September 10th, 2009 Dr. McKane
I have received an email from a patient that had a breast augmentation by another surgeon. Unfortunately, she experienced symmastia, a condition where one or both implants is able to cross the middle of her chest. She writes, “are you able to fix it?”
Symmastia can be a very challenging problem to fix. There are a number of procedures that have been proposed to address it including suture techniques, using flaps or other materials, adjustable implants, implant free periods, and changes in the implant pocket. I have used several of these techniques to address this problem with success. Now, I have something that I feel is more reliable to offer. The technique was presented by Spear et al. and recommends creating a “Neosubpectoral” pocket if the implant is already in the subpectoral position. This is a brilliant idea because it uses the patients own tissues to deal with the problem. It creates a new space for the implant between the pectoralis muscle and the implant capsule. In this way an appropriately sized pocket can be created that will resist malposition or recurrent symmastia. It eliminates some of the uncertainty, unreliability, and the drawbacks of a simple change of the implant into the subglandular (in front of the muscle) position.
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 symmastia or its correction. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Correcting Problems with Breast Implants, Home | No Comments »
August 21st, 2009 Dr. McKane
Today in clinic I visited with a patient that had silicone implants placed 20 years ago. She had been referred to me because she had undergone an MRI for an unrelated reason and her implants were noted to be ruptured on the study. I recommended that she replace her implants. She asked, “My breasts haven’t gotten any smaller. Why do I need to replace my implants?”
Unlike saline implants which will deflate, silicone breast implants can rupture and a woman may remain completely asymptomatic and not be aware of it. This is termed a “silent” rupture. If this occurs, the silicone gel spills into the space around the implant that is contained by the scar that the body develops around the implant (capsule). The problem with this is that at times the gel can then migrate from this space into the breast tissue. Silicone migration can occur even further and reports have shown that it can reach the elbow region, shoulder, chest, abdomen, groin, and even the shins. The migrated gel can cause inflammation that presents as nodules under the skin. These nodules are called siliconomas. Siliconomas can cause pain and at times may create a communication to the skin’s surface that will ulcer and then drain. Migrated gel has also been reported to cause lymphadenopathy (inflammed lymph nodes), infection, fibrosis, and skin retraction. The management of this problem usually requires surgical excision. Depending on the area involved and the amount of silicone to be removed this can be very difficult or disfiguring. So to answer this patient’s question; replacement of leaking silicone implants should be performed to avoid these problems.
Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of silicone breast augmentation for review. I invite you to schedule a consultation with me if you would like to learn more about silicone breast augmentation or silicone migration. 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 Contouring, Breast Implants and Babies, Correcting Problems with Breast Implants, Home, Safety | No Comments »
July 31st, 2009 Dr. McKane
I was saddened today when I visited with a transgender patient in consultation. She had undergone several silicone injections to her breasts by unlicensed individuals. These injections occurred in the back of a salon in a Latino neighborhood and at a “pump party.” She presented to me because now her breasts were basically “rocks” and she had developed several infections and draining areas. Unfortunately, she was so severely disfigured that all I could really offer her were mastectomies to remove her breasts.
The injection of non FDA approved products or industrial silicone at parties or salons is criminal. Anyone who considers this procedure is gambling with permanent disfigurement or death. There may be no way to remove the substance from your body without a radical procedure as I have indicated above. Severe tuberculosis infections have even been reported. Other complications can occur as did in this patient with chronic infections and draining wounds. When these substances are injected by an untrained individual there is no accountability for sterility, the product being used, or for the possible transmission of diseases like hepatitis and HIV.
There is absolutely no reason to consider these injections when there are approved alternatives that can be performed safely by a Plastic Surgeon or another trained physician. If you are considering undergoing an injectable procedure I recommend visiting www.injectablesafety.org a website with numerous resources for you to review.
Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of injectable procedures for review. I invite you to schedule a consultation with me if you would like to learn more about any of the injectables available for use. 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, Injectable fillers, Safety | No Comments »
July 17th, 2009 Dr. McKane
Today in clinic, I had a patient who was an aerobics instructor ask,”Can putting the implant behind the muscle cause distortion of my breast during exercise?” The answer to her question is yes, but I want to qualify this answer.
In patients where implants are positioned behind the pectoralis muscle, contraction of the muscle can change the shape of the breast. This distortion in shape is called an animation deformity and is graded on a scale ranging from no deformity to severe. It is something that occurs during contraction of the muscle and then resolves with relaxation. A recent study by Spear et al. looked at this issue and reported that muscle related distortion was not a problem during normal activities of daily living. In this patient cohort, interference occurred during weight training, exercise, yoga, and sexual activity. Interestingly, only 3% of patients reporting this problem would not consider subpectoral placement again. It is apparent that these patients accept animation deformity in return for improved breast cancer detection, less risk of capsular contracture, less problems with visible rippling, and a better chest/breast/implant interface. Although there are several techniques designed to help with this problem, the only definitive solution is to replace the implants into the subglandular (in front of the muscle) position. However, this is at the expense of increased risk of capsular contracture, implant visibility and rippling problems, and greater difficulty with mammography.
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 animation deformity. 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 Positions, Correcting Problems with Breast Implants | 2 Comments »
June 25th, 2009 Dr. McKane
Some of my patients ask me what will happen to them if they develop a breast cancer after undergoing aesthetic breast surgery. They wonder if they will be a candidate for breast conservation therapy and sentinel lymph node biopsy. As more and more breast surgery is performed, unfortunately, more and more women will be confronted with this problem.
Sentinel lymph node biopsy is used to stage the spread of breast cancer. It is a technique by which the “sentinel” or first lymph node to collect the lymphatic fluid draining from the breast is examined for the presence of metastasis. If breast cancer is present in this lymph node, a formal lymph node dissection is performed as there is a reasonable chance that the cancer has spread to additional lymph nodes in the arm pit or axilla. If no cancer is present here, oncologists can be reasonably certain that the cancer has not spread beyond the local site in the breast and a formal axillary lymph node dissection is avoided.
In patients who have had past breast surgery, the sentinel lymph node biopsy technique was contraindicated due to a hypothesized risk that the breast lymphatics were divided and that this would lead to an inability to accurately identify the sentinel node. Recent studies have suggested that this may not be the case and that the procedure can be appropriately performed. Fernandez et al. evaluated 70 patients who underwent breast augmentation via an inframammary or periareolar approach or a breast reduction that ultimately developed breast cancer. These patients underwent a sentinel lymph node biopsy as part of their cancer staging. The sentinel node was identified in 100% of these patients and none of them went on to develop recurrence of the tumor in their axilla at 19 months of follow up. This article suggests that sentinel lymph node biopsies can safely and appropriately be performed in women who have undergone previous breast augmentation or breast reduction.
Our websites, www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation and breast reduction for review. I invite you to schedule a consultation with me if you would like to learn more about breast augmentation, breast reduction, or breast conservation surgery. 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 Cancer, Breast Reduction, Home | No Comments »
April 24th, 2009 Dr. McKane
I review all of the comments that I receive to my blog. Occasionally, one will ask a specific question that I am happy to answer. A few days ago, I received a comment asking “It seems that breast reduction surgery can help women. Would you share more information and experience about this procedure?”
Breast reduction or reduction mammaplasty is a procedure that can be performed for women that experience neck, shoulder, breast, and back pain due to the large size and weight of their breasts. Other problems that a woman with large breasts may experience are shoulder grooving, neurologic symptoms of the hand, and intertrigo. Breast reduction surgery can improve these symptoms. Some insurance companies have benefits for the procedure.
Breast reduction surgery can help with women with large breasts, if you wonder about this, I would point you to a recent article by Woodman et al. that looked at women’s perception of life following breast reduction. This phenomenological study has a limited number of participants but provides valuable insight into the lives of several women that have undergone breast reduction surgery. The advantage of this study is that it looks at experiences from a first person (patient’s) point of view and not from the surgeon’s point of view. Patients often want to know if the surgery will improve their symptoms. The participants in this report noted a reduction or elimination of their pain symptoms, improved body image, increased self esteem, and increased self confidence. This study also found that there were some negative experiences associated with the surgery and its recovery. However, the improvements the women experienced made the surgery worthwhile and would lead them to recommend the surgery to other patients with breast hypertrophy.
Here is an example of a woman that experienced significant neck, shoulder, and back pain due to the large size of her breasts. Without a bra, she even experienced pain in the sides of her breasts. She wanted to undergo a breast reduction to help alleviate her symptoms. This is the preoperative photograph:
She underwent an inferior pedicle wise pattern breast reduction. This is the postoperative result:
The reduction improved her symptoms of neck, shoulder, back, and breast pain and dramatically improved her quality of life. The procedure also provided her with improved self confidence and self esteem. She was pleased that she ultimately decided to undergo surgery after waiting a long time while considering it.
Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast reduction for review. I invite you to schedule a consultation with me if you would like to learn more about breast reduction surgery or the improvements that can be experienced with it. Please feel free to contact our office at (713) 661-5255 if you have any questions.
-Brice W. McKane, M.D.
Posted in Breast Contouring, Breast Reduction, Home | 2 Comments »
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.
Posted in Breast Augmentation, Home, Motivations | No Comments »
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 »
