March 25th, 2009 Dr. McKane
I met with a woman yesterday that inquired, “Will I be able to breast feed after my breast augmentation?”
My answer: Many women can breast feed after breast augmentation, however, some cannot. The literature has several studies looking at this and the actual incidence of the problem probably ranges between 10 and 60%. It is important to consider that there are many factors that come into play in a woman’s ability to breast feed. Among them are maternal age, the parity status of the mother, birth weight of the child, education, and support of the mother. Even without breast implants, some women will experience lactation insufficiency. However, any type of breast surgery has been shown to negatively impact a mother’s ability to breast feed. In fact, Neifert et al. showed that women who have undergone breast surgery (not just augmentation) are three times more likely to have lactation insufficiency then women who do not. If the surgery was performed through a periareolar incision, the risk approached five times more likely to experience lactation insufficiency then women who had not had breast surgery. These findings have been supported by additional work by Strom et al. and more recently by Hurst et al. where again, a periareolar incision was associated with a greater risk of lactation insufficiency. It is likely that mothers experienced more difficulty with this incision due to the greater likelihood of sensation loss in the nipple and a reduction in the let down reflex. In addition, with the periareolar approach, it is likely that a percentage of the breast ducts are transected during surgery which would reduce the amount of milk reaching the nipple to be expressed. Overall difficulty following breast augmentation may be due to increased intramammary pressure which may cause loss of the glandular elements responsible for milk production, but this remains to be seen. To reduce the risk of lactation insufficiency, I counsel my patients that are very serious about breast feeding that they should consider postponing their breast augmentation until after child rearing, or to consider other incisions than the periareolar one to reduce their risk of this problem.
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 about breast feeding following 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, Breast Implants and Babies, Home, Lactation | No Comments »
March 23rd, 2009 Dr. McKane
Today in clinic I visited with a 16 y/o patient and her mother. The young woman, who had appropriate breast development, was seeking a breast augmentation and wanted to know if I would accept her case. I declined. My reasoning is that adolescents and breast implants don’t mix except in very special cases. The only time that I would consider using a breast implant in an adolescent would be for a reconstructive problem such as amastia.
My reasoning is as follows: Puberty is an earthquake of psychological and physiological change the aftershocks of which affect body image until an individual matures. The end of breast development is a moving target for a young woman. Normal weight gain experienced by females 18 to 21 years old may increase the size of a woman’s breasts. This may reduce her dissatisfaction with breast size and interest in an augmentation procedure. This logic is supported by the FDA’s position on silicone breast implants, and by the fact that they are approved only for women 22 y/o and older.
Dissatisfaction with body image tends to improve as an individual ages. In fact, dissatisfaction with a specific area such as the breast, may not be an issue by the time an individual is 18.
Furthermore, informed consent in an individual that has not matured is a significant issue. An adolescent is likely to have a very skewed view of cosmetic breast surgery. She is likely to have derived her ideas about the procedure from print, movies, TV, and internet media where implants seem to provide a “quick” solution to improve a woman’s contours and proportions. She is unlikely to have any understanding of the risks and complications associated with the procedure. Lastly, the ability to truly comprehend the risks and complications associated with this procedure may not have developed in an individual that is younger than 18. Due to the feelings of invulnerability and the risk taking behaviors that I myself went through as an adolescent, I don’t believe that if I informed an adolescent woman that she could experience an infection requiring removal of the implant that she would actually think that this could ever occur to her. In a patient like this, an informed consent is completely invalidated. Therefore, my counsel to adolescent women seeking breast augmentation is to sit tight until they are physically and psychologically mature.
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 about aesthetic procedures in adolescence. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Body Image, Breast Augmentation, Motivations | No Comments »
March 17th, 2009 Dr. McKane
I periodically offer my opinions to the public about the surgical procedures that I perform. Recently, I had an interview by a college student working on a paper for a class she was taking. She asked me, “Why would a woman want breast implants?”
An individual’s motives are obviously very personal. From one individual to another there can be very different motivations for a surgical procedure. However, when thinking about my practice there are common threads among woman seeking breast augmentation. When asked, most of my patients will note that they are internally motivated to feel better about themselves or their physical appearance. I often hear that my patients feel less developed than their mother or sisters and feel like they would look better with larger breasts in dresses or swimsuits. A common refrain in my practice is “I want to fill out my (insert article of clothing here),” or “I want my breasts to match my hips so I’m more proportional,” or “I want my breasts to be full again like they were before my kids.” In the past several years, I can think of only a few patients who had external motivations. One patient reported that she wanted to have a breast augmentation to be more attractive to her partner, another felt that having an augmentation would increase her chances in the dating scene.
These ideas seem to be substantiated by Gladfelter et al. in a study looking at more than 3000 patients undergoing silicone breast augmentation. The author also concluded that women are internally motivated and not motivated by external forces to please a partner, or attract a mate, or improve their sex life.
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 motivation for aesthetic procedures. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
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March 10th, 2009 Dr. McKane
Today in clinic I had a patient ask me, “Will my body image improve after breast augmentation?” Let me explore this interesting question a little bit.
Dissatisfaction with body image is a key motivator for cosmetic surgery. Evidence suggests that women seeking breast augmentation are more dissatisfied with their breasts than similar women not seeking the procedure. There is a a recent publication by Murphy et al. that looks to answer the question that my patient posed. This study used the Body Esteem Scale and the Rosenberg Self Esteem Scale to evaluate patients up to 6 years after their implantation. The study found significant improvement in the women’s scores for sexual attractiveness, physical condition, improved self image, social relations, and daily living following breast augmentation. These improvements were maintained by the vast majority of the women through the 6 years of the study.
This study (and my experience) supports the fact that their is a measurable improvement in body image following breast augmentation. So to answer my patient: Yes, there is an improvement in the vast majority of women.
Here is the preoperative photograph of a woman who felt that she had never developed the same way that her mother had. She wanted a breast augmentation that would help her fill out certain fashions. The picture is shown with a cover to help show the improvement in volume within a garment.
Inadequate cup fill
Here is the postoperative photograph using the same cover. There is improvement in the appearance of the breast within this garment.
Improved cup fill
This patient, as is typical with the majority of women, experienced a significant improvement in her body self image following her breast augmentation.
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 body image following aesthetic procedures. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Body Image, Breast Augmentation | No Comments »
March 9th, 2009 Dr. McKane
In clinic today I had a patient ask me, “Can you do some liposuction to my thighs and then inject that fat into my breast?” She was basically asking if I use fat grafts or fat grafting for breast augmentation. In theory, this seems like it would be a great procedure to perform. The patient would benefit by removing volume from a troublesome area and then putting it into another one that she would like to increase the volume of. While it is possible to perform a breast augmentation this way, it may not be the best option at this time.
Fat grafting has been used for over 100 years for both reconstructive and aesthetic purposes. In the breast, frequent complications including tissue scarring, cysts, and in particular, calcification had lead some to postulate that fat grafting may delay the diagnosis of breast cancer. For aesthetic purposes, the procedure was largely abandoned in the breast. There has been renewed interest amongst Plastic Surgeons in aesthetic applications for the breast due to the promising reports ”Structural fat grafting: More than a permanent filler,” and the followup paper “Fat grafting to the breast revisited: Safety and Efficacy,” by Dr. Coleman. This interest has led some surgeons to offer the procedure to their patients as a means of breast augmentation.
At this point, I don’t personally recommend the procedure to my patients considering breast augmentation. My reasoning is as follows: First, the procedure is probably best suited for a woman seeking a very modest increase in the volume of her breast and in one that is willing to tolerate multiple surgeries to achieve her goals. The technique needs to be performed using numerous injections of very small volumes of fat to reduce the risks of large fat cysts and volume loss due to graft failure. This also usually involves a secondary or even tertiary surgery for additional fat grafting. This does not fit the profile of my typical patient who wants an immediate significant change to the volume of her breast. This rapid change is easily afforded using saline or silicone implants. In addition, the technique is highly surgeon dependent and there is a learning curve for the procedure. My patients demand reliable results and implants deliver this type of reliability. Furthermore, the evidence in the literature surrounding the safety, efficacy, and outcomes of fat grafting for breast augmentation consist of case reports and opinion. To date, there are no randomized controlled trials demonstrating that fat grafting is superior to breast implants for breast augmentation. Because there is limited scientific evidence supporting fat grafting I am hesitant to offer it at this point.
Does this mean that I don’t offer fat grafting? Absolutely not. I use fat grafting frequently for reconstructive purposes. Would I use fat grafting in the future for breast augmentation? Yes, once additional research is conducted on the subject that demonstrates equivalent safety and efficacy to implants.
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 fat grafting. 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, Fat grafting | No Comments »
March 3rd, 2009 Dr. McKane
I received an email the other day from a woman who had visited another surgeon regarding breast augmentation. During her consultation he told her that he routinely uses drains during the procedure. She wanted to know if I also use drains during breast augmentation.
For those of you who may not understand what a drain is, let me get this out of the way first. A drain is a small tube that is placed into a space within your body that is designed to pull fluid away from this space and usually into a collection device. By their nature there is a path through the skin that the drain will cross. Drains are used frequently during any procedure that is prone to develop a fluid collection or “seroma.” A common procedure within Plastic Surgery that usually requires drains would be an abdominoplasty where a large space is developed beneath the skin. Here is a picture of a drain:
To answer her question about whether or not I use drains, the answer is: Almost never during a primary breast augmentation. There are few instances when I would consider one and this is usually during a revision case when extensive work is performed on a breast capsule. The reason that I don’t use them is that I believe that they are not necessary and it has been well demonstrated that drains increase the risk of surgery requiring complications and significant capsular contracture in patients who have them.
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 use of drains during a procedure. 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, Capsular Contracture, Correcting Problems with Breast Implants, Home | No Comments »
March 2nd, 2009 Dr. McKane
A patient in my clinic today asked an insightful question that I would like to share with you. She noted that she understood that there is evidence supporting that there is a decreased risk of capsular contracture after breast augmentation if the implant is positioned behind the muscle. She wondered, “Is there an incision that is associated with less risk for capsular contracture ?”
A prospective study by Henriksen et al. answered this very question. The authors looked at the causative factors surrounding surgery requiring complications and significant capsular contracture in 2277 women undergoing breast augmentation. The authors found that the “inframammary” or breast fold incision was associated with the least risk for complications requiring surgical intervention. Patients who elected to have this incision also experienced less risk of capsular contracture. In fact, patients opting for periareolar or any other incision were 5.8 times more likely to develop capsular contracture than those who had inframammary incisions. This evidence has led me to counsel my patients to strongly consider the inframammary incision for their approach to a breast augmentation.
Here are the pre and postoperative photographs of a breast augmentation done through an inframammary incision. This patient is very thin and had very little breast tissue. Even in this patient, the incision is very well concealed and is barely visible on front view.
Pre and Postoperative views
The postoperative photograph is taken at 1 month following surgery to show what an immature incision may look like when it is the most visible. The incision will continue to fade with time. This small investment in an easily concealable incision can have a significant impact on the need for additional surgery.
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 incisions involved in this procedure. 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, Capsular Contracture, Correcting Problems with Breast Implants, Home | No Comments »
