Category: Breast

An Update on Implant Position in Breast Augmentation

This is an update to a blog post that I made last year on whether patients undergoing breast augmentation should place the implants above or below the pectoralis major muscle. In conjunction with the study that I mentioned in that prior blog, we now have another, recently published study from one of my dear colleagues and associates in the Journal of the American Society of Plastic Surgeons.

In their study, they found that several things increased the risk of problems following breast augmentation. To quote the article, “In the primary augmentation cohort, subglandular placement of the device was the strongest univariate risk factor for development of capsular contracture”. This means that women who have their breast implants placed on top of the muscle are at greater risk for development of a tight scar around the implant. Positioning the implant in that location is the highest risk of all risks for this complication.

My nearly 30 years of surgical experience and my practical experience as a plastic surgeon confirm the findings of these colleagues. There are many unexplained factors that create risk of any surgical procedure, but we certainly need to do our best to minimize those odds when and where we can. I hope you’ll give us a chance to evaluate any concerns you have about a prior procedure or any anticipated future surgeries.

If you want to take a look at the previous blog that I mentioned, you can find it here:

The Plastic Surgery Channel Rocks!

In 2012, a plastic surgery colleague of mine founded The Plastic Surgery Channel to showcase important stories for plastic surgery patients and provide legitimate, board certified plastic surgeons a platform to present valuable patient educational materials.

Two years ago, and after careful consideration, I decided to join this group. My experience with these amazingly brilliant, dedicated, and conscientious colleagues of mine has been phenomenal. I’ve had many opportunities to interact with them, assist in producing educational videos with them, and we’ve spent many hours discussing issues important to patients and the specialty of plastic surgery.

This past weekend, I was fortunate enough to attend one of the many video production sessions at The Plastic Surgery Channel’s film studios in Dallas, TX. During this visit, I moderated panel discussions on Fat Grafting and bizarre Cases. Furthermore, I was on panels that talked about scar management, surgeon review sites and awake surgical cases.

Independently, I filmed shots about having the right size breast (#therightsizematters), what the priorities are in breast augmentation, and the associations/societies that patients should look to see that their surgeon is a member of. Keep your eyes open for the videos to be added to my video gallery in the near future.

You’ll also notice that my video gallery will include videos from my colleagues at The Plastic Surgery Channel. Because these are trusted, respectable colleagues, I am grateful to share their opinions with you. It is nearly impossible for me to individually create videos on every topic of potential interest to you all, so I’m publishing these for you to learn from.

Thanks for taking the time to support us and your fellow patients.

By: Brian Brzowski Categories:Body, Breast, Breast Augmentation, Uncategorized

I Gotta Give It To a Colleague

As we learn more and more about a very unusual condition called Breast Implant Associated-Anaplastic Large Cell Lymphoma, I think a colleague and fellow member of the Plastic Surgery Channel really summed up our current understanding of this condition.

I suggest you watch the video they produced that features Bruce Vannata, MD.

Key take home points from the video are as follows:

The disorder is extraordinarily rare = 238 cases out of millions of surgical patients.
It is a type of lymphoma (or overgrowth of lymphocytes) in fluid surrounding breast implants.
The condition is almost uniquely found in patients who’ve received a breast augmentation using implants with a very aggressive texture.
Patients with this disorder are usually discovered during evaluation for acute swelling of the breast years after their surgery. Evaluation by a plastic surgeon for swelling is recommended.
Treatment using implant removal with excision of the scar tissue around the implant is usually curative.

For further questions on this or should you desire additional information on breast augmentation with the best techniques that minimize your risk of this and other complications, please contact us for a consultation.

What’s Better? On Top of the Muscle or Underneath?

On Top or Below the Muscle? Too Much Compression if Above?
A recent research study published in the Aesthetic Surgery Journal concludes that patients who undergo breast augmentation by placing the implant directly underneath the breast gland (and on top of the muscle) may experience more loss of breast gland/tissue over time.

They hypothesized that the findings they discovered on MRI scans were possibly due to the pressure the implant was putting on the blood vessels going into the breast tissue. With enough compression, this diminished blood flow could cause shrinkage of the breast gland.  The expert commentary that followed the article stated that the MRI data might be a little inaccurate and that we shouldn’t accept these assumptions entirely. More studies were recommended.

Nonetheless, I have been a very active proponent of placing the implants underneath the muscle for three important reasons:

#1 the implants are harder to see and feel if they are deep and covered by muscle.  Rippling (which is the ability to see the outline or edge of the implant contour underneath) is much less of an issue in this location.
#2 the risk of developing a tight scar around the implant (called a contracture) is lower.
#3 mammograms are easier for the radiologist to interpret when the implant edge is separated from the overlying breast tissue by the muscle layer (this goes back to my years as a general surgeon when I took care of ladies with breast cancer).  Understandably, breast form AND overall breast health are very important to me.

If you’re interested in learning more about your options for breast augmentation from an experienced and trusted plastic surgeon, please fill out our request for consultation form or call the office for [...]

By: Brian Brzowski Categories:Breast, Breast Augmentation, Breast Implants

What’s the Difference Between Implant Warranties?

All of the implant manufacturers offer great warranties. They compete with each other so vigorously that you’ll likely find the company with “the best” warranty will have their warranty matched word for word very soon after it becomes known. You simply can’t chase the warranty rabbit.

The most important part of this to understand is that no matter which implant company your surgeon uses, you have unprecedented choices at this point in time. Breast implants today are more durable, more pleasing, and have far fewer complications such as capsular contracture and rippling. Even more reassuring is that if a company warranties their product for life (which they all do), you know that the company really doesn’t think that they’ll be giving out free implants very often. Like us, they understand that a breast implant rupture is becoming a very rare event.

You should spend your time considering the surgeon first and foremost. There are few true differences in implants, but HUGE differences in the training, experience and personalities of the surgeons you could utilize. Just like a lot goes into picking the person you choose to cut your hair, choosing where to go based on what type of hair clipper they use is, shall we say, misapplying your priorities.

Nonetheless, here is a great breakdown of warranties and how they vary from manufacturer to manufacturer. In my office we use all of these manufacturers and will select from all of these choices the implant that we think will provide our patients with the best result. Trust us to make the best decision for you and the one that will lead to the highest likelihood of a safe and long-lasting pleasing result.

By: Brian Brzowski Categories:Breast, Breast Augmentation, Breast Implants, Uncategorized

Even the Brits know there’s a problem

The attached news article is a real awakening to the pervasive problem across the globe of unqualified persons (often not surgeons or even MD’s) performing surgical procedures that are only traditionally taught in approved residency training programs.

When looking for a breast augmentation or any other elective cosmetic surgical procedure, your first stop should be to search for a board certified plastic surgeon who is a member of his or her state plastic surgery society. Once you have verified the surgeon’s memberships and professional affiliations, you should consult with friends and visit reputable sites that contain reviews from real patients. One of the most truthful and educational of these websites is Contributors are vetted for their legitimacy and reviews are carefully scrutinized for honesty.

We welcome a thorough review of our backgrounds and experience. A visit here in our offices in Ogden, UT will help you learn more about us and let you make a truly informed decision about who should be doing your elective cosmetic surgery.

Give us a call to schedule your consultation at 801-479-5722.

By: Brian Brzowski Categories:Breast, Breast Augmentation, Trends, Uncategorized

Which Implants Should I Choose?

I’m often asked what breast implant is the “best”. Here’s my usual answer.

Silicone implants are better for thin patients without much of their own breast tissue. For heavier chested women, the difference is minimal. These advantages are because silicone implants are softer and show less rippling; with the newer (5th generation silicone gel implants) that have been released in the last few months, this improvement is even more noticeable.

In years past, it was felt that silicone implants had a higher contracture (tight scar around the implant) rate than saline, but it really seems to not be as much the case anymore, so we really don’t need to give that a lot of worry.

The implants will behave differently when they rupture – saline implants deflate like a balloon – silicone implants generally don’t change at all (plus there is overall no health worries with a silicone rupture).

Saline implants do allow for more “on the table” adjustments in volume so, for patients with a lot of volume differences between the breast, that might equate to a small advantage. However, with our years of experience, we’re usually able to give the same improvement in breast symmetry using a silicone implant.

Lastly, silicone breast implants will cost more than saline. When factored out over the many years you can expect to get from your silicone implant, the increased cost is minimal.

The optimal way to find out the “best” implant for you is to come in and let us show you these differences and give you our opinion based on your specific situation. Every patient is different… so not every answer is the same.

By: Brian Brzowski Categories:Breast, Breast Augmentation, Breast Implants, Uncategorized

Can I get Silicone Breast Implants Before I Turn 22 Years Old??

Recent clarification from our largest cosmetic plastic surgery society legal counsel has verified what we have known all along: patients under 22 years of age can have silicone breast implants used for primary breast augmentation.

When the FDA granted the use of silicone implants for primary breast augmentation (removing qualifications that the procedure must be “reconstructive”) in November 2006, a few stipulations were put in place. One of these included their statement that silicone implants “are indicated for females for: Breast augmentation for women at least 22 years old…..and Breast Reconstruction.” If any patient younger than that age had any form of physical deformity such a scoliosis, rib cage abnormalities, or severe breast asymmetry, they would qualify under normal guidelines.

In the absence of any of these situations, patients younger than 22 years of age could still legally undergo silicone breast augmentation, but that surgery would be considered “off label.” In most situations, the implant manufacturer will not extend their customary warranty. Provided the patient has been notified of such, the FDA has permitted and will continue to permit the practice of primary breast augmentation in patients under 22 years of age with silicone breast implants.

The question then arises, are silicone implants safe in patients younger than 22 years of age. Since the implants are the same whether they are placed in a 40 year old or a 20 year old woman, the answer is a resounding YES!

Bottom line, if you are not yet 22 years of age and have met the usual requirements for an elective cosmetic surgical procedure, it is permissible and safe to use silicone gel implants for breast augmentation.

If this information applies to your current situation, please [...]

By: Brian Brzowski Categories:Breast, Breast Augmentation, Breast Implants



Breast lifts have become much more popular in the United States since the year 2000, statistics show.

According to numbers from the American Society of Plastic Surgeons (ASPS), in the years since 2000, the number of breast lift procedures performed in the U.S. climbed 70 percent. This increase in mastopexy surgeries grew by nearly twice the rate of breast-implant surgeries, which remains the most popular cosmetic surgery in the U.S. for women.

Changes in skin elasticity and sagging breasts can be caused by pregnancy, breast feeding, changes in weight and merely aging itself. A breast lift restores firmness to the breasts by using either the patient’s natural tissue only or by adding breast implants.

“Many women are looking for a youthful breast by using the tissue they already have,” said ASPS President Dr. Robert X. Murphy Jr. “The ideal candidate for a breast lift is a woman who has a good amount of breast tissue left, who doesn’t necessarily want to have implants. Many women aren’t sure if they are a candidate for this type of surgery, but a simple pencil test can tell them if they are.”

The pencil test involves placing a pencil under the breast: “If the breast tissue holds the pencil in place against the chest, that implies that there’s a hanging nature to the breast that can be fixed with a lift,” Murphy explained.

At Brzowski Plastic Surgery, Dr. Brian Brzowski offers several different types of breast lifts in Salt Lake City and Ogden, Utah. He will determine the best option for your body during your consultation.

Dr. Brzowski is board certified and has a special interest in breast augmentation and problems resulting from pregnancy [...]

By: Brian Brzowski Categories:Breast, Breast Lift

“Flexing Moves My Implant”

On occasion I have a patient who tells me that their implant moves around and looks funny when they flex their chest muscle. They forget that the implant is under the muscle and is naturally pressed by the pectoralis major muscle when it is flexed.

The muscle temporarily compresses the implant a little bit, causing the implant to move around and develop a momentary crease across it. This completely resolves when the active contraction of the muscle ends.

Since we are only talking about the small span of time- such as those isolated incidents when flexing nude in front of the mirror- the significant upside of having the implant underneath the muscle outweighs this small concern. The major benefits include a smoother appearance, improved visibility during mammogram and reduction in the risk of a tight contracture development.

As always, we welcome questions about any procedure that we perform and are happy to educate all patients regarding our recommendations and the best possible outcome that they can achieve.

By: Brian Brzowski Categories:Breast, Breast Augmentation, Breast Implants, Uncategorized