June 8th, 2011
Although television shows such as The Swan and Extreme Makeovers make cosmetic plastic surgery look exciting and glamorous, this so-called “reality” couldn’t be farther from the truth.
Cosmetic surgery remains popular because it makes people look and feel better. But make no mistake: it is real surgery with real risks and downsides. In my 15 years operating on patients from Dallas, Plano, Frisco, Richardson, McKinney, Carrollton, Irving, Southlake, and Lewisville, I have learned the realities of cosmetic surgery firsthand.
Virtually every surgical procedure is associated with the following negative factors:
1. Scars: Like it or not, any time you cut the skin, your body generates a scar. Part of my job is to make the scar look as inconspicuous as possible—but there’s still a scar. This is a necessary trade-off for the desired improvement in contour.
2. Pain: Surgery hurts. There is no such thing as a painless surgical procedure. You will require pain medicine (from anywhere from a couple days to a couple weeks), and you may wonder what you were thinking the first couple days after surgery. Fortunately, pain is temporary and generally well-controlled by medication. But it is unavoidable.
3. Time off work: You may be tough, but the combination of surgery, anesthesia, and pain medication will result in some time lost from work. If you have a desk job, you will likely be back to work very soon. If your job requires significant lifting, you may have to modify your work activities for several weeks.
4. Time off athletic activities: For most breast and body contouring procedures, you will require 4 to 6 weeks off heavy lifting, pushing, and pulling. (This includes strenuous workouts and lifting your children.) It’s inconvenient but very necessary.
5. Risks: Infection, bleeding, need for further surgery, unsatisfactory cosmetic results (to name a few). The good news: 90 to 95% of patients are happy with their surgical results. The bad news: 5 to 10% are not.
I feel privileged to be able to make a living doing something I really enjoy. But cosmetic surgery is more fun for me than it is for you. Make sure that your plastic surgeon takes the time to thoroughly educate you before you undergo any procedure.
Our cosmetic surgery and plastic surgery patients come from Dallas, Fort Worth, Plano, Frisco, McKinney, Allen, Richardson, Garland, Sherman, Denison, Prosper, Celina, Wichita Falls, Parker, Highland Village, Denton, Arlington, Irving, Southlake, Carrollton, Lewisville, Colleyville, and Trophy Club. For cosmetic surgery before and after photos, please visit www.plasticsurgerydallas.com .
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Breast Implants, Earlobe, Face, Home, Nipple Procedures, Plastic Surgery | 1 Comment »
November 5th, 2010
Implantes de seno de silicones se sienten mas naturale s y se ondean menos que los implantes salinos. Pero son seguros ?
Implantes de silicon fueron introducidos en 1962 y fueron muy populares en los Estados Unidos por tres decadas. Sin embargo, en 1992, el FDA (U.S. Food & Drug Administration) puso restricciones al uso de los implantes de silicon debido a varios reportes de enfermedades autoinmunes (como arthritis, fibromyalgia y lupus) vinculados al gel de silicon. Como resultado, cuando hice mi residencia en cirugia plastica en el Hospital de Parkland en Dallas de 1992 a 1994, sacabamos mas implantes de los que poniamos. Por supuesto, habia tambien demandas de $3 billones en contra de los fabricantes de los implantes de gel de silicon.
Durante los siguientes 14 anos, el gel de silicon fue la substancia mas estudiada en la tierra. A pesar de múltiples intentos para inducir la reacción de gel de silicon en animales de laboratorio, no se logro ninguna reacción inflamatoria. Los estudios en humanos fallaron en demostrar los anticuerpos de silicon. El America College of Rheumatology ( el colegio de Reumatologia) (reumatólogos tratan enfermedades del sistema inmune) llego a la conclusión que no había ningún vinculo que relacionara los implantes de seno de silicon con alguna enfermedad del sistema inmune.
En noviembre del 2006, el FDA retracto su decisión de 1992 y aprobó Allergan(antes Inamed) y Mentor implantes de seno de silicon para uso en los Estados. Unidos. Sin embargo, ha puesto algunas condiciones para el uso de silicon. Mientras que para los implantes salinos no hay restricciones de edad, los implantes de seno de silicon solo se pueden usar en mujeres mayores de 22 anos de edad. Ademas, el FDA ha estipulado que mientras que los implantes de siicon son seguros, la seguridad de los implantes de silicon que se han reventado no se ha establecido. Por lo tanto, el FDA recomienda un estudio de resonancia magnetica (MRI) de los senos a los 3 anos de la operación y cada 2 anos después. Estos estudios son caros (por lo menos $1500) y no los cubre el seguro medico. Como resultado, muchas mujeres no se hacen los estudios de MRI después de la operación.
Dado que los fabricantes ofrecen una garantía de 10 anos , que cubre todos los gastos de cirugía si se llega a reventar un implante de silicon, es buena idea hacerse un MRI antes de los 10 anos de la expiración de garantía. Es mejor que el fabricante pague el costo de reemplazar el implante reventado que usted.
Entonces, son seguros los implantes de silicon? Si los implantes están intactos, el FDA dice que si. Si se revientan, el FDA dice que “no estamos completamente seguros” . Yo personalmente no pienso que el gel de silicon sea una substancia mala. Siempre y cuando usted entienda que la controversia del uso de silicon sigue vigente, pienso que es muy razonable usarlos. Si los implantes de silicon la espantan , entonces los implantes de seno salinos siguen siendo una excelente alternativa para la mayoría de las mujeres.
Para mayor información acerca de implantes de senos, por favor visite: http://www.plasticsurgerydallas.com/procedures-breast-augmentation.php
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Breast Implants, Home | No Comments »
October 4th, 2010
What is a capsular contracture?
Capsular contracture refers to formation of a tight scar surrounding a breast implant following breast augmentation, causing the implant to look or feel hard. The implant itself does not actually become hard; it just feels like it because it is being squeezed by the scar tissue.
Mechanism of capsular contracture formation
When a breast implant is placed, your body recognizes it as foreign and builds a wall of scar tissue (capsule) around the implant to seal it off from the rest of your body. This is normal, and it’s a good thing. On a long-term basis, this capsule provides support to your implants, so they don’t drop down to your belly button later in life.
The problem is that sometimes the scar tissue contracts or tightens around the implants. This may be due to a postoperative infection or bleeding problem, either of which can increase internal scarring. Most of the time there is no obvious cause—it just happens.
Risk factors for capsular contracture
1. Capsular contractures are more common in implants placed above the pectoralis muscle (subglandular implants) than those placed below the muscle (submuscular implants). It is theorized that the constant motion of the pectoralis muscle over the subpectoral implants keeps the capsule from tightening excessively.
2. Capsular contractures are more common with silicone gel breast implants than with saline breast implants. This is likely related to the foreign—and therefore more reactive–nature of silicone gel compared to salt water.
3. Among women with subglandular implants (above muscle), capsular contractures are more common with smooth breast implants (smooth implant surface) than with textured breast implants. Surface texturing (smooth vs. textured) does not appear to make a significant difference if implants are placed in subpectoral position.
4. Significant trauma to the breast can cause a small amount of bleeding around the implant, precipitating the formation of a capsular contracture.
5. Immediate postoperative infection, bleeding, or implant exposure significantly increases the risk of capsular contracture formation.
6. Silicone gel breast implant rupture can cause an inflammatory reaction with silicone granuloma (small nodules adjacent to the implant) formation and/or capsular contracture.
7. Saline breast implant deflation will not cause an inflammatory reaction. However, if the implant is not replaced quickly (within a few weeks), the capsule contracts in an attempt to eliminate the empty space left behind by the deflated implant.
We’ll discuss grading and treatment of capsular contractures in the next blog. Stay tuned…
For more information about breast augmentation, please visit www.plasticsurgerydallas.com.
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Home | No Comments »
July 23rd, 2010
Determining the “right” breast implant size can be a major challenge. Let me explain the most frequent methods and their pitfalls:
1. Going by bra cup size: “I’m an A cup, and I want to be a full C cup.”
The problem: There is no standardization of cup size among bra manufacturers. A Playtex C is frequently a Victoria’s Secret D. A woman who fits a 34 D cup may also fit a 36 C. So cup size is imprecise—at best—and sometimes closer to just a guess.
2. Relying on a surgeon’s determination of the “correct” size based solely on breast measurements.
It has become popular among breast implant surgeons to measure the width of the base of the breast, find an implant with the same diameter (based on a chart provided the implant manufacturers), and then tell the patient that this is the magical “right size.” Although this seems reasonable anatomically, it seems to me that your wishes regarding size are much more important than the surgeon’s. While a surgeon can and should provide guidance regarding implant size, the ultimate choice should be yours. If your “right” size is different from his, your surgeon should be flexible (rather than mindlessly following his breast diameter chart).
3. Stuffing your bra with different sizes of implants until you find the right one.
This is great for marketing purposes. You get to “try on” different implants until you find the right size. The problem is that the actual implants go under the breast tissues, not over them. Superimposing the implants on top of your breasts creates a snowman effect (one sphere stacked on top of the other), which exaggerates the projection of the breasts relative to what will actually happen in the operating room. Women commonly choose implants that are smaller than they actually wanted.
What do I do in my breast augmentation practice?
I think in terms of implant volumes: 330 cc, 360 cc, 390 cc, etc. You think in terms of cup sizes. Neither of these allows us to communicate effectively. So I use the one thing we can both see: photos.
You can choose among the before and after photos of breast augmentations on our website, among the hundreds of photos in our office photo albums, or among any photos from any magazine or internet site. (There’s obviously no shortage of available breast implant photos.) Although you might not know the cup size of the women you choose or the number of cc’s, it really doesn’t matter. You simply look through breast photos and categorize them as “too big,” “too small,” or “about right.” I will analyze the photos with you. As long as your choices look reasonable for your frame, the choice of size is yours. I believe that there is a right range of sizes rather than a specific right size. Photos of desired breast size don’t work perfectly, but they seem to work better than anything else I’ve tried.
Click here to watch a video about breast augmentation and a patient’s experience with the procedure.
For more information about breast implants, please visit http://www.plasticsurgerydallas.com/procedures-breast-augmentation.php
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Home | No Comments »
June 25th, 2010
If a woman has not undergone prior breast surgery, I place the vast majority of implants below the pec major (pectoralis major) muscle. Why? Submuscular breast implants have the following advantages:
1. Reduced risk of capsular contracture.
The scar tissue around the breast implants is less likely to become excessively tight if it is being stretched constantly by the motion of the overlying muscle.
2. Reduced risk of interference with mammograms.
Although any breast implant may interfere with mammograms, the muscle can be used as a divider to separate the overlying breast tissue from the underlying submuscular implant.
3. Reduced risk of excessive implant descent or “bottoming out.”
Breast implants placed below muscle are supported by the overlying muscle. In contrast, implants placed above muscle (subglandular breast implants) are supported only by the overlying skin and breast tissues.
4. Reduced risk of visible implant rippling.
All breast implants ripple along their edges. Saline breast implants ripple more than silicone gel breast implants. When implants are placed below muscle, the upper inner two-thirds of the implants are covered by the pec major muscle, significantly reducing the extent of rippling.
5. Reduced risk of unnatural bulging of the upper breasts.
The pectoralis major muscle blunts the junction of the upper implant edge and the chest wall, generally yielding a more natural breast appearance.
On the downside, placing implants below muscle requires greater surgical time, effort, and skill and often causes more immediate postoperative discomfort. In athletes, implants below muscle may sometimes weaken the pectoralis major muscle, and the implants may “jump” with forceful muscle contraction. In my 15 years of private practice, however, the advantages of subpectoral implant placement have far outweighed the disadvantages in the vast majority of women.
Click here to watch a video about my breast augmentation technique and results.
For more information about breast implants, please visit http://www.plasticsurgerydallas.com/procedures-breast-augmentation.php
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Home | No Comments »
May 24th, 2010
Silicone gel breast implants feel more natural and ripple less than saline implants. But are they safe?
Silicone gel implants were introduced in 1962 and were very popular in the U.S. for three decades. However, in 1992, the FDA (U.S. Food & Drug Administration) placed restrictions on the use of silicone gel following multiple reports of autoimmune diseases (such as arthritis, fibromyalgia, and lupus) reportedly linked to silicone gel. As a result, when I did my plastic surgery residency at Parkland Hospital in Dallas from 1992 to 1994, we took out many more implants than we placed. Of course, there were also $3 billion of lawsuits against the silicone gel implant manufacturers.
For the next 14 years, silicone gel became the most thoroughly studied substance on earth. Despite multiple attempts to induce a reaction to silicone gel in lab animals, no inflammatory response could be incited. Human studies failed to demonstrate silicone antibodies. The American College of Rheumatology (rheumatologists treat autoimmune diseases) subsequently concluded that there is no demonstrable link between silicone gel breast implants and any autoimmune disease process.
In November 2006, the FDA reversed its 1992 decision and approved Allergan (formerly Inamed) and Mentor silicone gel implants for use in the United States. However, the FDA has attached some strings to the use of silicone gel. While there are no age restrictions for saline implants, silicone gel breast implants are only allowed in woman ages 22 and up. In addition, the FDA has stated that while intact silicone gel implants are safe, the safety of ruptured silicone gel implants has not been conclusively established. Therefore, the FDA recommends MRI (magnetic resonance imaging) studies of the breasts at 3 years postoperatively and every 2 years subsequently. These studies are expensive (at least $1500) and are not covered by insurance. As a result, most women are choosing not to undergo regular MRIs postoperatively.
Given the fact that the manufacturers offer a 10-year implant warranty that covers most or all surgical costs if the silicone gel implants rupture, an MRI prior to your 10-year implant anniversary is probably a good idea. Better to have the manufacturer pay the cost of replacing a ruptured implant than pay it on your own.
So is silicone gel safe? If the implants are intact, the FDA says “Yes.” If they’re ruptured, the FDA says “We’re not really sure.” I personally do not think that silicone gel is an evil substance. As long as you understand that there is still some residual controversy surrounding silicone gel, I think it’s very reasonable to use. If silicone gel implants scare you, then saline breast implants remain an excellent alternative in most women.
For more information about breast implants, please visit http://www.plasticsurgerydallas.com/procedures-breast-augmentation.php
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Home | No Comments »
April 16th, 2010
Welcome to the inaugural issue of the CosmeticSurgeryPlano blog! Our first series of blog entries will concern everyone’s favorite cosmetic surgery topic: breast implants.
Silicone gel advantages:
1. Softer to touch, feel more like breast tissue.
2. Reduced rippling relative to saline implants.
Saline advantages:
1. Smaller incisions (3 cm—about 1.25 inches versus around 5 cm for silicone gel)
2. Lower risk of capsular contracture (hardening of the implants due to scar tissue)
3. Lower cost (around $1200 to $1500 lower).
4. Less controversy (I’ll address this in the next blog).
There is no perfect implant. If there were, we’d only be discussing one kind of implant type (rather than two).
Silicone gel breast implants are probably better from a purely cosmetic standpoint: they feel very similar to breast tissue.
Saline breast implants are probably better from a purely safety standpoint: it’s hard to argue with the safety of a bag of saltwater.
In general, if you have a reasonable amount of breast tissue, subcutaneous fat, and breast tone, saline implants will be reasonably well-camouflaged and may be a good choice.
On the other hand, if your breasts are very small (A minus), you are extremely thin, and/or have poor breast tone (i.e. you don’t have much tissue to cover your implants), you may want to consider silicone gel.
With offices in Plano and Flower Mound, our cosmetic surgery and plastic surgery services are also convenient to Las Colinas, Lewisville, and Highland Village.
Click here to watch a video about breast augmentation and a patient’s experience with the procedure.
For more information about breast implants, please visit our webiste.
More about breast implant safety considerations in the next blog…
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Home | No Comments »
