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 »
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 »
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 »