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BIA-ALCL (Breast Implant Associated Acute Large Cell Lymphoma): dispelling the myths

BIA-ALCL (Breast Implant Associated Acute Large Cell Lymphoma): dispelling the myths

In the last few years a concern has surfaced over the possible risk of cancer after breast implant surgery. Many of the reports have presented startling statistics that are not at all accurate. I would like to use this opportunity to provide some accurate statistics in order that potential breast implant patients have a more realistic understanding of the connection between the implants and the risks.

What is BIA-ALCL?

BIA-ALCL is a rare and highly treatable form of lymphoma that can occur in the tissues surrounding breast implants.

Who is at risk?

Although it is rare, ALCL can occur in patients who had textured surface implants placed at least one year and typically several years earlier.

How common is it?

The lifetime risk of the development of ALCL in women with textured surface implants is estimated to be somewhere between 1 in 3800 to 1 in 30,000.

What are the usual symptoms?

Typically, ALCL presents with enlargement of a breast, pain, breast hardening, a lump in the breast or armpit or a large fluid collection around the implant. It occurs in someone who had an implant place at least one year and usually several years earlier. Only textured surface implants have been confirmed to put a woman at risk of the development of ALCL.

What should I do if I develop one or more of those symptoms?

You should contact your surgeon who will arrange for biopsy with drainage of any associated fluid for testing. If the testing shows evidence of ALCL, a scan such as a CT scan will be performed to help determine if there has been any spread of the disease.

What type of treatment is necessary.

In many patients, removing the implant and the scar capsule around it are curative. However, if the ALCL has spread, chemotherapy may be needed.

Does Dr. Weider use textured implants?

Very rarely. I almost always use smooth surface breast implants, and there is no clear association between smooth surface breast implants and ALCL.

How many implants are placed per year in the United States?

Approximately 550,000 breast implants are placed per year in the United States. This includes implants placed for both cosmetic and reconstructive reasons. About 70,000 of these are textured surface implants.

How many cases of BIA-ALCL are reported per year.

Less than 100 cases of BIA-ALCL are reported per year.

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Breast augmentation: What to Expect FAQs

Here is a primer for some of the most frequently asked questions regarding breast augmentation recovery.

Will the procedure be painful?

While everyone is unique, most of the women who undergo breast augmentation are pleasantly surprised that they don’t have much pain after surgery. Most describe tightness and some discomfort, however. We usually prescribe a painkiller and a muscle relaxer, but after 3-7 days most women can switch to over-the-counter pain medication. Some factors such as implant size and skin tightness will influence the level of pain and the duration of the discomfort and tightness. If the individual’s skin is tight, which is more common in younger women who have not had children, it will take longer for the breasts to soften up. By about three weeks, most women feel like they are back to “feeling like themselves.”

When can I go back to work, back to school and/or take care of my kids?

Typically, within three to five days, non-strenuous activities can be resumed. So, in the case of an individual who has a job that does not require strenuous activity such as heavy lifting, most women can go back to work after five days. If you have a toddler, then it would be a good idea to have help for the first seven to ten days. Again, everyone’s experience is a little different, but these are time frames based on the typical patient.

How should I sleep after breast augmentation?

For the first few nights, I recommend that you sleep on you back with your head elevated. This can be achieved with pillows or by sleeping in a recliner.  After about three days, you don’t need to sleep with your head elevated any more, but I would still recommend sleeping on your back for the first week. After that, if it feels comfortable, you can sleep on your side. I wouldn’t recommend sleeping on your stomach for several weeks.

When can I resume exercise?

We have many athletic patients, and this is a common question. This is the schedule I recommend, but it depends on how you are feeling during your recovery as well. For the first few days after surgery, I ask patients to take it easy. By that I mean they should be getting up and walking around but not doing any exercise. After about 4-5 days, it is ok to go on a long walk (10-20 minutes) if you feel like it. Alternatively, if you would rather walk on a treadmill, that is fine as well.   About 2-3 weeks after surgery, you can resume some light exercise. For example, riding a stationary bicycle or a spinning bike or using an elliptical trainer should be fine. In addition, doing lower body weight training is ok. The key is not to do any impact sports such as running as well as avoiding use of your pectoralis (chest) muscles. After six weeks you can resume running if you wish to.  We recommend that runners wear two sports bras for three months or even longer. This protocol is a general guideline and will need to be modified somewhat for some people. In addition, it is important to see how you feel when doing an activity. If it hurts, it is best to give it some more time before resuming that activity.

What about lifting? When can I lift my baby?

I recommend that women don’t lift more about 5-6 pounds for the first few days. By comparison, a gallon of water weighs just over 8 pounds. Then you can gradually increase how much you lift as the days and weeks go by. It will be about one to two weeks before you can lift your child up depending on what he or she weighs. However, it is ok to have someone else place your child onto your lap after a few days. Once you do resume lifting your child up, it is best to bend down low using your knees and not your back. Then hold your child against your hip to help support his or her weight as you stand up.

Will the procedure result in breast numbness (loss of feeling)?

Most women have some numbness after breast implant surgery.  However, this is usually temporary.  The numbness is due to the stretching of the nerves in the breasts.  However, normal feeling typically returns after six to eight weeks.  Many patients will note hypersensitivity in the first few weeks after breast augmentation.  This sensitivity will also go away after about three to six weeks.  It should be noted that the risk of any permanent numbness increases if very large implants are chosen.

Breast Feeding

Most women who undergo breast implant surgery can breastfeed in the future if they wish to.  I typically use an incision in the fold below the breasts (Inframammary fold) in order to place implants.  One of the benefits of this incision is that there are no incisions near the nipple that could potentially disrupt milk ducts or nerves near the nipples.  The inframammary incision means that almost no breast tissue needs to be cut in order to place the breast implants.

What are these weird sounds I hear coming from my chest?

That is a fairly common question. Many women hear odd sounds such as sloshing, squeaking or creaking coming from their chests. This is nothing to worry about. The sounds are due to the fact that there is some air and fluid in the pocket but outside the implant.  It sloshes around and makes some odd noises that can be alarming. You can rest assured that by about six weeks, that air and fluid will be safely absorbed by the body and the odd sounds will go away.

Implant replacement after 10 years

It is a commonly held belief that breast implants should be replaced every ten years.  However, with current implants, that isn’t the case. I advise my patients that if their implants are intact and they are still happy with their appearance, there is no need to change out the implants after ten years. That being said, silicone gel filled implants should be monitored periodically for leaks.  This is usually done with an MRI, but mammograms or ultrasound may also detect implant rupture.

Scarring and treatment

At the time of surgery, we take all measures we can to minimize scarring.  This includes inconspicuous incision placement and meticulous incision closure,  In addition, sterl strips or skin adhesive are placed after the incisions are closed. Two weeks after surgery, the experienced staff at Weider Plastic Surgery will explain the best methods and products to use to get the least visible scars.

Breast Augmentation in 2018: What to Expect

Almost 300,000 women underwent breast augmentation surgery in the U.S. during 2016 according to statistics from the American Society of Plastic Surgeons, making it the most popular cosmetic surgery in the nation – a spot the procedure has held for many years. While the surgery has been around for decades, it has undergone numerous changes during the past two decades. Improvements in technology and surgical technique have made the surgical outcomes more pleasing, more natural-looking and more predictable.

At the same time, shifting perceptions of plastic surgery in general have provided many more women with the confidence they need to feel comfortable having breast augmentation surgery. Reductions in both recovery time and cost mean the surgery is more accessible to women from all walks of life. If you are thinking about breast augmentation surgery, here is a quick review of those recent changes.

Size Matters

There was a time when breast augmentation was primarily relegated to women who wanted significantly larger breasts, with little regard to how their new larger breasts affected the overall ratio or symmetry of their bodies. But in the past couple of decades, this “bigger-is-better” approach to augmentation has given way to a preference for smaller, more proportionate implants that help women feel more confident without looking unnatural or obviously “altered.” While women of the 1980’s might have asked to move from an average B cup to a much larger double D, today women are far more likely to increase their breast size by one or two cups. Instead of aiming only for larger, more voluptuous breasts, many patients today are looking to achieve a  natural look and a more balanced figure or restore a more youthful profile that helps them look and feel more confident without feeling uncomfortable and burdensome.

In addition, women are more likely to rely on their plastic surgeon’s advice regarding the size of their implants. Experienced surgeons have long recommended smaller implants that enhance a woman’s appearance rather than drastically altering it. As women shift toward smaller implants, surgeons are able to provide them with results that match their overall body shape for more attractive results and greater satisfaction overall.

Different Demographics

Along with implant size changes, patient demographics have also shifted during the past couple of decades. In the past, breast augmentation patients were more likely to be women in their 20’s who were looking to transform their figures. But today, many breast augmentation patients are mothers in their 30’s and 40’s looking for a way to reverse some of the most noticeable physical effects of childbirth and breastfeeding.

Pregnancy and lactation cause significant changes in breast size, shape and texture, including an undesirable loss of firmness. While some pregnancy-related changes resolve, at least in part, in the months and years immediately following pregnancy, it is common for breasts to lose at least some of their natural buoyancy, resulting in a sagging, drooping profile that can add years to a woman’s appearance.

Today, women are more likely to recognize the benefits of breast augmentation in addressing these issues by restoring fullness and firmness to their breasts. As a result, they are far more likely to have breast enhancement surgery, either alone or as part of a more comprehensive “mommy makeover,” helping them feel better about the way they look.

Smaller Scars

Both incision size and location have changed over the years, and today, incisions are smaller and more discreet. Both silicone and saline implants can be inserted through very small incisions that can be placed in areas not normally visible. Using these innovative techniques, surgical scars are easily hidden by even the tiniest bikinis and most revealing fashions. In addition, advanced surgical technique means less discomfort, so women can return to their normal lifestyles more quickly.

New Implant Technology

 

Over the last ten years, major advances have been made in implant technology leading to more options for women as well as better and safer choices. Currently, silicone gel filled implants come in a wide range of sizes, profiles and gel types in order to meet the specific needs of each individual. The various sizes and profiles mean that an implant can be custom fit to each woman’s body and goals.  The different gel types range from softer to more cohesive (gummy bear) leading to less chance of visible rippling and more fullness in the upper part of the breast. Saline (salt water) filled implants have also seen major advancements. Ideal Implant structured saline implants mimic many of the best qualities of silicone gel implants without the need for screening MRIs to detect leakage. All of the current available implants are more durable and resistant to rupture. The “gummy bear” implants specifically are designed not to leak should the implant shell be compromised.

 

Given these advances and options, every breast augmentation procedure can be customized based on the unique anatomy and goals of the patient for optimal satisfaction. Your goals as well as all of the various options will be reviewed with you during your consultation with Dr. Weider.

 

Board Certified Remains the Gold Standard

Although breast augmentation surgery has seen a lot of changes during the past couple of decades, one factor that has remained the same is the importance of surgeon selection. Having a board certified plastic surgeon perform your surgery means you can feel confident in your care and your results. Why? Because a surgeon who is certified by the American Board of Plastic Surgery (ABPS) has received advanced education and training far beyond that required by medical school and licensure. Board certification indicates that a surgeon has several additional years of surgical training, as well as rigorous testing and ongoing coursework and evaluations to ensure that he or she remains up to date on advances in surgical technique and patient safety protocols. Look for certification from the American Board of Plastic Surgery, and check out the requirements for certification on the ABPS website.

Learn More About Breast Augmentation in 2018.

If you are considering breast augmentation surgery, the first step in learning more about the procedure and whether it is a good choice for you is to speak with an experienced plastic surgeon about all your options. As a top-ranked, board certified plastic surgeon in Dallas, Dr. Laurence Weider is skilled in breast augmentation surgery, using the most advanced techniques to help each woman achieve her goals. Ready to find out more? Call the office at 972-566-9444 or use our online form to request your personal consultation appointment today.

Saline vs Silicone gel filled implants; part #2

During this installment, I will discuss the advantages of silicone gel filled implants in comparison to saline filled implants. Certainly the greatest advantage of the silicone gel filled implants is that they feel more natural and in some cases look more natural than saline implants. This is because the cohesive gel fill material more closely mimics the feel of breast tissue. Cohesive means that the fill material is viscous. It is more like a gel than a liquid. While the cohesiveness of the silicone filler helps to provide a more natural feel, the significance of the fill material varies greatly from patient to patient. Slender women who have minimal breast tissue will notice the most benefit from silicone gel filled implants.

In general, the incision size is a little greater for silicone gel implants. This is because the silicone gel implants are pre-filled and must be inserted while inflated. However, I use a device called the Keller Funnel when inserting silicone gel filled implants. The Keller Funnel facilitates the insertion of the implants quickly, and without trauma. The Keller Funnel also allows for insertion of gel filled implants with very little touching of the implant by the surgeon. This cuts down the risk of contamination or infection of the implant. With the use of the Keller funnel, I can use the same small incision to insert a silicone gel filled implant that I use to place a saline filled implant, except when inserting very large implants.

While silicone gel implants do cost more than saline filled implants, they come with an upgraded warranty against leakage. Should a silicone gel filled implant leak, the manufacturer will provide a pair of new implants. That way, a patient can opt to change the size of both implants if she desires.

During your consultation, my assistant and I will review the unique benefits of each implant type for you. In addition, you will be able to examine both implant types. My staff and I will assist you in determining which implant will be best for you. Please give my office a call at (972) 566-8444 to set up your plastic surgery consultation.
To Your Health,
Dr. Weider

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Saline vs Silicone Gel Filled Implants, Part #1

One of the most frequently asked questions in my practice relates to the choice between saline and silicone gel filled breast implants. Over the next two blogs I will review the pros and cons of each type of implant. Once a woman is considering having a breast augmentation in Dallas, she needs to decide whether to choose saline or silicone gel filled breast implants. In my practice in Dallas, my patients are about evenly split between those choosing silicone and those opting for saline. During the first installment, I will highlight the advantages of saline implants. The second installment will focus on the advantages of silicone gel filled implants.

Both types of implants have a silicone elastomer shell. The current generation of implants has a thicker shell than earlier generation implants. The thicker shell makes them stronger, more durable and less susceptible to leakage.

It is the fill material of the implants that varies. Saline filled implants are quite simply filled with sterile salt water. Because they are filled in the operating room, the surgeon is able to vary the amount of fill in each implant to correct small discrepancies in breast size. The silicone gel filled implants, on the other hand, are prefilled during the manufacturing process, so their fill volume cannot be adjusted.

Another key difference between the two types of implants is leakage detection. While both types of implants have low leakage rates, the saline filled implants will deflate when they leak, typically making the leakage easy to detect for the patient and the surgeon. The saline is absorbed by the body and is harmless. If a silicone implant leaks, it is likely that the patient won’t be aware of it. This is because the gel will typically stay in the implant or in the pocket around the implant. Because of this, the FDA has recommended that women with silicone gel filled implants undergo an MRI three years after surgery and every two years after that in order to detect asymptomatic implant leakage. It is concern about a silicone leakage that could go undetected that many women site as the reason they chose saline implants instead of silicone gel filled implants.

Cost is another key factor that differentiates these two types of implants. A pair of silicone implants costs about $1000 more than a pair of saline filled implants. The price difference reflects the additional cost charged by the implant manufacturer. In my next blog, I will focus on the advantages of silicone gel filled implants.

 

Keller Funnel: The future of Silicone Gel Breast Augmentation…available today!

One of the greatest concerns after breast augmentation for patient and surgeon alike is the risk of infection. An infected implant often means that an implant will need to be removed for a prolonged period of time before it can be reinserted. This is just one of the many reasons why I am so excited about the Keller Funnel. Unlike saline implants, which are inserted into the surgically created pocket empty and then filled, silicone gel implants must be inserted while already filled. The traditional method for doing this has been to tediously push the implant through the incision in the skin. This often meant that there was significant contact between the implant and the patient’s skin. Especially with larger implants, this technique is also traumatic to the implant as well as the patient’s tissues. The Keller Funnel for Breast Augmentation eliminates most if not all of the contact between the implant and the patient’s skin. It also greatly decreases the forces on the implant that could lead to damage to the implant shell. The funnel, which has a slippery inner coating, facilitates passage of the implant into the pocket. A recent study from Emory University demonstrated a 27 fold decrease in skin contact when using the funnel. Use of this novel implant delivery device also cut the risk of bacterial contamination of the implant in half.
I have chosen to use the Keller Funnel on all of my silicone gel augmentations, because of the benefits it provides to the patient including:

  • Shorter incisions
  • Improved comfort and faster healing
  • More choices for incision placement
  • Reduced force on the implant and incision
  • Reduced risk of contamination and infection

Further information including a video demonstrating how it is used can be viewed here:

I am one of only a few board certified plastic surgeons in the Dallas metropolitan area using the Keller Funnel. Should you wish to discuss breast augmentation or any other procedure please call Weider Plastic Surgery today at (972) 566-8444.

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French Breast Implants and Medical Tourism

A recent report from France warns that silicone filled breast implants manufactured by a French implant maker called PIP have a very high rupture rate. In addition, PIP has been accused of using industrial grade silicone to fill the implants instead of more expensive medical grade silicone. The cheaper industrial grade silicone may lead to greater inflammation of nearby tissues. These implants were sold and implanted in several countries including those in Europe as well as South America. They were not available or implanted in the United States, however.

Health officials in several countries are now trying to determine whether to recommend that these implants be removed from those women who have them already. Interestingly, in the late 1990s, approximately 15,000 women had saline filled PIP implants placed in the United States. Some of them even had their surgery in Dallas, Texas. Those PIP saline filled implants had a high leakage rate and were banned by the FDA in 2000.

Currently, there are only two breast implant manufacturers who have FDA approval to sell their implants in the United States. They are Mentor and Allergan. The implants that are sold in the United States have undergone very rigorous testing and research done over multiple decades.

The PIP implant controversy serves to highlight one more reason why medical tourism (traveling to a foreign country to have cosmetic surgery) is often a bad idea. While you may find a competent surgeon, the safety standards in many countries are not as rigorous as those in the United States. I have personally seen women who have had non-FDA approved silicone implants inserted in a South American country that are now having problems with the implants. A small amount of savings initially could cost you much more in the long run.

To your health, for any more information on breast implants or to schedule a consultation feel free to contact us.

Dr. Weider

Study Shows Breast Implant Patients Have Same Breast Cancer Survival Rate

breastcancer-dallas-texasA Canadian study has confirmed what doctors have known, which is that women with breast implants who go on to develop breast cancer have similar outcomes as women who develop cancer but do not have implants.

There has long been a concern among women with breast implants that the implants themselves would create problems with obtaining accurate mammogram results. This study provides reassurance that there is no concern along those lines.

Along a similar vein, women with implants actually have a much lower rate of breast cancer as compared to peer groups in the population.

To your health & beauty,

Dr. Weider