I received an email from a patient that had undergone a breast augmentation through a periareolar incision.  She had decided to undergo the procedure through a periareolar incision because her surgeon assured her that this approach would provide an almost imperceptable scar.  She noted that her scar has spread significantly and “…looks terrible.”  She wondered if her scar could be improved. 

Without seeing this patient, I suspect that she experienced spreading of her scar because the muscle layer responsible for causing contraction of the nipple and areola during arousal or exposure to cold was not repaired during her surgery.   Vasquez et al. has done a nice anatomical study demonstrating the radial and circular muscle fibers responsible for this problem.  It is apparent from their study that failure to suture this muscle layer during a breast procedure would allow retraction of the muscle  and widening of the scar.  To correct this patient’s problem, the incision could be opened and the muscle layer identified and repaired. 

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of aesthetic plastic surgery for review.  I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or improvement of scars.  Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

© 2009, Dr. McKane. All rights reserved.

This morning as I sat down to read CNN online, I was struck by the article “Nip and tuck on a budget in Argentina.”  If you’d like to read it for yourself, here’s the link:  CNN.  The highlights of the article are “Thousands visit Argentina for cheap cosmetic surgery.  Combination of top doctors, weak currency make country attractive.  Patient: It would have cost $50,000 dollars in Canada but only $10,000 in Argentina.  Estimates say that 1 in 30 Argentines has gone under the knife.”   

This article is totally one sided and in my mind a disservice to the public.  It plants the seed that medical tourism is a great concept without any problems.  The issue that I have with this article is that it fails to recognize that Plastic Surgery is in fact surgery.  

The author likes to talk about the benefits of having surgery in a foreign country.  But what about the risks?  How can a potential patient assess the qualifications of the foreign surgeon?  Is the procedure being performed in a safe and clean environment?  Are there appropriate protocols in place to avoid the transmission of hepatitis or HIV or other diseases?  How will the followup be arranged?  Who’s going to responsible for this care?  Is it really a good idea to be mixing recovery with some vacation activities like swimming or remote locales?  What if there is a complication?  How is that handled?  At what cost?  What legal recourse will there be if there is a disaster? 

If you believe all the marketing hype about beautiful results in exotic locations, let me point you to an Australian Society of Plastic Surgeons survey that polled 68 surgeons.  59% of them reported  seeing patients with complications from cosmetic surgery done abroad.  22% of them had treated patients on more than one occasion. 

Furthermore, when you return home, what type of welcome do you think that you’ll receive if you need followup care or care for a complication?  From a kind and caring surgeon that you have an established relationship with?  Or, from one that is angry, worried about you, and concerned about medical  liability from a mess that you created?   There is a lot of resentment in the medical profession towards individuals that seek surgery away and then expect to be seen for care.  I received a response to my post “After medical tourism, how exactly do you plan to follow up?  that hits this sentiment squarely on the head.  The respondent notes, “I hope the medical tourism has turned out to be a medical disaster for the patient. ”

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of aesthetic plastic surgery for review.  I invite you to schedule a consultation with me if you would like to learn more about medical tourism or any of the procedures that we offer.  Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

© 2009, Dr. McKane. All rights reserved.

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.

© 2009, Dr. McKane. All rights reserved.

I’m compelled to blog today about a patient that presented to me for help.  She was a “medical tourist” who had undergone a tummy tuck procedure in Brazil because it was discounted.  She thought that she would be saving a bundle of money and getting a vacation in the process. 

What she didn’t account for was the complication she would experience and the cost that this would be to her.  Approximately six weeks after her procedure she presented to me with a large area of abdominal skin death and an invasive infection.  I took her case and before her problems were resolved she required several additional surgeries, weeks of dressing changes, antibiotics, and consultations with other physicians.  The cost of this care was not covered by her insurance company and rapidly resulted in hospital bills in the tens of thousands of dollars.    

The sad part of this story is that when she presented to me, the cat was out of the bag .  She had been attempting to nurse herself at home for a period of time until things became dramatically worse.  Had she been able to followup with her surgeon, the problems that she experienced could have been recognized sooner and appropriate treatment could have been initiated earlier. 

So my questions for you, the reader, considering medical tourism:  how exactly do you plan to follow up?  What will you do if you experience a complication from your procedure?  Even though it may seem like discount surgery abroad, can you really afford it?   

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of aesthetic plastic surgery for review.  I invite you to schedule a consultation with me if you would like to learn more about medical tourism or any of the procedures that we offer.  Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

© 2009, Dr. McKane. All rights reserved.

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.

© 2009, Dr. McKane. All rights reserved.

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.

© 2009, Dr. McKane. All rights reserved.

I received an email today that I would like to share with you.  “I’m thinking about undergoing liposuction.  I’ve read about CoolLipo, LipoLite, SmartLipo, and the Neira 4L laser.  There seems to be a lot technology out there.  I need an honest opinion.  Should I have laser liposuction?”

Within the past ten to fifteen years, there have been many technologies developed to augment liposuction.  These have included power assisted, ultrasound assisted, and more recently, laser assisted liposuction.  In laser liposuction, a laser device is either applied internally with probes or externally through the patient’s skin.  The laser devices are expensive to develop and to buy and because of this they are heavily marketed by both the manufacturer and the physicians using them in an attempt to recover these costs.  The laser devices are touted to be “less invasive,” to improve recovery, and to provide better results than the other non laser liposuction technologies.  To be honest with you, these are substantial claims that in my mind have not been adequately evaluated. 

I don’t want to identify any one of these products specifically, so I will be general in my opinions about this.  First, to claim that a laser assisted liposuction technology is non invasive or less invasive is completely false.  Don’t be fooled into the idea that because the incision at the skin’s surface is small, that these procedures are not invasive.  When you’re dealing with a 1 or 2 mm cannula (probe), of course the incision is going to be small.  However, the fact of the matter is that a metal rod or wire is still inserted beneath the skin to deliver laser energy to the tissues being treated.  This tissue is then effectively burned and the size of this burn corresponds to the area being treated.  This area of trauma is far larger than the small incision used to create it.  Furthermore, depending on the technology that you are dealing with and the size of the area being treated, the cannulae may be too small to allow adequate fat removal and so more conventional cannulae may be used to actually remove the fat.  As much as the manufacturer would like you to believe it, this is by no means non invasive or less invasive.  That idea is purely semantics.  Any form of liposuction is by its nature an invasive procedure.  To support claims about improved recovery and better results with laser technologies, clinical trials that were randomized and double blinded would need to be conducted.  I may be wrong about this, but I don’t think that this will ever occur.  At this point, these claims remain subjective and anecdotal at best. 

So to answer the question, “Should I have laser liposuction?”  Consider it, but realize that it may not be everything that it is supposed to be.  Other, non- laser liposuction technologies are also safe and effective when used by experienced surgeons. 

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of liposuction procedures  for review.  I invite you to schedule a consultation with me if you would like to learn more about any of the liposuction technologies available for your surgery.   Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

© 2009, Dr. McKane. All rights reserved.

Here is a new video about my practice.  It includes a segment with one of my patients, of my office, and with me.  Click on the link below to view it:

Meet Dr. McKane video

Our websites www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of aesthetic plastic surgical procedures  for review.  I invite you to schedule a consultation with me if you would like to learn more about any of these procedures.   Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

© 2009, Dr. McKane. All rights reserved.

I saw a patient in clinic today whose mother was diagnosed with breast cancer at a young age.  She had concerns that she might develop breast cancer in the future.  After having three children, this patient was considering a tummy tuck (abdominoplasty) as a means to contour her abdomen.  She asked a very important question, “If I have a tummy tuck, will I be able to have a breast reconstruction?”

There are several reconstructive options used to deal with the defects created in the treatment of breast cancer.  They fall into two general categories.  Prosthetic reconstructions involve the use of tissue expanders and implants to reconstruct the breast.  Alternatively, autologous reconstructions use a woman’s own tissues to reconstruct the breast.  These tissues are moved from the abdomen, back, or buttocks and repositioned to reconstruct the breast.  The abdomen can provide a large amount of tissue in some patients.  As such, it  may be the ideal donor site for reconstructing a large breast, or in some instances a reconstruction involving both breasts.  Since the abdomen is the source for such an important option, a woman considering an abdominoplasty needs to understand that following this procedure, the abdomen cannot serve as the source of tissue for a breast reconstruction.  This is due to the fact that the blood vessels necessary to support the breast reconstruction are cut during an abdominoplasty.  If the abdominal tissues were moved after an abdominoplasty, the reconstructed breast would die. 

So, to answer her question: “Yes, you can still undergone a breast reconstruction following a tummy tuck; however, the source of the tissues cannot be the abdomen.” A woman that has undergone an abdominoplasty who later develops a breast cancer will need to consider the back or buttock as her options for an autologous breast reconstruction.  Alternatively, she may consider a prosthetic reconstruction.  The abdominal flaps will not be available to reconstruct the breast.   

Our websites, www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs for review.  I invite you to schedule a consultation with me if you would like to learn more about abdominoplasty or breast reconstruction.   Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

© 2009, Dr. McKane. All rights reserved.

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.

© 2009, Dr. McKane. All rights reserved.