Category: Breast Implants

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:

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

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

“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

What should I know about the gummy bear/shaped implants?

It’s difficult to turn on the TV, drive down the road, or listen to the radio without some media personality or slick marketer doctor touting the “latest and greatest” thing available to plastic surgery patients. One of the frequent questions that my patients are confused by is the hype around the gummy bear shaped silicone breast implants. These implants are the most widely used implants outside of the US, and the first version available here was introduced for general use by plastic surgeons in early 2013.

On Sunday, April 27th in San Francisco, CA the American Society for Aesthetic Plastic Surgeons surveyed a group of over 300 people, mostly comprised of plastic surgeons, but including other medical and administrative plastic surgery personnel. During the survey, the audience was shown photographs of patients who had undergone breast augmentation. They were then tested to determine their ability to visually assess whether a patient had used a round or a gummy bear/shaped implant. The results were noteworthy!

From this experienced and savvy crowd, we saw the following results. In 50% of the cases, we were completely wrong. In the other 50%, we were correct. Apparently, as smart and insightful as we are, we are wrong 50% of the time when looking for the signs of a round vs shaped implant. That’s a complete coin toss, making it apparent that perhaps the differences in appearance are not as great as some would want you to believe.

One aspect of this survey that could introduce errors is the belief that some patients had preoperative breast/chest shape issues that were better corrected with one style of implant over the other. In other words, although the final results were indistinguishable, perhaps the great results [...]

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

Zero Can Be a Great Number

There are three manufacturers that provide shaped implants (not round) that contain a more cohesive silicone gel material in comparison to standard round silicone implants. When considering a surgeon for insertion of these implants, prospective patients should consider many factors. One of these important factors is the Dr.’s rotation rate for shaped implants.

Because these implants have a top, a bottom, a left and a right side, a unique technique must be performed by your surgeon to insert them correctly and ensure that they remain in place. This procedure requires specific training and experience compared to round breast implant augmentation. Failure of the implants to maintain the proper orientation can result in development of a misshapen breast requiring the patient to pay for new round implants and undergo additional surgery.

Manufacturers publish national statistics regarding cases that involve rotation of a shaped implant. Dr. Brzowski enjoys a much lower rotation percentage than the national average. What is his rotation rate? Well, ZERO. That’s right. He has NEVER experienced a rotation of a shaped implant. While we can rarely say never, and statistically it is possible that a future patient may experience this complication, but so far … so good! Zero is good!

If you want to have breast augmentation performed by a meticulous surgeon with years and years of experience, then contact Dr. Brzowski for a consultation. At that visit, you’ll see firsthand how careful planning and compassionate care add up to great results and happy surgical patients.

Don’t wait, Spring is coming!!!

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