Seattle Plastic Surgeon blogs about a surgical device that she really, really, really loves.
The Keller Funnel makes inserting silicone gel implants faster, gentler and cleaner. It may also decrease the chance of developing capsular contracture.
I was first introduced to the Keller Funnel in 2009 and have been using it with my silicone gel breast augmentations ever since. It is a device that is elegantly simple, very easy to use and even, well, fun.
It looks and works like a pastry bag. It has a coating on the inside that become lubricious (isn’t that just a great word?) when wet. The implant is placed directly from its package into the funnel without any touching, the tip of the funnel is inserted into the breast incision and firm but gentle pressure on the funnel propels the implant into position into the implant pocket. Inserting gel implants through small incisions without the funnel involves a lot of pushing and squishing and squeezing and is frankly, sort of traumatic and a little messy. And it’s hard on the surgeon’s hands. The implant gets rubbed on the skin around the incision and this contact makes contamination of the implant possible. And all of that squishing and squeezing could weaken the implant. This, by the way, is not an issue with saline filled implants. Those implants can be rolled up like a cigar and easily inserted through a small incision without skin contact or trauma to the implant or the surgeon’s hands.
About a year ago, an article was published reporting a study done at Emory University comparing the degree of skin contact and contamination of implants inserted with and without the Keller Funnel. This study showed a much lower incidence of both skin contact and contamination in the implants that were inserted using the funnel. This confirms what certainly makes sense.
Why is this important? Hardening of the scar tissue around breast implants, so called capsular contracture, is likely caused by a low grade infection around the breast implant. Even when the skin has been carefully washed with a disinfectant, bacteria that cause this low grade infection can hide in pores and escape the disinfectant. So it makes sense that less implant contact with the skin would lower the chance of a low grade infection and would lower the chance of capsular contracture. That particular study has not yet been completed but I think the argument is so compelling that I use a Keller Funnel on all my gel implants.
Seattle plastic surgeon’s patient shares her BREST BRA EVER.
I hope she is wearing a good sports bra.
Yesterday I saw one of my patients who had undergone a breast augmentation and was now training for the Seattle Marathon which (what were they thinking?) is held the Saturday after Thanksgiving. She was in the process of ramping up her mileage but was being careful not to ramp down her chest.
She had gone from not needing a bra to needing a really good sports bra. She discovered a great bra at Lululemon. It’s called the Ta Ta Tamer II and it looks like it would do the trick on the bounciest of bossoms and it’s even nice looking. No Brunhilda styling with this bra.
I tell all of my breast surgery patients to wear a really good bra when exercising. It’s all about protecting that investment against the ravages of gravity. So unless you live in the International Space Station, make sure you’ve got some great support.
Seattle Plastic Surgeon finds that fat transfer to the breasts allows for subtle improvements in breast shape.
Before fat transfer
After fat transfer
The more cases of fat transfer to the breast I do, the more I appreciate some of the advantages of fat transfer over breast implants. There are the obvious advantages of no cost or upkeep of implants, no need for anything other than teen tiny incisions and the improvement in the shape of the fat donor sites.
Another advantage that is nicely shown in these photos, is the ability to subtly improve the shape of the breast. This is possible because specific areas of the breast can be targeted for injection. In this case, before fat transfer, the bottom of the breasts was quite square. After fat transfer, the bottom is more rounded. Also, the fat filled up the upper part of her breasts. I think I hit a home run on the right side. She may be coming back for a little more to get that left side looking as good as the right.
After 20+ years in practice, it has been so exciting and enjoyable learning this new procedure and being able to offer it to selected patients.
Seattle Plastic Surgeon blogs about the highly variable “ideal” breast size.
Yesterday was a great day in the office seeing patients. It was one of those days where all my post op patients were pleased and all the new patients were good candidates for surgery. I had two patients, one a post op and one a new patient, that drove home the fact that there is no single ideal breast size. What is ideal for one woman may not be for another.
Patient A was a year out from a breast augmentation. She was thrilled with her result and was happy with her 34DD bra size. The breasts looked good with her shoulders, tummy and hip line. She was all curves.
Patient B also wore a 34 DD bra and was horrified at the size of her breasts. She wanted a reduction. Patient B’s breasts looked almost identical to Patient A’s augmented breasts but they did not fit her narrow chest or narrow hips and clearly they made her the recipient of a lot of unwanted attention. She wanted to go down to a C cup which is where Patient A started. Too bad they couldn’t have just swapped, huh?
Breast surgery is so individualized. The entire body must be taken into account as well as the woman’s age, child bearing plans, athletic endeavors, career goals, etc. This is what keeps my job interesting.
Seattle Plastic Surgeon is seeing some very nice results from fat transfer to the breast.
Left side : before fat transfer. Right side : 3 months after fat transfer. She has gone from a B to a C cup.
It takes quite a bit to get me enthusiatic about “new stuff” because “new stuff” pops up every day and more often than not, the reality does not begin to live up to the hype. This tends to make one (me, for instance) a bit skeptical.
As discussed on my website and previous blogs, fat transfer to the breast is a new procedure that I am now offering to very carefully selected patients. And now I am starting to get some sort of longish term follow-up and I am starting to get, well, a little bit excited.
This lovely mother of two darling boys had her fat transfer last fall and her size is holding steady. She was a B cup before transfer and a C cup three weeks after transfer and today is a C cup three months after transfer. She is thrilled and so am I.
She not only has no implant to maintain, she has virtually no scars on her chest and she has a subtle improvement in her breast shape. No, she’s not going to stop traffic with this chest but that was never her intent.
And another cool thing about fat transfer – it’s really a twofer. In this patient’s case, I took the fat off of her posterior hips and she is much slimmer in that area and with the increase in her breast volume, is much better balanced between her upper and lower body. SWEET!
Put this on your list for Valentine’s Day. It won’t end up on your hips and you can wear it in public!
Pink SmartWool Artisan Socks – Perfect for Valentines Day
I am totally smitten with SmartWool stockings, especially the Artisan variety. They come in an array of very cool and funky designs and colors and they last and last and last. There’s nothing like a new pair of snugly warm socks to warm my heart in winter.
Seattle Plastic Surgeon blogs about the psychological burden of tuberous breast deformity.
The tuberous breast is characterized by “puffy” and enlarged areolas, a pointy shape with a constricted breast base. They can come in any size, from extra small to really large. Also, breast asymmetry is very common in patients with tuberous breasts.
I do a lot of breast surgery and I spend a better part of my day looking at breasts. Just like my patients, breasts come in all shapes and sizes.
One breast issue that I see from time to time is called tuberous breast deformity. I have also heard it called tubular breast deformity. This problem does not become apparent until a girl starts developing with puberty. It is not uncommon for pubertal girls to be very, very modest and embarrassed with their development, even with sisters, friends and mothers. So many young women with tuberous breasts haven’t shared their problem with anyone and have just managed to choose clothing, bras and swimsuits that hide their tuberous breasts. I have seen young women in their 20’s and even 30’s with this “secret” and I have seen the psychological damage that tuberous breasts can cause.
Tuberous breasts is a problem that gets very little attention in the popular culture or even the medical culture and often patients with tuberous breasts feel very isolated and think that they are the “only one” with this deformity. That is until they come in and see me and I can tell them that I see this condition many times a year and that they are, in fact, not alone.
Treatment of this condition is always surgical and treatment varies depending on the severity of the deformity, the size of the breasts and the patient’s desires. I have never seen a tuberous breast that I could not make a lot better. Not perfect, but a lot better.
The surgery usually consists of treating the deficient base of the breast with an implant or fat transfer and then addressing the pointy and droopy shape and the puffy areola with some type of breast lift. In some cases, only a lift is needed to rearrange the breast tissue and reshape the nipple.
My tuberous breat patients are some of my most gratifying patients. It is so wonderful to see these women actually enjoy shopping for a bra or swim suit. I have seen some young women go from being very, very shy and self conscience to being confident and happy with their bodies.
I just wish that this problem would get a lot more attention. Maybe this blog will go viral? Who knows. Spread the word and thanks for reading. Dr. Lisa Lynn Sowder
Seattle Plastic Surgeon blogs about the realities of cleavage.
This patient has wide cleavage before and after surgery. God made her that way!
The term “refund gap” has recently come to my attention. This term is out there in the blogosphere and refers to the idea that a patient who does not end up with bodacious cleavage after breast augmentation is entitled to a refund from her plastic surgeon.
So here is a reply to all those disgruntled cleavage challenged patients out there. Take it up with God, Yahweh, Supreme Being, Higher Power, Allah, Mother Nature or your birth parents.
Plastic surgeons actually have very little control over cleavage. Cleavage is mostly determined by how your pectoralis muscles are inserted onto your sternum. Most breast implants should be placed under the pectoralis muscle and it is very, very unwise to disinsert (is that aword?) the pectoralis muscle from the sternum. Doing so can create a step-off deformity or uni-boob that can be very difficult to correct.
This patient has tight cleavage before and after surgery. God made her that way. BTW, her extensive scars were from an overdone breast reduction done by another surgeron.
I try really hard to educate my patients preoperatively about the cleavage issue by showing them a lot of photos which demonstrate the similarity of a patients pre and post operative cleave. The same goes for nipple position. Breast implants make the breasts bigger and really don’t do much else for a patients inherent anatomy.
Fat transfer to the cleavage area may be a way to enhance this area. I have done quite a few cases of fat transfer to the breast but want to wait an entire year before I pass judgement on my results. This could be the treatment of choice for the cleavage challenged. I’ll keep you posted!
Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder feels very lucky to be just down the street from First Hill Imaging and their awesome expertise with breast MRI.
Today I got a question from a lady regarding mammograms, breast implants and breast cancer. She had 20 + year old implants and they had become increasingly firm and it was difficult for her mammographer to get a good image. She had a family history of breast cancer and she was afraid of missing an early diagnosis if she were to develop breast cancer herself.
I recommended that she have an enhanced breast MRI which is very, very sensitive in diagnosing breast cancer, even when implants make the breast firm and difficult to examine.
Dr. Bruce Porter at First Hill Imaging in Seattle was one of the radiologists who explored this technology back in the 90’s. I remember attending one of his lectures where he showed MRI images that were just amazing in their detail and accuracy. And that was about 10 years ago. It’s even more amazing now.
In most cases, implants do not interfere much with mammograms, especially if the implants are placed under the pectoralis muscle. But if they do, it is so comforting to have First Hill Imaging and Dr. Porter and his colleagues within walking distance for my Seattle patients.
Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder finds breast lift and augmentation to be a difficult operation of opposing forces.
I saw a patient yesterday who needs a breast lift and wants an augmentation. If I just do an augmentation, she will have weirdly shaped and still saggy breasts and if I just do a lift, she won’t be as large as she desires. She needs both operations and I was obligated to explain to her how tricky it is to do both an augmentation and a lift at the same time.
This challenge is one of opposing forces. Placing a breast implant makes the breast tight and we want the tissues to loosen up and stretch some. Doing a lift makes the breast tight and we want it to stay tight. The weight and pressure of the implant can make a lift loosen up. And, to make it even more tricky, every patient reacts a little differently to the forces of the implant and gravity, depending on her breast and skin elasticity and whether or not she spends any time in the International Space Station (no gravity there!).
My revision rate for patients undergoing and augmentation and simultaneous lift is pretty high, about 20%. In most cases the revision involves re-tightening the lift and this can sometimes be done under just a local anesthetic but some patients need major revision, sometimes using $trattice or another acellular dermal matrix which acts like an internal bra. Every patient is different.
I must confess that I have no control over a patient’s breast and skin elasticity and certainly have no control over gravity (I wish!) And I must confess that I do not have a crystal ball to predict which patients will do great and which ones will need a revision.
If anyone out there has a crystal ball for sale (one that really works), let me know. I’d love to buy one!
@lisalynnsowder
