The FDA has recently decided to place a moratorium on the Allergan/Natrelle textured breast implants and tissue expanders. After FDA hearings and a few months of additional data collecting, the decision was made to follow the European Union and South American countries in halting their sales for now. This does not mean that patients with a textured Allergan/Natrelle implants need to have them removed/ replaced automatically. However, those patients should have a conversation with their surgeons about the risks associated and whether the implants should be exchanged. We have used a few Allergan textured implants for breast reconstruction patients in the past, but the overwhelming majority of implants used in out patients are Mentor smooth implants. If you have any concerns or cannot remember which implants you have, please feel free to give the office a call and we will find that information for you if possible.
The plastic surgery community and the FDA continue to be diligent with identifying and tracking reported cases of BIA-ALCL, as well as monitoring adverse events related to breast implants. The most recent update from the FDA reports roughly 550 documented cases worldwide. BIA-ALCL ( breast implant associated anaplastic large cell lymphoma) is a rare lymphoma that can occur in the scar tissue capsule surrounding a textured implant ( not the breast itself). The presentation of a patient with ALCL around the implant is someone that has ( or had) a textured shell implant and develops fluid build-up years later around the implant. There have been NO reported cases in patients that have had only smooth shell breast implants ( the overwhelming majority of implants used). The treatment in most cases has been to simply remove the implant and scar capsule. Currently, the suspected occurrence rate in women with a textured implant in the US is anywhere from 1:3000 to 1:80,000 depending on the type of implant texturing. In a smooth implant, the suspected occurrence rate is 1:5,000,000 + since there has not been a documented case in a smooth shell device.
A new botox toxin has just recently come to market. Jeuveau is the fourth botulinum toxin to enter the US market as of May 2019 and is approved for cosmetic uses in the glabella (between the eyes) and the forehead area. Early patients have been happy with the longevity and outcome of the treatments compared to their previous Botox results.
The 2018 Plastic Surgery statistics are out and the top five cosmetic surgeries continue to remain unchanged from previous years. Breast augmentation and liposuction are the top two cosmetic surgeries, while non-invasive treatments such as Botox and fillers continue to be robust.(top-five-cosmetic-plastic-surgery-procedures-2018.pdf)
Mentor has added a new range of silicone implants to their product lines that can help provide more fullness and maintain shape while still keeping the soft and natural feel of their existing implants. They are called the Xtra implants ( Moderate Plus Xtra and High Profile Xtra) and were launched in October of 2017. After using a lot of them in the past 1.5 years, the results are very positive at the long term post-operative time period. They feel soft and natural while providing more shape for those patients who want a little more fullness in the upper part of the breasts.
One of the latest non-invasive plastic surgery discussions center on an injection to help remove unwanted fat in the chin area. The treatment is called Kybella. In those patients who meet the criteria, it appears to remove localized fat in the under chin area. It involves a series of injections into the area, usually over two treatment settings spaced a few weeks apart. This is just coming to market after FDA approval and providers are getting trained in its use, so stay tuned. However, the cost is roughly on par with liposuction to that area, and while it is minimally invasive, there is still swelling/ recovery involved and may not address the entire neck area if needed.
Out of London, a group of plastic surgeons has identified what is most commonly seen as the ideal breast size and shape. With roughly 1300 participants in the study, the perceived ideal breast shape was more of a natural look. This is not surprising at all, since 95% of our patients who come in for a breast augmentation all say the same thing - they want to look good and restore/ enhance their volume, but still look pretty natural. The common media portrayal of breast augmentation patients are that women want to look round and fake, and that men prefer that as well. This is far from the truth and good to see actual data to support this. http://news.health.com/2014/11/04/what-the-perfect-breast-looks-like-according-to-men-and-women/
When it comes to breast implants, Mentor has the best implant warranty in the business. All three manufacturers warranty the silicone gel implants for lifetime replacement, as well as cover up to $3500 towards surgery costs in the first ten years. Now, Mentor is covering capsular contracture financially in the first ten years as well, an industry first. If you develop capsular contracture ( scar tissue internally around the implant), they will replace the implants and cover up to $3500 It is part of their enhanced warranty, and you can read the details on the Mentor website. It is an additional $300 to the company afterwards, but well worth it.
We work with Carecredit (www.carecredit.com) for patient financing. It is the largest patient financing company and is a division of GE. The American Society of Plastic Surgery (ASPS) has developed a partnership with them to make it easier for patients to obtain financing for both aesthetic and reconstructive surgeries. The application process is easy and can be done online. We have had a lot of positive repsonses from patients on the ease of the application and the terms of the loans.
Case of the Month
The patient is a 31 year old female who is 5'5 and weighs 135lbs. She underwent a full submuscular breast augmentation years ago by someone else and was not happy with her results. She felt that her breasts pulled off to the sides too much, and with any type of movement would cause the deformity below. She underwent an exchange of her implants to new Mentor 425cc smooth round silicone gel implants, conversion from full submuscular to the dual plane position, and internal lateral pocket reinforcement with Strattice ADM ( acellular dermal matrix). She is now five years out from surgery and extremely happy with the results so far.