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 Implants


14-Point Plan for Breast Implant Placement

June 26th, 2018 — 1:53pm

Surgical techniques are constantly evolving and breast implant technique is no exception.  In the past couple of years recommendations to minimize implant and implant pocket contamination have been developed.  This is in response to overwhelming evidence that bacterial contamination is the main cause of capsular contracture and may also be the cause of breast implant associated anaplastic large cell lymphoma (BIA-ALCL).   Both of these conditions have been linked to the presence of biofilm around the breast implants.  Biofilm is the product of certain bacteria, Staph epidermidis in the case of capsular contracture and Ralstonia piketti in the case of BIA-ALCL.  It is our hope that with the adoption of the Surgical 14-Point Plan for Breast Implant Placement the annoying and difficult problem of capsular contracture and very serious and potentially fatal problem of BIA-ALCL will drop in frequency.  If you are planning on breast implant surgery, you should ask your surgeon if he/she uses the 14 point plan.  They should!

Surgical 14-Point Plan for Breast Implant Placement, from Aesthetic Surgery Journal, 2018, Vol38(6) page 625

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

Breast Implants, New Technology

Liposuction-Augmentation Mammaplasty – A Bad Idea IMHO

May 3rd, 2018 — 9:33am

Liposuction-augmentation mammaplasty has been on my radar since I stumbled across an Instagram video a few months ago of a surgeon sucking the fat out of a perfectly full breast and then inserting an implant to make up for the lost volume.  I started humming Ozzy Osborn’s Crazy Train!  The rational for this procedure is to provide a bit of a lift without the lift scars. This procedure is described in detail in this April’s edition of the Aesthetic Surgery Journal.  The authors reported on 125 patients and compared them with 188 patients who had just a regular old breast augmentation.  The amount of lift achieved was very, very modest.  The authors were very meticulous in their details – age and weight of patients, how much fat was removed and how large an implant was inserted.  Their minimum follow up was 12 months. These authors put a ton of work into this study and I admire them for that.

BUT…………………………………………..Just because something can be done does not mean it should be done.  And I think this procedure is misguided.   Breast tissue is made to last a lifetime and it does.  Implants last maybe 20 years or so if a patient is lucky.  Here is a list of implant related problems:  too high, too low, too lateral, too medial, too loose, too tight, leak or rupture.  Here is a list of breast tissue related problems: benign cysts and breast cancer.  Why, oh, why would a lady trade in her natural breasts for implants (unless she has breast cancer)?  Apparently there are some patients out there, mostly young, who want a really fake look and you bet that this procedure can deliver a fake look that a breast lift cannot.  But isn’t it our duty to let these young patients know that when they are 60, they will likely be on their 3rd or even 4th set of implants with no end in sight because their natural breast volume was sucked away?????  And those high round globes will look pretty odd on their post menopausal body.

And there’s more:  Removing fat from the breast via liposuction leaves a breast more glandular and fibrous and thus harder for breast cancer detection on mammogram.  And add an implant and the mammogram is even harder to interpret!  A lifted breast poses no issues for mammograms once the internal scars have settled.  And speaking of scars, breast lift scars almost always fade to a point of being a non-issue.

There is one instance where I think liposuction-augmentation mammaplasty is a reasonable idea and that is in cases of breast asymmetry.  It is really, really hard to get a great result when one breast is mostly implant and the other either has no implant or a very small implant.  In these cases, i think it is reasonable to reduce the larger side either with liposuction or an actual breast reduction so implants of similar volume can be used.

I do not know if this technique will gain traction but I hope it does not.  My enthusiasm from breast implants has waned over my 26+ of practice.  I’ve just seen so many implant related problems.  If I can get a breast looking good without an implant, that is what I will recommend.  If implants are the only way to get a nice result, I will certainly go there but I can assure you that I am not going to sucking or cutting away perfectly good breast tissue and replacing it with an implant!

Thanks for reading and be careful out there.  Dr. Lisa Lynn Sowder

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

Breast Contouring, Breast Implants, This Makes Me Cranky.

Capsular Contracture 102: Treatment

April 19th, 2018 — 3:59pm

My last blog discussed the difficult and frustrating problem of capsular contracture of breast implants.  As with just about every problem known to mankind, prevention is the best approach. But despite doing everything correctly pre-operatively, intra-operatively and post-operatively, a small number of patients will experience capsular contracture.

First a little history:  Way back when the Earth was cooling and breast implants were the newest and coolest thing, surgeons would treat capsular contracture by “popping” the breast, the so-called manual or closed capsulotomy.  Here is how it worked.  The surgeon would take his great big strong paws and basically mash the poor breast until there was a pop and the breast went soft as the scar capsule ruptured and released its pressure on the implant.   As you can imagine, there was a lot of moaning and screaming in the exam room during this process.  It wasn’t long before surgeons realized that: 1. the capsular contracture always came back, 2. this can rupture a breast implant, 3. this can cause acute bleeding and 4. women don’t like being manhandled this way.  I was just starting my training in plastic surgery just as manual capsulotomy was falling out of favor.  I’m happy to say that I have never done this crude procedure and it is likely that I would not have succeeded had I tried.  I have teeny tiny and not-so-strong hands.  I would have likely ruptured one of my tendons before rupturing a capsule or implant.

Okay, that was then and this is now.  For early capsular contracture, it’s worth trying medication.  A dozen or so years ago it was observed that implant patients on a certain kind of asthma medication has a very low rate of capsular contracture.  These medications are leukotriene receptor antagonists and they work for asthma by reducing inflammation.  And inflammation is thought to be the final common pathway to capsular contracture.  The two medications used are zafirlukast and mohnelukast.   Accolate and Singular are the brand names respectively.  I have had several patients resolve an early capsular contracture with these medications. I have also had a few patients who did not respond to these medications

These implants were 41 years old and had a grade 4 capsular contracture. I removed them and the capsule and inserted new implants. She is shown 18 months after surgery.

Once a capsule is well established, surgical intervention is the only way to resolve it.  Complete capsulectomy removes the scar tissue and then the question  is how to prevent a recurrent capsule.  And does it make sense to just pop in another implant right away?  This is just such a difficult question because none of us has a crystal ball to tell the future.  Sometimes capsulectomy and a new implant works great but sometimes another capsular contracture starts forming despite doing everything right.  Sometimes we create a new pocket and make a pocket under the muscle if the over the muscle implant had a capsular contracture and vice versa.  Adding Accolate or Singular makes some sense.  Sometimes adding a piece of acellular dermal matrix like Strattice (which should be spelled  $$$$trattice) will decrease the chance of another capsule.  And whenever there are several different approaches to a difficult problem, you can be sure that none of them works every time.

The only surgery I know of that will for sure prevent another capsular contracture is implant removal and total capsulectomy without implant replacement.  This definitive treatment is readily accepted by many of my older patients who are sick and tired of their nasty, rock hard and uncomfortable implants.  They look forward to being implant free.  For younger patients, however, this can be a very, very difficult thing to accept, especially if they were really, really flat to begin with.  I have at least one patient that comes to mind who had several capsular contracture related surgeries by me and finally we just threw in the towel and removed her implants along with her capsules.  Her breasts returned pretty much to their preoperative size and shape but let me tell you, her wallet was never the same.  A problem with capsular contracture can be very, very expensive and result in a lot of down time – off work, off exercise, off fun.  This particular patient went on to have some fat transfer several years later and did well.  She and I are both glad to have her implant saga behind us.

Just writing this post makes me feel like I never want to do another breast augmentation!  And then I think of the patient I saw in clinic this morning.  She was very, very flat chested and was too lean to consider fat transfer.  I inserted 250 cc low profile cohesive gel implants last week and this morning I could not wipe the smile off her face.  I think as long as there is Victoria’s Secret, there will be a demand for breast augmentation.  I am just grateful that implant technology keeps improving as does our surgical technique.  Hopefully sometime in the near future capsular contracture will be of historical interest only.

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

Breast Contouring, Breast Implant Removal, Breast Implants, Plastic Surgery, Uncategorized

Capsular Contracture – the final frontier in breast implant surgery?

April 3rd, 2018 — 10:52am

Capsular Contracture 101

Anyone who knows my practice well knows that I am not a big fan of breast implants.  I much prefer fat transfer and/or breast lift to get a breast looking nicer.  But sometimes only a breast implant will get the patient the size and shape of breasts they desire.  Implants have many issues including malposition (too high, too low, too whatever), size problems (too big or too small), leaking or rupture problems.  Those issues can usually be address with revision surgery.  There is one issue that has tortured plastic surgeons and their patients from day one of breast implants decades ago.  That problem is capsular contracture.

All implants develop a capsule.  Actually it is the body that develops the capsule.  This is normal reaction to a foreign body and, yes, breast implants are a foreign body, a large foreign body.    A capsule only becomes a problem when it become thick and/or tight.  As the capsule thickens or tightens, it puts pressure on the breast implant and turns any shape or profile of implant into a sphere because a sphere is the shape that supports the largest volume in the smallest surface area, or something like that.  Geometry was a while ago for me!  Thus most badly encapsulated implant all look sort of the same – like a ball.  And they all feel hard, sometime really hard and often they are very uncomfortable.  Capsules can even become calcified in which case the implanted breasts are literally rock hard.

Capsular contracture: Looks bad, feels bad.

So what causes capsular contracture?  Good question and I hope the smart researcher who breaks the code wins the Nobel Prize in medicine some day.  A lot of progress has been made, especially in the past 10 years or so and it sure seems like inflammation is the common pathway to capsular contracture.  The most common causes of inflammation around the implant and resultant capsular contracture are 1. bleeding in the implant pocket, 2. subclinical infection and biofilm in the implant pocket, 3. leakage or rupture of silicone gel implants.  Let’s look at these a little closer.

Bleeding in the implant pocket has been known to result in capsular contracture for decades.  Plastic surgeons take a lot of care to really “dry up” the implant pocket prior to inserting an implant.  This is usually done with an electrocautery device call a Bovie.  This little gizmo allows the surgeon to zap little oozing vessels and help prevent any significant blood from accumulating around the implant.  Also, in the rare incidence of post operative bleeding around an implant, surgeons are very quick to take a patient back to the OR to “wash out” the pocket, find and treat the bleeding and reinsert the breast implant.  Sometimes a very minor bleeds can avoid a trip back to the or but in cases like these, the surgeon is on high alert for capsular contracture.

Subclinical infection and biofilm have been on our radar screen for 10 years or so.  Biofilm (which deserves it’s own blog post) is a slimy substance that is produced by certain types of bacteria.  It serves as a protective hiding place for bacteria and is resistant to antibiotics.  The most common example of biofilm is dental plaque.  Yuck.  Anyway, once the biofilm issue became well known, much more attention was paid to reducing the exposure of implants to bacteria.  We are now compulsive about washing out the implant pocket with antibiotic solution, using a no touch technique with a Keller funnel when inserting the implant, changing gloves prior to touching an implant and such.  Remember the billionaire Howard Hughes and his OCD about germs?  Well, we really go totally Howard Hughes with implant surgery!  Also, the location of incision has been shown to have an effect on the rate of capsular contracture.  Incisions around the nipple, through the arm pit or belly button have the highest rates of capsular contracture.   Incisions under the breast (the inframammary fold) have the lowest rate.  This is very likely due to a lower level of bacteria in the area of the inframammary fold as opposed to the other areas.  I use the inframammary fold incision almost exclusively for this reason and also because it allows me to see the pocket really well.

Leakage or rupture of gel implants results the in silicone gel coming into contact with the capsule and this often seems to cause inflammation and hardening or tightening of the implant capsule.  When I am going after a particularly nasty capsule, I expect to see an leaking or ruptured implant and I am usually not disappointed.  The advances made in implant construction – thicker implant shells and more cohesive gel – will hopefully decrease this cause of capsular contracture.

So that is Capsular Contracture 101.  Next up will be a blog about what can be done for capsular contracture.  Stay tuned and thanks for reading.  And I would be honored if you followed me Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

 

Breast Contouring, Breast Implant Illness, Breast Implant Removal, Breast Implants

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

Portion control in breast augmentation.

October 3rd, 2017 — 5:32pm

This cartoon is by the late, great B. Kliban. His book, “Never Eat Anything Bigger Than Your Head” is a treasure. Get your hands on one if you can. You’ll laugh until you cry.

Portion control is very important for maintaining a healthy weight and it becomes more and more difficult as restaurants, especially fast food restaurants, keep increasing the size of the offerings.  There is a Mexican place in Seattle that  has a poster of one of its burritos next to a new born baby.  They are the same size. So sick in so many ways, huh?

I would like to introduce portion control for breast implants.  There is a condition that we plastic surgeon’s call breast greed.  Those with breast greed want to go a little larger and then a little larger and then a little larger.  This results in the eager to please plastic surgeon putting a too big implant into a too little woman.  Supersized implants have an increased chance of having implant problems.  Big implants cause thinning of the breast tissue and skin and over-stretching of the pectoralis muscle if they are submuscular.  They are more likely to result in the dreaded unaboob or extend into the underarm area.  And, in my humble opinion, they look really, really bizarre.

Fortunately I do not get many patients looking for that super top heavy look.  Implant patients self select surgeons who feature these jumbo implants on their website or social media accounts.  You won’t fine many of those attached to my name.

Thanks for reading and if you want to supersize your chest, don’t come to me!  Dr. Lisa Lynn Sowder

Follow me on Instagram @sowdermd and @breastimplantsanity.

 

Breast Implants, My Plastic Surgery Philosophy

Anatomical versus Round Implants: The study that could never be done was done.

August 4th, 2017 — 10:57am

Can’t tell which side is anatomic and which side is round? Neither can I!

I think the anatomic implants vs. round implants smack down may finally be over.  As those who read my blog know, I am not a huge fan of anatomic implants although I have tried really, really hard to learn to love them over many, many years.  Anatomic implants are presented as the best thing since microwave nachos and those of us who keep going back to round implants are sometimes dismissed as Luddites.  Anatomic implants are pushed by industry paid “experts” who make the rounds at meetings and extol the wonder of these more-expensive-and-more-complicated-than-round implants.  And patients ask for these anatomic implants being lead to believe that they will look more natural.  

A few years ago, evidence started trickling in that anatomic implants actually did not have  advantages over round implants in standard breast augmentation in anatomically normal women. There were studies where before and after photos were shown to expert plastic surgeons and they could not tell which patients had which implants.  I was present at one of these sessions where a panel of experts did no better than a coin toss.  But the study that nobody thought could be done – put an anatomic in one side and a round in the other side on the same patient – has been done!  No patient would sign up for having two differently shaped implants used for her augmentation and no institutional review board would approve such a study.  But some very clever surgeons did this study in 75 volunteers.   Their average age was 39 and their average BMI was 20 (this, by the way, is quite thin).  The surgeons took the patients to the OR and put a round implant in one side and a comparably sized anatomic implant in the other side and then took standardized photographs.  They then removed the anatomic implant and replaced it with a round implant to match the other side.  The standardized photographs were shown to a panel of experts.  Even the panel of experts could not tell the round vs. the anatomic when presented with these side by side breast implants!

I really take my hat off to the Drs. Hidalgo and Weinstein for doing this study.  It is this sort of research that helps us make decisions based on reality rather than the latest hype from an industry hired gun.  

Intraoperative Comparison of Anatomical versus Round Implants in Breast Augmentation:  A Randomized Controlled Trial.  Hidalgo, David A. M.D.: Weinstein, Andrew L. M.S., Plastic & Reconstructive Surgery:  March 2017, Pages 587-596.

Thanks for reading!  Dr. Lisa Lynn Sowder

 

 

Breast Contouring, Breast Implants, New Technology

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

Breast Feeding and Breast Implants

June 24th, 2017 — 8:56pm

In a perfect world, women would wait until they were done childbearing and breast feeding prior to having breast implants, mostly because pregnancy and breast feeding can really change the breast.  In the real world, many young women opt for breast enhancement long before having children. I am often asked what effect childbearing will have on an implanted breast.  My answer?  Some ladies do great and some don’t.  I don’t have a crystal ball.  I do tell patients that whatever happens to their breasts, I can likely fix it!

I am also often asked about the effect implants have on breast feeding and if feeding a baby from an augmented breast is safe for the baby.  Here is what I know based on reading the literature and listening to patients for 25+ years.

In the recent “Cohort Study to Assess the Impact of Breast Implants on Breastfeeding” conducted by lactation specialists and doctors in Argentina published in the December 2016 Plastic and Reconstructive Surgery Journal (PRS Vol. 138, 1152-1159, 2016) 100 women with breast implants and 100 women without breast implants were followed from the time of childbirth through about 3 months.  All of these women received instruction and encouragement to breast feed by lactation specialists. Here’s what was found:  99 of the 100 women without implants were able to breast feed.  93 of the 100 women with breast implants were able to breast feed.  This was not found to be statistically significant.  At 3 months, more women without breast implants were breast feeding exclusively than the women with breast implants.  This was statistically significant.   The study showed no correlation in the type of implant or incision location as to the ability or inability to breast feed.  Sooo…it would appear that breast implants may impact the quantity of milk production and it may be necessary to supplement.  I have been telling my young patients for years if they will feel like a terrible mother if they are unable to breast feed, they may want to wait on that breast augmentation. I think based on this study I will change that to breast feed exclusively. I also over share with these patients that I am a lactational failure and my children (now 20, 20 and 16) have had one ear infection, 2 broken bones, one cavity, one torn thumb ligament between them and all are healthy and happy.  And I felt like a horrible mother for awhile but got over it. I also refer them to a article that appeared in the Atlantic in 2009: The Case Against Breast Feeding written by Hanna Rosen, the mother of three breast fed children.  It’s an fact filled and thoughtful look at this very prickly topic. It made this lactational failure feel a little better!

Is it dinner time?

And lately I have been questions about the safety of breast milk from an implanted breast.  I think some of this is being stirred up by the breast implant illness community which is doing its best to have breast implants banned.  One of the breast implant illness web sites has an extensive diatribe about this and there is also a recent alarmist Instagram post on this topic.  In doing a little research of the peer reviewed literature, I did come up with a paper regarding silicone gel implants and breast milk.  This paper (PRS Vol. 102, 528-522, 1998) looked at silicon levels (silicon is the element that silicone is made of) in breast milk in patients with and without breast implants and also in cow’s milk and various formulas. This study was done way back in 1997 at the University of Toronto.  The researchers looked at the milk of 15 mothers of newborns with silicone gel implants and 34 mothers of newborns without implants.  The silicon levels in the implant group was lower than the non-implant group although the difference was not statistically significant.  Now here’s the kicker. The silicon levels in cow’s milk (presumably the cows did not have breast implants although that is not stated in the paper) was over 13 times that of the mother’s milk!  Twenty six formulas were tested and they ranged from 13 times to 433 times that of mother’s mild.  The soy-based formulas had some of the highest levels!

How can this be????  Again this study did not measure silicone (the rubbery stuff made from elemental silicon).  Silicone is a big fat molecule and cannot be dissolved in solution and therefore cannot be measured.  Silicon, the element, can be measured.  And silicon is everywhere.  Silicon is the second most abundant element on  the earth’s crust, second only to oxygen.  Silicone, the man made rubbery stuff, is also very abundant in medical devices, prosthetics, pharmaceuticals and many consumer products (I love my silicone oven glove). Oh, and it’s used to make nipple shields for breast feeding moms and bottle nipples for bambino.

The other issue is the location of breast implants in relation to the milk producing glands and the lactiferous (great word) ducts.  Implants on top of the muscle sit under the breast tissue and are in contact with some of the milk producing gland but are well away from the ducts.   Implants under the muscle are not really in contact with the breast much at all.  I don’t have the imagination to visualize big gooey silicone blobs getting though the wall of an intact implant, thorough the fibrous scar capsule and into the milk producing glands and travelling out of the ducts.  I have removed a bajillion ruptured gel implants and have never seen or heard of leakage of gel from one of my patient’s nipples.

Based on this information and my intimate knowledge of the location of breast implants in relation to the milk glands and milk ducts, I would not advise patients with intact silicone gel implants to forego breastfeeding because of fear of some sort of contamination of their breast milk.  If an implant is ruptured, I think it would be prudent to bottle feed.

So there you have it, my take on breast feeding and breast implants.  Mothering is a wonderful, mysterious and complex task and sometimes doesn’t include lactation (and sometimes doesn’t even include giving birth).  I think most patients are very capable of making up their own minds about if and when they desire breast enhancement with breast implants.

Thanks for reading!  Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implants, General Health

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