Posted on March 1, 2010 in Breast augmentation, Breast implants, Breast lift (Mastopexy), Breast reconstruction, Saline implants, Silicone implants
Breast implant exchange surgery is the replacing of one or both of one’s implants for a newer one or pair after previously having had a breast augmentation, mastopexy with implants or breast reconstruction. Why would a woman elect to undergo such a procedure? There are many reasons for this with some of the more common ones being:
- size change – usually to increase the implant volume and therefore the breast size; rarely to decrease
- to modify the breast configuration such as to make them more projecting or less wide
- to switch from saline to silicone implants; rarely, silicone to saline
- replace a ruptured breast implant
- in the course of treating one of a variety of aesthetic breast issues such as drooping or capsular contracture, replacing older implants with newer ones.
The most common reason for implant exchange is that a woman is unhappy with the selected size and wants to be significantly larger. It is fairly infrequent to desire a smaller size and this is often due either to the surgeon placing a far too large implant initially or the patient gaining a considerable amount of weight resulting in a marked enlargement of breast tissue.
In my practice, it is fairly rare for my patients to desire a change their breast implant size and if they do, it is usually years later. Why can I keep this rate extremely low? When evaluating my patients in consultation, I listen carefully to exactly what they want or think they want. I also measure and size them in the office, have them try on a variety of implants, and show them photos of other patients to provide them with a greater understanding and visualization. During surgery, this is fine tuned, as I will employ temporary implants in order to assess the effects of various sizes and configurations.
By offering many different styles of breast implants, I can customize the appearance that would be most appropriate and desirable for my patients. For example, patients who are very narrow and desire significant projection would be best served with higher profile implants whereas women who are broad with a moderate amount of breast tissue present may benefit more from moderate profile implants. Many of the patients that I perform implant exchanges on were done elsewhere and indicated that they were never offered or explained the options.
It is essentially unanimous that women prefer the silicone implants over the saline ones as they feel similar to breast tissue. When switching between fill materials, virtually all go from saline to silicone whereas the opposite is almost never performed due to aesthetic issues.
If you would like more information on silicone or saline breast implants, breast augmentation, breast lifts or 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
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Posted on February 1, 2010 in Breast augmentation, Breast implants, Breast lift (Mastopexy), Breast reconstruction, Saline implants, Silicone implants
During the moratorium imposed by the U.S. Food and Drug Administration between 1992 and November 2006 that limited specific uses of silicone breast implants, women who wanted to have a breast augmentation could only be offered saline breast implants. Since the end of 2006, silicone breast implants have once again been available without restriction for all women desiring breast surgery. This includes for breast augmentation as well as breast lifts (mastopexy) with implants, breast reconstruction and those who want or need to exchange their implants for different ones.
Having been in plastic surgery practice for over 22 years in Scottsdale and Phoenix, Arizona, I have long been involved and dealt with and witnessed the multitude of factors and issues regarding silicone and saline breast implants. Prior to 1992, my patients used silicone implants exclusively and were quite happy. During the period of the moratorium in which all my breast augmentation patients and some of my mastopexy and breast reconstruction patients utilized saline implants, I noted that the aesthetic results and level of satisfaction with the naturalness of outcome were decreased and compromised compared to results with silicone implants.
This sentiment came as no surprise. Why? Silicone breast implants feel very natural and “soft”, like breast tissue, so that when they are in place, it often is very difficult to discern their presence particularly for the non-professional. Saline implants, on the other hand, can often be detected, either by sight, feel or both. This is exacerbated in very thin patients who often have “rippling” seen through their skin. These issues and others such as deflations do detract from their popularity. In patients of mine who have had both types of breast implants, every single one of them preferred and were far more satisfied with the silicone ones.
In the more than 3 year period since the lifting of the moratorium on the usage of silicone breast implants, virtually none of my patients select saline implants for their breast surgery which translates to around 99% silicone usage. For the rare few who do, it is only because of the lower cost of the saline implants.
If you are interested in obtaining additional information on silicone or saline breast implants, breast augmentation, mastopexy or any other plastic surgery procedure that I perform or to schedule a consultation with me, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on January 4, 2010 in Breast augmentation, Breast implants, Saline implants, Silicone implants
Unlike with silicone implants used in breast augmentation, the diagnosis of a ruptured saline implant is usually quite easy and apparent. Most of the time there is a rapid and dramatic decrease in volume of the implant and, therefore, in the size of the affected breast. This can occur in a matter of a few hours to a few days though I have had a few patients who have noted a very gradual decrease in size over a period of even several months.
What happens to the saline? Your body will absorb the fluid which is harmless. As it does, your breast will further decrease in size.
Once it is apparent that the implant is ruptured, I recommend that the situation be addressed sooner than later. The reason for this is that the tissue which had been previously stretched out will contract around the deflated breast implant over time and form variable amounts of somewhat constrictive scar tissue. This can make it more difficult to reacquire the level of symmetry that had been present prior to the deflation.
The plastic surgery options available for treatment of a ruptured saline breast implant following a breast augmentation fall into four general categories:
1. Replace just the deflated implant.
2. Elect to undergo a bilateral implant exchange. With this approach, one can also change size, style and switch to silicone implants
3. Remove both breast implants (also known as bilateral explantation).
4. Do nothing at all. This option is almost never selected.
In your consultation, I would discuss each of the above options in detail including the pros and cons in order to allow you to make an informed decision.
If you would like additional information on breast implants, breast augmentation, mastopexy with breast enlargement or any other plastic surgery procedure or to schedule a consultation, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on December 14, 2009 in Breast augmentation, Breast implants, Symmastia
Breast augmentation is among the most common plastic surgery procedures that women chose and is associated with an extremely high satisfaction rate in the vicinity of 94%. Despite such an astounding level of happiness, there are many variables and issues that can lead to less than desirable results. One relatively uncommon problem is where the two breasts seem to coalesce into one larger unit which is scientifically called symmastia (also synmastia) or in lay terms, a uniboob. In this situation, the breast implants can move or be moved so far to the midline that they may actually touch each other.
What are the causes and who is at a greater risk of developing this deformity? In general, women who are fairly thin and those who have a chest wall deformity known as pectus excavatum (where the sternum has a caved in appearance) are at a higher risk. This is risk is further amplified by a desire to have their breasts situated close together and by the selection of disproportionately large implants.
Symmastia is usually the result of overzealous dissection of the implant pocket medially (near the midline). In attempting to decrease the distance between the breasts so as to facilitate more cleavage, a surgeon may over-release tissue that is normally adherent to the underlying sternum. This allows the implants to migrate so far to the midline that they may actually touch. The skin then redrapes over the breast implants rather than discretely attaching to the sternum which results in the amorphous shaped uniboob versus two well defined breasts. Symmastia occurs both with breast implants that have been placed in submammary and submuscular pockets.
A few treatment options are available to correct this deformity including a relatively new approach using specially processed tissue (Alloderm® and Strattice®). Repair of symmastia can be very challenging and the results not always ideal. Selecting smaller and less wide implants will also assist in obtaining a more predictable and permanent correction.
If you would like additional information on symmastia, breast augmentation, breast implants, mastopexy or any other plastic surgery procedure or to schedule a consultation, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on November 30, 2009 in Breast augmentation, Breast lift (Mastopexy), Breast reduction
In an earlier post, we noted that women pursue breast reduction surgery for either functional or aesthetic reasons. The vast majority of women that I see as well as those who seek out a breast reduction in general, are doing so in order to alleviate the symptoms associated with their considerably enlarged breasts. These symptoms can include neck, back and shoulder pains, headaches, rashes, and discomfort and limitations engaging in sports and exercising.
However, just because you have one or more of these issues does not mean that your enlarged breasts are a cause or even the only cause of your problems. The best way to ascertain whether a reduction mammoplasty would benefit you is to consult with a Plastic Surgeon certified by the American Board of Plastic Surgery such as myself. If your plastic surgeon determines that a breast reduction could help to alleviate or resolve some or all of your symptoms, then you would be a good candidate for the procedure.
Some women desire their breasts to be reduced in size (and lifted if indicated) solely for aesthetic reasons and not because they are experiencing any related symptoms. They simply want smaller and perkier breasts. A breast reduction can surely accomplish this though a plastic surgeon like myself can assist you in arriving at a prudent decision based on your concerns and goals.
If you have the appropriate functional or aesthetic reasons for pursuing a breast reduction as confirmed by a plastic surgeon and you are a relatively low surgical risk, then you would indeed be a good candidate for breast reduction surgery.
For more information on a breast reduction, breast lift (mastopexy), breast enlargement or any other plastic surgery procedure, you can contact our office at 480-451-3000 or send us an e-mail.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on November 23, 2009 in Breast augmentation, Breast lift (Mastopexy), Breast reduction, Eyelid surgery, Liposuction, Tummy tuck (Abdominoplasty)
Just what is a “Mommy Makeover”? You probably have been hearing or seeing this expression used in advertisements recently and wondered what it is. Essentially a “Mommy Makeover” is the correction by plastic surgery of the changes that occur as a result of having children in order to regain a more pre-pregnancy figure. Often, related cosmetic procedures can be performed concurrently to improve one’s overall appearance. Pregnancy permanently affects to variable extents women’s breasts, abdomen and body fat deposition and so these are the areas that are addressed.
Following pregnancy, many women lose some firmness, shape and volume of their breasts which may also become droopy and develop stretch marks. These changes can be further exacerbated by breast feeding with the duration and number of children affecting the outcome. A few women actually have a net increase in breast size though the shape and positioning usually suffer. Procedures that can effectively address these changes include a breast augmentation, breast lift with or without a breast enlargement and a breast reduction.
Permanent changes in the appearance of the abdomen following pregnancy are quite variable among women and are affected by a multitude of factors. The often is some residual degree of laxity of the skin and the underlying muscle layer along with changes in the distribution of fat. Cosmetic procedures that could improve the appearance of the abdomen include a mini tummy tuck, a standard tummy tuck (abdominoplasty) and liposuction. Liposuction can also be performed elsewhere including the hips, thighs, knees and even back.
The combination of the appropriate cosmetic procedures of the breast and abdomen with or without liposuction performed at one surgical setting constitutes the “Mommy Makeover”. Of course, other procedures such as eyelid surgery can be done at the same time if warranted and indicated. This rejuvenation of one’s body back to a more desirable shape can do wonders for your psyche, self-confidence and sense of attractiveness.
If you would like additional information on breast augmentation, breast lifts, liposuction, tummy tucks (abdominoplasty) other cosmetic surgery procedure that I perform or you would like to schedule a complimentary consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on October 26, 2009 in Breast augmentation, Breast implants, Breast lift (Mastopexy), Breast reconstruction, Nipple-areola complex
There are many advantages of placing breast implants behind the pectoralis major muscle for a breast augmentation, breast lift (mastopexy) and in breast reconstruction. The most significant of these include:
- Better ability to detect abnormalities on mammograms versus in front of the muscle (submammary)
- Lower risk for capsular contracture (hardness of the breast caused by the formation of scar tissue around the implants)
- More soft tissue coverage overlying the implant resulting in a lower risk and extent of visible rippling
- Provides a better and more natural interface of the implant with the chest wall
- Serves to provide better support of the implant long term as compared to above the muscle where the weight of the implant will cause greater stretching and thinning out of the skin over time as well as its descent on the chest wall
Implants above the muscle. Note the rippling, harsher contours, stretched areolas and unnaturalness of the result. (not my patient)
Implants behind the muscle. Note the more natural shape and smoother curves. This approach is recommended for most of my patients.
Except for some rare exceptions, most women are best served with the submuscular placement of their implants. As a result, this is my recommendation for virtually all of my patients.
If you would like additional information on a breast augmentation, breast lift, breast reconstruction or any cosmetic surgery procedure or to schedule a consultation, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on October 5, 2009 in Arm lift, Belt lipectomy, Body contouring after Massive Weight Loss, Breast augmentation, Breast lift (Mastopexy), Massive Weight Loss, Panniculectomy, Tummy tuck (Abdominoplasty)
We are in the midst of an unparalleled epidemic of obesity in this country. This is related to a combination of a general overindulgence in food, excessive consumption of foods high in fat and calories, and a more sedentary life style. Many of these people have realized that, for a variety of reasons, this excess weight needed to be shed. Through arduous dieting, exercise often in conjunction with bariatric surgery such as lap banding or gastric bypass they have lost tremendous amounts of weight, often far exceeding 100 pounds.
Success, finally! Celebration? Maybe not quite yet. Despite the massive weight loss that was so difficult to achieve, what many people didn’t anticipate was the permanent consequences on their bodies of first gaining then losing this sizable poundage. The figure that they envisioned following all this effort is not what they are seeing in the mirror. Instead of being slimmed down, contoured and generally smaller, most are left with unsightly deformities consisting of an excess of lax, irregularly contoured stretched skin that frequently cascades in rolls creating hygienic issues and an aesthetic nightmare.
Which areas are affected? From the face on down, the sequelae from massive weight loss may be seen. There is considerable variability among individuals as to the severity and areas that are most affected. Common areas include the abdomen, buttocks, circumferential trunk, inner and outer thighs, breasts, arms and even face and neck.
Fortunately, cosmetic procedures have been designed and refined that can address essentially any and all deformities related to post massive weight loss deformities. Examples of these procedures include abdominoplasties, thigh lifts, belt lipectomies, breast lifts, breast augmentations, arm lifts, face lifts and back lifts. A strategy for body contouring can be uniquely tailored for your individual needs based on your deformities and goals which could be determined at the time of consultation.
If you would like to obtain additional information on body contouring surgery such as for a tummy tuck, belt lipectomy, breast lift (mastopexy), breast augmentation, arm lift and face lift, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on August 24, 2009 in Breast augmentation
The development of a hematoma (an undesirable accumulation of blood around the implant) following a breast augmentation is relatively uncommon with an estimated incidence around 1 to 4 percent. A few simple precautions can be taken before and after the surgery to help minimize the risk of it occurring.
Any medication or substance that will interfere with the body’s ability to appropriately form clots (blood thinners) will increase the probability of unwanted bleeding and therefore also increase the likelihood of developing a hematoma. Some of these include analgesics and anti-inflammatories such as aspirin, ibuprofen, Motrin, and Aleve as well as others such as Coumadin, Warfarin, and Plavix. Vitamin E, fish oils and many herbal supplements can also interfere with the clotting mechanism.
My patients are required to avoid taking most of these medications, Vitamin E and herbal supplements beginning from two weeks prior to surgery and continuing until two weeks following surgery. Specific blood thinners such as Coumadin and Warfarin are usually stopped two to three days preoperatively and restarted around two to three days postoperatively. Approval from your primary care doctor to temporarily discontinue this medication is mandatory. My patients are also provided with a comprehensive list of medications, both generics and proprietary, that should be avoided.
Hematomas are also frequently caused by activities that involve considerable exertion, heavy lifting or repetitive upper extremity movements. This would include sports, aerobics, jogging and similar activities. Though recommendations vary among physicians, I request that my patients avoid these activities for three weeks following surgery. For professions such as a hairdressing, nursing or waitressing, women can return to work sooner but with some restrictions.
A few simple precautionary steps are all that are need to minimize the risk of developing a hematoma and its undesirable consequences.
For further information on breast augmentation, breast implants or any other cosmetic procedure, you can contact my office in Scottsdale or Glendale, Arizona at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on August 10, 2009 in Breast augmentation, Breast implants
Girls in today’s world are exposed to more body image related issues and information than ever before. This includes from well informed (and endowed) peers, exposure to countless magazines displaying a profusion of voluptuous female bodies, countless sexually overt TV shows, and limitless information and images from the internet. With particular emphasis on breast size, those that are or feel deficient often know what they need to do. Get breast implants!
Dissatisfaction with one’s body image, including breast size, is the norm for the adolescent female. During this period of time, they are growing physically and experiencing myriad psychological and emotional issues and variability. This translates into a period of exceptional instability during which it would not be prudent to consider most cosmetic surgery procedures.
At what age, then, would a girl/woman be an appropriate candidate for a breast enlargement surgery? Though there is not be an exact right or wrong answer given the variability in emotional, physical and intellectual maturation between individuals, my personal recommendation is to wait until 18 years of age except in unusual circumstances. For many reasons, I feel this is best for all parties involved.
There are exceptions, of course. Girls who have breasts of markedly different sizes where the disparities are difficult to camouflage or who have extreme under-development or congenital absence on one side would be candidates for surgery at an earlier age. Technically, these can be considered to be reconstructive procedures.
For further information on breast augmentation, breast implants or any other cosmetic procedure, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on July 7, 2009 in Breast augmentation, Nipple-areola complex
Asymmetry of the breasts is present in the majority of women. Some might have been aware of the differences whereas some never even noticed the difference until it was pointed out much to their surprise during their consultation. Differences can involve breast shape, size, positioning on the chest wall, drooping, chest wall variations and nipple-areola asymmetries such as size, shape, positioning, contour and projection. Of course, whether or not there is a difference or if it ever was recognized previously, many expect perfect symmetry following surgery.
Breast augmentation surgery will not correct asymmetries. Some differences may be diminished whereas others will persist or may even be accentuated.
A frequent question regards differences in the vertical heights of the areolas and whether they will be situated at the same level following surgery. The answer to this is that they will remain dissimilar most of the time so that one will continue to be higher than the other (see photos). Furthermore, because the breast implants are placed so as to be at the same vertical height on the chest, aesthetically, one nipple-areola complex will always seem to not be in the ideal position. In situations where the areolas are located more to the side of the breast than centrally preoperatively, this malposition may be magnified postoperatively.
Despite these relatively minor issues, a breast augmentation still provides women what they desire from this procedure – fullness, projection, cleavage and a more attractive and alluring appearance.
Different nipple-areola heights preoperatively (frontal view)
Nipple-areola heights following breast augmentation (frontal)
Different nipple-areola heights preoperatively (oblique view)
Nipple-areola heights following breast augmentation (oblique)
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on July 1, 2009 in Breast augmentation, Breast cancer, Breast implants, Silicone implants
Silicone breast implants have been more thoroughly researched over the years than any other medical device. The purpose of many of these studies was to ascertain whether there existed a causal relationship between them and any disease processes. A quite unexpected discovery which has been well documented in several large patient population evaluations is that there is a lower than expected incidence of breast cancer occurring in women who have undergone a breast augmentation. In other words, women with silicone breast implants have a lower risk of developing breast cancer than the average women.
In the most recent large study, published in the International Journal of Cancer in January 2009, over 6200 Swedish and Danish women were followed post-implantation for a mean duration of over 16.5 years with over thirteen percent having the implants for at least twenty five years. What the researchers determined was that there was a statistically significant 27% reduction in risk of developing breast cancer in women with silicone gel breast implants. This is not a new finding as several studies performed previously reached the same conclusions with some actually showing risk reductions as high as 37 to 53%.
This is great news, of course, for both those women who have had a breast augmentation and those that are contemplating it. Why there is a lowered risk of breast cancer in women who have had silicone breast implants is not entirely clear and there may be several other factors in play. In discussing the procedure with my patients, I do not them that having breast implants will lower their risk of developing breast cancer. What I do indicate is that all evidence points to no increased risk of this type of cancer.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on June 13, 2009 in Breast augmentation
Since opening my plastic surgery practice in Scottsdale and Glendale over 20 years ago, there has been a markedly positive evolution in the postoperative course that my patients have experienced following a breast augmentation. This has resulted in shorter recuperation times, less discomfort, reduced postoperative nausea and shorter times off from work or school.
All my patients have their breast augmentation surgery performed using general anesthesia as it is far more comfortable and humane. Patients who have had their previous breast enlargement done using a twilight anesthetic (not fully asleep) will relate the uncomfortable nature of this approach – physically and emotionally. The anesthetic agents utilized for general anesthesia today are far more refined, effective, predictable and with fewer side-effects. Patients wake up far more rapidly, are lucid and functional in a much shorter period of time without an anesthetic “hangover”. The incidence of nausea has been markedly reduced and the extent is usually fairly mild and well controlled with one of several effective medications.
With an evolution in technique, I have found that the level of surgical discomfort postoperatively has been reduced tremendously. Though pain tolerance varies from person to person, most of my patients take medication to control the pain just for a few days and often not on a regular basis. They may take an occasional analgesic subsequently as they become more active. Some may only require pain medication for the first twenty four hours.
I do recommend light activities for the first few days with certain restrictions. The surgical dressing is typically removed two days after surgery at which point in time you are placed in a supportive but comfortable bra. At that time, you will notice that your breasts will be moderately swollen and firm. This will rapidly subside in the ensuing several weeks so that even at a month, they will appear closer to their long term shape. However, expect that it can take up to six months or longer for a more “stable” long term appearance.
Most patients can resume driving by three to five days. I strongly discourage driving if you are still taking narcotics as they can impair your senses and therefore your ability to drive safely. You are encouraged to resume most of your normal activities when you feel comfortable. I do restrict vigorous activities such as sports, aerobics, and heavy lifting for three weeks following surgery. Pectoralis muscle exercises should be avoided for eight weeks.
Virtually all of my patients return to school or work within five to seven days. If your job requires strenuous activity or long hours, you may need additional time off from work or some sort of temporary assistance or job modification.
If you would like additional information about recovery from a breast augmentation, information about the breast augmentation procedure in general or to schedule a consultation, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on May 31, 2009 in Breast augmentation, Breast implants, Saline implants, Silicone implants, Smooth surfaced implants, Textured surfaced implants
There are many decisions to be made when contemplating breast augmentation surgery such as implant size, shape, projection type, placement behind or in front of the muscle and saline versus silicone. Another factor to consider is the surface characteristics of the implant – smooth or textured. The first generation of breast implants that were used beginning in the 1960’s had a smooth outer surface. Over time, a significant number of these women developed firmness around the implants called capsular contracture. In the 1970’s, it was discovered that placing a thin layer of textured polyurethane foam around the implants resulted in a much lower rate of this contracture developing. The aesthetic results were superior both in feel and appearance to those that did not have this outer layer. These polyurethane implants remained quite popular until they were voluntarily removed from the market in 1992 due to theoretical concerns of long-term safety of the polyurethane itself.
Implant manufacturers sought to simulate these results by incorporating the texturing within the silicone outer shell of the implants without the need for polyurethane. These began appearing around 1986 from a variety of manufacturers and are still being offered today along with the smooth surfaced ones.
So, which is the better choice? The answer is not exactly straightforward. It may depend on several factors as well as on physician preference. Research data on textured versus smooth implants at times has been inconclusive with regard to the development of capsular contracture. For implants placed above the muscle (submammary), there may be a lower rate of firmness developing when the textured surfaced ones are used. However, textured saline implants in this location are associated with a high rate of rippling and irregularities of the skin contour, severely compromising the aesthetic result as compared to the smooth surfaced ones. This can also create discomfort in the breast where the edges of the implant are poking into the skin. The implant may also have a shorter life span.
Research results for the implants placed behind the muscle (submuscular) are less clear. There may be slight differences in the capsular contracture rates and durability between the textured and smooth implants, whether they are silicone or saline.
So, what do I recommend from my years of experience? For several reasons, rarely would I place an implant above the muscle. If I did, it surely would not be a textured saline one! My choice for saline implants behind the muscle is also smooth because they clearly provide a better aesthetic outcome.
Why saline implants placed above the muscle are not recommended - Frontal view (not my patient!)
Why saline implants above the muscle are not recommended - Oblique view (not my patient!)
Both smooth and textured silicone implants placed behind the muscle can yield great results. I base my recommendation largely but not solely on the dimensions of the implant that I am looking for. The textured and smooth implant configurations as designed by the manufacturer of preference, Allergan Corporation, are slightly different throughout the range of sizes with the latter tending to be slightly more projecting and less wide. If someone had a history of capsular contracture, I would more likely consider a textured surfaced implant in that situation.
I find that implant surface type is a non-issue with my patients. They will defer to my recommendations here. After all, they have much more important decisions to make. Like implant size…!
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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Posted on May 19, 2009 in Breast augmentation, Breast implants, Saline implants, Silicone implants
Although breast implants can be very durable, given enough time, they do not last forever. Over time, the cumulative effects of normal intrinsic and extrinsic “wear and tear” will affect the strength and integrity of the implant shell. Silicone implants do last noticeably longer as compared to saline implants.
What are some of the factors that can reduce the lifespan of implants? High impact trauma directly to the breast can significantly stretch and weaken the implant shell or even cause it to disrupt resulting in implant rupture. Common mechanisms for this include car and motorcycle accidents, major falls and even sports injuries. Nevertheless, I have evaluated and treated many women over the years whose implants have survived serious motor vehicle accidents including steering wheel breaking head-on collisions, being thrown from motorcycles, getting hit in the chest with batted softballs or thrown footballs, etc.
Anything that can markedly increase the pressure placed on the implants, sustained or intermittent, may predispose them to premature rupture. This can include extremely aggressive implant manipulations and massage, capsular contracture, and closed capsulotomies whereby the surgeon tries to treat the capsular contracture by intensely squeezing the breasts hoping to tear the scar tissue causing the firmness. (This is no longer an accepted practice because of the now known risks of premature implant rupture.) Rarely, very compressing and aggressive mammograms can precipitate an earlier rupture. This is more likely to occur with much older implants, particularly earlier generation ones that were not nearly as strong as the implants available today.
Penetrating injuries into the breast such as a result of trauma can pierce the implant envelope resulting in loss of integrity. This can even occur during a routine elective breast biopsy where a needle is inserted too deep, penetrating into the implant.
Studies have shown that breast implants subject to considerable forces at the time of insertion, will have weaker envelopes potentially leading to premature failure. This can occur by the plastic surgeon trying to insert a large silicone implant through a very small incision. Damage caused by surgical instruments at the time of surgery can also result in early deflation.
Saline implants that are under filled below the manufacturer’s prescribed amount, have a higher rate of failure. An example of this is a 420cc saline implant with a recommended fill range of 420 – 450cc that is only inflated to 375cc. Under filling will cause implant folds and creases that will ultimately weaken the envelope resulting in tears and, therefore, deflation. Moderately overfilling above the recommended range probably has little or no impact on durability.
Whether used for breast augmentation, mastopexy or breast reconstruction, breast implants are very durable. Their presence should not influence, within reason, “normal” activities of daily living.
Smooth (left) and Textured (right) Silicone Implants
Smooth (left) and Textured (right) Saline Implants
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Posted on April 22, 2009 in Breast augmentation, Breast implants, Silicone implants
Breast implants are not permanent medical devices and should not be expected to last forever. They can be quite durable and long lasting but given enough time, all will eventually need to be replaced or removed. Many of my patients have the misconception that implants have to be replaced every 10 years whether they are silicone or saline. This is absolutely not true. The silicone implants manufactured today can last up to 20 to 30 years or more. Saline implants on average will have to be replaced sooner. Allergan’s (an implant manufacturer) ongoing prospective Core Study of silicone breast implants noted a rupture rate of 2.7% in 4 years for primary enlargements.
Many factors influence the durability of the implants. Some of these include:
- Type of implant – Saline versus Silicone. Silicone breast implants generally last longer and are more durable compared to saline implants. There are studies that show a 5 – 10 time greater rupture rates of saline implants as compared to silicone implants at various time periods.
- Textured versus smooth implants. In particular, textured saline implants have a noticeably shorter life span when compared to the smooth ones.
- Size of implant. Large implants may not last quite as long as small ones.
- Manufacturer of the implant. There are technological, manufacturing, and proprietary differences between the implant manufacturers that affect the lifespan of the implants. In over 20 years of practice, I have clearly found that significant “brand” differences.
- Surgical technique. A less gentle, more traumatic insertion of the implant can weaken the shell of the implant and predispose it to earlier failure and therefore a shorter lifespan. This can occur in silicone implants by trying to insert a large implant through a very small incision.
- Incision location. A trans-umbilical (belly button) incision can affect the durability of the implant due to the trauma of insertion. Insert large silicone implants through limited sized periareola or transaxillary (armpit) incisions can also be detrimental.
- Trauma. Very high energy impacts such as car accidents can potentially affect the long term durability. I have seen many women over the years who have been involved in serious car accidents without any injury to their implants. Sharp objects that are stuck in the breast can definitely rupture the implants
- Mammograms and frequency. Frequent mammograms, particularly aggressively compressing ones, can weaken the implant envelope.
Breast augmentation is a very rewarding procedure and is associated with an extremely high satisfaction rate. Like many other things in life, (almost) nothing lasts forever and this is true of breast implants as well.
Silicone implants - Smooth (Left) and Textured (Right)
To learn more about breast implants, breast augmentation or other cosmetic surgery, contact Dr. Turkeltaub at 480-451-3000.
Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix Metropolitan Area, Arizona
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Posted on April 13, 2009 in Breast augmentation, Breast implants
Should I order that large entrée sized salad or still be hungry after eating the smaller appetizer salad? Will that 42” LCD TV look too small in the room or should I splurge and go for the 60” model. Do I want to live in a small apartment or a nice roomy house with a yard in a quiet neighborhood? Despite what you may have heard, size does matter.
With breast implants this is very true as well. When women come to see me in consultation, their first concern is about size. As is their second… They don’t request “I would like textured implants – in whatever size you have available.” or “Just give me something above the muscle.” No, it is size, size, and size. This is a variation on the mantra for a successful business where it is location, location, and location. Many studies show that the number one reason for reoperations in breast augmentation is unsatisfactory breast implant size. Nearly always it is because the size selected was not big enough.
Complicating this size issue is a misconception of what volume and proportion different cup sizes represent and what is truly proportionate or “fits my body”. One company’s “C” bra may fit exactly like another company’s “D” bra. Furthermore, many women think that a “B” is considered normal and proportionate whereas a “C” is too big. If I had proceeded to give them what they “wanted”, there would have been a lot of unhappy patients. We have had requests for a “small C”, a “regular C”, “large C”, a “small D”, etc. Have you ever gone to buy bras and asked the sales person to show you the selection of 34 large C bras? Or 36 small D bras? She would probably wonder what hole in the desert you crawled out from. There are no such bras! I’ve never seen them. Of course, then again, I have never personally bought a bra either!
Different Breast Implant Sizes
Another issue aside from cup size and proportionality is that often women don’t really know what they want. Women want to be bigger but to what degree? What is too large or not large enough? What may be too big for one woman will be too small for another even though they voiced similar desires. I have found a few constructive ways to help my patients determine what they are really looking for. Trying on implants in the office, although not entirely accurate, gives my patients a 3 dimensional perspective that they can relate to. The photographs of a wide variety of previous breast augmentation patients with specific cup sizes are reviewed. Pictures from magazines or the internet can also be helpful but are limited by several issues including their two dimensional nature, clothing (on some), air brushing, resolution and perspectives. Some people on their own have used bags of rice stuffed into bras to help in sizing. Don’t try doing this with pasta – raw or cooked. It will not usually be a pleasant experience. I find that by carefully listening to my patients, seeing where they are coming from, their overall goals, etc., plus some intuition, I virtually always can determine the general appearance/size that would make them happy.
Based on all this input from my patients and their assessment, I make the final decision on the ideal implant size during surgery. If there is any doubt, it is always better to go a little bigger than a little smaller.
Yes, size does matter!
To learn more about breast implants, breast augmentation or other cosmetic surgery, contact Dr. Turkeltaub at 480-451-3000
Steven H. Turkeltaub, M.D.
Scottsdale, Arizona
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Posted on April 2, 2009 in Breast augmentation, Breast implants, Silicone implants
Silicone gel breast implants have been around since 1962. Over the ensuing years and with many design and technological changes, it has evolved into the safe, refined, durable and aesthetically pleasing implant that we have today. In the early days, there was a very high rate of capsular contracture, a situation where the body forms firm scar tissue around the implant causing palpable hardness and a deformed appearance of the breast. Changes were made in the 1970’s which helped lower this rate. However, with thinner implant shells and a less viscous form of silicone, there was a higher rate of implant rupture as well as silicone leaching through this outer envelope.
In the 1980’s and 1990’s, the implant shells were thickened, strengthened and made largely impermeable to the silicone. This has increased their durability and life span quite substantially. In addition, the silicone gel was altered to be far more viscous, into a cohesive form much like taffy or cream cheese. If one takes a knife and cuts a silicone implant in half (you can try this at home if you have an extra implant!), the halves maintain their fullness and shape. There is no oozing of any silicone because it is very sticky and cohesive.
In the early 1990’s, the news media began relentlessly generating unwarranted hysteria regarding the safety of these implants. Their misinformation created such a “feeding frenzy” that tens of thousands of anxious women across the country were calling their plastic surgeons concerned that they had a ticking time bomb inside them. Unfortunately, many went so far as to have their implants removed just on this fear alone despite no scientific evidence to justify their decision. Even today, I still get asked by many of patients considering silicone implants for breast augmentation: “Are they safe?”
Silicone implants are probably the most investigated, scrutinized of any medical device ever. Countless basic science and clinical studies to assess risks and other issues have been done over the years by a broad array of researchers including physicians, scientists, and manufacturers. In fact, the FDA restricted the usage of silicone implants between 1992 and 2006, until additional studies were performed to substantiate the safety of these implants. This data overwhelming supports the safety of silicone breast implants. It also shows that there is no causal relationship with significant diseases such as autoimmune diseases as had been contended by non-scientists. Quite importantly, there also is no increased incidence of breast cancer in women who have silicone implants.
When you are contemplating your breast augmentation, remember:”Yes, silicone implants are safe!”
To learn more about breast implants, breast augmentation or other cosmetic surgery, contact Dr. Turkeltaub at 480-451-3000
Steven H. Turkeltaub, M.D.
Scottsdale, Arizona
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