July 31st, 2013 Miguel A. Delgado Jr, MD
Marin, California – This is a 55-year-old, female resident of Marin, California who presented to the Novato office for evaluation for revisional breast surgery. She underwent bilateral silicone breast implants in 1975. She developed bilateral ruptures of both implants and severe capsular contractures. She underwent removal of silicone material with subpectoral placement of 300 cc, Mentor silicone- gel breast implants. Her procedure was performed at Marin Cosmetic Surgery Center in Marin County, California.
San Francisco, CA-Manufacturers of breast implants all state that implants are not lifetime devices, however, most companies including Mentor give free replacement of qualifying devices that have failed, for the lifetime of the patient. Most companies offer additional monetary compensation to help defer the cost of breast revision surgery for up to ten years.
Statistics show that the percentage for failure of an implant is approximately 1% per year. At 10% probable failure rate at 10 years, the manufacturers no longer offer to help with cost of surgery for replacement. This statistic has caused confusion for many (see the previous blog dated July 15, 2013). This does not mean that implants must be replaced at the 10 year point. Some women will have issues with their implants much earlier and some much later and for a lucky few maybe never. You should assume that you will need a revision at least once in your life and very possibly within the first ten years. If you are not having any issues with your implants, you do not need to have them replaced, but you should keep current with your breast exams with your doctor. See breast implant pictures before and after revision of some of Dr. Delgado’s patients here.
It is interesting to note that many people use the terms rupture and deflation interchangeably. Some say rupture refers only to silicone implants, and deflation refers only to saline implants. The FDA states that the term rupture can refer to any type of breast implant, but deflation will only be used to describe saline breast implants.
Saline implants are filled after insertion during surgery by a valve that can fail at some point or leak. Silicone gel implants are pre- filled by the manufacturer, requiring a somewhat larger incision for insertion, but they have less probability of rupture.
Saline breast implants can deflate very quickly or slowly over a period of a few days. The deflation will be very evident to the patient as the breast will have lost volume looking like a flat tire or a deflated balloon. The saline that leaks into the body is harmless and will come out in your urine. It is not a medical emergency requiring replacement surgery immediately, but the sooner the better as the pocket will start to shrink, and scar tissue may set in making revision surgery more difficult.
Silicone gel implants prior to 1992 were filled with a gel that was more of the consistency of thick honey. If an implant were to rupture, the gooey gel could migrate to other parts of the body, making the removal of the implants a challenging and tedious procedure for breast revision specialists. Suspicious health problems were surfacing, and the FDA placed a moratorium on silicone implants until major improvements and studies were conducted. After many years of trials, in 2006 the FDA approved the new silicone implants that are made of a more cohesive gel.
With the approval of the new gel implants came a warning from the FDA. Besides only being available to women 22 years of age and older, the FDA recommends that women have a magnetic resonance imaging (MRI) of their breasts after 3 years of their original surgery, and then every 2 years after that, to monitor for “silent leaks”. Due to the costs involved for this test, which can range from $1,000 to $2,000 depending on what part of the country you are in, many women choose have a MRI only if they have issues. Keep in mind that a MRI is not a perfect science; false positives have been known to occur. Any concerns that you may have with your breasts should be brought to the attention of your plastic surgeon who will help you determine the best course of action.
Some causes for deflation of breast implants are:
• Capsular contracture, (the constricting formation of scar tissue around the implant)
• Mammogram, (be sure to inform your technician that you have implants)
• Implant age
• Overfilling/under filling of saline implants(beyond what the manufacturer recommends)
• Breast trauma (car accident, closed Capsulotomy)
• Non-FDA approved incision site (the belly button)
• Surgical instruments during surgery
• Defective valve of the saline implant
Even with the possibilities of future breast revision surgeries, breast augmentation for women in the United States was the most sought after of all cosmetic procedures in 2012, according to the American Society of Aesthetic Plastic Surgeons (ASAPS). ASAPS reported that there were over 330,000 breast augmentation procedures performed with 72% of women choosing silicone implants over saline.
July 15th, 2013 Miguel A. Delgado Jr, MD
San Francisco, Mentor Implants
San Francisco, CA-Breast augmentation has been the number one cosmetic surgical procedure since 2006, according to the American Society of Plastic Surgeons. The evolution of the breast implant has changed dramatically since it was first introduced about 50 years ago in the 1960’s.
The first generation of breast implants introduced was a Cronin-Gerow implant in 1963. It was a tear drop shaped implant filling a silicone rubber envelope with a viscous silicone gel.
The 1970’s brought the second generation of breast implants, which had a thinner shell and low cohesion silicone gel filler, improving the size, look and feel of the implant. The second generation implants proved to be fragile with high rates of rupture and “gel bleed” where the silicone actually leaked through the shell, causing increased incidents of medical complications.
In the second technological stage, a polyurethane foam coating was used on the implant to reduce the incidence of capsular contracture. The third technological development was the double lumen implant which as a silicone implant inside a saline implant but the complex design proved to have a greater failure rate than the single lumen implant.
The 1980’s brought the third and 4th generation of implants with continued advances in technology that further reduced gel bleed and increased the cohesive gel.
The mid 1990’s brought the fifth generation of silicone breast implants that were made of a semi-solid gel practically eliminating filler leakage, with improved safety and lower rates of capsular contracture and device shell rupture.
In 1992, the FDA placed a moratorium on silicone implants allowing only women needing breast reconstruction or breast revision surgery to have them until further studies could prove their safety.
The breast implant manufacturers conducted many clinical trials, and in 2006, the FDA lifted its restrictions on silicone implants for women 22 years of age and older. The FDA does recommend that women have periodic MRI screenings to rule out “silent leaks”.
The manufacturers give a lifetime warranty on their implants should they deflate or rupture due to a malfunction of the implant. If this should happen within 10 years of the implantation, the manufacturers also give some monetary compensation to the patient to help offset the breast implant costs of surgery. This warranty has caused some confusion for women as to the life of their implants. Some believe that, after 10 years, they must have their implants replaced. This is not the case.
Napa, California – A 35-year-old resident of Napa, California who presents to the Novato office in Marin County for breast revision surgery. Her initial breast augmentation was with 300cc normal saline implants and developed early breast contracture and mal-position on her.
It is true that breast implants are not lifetime devices and most women will have to have them replaced once and maybe more in their lifetime. As a general rule of thumb, 10 years is the average that women may need to have some type of revision surgery.
There are several different scenarios where a woman may need to have breast revision surgery, most commonly it may be a deflation or a rupture or capsular contracture. Sometimes revision is needed if the implant has shifted its position or a woman may desire to change the size of her implants. In addition, a need for revision could be the development of a “double bubble” where the implants rests below the natural crease of the breast or the implant has “bottomed out” where the nipple is sitting too high on the breast. Women’s breasts change after pregnancy and childbirth and/or with weight fluctuations causing many to need a breast lift. See before and after pictures of breast implant revision surgery cases of Dr. Delgado’s here.
Women who are not having complications do not need to have their implants replaced, and for some lucky women this may never happen. Women who are planning on having breast augmentation need to assume that they will need revision surgery at least once in their life. It is strongly recommended that women have periodic visits with their plastic surgeon to maintain the health of their breasts.
July 1st, 2013 Miguel A. Delgado Jr, MD
This is a 55-year-old resident of San Francisco, California who presented to the San Francisco office at Union Square for evaluation for facial rejuvenation. He underwent a facelift, temporal brow lift and fat injections to his face and a pre-jowl chin implant.His surgery was performed at Marin Cosmetic Surgery Center in Marin County, California.
San Francisco, CA-In February 2013, The American Society of Plastic Surgeons (ASPS) published their statistics for 2012. The total number of rhytidectomy surgeries, better known as facelift surgery, performed in the United States was up 6% over 2011. Of the total 10% was for men. Men strive to look younger to remain competitive in the work place, but some are motivated to have a facelift after seeing how refreshed their wives look after their surgery.
During a consultation for a facelift, one of the most important issues discussed is the placement of the incisions. The goal, besides a more youthful refreshed face, is to have the incisions well hidden so that it is not evident that any surgical procedure has been done. Women want the choice to be able to wear their hair in any style, and men who don’t have many hair style options just want scars that don’t show.
The facelift procedure is very different for a man than for a woman just as other cosmetic surgical procedures can differ, such as female breast reduction versus male breast reduction. Great care needs to be taken not to feminize the male face. The incisions should be well hidden in the natural skin creases and shadow of hair. The incision can be in front of the ear (pre-tragal) or inside the ear (intra-tragal), but attention needs to be made regarding the hairline, side burns and the beard. The beard should not be pulled into the ear, and the side burn position needs to be preserved. Laser hair removal can be done if the hair is too close or in the ear.
Male Face Lift Incision
In the long term, the pre-tragal incision will heal the best and look more natural. The location of the incisions will depend on skin laxity, quality of the skin, how much sun damage there is, and color of the skin. Some men have a distinct change of color between the skin of the cheeks and the tragus; therefore, each patient needs to be evaluated individually. There is also an incision behind the ear and the surgeon must take care not to move the hairline. If the man has a brow lift and eyelid surgery at the same time as the face lift, great care needs to be taken to keep a natural look and not be too aggressive.
A face lift for a bald man or a man with thinning hair is more of a challenge but can be done with excellent results. The conventional incision for a male facelift cannot be done because without hair, the resulting scar will not be hidden. Instead, a surgical approach called circumauricular is preferred. This incision goes around the ear but not into the scalp, keeping the incision hidden in the creases and shadows of the ear.
It is important for the man to take care of the incisions until they are well healed. For the first few weeks, the incisions will be red, and the best way to hide them is to let your hair grow longer before surgery and/or the use of makeup. Our esthetician would be able to assist in choosing an excellent mineral based cover-up and show the patient how the application should be done to conceal the incisions. Use of sunscreen is highly recommended as the sun can make scars much more prominent, in fact it would be wise to stay out of the sun as much as possible for several weeks or months.
Continuing with a healthy diet is important in healing as well as taking high quality vitamins such as VitaMedica. Smoking is one of the worst things anyone can do before and after surgery as the nicotine and carbon monoxide starves the cells and keep them from delivering oxygen to the tissues. This prevents the incisions to heal properly, and in addition making the patient more susceptible to infections. Besides increasing inflammation, there is also an increase in risk of cardiovascular complications.
It is important for the patient to take an active role throughout the healing process in order to get the best surgical result.