Posts Tagged ‘Breast Enhancement’

Ideal Implant ®: Donald W. Hause, M.D. FACS is selected to participate in the FDA Approved Clinical Trial

Wednesday, September 23rd, 2009

Ideal Implant ®: Donald W. Hause, M.D. FACS is selected to participate in the FDA Approved Clinical Trial

Donald W. Hause, M.D., FACS and Sacramento Aesthetic Surgery, inc. are proud to have been selected to participate in the FDA Approved National Clinical Trial of the Ideal Implant ®.

Although silicone gel implants are now available, have a strong safety record and give a very natural breast enhancement result, some patients are still concerned about the issues of incision requirements, possible silent gel rupture and the recommended costly surveillance of gel implants. The Ideal Implant ® was designed to combine the natural result of silicone gel and the safety of saline in one “hybrid” breast implant. This hybrid Saline-filled implant utilizes a series of additional implant shells that are nested internally with perforated baffles. This design controls the flow of the saline within the implant which, in turn, reduces the feeling of sloshing and bouncing. In addition it supports the implant edges to minimize wrinkling and upper pole collapse. They also give the implant a firmer feel which is similar to that of silicone gel. The Ideal Implant ® looks like a standard saline implant, except the edges have been lowered so it may contour better to the chest wall.

During the study surgical costs will be the responsibility of the patient and warrantees offered by Ideal Implant ®, incorporated will be similar to those of other implant manufacturers. However, the study will also require dedicated follow-up with Dr. Hause for an extended period of time for which Ideal Implant ® inc. will offer compensation. For specifics about the study and compensation for follow up participation please go to http://www.idealimplant.com

If you would like more information about participation in the FDA Approved Clinical Trial, please contact Sacramento Aesthetic Surgery’s office at info@hausecall.com or call (916) 646-6869 and schedule a free consultation and evaluation.

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Posted in Breast Enhancement, Plastic Surgery, Plastic Surgery Innovation | No Comments »

“Dr. Hause, what Plastic Surgery do I need?”

Monday, June 29th, 2009

I was at a Swimming Meet this weekend and one of my friends asked me if I perform Abdominoplasty at the same time as Breast Augmentation. My reply came in the form of explaining the concept of the “Hot Topic” of Mommy Make-overs and what they involve. She next told me that she knew a couple of friends (from the same grammar school) who had undergone these procedures. Strangely, both of them had gone in initially for Breast Enhancement and were strongly encouraged to add the Tummy Tuck. This was because that “would make the Breasts look even better.” I was visibly taken aback.

This brought up the discussion of “needing” versus “wanting” Aesthetic Surgery. Now let’s be honest. Although writing this may be blasphemy to the Priests of Nip Tuck, in reality no one “needs” Cosmetic Surgery. They “want” Cosmetic Surgery to improve their appearance. It is elective. I personally would find it appalling if I went to a Plastic Surgeon with one concern and they talked me into something additional.

This brings up the concept of vanity. We’re all familiar with the criticisms that Cosmetic Surgery is all about vanity. Well, frankly, it is. However, let’s put this into perspective. Since the dawn of time human beings have been altering their appearance to reflect the values of their culture. Consider the tattoos, piercings and scarification that are customary in some societies. Whether or not we want to accept it, the truth is that how we appear has an impact on how we feel about ourselves and how others perceive us. However, like most things, intelligent moderation is the key to success. A healthy amount of vanity may aid in maintaining our sense of self worth and positively impact our interpersonal relationships. In contrast, extreme vanity can emotionally cripple someone and turn them into a nightmarish Hollywood Cliché’.

It is true that when someone visits a Plastic Surgeon, they are looking for expert advice about their concerns. However, it is also true that this person is probably somewhat insecure and vulnerable. In my opinion, encouraging someone to have additional surgery when the advice was not specifically sought out is unethical. It is really easy to manipulate an insecure and vulnerable person into doing what you want them to do. As physicians, we have a much higher moral obligation to our patients. We are not selling cars and adding on an extended warrantee. Unfortunately, especially in our challenging times, patients need to beware of practitioners that insist on “the extreme makeover.”

As a Plastic Surgeon, it is a great privilege and humbling to have someone entrust their safety and well being to you while attempting to improve their life with surgery. However, the patient is the only one who has the right to decide what will work for them. I always tell my patients “There are a lot of things I know how to do that are great for my kid’s college funds. Not all of them are good for you.” When considering Aesthetic Surgery, be clear on what you are trying to accomplish and keep that in perspective. If you are curious, get options and get educated. Beware of grandiose artistic surgeons who “have a plan to make you better than you ever were before.” Getting more than one opinion is always prudent. As statistics of patient satisfaction will tell you, if done safely and well, Aesthetic Surgery can enhance your life. However, don’t let any interested party influence what you believe is right for you.

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Posted in Body Contouring, Breast Enhancement, Cosmetic Surgery Ethics, Plastic Surgery | 1 Comment »

Mastopexy (Breast Lift)

Tuesday, June 23rd, 2009

Some patients desiring Breast Enhancement have breast tissue that is loose and saggy. The medical term for this condition is Breast Ptosis. This may be a consequence of advancing age, pregnancy, nursing and/ or weight fluctuations. Breasts progressively hang lower on the chest with loss of upper breast projection (perkiness), elongation and flattening. In some cases, the nipples point straight down. These changes are also common in patients with naturally large breasts.

The basic problem with ptotic (saggy) breasts is that there is too much skin for the amount of breast tissue present. Additionally, the nipple may reside too low on the chest wall. With mild stages of breast ptosis, a breast implant may be all that is needed. However, in many women, the breast has fallen too far down the chest to allow an implant to give an aesthetically pleasing result. In these women, some form of breast lift (Mastopexy) is indicated. In this situation, a simple breast augmentation would result in the implant residing in the normal location with the nipple appearing to have slipped off the front of the breast. Some doctors may suggest placing the implant above the muscle to minimize this appearance. It may work. However, all too often what results is a “rock-in-a-sock” appearance. In my opinion, this is totally unacceptable. It is also very difficult to fix and may require multiple operations to improve.

When natural breasts are large, similar changes to the skin and nipple position usually occur. The techniques of Breast Reduction and Mastopexy are similar with the exception that in Reduction, breast tissue is removed to fashion a more pleasing size and shape. Reduction may also relieve symptoms of neck and back pain.

Because of the anatomical changes described above, Mastopexy and Breast Reduction procedures are designed to remove the extra skin (+/- the extra breast tissue) and reposition the nipple. One of the consequences of doing this is a visible and permanent scar on the breast. This is a real compromise (a scar versus a saggy and/ or large breasts). Although many scars will heal with little visibility, if a scar is completely out of the question, you are not a candidate for mastopexy, period. The only exception is in patients that have a small amount of enlargement that can be improved with liposuction alone. As common sense would predict, this usually worsens any ptosis and produces a more saggy and bottomed-out breast.

The classic technique of Mastopexy and Breast Reduction requires a scar that resembles an “anchor.” This scar is located around the areola (pigmented part around the actual nipple), down the front of the breast and along the fold under the breast. Most Plastic Surgeons continue to use this technique because it can give a reliable and safe result. It is still the gold standard for comparison within the Plastic Surgery community and many excellent results have been achieved. With the Anchor Technique, skin is removed so as to create a new “skin brazier” which holds the breast tissue in place. Relying on the skin for the result can be a negative because, after all, what caused the problem in the first place was the stretchy skin. Because of this fact and the resulting large scar, newer methods of “Minimal Scar” Mastopexy evolved that may offer a better option. Not all women are candidates for these techniques, but many are.

In selected cases of women desiring enlargement and mastopexy, the scar can be limited to around the areola. This technique is called a Doughnut or Binelli Mastopexy after Louis Binelli, the French Plastic Surgeon who described it. In essence the procedure is done is by removing a doughnut-like circle of skin from around the areola and leaving the nipple attached. This allows for placement of the implant and can lift the nipple up to 1 inch.

In women who desire to lift their natural breasts into a more youthful position and contour, a third technique, called Lejour Mastopexy (Verticle Mastopexy) after the Belgian Plastic Surgeon Madeline Lejour, may be the best option. This technique differs from the others in that the result is not dependent upon the breast skin. In this technique, the breast tissue itself is molded with sutures into a new natural shape. The scar can usually be limited to around the areola and down the front of the breast (”lollipop”). Also, the result can be more natural and last longer. Because of these factors, the Lejour technique is my preferred method for correcting breast ptosis in those not desiring enlargement and in those women needing moderate amounts of reduction.

Mastopexy is performed as an outpatient and patients can usually return to work in 5 to 10 days.

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Posted in Breast Enhancement, Breast Lift, Breast Reduction, Plastic Surgery | 1 Comment »

Breast Augmentation: A Perspective

Monday, June 15th, 2009

SAS Blog: Breast Augmentation; a Perspective

Breast implants were invented in the early 1960’s by Dr. Frank Gerow and Dr. Thomas Cronin, two Plastic Surgeons from Houston, Texas. The first implants were made from an outside shell of silicone rubber and contained silicone gel. They had a remarkably natural feel that compared to normal youthful breast tissue. The major complication of silicone breast implants was scar formation around the implant, which made them get very hard and even, in some cases, very painful. This is not surprising since all foreign objects that are placed into the body cause scar tissue to form. However in the case of stainless steel plates for fractures or a pacemaker, no one cares if they are hard because they started out that way. In the case of breast implants, it was a very big deal. After some research, Plastic Surgeons began placing the implants under the Pectoralis muscle in an attempt to prevent this “Capsular Contracture” from forming. This showed some improvement. Then research was done changing the surface of the implant to what is called textured or rough. The most successful of these was an implant that was covered with Polyurethane foam. However, because this foam degraded into possible carcinogens, it was discontinued. The use of modern textured surfaces has been somewhat controversial because they can be more easily felt through the skin and it is unclear of they truly make a difference in Capsular Contracture. Thankfully, with the latest generations of smooth implants, the likelihood of developing serious scar tissue has been remarkably reduced. In some patients utilizing Gel implants, successful augmentation can be done above the muscle.

In the early 1990’s a group of women who had undergone Breast Augmentation and Reconstruction began making claims that their Silicone Breast implants were causing diseases in their bodies. These were serious, progressive and non-curable auto-immune diseases such as Rheumatoid Arthritis, Lupus, and Chronic Fatigue Syndrome. Since the initial FDA’s ban on their use in the early 1990’s, silicone gel implants have been thoroughly investigated and there is no evidence that they cause any medical diseases. On November 17, 2006, the FDA reinstated their approval for the use of silicone gel for routine Breast Augmentation.

In recent years, implant manufacturers have been using a new type of silicone gel called cohesive gel or “Memory Gel.” You may have heard of this referred to as “Gummy Bear” implants. The issue that was addressed by this technological improvement was the fact that, with the old implants, if the implant ruptured and the scar tissue that was formed by the body did not seal it off, it could squirt out and cause serious inflammatory problems in the tissue. This new Gel actually sticks to itself and maintains its shape. So even if the implant wall breaks, the gel should not squirt out and cause problems.

Silicone Gel versus Saline-filled Implants. Issues and Answers:

Saline-filled Implants: Saline implants are made of a silicone rubber shell and are inflated at the time of surgery to their appropriate size with saline (0.9% salt water). If they leak (rupture), the body just absorbs the water with little side effect other than the volume is lost (Some patients just wake up with a “flat tire”). This is one big advantage of Saline-filled implants. A second advantage is that they come deflated and, therefore, require a much smaller incision for placement. However, saline-filled implants do not feel anything like silicone gel or normal breast tissue. This is why we recommend placement of these implants under the Pectoralis Muscle. This is a sculpting technique to hide this implant under normal soft tissue. In this way, the implant is less visible and feels more natural. They are still not as natural feeling as silicone gel but they are acceptable in appearance and feel for patients with adequate soft tissue (breast and muscle tissue).

Silicone Gel Breast Implants: Now that the FDA has concluded that Silicone Gel is safe, I expect that most Plastic Surgeons use them in a significant number of patients. This is because Silicone Gel is far and away the most natural feeling and looking breast implant available. However, like everything in life, they are not perfect. The most noticeable disadvantage of Gel implants is that they require a larger incision (2 inches) for placement. This fact may prevent the patient from using the preferred peri-areolar incision. This could require an infra-mammary approach and a more visible scar. Also the maintenance of Gel is more involved. The FDA and Manufacturer recommends routine follow-up with MRI scans (very costly) at various intervals to detect rupture. Another concern that has recently come to light is that some Health Insurance Carriers may have issues with these implants and this may even cause you to lose or prevent your getting individual coverage. I have not actually heard of this happening, but you should check this out with your carrier to be safe.

There are three standard options for placing breast implants; Around the nipple (Peri-areolar), Armpit (Trans-axillary) and under the breast in the fold (Infram-mammary).

Trans-Axillary Incision: Placing the incision in the armpit may be considered advantageous because there is no incision on the chest. However, the most critical part of Breast Augmentation is the placement of the implant in the fold below the breast. Since this incision is the farthest from the fold, it is technically more difficult to place the implant precisely. This may result in mal-position of the implant. Also if re-operation is necessary in the future, it may be impossible to re-use the incision and require a new second scar.

Infra-mammary Incision: Under the breast fold is the original method most Plastic Surgeons were trained to do because it is straight-forward and can be used with all implant types. The potential disadvantage with infra-mammary incisions is that they may widen and become visible. Unless I am revising a patient from another practice who has this scar or am required to use it because of the need of a larger incision, I do not prefer to use this approach. However, if I am placing a Silicone Gel implant and the patient’s areola is too small to accommodate a gel implant, I do not hesitate to use the infra-mammary incision and have found it to heal acceptably in most patients.

Peri-areolar Incision: There are three reasons that most surgeons prefer this incision when possible. For one, it is technically easier to create the implant pocket precisely. Two, it can easily be used for nearly all revisions, if necessary. However, the biggest reason why most surgeons use this incision is that for some reason, and no one knows why, this area heals with nearly an invisible scar in the majority of patients. There are some misconceptions about this incision. You might have heard that if you go through the nipple, you cannot breast feed in the future. This is not true. We never cut through the ducts that connect the nipple to the breast tissue and, therefore, patients should have no difficulty breast-feeding. Maybe you have heard that it is more painful to go through the nipple. This is, again, not true. Most of the pain associated with Breast Augmentation is related to muscle spasm that results from making the pocket for the implant. Since the same pocket is made regardless of the incision, the post-operative pain is the similar regardless of the incision. Lastly you might think that going through the nipple causes the nipple to become numb. This is not true either. However, can you get nipple numbness from this operation? The answer is yes. But it has little to do with the incision. The nerves that go to the nipple are located near the pocket for the implant and commonly get stretched and bruised. If they get stretched or bruised enough, they can stop working. In the 15 to 20 percent of cases that have numbness after surgery, most will resolve and be normal at 12 months.

Trans-umbilical (Belly Button): For a while it was trendy to put Saline implants in through the belly button. Because of the difficulty controlling where the implant would end up, the inability to safely place the implant under the muscle and the great difficulty of fixing anything, this option is not well thought of by the vast majority of Board Certified Plastic Surgeons.

Breast augmentation is performed as an outpatient. Although some practices perform Breast Augmentation with sedation and local anesthesia, I believe that general anesthesia (being completely asleep) is a much more pleasant experience which allows improved precision in implant placement. The risks of general anesthesia are greatly over-stated by some sources. After being in practice for 15 years, I would argue it is much safer than sedation. In fact, patients have a much larger risk of injury and death by getting into their car than from the sophisticated general anesthesia techniques now available.

Most patients take 4 to 7 days off of work. Most patients can only lift 10 to 15 pounds for the first two weeks. Mild exercise can usually be started in two weeks but upper body work outs should be put off for four to six weeks.

It takes about 6 weeks before you can draw any conclusions about the result so don’t stress out. As the implant settle, they will look and feel more natural. They may actually change for up to a year, but changes after 8 weeks are usually subtle.

Breast Augmentation has been a relatively safe and effective way to enhance your appearance and proportions for over 40 years. By choosing a Plastic Surgeon certified by the American Board of Plastic Surgery, you can increase your chances of a successful and satisfactory result.

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Posted in Breast Enhancement | 4 Comments »