A good plastic surgeon must be precise, discerning, have a great sense of aesthetics, balance and harmony. In a recent post (Breast Augmentation Fail or When Not to Disclose One’s Assets), I discussed the case of actress AnnaLynne McCord and her less than ideal results from a breast augmentation. Despite the significant asymmetries of projection and shape between the left and right side, she seemed quite determined to flaunt her flawed assets. Because she is beautiful, does great charitable work, and stays out of trouble and the headlines, she gets a pass.

AnnaLynne McCord flaunts her flawed results

Now let’s look at the case of Adriana Lima, the Brazilian born model. She is most well known as a Victoria Secret Angel and as a spokesmodel for Maybelline cosmetics but she also is a supermodel, actress and has graced the covers of countless magazines for more than ten years. Since 2005, she has been ranked in the top five of Forbes’ lists of the 20 highest-earning models in the world.

Looking for some good and interesting material to write about, I came across a recent photo shoot of her in a bikini that was posted online which caught my eye (actually both of them). I thought to myself: “Aha. She’s the one that I’ve been looking for!” Who knew that she was so famous?

Now about breast implants and a more tasteful breast augmentation. Below is a photo of her “aug” natural. Before plastic surgery.

Adriana Lima au natural - before breast implants

Pretty. Has potential. Not much money or fame – yet.

Now, after a very nice breast augmentation.

Adriana Lima, supermodel, after breast augmentation

Her breasts are relatively “natural” in appearance rather than being disproportionately or grotesquely large. In clothes (this is a bit of a stretch!), she has good symmetry, cleavage, projection and her breast implants are situated at the same height on her chest.

Worthy of fame and fortune.

My only gripe has nothing to do with her breast enlargement. It has to do with her emaciated, pseudo-anorexic appearance. Look at those ribs and her extremely skinny body!

If you would like to schedule a complimentary consultation with me or obtain additional information on breast augmentation surgery or on any other plastic surgery procedure that I perform, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Breast ptosis, the medical term for drooping of the breasts, occurs to some degree in a vast majority of women who have at least some breast volume present. This is the inevitable result of a combination of loss of elasticity of the skin of the breast and the stretching of underlying tissue support “fighting” against the unrelenting forces of gravity. The picture is not a very pretty one for the many women who want to regain or obtain that more youthful, firm, voluptuous, alluring shape. Furthermore, there is a negative impact on their self-confidence, sexuality and allure.

What can be done to either recoup or obtain that youthful, perky and sexually attractive shape?

Clearly, a breast lift (mastopexy) with or without implants (breast augmentation) will provide the rejuvenation of the breasts with lifting, recontouring, tightening and even adding volume. This can be facilitated employing incisions that range either from one just around the areola to an anchor shape one that also involves a vertical and horizontal component. Unfortunately, many women are very apprehensive about these incisions which ultimate become “scars” and want to avoid them at all costs.

A question that I am frequently asked and which many women have as also evidenced by myriad postings online is: “Can I just get much bigger implants to avoid having to do a breast lift?”

Often, women either know other women who have pursued this approach or they were told this in consultation with other physicians, many who either didn’t have the experience, sensibility or training regarding this issue or lowered their standards in order to “close the deal” and perform the surgery. It is unfortunate that these physicians, quite often not plastic surgeons, wouldn’t do what was in the best interest of their patients just to make a buck (or lots of bucks).

Personally, I will either do what is right for my patients or won’t perform the surgery. It’s all about principles. Period!

Now, why is placing too large an implant in the breast in order to avoid having to do a breast lift a very bad idea?

Let me explain this briefly. The skin is already thin (or thinner) with decreased elasticity (stretchiness) with breast ptosis. Placing an even larger implant than is ideal will stretch out and thin the skin even more. Added to this, many of these physicians recommend that the best way to counter the drooping breast skin is to directly stretch it out by placing the implants above the muscle. What eventuates is that the breasts descend at a more accelerated pace lower on the chest and abdominal wall. The granny breast caricature (no offense to grandmothers)!

Not a pretty picture!

Ultimately, the only treatment of this would be a complex reconstruction that would require an anchor shaped scar (which may or may not have been originally recommended) and possibly one or two procedures. The skin will be much thinner and less elastic than it would have been had the appropriate procedure been performed initially. The final outcome, after spending at least double or more the amount of money than it would have originally cost, will always be significantly inferior to what it could and should have been. Add to this the extra down time, discomfort, inconvenience, etc. and you should easily conclude that not pursuing the correct procedure was a very poor choice.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

While web surfing news and political websites, an intentionally selected salacious photo on the home page of the FOX Nation grabbed my attention. In this Pic of the Day section (it actually has been there several days now and you probably can figure out why!), was a photo of a young actress showing off a large portion of her cleavage in her hot red and red hot keyhole gown (see below).

The title associated with the picture was “AnnaLynne McCord Gets Something Off Her Chest”. The writers might have thought this was a cute phrase as they were referring to her recently acquired cleavage through breast augmentation surgery. Unfortunately, their phrase “Off Her Chest” was the exact opposite of what was done. Actually, the more precise description should have been “AnnaLynne McCord Gets Breast Implants For Her Chest”.

You might have recognized immediately that the photo was indeed of AnnaLynne McCord from “90210” but having never watched “90210”, I didn’t know. It took some googling to discover exactly who she is. What I learned is that she may be more than just another beautiful face (and body) – having some acting talent (though again I wouldn’t know that first hand). She does apparently devote a tremendous amount of her time to charities which is more than most Hollywood narcissists do … and that is an admirable endeavor.

However, she does need to devote a little more time and discretion about the clothes that she selects and some things which I will now discuss.

You may be wondering why I am writing about a voluptuous actress on my plastic surgery website, posting a revealing photo and even tossing in some nice comments about her. Well, here is the reason:

Her breast augmentation results as seen in this and other photos are … well, very unacceptable! And to make matters worse, she is brazenly flaunting what I consider to be a suboptimal outcome. Of course, both the less than ideal results and the ostentatious display of them are not a rare phenomenon in Hollywood.

No matter who my patients are, normal every day women or Hollywood actresses (I do have experience in this department), I would NEVER knowingly accept this inferior result in my own patients.

Yes, there are many women on whom it is impossible to obtain great, ideal or even very satisfactory breast augmentation results for a variety of reasons. However, in AnnaLynne’s situation, based on her photos prior to surgery, this did not appear to be the case.

So what am I seeing in the photo?

There is a striking difference in the shape and projection of the left versus the right breast implant with the left one being less projecting. This is independent of the asymmetrical position of her shoulders. Whether or not they are situated at the same vertical height can’t be ascertained by this one view. However, her revealing dress seems to accentuate the substantial disparity between sides – never a good thing.

My philosophy has always been that a breast augmentation is more than just inserting breast implants and trying to obtain a particular cup size. It is a procedure that MUST be performed with precision and this starts right in my office during the consultation. There is a very comprehensive examination that includes not only an assessment of the size of the breasts but also other issues such as their shape, location on the chest wall, asymmetries, skin tone, etc. Sizing is also done but this doesn’t end in the office. I also evaluate various sizes and styles of breast implants during surgery and will use what will give my patient the best possible results based on what the goals are.

You most likely aren’t an actress and probably will never be a movie star, but I sure want to make sure that the excellence of results from your breast augmentation will be what these famous actresses would have wanted (but didn’t receive) as their outcome.

For more information on breast augmentation or on any other plastic surgery procedure that I perform or to schedule a consultation with me, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The incision that I have preferred for virtually all of the primary breast augmentations that I have performed on my patients over the years has been the inframammary one. There have been several reasons for this including the relatively inconspicuous location and scar healing, a lower risk of the development of capsular contracture (firm scar around the implant making the breast feel hard), better surgical exposure that also allows for greater control and precision for the dissection and what intuitively seemed to me to be an approach with a lower risk of affecting the nipple-areola complex sensation. There was no large study performed that evaluated the possible effect of the incision location on nipple-areola complex (NAC) sensation … until now.

Finally, we seem to have a more definitive answer to this issue.

A large retrospective (evaluating patients who already had surgery) study was performed in Italy that evaluated the possible effect of incision location for breast augmentation on the subsequent sensation of the nipple-areola complex. This involved over 1200 women who had the surgery performed by a single surgeon over a more than 6 year period of time using either an inframammary or a periareolar incision. Variables evaluated included patient age, breast implant size, and implant pocket location (in front of or behind the muscle).

What were the findings?

Implant size had no significant impact on the sensitivity of the nipple-areola complex postoperatively. Neither did the age of the patient nor whether the implant was placed in a submuscular pocket (behind the muscle) or submammary pocket (in front of the muscle). The only factor that had a statistically significant effect on the sensation and discomfort of the NAC was the incision location. The periareolar approach resulted in either a decreased or total loss of sensation in 9.5% of patients versus 3.5% with the inframammary one. This translates into a 2.7 times greater risk for sensory loss with the periareolar incision as compared to the inframammary one. The analysis also revealed that the periareolar incision led to a 3.5 times greater likelihood of experiencing areolar pain.

This study provides even more scientific proof of the superiority of the inframammary incision for breast augmentation surgery.

For more information on breast augmentation surgery or on any other plastic surgery procedure that I perform, or to schedule a consultation with me, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Breast augmentation is the number one cosmetic surgical procedure that women undergo. It is also among the top two in overall satisfaction with 94% stating that if they had to do it all over again they would still make the same decision. That is an amazingly high number particularly in light of all the risks and complications that plastic surgeons must discuss with their patients prior to this breast enlargement surgery.

One of these risks in breast augmentation and one which I review in detail with my patients is the occurrence of numbness of the nipples and the breast skin in general. How common is numbness of the nipples? Is it temporary or permanent?

As with many surgical procedures where incisions are made and the skin elevated (lifted), there will be some postoperative numbness, albeit usually transient, and such is the case with breast enlargement surgery. Right after surgery, the skin of both breasts can/will be somewhat numb which is also compounded by the initial swelling. Over a period of a few weeks, most if not all of this will resolve in a majority of women; others can take several months. There is a very small percentage of women who may take a year or more for their sensation to return.

The incidence of permanent loss of sensation of the nipples as identified by several studies is around the 3 – 5% range though in my practice, it is extremely rare. This risk is influenced by many factors including surgical technique, skill of the surgeon, incision location and breast implant size. Incisions placed around the areola have a substantially greater risk of resulting in temporary and permanent numbness than those placed through one situated either in the lower breast crease (inframammary fold) or the armpit (axillary approach). Breast implants that are disproportionately large in relation to the chest wall and starting breast size also elevate the risk.

For more information on breast augmentation surgery in Scottsdale or on any other plastic surgery procedure that I perform or to schedule a free consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A question that is often on the mind of women who are contemplating undergoing a breast augmentation in Scottsdale and are also planning on having children in the future is “will my getting breast implants have an effect on my ability to breast feed?” This actually is a very good question that has a positive answer which I will share with you in one word:

No!!

Let me explain this to you in a little more detail.

When breast implants are inserted for a breast enlargement using either the inframammary (lower breast crease) or transaxillary (armpit) approach, there is no need to disrupt any of the breast tissue whether or not they are placed in front of (submammary) or behind the muscle (submuscular). When a periareolar (around the areola) incision is employed, there is actually a disruption of some of the ducts in the process of creating a pocket for the implants whether or not they are placed above or below the muscle. Even with this approach (where dissection traverses some breast tissue), most of the ducts and their connection to the areola and nipple still remain intact.

Over the years, many of my breast augmentation patients have had children some time after their surgery and I am unaware of anyone who was unable to breast feed. Of course, there are women who do not have breast implants and who are unable to breast feed.

If you would like more information on breast augmentation surgery in Scottsdale or breast implants or for any other plastic surgery procedure that I perform, please feel free to contact my office at 480-451-3000. At that time, we would also be happy to schedule you for a complimentary consultation with me.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Who knew that the harmless but descriptive term “blonde bombshell”, an epithet for a voluptuous, well endowed, drop dead gorgeous blond woman could one day be taken literally?

The same goes for the expression that “she has killer boobs”.

This weaponized breast/bra approach will definitely capture the attention of airport security.

Our world is being threatened by religious forces of evil and hatred that are twisting and perverting scientific, technological, aesthetic and medical advances for destructive purposes. This is not unlike many previous groundbreaking advances such as controlled nuclear fusion and fission that can be employed for peaceful purposes like nuclear power plants or for war and lethal uses as in annihilative nuclear weapons.

Now it seems that even a breast augmentation can be used for nefarious purposes.

What is the world coming to?

What is this all about?

Islamic terrorist groups are seeking to use implantable explosive devices that won’t raise suspicions and are nearly impossible to detect, allowing the terrorist to effectively evade security in order to wreak havoc on airplanes and elsewhere. Breast implants are the ideal readymade device to accomplish these nefarious acts. They are large enough to hold a highly lethal amount of explosives that could predictably blow a plane out of the sky. Pectoral and buttock implants are other possibilities that also would not raise much suspicion.

How can this be done?

The implants, which normally may be filled with saline can instead, be filled with an explosive such as PETN which is stabile until a chemical reaction is initiated. This reaction is simply precipitated by injecting the chemical trigger into the implant at the desired time which is accomplished by puncturing the skin with a sharp device that contains the element. The object can be modified and disguised to appear as a nondescript pen. All the terrorist has to do is just pull out the device and stab himself/herself to initiate the lethal reaction. This can be performed anywhere on the plane: while sitting in a seat, in the restroom or even near the cockpit.

The only good news about this is that if you had an “irrational” fear of flying before, it is at least not so irrational any longer.

Finally, to paraphrase a slogan from the 60′s so as to apply it to breast augmentation surgery: Make love, not war!

For more information on peaceful uses of breast implants or on breast augmentation surgery, please feel free to contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Silicone breast implant

There have been considerable technological advances in the design and construction of silicone breast implants since their early days. They are made with much thicker, stronger and durable outer shells that are filled with a very cohesive silicone gel – almost like taffy. The result is that they will withstand much more and last longer on average compared to previous versions.

But, they will not last forever?

Of course not!

The FDA in 2006 recommended (not mandated) that women who have silicone implants inserted for a breast augmentation in Scottsdale or breast reconstruction should have an MRI (magnetic resonance imaging) three years postoperatively then every other year afterwards. There was no specific data supporting their recommendation, however. Given the expense of an MRI which often may not be covered by a woman’s insurance plan, is this a prudent recommendation? Is it worth the money?

A retrospective study was performed at the University of Michigan and published in the March 2011 issue of the Plastic and Reconstructive Surgery® journal which examined 21 previous studies that had evaluated MRI’s and their ability to detect silicone implant rupture. The findings of the combined data were quite interesting and enlightening.

What was confirmed was that MRI’s were fairly accurate in detecting implant rupture but this wasn’t the whole story. In those women who presented with symptoms related to their implants, MRI’s were 14 times more likely to detect a rupture than in those who were asymptomatic. Looking at this from a different angle, the MRI’s were less helpful in women who had no symptoms.

Given that silicone gel implants on average last in excess of 10 years, can one justify the expense of repeated MRI’s as a screening tool for implant rupture (and breast evaluation) in otherwise asymptomatic women at least during this period of time compared to a routine screening mammogram for cancer?

With the present technology and the findings from this study, the answer is probably not. Mammograms and or ultrasounds (which are less accurate in the detection of implant rupture) should be performed for routine breast cancer screening. If there is evidence or a suspicion of an implant rupture, then an MRI can be considered or performed.

For more information on silicone gel breast implants, breast enlargement surgery in scottsdale, breast reconstruction or for any other plastic surgery procedure that I perform please feel free to call my office at 480-451-3000. A consultation can be scheduled at that time as well.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

For several years now, word has “leaked out” that there is a new type of silicone gel breast implant available for breast augmentation and breast reconstruction that is the state of the art, “safe” and the one to request. My office has received countless calls regarding these implants and I am also frequently asked about them by patients during their consultations.

What are these implants called and how are they different?

Even more important: Are they available to use here?

The silicone breast implants that I am referring to have been labeled “gummy bear” implants because in some ways they have characteristics of the candy after which they were nicknamed. I’m sure that this doesn’t include  taste though someone probably has already checked this aspect out. The major way that these silicone implants differ from earlier versions is that the gel is highly cohesive and form-stable which means that it resembles taffy rather than a viscous gel and maintains a stable shape.

These implants have been used in breast enlargements elsewhere since the early 1990’s. Extensive research on these implants has been performed both in this country and internationally but unfortunately they have not been cleared for broader usage here yet by the FDA (Federal Drug Administration) although their approval may be imminent. (Note: Plastic surgeons in the United States have been under the impression for the last several years that FDA approval was imminently forthcoming … but we are still waiting.)

There are a few advantages of these form-stable silicone implants (as well as some disadvantages) over the present day cohesive gel silicone implants. They will last longer in general and there will be virtually no potential of “gel” migrating elsewhere. The risk of developing capsular contracture appears to be lower, somewhere around 3% versus 5 – 10% or more with the standard silicone implants.

The cost for these implants are yet unknown though they are expected to be significantly more expensive than the present day silicone implants. This may affect their popularity and selection to some extent. Ultimately, several factors will play a role in deciding which type of silicone implant would be the best choice.

If you would like more information on silicone gel breast implants, breast augmentation surgery or for any other plastic surgery procedure that I perform or if you would like to schedule a consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

For many reasons, I have always been a strong proponent of placing breast implants behind the muscle (submuscular) versus in front(submammary) in breast augmentation surgery. These include better support and soft tissue coverage of the implants, lower risk of capsular contracture developing, a softer and more natural overall appearance and feel. An even more important reason is that the breasts can be better assessed on mammography when the implants are situated behind the muscle rather than in front.

Rarely, will I ever place breast implants above the muscle and when I do, it is usually as an exchange for someone who has had reasonable results with their implants situated in this location. Body builders are another exception.

It is amazing to me that there are still many physicians who place a majority of their patients’ implants in a submammary pocket. Many of these happen to be non-plastic surgeons who find that performing the procedure is easier this way and therefore dismiss or ignore important aesthetic issues and outcomes.

Over the years I have seen countless poor results from saline implants placed above the muscle in women of all ages, a situation which is exacerbated by those with thin skin. Even more disheartening are those women in their 20’s who have sustained permanent damage by what I consider to be very poor “choices” by their surgeons.

The following video illustrates one such individual who is in her mid 20’s. Note the severe static and dynamic rippling, skin stretching and very poor cosmetic appearance.

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Video of Saline Implants Above Muscle

If you would like additional information on breast implants, breast augmentation or any other plastic surgery procedure that I perform or to schedule a consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

An issue that I review with my patients during their consultation for a breast augmentation in Scottsdale is how soon after surgery can they can exercise. This is of acute interest to those who seem to inhabit fitness centers as their home away from home. However, most women do want to know this answer for many reasons including not risking the results of their surgery.

There is no fixed scientific answer for this but I will share with you what I have found that works and minimizes your risks for complications, most notably bleeding including the formation of a hematoma (blood accumulating in the pocket around the implant). In the rare situation where a patient does develop a hematoma, invariably she either engaged in an activity that she was instructed against or took blood thinners such as aspirin or anti-inflammatory medications such as ibuprofen, Motrin®, naprosyn, or Aleve® within 10 days of surgery – before or after.

Typically, you should avoid heavy lifting, straining, aerobics and sports for 3 weeks following surgery. This would also include any activity that will significantly increase your heart rate and/or blood pressure (such as jogging/running). If you do pectoralis muscle strengthening exercises, you should wait until at least 8 weeks after surgery before restarting them.

Other plastic surgeons may have different recommendations and alternate ways of doing things. This doesn’t mean that one way or another is necessarily right or wrong, at least within a certain range. However, I have seen and heard of other plastic surgeon’s patients who resumed full work-out activities within one week, developed hematomas and had to be taken back to surgery to evacuate the accumulation of blood. This is a largely avoidable and unnecessary additional expense and recuperation.

If you would like more information about a breast augmentation in Scottsdale or any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

It has been my experience that most women who have had breast implants placed either for breast augmentation, breast lifts with enlargement or even for breast reconstruction rarely elect to have them removed permanently unless they have been experiencing long term problems. In fact, I have had numerous patients in their late 70’s and even early 80’s who needed either to have their implants removed or replaced with new ones due to rupture and most all opted for the replacement. They were so happy with their results and appearance that they could not nor did not want to imagine themselves without them.

There are, however, women who elect for a variety of reasons to have their breast implants permanently removed. A frequent question that they ask of this breast revision surgery is what their breasts will look like after the explantation (implant removal).

There are many factors that play a role in affecting the outcome so that there is not one simple answer to this question. The only consistent response to this is “smaller”. Some of the factors that can influence the final appearance of the breasts can include how long the implants have been in, their size, whether or not they are above or below the muscle (submuscular versus submammary), the quality of the skin, any and number of intervening pregnancies, any breast feeding and total duration, weight fluctuations and extent and even the existence of capsular contracture.

The following patient demonstrates a good result following breast revision surgery with removal of her implants but this is not representative of all results. This 40 year old woman had originally undergone a breast augmentation more than 10 years ago with saline implants that were placed above the muscle. Recently, she noted a deflation of the left breast implant (photos A, C and E) and just wanted the implants permanently removed.

A.) Before breast implant removal

B.) After removal of breast implant

C.) Before implant removal

D.) After surgery

E.) Before explantation

F.) After surgery

Her surgery involved the straight forward removal of the implants through her previous incision along the bottom of her areola. There was virtually no discomfort postoperatively and she was back to work within a few days. At little more than 3½ months after surgery, her breasts have a very pleasing appearance (photos B, D and F).

If you would like additional information on any type of breast revision surgery, on breast augmentation or for any other plastic surgery procedure that I perform, you can call my office at 480-451-3000. We would also be happy to schedule a complimentary consultation for you if you so desire.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Do you find that shopping for bras is not a very enjoyable experience? The lingerie company, La Senza, which is a subsidiary of the Limited Brands (which also owns Victoria Secret), has created a unique advertising approach that makes selecting and buying bras quite entertaining – for both women and men. As an added bonus, it is geared for the holiday season.

What is this innovative … and alluring approach?

It may generous to call it a musical video but it features “The Cup Size Choir”. The company has assembled seven scantily clad attractive women wearing different bra cup sizes ranging from an “A” to a “G”. They then are filmed lying in beds singing the Christmas song “Deck the Halls” with each model contributing notes to the song based on their individual bra cup sizes. That is the woman wearing the “A” cup sings all the “A” notes,  etc.

The video is a very effective, eye-catching ad which has become an internet sensation. It may even get you and your significant other in a frisky er festive mood.

If after viewing this video, you really would like to be able to fill up one of these attractive bras quite nicely but don’t have what it takes yet – feel free to give us a call. We can provide you with information on breast augmentation surgery, breast lifts or for any other plastic surgery that you may be considering or to schedule a complimentary consultation with me. Our office number is 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A not infrequent reason that women see me in consultation for breast revision surgery is that they have had their implants in for many years and are considering some “updating”. In the intervening time, often involving the child raising years, many have had significant changes in the appearance of their bodies including a noticeable increase in weight and girth and may have also developed drooping of their breasts. Some state that their breasts have felt hard for a few years and have developed an irregular shape.

The following patient of mine is a 54 year old woman who had her original breast augmentation performed 32 years ago which was followed by three pregnancies and three children (photos A, C and E). For the last several years she has noted firmness of both breasts and irregularities of shape. Her desire was to have larger, softer and more attractive appearing breasts but not very ostentatious.

A.) Before breast revision surgery (frontal view)

B.) After breast revision surgery (frontal view)

C.) Before surgery (oblique view)

D.) After surgery (oblique view)

E.) Before surgery (side view)

F.) After surgery (side view)

Her breast revision surgery consisted of removal of the old silicone breast implants which were still intact, resection of the calcified scar tissue that surrounded them (capsulectomy), recontouring of the pockets in which the implants were situated and placement of smooth surfaced, high-profile silicone breast implants which were substantially larger than the ones that they replaced. Their volume was selected based on her desired overall general cup size and was tempered to keep her outcome more age appropriate (photos B, D and F).

She experience little discomfort postoperatively and was up and around her house the day of surgery. The size, shape and proportionality were exactly what she had desired which made her quite happy, satisfied and proud.

For more information on breast revision surgery, breast augmentation or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

All my patients who are considering cosmetic or reconstructive breast surgery procedures that involve the placement of breast implants are given the choice of using either silicone or saline implants. This includes women contemplating a breast augmentation, breast lift with implants, breast implant exchange and breast reconstruction. During their consultations, I extensively discuss the relevant issues regarding both types of implants such as durability, aesthetics, concerns and risks and they also are able to closely examine and feel each one. Ultimately, they decide for themselves which one they want: silicone or saline.

Silicone breast implant

Virtually all of my patients ultimately select silicone implants for their procedure, whether it is for aesthetic or reconstructive reasons. The very few cosmetic patients who do choose saline implants do so because of the cost differential: they are around $1,000 less per pair. The aesthetic outcome and satisfaction of my patients from these procedures irrefutably supports the far greater superiority of silicone implants as compared to the saline ones and this is true for both cosmetic and reconstructive procedures.

This preference has been borne out in the medical literature including a multicenter study just published in the November issue of “Cancer”. This study carefully examined and analyzed the responses of 672 women who had undergone post-mastectomy breast reconstruction using either saline or silicone implants at one of three major institutions in this country. The findings were statistically significant in that the level of satisfaction was much greater in those women who selected silicone implants to be used in their reconstruction as compared to the saline ones.

If you would like additional information on silicone or saline breast implants, breast augmentation, breast reconstruction or for any other plastic surgery procedure that I perform, please call my office at 480-451-3000. We would also be happy to schedule a consultation for you if you desire.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Much has changed since I first opened my practice in cosmetic and reconstructive plastic surgery in the Scottsdale and Phoenix metropolitan area more than 23 years ago. Back then, we listened to music on our Walkmans. Now we have tiny MP3 players and iPods. Cell phones the shape and size of bricks have been replaced by essentially miniature computers – iPhones, Androids and Blackberrys. And our wealth has … well never mind!

Not everything has shrunk in size, though. The Phoenix area has grown from an afterthought Western city situated somewhere between Chicago and L. A. to the 5th largest city in the country. And the average breast implant size has become larger. Much larger!

I find that women of all ages want breasts that are significantly greater in size than were desired years ago. Consequently, they are requiring much bigger breast implants for their breast augmentations in order to obtain that goal. This is a national phenomenon though some areas remain more “conservative” than others.

Larger implants with their increased volume and weight do introduce some important considerations that should be addressed as part of your consultation. The relatively greater weight will cause the skin at the bottom of the breasts to stretch out and become thinner to a much greater degree over time, causing a “bottoming out” appearance with less fullness higher up. This is more significant and substantial when the implants are situated above (submammary) versus below (submuscular) the muscle.

The weight can also tear or disrupt normal tissue structures of the chest wall at the crease at the bottom of the breast resulting in the implants becoming displaced lower, onto the abdominal wall. This is independent of the stretching effect noted above.

Finally, for disproportionately gigantic implants, especially those placed above the muscle, it wouldn’t be out of the realm of possibility that they could precipitate some lower back pain not dissimilar to that produced by naturally enlarged breasts.

What may be considered to be a “large” breast implant size for a breast enlargement? There is no precise or generally accepted volume where these effects would start to manifest themselves. It all depends on multiple factors including an individual’s size, width, skin tone, pregnancy history, activity level, bra usage and type, etc. Nevertheless, some patients may experience changes such as gradual skin stretching starting at around a 400cc size. At 500cc and larger, such changes would be far more likely to occur.

If you would like additional information on breast implants, breast augmentation or for any other cosmetic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Advertisements are appearing promising breast enlargements accomplished through injections of your own body fat. This almost sounds too good to be true. After all, they claim that your unwanted body fat can be removed with liposuction and then injected into your breasts to augment them.

This raises many questions including:
1. Is this legit?
2. Is it safe?
3. Is it an approved or mainstream option/procedure?
4. What kind of results can be expected?
5. Do they look natural?
6. Do they feel natural?
7. Are there certain individuals more likely to obtain a better result?
8. How long does this last?
9. Are there limitations to the size that can be obtained?
10. Can this be performed in one procedure or does it require multiple procedures?
11. Can this procedure make it more difficult to interpret mammograms?
12. Is there any evidence that these injections may increase the risk for breast cancer?
13. Who should not be considered a candidate?
14. What are the total costs?
15. How do the total expected costs compare to those of a breast augmentation using silicone implants?
16. What are the complications and their rates of incidence?

These are just some of the important questions that need to be considered with fat injections for breast augmentation. There have been several studies conducted and case reports of various techniques that have been employed to perform this procedure but no large scale prospective studies completed using well controlled variables. With time answers to all of these questions will be forthcoming and more definitive.

Fat injections to obtain breast enlargement is not a mainstream procedure (at least not at present) and should only be contemplated with extreme caution as there are far too many unanswered questions and issues of risk and outcome that have not been definitively resolved. It is clearly not an option in thin individuals with little body fat and should not be contemplated in women who are at a higher risk for the development of breast cancer.

As more research is completed and questions are answered, I will report them to you in future posts. Clearly, this may someday be an exciting and great option for certain groups of women.

If you would information on a breast enlargement or any other plastic surgery procedure that I perform or to schedule a complimentary consultation with me, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Whether inserting implants for a breast augmentation or in breast reconstruction, the outcome is not always what was expected or desired. One such unplanned result is where the breast implants are so close together that they form a “uniboob” which is technically known as symmastia. A variant is where the implant on one side crosses the midline of the chest and extends to the other side. In my post of Dec. 14, 2009 (Etiology of Symmastia aka the Uniboob Following Breast Enlargement), I explore symmastia issue in some detail.

Though occurring far more commonly as a result of breast augmentation surgery, this condition can also manifest itself with breast reconstruction. It is not a rare problem but it can be quite challenging requiring very tedious and intricate techniques to correct. With the advent of AlloDerm®, Strattice® and other tissue matrix (dermal graft) options, the treatment can potentially be more predictable, desirable and permanent.

The following case of mine illustrates an example of a symmastia variant that was successfully treated with this approach. This is a 60 year old female who underwent an implant exchange a few years ago, replacing those which had been present from her breast augmentation performed 30 years. The symmastia occurred following this most recent procedure. She was very unhappy with the deformed appearance, contour irregularities, the substantial asymmetries, rippling of the skin which had developed and the limitations that she had in wearing many styles of clothes (photos A, C, and E). Notice the right breast with the implant extending well over to the left side and the associated irregular contour. The left implant is also significantly higher than the right.

A. Symmastia and deformities - before surgery

B. After surgery

C. Side view before surgery

D. After surgery

E. Before surgery - oblique view

F. After surgery - oblique view

Her breast revision and symmastia surgery consisted of exchanging her large broad implants for more projecting high profile implants that were smaller in volume and precisely placed. Contouring and repositioning of the tissues were performed and AlloDerm® tissue matrix graft was employed to meticulously secure and configure the breast implant placement.

The results shown just 7 weeks following the reconstructive surgery illustrate the substantial improvement in her breast positioning, contour and projection with resolution of the rippling that she was experiencing (photos B, D and F). Needless to say, she was quite satisfied with the outcome.

If you would like additional information on symmastia and its treatment, on breast augmentation, breast reconstruction or any other plastic surgery procedure or to schedule a consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

There is great news for women as well as men: women’s breasts have been getting noticeably and naturally larger over the past 50 years. This is an unmistakable finding which is unrelated to weight and height issues and is completely independent of breast implants.

Many theories have been advanced to explain this burgeoning of breast volume but there is no one definitive answer. Some feel that it is related to the improved general nutrition in experienced by women during this period of time including increased intake of fruits, vegetables and most importantly, proteins. Others ascribe this change to estrogen and other substances in our foods and environment including hormones injected into poultry and livestock and even from the BPA in plastic bottles. Birth control pills do facilitate an enlargement of the breasts but only in those who are taking them – so this doesn’t explain the global changes that have developed.

During this same period of time that the average size of women’s breasts has significantly enlarged, women have also increased the desired size that they ultimately want their breasts to be.

What are the results of all of this?  More women than ever are desirous of a breast augmentation. Seemingly ironic, at the same time and as a result of other factors as well, more women than ever are undergoing breast reduction surgery. This may seem totally confusing and conflicting but it really does make sense. I have seen these trends in my practice over the last 23 years.

If you would like more information on breast augmentations, breast reductions or on any other plastic surgery procedure that I perform or to schedule a free cosmetic consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

My preference for the insertion of breast implants in breast augmentation surgery is usually through an incision along the fold at the bottom of the breast also known as the inframammary approach. There are many advantages for this technique some of which I have enumerated on the website. One that wasn’t specifically mentioned is that the final scars from surgery will always be covered by one’s clothes and that can be important for those at a higher risk for more conspicuous scars.

An extremely small percentage of women state that they don’t want any scars located on their breasts as they will serve as telltale signs of them having had breast enlargement surgery. Instead, they request the transaxillary (armpit) approach for breast implant insertion. If their scars do not heal satisfactorily, they may have more significant issues.

The following patient saw me in consultation having undergone a breast augmentation elsewhere using this transaxillary technique. Thick hypertrophic scars developed that were re-excised by her plastic surgeon only to have them recur. Now she is faced with exposed, prominent scars that are clearly visible when she wears sleeveless tops and bathing suits. Furthermore, she does experience discomfort at times when reaching due to pulling on the thick scar.

View of right armpit revealing keloid that resulted from transaxillary incision. It has already been revised once by her original plastic surgeon.

If, instead, these same thick scars were situated on her breasts, at least they would be covered by her clothes and would not be apparent to anyone else until she removed her clothes. Furthermore, she would not have any restrictions in the clothes that she wanted to wear including sleeveless tops and that can be quite important in Arizona summers with temperatures far exceeding 100 degrees Fahrenheit.

If you have any questions regarding breast augmentations or incision choices, breast revision surgery or on any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona