A ^Retired Plastic Surgeon's Notebook

Tag: breast enlargement


Should I have my Biocell textured breast implants removed???

June 17th, 2019 — 11:50am

Looking pretty awesome after all these years.

This is a question posted by a patient on RealSelf.  She’s a lady in her 50’s with 11 year old anatomic Allergan Style 410 implants.  She has typical menopausal symptoms and does not think her implants are causing her night sweats, mild brain fog or hot flashes.  She’s heard about BIA-ALCL and wants to know if she should have her implants removed.  The photos she submitted show an absolutely beautiful long term result and the rest of her looks pretty awesome too.  She’s obviously either biologically privileged or she’s a gym rat or maybe both.  She’s very lean.  She doesn’t have enough fat for a meaningful fat transfer. Her breast volume is mostly implant. She loves her implants but she is scared.  What should she do?

So let’s be rational about the advice we give her based on what we know about BIA-ALCL.  First of all, she cares about her appearance.  Will she look good after explant?  IMHO, no.  She will be very, very small breasted.  If she’s okay with that, fine.  But I don’t think she will be okay with it.

What are the odds that she will get BIA-ALCL?  The latest numbers coming out of Dr. Mark Clemen’s work at MD Anderson estimate the chance of her developing BIA-ALCL is about 1 in 3000.  What about the chances of her DYING from BIA-ALCL?   Well, with increased awareness, early diagnosis and proper treatment, those chances are approaching ZERO.  I cannot rationally recommend she part ways with her awesome and great looking implants for those odds.

Now let’s look at breast cancer.  What are the odds?  Well, about 1 in 8 or 9 women will be diagnosed with breast cancer. The cure rate for breast cancer is much lower that the 90% plus cure rate for early diagnosed and properly treated BIA-ALCL.  Do we recommend bilateral prophylactic mastectomy for your average patient with average breast cancer odds?  Of course we don’t.  Women should be freaking out about the fact that they have breasts instead of the fact that they have textured breast implants!  And this post is in no way dismissing the suffering and, yes, death of patients with delayed diagnosis and/or treatment of BIA-ALCL.  These numbers mean nothing to someone who has died or lost a loved one BIA-ALCL.  We now know so much more about the etiology, diagnosis, prevention and treatment of this really weird malignancy.

So this is what I would advise this lady if she were my best friend or sister:  Her implants are getting up there in years.  I would get them removed and replaced with smooth, round cohesive gel implants.   With her anatomy she will look fine with round implants.  It’s been demonstrated very well that anatomic implants offer almost zero benefit over round implants in patients with normal anatomy.  If her surgeon finds seroma fluid or capsule nodules, he/she should do a capsulectomy and send the fluid and capsules for examination.  If the capsule is smooth and thin and unremarkable, he/she can just adjust the implant pocket if necessary to accommodate the new implant and leave the existing capsule in place.

And then she needs yearly exams and regular mammograms based on her breast cancer risk.

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

Breast Implant Illness, Breast Implant Removal, Breast Implants

Breast implant revision vocabulary

November 1st, 2018 — 12:05pm

Over the years, I have done a bajillion implant revision cases.  This comes with the territory of being in practice many years (27 years and counting as of this blog post!) and also with showing and voicing an interest in revisional surgery.  Implant revision is a fact of life.   Breast implants are not life time devices and in general what goes in must eventually come out.  Here a primer on the vocabulary of breast implant revision.  Your surgeon may throw around these terms.  Make sure you understand what he/she is saying and ask for clarification if you need to.  Here goes:

Capsule:  The scar tissue that forms around the implant.  This happens with ALL implants.  It’s a normal response to a “foreign body”.  Yes, breast implants (like all non-biologic implants) are a foreign body. 

Capsular contracture:  The presence of a tight and often thick and sometimes calcified capsule.  This results in a “hard implant”.   This is abnormal scarring.

Implant pocket:  The space where the implant resides.  In cases of submuscular implants, the pocket is between the pectoralis major and the rib cage.  In cases of subglandular implants, the pocket is between the breast gland and the pectoralis major.  Sometimes a change in the implant pocket is advised for implant revision.  

Implant malposition:  Implants that are too high, too low, too medial or too lateral.  This is most often corrected by modifying the implant pocket.

Bottoming out:  A condition that occurs when the implant settles too low and/or is too loose.

Inframammary fold (IMF):  The crease under the breast that is densely attached to the chest wall.   The IMF tends to go back to where it was before implants after implant removal. 

Double bubble: A condition that occurs when the implant falls below the inframammary fold.  This is often accompanied by a crease along the lower breast at the level of the native inframammary fold or the edge of the pectoralis muscle.   

Waterfall deformity: A condition that occurs when the implant stays put but the breast sags as it ages and falls over the implant. 

Synmastia a.k.a. unaboob:  Implants that are too close together.  This looks really weird and is very, very hard to fix. 

The gap:  The space over the sternum that separates the breast.  Sometimes the patients anatomy will result in a wider gap than she desires.  Trying to close the gap can result in really lateral nipples or the dreaded unaboob.  See above.   

Capsulotomy:  Cutting open the layer of scar tissue either to loosen it up or to change the position of the implant.  This can sometimes be done with a local anesthetic.

Capsulectomy:  Cutting out the capsule.  This always requires a general anesthetic.  This can be very difficult.  

Capsulorrhaphy:  Putting stitches into the capsule to either tighten it up and/or to raise the implant.  This usually requires a general anesthetic. 

En bloc capsulectomy:  Removing the implant capsule with the implant without opening the capsule.  This is the preferred method for removing a ruptured silicone gel implant.  This is not always technically possible. 

Acellular dermal matrix (ADM) and surgical mesh:  A sheet of collagen or other substance that controls position of the implant and may prevent recurrent capsular contracture.   Alloderm and Strattice are two of the ADMs I have used.  I have also used Seri surgical mesh.  Think of these as an internal bra, a very, very expensive internal bra.

Perfect symmetry:  Not possible but we try.  

Touch-up:  This term best used when referring to make-up application.  I try to avoid this term when it comes to breast implants.  It implies that it’s easy and it’s never easy. 

Revision:  This term best used when referring to repeat surgery on a breast with an implant.   

So there you have it.  Now you can translate what your surgeon has told you needs to be done.  And again, if you don’t understand make him/her go over it again until you do understand.  Tell them Dr. Sowder told you to do so.  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

Maximizing Follow-Up in Cosmetic Surgery Clinical Trials – Money Helps

July 26th, 2018 — 9:05am

In a previous blog post bemoaning the difficulty of good follow-up in clinical research I sort of place most of the blame on patients who blow off the follow-up  once they have their desired implants.  This was my experience with the implant study I participated in many years ago.  I had an 80% follow-up at 5 years (which was really, really high)  mostly because I pestered patients relentlessly to come back for their follow-up exams.  I have taken a bit of flack (especially from the breast implant illness activists) for my blame-the-patient stance but now there is a recent study out that supports my politically incorrect opinion.  Check this out.  It seems if you pay the patient big bucks to show up they do!  This study has an astounding 94.9% and 96.7% follow-up compliance at 5 years.  The study has another 5 years to go and my guess is that given the size of the monetary award, those numbers will also be very high.

“Maybe I will show up for my follow-up.”

Novel Approach for Maximizing Follow-Up in Cosmetic Surgery Clinical Trials: The Ideal Implant Core Trial Experience

Mueller, Melissa A. M.D.; Nichter, Larry S. M.D.; Hamas, Robert S. M.D.

Plastic and Reconstructive Surgery: October 2017 – Volume 140 – Issue 4 – p 706–713
Cosmetic: Original Articles
Background: High follow-up rates are critical for robust research with minimal bias, and are particularly important for breast implant Core Studies seeking U.S. Food and Drug Administration approval. The Core Study for IDEAL IMPLANT, the most recently U.S. Food and Drug Administration–approved breast implant, used a novel incentive payment model to achieve higher follow-up rates than in previous breast implant trials.

Methods: At enrollment, $3500 was deposited into an independent, irrevocable trust for each of the 502 subjects and invested in a diversified portfolio. If a follow-up visit is missed, the subject is exited from the study and compensated for completed visits, but the remainder of her share of the funds stay in the trust. At the conclusion of the 10-year study, the trust will be divided among those subjects who completed all required follow-up visits. For primary and revision augmentation cohorts, the U.S. Food and Drug Administration published follow-up rates from Core Studies were compared for all currently available breast implants.

Results: Five-year follow-up rates for the IDEAL IMPLANT Core Study are higher for both primary augmentation and revision augmentation cohorts (94.9 percent and 96.7 percent, respectively) when compared to all other trials that have used U.S. Food and Drug Administration standardized follow-up reporting (MemoryShape, Allergan 410, and Sientra Core Studies).

Conclusions: This trial demonstrates the utility of a novel incentive strategy to maximize follow-up in cosmetic surgery patients. This strategy may benefit future cosmetic surgery trials and perhaps any prospective research trial by providing more complete data.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Hey, thanks for reading and I really thank Drs. Mueller, Nichter and Hamas for this awesome article.  And my hat is really off to Dr. Robert Hamas who not only thought up the idea of the Ideal implant but actually brought it to market.  And Ideal only sells its implants to surgeons certified by the American Board of Plastic Surgery.  That means if your surgeon is using an Ideal implant, he/she is actually a real honest to goodness plastic surgeon, not just poseur.

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

Breast Implant Illness, Breast Implants, New Technology, Now That's Cool

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

Is the ideal female breast of the future smallish? Yes, according to Blade Runner 2049.

October 10th, 2017 — 2:11pm

K (Ryan Gosling) and the very evil Luv (Sylvia Hoeks) stroll among the newly finished small breasted replicants.

My husband and I went to Blade Runner 2049 this past weekend at Seattle’s wonderful Majestic Bay Theater.  I am a big fan of the original Blade Runner thus the bar was very, very high for 2049.  IMHO, Blade Runner 2049 was too frenetic, too convoluted and the only characters I really cared much about was Rick Deckard (the still handsome and wiley Harrison Ford) and his big ass shaggy mongrel doggie.  I shed a tear when the doggie is shown peering out of a shattered building, wagging his tail just a bit, wondering where his human went.  I’m tearing up now just remembering that scene.

One thing I found interesting throughout the movie was the relatively smallish breasts of all of the female characters.  Hardly any cleavage at all – a real change for Hollywood.  K’s (played by a deliciously disheveled Ryan Gosling) made-to-order AI concubine Joi (Anade Armas) and her human side kick, Mariette (Mackenzie Davis) with whom she mind and body melds, were both small chested.  The LAPD’s Madame played by the ever wonderful Robin Wright was lean and mean and small chested.  The still-under-construction and just “born” female replicants would all measure into an A or B cup bra.    Even the gigantic virtual reality pleasure girl with the pastel hair was small breasted.  The only bouncing breasts seen in the movie was in the cocktail lounge hologram dancing girls of the distant past.  They contrasted nicely with Deckard and K beating the bejesus out of each other.

So maybe this return to a natural sized breast will be the next not-so-big thing for the ever scrutinized female figure?

Thanks for reading and if you haven’t seen the original Bland Runner, you are missing out on a great movie.  Follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Contouring, Now That's Cool, Stuff I love

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

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

Back to top