Beauty and The Breast - and my Silicone Implant Position

Beauty and The Breast blogged on my Silicone Implant Position Post. They placed a picture of a Saline-filled implant explantation specimen with what appeared to be thick capsules seemingly to say "see this happens with saline implants too." The capsule pictures they showed were kinda low resolution but did not seem to have calcium deposits.

Maybe I need to clarify this a bit. The process of capsular contracture happens with all foreign bodies placed into the body. The body makes a capsule with all breast implants silicone and saline. The question when such a device is placed is not whether it will occur but how can we make it occur to the least extent.

Things that can make capsules worse (generally thicker) include:

(1) Bleeding and/or Trauma

(2) Smoking

(3) Poor or Thin Soft Tissue Coverage

(4) Infection

(5) Radiation therapy

and arguably Silicone Gel.

Now why the Silicone Gel:

First by "Gel" we mean the stuff in the implant container or "shell." The hard silicone gel "shell" that holds the contents of all breast implants is the same as the cover of other implants such as pacemakers etc. This alone has never been shown to be associated with thick capsules without one of the other things we mentioned above going on as well. When those capsules get thick, they rarely get calcified. This is relative to the "shell's" solid silicone alone.

Silicone Gel is a non-biological filler put in the "shell" in Silicone Gel implants. It unfortunately does not stay in its container well. When you put Silicone Gel into the "shell," we find that it weeps right through this "shell" in a process called Silicone Gel "bleed." This is not the same with Saline-filled and Silicone Gel implants.

It is my belief that this added gel bleed contributes not only to thick capsules, but to the development of calcium deposits that make silicone gel implant capsules harder than any Saline-filled implant capsule. Those are the "glistening white shards" you see in the video from my previous post. So you can get thick capsules with any implant if other things happen, but the calcium deposition seems to be much more of a problem when you add the Silicone Gel. And this makes really hard; uncomfortably hard capsules.

The problem with these observations is that some women have had both Saline-filled and Silicone Gel implants. You never really get all the gel out of there when you remove a pair of implants. The gel as we mentioned weeps into the breast tissue as well. You get most of it out by removing the capsules with the implant. So there are cases of women who have had both types of implants having capsules. It kinda blurs the margin between the two when you are trying to keep track.

I appreciate the gals at Beauty and The Breast posting on this as it showed me that further discussion was needed. Again I am not saying Silicone Gel implants are "bad" and Saline-filled implants are "good." I am saying that the severity of the local tissue reactions that develop with breast implants tend to be less over time with Saline-filled rather than Silicone Gel implants. This has been the summation of my experience working with them over the last 13 years. When a woman chooses to have breast implants she has to make a choice. This choice has something to do with risk tolerance. If women choose Silicone knowing this, that is of course their choice. I am mostly a Saline-filled breast implant surgeon although I do place some Silicone Gel implants as well.




Best Regards,

John Di Saia MD

Post Remark of the Day - Audrina Patridge's Fake Breasts

Derek Hail Post
Hollywood Tuna Post
DrunkenStepfather Post


Derek Hail posts: "Audrina’s fake boobs are awesome." Hollywood Tuna and DrunkenStepfather are similarly dazzled.

They do look good because she didn't go huge on her small frame and she knows that they get her blog exposure time. She's playing them like a violin. Nothing like ROI.



Best Regards,

John Di Saia MD

OC Register Blogs on Breast Implant Safety

OC Register Blog

OC Register's Cosmetic blog opens the hot discussion of breast implants and toxicity.

Despite their critics, breast implants are like cell phones — embraced by enthusiastic consumers who are willing to overlook the problems they cause.

Apparently Dr Michael Zenn, a plastic surgeon at Duke, entered the fray on the NY Times blog recently:


Today’s breast implant options are saline or silicone. Saline implants are a silicone shell filled with salt water, silicone implants are a silicone shell filled with cohesive gel. Both implants are equally safe, both have the same safety profile.

The Institute of Medicine found that much of the concerns were hoopla — except for the problems that they both have: rupture, scarring, and infection. Most plastic surgeons and patients will tell you silicone just feels better. Implants are replaced when one of the above problems occurs — about 35 percent will have something fixed after 5 years.

While most of his other comments on the blog seem OK to me, it is on silicone gel that we disagree. It is a matter of focus:

What does "Safe" mean?

I do not believe that silicone gel is dangerous per se, but local tissue reactions to silicone gel implants are not the same as with their saline counterparts. I have produced a few short videos to show what happens inside some patients with silicone gel implants over time. We just do not know to what extent this may happen with newer generation silicone gel implants. It has not in my experience happened to the same extent with saline-filled implants. Patients need to make a choice when they choose breast implants. The choice is really deciding on a level of comfort with silicone gel. It is the reason that in my practice many patients still choose saline.


Best Regards,

John Di Saia MD

Jamie Lee Curtis - Plastic Surgery Drug Abuse?

OC Register Blog

OC Register's Cosmetic blog reports on a few Jamie Lee Curtis interviews. I have always liked her demeanor before. She never seemed to be in the "plastic surgery did this to me" crowd. I can't quite figure out where she's coming from in this piece though:

“I attempted various types of plastic surgery, minutely but enough to stave off this encroaching middle-aged body. And every time I did, something went wrong. I felt misshapen, just not natural any more. It was a big stimulator of my drug abuse."

It sounds like she wasn't the greatest candidate for plastic surgery in the first place as it sounds like external influences drove her to it. And she may have had a poor surgical experience, but every time? Drug abuse is not very common in my practice at least. Did she have any drug problems beforehand? Her impression of her surgical results sounds kinda like Body Dysmorphism. There is a lot going on here.



Best Regards,

John Di Saia MD

Liposuction - Is It For You? - YouTube Video

I made this little video with some thoughts for the patient considering liposuction.





Best Regards,

John Di Saia MD

Travel Tourism For Breast Implants - The Price You Pay

As many of you know I host a forum at MakeMeHeal upon which I address questions. Sometimes people need more than can be offered via the internet alone. Here is such a case:

The Question:


Hi There,
I had my BA in Oct 2007, My left breast swelled up 2 days after surgery so I had to go back and have my implant taken out and put back in, I was not told why this was. The surgeon then checked it 3 days later and everything was fine. [Ed - This was probably a hematoma.] BUT I am now noticing that my left breast at the top seems firmer then the right - abit like a ridge??
It is not painful and I am not unwell from it. BUT I am concerned maybe its CC? or does it look a strange shape because my Nipples are so saggy? I am looking into a Nipple lift but am worried sick about my breasts. I had my surgery in Belgium and its proving Impossible to talk to them. My GP is now closed until Monday and A&E are unable to help me...

My Answer:

Hello,

You went out of your country to have your breasts operated. Now you ask a surgeon in a third country to help you sort out what's going on. You need someone to examine you in order to properly address your concern.

Without seeming cruel, your case exemplifies the leading problems with surgical tourism. You had an operation by a surgeon you couldn't have possibly been able to validate who is now AWOL now that you need assistance. This is the price you pay to get it cheaper in that other country. I do hope you are able to get things properly evaluated but using the internet alone is really inadequate for you at this stage.


Best Regards,

John Di Saia MD

Victoria Secret Lawsuit

Having filled a fair amount of lingerie in my cosmetic practice and even made a few enlarged Labiae more "thong-ready," I find this lawsuit laughable. Frivolous lawsuits are everywhere folks and they cost everyone money.




Best Regards,

John Di Saia MD

Charity Hodges - Over the muscle "Fake" Breast Implant Job

Images


Breast implant results vary with technique and unfortunately people don't know the difference usually. Her images show some "Over the muscle" implants with "cavernous cleavage" typical for that placement. I prefer to put them under the Pectoral muscles, but some women like the "fake look" you get with "Overs" like Charity seems to have.

Best Regards,

John Di Saia MD

Bernadette Peters - Plastic Surgery?

Bernadette Peters looks pretty good for 60. On TMZ, the question posed is "Good Genes or Good Docs?"

TMZ Images

It is likely a bit of both. I'd bet she was not a big smoker and likely employed some good or better surgical talent.






Best Regards,

John Di Saia MD

Plastic Surgery Knowledge Dangerous for Hollywood?

Apparently Janine Turner became angered when a post on AwfulPlasticSurgery.com claimed she had had plastic surgery. The post likely pointed at perceived flaws in surgery the blogger claimed she had had. A letter from Janine Turner's lawyer to that site claimed:

"Ms. Turner has never had plastic surgery, so the statements published on your website are false. These statements are injurious to Ms. Turner’s reputation in her profession, and therefore your publication of them counts as libel per se. Since there appears to be no attempt on your part to verify the truth of the defamatory statements, they were obviously published with a reckless disregard for the truth."

Awful Plastic Surgery Post

The image of a lawyer marching to a banner touting that someone had "reckless disregard for the truth" makes me laugh quite a bit. Many lawyers twist the truth in a pretzel-like fashion daily in the name of service to their clients. I don't know if Ms Turner had surgery or not to tell you the truth.

The issue however brings the question of whether or not public knowledge of plastic surgery by itself is damaging to someone's reputation particularly that of a celebrity. If it's "good" plastic surgery, is this still the case? Quite honestly until this post, I really had little idea who Janine Turner was. At least in my case, this post increased my awareness of her.

Best Regards,

John Di Saia MD

Unsatisfied Patient After Plastic Surgery - Forum Question

A recent question from my MMH forum tells of a woman unhappy with her plastic surgery after weight loss:


The Question:

Hi there! I am 3 weeks PO today and am still seeing loose skin at the top of my abdomen (more on the right side vs. the left side, but definitely enough to grab from each side) I had a TT with MR, breast lift with implants and arm lift with lipo 3 wks ago. I saw my PS on Monday (and was released from all of my garments: abdominal binder, ace wraps for my arms and surgical bra) and he said that he wants to wait at least another month to see how my skin settles. Needless to say that I am just feeling very discouraged. I lost 100 lbs and wanted to see the body that was under all of that skin, but think he could've taken more skin than he did because I am still not happy because I still see loose skin.


An Answer:


Hello,

You can't really expect a surgeon who has never seen you to magically know what happened in your case knowing so little of what happened to you medically. Let me take a shot anyway. You sound like an extreme weight loss patient who had plastic surgery following that weight loss. You had a lot of surgery in one sitting from the sounds of things.

What people don't understand about plastic surgeons is much of what we do really has more to do with our philosophy than anything else. My philosophy is to do one large scale operation at a time starting with an extended tummy tuck or lower body lift on an extreme weight loss patient. I find that when surgeons do less patients tend to be unimpressed with the results. My way is more expensive and takes more operations to get things done but my results are better. Then again extreme weight loss patients frequently see “loosening” of their results. Revisions in this patient group are not uncommon.

Other surgeons do multiple procedures in one sitting and don't extend them as much. It is the only way to get through longer operations in less time. This is less expensive and gets things done faster.

At this point you need to have along "sit down" with your surgeon to figure what to do from here.


Best Regards,

John Di Saia, MD

Alicia Douvall and Implant Breasts

Drunken Stepfather Post

Alicia Douvall is a former UK Glamour girl and reality television star who has admitted to several breast implant operations by report.

My frequent source for images and mayhem DrunkenStepfather has a post on her with her frequently flashed breasts. For having been done several times, they really don't look that bad. A tell tale "stand up straight with reclining" is shown amongst the pics. This is especially prominent with silicone gel implants or multiple implant cases in which significant contracture is present.



Best Regards,

John Di Saia MD

Dr D's Labiaplasty Interview Segment 060308

I did an interview with Angela Segal on LATalkRadio last week. The topics included Labiaplasty. Below is an excerpt of that segment in Mp3 format. The entire interview is online at the LaTalkRadio site as well.

Special thanks to Angel for allowing me to share this with you:

FileFactory.com

Backup download:
AFileHosting






Best Regards,

John Di Saia MD

A Botox Boobjob?

NBC News


"It's so new that the doctor said he doesn't have any before and after pictures yet. But he has plenty of women who work in his office lined-up, ready to be guinea pigs.

Nurse Maureen Councillor, of Merchantville, doesn't want surgery but hopes the shots will make her look better in clothes."

Botox injections are being given by this doctor to make people "straighten up." In my opinion, these people are very likely "guinea pigs." How a paralytic is going to lift anything is beyond me. Be careful here folks.


Best Regards,

John Di Saia MD

A Plastic Surgeon in an Electric Car? - Maybe

With gasoline over $4 a gallon, the utility of electric cars is becoming more clear. In the not too distant future, I may be the only plastic surgeon driving one. I like the idea of "no gas" from a number of standpoints.

Trying to find one that looks OK may be difficult, but I am on the lookout:

The Tesla probably looks the best, but I am not spending $100K.

Then again I don't want a "geek mobile" either.

The Aptera might be a good bet, but they have been pretty quiet lately. Hopefully they aren't about to be bought off by "Big Oil" or one of the "Dinosaur Car" makers.

Best Regards,

John Di Saia MD

Douche Bag of The Week - Spencer Pratt

This guy could be the stand in for this illustrious Weekly Post without a doubt:

TMZ



Best Regards,

John Di Saia MD

Men vs Women on Breast Implants and Botox

OC Register Blog


Women don't believe men when they say they don't like augmented breasts and botox'd faces? Say it ain't so.


Best Regards,

John Di Saia MD

Xtina Breast Implant Change With Pregnancy

Image Source


Breast implant results can change with pregnancy and these changes are sometimes better seen in tight tops. So here we have Xtina showing this for us. The way to limit this potential problem is to place smaller implants in the first place although this is obviously not a popular option. A lift operation at this point can also help things by taking in the slack of the stretched out skin - stretched out once by the surgery and again by the pregnancy that followed.


Best Regards,

John Di Saia MD

Donde West Death Fallout

TMZ

"Yolanda Anderson, niece of Donda and cousin of Kanye, along with Calif. Assemblywoman Wilmer Amina Carter, introduced a bill into the Cali legislature that would require patients to receive a physical exam before plastic surgery."

That's great, but it is already the Standard of Care for cases involving a general anesthetic at least. If she was not examined before surgery, her surgeon could already be held below that standard. Our legal system is less than consistent. This is part of the problem.


Best Regards,

John Di Saia MD