Seattle Plastic Surgeon feels like an archaeologist while removing 42 year old silicone gel implants.
Dr. Sowder, breast implant archaeologist.
Recently I saw a lovely woman in my office who wanted removal of her breast implants and replacement with new ones. This is a common procedure in my practice. What made this case really memorable was the age of her implants. They were 42 years old! This patient was one of the breast implant pioneers and here she was, all those years later finally ready for an upgrade.
Her old implants were as hard as rocks and upon removing them, the reason why was immediately evident. The scar tissue around the implants (this is called the capsule) were very thick and had calcified. The capsules had literally turned to rock.
Paradoxically, the thicker and harder the capsule, the easier it is to remove and I was able to remove the implants and capsules in two tidy pieces with zero spillage of silicone gel. Remarkably, when I opened the capsule to reveal the implants, the implants were not ruptured but they had oozed a lot of silicone gel into the surrounding capsule. The capsule and calcification was the body’s response to the oozed silicone gel. The gel implants currently on the market are much sturdier and do not have the same degree of rupture or gel ooze and these old ones did.
I inserted some brand new silicone gel implants under her chest muscle, stitched her up and she is thrilled to have a chest that doesn’t look and feel like there are two tennis balls under her skin. As for her husband, I can’t wipe the smile off of his face.
Have I told you lately that I really dig my job? Thanks for reading! Dr. Lisa Lynn Sowder
Seattle Plastic surgeon blogs about one of her pet peeves – Big breast implants and a Benelli (circumareolar or donut) lift done to avoid a full breast lift.
Big implants and a Benelli lift. IMO it’s just not a good look. A full lift and smaller implants would have served this patient better.
I do alot of breast revision surgery and I see at least one patient a month who had the operation shown on the left who is unhappy with their result. And it is almost always the case that the patient did not want the scar from a full breast lift to treat significant sagging. So she and her surgeon agreed on a large implant to take up some of the slack breast skin and a Benelli (a.k.a. circumareolar a.k.a. donut) lift to lift and reduce the diameter of the nipple and remove some excess breast skin.
The Benelli lift always flattens the area around the nipple as is seen in this case. Occasionally flattening is indicated if a patient has a tuberous deformity. And if the Benelli is expected to lift just a little and tighten just a little, the results can be very pleasing. Problems occur when surgeons and their patients ask too much of this technique.
With breast and body surgery, shape and contour is more important that length of scars. A long scar almost always will fade and smooth out but a weird contour will not change over time.
Seattle Plastic Surgeon explains what causes a double bubble deformity in the implanted breast.
The implant rides high and the breast falls over the lower edge of the implant creating the weird shape of the “double bubble”.
I saw two patients this week with the so-called double bubble. Both of these ladies had implants that were over 10 years old and both had experienced some sagging in their natural breasts.
The double bubble occurs when time and gravity result in the natural breast drooping and falling below the bottom border of the breast implant. Breast implants tend to stay put over time because they are held in place by the implant pocket and the resultant scar capsule that forms around them. Or, in some cases, the scar capsule starts to thicken causing a so-called capsular contracture and the implant can be displaced up which can result in an early or really bad double bubble.
Treatment depends on how much the double bubble bothers the patient, how bad the double bubble is, the age and condition of the implants and the condition of the patient’s breasts. Usually treatment will consist of doing a breast lift to get the breast back up into a better position relative to the implant. If the implant has developed a tight capsular contracture, removal of the old implant and capsule and replacement with a new implant may be necessary.
Sometimes ladies in middle age develop the double bubble and don’t really want to do anything surgical. It can be “fixed” with a good bra. And sometimes ladies in middle age decide that their implant days have come to an end and opt to have the implants out and a breast lift. These ladies are often relieved to be implant free and often just love their smaller and perky breasts.
So, with the double bubble and many other things related to plastic surgery, the main culprit of is time and gravity, which keeps me in business.
Seattle Plastic Surgeon will present “Breast Implant Removal and Breast Lift in the Middle Aged Patient” at the annual meeting of the Northwest Society of Plastic Surgeons.
Implants? I am so over implants!
Tomorrow I am heading off to my favorite meeting to give a talk on the surgical treatment of women who have either physically or mentally “outgrown” their breast implants. I see a lot of these ladies in my practice and I have been very happy with the results I obtain with doing a breast lift at the same time as implant removal. This leaves, of course, a smaller breast but the shape is usually very nice and almost all of my patients are pleasantly surprised at the results.
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 warns women of a certain age: Breast implants that made you look voluptuous 20 years ago may be making you look matronly today.
I think she has crossed the line to matronly. Implant removal and a breast lift can take a lot of bulk off the chest and years off the postmenopausal figure.
Recently I have had several ladies come in with implants that are no longer enhancing their figures. These ladies are all several years postmenopausal and even without overall weight gain, have added a cup size or two to their chests. This is often how weight redistributes after menopause. Don’t ask me why. It just happens.
In these cases, it is often beneficial to remove the breast implants and do a breast lift. Many, many of these patients have enough breast tissue to leave them with a B, C or even D cup. And to think that they started out flat chested so many years ago! Crazy, huh?
Doing implant removal and a lift unloads the chest and makes the torso look much slimmer (much the way a breast reduction does in a lady who carries some extra weight around the middle). These patients are often just thrilled to look slimmer and have their breast be “the real thing” after having implants for so many years.
Also, since implants don’t last forever, removing them provides a lot of peace of mind. Very few ladies over 60 relish having a new set of implants and then thinking about another new set at 80!
Now if I could just figure out a cure for the postmenopausal weight redistribution, I could retire and buy that little island in the Caribbean.
Oh, never mind. I love my job and I’m sure I would be bored to death.
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.
Breast implants are arguably the most studied medical device in the world.
Seattle Plastic Surgeon discusses the breast implant revision.
Last weekend I gave a presentation on Breast Implant Revision at the annual meeting of the Washington Society of Plastic Surgeons. This is a topic I present frequently.
About 15 years ago, several well established and very busy plastic surgeons in Seattle retired and I started seeing a lot of their patients with old implants that needed attention. Now that I have been in practice almost 20 years, I am starting to see my own patients whose older implants need attention. Between their patients and my own, I do a lot of breat implant revision, removal and replacement surgery. Hence my interest and experience.
My presentation turned out to be very timely because on June 22nd, the FDA issued their lastest report on breast implant follow-up. Despite some sobering statistics on the incidence of reoperation after breast augmentation, the FDA still concludes that breast implants are safe and effective.
Reading this report really drives home several points about breast implants:
Breast implants don’t last forever.
Most breast implant patients will need reoperation.
The older the implants, the more likely the need for reoperation.
Long term follow-up in breast implant patients is very difficult of obtain. This is a highly mobile and highly private patient population.
SOOOO – my conclusion about breast implants remains unchanged. It’s a great operation for the flat chested woman (patient satisfaction rate is very, very high) but it is not a perfect operation.
Seattle Plastic Surgeon discusses the limitation of cosmetic breast surgery.
Seattle is a very high tech city and I often have patients requesting breast implants bring in photos they have found on the internet. Internet photos can be very helpful IF the woman on the internet is in the same ball park as the patient in my exam room as far as age, height, weight, breast shape, breast size, nipple position, nipple size, skin elasticity and rib cage anatomy. Finding your breast doppelganger on the internet can be a very, very time consuming task.
Several years ago I had a 50 something lady bring in a Playboy centerfold as her desired look. That consultation required a rather difficult conversation about what plastic surgery can and cannot do and also the fine art of photographic lighting and airbrushing.
So click away on those before and after photos but keep in mind that what you end up with has a lot to do with what you and I start with!
One thing that is easy to find on the Internet are examples of what a patient does not want. Those photos are very, very valuable and help determine if the patient and I are “on the same page”.
Seattle Plastic Surgeon discusses the FDA’s recommendations for MRI following breast impant surgery.
About 4 years ago, breast implants were once again on the market after extensive review by the FDA. One of the stipulations was that women would need to get an MRI three years after implantation and every two years thereafter. These MRI exams are intended to fine “silent ruptures” meaning a breast implant that looks and feels fine but has in fact ruptured. I often get this question: “Do I really need to have all those MRI’s if I have silicone gel implants?”
Answer: “No one is going to show up at your door and haul you off to the MRI suite. Undergoing the MRI recommendations is a decision every patient will have to make for herself.”
Here is an article written by Dr. Thomas Wiender, a Houston plastic surgeon to help each patient make her decision. I cannot improve on his writing so this is an exact copy of his article:
MRI Recommendation After Silicone Gel Breast Augmentation
The FDA has recommended an MRI of the breasts at three years post-op and every two years after. You are currently at one of these postoperative time frames.
Most silicone gel implant ruptures are silent. In other words, there are no symptoms.
MRI is not 100 percent accurate. Some intact implants will appear ruptured, and some ruptured implants will appear intact. This is not a fault of the radiologist or the MRI – this is the limitation of the technology.
Over many years of research, there is no indication that a ruptured implant will cause any disease.
If an MRI indicates a ruptured implant but at surgery it is found to be intact, for Allergan implants, the manufacturer’s full warranty still applies. For Mentor implants, the manufacturer will provide the implant replacement but no financial assistance.
You must understand that because of the limits of MRI technology, you may have surgery for an implant that is found to be intact, but you will still have undergone the possible risks and complications of surgery.
In most countries outside of the United States, the equivalent of the FDA does not recommend routine follow-up MRI.
The cost of the MRI is your responsibility. You insurance company and the implant manufacturer will not pay for this.*
The decision to proceed with a postoperative MRI must be made by you, the patient, based on the above information and the information provided to you prior to surgery in the manufacturer/FDA brochure.
* First Hill Imaging in Seattle charges $1,955 for a breast MRI to look for implant rupture. If the patient pays cash up front, the fee is $1,271. I obtained this information in early 2010. Their fees are subject to change.
@lisalynnsowder
