Breast Augmentation and Liposuction Blog - Dr. Bottger

Philadelphia, Bryn Mawr - Pennsylvania

Thursday, February 16, 2012

New Research Suggests Breast Implant-Connective Tissue Disorder Link

One of the concerns that led to the temporary ban of silicone breast implants for breast augmentation from 1996 to 2006 was the potential link between breast implants and connective tissue disorder. When breast implants were reintroduced for cosmetic surgery in 2006, the FDA stated that there was no evidence that breast implants were associated with connective tissue disorders, breast cancer, or autoimmune disorders. When the FDA released information from its postmarketing surveillance studies last year, it echoed this stance, though it did hold open the possibility that such a connection did exist, but could not be discerned due to the overall rarity of the complication.

Now, however, a new review suggests that there may actually be a connection between breast implants and connective tissue disorder. The study looked at 23,847 US women with or without breast implants for diagnoses of connective tissue disorders. The study considered 3950 women with breast implants and 19,897 who did not and found that women with breast implants had a higher risk for connective tissue disorders according to self-reported disorders, pre-screened disorders, and medical record confirmed disorders. The rates were significant for all but medical record confirmed disorders. Women's increased risk of self-reported connective tissue disorders was 60%, for pre-screened symptoms was 80%, and for medical record-confirmed connective tissue disorders was 39%.

Researchers caution that these results are tentative, but state that at the very least they seem to rule out a large increase (much greater than a doubling of risk) in connective tissue disorder risk.

Safety is an important concern if you are considering breast augmentation. To talk to a board-certified plastic surgeon in Philadelphia about risks associated with breast augmentation, please contact Dr. David A. Bottger.

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posted by Dr. Candelaria at 3:10 PM

Monday, January 9, 2012

Poly Implant Prostheses (PIP) Defective Breast Implants

Over the last couple months, French officials have been grappling with the magnitude of the defective Poly Implant Prostheses silicone breast implants. Since a 2010 inspection revealed numerous quality problems at the French manufacturer's facility, and the company has gone bankrupt, hundreds of thousands of women may be facing the hard choice of whether to remove their potentially dangerous breast implants.

It is important to note that these breast implants were never approved for use in the US, so unless you received your breast augmentation abroad, you likely do not have to worry about the potential risk.

Inspections and interviews with personnel from PIP have revealed numerous problems with this brand of French-made breast implants. The first concern is that the rupture rate for these breast implants may be very high.

At this point, we do not have any reliable figures to say just how high. Speaking anecdotally, one surgeon noted that the breast implant rupture rate may be as high as 10% in the first year, compared to almost no spontaneous ruptures in the first year among other breast implant manufacturers. Other figures are even more worrying. One study of 453 patients who received this breast implant showed rupture rates between 16 and 34 percent. Another report comes from a British hospital where half of the patients receiving the PIP breast implants experienced a rupture. In contrast, one British plastic surgery practice says there is no concern about PIP implants. They said their observed rupture rate is only about 1.3% in the first four years.

An additional concern with PIP breast implants is the quality of material used for filling the breast implants. The British tabloid Daily Mail reported that many of the breast implants were filled with a silicone gel commonly used for filling mattresses, rather than the medical grade silicone that should be used for breast implants. A company has come forward stating that it supplied the manufacturer with the silicone, which is supposed to be used for weatherproofing and paints.

It is unknown whether the industrial grade silicone is more likely to result in more serious side effects than medical grade silicone, but there have been numerous anecdotal reports of cancers and other illnesses related to the PIP industrial grade silicone. Remember, the FDA has stated that there is no evidence of breast cancer associated with the silicone breast implants used in this country.

The PIP breast implant scare is another reminder that looking for cheap breast augmentation by traveling overseas is not worth it. Nor is it worth working with a local breast surgeon who is not a board-certified plastic surgeon and therefore bound to use the highest-quality materials in performing your breast augmentation.

If you are considering breast augmentation and want to learn more about what makes the breast implants we use safer than these French-made ones, please schedule a consultation with Philadelphia plastic surgeon Dr. David A. Bottger today.


posted by Dr. Candelaria at 11:55 AM

Wednesday, December 14, 2011

Want to Keep Your Nipples after Breast Surgery? Quit Smoking.

How serious is your surgeon when he tells you to quit smoking in preparation for your plastic surgery? Very. If you cannot quit smoking for your breast surgery, whether it is breast augmentation or a breast lift, you put yourself at risk for serious postsurgical complications. How serious?

Consider the recent memoir by Dr. Anthony Youn, who talks about the potential complications related to smoking around breast surgery. He says he has personally seen a woman's nipples almost turn black and fall off following a breast lift. When the woman's nipples turned purple, the precursor to black, they used the only treatment option available to save her nipples: leeches.

Why leeches? The problem with smoking is that it impairs your body's ability to remove blood from a treatment area, especially in the skin, and when the blood can't be removed, it prevents the supply of fresh blood from reaching the area, so the tissues will die. Leeches remove the excess blood so fresh blood will flow. Leeches give your body time to grow new blood vessels to replace the failed ones. To work properly, the leeches may have to be applied for several days.

This is less common in breast augmentation, but tissue necrosis (death) is a tangible risk whenever a smoker has surgery. So when your surgeon tells you to quit, take that recommendation seriously.

Another recommendation to take seriously is to always work with a board-certified plastic surgeon. In Philadelphia, please contact plastic surgeon Dr. David A. Bottger for a consultation today.

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posted by Dr. Candelaria at 2:40 PM

Wednesday, November 30, 2011

Acellular Dermal Matrix: A Better Method for Breast Reconstruction?

In recent years, there has been a significant increase in the use of acellular dermal matrix (ADM) in breast implant-based breast reconstruction. The increased popularity of this material is due to a number of perceived advantages. However, according to a recent review of the scientific literature, there is little objective evidence to support these claims.

ADM is material prepared from the skin of various animals. The dermal cells are removed, leaving only a framework of collagen material that can then serve as a scaffolding in many types of reconstructive procedures, providing structural support and a framework for cells to grow on. One common source of ADM is cadavers, but fetal cows and pigs are also used as donors for ADM.

In breast implant-based breast reconstruction, ADM is supposed to give numerous benefits. It is supposed to provide support for the implant or expander in the early phases of recovery, before the body's tissues are recovered. This allows, according to claims, for better aesthetic outcomes, fewer expansions, and larger breast implants during breast reconstruction.

In a recent review of all studies done on the use of ADM in breast reconstruction, researchers found no support for most of the claims made about the use of ADM, including reducing or eliminating the need for expanders, the use of larger initial fill volumes, faster time to completion, decreased rate of revision, and improved aesthetic outcome. However, the researchers did find evidence for decreased rate of capsular contracture, which is significant for breast reconstruction, which generally faced an even higher rate of the condition than breast augmentation patients.

Board-certified plastic surgeon Dr. David A. Bottger does not perform breast reconstruction, but he does utilize breast implants for breast augmentation, and continues to evaluate the use of advanced techniques to improve outcomes. To talk to Dr. Bottger about breast augmentation, please schedule a consultation today.

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posted by Dr. Candelaria at 8:46 AM

Monday, October 31, 2011

Obesity Linked to Complications of Breast Surgery

We have long known that obesity increased the risk of complications from body contouring surgery like tummy tuck or liposuction. Now a study published in the November issue of Plastic and Reconstructive surgery, the official journal of the American Society of Plastic Surgeons, shows that obese women are also at a significantly increased risk for complications after breast surgery.

The study looked at data from about 8000 women who had elective breast surgery, and found that obese patients had a 12-fold increase in risk of complications following breast surgery. Although this study is an important one, it is worth noting that the study did not look at breast augmentation or breast lift. It only looked at procedures covered by insurance. About 80% of the obese women in the study and 64% of the nonobese women were undergoing breast reduction surgery, with 10% of obese and 24% of nonobese women undergoing breast reconstruction. The complication rates were compared within the same procedure.

The overall rate of complications for obese women was 18% and 2% for nonobese women. After eliminating other factors, researchers calculated the relative risk at 11.8 times higher for obese women.

This is another reminder that if you are considering plastic surgery, it is important for you to reach a stable weight at or near your ideal weight before seeking surgery.

To learn more about breast surgery and possible complications, please contact Philadelphia board-certified plastic surgeon Dr. David A. Bottger today for a consultation.

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posted by Dr. Candelaria at 1:12 PM

Thursday, October 27, 2011

Did Researchers Find the Ideal Breast Shape?

In attempt to describe ideals of beauty, the primary drivers have generally been evolutionary psychologists, who frame their results in terms of their particular grinding wheel, proving that the evolutionary forces that shaped humans in the Holocene still impact us today. Now, though, a plastic surgeon has described what he claims is the "ideal breast shape."

Before we get to considering his results, let's consider the noble goals of his quest. As a plastic surgeon, he performed many revision breast augmentation surgeries, correcting the poor results that women received from other surgeons. One of the things he found was that patients often got results whose shape they found unattractive, in part because they knew how to talk about breast implant size, but were unable to describe their ideal shape to their surgeon, whose ideal of breast shape was often based on personal formulas or poorly defined. To correct this, the British plastic surgeon sought to define the breast shape that most would agree were attractive.

To attempt to define the ideal breast shape, the plastic surgeon started by looking at The Sun's daily Page 3 girls. For most of the world, Page 3 means little, but Britons have been accustomed to seeing a topless girl on Page 3 of the Sun tabloid since 1970. In the early years, there were no restrictions, but since the early 90s, only women with natural breasts have been allowed on Page 3, and it is this feature that inspired the plastic surgeon to look at the Page 3 models to determine the ideal breast shape.

The surgeon selected 100 models and a computer was used to analyze the dimensions and proportions of each breast and found that there were four common features. First, the nipple meridian (a horizontal line drawn at the level of the nipple) divided the breast into two uneven parts, with 45% of the breast volume above the meridian and 55% below the nipple. Next, the upper surface of the breast was either straight or slightly concave. The nipple pointed slightly upward at an angle of about 20ยบ, while the lower pole of the breast had a tight concave curve.

Next, to test whether these parameters actually described an ideal breast, the surgeon asked women to rate the attractiveness of before and after photos of breast augmentation patients. He found that when results deviated from these described features, they were considered less attractive.

Although we are a long way from being able to state that these factors actually represent an "ideal breast," they do give plastic surgeons and patients considering breast augmentation a better starting place for discussing breast shape than they have ever had in the past. This is crucial because nearly as many women seek breast augmentation to improve the shape of their breasts as to increase the size.

You can read the study in the August 2011 issue of the Journal of Plastic, Reconstructive, & Aesthetic Surgery.

To discuss your shape and size goals from breast augmentation with a Philadelphia board certified plastic surgeon, please contact Dr. David A. Bottger today.

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posted by Dr. Candelaria at 12:36 PM

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