Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Category: Breast Implant Removal


Breast lift: Fear not the scars!

January 23rd, 2018 — 9:57am

I see many, many women for implant removal after years of being unhappy with their breast implants.  Many of these ladies consulted a plastic surgeon for sagging of the breasts and instead of ending up with a breast lift, ended up with breast implants.  Often the explanation for this is that the patient did not want the “scars of a breast lift”.

So here’s the deal on breast lift scars.  Yes, they are more extensive than the scars from an augmentation but,………………………..in the vast majority of patients, the scars fade to near no-big-deal status in about a year.  Check out the example shown.  The top photo is before a lift, the middle photo about 6 months post op and the bottom photo is one year post op.  See the scar?  Well you hardly can see the scars in the bottom photo.  This is not an exceptional case.  This is usually how it goes.  Now there are some rare individuals who scar badly because of their particular biology but they are the exception.

So………….if you are saggy, you should get a lift.  If you are really small you should get an augmentation with either an implant or fat transfer.  As with everything, the correct diagnosis should lead to the correct treatment.

Thanks for reading and follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift, Scar

More on Breast Implant Illness

November 28th, 2017 — 11:41am

If you have not read my initial post on Breast Implant Illness, I recommend you do so now.  In fact, I implore you to read it.  Here’s the link.  https://www.sowdermd.com/blog/breast-implant-illness/.

I belong to a few physician only message boards and breast implant illness has been a hot topic in the past few months.  It is interesting to see what other plastic surgeons think and especially what physicians in other specialties think about this controversial topic.  These boards encourage free discussion without anyone being shut down, banished, blocked, or slammed on social media.  This makes me grateful to be part of a group of professionals that value serious and candid discussion of complicated issues.  Here I present a few thoughts I have curated from the past several months.

Dry eye and breast implants:  Many, many ophthalmologists weighed in on this one.  The consensus is that dry eye is very common in middle aged women.  Women are 10 times more likely to develop dry eye. One doc said 80% of his female patients over 50 had dry eye.  Conditions that contribute to dry eye include previous eyelid surgery (blepharoplasty), too much screen time, and some medications including SSRI antidepressants.  Implants?  No support for that theory from any of the ophthalmologists.  My ophthalmologist, who recently did my cataract surgery, looked at me like I was nuts when I asked him about implants and dry eye.  The eye docs also reminded us that silicone products are used extensively in ophthalmology:  punctal plugs for dry eye, silicone stents for nasolacrimal duct reconstruction, silicone buckles used to treat retinal detachment, silicone oil used as a replacement for vitreous humor in the posterior chamber (eyeball), silicone intraocular lenses used after cataract extraction and finally silicone contact lenses.  WOW.  That’s a boat load of silicone.

When docs congregate is it wisdom of the crowd or groupthink?

Mold and biotoxins:  General consensus from internal medicine and infectious disease is that patients ill with systemic fungal infections should be in the intensive care unit.  None of the plastic surgeons, with one  exception, had seen a case of mold growing in a saline implant.  I added up the years of practice and it came to about 250 years.  That is a lot of experience.  One plastic surgeon who has written a book on BII seems to see mold and biotoxins wherever she looks.  She puts her implant removal patients on extensive anti-fungal therapy post-operatively.  She has extensive experience with mold and biotoxins but has not been published in any recognized peer reviewed medical journals.  Her reason for not doing so has something to do with being targeted by Big Pharma.  Hmmm.

Autoimmune issues:  There were several rheumatologists weighing in on silicone triggered illness.  Their opinions varied from no evidence whatsoever to there are some individuals who are genetically susceptible to autoimmune diseases (this is well known) and exposure to silicone may trigger the onset of disease in these individuals.  It was noted that women are affected by autoimmune disease about 4 times more commonly than men.   One infectious disease doctor thinks breast implants caused slceroderma (which is very, very serious connective tissue disorder and is usually fatal) in 6 of his patients.  He recommended checking how wide an implant patient can open her mouth to diagnose early perioral and TMJ fibrosis and scleroderma.  The rheumatologists thought that this doc was really out there.  The plastic surgeon who has written a book on BII, who is not a rheumatologist, stated that rheumatoid arthritis is caused by an intracellular mycoplasma infection and she can cure rheumatoid arthritis and scleroderma with non-conventional therapy.  None of the rheumatologists believed her.  They all wondered why she had not published her results in a peer reviewed medical journal.  Same answer.  Big Pharma.

Breast Implant Associated Anaplastic Large Cell Lymphoma:  It is rare.  It is treatable if caught early.  It is really creepy.  It is associated with textured breast implants and/or tissue expanders. The plastic surgeon who wrote the BII book stated that BIA-ALCL was the most common cause of death in her implant patients prior to 2005.    It was pointed out by several other doctors that BIA-ALCL was recognized as a disease around 2012.

Other stuff:   Many of the internal medicine docs, ER docs, pain specialists, psychiatrists and OB-gyns weighed in on so called functional and somatic disorders including fibromyalgia, chronic fatigue syndrome, pelvic congestion, brain fog, anxiety, poor memory. depression, and malaise as primarily affecting women and pointed out that the vast majority of these women with these disorders do not have breast implants.  This chatter of functional and somatic disorders made me think of the Freudian disorder of “hysteria” of yesteryear which was supposedly caused by the uterus wandering around looking for a baby.  This sort of stuff gets my hackles up a bit, being a woman and all.  One doctor wondered if there were any male to female transgender individuals with breast implant illness.   Now that is a great question.

Future research:  Everyone pretty much agreed that a large, multi-center, long term (10+ years) may help answer many questions about breast implants.  Several plastic surgeons, myself included, pointed out that the dismal long term follow-up in previous studies was in part due to patient non-compliance with follow-up.  I know this will make a lot of people angry but it is really true.  Back when gel implants were only available through studies like the one I participated in, once patients had their coveted gel implant, they were gone, gone, gone.  My follow-up for the McGahn study was about 80% which is really high because my staff and I pestered the participants mercilessly to come in for their appointments.  Once doc suggested maybe a prison study using inmates with really long sentences.  Maybe this could be Orange in the New Black meets Extreme Makeover?

Breast implants in general:  Whoa, were there some strong opinions about this.  Many, many non-plastic surgeons think any woman who gets implants is by definition is a mentally impaired bimbo.  One doc divulged that his wife was going to get implants to treat her postpartum atrophy and boy did he get an earful!  Many of the male doctors assumed that she was preparing to leave him once he had paid for her surgery!  Such cynicism.  But there was one family practitioner who has had the same set of implants for over 30 years (!) who said they absolutely changed her life.  She went from a wallflower to a confident young woman.  She even credits her implants for giving her the confidence to apply to medical school!

Plastic surgery and plastic surgeons in general:  Some of the docs think that any sort of appearance altering surgery (except for obvious reconstructive procedures) was morally and intellectually bankrupt.  This was an opinion shared by many anesthesiologists!  Weird, huh?  I wonder if my anesthesia group thinks they are slumming to work in my OR?  I guess I should ask.   Many of the male docs stated they didn’t need plastic surgery because their female partners found them totally smokin’ hot just the way they are.  Hmmmm.  Some of the docs think we plastic surgeons are a bunch of money grubbing fools.  Oh well.  I chalk that one up to jealousy.  ; )

So there you have my carefully collected and curated review of some wild times on the doctor only message boards.  You too can join a doctors only message board but first you have to finish medical school.

Thanks for reading and check out my Instagrams @sowdermd and @breastimplantsanity.    Dr. Lisa Lynn Sowder

 

 

Breast Implant Illness, Breast Implant Removal, Breast Implants

I have oldish breast implants. Should I get an MRI?

June 29th, 2017 — 3:09pm

MRI is the best test for detecting implant rupture (other than surgery) with a very high accuracy rate, much higher and mammogram, ultra sound or physical exam.  I think it is prudent for patients with gel implants, say 10 years old or older to get an MRI to make sure there is not a silent rupture.  If a patient has saline implants, there is no possibility of a silent rupture so an MRI would be worthless unless there is another reason for MRI (cancer detection for example).  I often have patients who are coming in to have their old gel implants removed regardless if they are intact or ruptured and in those cases I don’t really think an MRI is absolutely necessary.  Yes, it is nice for the surgeon to know ahead of time if there is a rupture but honestly, I approach every implant removal as if the implant is ruptured.  I try to do an en block resection and have everything ready in the event the implant is ruptured and there is silicone spillage.  We have special suction set up for ruptured implants and also some old fashioned surgical lap pads ready for clean up.  And even with a rupture, it’s usually not as messy and one might think it would be.  Even the messiest cases almost always allow the surgeon to scoop out the gel and then get all of the capsule.

“Just relax. It doesn’t hurt one bit but it is a little noisy.”

In Seattle at Swedish Medical Center, as of 2017, an out-of-pocket MRI to rule out breast implant rupture is about $1300 – $2200.  If you pay up front, you get the lower price.  The actual procedure requires the patient to lie prone (on the stomach) with the breasts hanging though these little openings in the MRI bed.  It’s important to lie really, really still for a good image.  MRI does not involve any irradiation so don’t worry about that but it can be kinda noisy with pings and dings.  When I had my knee scanned, they gave me earplugs. And after an MRI, please make sure you get the radiologist report.  It is more useful than the actual MRI itself.  Plastic surgeons are not experts at reading MRI’s although we can usually see an obvious rupture. More subtle things may not be obvious to us.  

Thanks for reading and if you are concerned about your oldish gel implants and an MRI will either ease your mind or prod you into action, you should get one!  If are ready to bid goodbye to your oldish implants regardless of their status, come on in.  I’m here to help!

Thanks for reading!  Dr. Lisa Lynn Sowder.    Follow me on Instagram @sowdermd and @breastimplantsanity.

Breast Implant Removal, Breast Implants

Clinical research is really, really difficult!

June 19th, 2017 — 6:19pm

That’s a lot of paper work!

I was doing some office spring cleaning the other day and came across two file boxes of patient charts from a breast implant study I participated in years ago. The study was the McGahn Silicone Breast Implant Adjuvant Study which was being conducted to gather information about the efficacy and safety of silicone gel breast implants which had been taken off the market in the early 1990’s. I enrolled 56 patients over about 9 years and had a study completion rate of about 80%. I remember how difficult it was to get patients to come in for follow-up although that was part of the agreement in order for a patient to participate. The follow-up was free but it still took phone calls, letters, e-mails and a little begging to get some patients to come in. During this study one of the new implants, the 153 anatomic gel, was found to have a very high early rupture rate and was quickly taken off the market. I had several patients with this implant that required removal and replacement but I had no other serious adverse events. I was happy to participate in this study even though it was a ton of work for me, my patients and my staff. It was many, many surgeons participating in studies such as this that lead to the new generation of gel implants being put back on the market and made available to patients for breast enhancement or reconstruction. Some groups that are pushing to have breast implants banned have criticized these clinic studies and have pointed out the less than perfect follow-up. I cannot speak for other study participants but we worked very, very hard to get our follow up number. I think that the difficulty of clinic studies is not appreciated by those who have not participated either as investigators or patients. And the think most of the lay public is clueless on this topic. I have done a lot of research in my career, mostly lab research in college, medical school and residency and mostly clinical in practice and I can say that I think lab research is a lot easier!

Thanks for reading! Dr. Lisa Lynn Sowder
Follow me on Instagram @sowdermd and@breastimplantsanity

Breast Contouring, Breast Implant Removal, Breast Implants

Breast Implant Illness Fear Mongering

May 23rd, 2017 — 10:01am

I came across a post on the Breast Implant Illness Instagram site recently that really made me really cranky.  And it made me want to holler, “STOP THE FEAR MONGERING!”

Let me walk you through this image.  Obviously it is a lady and in the upper left corner you can see her breasts which have been removed and placed on a serving tray.  Um, very edgy.  And you can see the chest width slash across her chest where her breasts used to be.

The Breast Implant Illness community is on a mission to ban all breast implants, saline and gel, for enhancement and for reconstruction.  Their modus operandi is to scare the bejesus out of anyone who has breast implants, has had breast implants or is thinking about getting breast implants.  I find their IG posts mostly rather boring especially when it is the same set of moldy and/or ruptured implants that have been posted half a dozen times already.  But this post really crosses the line.  This post implies that breast implant removal requires a double mastectomy and an incision across the width of the chest.  I have been doing breast implant removal for over 26 years and I have never, make that NEVER had to do a mastectomy or use an incision of this length.  And most of my patients look better after parting ways with their implants.  I see ladies in my office frequently with old, hard, nasty implants who have suffered with pain and tightness and embarrassment for years but have been fearful to seek implant removal because they equate implant removal with mastectomy. Disinformation like this IG post feeds that fear and is a disservice to women.

Posting this sort of rubbish must provide a certain type of person with a feeling of satisfaction and self worth.  As for me, I prefer to satisfy myself by providing careful, competent and reality based care for women seeking breast implant removal.  If you want to see what breast implant removal really entails, I have a ton of information on this web site and also my IG:  @breastimplantsanity.

Thanks for reading.  Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implant Removal, Breast Implants, This Makes Me Cranky.

Louis Pasteur and why you shouldn’t worry too much about mold or fungus in saline breast implants.

April 25th, 2017 — 9:49am

Louis Pasteur in his lab.

I have had a lot of questions lately about mold and fungus in saline implants. I have even read online that some people think intact sterile saline breast implants can somehow get filled with germs.  When I read stuff like that my thoughts go to the great French Scientist Louis Pasteur and your thoughts should too.   Pasteur contributed many, many great inventions and discoveries.  If you drink milk or wine, you can thank Pasteur for the safety of those two nourishing beverages.  If you and your children benefit from vaccinations, you can thank him for that too.  If you have pondered the deeper meaning of stereoisomers in your organic chemistry class, thank Louis.

But enough about that stuff and lets talk saline breast implants. One of Pasteur’s greatest contributions was the debunking of the myth of spontaneous generation.  You see, way back then before microscopes, microbes could not be seen.  When something would ferment or rot or putrefy or suppurate (I’m making myself a little sick), it was believed that the agent of this process just materialized from, well, nothing. The noxious effluvia that generated the aforementioned conditions was referred to as miasma.

In a series of really elegant experiments using some custom made glass vessels, Pasteur showed that a liquid rendered sterile by heating would remain sterile unless it came into contact with something that had not been sterilized.  The infectious agent had to exist in the environment.  It just did not spontaneously generate.  He figured all of this out before even seeing those nasty little germs under a microscope.  Very smart guy.

So what does this have to do with mold, fungus or bacteria in saline breast implants?  Every reasonable implant surgeon on the planet uses a closed system to fill an implant. The saline that goes into the implant comes from a bag of sterile saline for intravenous use into a sterile length of IV tubing and into the sterile implant.  The saline is never exposed to the air which can harbor spores and other creepy things we cannot see with the naked eye.  No contamination means the saline in the implants stays sterile.

What about the implant pocket?  We know that bacteria are present in cases of capsular contracture.  The current working theory of capsular contracture is that it is an inflammatory response caused by biofilm caused by certain types of bacteria.  One type of biofilm causing bacteria, Staph epidermis, is ubiquitous.  A conscientious surgeon does everything he/she can to help minimize the exposure to the implant to the environment, including the patient’s skin, prior to insertion.  Another type of bacteria could be one cause of the very creepy BIA-ALCL and again a conscientious surgeon will use techniques to minimize contamination.   So yes, we know the breast is not a perfectly sterile environment.  The more we learn about the microbiome that is us the more we realize that healthy people co-exists with a lot of “germs”.  If the presence of a microorganism meant illness, we would all be at death’s doorstep.  In fact, our mitochondria (tiny organelles in our cells that generate energy) are likely the descendants of bacteria that some single celled organism co-opted.  God, I love cell biology.  Don’t you?

What about saline implants that leak from a tear or from the fill valve?   Could microorganisms creep in there?  Yes they could but they will need something to eat.  Normal saline, which is used to fill saline implants has no energy source. Those microorganism are going to go pretty hungry.  I am aware that here are some really weird life forms that seem to exist in the most hostile and unnourishing environments – bubbling mud pots in Yellowstone, deep ocean sulfuric steam vents, etc – but me thinks that those critters aren’t going to show up in a beast implant.

I have taken out a bajillion old saline implants and, I swear on a stack of plastic surgeon journals, have never seen one that was contaminated with fungus.  I have seen a few with little floaters that I cannot explain.  When I’ve sent the saline in such implants, the cultures have come back no growth.  What does that mean?  I don’t know.  There I said it:  I don’t know.  Could a little speck of something floating around in an intact saline implant destroy a person’s health?.  I don’t know but it seems unlikely to me unless that little speck was Polonium-210.

I have had a quite a few breast implant illness patients who were absolutely bummed that their implants were not contaminated because they had become convinced that they were.  Yes, I have seen photos of really nasty and moldy implants out there in cyberspace and yes it is obvious that some implants are contaminated and that there are unreasonable surgeons who don’t used a closed system but I think those cases are rare. Nobody posts photos of old, pristine saline implants (except me on my Instagram @breastimplantsanity).  Pristine saline implants are boring.  And I promise, cross my heart, if I take out a nasty implant filled with fungus balls, I will let you know.

Soooo, if you think your implants are moldy, you could be but probably are not right.   But as anyone who knows my practice, I will take implants out for any reason.

Thanks for reading and you should read up on Louis Pasteur.  The contributions he made to science are nothing short of amazing.  Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Breast Contouring, Breast Implant Illness, Breast Implant Removal, Breast Implants, Stuff I love

BIA-ALCL

March 24th, 2017 — 3:24pm

Updated June 27, 2107

Breast Implant Associated Anaplastic Large Cell Lymphoma first crossed my radar screen in 2011.  At that time, there were 34 reported cases out of an estimated 10 million implant patients worldwide.  Recent reports indicate that this really weird and poorly understood disease may still be very rare but not as rare as we once thought.  For a good review of BI-ALCL check out the FDA information.

If you have breast implants, I implore you not to freak out about this. BIA-ALCL is not breast cancer. BIA-ALC is cancer of the breast implant capsule.  How bizarre is that???  BIA-ALCL has signs and symptoms.  It doesn’t just show up in a normal implanted breast.  The signs and symptoms include breast pain, a lump or mass in the breast or armpit, and/or fluid around the implant.  Should any patient with implants have any of these issues, she should be evaluated.  

If BIA-ALCL is diagnosed in a timely fashion, removal of the implant and the implant capsule is almost always curative.  Some patients, however, will need chemo and/or radiation.  Any yes, there have been a handful of deaths.  All of these deaths were in women who had a delayed diagnosis and/or delayed treatment.  As is the case in many illness, awareness is key.

It looks like BIA-ALCL occurs only in women with either textured implants or a history of a prior textured implant or tissue expander.  I have used very few textured implants over the years and don’t plan on using them in the future until all of this is sorted out.  And it gets even weirder.  BIA-ALCL seems to occur in clusters.  Australia and New Zealand have a higher incidence than North America or Europe and there are some parts of the world where it has never been seen or at least reported.  This geographic variation may reflect some genetic susceptibility to the disease and/or there may an environmental/infectious component.  And there’s more weirdness.  It probably isn’t the actual texture of implants that is the issue but rather the much increased surface area that a textured implant involves.  An increased surface area provides a larger area for inflammation and/or low grade infection from certain types of biofilm forming bacteria (this is a whole topic of it’s own and I am working on a blog about it).  One thing that is clear is that BIA-ALCL does not occur without symptoms.  There is currently no recommendation that women with unproblematic textured implants have them removed and replaced with smooth implants. 

MD Anderson (the cancer research and treatment Mecca) has devoted an entire research lab to BIA-ALCL and I expect we will have more information on the etiology and optimal treatment of this weird and rare disease.  

I have never seen a case of BIA-ALCL although last year I thought I had a case.  This lady had textured implants done in Thailand several years earlier.  She had a chronic fluid collection and the weirdest, thickest, gnarliest capsule I have see in 25+ years of practice.  It took me two hours to get the monstrosity out.  Examination of the fluid (cytology) and the capsule (pathology) was negative for ALCL.  I was the happiest surgeon in the world when those reports came across my desk.  You can see a photo of this capsule on my Instagram @breastimplantsanity, January 18, 2017. 

If you have implants and any of the signs or symptoms mentioned above, get thee to a plastic surgeon for evaluation!  In fact, if you have implants and haven’t seen a plastic surgeon in awhile, it would be a good idea to do so. 

Thank you for reading and I would be honored if you would follow me on Instagram @sowdermd and @breastimplantsanity.   Dr. Lisa Lynn Sowder 

Breast Implant Removal, Breast Implants

Breast Implant Illness – a seasoned plastic surgeon’s humble opinion. Updated October, 2017.

February 28th, 2017 — 2:24pm
worried_1375864c

“This stuff online just scares me to death.”

Warning:  This is a long one.  A really, really long one.

I recently counted up all of my operations for 2016 and I removed more breast implants than I put in.  Last year I removed implants from 44 women. Twenty-seven of those women had removal for the usual reasons:  “I don’t like them anymore, they make me look fat, they are too hard, I finally divorced that s.o.b., I’m becoming a nun, etc.”  But 17 women had breast implant removal because they believed their implants were ruining their health.  I have gotten to know these patients (and many more from prior years) and their families, have heard their concerns, looked at their medical histories, examined them and removed their implants.

I have given this topic of breast implant illness a lot of investigation and thought.  This blog represents my opinion based of what I have read, what I have heard from patients and my colleagues, what I have seen in the exam room and OR in over 25+ years of practice.  I recently presented a paper on breast implant illness for the Northwest Society of Plastic Surgeons.

A very brief history:  Back in the early 1990’s, just when I was entering private practice, silicone gel breast implants came under intense fire for being linked with health problems, notably autoimmune diseases like lupus and rheumatoid arthritis.  This concern led to silicone gel implants being taken off the market in the United States for cosmetic purposes.  It also lead to large amounts of money finding its way into the pockets of trial attorneys, the bankruptcy of silicone supplier Dow Corning, and at least one case of a woman removing her own implants with a razor blade in a fit of anxiety.  This moratorium on gel implants lasted well over a decade.  For over ten years, the only gel implants I used were used in one of the several studies of gel implants in which I was an investigator.  Finally, in late 2006, after exhaustive analysis of many implant studies, gel implants were again approved by the F.D.A. for cosmetic use.  Interestingly gel implants remained available for post-mastectomy reconstructive use during the moratorium.  I always thought it was odd that the it was okay for patients with a history of breast cancer to have the same silicone gel implants that were deemed too risky for a healthy woman.  And I thought it was odd that the FDA was not recommending the removal of implants that were deemed unsafe for use.    So did breast cancer survivor and congresswoman Marilyn Lloyd who asked in 1992, “How scientific is the FDA’s decision that no woman should have implants put in, and no woman should have them removed?”  Good question.

Fast forward to the past few years and I start seeing women with implants who are convinced their implants are ruining their health.  About 1/3 of them have saline implants which were never taken off the market.  These breast implant illness ladies tend to be a little younger than my average breast implant removal patients.  They tend to embrace alternative medicine and distrust the medical establishment.  And they are all connected to the online breast implant illness community.  And another thing I find so odd – some ladies with all of these symptoms often look so healthy and they ask questions like “When can I go back to teaching Pilates?”,  “Can I hike the Appalachian trail two months after surgery?”, “Is it okay if I go snowboarding after a couple of weeks?”.

Many of the symptoms of breast implant illness are a vague and/or very common complaints.  Most of these symptoms have significant overlap with the most common complaints related to common health issues including menopause, hypothyroidism, depression, anxiety, general aging and the human condition.  And some patients blame conditions with very clear etiology on their implants.  A few examples include plantar fasciitis (an overuse injury of the foot seen in runners and dancers), chronic Epstein-Barr virus (cause by a ….. virus!), Lyme disease (a tick-borne bacterial infection) and dental cavities (caused by the acid produced by sugar loving bacteria).    And then there are the fringe disorders such as leaky bowel, chronic candidiasis, multiple chemical sensitivity, etc.  To quote the very smart Dr. Marcia Angell, former editor of The New England Journal of Medicine: “These much discussed but elusive disorders remain entirely speculative …. they are variously said to consist of just about every symptom imaginable in biologically improbable and shifting combinations.  Since they have yet to be objectively and consistently defined, it is impossible to study whether they have anything to do with breast implants.”  For some really good reading and a wonderful primer on the scientific method and statistical analysis by Dr. Angell, you should really check out her book:  Science on Trial:  The Clash of Medical Evidence and the Law in Breast Implant Cases by Dr. Marcia Angell This book is a decade old but its lessons are very timely.

If a patient goes to enough alternative health providers, they will eventually find one willing to take their money to tell them that they have one, two or more of these disorders and that it’s their implants that are at fault.  They may even offer $50,000 worth of testing and treatment (as reported by one of my plastic surgery colleagues). I have one patent who saw seven naturopaths before she found one who told her what she wanted to hear. Did she ever go at an actual rheumatologist for her autoimmune symptoms?  Of course not.  She could not trust a rheumatologist.  I have patients who pay hundreds of dollars for hyperbaric oxygen treatment that does not involved a pressurized capsule.  Ladies, if you are sitting in a room without an airlock you, are not getting hyperbaric oxygen!   Several months ago I saw a middle aged lady who after reading one of the breast implant illness websites was worried that her implants were causing her sleep disturbance, brain fog, low energy and general feeling of malaise.  Then she told me that those symptoms had recently resolved.  Upon further questioning, she told me her primary care doctor had diagnosed depression and had put her on an SSRI.  After a week or so on medication, she was feeling so much better.  And her implants not only looked fine, they looked great!  This lady did not have breast implant illness.  She had depression.  She needed medication and a boost in her seratonin, not an operation.  Oh, and then a few weeks ago my nurse took a call from a lady who was in a panic about needing her 10+ year old implants removed the next day before they killed her.  I was scrubbed in the OR and could not talk to her.  My nurse explained that she would need to come in for a consultation and that it may be a few weeks before I had the OR time to do her surgery.  She berated me, my nurse, the universe and then hung up before we could get contact information on her.  I have no idea what has happened to her but whoever in the BII community scared her silly about her breast implants did not do her a favor.

I regularly visit some of these breast implant illness websites and Facebook groups and Instagram and to be very honest, I find so much of the content just outrageous.  Several of my patients noted the onset of their breast implant illness after stumbling into one of the breast implant illness communities.  Is this the nocebo effect (the placebo effect’s evil twin a.k.a. the power of negative thinking)?  Maybe.  One thing I find very interesting is the number of women who have their implants removed and still feel ill months and years later.   Do they think that maybe their problems were perhaps not related to their implants?  No, they are told that even after removal of the implants and scar tissue, the fact that they ever had implants condemns them to a life of ill health as if implants somehow have thrown a biological switch from healthy to sick.  Some of these posts are just heartbreaking to read. And most of the advice being given by non-physicians has no basis in reality based medicine.  And then there is the dismissal of surgeons like me who spent their youth training in medicine and surgery (I completed my residency training at the tender age of 35), took the Hippocratic Oath and devote most of their waking hours doing their best to provide competent and conscientious care to patients.  I take it a little personally when someone is more receptive to the advice or opinion of someone on Facebook who posts photos of themselves having a coffee enema that to the advice of a fully trained and experienced plastic surgeon.  And then there are those who feel that banning breast implants and denying their access to women who either want to enhance or rebuild their breasts is somehow empowering.  Give me a break.  I get cranky just thinking about it.

Do I think breast implants can cause problems?  Oh yeah.  For a small number of unlucky patients, breast implants can be a mess.  Although implant construction has improved over the years, implants can still get hard, they can become too loose, too tight, too low, too high, too medial, too lateral, too anything.  They can develop thick scar capsules that can cause distortion and cause pain in the breast, chest wall, upper extremities, neck and back.  Implants can leak which will deflate a saline implant.  A leak or rupture of a gel implant can result in silicone granulomas of the breast and even the chest and abdominal wall.  And then there is the more recent worry of ALCL which is looking like it occurs exclusively with textured implants but the jury is still out on that one.  I sometimes see patients who have had 3, 4 or more operations related to implant problems.  And yes, I am the original surgeon on a couple of them.  And yes, if a woman has breast implants she will likely need an implant related procedure sometime in the future.  And one more thing – IMO the bigger the implants, the bigger the problems.  That’s why you don’t see any large casaba melons in my photo gallery!  And you will also see a lot of non implant breast surgery in my photo gallery.  If I can make a breast look nice without an implant, I will encourage the no-implant route.

Do my implant removal patients feel better after removal?   Most, but not all of them, do feel better.  One interesting finding in almost all of my breast implant illness patients is a tight implant capsule.  Sometimes it is very thin and fragile and sometimes it is thick and even calcified but they are always really, really tight.  That tight scar tissue can cause discomfort that can include the entire upper extremity, chest, back and even the neck.  Removal of the scar tissue capsule (a procedure called a capsulectomy) will often result in a lot of relief.  Sometimes in surgery, I think I can hear the pectoralis major muscle breath a sigh of relief as I remove the tight scar tissue.   Also, capsule formation is an inflammatory process and we all know that inflammation is the new bogeyman.  And then there is the placebo effect.  I have a deep belief and deep respect for the mind–body connection.  Some patients fret every day about their implant’s effect on their health.  After removal, they often report just feeling better all over.  Is it that they don’t have the constant worry anymore or something else?  I really don’t know.  I can never guarantee what effect breast implant removal will have on a patient’s health.  I think many of my breast implant illness patients are worried sick and if the object of their worry – breast implants- can be removed, I am happy to do that.   I will also go after every bit of the scar tissue around the implants if it is safe to do so.  And, if the breast tissue is healthy enough, I will do a breast lift at the same time if it will improve the appearance of the breast.  And there’s more!  I will consider doing fat transfer a few months later if the patient wants a little volume back and has some good donor fat.  And I have to say, I just love sending patients on their way to an implant-free rest of their lives with no worries about the need for further implant related surgery. I call this “graduation” from breast implants.

If you are looking for a careful and conscientious surgeon who will remove your implants and capsules and offer non-implant options to enhance your breast appearance, I’m your gal.  Come see me!  If you are looking for a surgeon who believes that breast implant surgery destroys women’s health, I am not your gal.  And really, would I use breast implants if my implant patients came crawling back to my office sick?

So, if you want your implants out for any reason, come on in.  I will  listen to your concerns and answer your questions to the best of my ability.  I’m not Marcus Welby but for a surgeon, I am really pretty nice (at least that what I have heard).

Wow, this was a long one.  Thanks for reading!   Dr. Lisa Lynn Sowder

If you want to follow me on Instagram, I would be honored.  Look for me at @breastimplantsanity. and @sowdermd.

 

 

Breast Implant Illness, Breast Implant Removal, Breast Implants, General Health, This Makes Me Cranky.

Why are some breast implants as hard as rocks?

January 13th, 2015 — 11:43am

Calcified breast implant capsules can make a breast rock hard.

KE1

Calcified breast implant capsule surrounding an 32 year old ruptured silicone gel breast implant.

KE2

32 year old ruptured silicone gel breast implant after opening the calcified capsule.

I recently removed  32 year old breast implants from a lovely lady in her mid 60’s.  She was embarrassed how the implants felt when she hugged someone.  “It’s like having two rocks in my bra.”  Here is the reason her breasts felt like rocks.

The photo on the top shows the implant surrounded by the implant capsule.  The photo on the bottom shows the implant (which was ruptured) and the capsule after the capsule was opened.  The yellow gooey stuff is the implant material.  The white structure under the implant is the inside of the capsule.  The white stuff is calcium.  Yes, calcium – the same stuff that makes your bones nice and hard.  The calcium deposits are hard and brittle and can make an encapsulated implant literally rock hard.  Nasty capsules such as this are most common in old silicone gel implants but I have also seen cases like this in saline breast implants.

These photos also illustrate another important point with removal of ruptured breast implants.  In this case, I was able to remove the ruptured implant and the capsule in one tidy piece and there was no spillage of the silicone into the breast.  I love it when I can do this.  It is not always possible but I always try.   When it is not possible and I have to remove the ruptured implant before removing the entire capsule, there is often some spillage but I do my best to minimize it and clean up any spilled silicone prior to closing the breast.

And yet another important point should be obvious from this photo.  Should the capsule be removed along with the implant?  YES!  It would be crazy to leave that nasty capsule behind.  It would shrivel up into a hard mass, be palpable and possibly visible and would look really, really funky on mammogram.   I always go after thick and nasty capsules.  If removing the capsule puts a vital structure at risk, I may leave some of it behind but I try to get as much out as possible.  Removal of the capsule is the hard part of the case but it is worth the effort and time to leave behind a nice, clean breast.

Oh, and one more point.  This were really old implants.  The implants available currently are much tougher and have thicker gel and are less likely to rupture.   The problem illustrated with this case are less likely to occur with the new generation of implants.

And check out my video where I remove a calcified capsule from a saline implant.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Implant Removal, Breast Implants

The Ideal Breast

November 6th, 2014 — 10:08am
blog ideal breast

The ideal breast has a little more fullness below the nipple and above the nipple.

The Ideal Breast

I just read an interesting review of an article published in the Journal of Plastic and Reconstructive Surgery about the ideal breast.   Here’s the link.

If you don’t want to read the review, I will summarize.  A bajillion individuals which included men and women of various ages and nationalities were asked to rate a series of breasts on their attractiveness.  The findings were interesting in that size was not as much of a factor as was the shape and proportion of the breast.  And – surprise!- the majority of judges preferred a breast that looked natural which translates into a breast that does not have a bulging upper pole.

I am just glowing after reading this article.   I have made it my life’s work to make breasts look like they could have occurred in nature on a really, really, really good day!

Thanks for reading!  Dr. Lisa Lynn Sowder

 

Breast Contouring, Breast Implant Removal, Breast Implants, Breast Lift

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