The study today has now been disclosed on January 26, 2011 by the FDA stating a slight but small possible risk of an anaplastic large cell lymphoma in patients who have undergone silicone and saline implants. Approximately 60 cases of disease worldwide have been estimated in 5 to 10 million women with breast implants. This statistical evidence has been tabulated since 1997 and given to the FDA.
In general, Allergan Pharmaceuticals and Johnson and Johnson (Mentor Corporation) will continue to follow patients and monitor those with this ALCL form of cancer. This very small number of cases to me is not alarming and patients should not run out and have their implants removed nor be persuaded not to have breast enhancement or breast reconstructive surgery in the future. I do agree that healthcare professionals should confirm all cases of ALCL with the FDA and if a patient has chronic seromas or capsular contracture with scar tissue, then the capsule should be sent to Pathology for final diagnosis for cancer. Women should monitor their breast implants, contact their physician with any noticeable changes with scar tissue or fluid collections and that discussion with future patients of all risks should be continued.
NATRELLE GEL-FILLED IMPLANTS
Now in 2011, women have four choices for smooth, round, silicone gel implants for both cosmetic and reconstructive purposes. Natrelle Allergen gel implants come in sizes of Style 10, 15, 20 and now 45. Style 10 is a moderate profile smooth, round implant that has low projection, AP projection and wide diameter. Style 15 implants are the mid-range implants that are a moderate profile and have a little more projection and less diameter. Style 20 implants are very useful high profile smooth silicone implants with a narrow base and increased significant AP projection. The Style 45 is the fullest, roundest implant on the market. It is the extra high profile implant with a narrow space and most fullness. I prefer not to use Style 10 moderate profile implants at any time. Style 15 and 20 are the most commonly used implants in my practice. Style 20 implants are for more upper pole fullness than Style 15, for patients who want a little less. Style 45 implants are now available and show increased AP projection and may be too much fullness for patients who want a more natural upper pole. However, Style 45 implants may also be useful to reduce visibility because they are a rounder shape and by physics, the rounder the shape of the object, the less visibility and rippling of the sides.
On the majority of double bubble deformity surgeries it is vital to use a breast compression upper pole band to maintain the implant in the new lower position and prevent rebound superior retropositioning. It normally takes 2-3 weeks for the lower pole of the pocket and inframammary fold to maintain it’s new reformed shape by relaxation.
It’s seem weekly that I am performing tummy tucks on patients that have undergone gastric bypass surgery with lap bands! In fact we had 3 last week in surgery. It is important to have a board certified general surgeon in the operating room to assist with the port!
As safety is our number one issue , it is vital that the lap band port remain uninjured during the abdominoplasty surgery and be repositioned to a usable new site if necessary.
Thank You, Dr. Stuart A. Linder
BEVERLY HILLS BREAST REVISION
When performing breast revision surgery, it is extremely important to understand when to do a capsulectomy versus capsulotomy or perform both operations at the same surgical setting.
One of the most common complications after breast enhancement surgery is scar tissue formation around the implants. This can happen to any patient at any time postoperative. It may be associated with micro infection of staph; however, the specific etiology is unknown. Capsulectomies are performed with scar tissue release to remove circumferentially around the implant from the underbelly surface of the pectoralis major muscle or in the retromammary plane directly from the breast tissue. Severe encapsulation and a Baker IV capsular contracture usually requires some form of scar tissue removal through a capsulectomy. Patients who have very thin ectomorphic build and have minimal breast tissue may only be able to undergo capsulotomy with releasing the scar tissue; however, not removing much of any in order to prevent visibility and rippling of the implants. An experienced Board Certified Plastic Surgeon should understand the difference between the scar tissue removal versus release and when to remove versus release the scar tissue only. Each patient must be specifically identified as a unique individual and capsulectomy versus capsulotomy can only be determined by an experienced Board Certified Plastic Surgeon.
HAPPY NEW YEAR PLASTIC SURGERY
BEVERLY HILLS, CALIFORNIA
There is no better time than now to have your dream plastic surgical procedure performed. Here in Beverly Hills, many patients wait until after the holidays to have their cosmetic surgery procedures. We perform breast augmentations, breast revisions, tummy tucks and total body liposculptures throughout the months of January and February on patients who decide that they want to start the year off improving their body, self-image and self-esteem by either a breast enhancement procedure, breast lift or body sculpting operation. Remember, body sculpting surgical procedures should be performed by Board Certified Plastic Surgeons or Diplomates of the American Board of Plastic Surgery. In general, we perform our operations with Board Certified Anesthesiologists under general anesthesia as well as use of an accredited certified ambulatory surgical center.
Best wishes and a happy and healthy New Year to all.