November 30th, 2013 Miguel A. Delgado Jr, MD
San Francisco, CA-Silicone breast implants were reintroduced in 2006 after a moratorium by the FDA removed them from the market in 1992. It was believed that silicone implants may have been causing autoimmune diseases. After many years of clinical trials, it was determined that silicone implants were safe, and once again manufacturers made them available for breast augmentation surgery to women 22 years of age and older. The FDA recommends that women have an MRI periodically to check for a possible “silent leak”.
Allergan’s Natrelle, which is a cohesive implant, was approved in February 2013, and Sientra has a cohesive implant that was approved in March 2012. Mentor is the only breast implant company that manufactures their implants in the United States, but the other companies follow the same strict guidelines.
Mentor is the manufacturer of “MemoryShape” a highly cohesive breast implant, also known as the “gummy bear” implant. The implants firmness and gel consistency are similar to the “gummy bear “candy. Even though it has been available for 10 years in 70 countries, it has only just been approved by the FDA as of June 2013 and now is available in the United States. It has been in great demand, and Dr. Delgado is happy to announce that it is now being offered to his patients.
MemoryShape implants have a natural teardrop shape, which are thinner at the top and gently slope to a fuller projection at the bottom. The implants have a textured design which helps keep the implants in position.
Some of the advantages of these new implants that are appealing to women are; the firmer, perkier look plus the implants are less likely to ripple, leak through the breast tissue or rupture. The downside is that some more mature women do not want the firmer implants, preferring the softer more natural feel and look that the standard gel implants give.
All of the cohesive gel implants vary in shape, firmness and dimensions. Due to their anatomical shape, all manufacturers have used textured shells to help keep the implants from rotating. Breast implant companies have their own specifications as to how cohesive their implants are and how much gel is placed in them, so there is varying degrees to the firmness.
Predicting that the FDA would approve silicone implants once again, manufacturers began clinical trials with different types of silicone implants, in particular the cohesive gel implants in 2001. Clinical trials are still ongoing today, but getting needed feedback from patients and surgeons is extremely challenging as many woman who are satisfied with their surgery do not return for their follow up visits.
Breast augmentation remains the number one cosmetic procedure for women in the United States, with over 286,000 performed in 2012 according to the American Society of Plastic Surgeons. It is unknown how many breast enhancement procedures are done around the world, but the popularity is such that manufacturers are extremely competitive in trying to grab the majority of the market share. Each company has its own philosophy regarding the amount of cohesiveness, anatomical shape, dimensions, and design of the shell. It is recommended that women seek out a Board Certified Plastic Surgeon that specializes in breast surgery to help them make a decision as to which breast implant is best. For a woman to try to make this decision on her own would be daunting.
In addition to the new implants, Dr. Delgado continues to bring the latest innovative cosmetic treatments to his patients which includes CoolSculpting, a non-invasive treatment for reducing pockets of fat mainly for the abdomen, waist and hips. For men an additional area could be for their chest if they suffer from pseudo-gynecomastia which is man boobs caused by fat. The other new treatment available at the “Non-surgical Center of Excellence” is Ultherapy an exciting non-surgical tightening of skin for the face and neck. Schedule a consultation with Dr. Delgado to find out what options may be of benefit to you by calling (415) 898-4161 or email.
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.
April 30th, 2013 Miguel A. Delgado Jr, MD
San Francisco, California-Dr. Delgado was selected by Haute MD to join their prestigious directory of top physicians. Haute MD is an upscale internet publication with informative stories on the latest health and beauty trends. The online publication offers readers access to premiere cosmetic specialists around the country.
Due to his exceptional reputation and skills, Haute MD has featured Dr. Delgado as their newest member as a specialist in plastic surgery for the body, including such procedures as; breast augmentation, breast revision, tummy tuck, mommy makeover and gynecomastia or male breast reduction.
Besides having a directory for top physicians, Haute MD also gives the readers a detailed profile of the doctor’s with before and after pictures of actual patients, videos the doctors may have produced and patient testimonials.
The exclusive website delivers San Francisco Bay Area men and women intriguing articles like:
• “Auriculotherapy Beads for Celebrity Wellness”
• “Cupping Celebrity Health Fad: Groundbreaking or Totally Useless?”
• “Benefits of Dead Sea Salt”
• “Power Juice and How it Helps You”
“Haute MD connects the most trusted doctors and specialists with the country’s most discerning affluent audience. The network is an exclusive, invite only membership circle with only one representative per market for each of the nine medical specialties.”
September 29th, 2012 Miguel A. Delgado Jr, MD
After breast augmentation surgery, Dr. Delgado has his patient begin breast massage exercises. This may be uncomfortable for a few days but is a very important step to soften and relax the breast implant pocket. Being vigilant with the massaging will greatly help in the prevention of a possible capsular contracture from forming around the implant which would prevent it from moving freely.
The body’s natural response to a foreign body (in this case the breast implant) is to form a lining around it by your own living tissue. This is referred to as the “capsule”. For some Marin County women, the capsule may tighten and squeeze the breast implant making it feel hard. Capsular contracture can happen at any time for anyone but seems more common after the first few months of surgery.
The degree of contracture is graded on what is called the Baker Grading system. Baker Grade 1 is where the breast is normally soft and looks natural. Everyone is at least Grade 1 as everyone has a capsule form. If it starts shrinking/contracting, the implant will feel more firm going from a grade 2 to grade 4, grade 4 being the most severe, causing pain and distortion.
The cause of capsular contracture is still not clear. It is believed that infection, hematoma or a seroma may put a woman at greater risk. Some women may develop a capsular contracture for no known reason.
Studies have shown that massaging seems to reduce the likelihood of forming a capsular contracture. Dr. Delgado will give detailed instructions on how to do this at the first post operative appointment usually three days after surgery. The exercises are to be done hourly for three months and then daily.
August 22nd, 2011 Miguel A. Delgado Jr, MD
One of the biggest dilemmas that San Francisco breast augmentation patients face is what size breast implant they want. It is a choice that they will have to live with unless they want to go through another breast surgery, so most try to make the right choice the first time. Breast augmentation specialist, Dr. Miguel Delgado helps his patients determine the correct size by showing them how to do the “rice test”.
The materials you need for the rice test are:
• a bag of uncooked rice
• a measuring cup
• a soft bra, without padding or under-wire
• a pair of pantyhose cut off above the ankle or a pair of knee highs
One cup of uncooked rice equals 250cc’s of volume. So you might want to start with 1 ¼ to 1 ½ cup of rice for each stocking, do not tie off too tight, you want the rice to be able to move around a bit. Then lay a bra on a table top facing you, set each bag of rice into a cup of the bra, lean over and fasten the bra. Stand up and move the rice around your breast as evenly as possible. Now put on a tight fitting T shirt and see if this is the look you want for your breast enhancement. Adjust the amount of rice if you want bigger or smaller. Try on several different outfits to see how you will look in your clothes. When you have the size you want try wearing the bra with the rice when you go out and about for a couple of days and see if you are still comfortable with the breast enlargement size. Once you have determined the size, measure the rice for each breast and your surgeon will be able to determine what size implant it would be equal to. See breast augmentation before and after pictures on Dr. Delgado’s main website: www.sanfranciscocosmetic-surgery.com.
July 22nd, 2011 Miguel A. Delgado Jr, MD
Many San Francisco Bay Area women have asked about the potential of breast augmentation by fat injections. Breast augmentation by use of the body’s own fat has been around since the 1980’s. But augmentation by fat grafts has multiple side effects, such as tissue scarring, calcification and oil cysts. The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) caution its members against the technique.
According to one study of 48 women who had autologous fat injections for breast enhancement between 1999 and 2009, eight of the women’s mammograms showed “clustered micro calcification”. Micro calcifications can be regarded as highly suspicious for breast cancer. Biopsies showed no presence of cancer but the necroses of the fat cells are indistinguishable from abnormalities associated with breast cancer.
The new generation of mammography, in particular digital mammography seems to be better in distinguishing cancer cells from benign ones in dense breast tissue. The method for harvesting and injection has improved greatly over the years, which may increase the survival rate of fat cells, but equally important is the skill and experience of the surgeon. But a debate continues on how long these fat cells will last. Frequently they do not survive and may be absorbed by the body or become liquid and form a cyst that can mimic or obscure breast cancer.
To have breast enlargement by fat transfer takes several sessions making for an expensive treatment and usually will only increase breast size by up to one cup. Recovery is longer than with traditional breast augmentation with saline or silicone implants. The final result will not be evident for about six months, whereas with implants about six weeks.
At this time fat grafting is an accepted procedure for facial and hand rejuvenation, and corrective breast surgery for breast defects or reconstruction. The societies (ASAPS and ASPS) do not recommend fat injections for breast augmentation until there is more clinical evidence that documents safety and efficacy.
February 7th, 2011 Miguel A. Delgado Jr, MD
The Food and Drug Administration (FDA) released what they call a “white paper” on January 26, 2011. This is an advisory statement on Anaplastic Large Cell Lymphoma (ALCL) and a possible link for women with breast implants. ALCL is a non-Hodgkin lymphoma which is a rare cancer that can occur anywhere in the body, and even more rare to be found in the breasts.
The FDA identified 34 unique cases of ALCL in women with breast implants, in scientific literature from January 1, 1997 through May 21, 2010. This is out of about 10 million implanted devices. It is believed that the vast majority of California Bay Area plastic surgeons and plastic surgeons world wide, will never see a single case in a lifetime of practice. Most cases were discovered when women sought medical attention for; capsular contracture, lumps, pain or seromas around their breast implants. The cancer is usually inside the scar tissue of the capsule and is not considered breast cancer.
Recently there have been articles in several publications regarding a possible link between ALCL and breast implants, and there may be more articles to come. While it is important for women to be aware of the situation, there is no need for alarm. The FDA emphasizes this is not breast cancer. The FDA has published a safety communication so that health care providers and the public are informed of the possible association. They are not recommending that women that do not have symptoms or other abnormalities have their implants removed. They have not changed the availability or status of breast implants and have reaffirmed the safety and effectiveness of the devices when used as labeled.
The American Society of Plastic Surgeons (ASPS) and the FDA are establishing a registry to gather more information about ALCL for women with breast implants. Hopefully this information will put San Francisco and Bay area women’s minds at ease, however any questions or concerns, should be directed to their plastic surgeon.
November 18th, 2010 Miguel A. Delgado Jr, MD
Revisional breast surgery or breast augmentation redo, is one of the most common procedures performed after breast augmentation. Almost 100% of women undergoing breast augmentation will require a revisional breast surgery during some point in their life. This may take the form of replacement due to breast contraction or hardening, deflation or slow leakage; mound position of the breast implant or a change in shape of the breast after pregnancy.
The art of revisional surgery requires much breast surgery experience since this is a corrective procedure. Due to the amount of scarred tissue that is present and the issues that require revision breast surgery, choosing a surgeon initially with great experience and confidence is critical.
Breast revisional surgery may entail; excision of scarring and replacement of implants which may be with larger or smaller implants. Or it may be replacing the implants and doing a Mastoplasty or breast lift to reposition the skin and tissue or possibly to remove the implant with the leakage of silicone and replacement of the implant. Regardless of which issue exists, a customized surgical plan must be created to accomplish the goals that you may have. Dr. Delgado has over twenty years of experience working with breasts performing breast surgery. This takes the form of breast augmentation, breast lifts, breast reduction, and breast reconstruction. Dr. Delgado has many photographs to share regarding these procedures. You may view more by going to his website at www.dr-delgado.com
October 11th, 2010 Miguel A. Delgado Jr, MD
The Mommy Makeover is a procedure made popular by many California celebrities, that entails breast surgery, tummy tuck and some degree of liposuction. It has been popularized over the past year-and-a-half to two years due to the increasing demand for women wanting to regain their shape, body image and self-esteem. The technique involves either a breast lift or a breast lift with a breast augmentation. On some occasions, the patient may require a breast reduction. However, in most cases women lose a fair amount of volume in their breasts and require either a lift or a lift with breast enhancement using an implant. At your consultation in San Francisco or Marin, Dr. Delgado will help you decide the best procedure for you.
The tummy tuck is a key note of this procedure in which the pregnancy has changed the abdomen, both in the abdominal wall as well as the skin. For a pre-pregnancy look, the procedure entails tightening the abdominal wall and stretching the skin down to a nice, taut, contoured figure. Liposuction of the flanks is an added bonus which gives a nice waistline. The Mommy Makeover is a significant procedure which takes approximately two weeks to recover, but the results are amazing. Dr. Delgado performs numerous Mommy Makeover procedures at his Marin Cosmetic Surgery Center,with beautiful results and very happy patients. Please click here to view a Mommy Makeover video of Dr. Delgado’s patients.