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Category: Breast Implants

Positive Evolutionary Changes In Shaped Gel Implants

Shaped gel implants have undergone a renaissance in the last year or so. In one of my first blogs I was particularly difficult on them. There were limited options of shapes and sizes. The manufacturer’s have implemented significant advances including many many new shapes and sizes which open up the use of Shaped Gel filled implants to augmentation and reconstruction patients. Lets make it clear, no one style implant fits all patients.

There are a multitude of body shapes, breast shapes, conditions and patient desires. There is no perfect device.

I have been using shaped gel implants more and more for certain characteristics with good results. It is not necessarily based on a patients desire to have a Shaped or “natural result”. Some of the most natural results come from round smooth surface gel implants!

It is a complex decision process that only an experienced Plastic Surgeon has a grasp of. (torso curvature, rib asymmetry, starting breast volume, internal tissue laxity or tightness, nipple to breast fold starting distance, existing asymmetries and goals for outcome just to name a few…).

…So don’t look at the website and try to guess who has what. You (along with other plastic surgeons) will be and have been statistically wrong in your guess nearly 50% of the time!

In the end it takes good listening, thoughtful examination, and planning to limit the innumerable variables the human body presents.

Follow her Recovery…

The “follow her recovery” section of our website is a  unique section where we follow the progress of healing from surgery with periodic post op photos. This is particularly useful to see in breast augmentation where variability in female chest wall and breast anatomy as well as patient desired outcomes often require a certain period of healing time in order to see the “final” cosmetic outcome. In breast augmentation, the immediate post op outcome may be visually altered for a period of weeks by tight tissues and sub-optimal cosmetic anatomy. Release of constricted anatomy, for instance, may take several months to fully loosen and soften. (see new case 1 in follow her recovery.) Extra tight (tighter than typical) tissues may take more time to soften (about six weeks) than more ideal anatomy (which may take only three weeks to soften). Implants (Technically speaking) in my practice are precisely placed, it is the anatomy surrounding the implant that needs time to soften and remodel. By doing this, the volume within the implant re-positions itself( generally speaking) to the anticipated planned outcome set forth at he original surgical procedure.

Therefore, it is constructive for patients to see how typical outcomes come about. Enjoy!

Beauty and Shape

There is something magical about the combination of tummy tuck, liposuction, fat grafting and breast augmentation or lifting: it is the beauty of shape, of curves , of connotation of youth and femininity. It is truly transformational. Please check out the abdominoplasty section of before and after photos to see what I mean!

Patient Testimonial

I have decided to share with my blog readers some of the kind words my patients have had about their experiences with me. So each week for the next nine weeks you will get to read the reflections of former patients. Their words will reveal a lot about me to you.

I have wanted breast augmentation ever since I had two biopsies on my left breast six years ago which left my A size breast now disfigured somewhat and even smaller than the other. As I have approached my fifties, I have realized that I wanted to feel better about myself and had upper lid blepharoplasty last year and felt and looked younger. And now I did not hesitate to research Dr. Spiro after a friend of mines sister had her breast augmentation last November.

I agree, Dr. Spiro is an artist. He made me feel confident about my decision and his staff is the absolute greatest.

His office is run so smoothly and professionally. I never had to wait; the staff is extremely attentive and courteous. His nursing staff is the absolute best, because I have used the 24/7 service for so many unexpected questions that came up that I did not anticipate…And the results are phenomenal. They look and feel real. There is no way you can tell I had the procedure. I look nicely proportioned with my 36C plus breasts. If I do any other procedures, which I may in the future, I will certainly see if Dr. Spiro performs those as well. I am absolutely beyond happy!

Thanks!

-Renee

Patient Testimonials

I have decided to share with my blog readers some of the kind words my patients have had about their experiences with me. So each week for the next nine weeks you will get to read the reflections of former patients. Their words will reveal a lot about me to you.

I just wanted to say a few things about my experiences at Dr. Spiro’s office. I had a breast lift with replacement of implants with muscle complications that the Dr. found and corrected when he went in. First of all I’ll start with the staff, from my first appointment when I walked in I had a good feeling, and I didn’t have to wait too long, the staff was amazing, very nice, very helpful and they did their job above and beyond. This was through my whole experience, before my surgery and after (everyone was even better). I also want to thank everyone in Dr. Spiro’s office for making this complicated surgery and experience very easy to go through. Dr. Spiro’s work and knowledge about breast surgery and beyond was unbelievable. His bedside manner never changed before and after my surgery, he put a smile on my face even the day of my surgery even as scared as I was, he made me very comfortable. This was the best life changing decision that I have made with the help of the staff and Dr. Spiro. Three months later and my results are more than I expected, my breasts are exactly what I wanted and more. They look better than before I had children, the scars are barely there and in another three months they will look even better. I am SO happy that I chose Dr. Spiro; words really can’t describe how I feel. If I choose to have any other surgeries in the future, no doubt I am going back to Dr. Spiro. Thank you so much for my new (better) look and great experience Dr. Spiro and Staff.

 

A.L.

Management decisions for possible ruptured silicone gel implants previously placed over muscle

Prior to the late 1980’s it was commonplace and standard practice to place silicone implants under or within breast tissue over the muscle. As awareness of breast cancer surveillance became increasingly important along with the general understanding that implants were better off under muscle, implant placement underwent a renaissance by the late 80’s early 90’s.

Now we are seeing many women in their late 50’s to late 60’s with 30 year old disintegrating implants. They are not experiencing health issues, but rather cosmetic concerns of hardened malshaped breasts.

My solution has always been to remove all existing implant and scar capsule called total capsulectomy. This is combined with new implants (usually silicone gel) placed under muscle with the addition of a-cellular dermal matrix as a needed tissue graft support for the new implant space. Often a breast lift is necessary at the same time to optimize aesthetics.

This procedure is done as an outpatient and the recovery is fairly simple.

Occasionally, patients will request that no implant be replaced. This may present a challenge to create an aesthetic appearing breast. I use auto augmentation techniques when applicable to solve the dilemma of camouflage.

Finally, it should be restated that there are numerous options for women with “old tired” implants that need attention.

Revisions In Breast Implant Surgery

How Do We Rescue Your Breast?  Dealing With Capsular Contracture or Implant Malposition.  Well, You Needed A Lift!

Look, no one wants unwanted scars. But there’s a difference between unnecessary scars and needed. My experience over 20 years has been that the saggy flat breast which has an implant placed within it is generally looked upon as ugly and matronly and rejected by the patient as not ideal. Fixing this issue entails not only doing a lift usually, but also reconfiguring the implant space internally higher since it was likely originally placed too low in an effort to better match the existing breast. This requires another type of capsulectomy and capsuloplasty– read the previous recent blogs to get up to speed on these fancy terms–

After the lift and implant repositioning, even though there are scars now , and initially more visible, the patients universally accept this new breast as being far more aesthetic, and more attractive. They gladly trade the old aged look for a fresh young look. Instead of being a detractor to their appearance, their new breast helps to convey a youthful interpretation of body image and gives these women a new sense of confidence.

When I do this procedure the objective is to correct or eliminate the disconnect between natural breast gland, fat and skin and underlying implant. So,  I carefully sculpt overlying breast tissue, preserving an envelope of volume to help hide the implant while tangentially eliminating the most sagging breast. Under the muscle, I raise, recreate, or create  the implant space to coincide. The result is a high centrally positioned implant joined with overlying breast tissue in unison. Everything form fits. There are no loosely disconnected parts. Just an ideal feeling new breast !

 

Revisions in Breast Implant Surgery

How Do We Rescue Your Breast?  Dealing With Capsular Contracture or Implant Malposition

Capsule formation is a natural process of healing around any implant; not necessarily a breast implant. There is no true “normal” capsules; Just variations. Capsules  are a layer of scar tissue the body forms circumferentially around a breast implant. They may be ideally soft or unusually hard. To complicate matters, the timing of capsule formation, the type of breast implant getting encapsulated, as well as the chest wall shape that the encapsulation is occurring on, all influence breast  appearance outcome.

For the purposes of simplicity, capsule formation has classically been gradiated in four grades. Grade 1 being soft capsules not influencing breast implant shape. Grade 2 capsules are firmer and make the breast implant subtlety firmer. Most women don’t even realize they have this type of scar formation. Grade  3 and 4 scar capsules alter appearance of the implant and generally will necessitate revisionary surgery.

Interestingly, grade 1 capsules- not even palpable, and leaving implants ideally soft, may also have an implication in reoperation  for conditions known as implant malposition.

Here, for instance, if the chest wall is keel shaped or curved, and implants are saline filled, and negligible  scar essentially forms around the implant, then , the implants may insidiously migrate low and laterally. Not ideal, and not where surgeon or patient had envisioned for the outcome. This requires selective capsulectomy and capsuloplasty for management. This means tightening the lower and or lateral internal space so the implant can’t migrate as well as removing part, most, or all of the remaining capsule so allow for better projection or position of the new implant. If the muscle was incompletely divided medially, the forces exist which would tend to push the capsule laterally. Switching to silicone gel implants and properly dividing muscle often helps stabilizes and neutralize the physiologic dynamics associated with implants under muscle. Most often I see this incompletely done – in effect underestimating what it really takes to get a great outcome. Some of the best of the best beautiful breast outcomes come from rescues I’ve performed as secondary augmentation.

 

Revisions in Breast Implant Surgery

How Do We Rescue Your Breast?

As promised in previous blogs, we’ll review this challenging topic.

I would say revision breast implant surgery involves far more planning, better skill, and more of an artistic eye than even initial breast surgery. Patients often come to see me from around the world to tackle complicated cases which have caused them to have had in some instances multiple pervious surgeries. In effect, the initial issues and the anticipated management are too often underestimated and or taken for granted leading to additional failures.

First and foremost lets be clear on one thing- problems and problematic outcomes occur from many sources. First their is poorly planned surgery. If you don’t pick the right implant your going to end up with issues. An example of this would be to put too narrow of implants in a wider torso and then wonder why the breasts appear far apart? Next is poorly executed  surgery. An example of this would be to under or incompletely separate the pectoralis muscle leaving the implants pushed outward or upward. Also there is the poorly compliant patient who underestimates the subtle healing issues inside the tissues which require a period of time to settle predictably and injudiciously does not follow early post op instructions. Then there is human variability of healing and despite the best efforts of patient and surgeon, things just don’t heal ideally. Remember we are dealing with a unique area- implants placed bilaterally in a body in constant motion and asking it to heal predictably well in a bilateral setting essentially all the time- things are going to happen. It’s how you rescue these misguided events that I believe separate  plastic surgeons.

My evaluation looks at implant position, size and shape. I ask patients for their desired goals and map out a strategy. Sometimes the problem includes failure to recognize that a breast lift was really needed initially with the first surgery. Sometimes it was because the implant was placed over the muscle and has caused accelerated breast aging. Sometimes it is due to hard scar formation called capsular contracture . Sometimes it’s because these healing processes don’t happen symmetrically. Sometimes it’s because previous attempts at correction were ill conceived or incompletely addressed the problem. Read the next blog on dealing with capsular contracture, see the section on the web site with before and after photos, and read the patient testimonials.

Breast Augmentation Characteristics

The seven characteristics that go into breast augmentation

The fifth point to discuss is incision placement. By now you can guess I have strong feelings about this as well. We’ll talk about only simple augmentations and not implant augmentation combined with breast lift.  Essentially there are four options,infra-mammary fold approach, peri-areola approach, trans-axillary approach, and trans-umbilical approach.

The new device known as the Keller funnel  has allowed pre filled silicone implants to be placed now with incisions nearly the same size as those used for saline filled implants which are unfilled or partially filled when placed. See my you tube video ” Implant Magic” to see how large pre filled silicone breast implants can be placed thru tiny incisions — you’ll love it!

Peri-areola incisions are popular. The problem is that it increases the likelihood of nipple numbness. A bigger problem to me is that the incision goes thru breast tissue and directly down to implant space. I have always had a problem with this. It often triggers a local contracture response which can pucker the breast, tighten and alter the  urge of the lower breast and create unsightly shape issues. They are sometimes not completely correctable.

Trans-axillary augmentation sounds great in theory but the problem here is that this incision is the farthest away from the most critical area to precisely dissect internally to release muscle in order to get the best cosmetically shaped and aesthetically appealing breasts. In precision oriented surgery this is a problem. And this is why trans-axillary augmentation notoriously leads to implant malposition most commonly, high and widely positioned breasts and is known to have the highest reoperation rate. Unnatural!  And I don’t like it.

Trans-umbilical implant placement is a gimmicky approach used in marketing. Did you know that manufacturers will not warranty their implants placed that way? Interesting.

It is virtually impossible to get an anatomically correct sub muscular implant placement this way. Essentially all are subglandular and look like half grapefruits. No artistry here. Just because you can doesn’ t mean you should. Not good.

Finally, we get to infra-mammary approach. This allows for precision placement and artistry of implant space creation. It is the most versatile in dealing with the myriad of anatomical nuances our bodies present with. It is by far the best. So I favor this method. Look at my web site. I’ll bet you can’t find a single incision on any view of any breast augment patient!

 Click here to read about the 1st characteristic

Click here to read about the 2nd characteristic

Click here to read about the 3rd characteristic

Click here to read about the 4th characteristic

 

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