original surgery.

Breast implants are durable and long lasting, and both silicone and saline breast implants are FDA approved for cosmetic breast implantation in the United States. Occasionally a patient will experience a leak or rupture, in which case the implant must be removed. Many patients choose to replace it with another implant at that time.

What happens when an implant leaks or ruptures? If the implant is saline, the body will absorb the liquid and excrete it. If the implant is silicone, the gel remains inert and nearly always stays within the breast pocket from where it is surgically removed. It is simple to tell if a saline implant has ruptured because the breast will be noticeably smaller. A ruptured silicone implant will maintain its shape, however. There are no liquid silicone implants on the market in the United States. All silicone implants currently used in the U.S. are filled with silicone gel. This gel generally stays in place even in the event of a rupture. Because of this and as a precaution due to prior bad press, it is an FDA recommendation for patients who choose silicone implants to get a routine MRI every few years to check for "silent" ruptures.

The good news is that the implants carry a lifetime "parts" warranty, and with silicone, the manufacturer pays for the surgery (much more expensive than the implant itself) if the implant should rupture within 10 years.

 

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The Dangers of "Vacation Breast Implants"

Several years ago all of the news outlets were reporting on the new trend of getting “vacation breasts implants.” A plastic surgeon in New York, Dr. Norman Rowe, developed a procedure that consists of injecting saline into breast tissue. For a short period - from a few days to up to three weeks, before the body absorbs and excretes the extra water - this will give a woman the experience of having larger, fuller breasts without having to undergo surgery.

It sounds great, right? This should give you all of the benefits of breast augmentation without any of the drawbacks. Well, as with many things, it may sound too good to be true. We at Bancroft Feldman do not recommend having “temporary breast implants” for a number of reasons:

A temporary fix - While saline injections are advertised as a way to “try out” breast implants, the truth is an experienced surgeon will know and can communicate to his patients what different implants will look like on her body. This is especially true for the dimensional planning approach used at Bancroft Feldman. Every woman’s breasts and body are different, but when, like Dr. Feldman, a doctor specializes in breast augmentation and does hundreds of these procedures each year, it’s not difficult to see how certain types of implants will work for different patients. Injecting saline will not behave the same nor simulate different styles or profiles of implants so it's not truly demonstrating the shape of an implant result it's only simulating an increase in volume.

The downside of saline injections is that they are temporary. If you are dissatisfied with the way your breasts look, will you be happy when they return to that same condition after the saline is absorbed?

The costs - The price tag attached to these temporary breasts is at least $2500 per procedure which is money that could be saved and spent on a more permanent solution to your figure problems. For women who do not have money to burn, this is simply a waste of resources.

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Why Is Submuscular Breast Implant Placement Important?

There are typically three types of breast implant placements used to increase a woman’s breast size. These are: subgladular, subfascial, and submuscular. Within the anatomy of the chest are breast tissue/mammary glands, a layer of muscle called the pectoralis major muscle, and behind that another layer called the pectoralis minor muscle. Subglandular placement means that the implant is inserted directly behind the mammary gland and in front of both layers of muscle. Subfascial placement means that the implant is partially inserted under the fascia (the connective tissue) of the pectoral major muscle.

 

Submuscular placement means that the implant is inserted under the pectoralis major muscle and above the pec minor. Dual Plane means just that, as much as possible under the muscle and some under the breast tissue as the muscle and breast borders are not always lined up.

 

Dr. Feldman firmly believes that submuscular (and dual plane) implant placement is the best choice for overall patient health and optimal breast aesthetics.

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Bancroft Feldman Plastic Surgery Continues Helping Patients with PIP Implants!

Although PIP implants were never approved for sale and use in the United States, our global, diverse society has resulted in many inquiries, about the now infamous, recalled, French made, Poly Implant Prothese (PIP) breast implants by patients who had their surgery in Central and South America. These implants were manufactured in the south of France, until the company went bankrupt in 2010, and were sold and placed by surgeons throughout Europe and Central and South America. French authorities believe PIP was using industrial grade silicone, not approved for medical use, rather than the more expensive medical grade silicone. It is alleged by authorities, after reviewing many surgeons’ records, that the industrial silicone implants may have a higher rate of implant failure. It is unclear what other health risks this industrial silicone may pose once the implant fails, as it was never intended for implantation in humans, and studies are ongoing.

There are some reports of increased risk of cancer originating in France, but the level of medical evidence supporting these claims is unclear. As a result of these concerns, France, the United Kingdom and Columbia have all recommended removal of these recalled devices. PIP implants were never approved for use in the United States, and the FDA assures patients and surgeons that the two current manufacturers of US approved implants, Allergan and Mentor, use medical grade silicone and are safe. At Bancroft Feldman Plastic Surgery we believe removal of both the PIP brand implants, as well as removal of the capsule or scar tissue around the implant with microscopic analysis and replacement with US FDA approved devices to be prudent. For these reasons, we always encourage patients to avoid the temptation to seek lower prices on cosmetic surgery in other countries, and to undergo Plastic Surgery in the US, by fully trained, Plastic Surgeons, like Dr. Feldman and Dr. Bancroft.

By: Evan Feldman, MD

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