Breast reconstruction in irradiated patients

Many women following mastectomy will receive adjuvant radiation therapy. 

A recent study by Dr. Steve Kronowitz from MD Anderson in Houston appeared in the October issue of “Plastic and Reconstructive Surgery”.  

Generally, it was found using a patient's own tissue (autologous) for reconstruction gave better results. 

Implants, however, may be the only choice available.  In one study, they found a complication rate of 45% for women receiving implants WITH radiation compared to 24% in women with NO radiation.  Complications were more common when the patient received radiation BEFORE rather than after reconstruction.  

Basically, radiation therapy affects the skin, which ultimately compromises the reconstruction.  It is also important for me to remember, as a cosmetic surgeon, disease control / eradication is ALWAYS my primary goal.

What's the best breast implant?

Breast augmentation has remained one of the MOST popular operations cosmetic surgeons do.  The main complication that I see as a Fort Myers plastic surgeon is the development of a firm capsule post op.

I recently read a study comparing smooth silicone breast implants versus textured implants.  The study involved 168 women with smooth implants versus 181 women with textured implants.  

The results were pretty amazing - 19% of women with smooth implants developed capsular contracture versus only 1% for textured.  

A corollary study was done to compare incision sites.  The highest rate of hard capsular was with the transaxillary (underarm) followed by the peri-areolar (around the nipple where it meets breast tissue) and the best was inframammary (the fold where the breast tissue meets the chest wall).

The more we learn, the better informed you are as a patient.

Breast Size - Try before you buy.

Women get breast augmentation all of the time to restore a more youthful shape to their breasts following pregnancy or to enhance what they consider an under-developed breast. 

We now have a way to help women kind of see what size they may want to be.   

We have implant "sizers" of different sizes, ie.  275 cc, 300 cc, etc.  It's interesting that a recent study found women often had a cup size in mind but once they tried on the "sizers" – guess what: They they actually selected a larger breast size. 

For years I have told my patients, if anything, I will recommend on the side of a little “too big” rather than too small.  Women adjust up easier than they adjust down.  

But I am also quick to remind them at the end of the surgery, I have to be able to close the incision.

Did you know?

Bringing health news to Fort Myers for the patients and followers of cosmetic surgeon, Dr. Robert J. Brueck MD

DID YOU KNOW...              

This is a special year because it marks the 50^th anniversary of breast implants.  Breast augmentation was the 2^nd most popular procedure in 2011.  There were 317,000 augs done and 127,000 breast lifts.  Silicone implants come back on the market in 2006 and of the augmentations done in 2011, 69% were silicone which has been and to this day is my implant of choice.

DID YOU KNOW...

Patients who were given 3 ½ servings of dairy products a day saw their blood pressure decline and had less inflammation compared to people receiving an ½ a serving.  Based on this, researchers recommend 3 daily servings of dairy.

DID YOU KNOW...

Increasing the amount of fiber in your diet will lower your levels of C reactive protein which indicates LESS inflammation in your body.  This increased fiber can also lead to less resistance to insulin.

Breast Augmentation & Quality of Life

            Of all the cosmetic procedures that I do, breast augmentation has one of the highest satisfaction rates.  


A team of researchers led by Dr. Colleen McCarthy of Sloan Kettering in New York developed a BREAST-Q questionnaire.  


Forty one women filled out the form before surgery and then 6 months post-op.  More than 80% of the women reported “significant improvement” in 3 out of 6 areas; they are:


1. satisfaction with breasts, 


2. psychosocial well being 


3. greater sexual well being.  


In my experience, I feel the overall satisfaction rate is more than 90%.  In almost 34 years as a plastic surgeon in Fort Myers, I have never been asked to take out implants because a woman didn’t like them!  That’s saying a lot.

How "Hot" is this?

Talk show host, Bethenny Frankel, discusses the affect of breast implants on her sexual experience. The link references an article and and video from the MailOnline. PLEASE NOTE: This conversation is very graphic and may be unsuitable for children.

IMPLANTS ARE SAFE

A lot of concerned was expressed recently when the French government announced it would pay to have all Gel implants in French women removed.

Concerned patients should know that only implants manufactured by PIP (Poly Implant Prosthesis) were to be removed. Apparently, from what research I have done, the gel used in PIP implants was INDUSTRIAL grade NOT MEDICAL grade.

As a Fort Myers plastic surgeon, I only use MENTOR implants, which are medical grade silicone.

I guess it’s like buying steak-you can have choice or top-of-the-line prime. I’m sure there are many European women with PIP implants. PIP used industrial grade silicone because it simply was CHEAPER.

Years and years ago, I took care of several patients who had “industrial” grade silicone actually injected into their breasts. No implants. Just industrial grade material placed into syringes and then injected into their breasts. The results were terrible. These women developed severe inflammations and multiple nodules. Mammograms became more difficult to perform. Many of these women required simple mastectomies and reconstruction.

The company, PIP, went bankrupt in 2010 and shut its doors. Their president/founder is M. Jean-Claude Mas. He is 72 and in poor health. As always this will be played out in the courtroom…many years later. Till then, rest assured, unless you received a PIP implant, most likely in Europe, all is well.

PAINT BALL PLAYERS BEWARE

Another blog message from Fort Myers plastic surgeon, Dr. Robert Brueck MD FACS.

Life is always filled with risks.

Now we learn that breast implants and paint ball don’t mix. A woman playing paint ball in the United Kingdom was hit in the chest with a paint ball and her “implant exploded”.

If it was saline and it ruptured, it would deflate almost immediately, so the person would know it. However, a silicone rupture would be harder to detect because the “capsule” would contain the silicone in the ruptured implant.

Now, if you have implants and you want to go paintballing, you have to sign a special release AND have extra padding.

Hope the air conditioning is working that day!

Breast Capsule Formation - Dr. Brueck comments.

Another message in Dr. Brueck MD's continuing series of blogs about health and plastic surgery. As a Fort Myers plastic surgeon with board certification, Dr. Brueck strives to keep his patients and others informed about developments in cosmetic surgery. For more information about Dr. Brueck, visit his web site at Beauty-by-Brueck,com.

Having done hundreds of breast augmentations over the past 32+ years, I have to say the most puzzling, most aggravating unintended result is the development of severe encapsulation or breast hardening.

Some things are well known in that if a breast develops a hematoma or collection of blood post-op, the rate of hardness increases. I think it is fair to say that thin tissues or lack of breast tissue leads to greater risk of hardness. I also feel severe encapsulation is more prevalent in smokers. I think severe encapsulation is multifactorial.

A new area of research is shedding light on “biofilm”.

There is now evidence that when the implant is placed in a pocket that bacteria cling to the surface of the implant forming a biofilm or biological coating. Strategies are being developed to prevent this.

One study involves an antibiotic impregnated mesh that is implanted with the implant. In a pig model, all 14 animals that had implants without the mesh, developed capsular contracture AND none of the animals that had the antibiotic mesh developed capsular contracture.

Looks promising. Sign up to receive this blog via RSS feed to stay in touch with developments.

Silicone Breast Implants & MRI

Dr. Robert Brueck MD, Fort Myers Plastic Surgeon, keeps abreast of developments and questions in Cosmetic Surgery. He periodically blogs here about items in the news.

Many of my patients who have had silicone implants will often inquire about weather or not they need MRI.

The FDA made it one of their recommendations several years ago when they allowed silicone implants back on the market. I personally have not been overly impressed with the accuracy of MRI in detecting implant rupture.

I have gone to the OR with patients who had an MRI saying they were ruptured only to find the implant intact. Conversely I have had patients with normal mammograms and/or MRI who came in for implant exchange and when we go to the OR, I find both implants are ruptured.

It was found that women who were symptomatic, i.e. maybe in discomfort, that MRI was more accurate in detecting problems with the implant verses women with NO symptoms.

Another very important point: most of the ruptures were found in women with implants that were greater than 10 years old. This has been my experience when a patient comes in to see me who’s implants are 15, 20 or even 30 years of old I almost know with near 100% accuracy that one or both maybe leaking or completely ruptured.

So the benefit of MRI screening is questionable.

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Plastic Surgery - Do breast implants cause cancer?

Do breast implants cause cancer?

It's a question I have been asked over and over.

There is a new study published in the "National Journal of Cancer" that suggests women with breast implants have a lower risk for breast cancer. The analysis included 6,222 women in Sweden and Denmark, 80% of whom had silicone implants.

This study represents the longest follow-up to date of women with breast implants . 85% of the women were followed for over 10 years and 50% for more than 15 years.

Based on general population rates, researchers expected 115.62 women out of this study group to have breast cancer, but only 84 cases developed.

This is statistically significant and once again proves the safety and efficacy of breast implants.

For more information about implants for breast augmentation, please visit my Web site at Beauty-by-Brueck.com and click on the link to breast augmentation.

Silicone vs. Saline and other breast questions

The trend among plastic surgeons and patients is toward the softer, more natural silicone gel implants.

50% of implants NOW sold are silicone gel.

The number of gel implants used before the ban was single digits, ie. less than10%.

There is no question they give a softer, more natural look for the most part. This is especially true for women with minimal to no breast tissue.

Breast hardness after augmentation

Every patient who undergoes breast augmentation develops a capsule. The key is to keep the capsule soft and natural.

Why do some breasts get hard?

There are probably many factors, one of which is bacterial contamination in the pocket receiving the implant. A company named TxRxPharma Inc. is developing an anti-biotic sleeve to place around the implant just prior to placement. The anti-biotics in this wrap are tetracycline and rifamycin. In preliminary studies, the capsule formed by the implants wrapped in this special sheet were much softer and more natural.

Perhaps the holy grail for breast augmentation is just around the corner. More to come.

For more information about breast implants, make a visit to my website, Beauty-by-Brueck.com and navigate to any of the pages about breast enhancement.

Thank you