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Archive for the ‘breast implants’ Category

Case Study – Breast Implants and Stretch Marks

Sunday, February 12th, 2017

 

Background:  The finding of stretch marks on the breasts is common and reflects loss of skin elasticity from pregnancy and/or weight gain/loss. They always occur in a radiating pattern around the areola like rays of the sun. Careful inspection of the stretch marks will reveal that they are thinner than the surrounding skin and have less pigment. In many ways, they represent skin that has partially torn and is now a line of scar.

It is rare that breast implants ever cause stretch marks. It can happen, and it is an occurrence I have read about, but no a postperative breast augmentation finding that I have ever seen. Conversely, the other question is whether placing breast implants will make existing stretch marks look worse. Since so many women have them it is an understandable concern of will happen to them afterwards when the breasts become larger.

Case Study: This 32 year-old female came in for breast implants. She had lost most of her breast volume after multiple pregnancies. Despite the involution her nipples had good position above her inframammary folds. But she did have many wide and deep stretch marks radiating outward from her areola in a 360 degree pattern.

Breast Implants and Stretch Marks result front view Dr Barry Eppley IndianapolisUnder general anesthesia and through inframammary incisions , 325cc smooth round silicone breast implants were placed in a dual plane position. Her stretched out breast mound skin had no problem accommodating these modest size breast implants.

Breast Implants and Stretch marks result oblique view Dr Barry Eppley IndianapolisBreast Implants and Stretch Marks result side view Dr Barry Eppley IndianapolisHer breast appearance just a few weeks after surgery shows stretch marks that actually appear worse. Often times the immediate stretch of the tissues from the implants makes the scar hyperemic and the small capillaries in them dilate. This subsides over first couple months as the swelling goes down and the skin relaxes.

Highlights:

1) Having stretch marks on the breasts does not preclude one from having breast implants.

2) Breast augmentation surgery may temporarily make severe stretch marks look worse due to temporary redness.

3) Breast augmentation surgery, on average, does not appear to make stretch marks look better or worse in the long run.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Weight Loss Breast Augmentation

Saturday, February 11th, 2017

 

Background:  Significant weight loss, albeit through diet and exercise or bariatric surgery, will have a dramatic effect on all body areas. As the fat is burned off the support for the skin is lost. This causes an overall body sag that creates a well known collection of body changes that are most reflected centrally in the trunk.

For women one of the most affected areas is that of the breasts. The loss of breast volume allows the overlying skin to sag and the nipples to head south. What degree of breast sag that ensues depends on how large the breasts were initially and whether they had any significant sag before the weight loss. Smaller breasts develop less sag while larger breasts can have a dramatic sag with a large skin sleeve that ends up having them lay against the upper abdomen.

Breast implants are almost always needed for ‘reconstruction’ of the weight loss breast. Whether they can be effective by themselves without the need for a breast lift depends on how much skin sag exists.

Weight Loss Breast Augmentation Female before surgery Dr Barry Eppley IndianapolisCase Study: This 22 year-old female underwent a 60lb weight loss on her own without the need for bariatric surgery. The breasts must have been initially small ad the skin sag was slight and the nipples still remained fairly centralized on the reduced mound size.

Weight Loss Breast Augmentation result front view Dr Barry Eppley IndianapolisWeight Loss Breast Augmentation result right oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, a transaxillary approach was used to place 375cc saline breast implants that were filled bilaterally to 450ccs in the partial submuscular position. This filled out her breasts fully. Like many transaxillary breat augmentation approaches, the initial result will have slightly too much upper pole fullness which will settle over time.

Weight Loss Breast Augmentation result side view Dr Barry Eppley IndianapolisWith the nipples above the inframammary fold, breast implants is all that is needed in the large weight loss female. Unfortunately for many weight loss women the breast condition is not so favorable that implants alone will suffice.

Highlights:

1) Significant weight loss affects the breasts through loss of breast tissue and often creating a breast mound sag.

2) Breast implants can produce a dramatic change in breast size and shape in breasts that have lost a lot of volume. (weight loss breast augmentation)

3) Breast implants alone will work in the weight loss patient IF the position of the the nipple is at or just below the inframammary crease.

Dr. Barry Eppley

Indianapolis, Indiana

Anatomic vs Round Silicone Breast Implants

Sunday, January 22nd, 2017

 

Anatomic Breast Implants Dr Barry Eppley IndianapolisAnatomic or tear drop breast implants purportedly offer a more natural breast augmentation result. This seems to make complete sense when one looks at the shape of an anatomic implant where it has a teardrop shape that more closely mimics a natural breast than a round-shaped implant.

In the January 2016 issue of the journal Plastic and Reconstructive Surgery a paper on this topic was published entitled ‘Comparing Round and Anatomically Shaped Implants in Augmentation Mammoplasty: The Experts’ Ability to Differentiate the Type of Implant’. In this paper thirty (30) plastic surgeons and nurses looked at before and after pictures of thirty (30) submuscular silicone breast implants, either round or anatomic shaped) with an average volume of around 300cc (none greater than 340cc) within the first 3 months after surgery. Among the total of 1800 observations done, the observers could only accurately identify the correct implant style 50% of the time.

While previous studies looking at the same breast implant shape issue have shown similar inabilities to identify the type of implant shape used, this is the first one that has done so in a prospective analytical designed fashion. It is well known that the round or convex form of a breast implant will change into an anatomic shape in the standing position due to both the pressure of the overlying pectoral muscle and gravity. It only re-assumes a more rounded shape when laying down just like the implant looks when laying outside the patient on a table.

Anatomic Breast Implants results front view Dr Barry Eppley IndianapolisAnatomic Breast Implants results oblique view Dr Barry Eppley IndianapolisWhile these study results are both solid and I believe accurate, it is important to point out that its relevance is with smaller implant sizes and with them in the subpectoral pocket. Whether similar results would occur in larger breast implant sizes or in the subfascial position is open for debate. It has been my experience that in larger breast implants the effect of an anatomic breast implant is more relevant particularly in the short term. I would also have little doubt that a shaped implant would look more natural in the subfascial location.

When choosing an anatomic breast implant there should be compelling reasons to do so given their higher cost and risk of malrotation and breast shape deformation, a complication that does not exist with round implants.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Combination Breast Implant and Lift Surgery

Sunday, January 15th, 2017

 

Background:  The breast is subject to many changes from the influences of time, gravity, pregnancy and fluctuation in weight. But whatever the cause the changes are very typical, loss of breast volume and sagging. Efforts to reverse these negative shape changes are also very consistent through the addition of volume and lifting and tightening the breast skin.

Breast implants can have a lifting effect but it is not as significant as many patients hope. The lifting effect of an implant works best when the breast sag is no greater than the nipple being ideally above the lower breast fold or even just at the fold level. Because one of the effects of implant expansion on the breasts is to fill out the lower pole and even lower the level of the fold to accommodate the additional volume, the nipple and the breast mound will seem to be lifted. This change is partly illusionary but there is some real lift involved also.

Significant breast sagging, however, requires some type of breast lift even when implants are used. The two types of breast lifts that have real lifting power are the vertical (lollipop) and combined vertical-horizontal (anchor style) techniques. Combining implants and lift in a single breast reshaping operation is challenging as the two operations work against each other, one expanding the breast volume and the other lifting and tightening the breast mound. Getting the right balance between the two that can meet the patient’s expectations often requires more than one operation.

Case Study: This 32year-old female wanted to reshape her deflated and sagging breasts after having several children and losing weight. She had loose stretched out breast skin as well as asymmetry with the left breast sagging lower than the right.

Breast Implant and Lift surgery result front view Dr Barry Eppley IndianapolisUnder general anesthesia, she had vertical breast lifts which moved her nipple-areolar complex upward by 6cms on the right and 7cms on the left. Concurrently 500cc high profile silicone breast implants were placed in the submuscular position

Breast Implant and Lift surgery result oblique view Dr Barry Eppley IndianapolisBreast Implant and Lift Surgery result side view Dr Barry Eppley IndianapolisHer three month after surgery results show good implant positions, adequately lifted breast mounds up on the implants and good symmetry. Her breast scars remain red as expected at this point after surgery and will take another six months to lose the red color.

This combination breast implant and lift surgery had about as good a result as could be expected for this type of body contouring operation. Whether she will ever need a revision will now depend on how the scars mature and appear later. But many such breast reshaping operations will not do as well nor should patients expect them to do so. There are many variables in this operation that make for less than perfect results. The national average for the need for a revision in combination breast implant and lift surgery is over 30%. The most common reason is that the breast tissue remains inadequately lifted and tightened around the augmented breast mounds…or has dropped off of them a bit as the tissues have relaxed in the healing process.

Highlights:

1) Breasts that have lost volume and sag usually need a combination of implant volume and a lift.

2) The breast reshaping combination of breast implants and a lift is a challenging procedure to achieve good symmetric results in a single operation.

3) The revision rates in combination implant and lift breast operations is high and averages over 30%.

Dr. Barry Eppley

Indianapolis, Indiana

Supernumerary Nipple in Breast Augmentation

Monday, January 9th, 2017

 

A extra nipple, in either men or women, is not rare. Occurring in up to 5% of the population, it is often mistaken for a mole due to its circular appearance. What separates it from a mole is that it is raised and has a textured and not a smooth appearance. It does not usually grow in size and only gets bigger in proportion to the body as it grows.

milk-linesThe location of a supernumerary nipple is also a giveaway as it will lie along the milk lines. The milk lines are embryonic vertical lines that extend from the armpit to the legs from which arise breast tissue and nipples. They appear early in embryonic life by the end of the second month in utero and well before sexual identity is formed. (hence why men have nipples even though they will never breastfeed) The nipples will form along this line and humans always have two nipples…although more are capable of forming along the milk lines.

In most cases of extra nipples, medically known as polythelia, it will just be a single one and is usually located below the breast or chest. Hence the term third or triple nipple. In more rare cases it will be more than just a nipple and it may develop into an actual breast mound albeit much smaller than a natural breast. (polymastia)

supernumerary-nipple-dr-barry-eppley-indianapolissupernumerary-nipple-next-to-augmented-breast-dr-barry-eppley-indianapolisGiven the relative common occurrence of an accessory nipple, it would not be rare to find it on a prospective breast augmentation. This is an example of a 35 year-old female who came in for breast implants and wanted to have a raised mole removed at the same time. Its appearance was clearly that of a nipple and not a typical mole. When removed at the time of surgery, its appearance can be seen to be similar to a nipple when laid up against the augmented breast.

Dr. Barry Eppley

Indianapolis, Indiana

Product Review – Natrelle Breast Implants (Inspira Round Gel)

Sunday, December 25th, 2016

 

Silicone breast implants continue to evolve both in its external shell and the gel that resides inside it. The silicone gel has become far less like the liquid it originally was many years ago. The silicone has become more firm or cohesive through increased crosslinking of the silicon molecules. The urban term for these newer type of breast devices is known as ‘gummy bear breast implants’. But the manufacturers of them use the term ‘highly cohesive’ or more form stable.

natrelle-inspira-round-breast-implants-indianapolis-dr-barry-eppleyAllergan has offered silicone breast implants for years, known as the Natrelle breast implants line. They have had a highly cohesive gel in their shaped implants since 2013. (Natrelle 410 Anatomically Shaped Breast Implants) They have recently introduced this more highly cohesive gel in a round implant form. (Natrelle Inspira Round Gel Implant) The purpose in so doing is to achieve two effects: 1) hold the implant’s shape better, particularly in an upright position, to maintain upper pole fullness, and 2) for the gel to stay in place when the implant is either ruptured in vivo or cut in half when outside of the patient.

natrelle-inspira-round-gel-breast-implants-dr-barry-eppley-indianapolisAllergan’s tested comparative physical features show it is 51% more cohesive that Mentor Memory Gel and 37% more cohesive than Sientra’s style 106 implant. Comparing form stability (what happens when the implant sits straight up), the Allergan  implant was 47% more form stable than Mentor Memory Gel and 28% more form stable than Sientrs style 106 implant.

It is clear that increased gel cohesiveness is a desirous feature of a silicone breast implant. This is true both for how the implant performs long-term in the patient but also in how it is perceived by potential patients. (patients want ‘gummy bear’ breast implants) Each manufacturer now has their own version of them and they actively compare their gel cohesiveness and form stability. Natrelle breast implants now has a very competitive round silicone gel implant that is truly a gummy bear type.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Breast Implant Reconstruction in Poland’s Syndrome

Sunday, December 11th, 2016

 

Background: Poland’s syndrome is a well recognized congenital body deformity that affects the chest wall and upper extremity. It is almost always affects just one side of the body, most commonly the right side, and affects men more than women. There is a hypoplasia of the chest muscle in both men and women and lack of a breast mound in women. Despite the chest wall deficiency a nipple-areolar complex almost always is present albeit displaced superiorly and laterally from the opposite side.

Reconstruction of the breast mound in women with Poland’s syndrome is the mainstay of treatment. Since the breast mound is always absent, an implant is commonly used. There may be a role for injection fat grafting in some women but an implant produces a more predictable and stable result.

Because the chest wall is underdeveloped, creation of a breast mound with an implant will come with some inherent asymmetries. Most noticeable is the more highly positioned nipple-areolar complex. As the breast mound is created the nipple-areolar asymmetry will become more noticeable. Its superolateral position can become accentuated as the new breast mound pushes it even higher. In addition the tighter skin of the hypoplastic breast makes the implanted mound look rounder than the opposite normal breast.

Case Study: This 17 year-old female presented with Poland’s syndrome affecting her right side. She had a very small breast mound with a large nipple-areolar complex that was a large as the opposite normal side although more highly positioned. Her pectoralis muscle was also affected as it was shortened and created a band across the axilla when she lifted her arm away from her body.

breast-implant-reconstruction-in-polands-sundrome-result-front-view-dr-barry-eppley-indianapolisbreast-implant-reconstruction-in-polands-syndrome-result-oblique-view-dr-barry-eppley-indianapolisUnder general anesthesia and using a small inframammary incision, a 225cc saline breast implant was placed in the largely subglandular position. (due to the high position of the deficient pectoralis muscle) As expected the resultant breast mound was rounder. Unexpectantly the nipple-areolar complex looked better and more symmetric than before surgery.

Her breast implant reconstruction results for a Poland’s syndrome patient is better than many other such patients. This is undoubtably due to the more mild presentation of her Poland’s syndrome. This is evident before surgery with an affected nipple-areolar complex, that while malpositioned, is of normal size. These more favorable tissue characteristics bode well for congenital breast reconstruction efforts

Highlights:

1) Poland’s syndrome affects breast mound development and nipple-areolar positioning.

2) An implant is the standard approach for breast reconstruction in this congenital breast deformity.

3) Breast symmetry is never achieved in the Poland’s patient due to the hypoplastic tissues on the affected side.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Large Breast Implant Replacements

Thursday, December 8th, 2016

 

Background: Breast implants are often perceived as one-time lifelong devices. But this is the exception and not the rule. Depending upon the age at which they were placed, breast implants are often replaced at some point in a woman’s life. (and in more rare cases even removed) They are numerous reasons for why breast implants would be replaced including device failure as well as an aesthetic desires for a change in breast size.

The desire to change breast implant size, while often believed to occur early after their initial placement, is usually much later. It often is a decade or more particularly if one has had them placed before children. The breasts will undergo changes from pregnancy and weight loss and this often leads to loss of breast tissue and a real negative change in breast size and shape.

When replacing breast implants for a size increase, it is important to remember the volumetric rule that it takes at least 25% to 33% more volume to see an external change. For example, existing 300cc implants would need to be replaced with 400cc implants to see a visible change. This is usually a 1/2 cup or so. Large increases in breast size will require a 50% or greater volumetric increase. Thus 300cc implants need to be replaced with 450cc implants for a full cup size increase.

Case Study: This 47 year-old female originally had saline breast implants placed fourteen (14) years previously. They were 300cc implants filled to 350ccs. Between her age and loss of some weight she now desired a significant size increase with the desire for a two cup size increase.

large-breast-implants-replacements-front-view-dr-barry-eppley-indianapolisUnder general anesthesia her existing areolar incisions were used to remove her saline implants. The upper and inner capsule was released to accommodate the larger implants. Ultra high profile silicone implants of 700cc size were placed.

large-breast-implants-replacement-results-oblique-view-dr-barry-eppley-indianapolislarge-breast-implants-replacement-results-side-view-dr-barry-eppley-indianapolisThe reason it takes much more implant volume than one would think is due to multiple factors. The stretch of the breast tissue and skin that now exists that was not present initially during the initial procedure is a major reason. There is also the long-standing perception of breast size which initially seemed like a dramatic change but is now well visually accomodated.

As a general rule a moderate breast size increase requires 25% to 33% more volume, a moderate increase requires 50% more volume and a dramatic change requires 100% more volume.

Highlights:

1) Some women over their lifetime may desire to replace their breast implants to a larger size.

2) Secondary breast implant replacements surgery has a much more rapid recovery than their initial placement.

3) To make a visible difference in breast size with implant replacement the volumetric increase is usually greater than one would think.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Transgender Breast Augmentation

Monday, December 5th, 2016

 

Background: Transgender plastic surgery is a large compilation of feminizing face and body procedures. Of all of these procedures breast augmentation has the greatest impact on making a feminization change. It also do so in a rapid and assured manner, creating an instantaneous body shape change as all breast augmentation surgeries do.

On average transgender breast augmentation consistently creates good breast mound shapes. This has to do with the genetic male chest which is not exposed to the tissue stresses of pregnancy and weight gain/loss. Even in the male chest that may have some slight sagging the volume expansion effects of a breast implant quickly overcome any loose tissue.

To avoid scarring many transgender breast augmentation are done through an axillary incision. But with larger breast implants or when the use of a textured anatomic shaped implant style is desired, the axillary incision is more problematic. It is far better to switch to an inframammary incision to successully get these types of breast implants into good partial submuscular position.

Case Study: This 21 year-old transgender female desired breast implants. She had been on hormone therapy for several years but had developed little breast tissue or enlargement. She wanted a fairly large breast increase but also wanted a more natural shape and opted for anatomic silicone breast implants.

transgender-breast-augmentation-intraop-result-right-side-dr-barry-eppley-indianapolisUnder general anesthesia and through 4cm long inframammary incisions, 600cc shaped anatomic silicone breast implants were placed in a partial submuscular position.

ar-bam-results-front-viewar-bam-result-oblique-viewWith good overlying breast skin and nipple position, the results of her breast augmentation were satisfying. The tautness of the breast skin and the size of the implants made for rounder breasts than what one would think from using anatomic shaped implants.

Highlights:

1) Breast augmentation is one of the most important of all body contouring procedures for male to female transgender patients.

2) There is nothing unique about the genetic male chest that would not make it amenable to successful breast implant placement.

3) Because of the good quality of the genetic male chest skin, transgender breast augmentation is highly successful with the creation of good breast mound shape.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Large Breast Implant Replacements

Thursday, December 1st, 2016

 

Background: Breast implants are known to have a limited lifespan due to potential disruption of the implant shell. But as long as the implant shell remains intact the volumetric effect of the implants persist. Yet while breast implants remain stable the long-term effect of the appearance of the breast changes many years or decades later.

Whether a woman has an implant in or not, the breast tissue and skin envelope changes. Breast tissue may be lost and the skin will develop some sag. This effect is accentuated with pregnancies and weight gain/loss. The presence of implants may delay or blunt these body-related changes but they almost always occur. Over time the natural breast tissue may slide off of the implant as the tissues weaken and the breasts will look much less perky.

With these breast changes women may seek to exchange their breast implants for larger ones to get a breast rejuvenation effect. The question is what size increase is needed to see a visible change.

Case Study: This 44 year-old female had 350cc saline breast implants placed twelve years ago. She had two subsequent children and then lost some weight as she became much more of a fitness enthusiast. While her saline implants remained intact her breasts had developed some sag and she felt they had lost overall size. She wanted new breast implants that produced a dramatic change in implant size and upper pole fullness.

large-breast-implants-replacements-front-view-dr-barry-eppley-indianapolisUnder general anesthesia through her existing areolar incisions, her saline implants were removed and replaced with 700cc ultra high silicone implants into her existing submuscular pockets.

large-breast-implants-replacement-results-oblique-view-dr-barry-eppley-indianapolislarge-breast-implants-replacement-results-side-view-dr-barry-eppley-indianapolisWhen replacing breast implants for a larger and fuller look, it takes more increased volume than one would think. Of course it depends on what final breast size one wants but anywhere from a 50% to 100% volume increase is needed. That could be anywhere from 150 to 300ccs for most women.

Highlights:

1) As long as breast implants remain intact, they maintain a persistent volume.

2) The tissue around breast implants does change over time through some loss of volume and tissue sag off of the implants.

3) To re-expand saggy breasts with new implants a much larger breast implant size must be chosen than one may think.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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