Tag Archives: breast

Latest Cosmetic surgery techniques 2014

The American Society of Aesthetic Plastic surgery meeting 2014

latest techniques

I was recently at the annual meeting of the American society for aesthetic plastic surgery (ASAPS) in San Francisco to see the latest cosmetic surgery techniques 2014.

There are about 6500 Board certified plastic surgeons in the US. Of those, only about 2000 are members of the American society for aesthetic surgery (ASAPS). This select group of plastic surgeons are those whose practice is primarily devoted to aesthetic plastic surgery- cosmetic surgery. Plastic surgeons from all over the world go to the meeting to learn the latest techniques in cosmetic surgery.

Fat injections to the face

The concept of fat injections, and by definition almost, stem cells, continues to be widely popular.

Plastic surgeons are increasingly injecting fat into the face for facial rejuvenation during a face lift. The fat seems to stay in the face for some patients and not for others. Cause unknown.

Fat injections into breasts

fat injections into the breast continues to be problematic. A recent study shows that fat injection by itself does not cause breast cancer. But… if you have a breast cancer, the fat injection will make the migration of  the cells faster and increase the chance of metastatic cancer- not good. Specially when 1 out of 9 women in the US is going to get cancer, getting metastatic cancer is a death sentence.

Fat injections into joints

The most exciting reports for fat/stem cell injections come from studies where fat is being injected into knee joints that have suffered injury. The torn cartilage actually seems to heal itself. Studies are being done now to reproduce the early study which cam from Pakistan…

Deep Vein Thrombosis

Deep vein thrombosis or DVT is a cause of pulmonary emboli which is the number one cause of death in cosmetic plastic surgery patients. Several protocols have been identified for dealing with patients at high risk for DVT. These are patients with previous history of DVT, women who are smokers, and women on birth control. Sitting in a particular position for a long time will also increase the risk.

Putting patients on blood thinners before the surgery was widely advocated as the thing to do. It now turns out the the risk of bleeding during the surgery outweighs the risk of actually getting a PE.

Bacteria around breast implants

Bacteria have long been thought of as being contributors to capsular contracture- a condition which occurs for unknown reasons around some breast implants. The bio-film, a film of bacteria that covers the implants was thought to be the main contributor to this “chronic infection”. Now it may be that the bio-film does nothing or may actually protect against the contracture! Essentially, no one knows.

Take home message

I have rarely come back from a medical conference more confused that when I went there. It seems that the science of cosmetic surgery is in a period of flux. What we thought was true, isn’t, and  what was not true is not true or is true.

What was it that former defense secretary Rumsfeld said recently,

“Reports that say there’s — that something hasn’t happened are always interesting to me, because as we know, there are known knowns; there are things that we know that we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns, the ones we don’t know we don’t know.”

 

 

Google Glass for plastic surgery

Google Glass the future in surgery

Last week I was at the American society for aesthetic surgery (ASAPS) meeting in San Francisco. The Keynote speaker was the man in charge of Google glass marketing, Ed Sanders, and he proved to be an interesting choice for elucidating the medicine of the future.

Google Glass is essentially an computer hooked up to a pair of glasses. The commands for different actions are given by voice, The glasses have a small screen on the upper right hand side which function as the screen and a camera is also included in the front. You can thus take photos with the glass and store or delete them by voice, surf the web and perform most of the functions that you would do with a normal computer.

Google glass

Google glass for plastic surgery

The applications of google glass to surgery and to cosmetic plastic surgery in particular are particularly exciting.  Mr. Sanders first gave the example of how he uses google glass in his daily life ( he has access to the glasses which currently sell for $6999 on E bay). He told of how his wife watches a game of soccer that their child is playing with the glasses, and relays that info in realtime to her husband who is often traveling. This does not require the cumbersome hand held devices which arguably can do the same ting now. In fact, Mr. Sanders could be watching the game while having a business meeting!

For the cosmetic plastic surgeon, the application of google glass in the operating room is most interesting. In plastic surgery, the surgeon is often the only one who can actually see what is going on  in the operating room. Be it a breast augmentation, face lift surgery or a tummy tuck, the assistants in the operating room usually see nothing and hence cannot be as responsive to the plastic surgeon’s need as in other more “open” surgeries.

The very same small incisions that cosmetic surgery patients want slows the surgery. With Google glass, the surgeon can be relaying the information of what he sees and what he is doing to the whole of the operating team. Paraphrasing the words of Mr. Sanders, Goggle glass gives others your point of view- it gives others your perception. Now we can all see the world through other peoples’ eyes.

Fat injections for breast enlargement

Fat Injections to Breasts

 

I have previously written about fat injections for breast enlargement but new information keeps on coming up and cosmetic plastic surgery patients continue to show interest in this plastic surgery procedure. here are photos from an article in the Aesthetic Surgery Journal of March 2014 by Drs. Spear and

 

Breast augmentation with fat injections  Breast augmentation with fat injections

Breast Enlargement with implants

The traditional methods of breast enlargement by either placement of saline or silicone breast implants under the chest muscles have been performed by board certified plastic surgeons since the late 1960 s.  Breast augmentation surgery has withstood the test of time. The surgery will produce consistent results and has a 98% satisfaction rate amongst patients.

Multiple variations of breast sizes and shapes are possible now that moderate profile implants, moderate -plus sized implants, and high profile implants are available from multiple breast implant manufacturers. These implants satisfy the needs of patients who typically are looking for at least a 2 cup size increase in their breasts.

Breast implants are foreign objects for the body and will form capsules of scar tissue around them which can become problematic at time. The implants can also break or rupture and in general need upkeep.

100% of patients will get a substantial improvement in breast size that is long lasting. Breast surgery with implants takes one hour.

Breast Enlargement wit Fat injections

In order not to have the problems that implants can sometimes cause, fat injection to the breasts has been advanced as an alternative surgery by some plastic surgeons.

Fat is removed by liposuction from one area of the body and injected into the breasts to enlarge them. Breasts are made up of a combination of breast glandular tissues and fat. Breast enlargement with fat injections adds to the fatty tissue already there.

Advantages of breast augmentation with fat injections

  1. Natural tissue and feel of breasts

Disadvantages of breast augmentation with fat injections

  1. Un-predictable loss of  breast volume- some of the fat always dies after a fat transfer. How much will die is unpredictable despite multiple techniques for handling and injection of the fat. Typically the latest study shows that only 30% – 40% of the fat injected remains within 6 months.
  2. Risk of development of breast cancer – The fat that is injected will have stem cells which when in the vicinity of breast tissue could cause breast cancer. This has been shown to occur in animal models. Even the latest plastic surgery article about breast enlargement with fat injections mentions that patients should be counselled about the risk of developing breast cancer!
  3. Small volume of breast enlargement possible.  In general breast augmentation achieved with fat injections only gives one cup enlargement of the breast. Typically about 250 cc fat is injected.  Within a few months after surgery only 30- 40 % of the fat remained. How much of that actually stays long term is unknown.
  4. Longer operative time. Typically surgery took 3 hours for fat injections.
  5. 10% of patients have substantial improvement in breast size, and 50% have a moderate improvement in breast size.

So,

Breast enlargement with fat gives minimal improvement in breast size ,has un-predictable results, of unknown duration, requiring three times longer surgery, and increases the risk of breast cancer.

No thanks- I’ll stick to implants for now.

 

 

 

Breast enlargement surgery revisions

Breast augmentation revisions

 

Breast enlargement surgery revisions are a tricky topic since its is a mixture of  a number of factors which are all prickly to consider for plastic surgeons and patients. This patient came to me complaining of differences in breast size after surgery elsewhere. The previous  plastic surgeon had placed two implants of markedly different sizes in her. I assume he had his reasons. She was unhappy with the difference in size and in the revision surgery I performed, I placed two implants of the same size for a great result.  However, breast revision surgery can be a tricky surgery due to previous scarring and changes in blood supply and the results can sometimes be worse! A careful analysis of the risk benefits of the cosmetic breast surgery must be performed. Even here the difference may not be noticeable to the untrained eye!

 

Before breast revision surgery

after breast surgery

 

 

 

 

 

Causes for breast augmentation revisions include

  • Technical error by plastic surgeon
  • Poor tissues  and tissue healing of patient
  • Lack of patient following directions post op
  • Complications of surgery
  • Perception of a bad result by patient
  • Perception of a bad result by plastic surgeon
  • perception of results by everybody else
  • Bad luck

Technical errors

Problems arising from technical errors by the surgeon at surgery include

  • rupture of breast implants
  • mal-position of breast implants
  • Inadequate hemostasis leading to bleeding

Poor Tissues

These problems arise from poor genetics on part of  patients.

  • Loose skin /poor elasticity
  • Thin skin / lack of strength
  • Reactive skin / skin which does not heal properly

Poor follow up

Specifically poor follow up of the plastic surgeon’s directions. After breast augmentation massage is essential. Lack of massage can lead to capsular contracture and breast hardening needing a revision surgery.

Complications of Breast surgery

  • Bleeding
  • Infection
  • Nerve damage
  • Implant deflation
  • Scarring
  • These are all known reasons for complications of surgery amongst many others

Perceptions of surgery result

Perceptions of defects ion the surgery results and the reason to change the surgical result with another procedure differ amongst

  • Plastic surgeons- for whom minor defects in the surgical result are acceptable based on the patient’s anatomy and the naturalness of the result
  • Patients – who may have expectations that are not real. Often patients forget that their two breasts are not exactly the same and never will be
  • Friends and family of patients may say something regarding the surgery result which even the patient and plastic surgeon were unaware of .

Bad luck

Sometimes the reason is just bad luck and no known cause can be found and there is no one or anything to blame!

In summary- beware of revisions and listen to your plastic surgeon. Sometimes the risk is just not worth it.

 

 

Mommy makeover-Breast-Abdomen plastic surgery

Mommy makeover

Mommy surgery before

                                                                                    Mommy surgery after

Cosmetic Plastic surgery of breast and abdomen after childbirth or massive weight loss is often called a Mommy makeover. Recently a patient asked me if in fact it was not a ‘Mummy makeover” since patients are often bandaged up like mummies after this cosmetic surgery duo!

 

Changes  to body after pregnancy or weight loss

Several distinct but common changes occur to the body after pregnancy or weight gain and loss.

  • Fat Deposits – occur in the flanks, love handles, back and abdomen
  • Loose skin – as a result of stretching of the skin leads to loss of elasticity of skin and its hanging down
  • Breasts become smaller and may also become droopy due to loss of volume and elasticity- in women and men!
  • Arm skin becomes droopy but fat accumulation in the arms may increase
  • Facial  and neck skin may droop giving an older look

 

Surgery of the abdomen and breasts

Mommy makeovers typically include

Other procedures may include

Mommy makeovers will take between 3.5 to 4.5 hours depending on the type of surgery that needs to be performed. Though some surgeons like to continue to operate on other body areas at the same time, I find that 8 hour cosmetic surgeries are just too much for me. They are also way too much for the patient! I prefer to divide up the surgeries into more reasonable segments, sometimes just by a few days, to allow easier healing for patients.

Recovery from Mommy makeover

After a mommy makeover the recovery will depend on the number and type of procedures performed as well as all the usual reasons for differences in individual healing. Although patients are up and walking the same day as surgery, typically it will take about 10-14 days before patients are back at work. I have had patients return as soon as 3 days after surgery and as long as 14 days.

Here is a link to a patient returning to the office after only 12  hours following mommy surgery;  http://www.youtube.com/watch?v=HCqqri8Yt5M&list=UUGHAP0wTkrkJuRo1yN1CFjg

Full healing though will take about 4 months though their healing is gradual and progressive.

Mommy makeover surgery gives women a new look . A new look for their bodies and a new look on life.

Bariatric surgery in children

Bariatric surgery in children- is it right?

 

There has been a huge explosion of bariatric surgery as a weight loss technique in the US. I have operated on many such patients as a board certified plastic surgeon. Cosmetic surgery for patients who have lost large amounts of weight include removal of excess skin from the abdomen (abdominoplasty), thigh (thigh lift)  and arms (arm lift). Weight loss patients also need to have breast lifts with or without breast enlargement with implants.

chubby kids

Here is a previous blog about this topic. https://www.tavmd.com/2010/11/02/after-weight-loss-comes-the-surgery-arm-lift/

Whereas bariatric surgery for adults has proven safe and effective now there is a growing movement to perform weight loss surgery on children. In the US children as young as 14 are routinely patients for this type of surgery. In Saudi Arabia one bariatric surgeon has performed weight loss surgery on over 1500 children, the youngest being 3 years old!

Reasons for weight loss surgery

Being overweight causes significant medical problems for patients including,

  • Diabetes – over 50 %  of obese patients have Type 2 diabetes
  • Hypertension – and resulting heart disease
  • Sleep apnea – inability to sleep lying down causing breathing to stop
  • Joint pain – from carrying extra weight
  • inability to exercise
  • Cosmetic appearance suffering

These same medical problems occur for children in addition to social alienation specially due to lack of participation in sports and other activities.

Reasons not to have bariatric surgery

There are a number of possible complications to consider for patients who want to have weight loss surgery.

  • Infection- 2% rate
  • Leakage from intestines – 2% but with grave consequences
  • Bleeding – 10% rate
  • Malnutrition from mal-absorption of nutrients

amongst many other risks of surgery.

In children though the severe weight loss that occurs may cause problems with brain development and sexual maturation. Both these activities require sufficient energy and good nutrition.

 

The surgeons who perform weight loss surgery in children, argue that they must use all techniques available to improve the health of these children. it is true that many of these obese children are sick and will have remarkably shorter lives. Some may even gain notoriety in one of the many TV shows about the morbidly obese.

Plastic surgeons will also need to be on board with this idea. Sooner or later a parent of a child who has lost a large amount of weight and now has that weight hanging down will come forward and ask for a tummy tuck on a 10 year old or a thigh lift. Is that to be accepted medical practice?

Obesity in children occurs in 14% in developed countries and 9% in underdeveloped countries. Places like Saudi Arabia , Qatar and the gulf countries have rates of obesity much higher probably due to genetic factors also. The whole world is actually getting fat and our children are getting fat faster than is healthy for them.

Changes in nutrition, eating cultures, activity and parental ability to say NO to chubby youngsters will all be more important in years to come.

 

 

Breast Augmentation Implants

Confusion about breast augmentation implants enlarged

 

The other day a patient came for consultation for breast augmentation. I have written extensively about these procedures in the past. Here are a few of those posts;

https://www.tavmd.com/2011/12/08/how-to-choose-breast-implant-size/

https://www.tavmd.com/2010/11/04/saline-breast-implants-or-silicone-breast-implants/

https://www.tavmd.com/2010/12/12/breast-enlargement-surgery-with-implants/

A great deal of confusion has arisen over the past 20 years with respect to breast implant sizes and types.

1. Saline vs Silicone

Initially there were just two types of implants;   Saline and Silicone. The shapes were the same; what we now call moderate profile implants.  Patients choose between volume they wanted and the type of material.

Then came new types of textures.

2. Smooth vs textured

Patients ( or rather their plastic surgeons) could now choose between smooth silicone implants and textured implants. The idea behind textured implants was to decrease the rate of capsular contracture or scar formation around the implants. There was no difference in shape of implants with textures…initially.

smooth-round-implants-

            siltex gel family plus ultra

3. Round vs Teardrop

Textured implants were noted not to move! So the breast implant manufacturers came forth with tear drop or “anatomic implants” which supposedly gave a more natural form to the implants. However it was noted that all implants in the body will have some tear drop shape due to gravity anyway. Also these anatomic implants sometimes flipped giving a very “un-anatomic” shape to breasts.

tear drop breast implants

 

 

 

 

 

 

4. Low, Moderate, Moderate plus, high profile implants

More recently there has been an explosion in breast implant shape options. The are now different profiles, or base diameters, for every volume of a breast implant. The same volume can now look very different indeed.

Breast implant profile

 

 

 

 

 

Here is an example of just a how different an implant of the same volume can look.

 

Given the huge choices that now exist in breast implant shapes, types, textures and volumes, things are now complicated. It is no longer enough to say i want a “350 cc implant”  . Let your board certified plastic surgeon choose the right implant for your body. That should be based on your

height,

weight,

size of hips

chest wall

amount of breast tissue

quality of the skin of your chest

experience of the surgeon

your preference for materials based on risks and upkeep, size of scars, just to mention a few of the variables.

Breast augmentation surgery with implants; Its complicated.