Topics:

Breast Implant Revision Surgery

Q:

When should you consider a breast revision? What are the benefits of having a breast implant revision surgery? How do you tell if you are you a good candidate for breast revision? How is a breast revision procedure performed?

A:

Breast implant revision surgery, (also known as breast implant replacement) commonly involves removal and/or replacement of saline or silicone breast implants. This surgery is performed to change the size or type of a patient’s implants and to correct any complications from a primary breast augmentation. Restoring a youthful breast contour and appearance is one of the benefits of this procedure.

The following are suggested guidelines:

  • If your saline breast implants have deflated or an X-ray or MRI suggests that your silicone implant has a shell leak.
  • If you want to change your implant/breast size
  • If you have tightening of the scar tissue around the implant (capsular contracture) or your breast implants have shifted in position.
  • If your breast tissue has changed as a result of skin stretching or weight loss/gain.

These are some of the benefits that patients have experienced:

  • Your breasts will regain a youthful shape.
  • You have the ability to increase or decrease your breast size.
  • Your breast symmetry will be improved.

Even if your breast implant surgery was perfectly planned and beautifully executed, changes can occur over time. If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.

The exact procedure your surgeon will use for breast implant removal and replacement varies depending on the reason for your breast revision.

Change in implant size: If you decide to change your implant size, your surgeon will frequently use your original incision for implant removal and replacement. If you want a larger implant, your doctor will surgically enlarge the “pocket,” or space in the breast, surrounding your implant to accommodate a larger implant. If you want smaller implants, your doctor may surgically reduce the size of the pocket with sutures to properly fit smaller sized implants. A breast lift may be done at the same time.

Capsular contracture (hardening of the capsule and implant): Your doctor will probably use the same incision used to insert the original implants to remove the hardened capsule and implant. He or she will then insert a new implant.

Implant rippling: When the edges of saline breast implants are visible and palpable (able to be felt), your surgeon may use the same incision to remove or reposition the implants as was used to originally insert them. Other options include using a different type of implant or placing the new implant into a different breast pocket that either has thicker muscle coverage or uses other tissues to cover the implant edge.

Implant malposition: Sometimes implant pockets are created too far apart or too close together, resulting in poorly positioned breasts. To correct this, using the prior incision, your surgeon will manipulate the scar tissue from the capsule surrounding the implant and reconstruct the pocket in the appropriate position using suturing techniques. Your surgeon may need to utilize other tissues to reinforce this new implant pocket and may recommend using a cellular dermal matrix product to add additional support.

Implant removal: If your implants are large and your skin has stretched, your surgeon may recommend a breast lift in addition to implant removal, but implant removal alone may suffice. The original incision created to insert the implant will almost always be the same one used to remove it. The lining around the implant, or “capsule,” is often surgically removed at the same time to facilitate rapid healing.

Elevation of nipple and areola position: If it is necessary to elevate the position of your nipples and areolas (pigmented skin surrounding the nipples), you will need additional incisions. Incisions around the upper portion of the areola will be adequate in cases where not much elevation is needed. When more lifting and tightening is necessary, an incision all the way around the areola, including a vertical scar extending down from the areola to the crease under the breast, may be necessary. For cases where significant excess skin needs to be removed (such as in women who have had massive weight loss), a third incision may be necessary that will extend horizontally beneath the breast, following the natural curve of the breast crease. If your nipples need lifting, the nipples and areolas remain attached to underlying mounds of tissue and this usually allows for the preservation of sensation and the ability to breastfeed.

The goal of the board-certified plastic surgeons at Edina Plastic Surgery and our entire staff is to help you achieve the most beautiful and natural-looking results, as well as making your surgical experience as easy and comfortable as possible.

Breast Implant Considerations

Q:

I am considering getting breast implants. What are the steps involved in deciding what size implant will look most appropriate?

A:

Breast implant preferences vary substantially from woman to woman and the size choice can be influenced by factors such as lifestyle, goal appearance, and modern trends.

Past trends/future trends.

In the past, the larger, more obvious breast implants were a popular look. While a full, high, and round silhouette will always have some popularity, many women today are leaning towards a more modest, natural-looking breast enhancement.

Bigger Isn’t Always Better.

Dr. Robert Wilke, a board-certified plastic surgeon from Edina Plastic Surgery shares his thoughts on this topic. “When patients come in for a breast augmentation, we listen carefully to their goals. What is the type of look that they are hoping to achieve?” Dr. Wilke emphasizes the importance of the consultation. “We devote a lot of time during the consultation to implant sizing. We have the patient try implant sizes in a bra to see how this looks, then proceed to using computer imaging on our Vectra XT 3D Camera to determine the optimal size for each patient.”

Trends in breast augmentations: “The Brazilian B”.

While the United States consistently performs a high number of cosmetic surgeries compared to most other countries, Brazil is a solid competitor for the most annual cosmetic surgeries. Breast augmentation is one of the most commonly performed surgeries in both countries, but it’s the Brazilians who have popularized the modern trend toward smaller implants, dubbed the Brazilian B. The trend has since gained traction in the United States as iconic Brazilian models such as Gisele Bündchen showcase how sexy a perkier breast size can be.

One Size Does Not Fit All In Breast Implants.

When deciding which implant will provide a patient with her desired appearance, the surgeon must account for many factors besides size. For example, different implant profiles involve varying levels of height from the chest with corresponding base widths. The implant profile you choose can influence your breast shape as well as how natural your chosen size appears on your body frame. Additionally, chest proportions, breast shape, and the amount of pre-existing breast tissue can all impact the end results of the augmentation; which means that the same implant volume can deliver a variety of different looks on different patients.

The Vectra XT 3D camera at Edina Plastic Surgery is a high tech tool to help determine the appropriate implant size for each patient.

Patients love it that they can see the virtual results of breast augmentations on their very own bodies. Here is just one of many testimonials we’ve received about this incredible technology.

“I am 57 years old and giddy with joy at the results of my breast augmentation. I credit the Vectra 3D camera with giving me the courage to “go for” the size implants that I chose. I have always been a small-breasted woman and am quite petite so it was difficult for me to imagine myself with larger breasts. When I tried on the implants with a “demo bra” I thought I looked ridiculous but when I saw myself on the Vectra 3D camera it made all the difference. I looked great! Thank you Edina Plastic Surgery for my new beautiful breast and for having this technology.”

Breast lift surgery

Q:

After having two children I am very unhappy with how my breasts look. Is a breast lift a good option for someone like me?

A:

Statistics released by the American Society of Plastic Surgeons (ASPS) show that breast lift procedures are growing at twice the rate of breast implant surgeries. Since 2000, breast lifts have grown by 75 percent. Breast implants are still by far the most-performed cosmetic surgery in women, but lifts are steadily gaining. In 2014, more than 90,000 breast lift procedures were performed by ASPS member surgeons.

Dr. Robert Wilke, a board certified plastic surgeon at Edina Plastic Surgery says, “Many women develop droop in their breasts over time, often due to the effects of pregnancies and breastfeeding. Some really like the idea of achieving a more optimal breast shape by using the tissue they already have, while some choose to restore breast volume with an implant in addition to a lift. Breast lifts can help them look and feel younger, which is why this procedure has such a high satisfaction rate.”

According to the statistics, women between the ages of 30-54 made up nearly 70 percent of the breast lift procedures performed. More women who have had children and whose breast volume has decreased are consulting plastic surgeons.

Over the years, pregnancy, nursing and the force of gravity take their toll on a woman’s breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. Patients want a solution for the excess skin and want to see their breasts “back up where they are supposed to be”.

Women often ask if they are good candidates for a breast lift. The ideal candidates for a breast lift are healthy women who are realistic about what the surgery can accomplish. The best results are usually achieved in women with small, sagging breasts. Breasts of any size can be lifted, but the results may not last as long in heavy breasts.

A simple home test can help determine whether a breast lift may be appropriate. To perform the pencil test, a woman simply places a pencil under her breast. If the breast tissue holds the pencil in place against the chest, this can imply that there’s a hanging nature to the breast that can be fixed with a lift.

Patients who had had breast lifts often say that they feel more confident after having the procedure. Many say that they are delighted to be able to wear clothing that would either have not fit correctly, or not looked appropriate before their surgery.

Breast augmentation remains the most popular plastic surgery procedure for women. In 2014, there were 286,254 breast augmentation surgeries performed by ASPS member surgeons. That represents a growth of 35% since 2000, less than half the rate of the statistical growth of breast lifts (75%).

Breast Augmentation Satisfaction Rate

Q:

I’ve heard that the satisfaction rate for breast augmentation surgery is very high, but how high is it?

A:

According to a study published in Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons, ninety-eight percent of women undergoing breast augmentation surgery say the results met or exceeded their expectations.

The women surveyed in the study also reported improvements in self-esteem and quality of life after breast augmentation.

“So many patients tell me that their breast augmentations have changed their lives for the better,” says Dr. Robert Wilke, a board certified plastic surgeon at Edina Plastic Surgery. “For many women it improves their confidence and makes them feel much more comfortable to wear all types of clothing. Breast augmentation is the most common procedure that we perform. We do see an increased demand in the springtime, however, as people are thinking about shedding the winter clothes and getting ready for swimsuit season.”

225 consecutive women who returned for interviews at least one month after breast augmentation over a five-year period were interviewed for this study. Interviews included questions about the recovery, results, complications and psychological effects.

The average patient age was 34 years old, and the majority of women received saline-filled breast implants placed under the muscle. The average implant volume was 390cc.

Eighty-five percent of women rated their new breast size “just right.” Thirteen percent would have preferred a larger size and less than two percent a smaller size. Only one percent expressed dissatisfaction with their scars, which were usually located in the crease under the breast. Seventy-five percent of women rated their breast firmness “just right.” When asked to rate the result, over half of the patients gave it a perfect 10 on a scale of 1 to 10. Almost all patients (98 percent) reported that the results met or exceeded their expectations.

Increased Self-Esteem and Other Psychological Benefits.

When asked about psychological effects, 92 percent of women reported improved self-esteem after breast augmentation and 64 percent reported an improved quality of life. Before surgery, the majority of women (86 percent) were self-conscious about their breasts. After surgery, only 13 percent were self-conscious about them.

Breast augmentation is the most popular cosmetic surgery procedure in the United States-approximately 286,000 operations were performed in 2014, according to ASPS statistics. The study results provide new information for women considering breast augmentation, particularly in terms of their expectations of the recovery and results.

Plastic surgery for people over 50?

Q:

Is plastic surgery becoming more of an accepted practice for people over 50 years of age?

A:

Seniors are turning to plastic surgery in record numbers. It may be a current trend for the “more mature” to let their hair color go to a natural silver, but those same seniors are clamoring to have plastic surgeons erase other marks of aging like sagging breasts, wrinkles and droopy eyelids.

No matter how hard they look, these men and women know that there are no creams, potions or drugstore remedies that can completely erase the effects of aging. There is no such thing as an over-the-counter miracle cure. The former head of Revlon, Charles Revson was quoted as saying “I am selling hope in a jar.” Today older Americans are often finding that hope is in the hands of board-certified plastic surgeons.

A record number of senior citizens are electing to undergo plastic surgery. In 2014, women and men from the ages of 51 – 64 accounted for 25% of the surgical and 32.9 percent of the non-surgical cosmetic procedures. The total of those procedures for the year was more than 10 million. Add to that the number of people 65 and over who made up 8% of the total of yearly surgeries and 11% of the non-surgical procedures and you have got some very significant numbers of people over the age of 50 opting for cosmetic procedures. And the numbers are increasing every year, so the trend is clearly growing.

It’s not that hard to answer the question “Why are cosmetic procedures becoming more popular for people 50 and older?” Medical technologies are ever-advancing. This means that people are living longer and living more healthy lifestyles. They feel good and they want to look just as good as they feel.

If they are still in the work environment these patients often feel the pressures of the work environment and want to “continue to fit in”. Many have returned to the dating world and want to look their best to meet new people.

When asked about this trend, Dr. Robert Wilke, a plastic surgeon board certified by The American Board of Plastic Surgery said, “Every year we see more patients that are over 50, and the over-65 patient base is growing as well. My partners and I perform procedures that make people look and feel more youthful, but in a very natural way. Most people want a natural looking result. They still want to look like themselves, just a more refreshed and rejuvenated version of themselves.” The surgeons at Edina Plastic Surgery are experts in performing these procedures, as evidenced by all three of them being named as Top Doctors.

Seniors are asking for all types of surgeries and cosmetic procedures, but the most commonly requested surgeries are: facelifts, eyelid lifts, breast lift, tummy tucks and liposuction. These are followed in popularity by breast augmentation, breast reduction, lower body lifts and forehead lifts.

Do the risks increase as the age does?

“Many people are under the impression that advanced age automatically increases the surgical risk for patients,” says Dr. Wilke, “but that is not necessarily the case. Age does not have to be a limitation, but any co-morbidities and extenuating medical conditions that the patients are experiencing can play a part as to whether they are a good candidate for plastic surgery. Every patient needs a full medical evaluation preoperatively, and we, along with their primary physician, need to assess their surgical risk to determine if elective surgery is appropriate for them.”

Dr. Wilke goes on to say, “Because of advances in medical technology and techniques, plastic surgery is not only safer than ever, the results are better than ever as well. With our refinements in surgical techniques, as well as better and safer anesthesia, it all adds up to make it easier for these more mature patients to enjoy the benefits of plastic surgery.”

And with social mores and opinions on plastic surgery becoming more accepting, the social stigma of having “something done” has been all but erased. Surgeries are no longer considered a mark of vanity and they are no longer limited to Hollywood divas and jet-setting executives. The vast majority of people electing to have procedures are middle class wage earners who have saved up to get plastic surgery because it is important to them.

Looking more youthful with non-surgical alternatives.

For the maturing population who want to avoid or postpone a surgical option, the non-surgical alternatives are also very popular. Seniors are flocking to the offices of plastic surgeons and to skin clinics for all kinds of treatments including Botox® to erase wrinkles and facial fillers to plump up hands and face. They are also trying skin rejuvenation in record numbers. These include chemical peels, dermabrasion, skin-tightening lasers and laser skin resurfacing.

“At Edina Plastic Surgery we have a great skin clinic,” says Dr. Wilke. “So our patients have the option of any type of surgical or non-surgical procedure in their pursuit of looking more youthful. As people go through life transitions they want to look good; and no matter what avenue they choose we are there to help them reach their goals.”

The Ideal Implant

Q:

I’ve heard about a new saline breast implant called the “Ideal Implant”. What makes it different?

A:

Edina Plastic Surgery has the exclusive rights in Minnesota to use the new Ideal Implants recently approved by the FDA. We know that when it comes to breast augmentation, women appreciate having options, and the more options the better. At EPS we offer patients the very latest in breast augmentation advancements.

The Ideal Implant is a revolutionary new design in saline-filled implant. It has a baffle structure, two lumens and a series of shells of increasing size nested together to control saline movement; making it behave much like a silicone implant

Many women don’t like the look and feel of the typical saline-filled breast implant which can wrinkle or “scallop” over time. However, these same women may not be comfortable with the silicone gel options.

This new saline breast has recently been approved by the FDA and offers women a great new option. It has two valves that fill the device with saline. This revolutionary new design controls the saline movement to prevent bouncing and provides a more natural result than current single-lumen saline implants. The structured design also provides internal support to the implant edge, while minimizing scalloping and wrinkling. Study results have found this new implant to have a high rate of patient and surgeon satisfaction along with a low rate of capsular contracture compared to current, single-lumen, saline-filled implants.

“The saline-filled implants that we have used to this point were essentially balloons filled with freely-moving fluid,” says Dr. Nathan Leigh of Edina Plastic Surgery. “They can result in an unnatural feel and sometimes the aesthetic results are not as pleasing as we’d like them to be. I believe that the Ideal Implant has the promise to be an excellent alternative to current saline options and some silicone gel-filled implants options, especially in view of the low rate of capsular contracture shown in the studies.”

The IDEAL IMPLANT meets a clear need for saline-filled implants that offer a more natural result for patients who don’t want silicone gel-filled devices.

Plastic Surgery in the Cold Months

Q:

Friends have said that the cold weather months are great for having plastic surgery procedures; why is that?

A:

Just like there are good seasons for sporting activities there are seasons that can greatly benefit patients considering plastic surgery procedures. The cold months of winter/early spring can have their benefits

The months from February through April can be the ideal time to undergo just about any type of cosmetic surgery from facelifts to breast augmentations to tummy tucks and liposuction.

  • There is less direct sunlight during these months which is advantageous when having any facial cosmetic surgery or laser treatments.
  • Turtlenecks, scarves and hats can help hide the temporary bruising/discoloration from a facelift, laser resurfacing or brow/eyelid lift.
  • The cooler weather allows patients to conceal any temporary swelling/bruising or bandages with seasonally appropriate bulky clothing such as heavy sweaters and winter weight slacks.
  • Many patients find it easier to “take it easy” after a surgery during the colder months when most everyone tends to be less active.
  • Usually the months immediately after the holidays are simply “less social” so there are fewer events to be missed with post-surgery downtime.

Which procedure is the most popular?

Q:

Are plastic surgery procedures still on the rise and which procedure is the most popular?

 

A:

Dr. Nathan Leigh, Dr. Robert Wilke and Dr. Michael Philbin are all members of The American Society of Plastic Surgeons. This group which is the largest organization of board-certified plastic surgeons in the world, published their annual results on plastic surgery procedures in the U.S. The report shows that 15.1 million cosmetic procedures were performed in 2013, a 3% increase from the previous year.

Some of the findings were not surprising. Breast implants, for instance, remain the top cosmetic surgical procedure. The top minimally invasive procedure was once again Botox®. Facelifts and eye surgeries were both up 6% from the year before.

Interestingly, two procedures that are gaining a great deal of popularity among American patients are buttock augmentation and neck lifts.

 

Different types of silicone implants?

Q:

How are modern silicone gel implants different from silicone implants of the past? What is a “Highly Cohesive/Form Stable Implant?” Where did the name “Gummy Bear Implant” come from?

A:

The modern silicone gel implants are much different than the earlier generation implants used prior to 1992, and vastly improved. The silicone gel used today has a greater viscosity compared to saline, so the implant feels a bit more like natural breast tissue. The outer shell is stronger and the gel itself is much more cohesive. At Edina Plastic Surgery, all the gel implants that we use in our practice contain a cohesive gel that will not freely leak out of the shell if it is ruptured.

In the past year, a new form-stable, teardrop-shaped silicone gel implant has been approved for use by the FDA. This implant is made with a more highly cohesive gel that allows it to maintain its shape and have a firmer feel. The form-stable implant may be the best choice for certain patients due to their natural shape and anatomy. The surgeons at Edina Plastic Surgery still agree that the round, standard silicone implants produce the best result for many types of anatomies.

Many patients ask about the “Gummy Bear” implants because they’ve heard about them through the media or on the internet.

This is a colloquial term that doesn’t apply directly to any specific implant, but was originally coined to describe the more highly cohesive, form-stable shaped implants.

There is an interesting story about how the name “Gummy Bear” was coined. The name was started by the president of a breast implant company to describe the characteristics of the highly cohesive silicone. He was in a meeting and was biting the heads off of gummy bears and came up with what he thought would be a good and catchy term.

What is the latest technology in visualization for plastic surgery?

Q:

What are the benefits of the Vectra XT 3D Camera? What can the Vectra XT 3D Camera show patients?

A:

The Vectra XT 3D Camera is the only camera in the state of Minnesota that creates three dimensional images of patients’ bodies and faces. Patients of Edina Plastic Surgery get to see these images at their FREE consultation. The camera technology is so advanced that the surgeons can simulate every possible size of breast implant and even every brand name of implant. It is a remarkable visualization tool and only available at Edina Plastic Surgery.

Patients love that they can see a very accurate representation of what their “after” results will look like before their surgeries. Rhinoplasty patients can see images of their post-surgery noses and breast augmentation patients will see how different sizes and shapes of implants will look on their bodies in order to make well informed decisions pre-surgery.

Here are two testimonials from patients who have used the Vectra before their procedures:

“I am 57 years old and giddy with joy at the results of my breast augmentation. I credit the Vectra 3D camera with giving me the courage to “go for” the larger size implants. I have always been a small breasted woman and am quite petite so it was difficult for me to imagine myself with larger breasts. I was concerned if I went for a D cup it would be too much for my frame. I work as a health professional and didn’t want to look like Dolly Parton. When I tried on the larger implants with the Demo Bra in the clinic I thought I looked ridiculous, but when I saw myself on the Vectra 3D camera, Wow-it made all the difference-I looked great! Thank you Edina Plastic Surgery for having the Vectra 3D technology!”

“I had wanted to get a breast augmentation for a long time and when I left my first appointment at Edina Plastic Surgery I literally cried from happiness and excitement. The ability to see my own body on the computer was very important to me. Not only was I able to see what the implants would look like when placed under the muscle, I was able to see what it would look like on me vs. what it looks like on others. For patients looking for unsurpassed expertise and the highest level of technology, Edina Plastic Surgery is the only place to go. I am extremely happy with my results and would recommend them highly.”