A study published in the Annals of Oncology in May 2011 provides some answers that may be helpful in resolving this issue. The research involved analysis of data on 321 women who had surgery for breast cancer performed in Milan, Italy and who subsequently underwent lipofilling as a component of their breast reconstruction. They were then case matched to 642 women who also underwent surgery for breast cancer but did not have any fat injections as part of their breast reconstruction. Follow-up after the surgery for breast cancer averaged 56 months; for those who underwent lipofilling, this number was 26 months.

What were the results?

It was found that eight women from the lipofilling group and nineteen women from the control group had local recurrences, a difference that was not statistically significant. For recurrences of noninvasive breast cancer, also known as an “in situ” cancer, there were three recurrences in the fat injection group whereas there were none in the control group, a difference that was statistically significant. The researchers felt that this result may have potentially been affected by the very small numbers involved, the relatively shore follow-up time, and the fact that previous research has shown that the control group should have had an average rate of recurrence of over 2 percent for this period of follow-up time yet this particular group yielded none.

Though this study is by no means the definitive answer on the subject of the safety of fat injections for women undergoing breast reconstruction, it surely does provide comforting evidence to those women considering lipofilling as part of their overall reconstruction.

For more information on breast reconstruction surgery including the usage of fat injections or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please feel free to call 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

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

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

One important concern that many of my patients have who are planning to have children in the future and who also are also considering breast reduction surgery is whether or not they will be able to nurse. Fortunately, there is a relatively definitive answer for this question and which is also good news. Medical studies investigating this issue have been performed and have revealed that the most common techniques employed for breast reduction do not preclude the ability to breast feed. That is, if you would have otherwise been able to breast feed independent of any considerations for surgery, you should still retain this ability after breast reduction surgery.

The one major technique where this is clearly impossible is with the free nipple graft (FNG) approach where the nipples are totally detached intra-operatively and then replaced in the proper position later during the surgery as skin grafts. By the nature of this procedure, the milk ducts are necessarily divided.

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

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

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

The following 62 year old patient underwent a prophylactic mastectomy with breast implant reconstruction 25 years ago (specifically called a subcutaneous mastectomy) due to a strong family history of breast cancer. This was followed by multiple procedures over the years in attempts to improve the outcome. She consulted with me because of the chronic and substantial pain that she was experiencing in both breasts, their extreme hardness as well as the significant and problematic deformities of appearance.

Prior to breast revision surgery - frontal view

Following breast revision surgery - frontal view

Before breast revision surgery - oblique view

Following breast revision surgery - oblique view

Before breast revision surgery - side view

After breast revision - side view

After breast revision surgery

Before surgery

In her photos you can appreciate the marked asymmetries of shape, contour and implant position with the right side being situated too high. The skin has extensive irregularities and folds and in areas is quite thin. Her nipples also are too low relative to the breast mounds creating far too much fullness higher up.

Her breast revision surgery consisted of meticulous removal of deforming scar tissue known as a capsulectomy, reshaping of the breasts and placement of AlloDerm® (a regenerative tissue matrix – dermal grafting material) in both sides for support, contouring, durability and increased tissue thickness. Appropriately configured and sized implants replaced those that were present.

The outcome of all this were significant improvements in the appearance of her breasts for which the patient was extremely happy and quite thankful. It also boosted her self-confidence tremendously.

If you have any questions regarding breast revision surgery, breast reconstruction or 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

1. size change – usually to increase the implant volume and therefore the breast size; rarely to decrease
2. to modify the breast configuration such as to make them more projecting or less wide
3. to switch from saline to silicone implants; rarely, silicone to saline
4. replace a ruptured breast implant
5. 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

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

Several biomedical companies offer this tissue though there are clearly differences in the products, results and risks. AlloDerm® by LifeCell Corp. has been the most studied of these with the results being superior.

In the December issue of Plastic and Reconstructive Surgery (Vol. 124 Number 6), a study from the University of Rochester delineated several advantages of acellular dermis in breast reconstruction. For immediate breast reconstruction using tissue expanders, they noted that the expanders could be filled to far greater amounts when AlloDerm® was employed as compared to a different technique. Postoperative inflations were fewer and completed much sooner and allowed for the insertion of the final breast implant at an earlier date. This translated into an accelerated rate of reconstruction, more predictable and satisfactory results and the potential for a better aesthetic appearance. Best of all, there was no significant difference in complication rates with its usage.

I have been using AlloDerm® in my patients undergoing immediate as well as late breast reconstruction procedures and have found it to be an incredibly invaluable addition. It allows for clearly superior and more predictable results in configuration, positioning and softness and reduces the need for subsequent procedures to further refine the results.

If you would like to obtain additional information on breast reconstruction including the usage of tissue expanders or on any other plastic surgery procedure that I perform or if you want 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