August 18th, 2008 Dr. McKane
I saw a young woman today in clinic who was considering breast augmentation. She was recently married and considering when she and her husband might like to have children. She wondered, “Will breast implants harm the development of a baby?”
This question is not an infrequent one. Women are concerned about the possibility that their baby could be exposed to silicone during the pregnancy or afterwards during breast feeding. In addition, there are several reports that have suggested a relationship between esophageal problems attributed to a scleroderma like syndrome, myalgias, neonatal lupus, perinatal mortality, and congenital anomalies in children born of mothers that have undergone cosmetic breast augmentation using implants. Unfortunately, these reports are very limited by the number of patients involved and it is difficult to draw conclusions from them.
Let me first begin by saying that women with implants do not have higher circulating silicone levels than women that do not. Second, silicon levels are comparable in breast milk from women who have implants and those that do not. Kjoller et al. posed a similar question about breast implants and reviewed four epidemiological studies to answer this question. I’d like to summarize this report because it does a nice job of looking at the current state of this issue. The conclusions from this review were derived from looking at the data surrounding literally thousands of children born to mothers who had undergone a breast augmentation in comparison to children whose mothers had either undergone a breast reduction, other surgical procedure, or selected randomly from a Medical Birth Registrar. The numbers of children involved are the real strength of these studies and allow for adequate power to make some reasonable conclusions about how implants may affect the development of a baby.
The bottom line of this review is that the current evidence does not suggest that there is an increased risk for connective tissue diseases, birth defects, esophageal problems, or perinatal mortality in infants born to mothers who have implants versus those that do not.
Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation for review. I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or implants in pregnancy or lactation. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Breast Implants and Babies, Home | No Comments »
August 12th, 2008 Dr. McKane
I am writing today to talk about a problem that I see frequently in my clinics. As a board certified Plastic Surgeon it is my obligation to inform my patients to the best of my ability about the procedures that they are considering. Ethically, I am unwilling to minimize or to ignore the risks associated with the surgeries during my discussions with my patients. This discussion is a vital component to an informed decision.
Unfortunately, this doesn’t seem to be the case for all surgeons. I see a fair number of revision breast augmentation cases in my practice and very frequently I hear, “I thought my breast implants would last forever! My surgeon never told me that I would need another operation!” This misconception about the “immortality” or implants can be perpetuated by misleading information found on the internet or in advertising, or through the anecdotal experience of a patient’s friend who had undergone the procedure before her.
I am here to set the story straight. Implants do not last forever and there can be problems with them. Unfortunately, the fact of the matter is, many women who undergo a breast augmentation will need a secondary procedure in the future to address some issue with their implants.
Rupture of either a saline or a silicone implant may occur at some point in time following a breast augmentation. Removal of the implant is recommended following a rupture, and this is particularly true of silicone implants. The reason for removal is that the silicone gel can escape from the implant and implant capsule and penetrate into the breast tissue. Gel that has migrated into the breast tissue may require removal of some of the breast tissue to fully address. Replacement of implants is common following rupture as many women are unwilling to return to a smaller breast size .
The development of capsular contracture is another problem that can occur with time. As this develops, the breasts can become firm, change shape and even become painful. Significant capsular contracture is another reason that a woman may consider a reoperative procedure following her breast augmentation. This may prompt you to ask, ”If you have surgery to address capsular contracture, it won’t come back. Right?” Unfortunately, that’s not the case and the risk of recurrent capsular contracture is higher following the secondary surgery. Furthermore, reoperative procedures do not reduce the risk of needing future surgeries for other reasons.
Here is an example of patient that underwent a saline breast augmentation 13 years ago. She presented to my clinic with a complaint that “I woke up this morning and my implant had ruptured.” She wanted to replace her implants with new implants of similar volume. On examination there was marked asymmetry of her breasts and she had a ruptured left saline implant. The right breast had a very mild capsular contracture. There was a nearly imperceptible inframammary (breast fold) scar. Here is the preoperative photograph:
During our consultation I spoke with her about removing and replacing her implants into the dual plane. I performed capsulotomies (incisions in the capsule) on both sides to help open the scar and allow it to remain soft. I did not remove the capsules on either side because they were mild. The patient’s original implant volume was not known until the time of surgery as there was no record of her procedure available. She decided that she would like to use a 325 cc size and this is what I used for her. The original implant volume turned out to be 300 cc’s. Here is the postoperative result at 3 months:
This patient was very satisfied with her saline implants and wanted to remain augmented following her rupture. She was unprepared to return to her pre-augmentation size as she felt more proportional with her implants. The operation that I performed achieved her goal of restoring the volume lost when her implant ruptured.
Our websites, www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation for review. I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or reoperative surgeries. Please feel free to contact our office at (713) 661-5255 if you have any questions about this procedure.
-Brice W. McKane, M.D.
Posted in Breast Augmentation, Correcting Problems with Breast Implants | 1 Comment »
August 8th, 2008 Dr. McKane
I had a consultation with a woman today for a breast augmentation. She was very concerned about nipple sensibility after breast augmentation and inquired if it is possible to lose sensation with the procedure.
Unfortunately, sensation changes of the breast skin or the nipple and areola can occur following breast augmentation. If you look at the data available from the manufacturer from a study involving 901 patients using saline implants, the reported rate for moderate or greater loss of sensation is 8% at 3 years. This sensation loss ranged from having no feeling in the nipple or breast to having partial feeling or strange sensations. The changes that a patient experiences may be temporary or may be permanent. This depends on the type of injury a nerve experiences during the surgery.
So how do you reduce the risk for sensory loss following breast augmentation? There are several things to consider for this. In the past, anecdotal evidence suggested that the incision used may impact breast sensation. However, recent literature indicates that choice of incision, either periareolar or inframammary, does not appear to have a signficant effect on nipple sensitivity following breast augmentation. Mofid et al. evaluated nipple sensitivity after breast augmentation and found no significant difference in sensation with either approach. However, both approaches were associated with a significant change in sensation when compared to unoperated control patients. A surgeon’s technique may contribute to sensation loss following breast augmentation. Anecdotal evidence suggests that surgeons who use less sharp dissection in the outer portion of the breast pocket may have patients that experience less sensation loss. While there is no study that I know of that can substantiate this, it makes anatomic sense. The path of a portion of the nerves that supply sensation to the breast are not cut, and hopefully, are only stretched. This potentially allows for improved recovery in comparison to nerves that are completely transected. Recovery seems to reach its maximum at 3 to 6 months following surgery. Beyond this time point, patients were unlikely to enjoy further recovery of sensation. This study also implicates implant size as a controllable risk factor that impacts sensation. Data support that there is an inverse linear correlation between implant volume and sensation outcomes. That is, patients who choose to use larger implants relative to a smaller or tighter breast envelope will be at greater risk for sensation loss. This was particularly true for implants larger than 475 cc. Therefore, if you would like the greatest chance of preserving nipple sensation, select an implant with the help of your surgeon that is appropriate for your soft tissue characteristics.
Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation. I invite you to schedule a consultation with me if you would like to learn more about breast augmentation. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Breast Augmentation, Home, Nipple Sensitivity | No Comments »
August 6th, 2008 Dr. McKane
I received an email from a woman yesterday looking to use a very large implant on a very small frame. She inquired if there would be problems in doing this. In a word, “Yes.” There will be problems to using a very large implant in a patient like herself. Let me go into this further.
Appropriate implant selection is one of the most important decisions that a woman will make when choosing breast implants. There are long term ramifications to using an implant that is larger than the soft tissues can handle. An implant has weight and over time will thin the breast tissues and cause descent of the breast on the chest wall. Furthermore, it is possible that breast tissues can thin enough to cause significant problems with rippling or even implant extrusion. Large implants are very heavy and cause significant stretching and thinning and put patients at greater risk for these problems. The fact that heavy breasts fall sooner may be obvious to women who were well developed in their teens who later in life have breasts that are much lower following pregnancy or breast feeding. However, young women who are seeking breast augmentation usually don’t have issues with breast positioning and are unlikely to recognize this potential problem.
During your consultation with me, I analyze your breast using a technique outlined by Dr. Tebbetts. The approach is called the “High Five Process” and is designed to systematically assess five critical aspects of breast augmentation planning to come up with an “ideal” procedure for an individual patient. I use the process because I believe that there is probably an “ideal” implant volume for a given patient that can be derived from her soft tissues. Implants that are signficantly larger than this “ideal” will be at greater risk for complications. Furthermore, I believe that if an “ideal” procedure is used that there will be a reduction in the rate of reoperations following breast augmentation.
Here is an example of a patient that underwent a breast augmentation in my practice using the “High Five Process.” She is a 27 y/o that presented wanting a saline breast augmentation. She was internally motivated and wanted a proportional augmentation that would not have an increased risk of breast thinning and descent with time. On examination she has some mild asymmetries and modest soft tissue coverage. Here is the preoperative photograph:
During our consultation I used the “High Five Process” to derive an implant volume based on her soft tissue characteristics. The implant volume was 425 cc’s. Due to the thinness of her soft tissues at the upper pole of her breasts the implant was positioned into the dual plane. Here is the postoperative result at 4 months:
The operation achieved her goal of a proportional breast augmentation using an implant that was individualized and idealized for her soft tissue needs. This implant should reduce her risk of tissue thinning and other complications in comparison to a larger implant.
Our websites, www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation for review. I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or the “High Five Process.” Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Breast Augmentation, Breast Implant Selection, Home | No Comments »
August 4th, 2008 Dr. McKane
I wrote the other day about silicone implants. Following this, I received an email from a woman in Clear Lake asking if saline implants were a good choice. Implant selection is a very important decision to make, and as such I feel that I should also spend some time addressing saline implants.
Again, let me begin by saying that both types of implants have benefits and trade-offs associated with them. Since the recent FDA approval for their use, it has become fashionable to use silicone implants. Certainly in some patients there are benefits to using a silicone implant, but let’s not forget that saline implants have a large amount of long term data collected on them that support that they are not only effective devices, but that they are safe devices. The current generation of silicone implants does not have long term data collected on them at this point. Definitive conclusions about their safety and efficacy can’t be made yet. In fact, the post approval study to address these very issues is being conducted as we speak.
In the plus column for saline implants: Saline implants are approximately half as expensive as silicone implants at the time of surgery. They are also less costly in the long run. To monitor for silicone implant rupture, the FDA has recommended that patients undergo a breast MRI at year 3 following their surgery, and every 2 years thereafter. This is a very expensive study, and is not necessary for saline implants. When saline rupture occurs, the patient or her surgeon are usually able to make the diagnosis. Saline implants can be placed through a much smaller incision since they are not prefilled and can be rolled to a small size during insertion. Revision surgeries are often necessary after breast augmentation and these procedures may be easier if saline implants were used during the initial procedure. The rupture rate for saline implants is probably lower than silicone implants. This is being evaluated currently in the post approval study. Between 93 and 98% of saline implants remain intact at 10 years, contrasted to 60-85% seen in the historical data for silicone implants. The capsular contracture rate for saline implants is also probably lower than silicone implants. This question is also being evaluated currently. The capsular contracture rate after saline implants is 16.6% at 10 years in comparison to 38.5-90% seen in the historical data for silicone implants. Lastly, patient satisfaction with saline implants is also very high and is on the order of 87-95%.
In the negative column for saline implants: Feel. Some patients prefer the texture of a silicone implant and believe it to feel more like breast tissue. Wrinkling and rippling is also a greater problem for saline implants as saline is not a cohesive substance. Silicone implants have less problem with wrinkling and rippling, and may be a very good choice for a woman who is thin and who has little soft tissue coverage for this reason.
So to answer the question ”Are saline implants a good choice?” The answer is yes. We have a large amount of data in the literature that supports their use. Are they better than silicone? It depends. The individual needs of the patient will make this determination. Again, I truly believe that a patient that is fully informed about her options will make the best decision for herself, be it saline or silicone.
Here is an example of a patient that underwent a saline breast augmentation in my practice. She is a 25 y/o that presented desiring saline implants. She was concerned about needing repeated MRI’s to monitor for implant rupture. She was uncomfortable with the fact that she might not know that her implant had ruptured and could be leaking silicone gel. On examination she has some mild asymmetries, and fair soft tissue coverage. Here is the preoperative photograph:
During our consultation, she expressed a desire to have a proportional for her frame augmentation that would appear natural. She did not want an overly round look to her breasts. She decided that she would like to use a 325 cc saline implant and to place it in the dual plane. Here is the postoperative result at 7 months:
The operation achieved her goal of a proportional, natural appearing breast augmentation using implants that have demonstrated both safety and efficacy in many patients without the need for an expensive followup study.
Our websites, www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation. I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or saline implants. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Breast Augmentation, Breast Implant Selection, Home | No Comments »
