The IDEAL Structured Breast IMPLANT®

ideal-implant

 

The IDEAL Structured Breast IMPLANT® is essentially a structured double-lumen saline implant similar to a balloon within a balloon, complete with an inner and outer shell that not only supports the shape but also gives the implant a more natural feel. Depending on the size of the implants, in the outer lumens are one to three baffle shells, which float within the saline of the outer lumen to make the saline feel more viscous similar to silicone. The internal structure of IDEAL Structured Breast IMPLANT also controls the sloshing movement of the saline solution, making it feel less like water and behave more like natural breasts would.

Am I A Candidate for IDEAL Structured Breast IMPLANT®

IDEAL Structured Breast IMPLANT BafflesAn IDEAL Structured Breast IMPLANT® candidate is someone who likes the natural feel of silicone implants but also wants the benefits and peace of mind of a saline implant. The candidate should be over the age of 18 but not currently pregnant, breastfeeding, or with an active infection anywhere within the body. Patients with existing cancer or pre-cancer who have not received adequate treatment, as well as patients with bleeding disorders or poor overall health, may not be good candidates for the implants. Candidates for breast implants have a choice of 3 main incision sites which are underneath the fold of the breast, through the areola, or the armpit. The insertion site for the IDEAL Structured Breast IMPLANT® can be made in any of these places.

Recovery and Downtime of the IDEAL Structured Breast IMPLANT®

The recovery after having an IDEAL Structured Breast IMPLANT® breast augmentation is comparable to traditional breast implant surgeries. The patient will be sore but is expected to be ambulatory and maintain some arm movement throughout the day to help reduce complications. There will also be a potential for bruising and some swelling after the implant procedure. The downtime really depends on the work and other related activities of the patient. A patient who has a physically demanding job may need four to six weeks off after the procedure but a patient who sits at a desk might only need less than a week off from work. Patients should not do any heavy lifting or physical exercise until they are cleared to do so by their doctor.

Results of IDEAL Structured Breast IMPLANT®

The IDEAL Structured Breast IMPLANT® has a 5.7% five year capsular contracture rate which is lower than traditional saline or silicone implants. A 5-year clinical test was conducted to determine the effectiveness of IDEAL Structured Breast IMPLANT. The test results showed that Ideal had a lower rate of infection, deflation and wrinkling compared to traditional saline or silicone implants. In general, a woman with breast implants will likely have an improved look over a person without breast implants. When breast tissue is stretched or sagging due to aging or pregnancy, the breast loses some volume on top. An implant maintains the volume on top which can be a plus for a woman after pregnancy.

IDEAL Breast Implant

Limitations and Risks of IDEAL Structured Breast IMPLANT®

Because traditional saline implants have only one lumen, it can be rolled up like a cigar and then placed through a tunnel starting from an incision in the belly button and filled with saline once inside the breast. The IDEAL Structured Breast IMPLANT® procedure is limited in that respect because it has two lumens and small baffle shells. However; The incision is slightly smaller and hence less scarring than the silicone gel implant since it can be filled inside of the body rather than outside like silicone implants. As the IDEAL Structured Breast IMPLANT® has only been recently released for general use by the FDA, they are limited in some of the very small and very large size selections for the moment, but the most common sizes are readily available. The manufacturer is currently working on producing a wider array of implant sizes once the demand is sufficient.

The IDEAL Structured Breast IMPLANT is subject to the same risks as standard saline implants. The implant could rupture but since it is saline, the body will safely absorb it just like drinking a glass of water. If a silicone implant ruptures, the patient usually cannot see or feel a difference. With the IDEAL Structured Breast IMPLANT®, there are no expensive tests to check for leaks since a patient can see the deflation immediately in a mirror. With any ruptured implant, the patient will need a follow-up procedure in order to replace the damaged implant. There is a warranty against rupture by the manufacturer that covers this problem.

Although the rate of capsular contracture is lower with this type of implant, it is still a risk. The scar tissue can build up and press against the implant causing it to become firm, too high, and even cause discomfort while the capsule pushes the implant upwards on the chest wall.

Available to Trained Professionals Only

At a safeguard to patients, the IDEAL Structured Breast IMPLANT® is only sold to board-certified or board-eligible plastic surgeons certified by the American Board of Plastic Surgery. A patient looking to have this procedure done can be assured that their surgeon has been properly trained to perform the procedure. Limiting the distribution of IDEAL Structured Breast IMPLANT® to knowledgeable and well trained surgeons is an effort to minimize the risk of botched implants and complications.

The IDEAL Structured Breast IMPLANT® is subject to the same risks as standard saline implants. The implant could rupture but since it is saline, the body can safely absorb it just like drinking a glass of water. If a silicone implant ruptures, the patient usually cannot see or feel a difference. With the IDEAL Structured Breast IMPLANT®, there are no expensive tests to check for leaks since a patient can see the deflation immediately in a mirror. With any ruptured implant, the patient will need a follow-up procedure in order to replace the damaged implant. There is a warranty against rupture by the manufacturer that covers this problem.

Although the rate of capsular contracture is lower with this type of implant, it is still a risk. The scar tissue can build up and press against the implant causing discomfort while pushing the implant upwards on the chest wall.

Available to Trained Professionals Only

Dr. Larry Nichter
Dr. Larry Nichter

At a safeguard to patients, the IDEAL Structured Breast IMPLANT® is only sold to board-certified or board-eligible plastic surgeons. A patient looking to have this procedure done can be assured that their surgeon has been properly trained to perform the procedure. Limiting the distribution of IDEAL Structured Breast IMPLANT® to knowledgeable surgeons is an effort to minimize the risk of botched implants and complications.

Written by Cosmetic Town Editorial Team – SP
Based on an exclusive interview with Larry Nichter, MD in Newport Beach, CA

Breast Reduction: Determining Optimal Amount/Weight to Remove

Dr. Larry Nichter
Dr. Larry Nichter

Breast Reduction is a complicated procedure that is best done by those with the most training and experience. It is very difficult to determine the resultant cup size and shape based solely on the number of grams that are removed from your breast to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast reduction and lift surgeries, including different approaches, techniques and even fat transfer and implant choices if you are lacking superior breast fullness.

This is because several measurements—not to mention breast characteristics such as density—are needed to determine how much and where to remove breast tissue to meet your goals. Without knowing your existing breast shape, dimensions, and the density of your breast tissue, it would be difficult to make this determination. For example, the same volume of breast tissue will weigh different amounts (measured in ounces or grams) in different people depending on its density. The existing base width of your breast and what you will ultimately want to look like will determine, in many cases, the maximal volume and weight that will need to be removed for the best result.

To illustrate: removing 300 grams of breast tissue may make a significant difference in cup sizes (e.g. 2–3 cup sizes) with a narrow base width breast, but much less of a difference (e.g. Perhaps 0.5–1 cup size less) if you have a wide chest wall and wide breast “foot print”. Your friend may have a great result from removing 500 grams of breast tissue to make her go from a “DDD” cup to a “C” cup size, but this does not mean that you will have the same result with the same weight of breast tissue removed.

To make matters even more complicated, different bra manufacturers have different cup size labels for the same breast size. Computer software morphing programs that automatically determine what you may look like after a breast reduction can be helpful in some but not all cases (e.g. doesn’t work well in my experience with sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to your surgeon in advance for preoperative discussion.

Personally, I have found it most helpful for patients to bring in photos from my or other plastic surgeons’ websites to illustrate what they would like to look like. This gives me detailed standardized views and information both qualitative (shape, perkiness) and quantitative (size) and allows me to discuss with my patients how I can best achieve their objectives as well as realistic expectations. For example, though I always tell my patients that I cannot make them exactly the same as a photo because everyone has different anatomical constraints, your “ideal” breast photos are brought to the operating room for reference during surgery so that I have the advantage of “seeing through my patient’s eyes” to best achieve their wishes. Even if the photo does not match their height or weight, I and most plastic surgeons are very good at translating the proportionality of the photo to your features and will try our best to match your goals. For assistance in finding the best Breast Reduction plastic surgeon see this article:

Picking the Best Plastic Surgeon: Finding Dr. Right

Breast Implant Rippling and Strategies for Correction

Dr. Larry Nichter
Dr. Larry Nichter

Breast Implant Rippling most often occurs when there is insufficient soft tissue coverage due to little overlying body fat and breast tissue. Implants placed beneath the muscle help to minimize this phenomena but the lower and outside breast (as pectoralis muscle is no longer present), towards the cleavage where the muscle thins out or on top of the breast where breast tissue is often lacking are the most common places to see rippling. It is often accentuated with certain positions (e.g. bending over,or leaning). Most of the time, rippling is felt along the outer side of the breast and the inner side of the breast next to the cleavage. Breast implant waviness (rippling) that is felt but not noticeable to the eye is very common and should not be a concern. However, when rippling is visible, patients are often self-conscious about their appearance.

Factors that are associated with increased rippling include:

  • Traditional Saline implants (IDEAL® Saline implants less likely)
  • Textured implants
  • Large implants
  • Thin patients with low BMI
  • Implants placed above the muscle
  • Prior history of rippling

Factors which are less likely to have rippling include:

  • Heavier and larger breasted women
  • Using a highly cohesive form-stabile silicone implants (gummy bear)
  • Smooth implants
  • Smaller implants
  • Submuscular placement

Once rippling occurs it is very difficult to correct. Rippling can be minimized by placing a biologic fabrics (e.g. AlloDerm®, Strattice™, SERI®), submuscular conversion if implants are above the muscle, fat transfer, use of adjacent tissue (muscle or fascia) if available, and in persistent cases implant removal and fat transfer. Seek the care of the best board certified plastic surgeon possible with experience in breast revision surgery.

Best Mommy Makeover Options

Dr. Larry Nichter
Dr. Larry Nichter

For women, having a child life-changing event. The capability to create, foster, and give birth to a child of your own distinguishes women in the human species. The nine-month transformation from a tiny embryo to a human being in itself is a magical event, but it transforms the mother’s body as well, often in a non-favorable direction. A mother goes through many different changes during pregnancy and the birth process. In many cases, areas of a woman’s body may not return to the same shape prior to pregnancy.

Thanks to current medical procedures, mothers are often able to restore their bodies back to their pre-birth shape or even better. After breast feeding is complete and you have fully recovered from pregnancy, there are various steps that can be taken to get your body back into shape. In what is commonly known as the Mommy Makeover — various procedures such as breast augmentation, breast lifts, liposuction, tummy tucks, fat transfer, and other procedures — can be done to get your body back into top condition. Most of these procedures can be done in combination to complete your makeover or can be done in separate steps.

Breasts

In most cases after childbirth, women often find that their breasts become out of shape due to breast-feeding or growth then shrinkage after pregnancy. The breast often loses volume on the top and sags and becomes less firm and out of shape (post-partum involution). This can produce visual changes that women want to fix and improve. With straightforward procedures, breasts can be transformed to the desired state with a variety of techniques including breast augmentation using fat transfer (called California Breast Lift in my practice) or implants with or without a lift. These procedures can give your breasts a natural look and maintain volume that was present prior to pregnancy. Some surveys have stated that up to 90% of patients have found success with these procedures, with remarkable results and happiness.

After breastfeeding and childbirth, mothers often find that excess skin results or the skin around the breasts is loose resulting in sagging. In these cases, a breast lift can also be done to reshape the skin envelope and uplift the areola/nipple position. By itself, this procedure isn’t done to change the size of the breasts, but is done more to affect the contour and firm up the breast skin and underlying breast tissue. Newer, minimal scar breast lift techniques, can affect the breast size if combined with a breast augmentation or reduction procedure to enhance the shape, size, and position of the breasts.

Tummy and Hips

Following pregnancy, women often find that the tummy and hip areas are the main concerns for improvement following delivery. After giving birth, women often try to return to their pre-baby weight and find that even if they lose those pregnancy pounds, that they cannot get their tummies back into the desired shape. A tummy tuck with or without liposuction can be performed in this case to remove excess skin, fat, and tone up your tummy muscles. This tried-and-true procedure in the hands of an experienced plastic surgeon will result in a firmer and smoother stomach. Weakened, stretched, and separated muscles (Diastasis Recti) are reshaped during this procedure and will transform your abdominal wall into a well-toned tummy. Giving birth can result in your abdominal skin and muscles being stretched out of shape. A tummy tuck will reshape it back into its toned natural shape, sometimes even better than before you were pregnant. Liposuction is often done at the same time and the fat removed can be used by transferring it to areas that may have lose volume such as your buttocks (Brazilian Butt Lift) or breasts.

Skin

Most women following pregnancy will get stretch marks but this doesn’t mean you can’t do anything about them. Stretch marks, also called striae, can also occur as a result of pregnancy. The tummy tuck not only reshapes the stomach muscles and skin, but also removes these a large number of stretch marks below the belly button. Certain lasers are also available that can get rid of the redness and shrink the width of stretch marks while improving the texture of your skin. Spider veins or red spots (angiomas) following childbirth can vanish seemingly instantly with special lasers and without downtime afterwards. Prominent superficial veins in the legs and other areas also can occur after having a baby. These can be treated in the office with lasers and injections (sclerotherapy).

Skin tone and texture can also be improved. For example, Cellulite and skin wrinkling can be tightened noninvasively. Likewise, circumferential reduction of the waist and thighs with a series of non painful, non-invasive treatments combining the energy sources of RF (radiofrequency), IR (infrared) aimed at improving the skin and superficial fat (e.g. Velashape III).

Fat

After pregnancy and with age, fat can accumulate in different areas that are resistant to diet and exercise. In concert with the Velashape® treatments, Liposuction or other non-invasive non-surgical fat reduction procedures are often helpful. Whether it’s the tummy, hips, thighs, back, or upper arms, liposuction can get rid of the excess fat collection that occurs after pregnancy. By getting rid of these excess bulges along with a sensible diet and exercise plan, you can get your body back into top shape. Other non-invasive techniques such as CoolSculpt® and newer techniques such as Ultrashape®, and Vanquish® are all possibilities for non-surgical fat reduction. As all techniques work differently make sure you go to an expert plastic surgeon to decide which is best for you. These techniques reshape your skin and body towards to your desired shape and best of all there is no down time and minimal if any discomfort. With regular core exercises, you are well on your way to an “abs of steel six-pack”. Exercise maintenance and a stable weight should give you a life-long result.

Belly Button

Another part of the body that might be affected post pregnancy is the belly button, also called umbilicus. The pregnancy cycle can stretch or distort the belly button area. The tummy tuck can assist with making your belly button smaller, however if this is your only concern, improving your belly button’s appearance via a procedure known as umbilicoplasty is possible. An umbilical hernia usually recognized by an “outie belly button” can also be repaired at the same time and often performed under local anesthesia as an office procedure.

Vaginal and Labial Rejuvenation

Especially following vaginal delivery, and important to femininity and intimacy, sometimes the vaginal area is stretched out and loses optimal tone. This can be corrected with a vaginoplasty to firm up and increase tone to the vaginal canal, giving increased intimate sexual satisfaction to the woman and her mate. Likewise, the labia minora (inner lips) might be overly large as a result of pregnancy or genetics. Labia reduction is corrected with a procedure called labiaplasty. The mons pubis, hair bearing area, often becomes bulky, sags, and shows through clothes following pregnancy. This can be corrected with a “monsplasty” procedure. These procedures are often performed as an outpatient procedure, often at the same time as other mommy-makeover procedures.

Skin Pigmentation

Lastly, persistent darkened skin pigment changes may occur on your face, also called Chloasma or Melasma (“mask of pregnancy”). Tailored medical grade lightening creams, peels, and lasers can be done to help with the discoloration that can occur following pregnancy in the facial and other areas.

Conclusion

All of these mommy makeover procedures and others are done in an effort to regain your ideal image, shape and composure following pregnancy. Just because you’ve had a baby, this doesn’t mean your body should be neglected. You can choose from a combination of procedures to get your body back into shape, firmer, and smoother following pregnancy. As always, consult an experienced board certified plastic surgeon before any procedure, discuss treatment options, as well as recovery time, risks, and possible non-surgical alternatives to surgery. Where the gift of lift is a wonderful thing, a mommy makeover can be the best gift you give yourself after pregnancy.

Capsular Contracture: Prevention and Treatment

Dr. Larry Nichter
Dr. Larry Nichter

Although capsular contractures following breast augmentation can occur just about any time, most women start having symptoms around three months after their breast implant surgery. This is because it takes some time for a capsule to form and then to scar down (contracture).

Capsular Contracture is a condition in which the capsule surrounding the implant thickens and contracts, squeezing the implant making it overly firm or hard and often changing the shape and position of the implant. As the capsule contracts it moves the implant further up your chest wall making upper portion of your breast too large and unshapely. It is more far more common in nicotine users (e.g. smoking, vaping or nicotine gum or patches).

Treatment for capsular contracture often involves en bloc capsulectomy, complete removal of the capsule, or making the pocket larger by capsular incisions (capsulotomy) with implant replacement. Recent studies suggest that using the same implant may increase the chance of recurrence. Placement of the implant in an new pocket is also often done as well as using textured implants. In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used but has been associated with implant rupture and other complications and few surgeons use this technique any more not to mention that your warranty will be void. On occasion, the use of a biological fabric like Strattice or Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9–11%, in my practice it is significantly lower after the primary implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. Capsular contractures are lower with non-smokers, and with use of textured silicone implants placed below the muscle. The location of the incision also plays a role. Inframammary incision also has the lowest and periareolar and axillary (arm pit) incisions have the highest capsular contracture rate. Smoking/nicotine use greatly increases your risk for capsular contracture greater than 10 times the incidence of a non nicotine user.

Non-surgical management includes prophylactic massage to prevent it and if it occurs, the use of certain anti-asthma medications: Singulair and sometimes Acculate as off-label FDA usage to treat Capsular Contracture and in some cases of recurrence of capsular contracture in a preventative fashion. In my experience this works best for early diagnosed early contractures and used as a prophylactic, perioperatively when doing a capsular contracture surgery. The price for capsular contracture surgery varies greatly by geographical location, experience of the surgeon, whether in an outpatient surgery center vs hospital (hospital more expensive), type of breast implant, whether it is ruptured or not, estimated length of operating room time, and other factors.

‘Bottoming Out’ and Lateral Displacement of Breast Implants Explained

Dr. Larry Nichter
Dr. Larry Nichter

Cause: Large Implants due to their weight, gravity, thinning of tissues, chronically not wearing a bra, loss of elasticity and other factors may cause continued stretching so that your breast implant is no longer supported in its ideal position. This results in the progressive lowering of the inferior breast crease (inframammary fold). When the implant moves South to an undesired inferior position it results in the loss of volume and flattening of the upper pole of the breast, too much volume at the lower pole, increasing the distance from the fold to the nipple and finally the nipple position being abnormally high ( pointing up) and not centered. Similarly, the pocket can also stretch to the side (lateral) so that when lying down your implants fall towards your arm pits or sides, causing the “Side Boobs” appearance.

Bottoming out and Side Boobs Contributing Factors:

  1. Larger/Heavier Implants
  2. Implants placed above the pectoralis muscle
  3. Chronically not wearing a bra when upright
  4. Over dissection of the Implant Pocket
  5. Smooth Implants
  6. Large swings of weight including pregnancy
  7. Skin and soft tissue laxity, loss of elasticity

Repair: Surgery is the only effective remedy. Revision surgery is almost always more complex than breast augmentation. Correction techniques vary based on your plastic surgeon’s experience and skill sets. Always choose a board certified plastic surgeon with expensive revision experience as even in the best of hands recurrence is frequent especially if larger implants are used. Repair techniques include some of the following techniques and recommendations:

  1. Textured implants (“Velcro effect”)
  2. Use of Smaller Implants
  3. Maximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)
  4. Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)
  5. Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.
  6. Change of position of implant to a new pocket location “neo pectoral pocket”
  7. Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)
  8. Removal of Implants and replacement of volume using your own fat (Fat Transfer).

The procedure is performed under general anesthesia on an outpatient basis most often using an existing scar or making an incision beneath the breast. Recovery is similar to your original breast augmentation procedure. Use of taping after surgery and prolonged use of a support bra is often recommended. It is far more important to pick the best plastic surgeon rather than trying to pick the best procedure as they are in the best position to guide you to the right decision. See this article for help in selecting the best breast revision specialist.

Breast Augmentation (Mammoplasty)

Overview

Dr. Larry Nichter
Dr. Larry Nichter

Many women who would like to restore or enhance the size and shape of their breasts may benefit from breast augmentation, also known as mammoplasty. It is one of the most common procedures performed annually by members of the American Society for Aesthetic Plastic Surgery. Breast augmentation is performed to enhance the breast size and shape due to lack of development, congenital abnormalities, changes or asymmetries following aging, weight loss, and/or pregnancy. In addition, there may be personal reasons for augmentation mammoplasty. For example, some women may perceive their breasts to be underdeveloped and not proportional to their body size and image they wish to project. Women may also decide on breast augmentation, though they may be happy with their breasts, just because they would like them to be fuller. A positive impression of their body image is important to most women, and breast augmentation may aid in offering a more proportional breast size and shape as well as in improving self-confidence.

Would I be a good candidate for breast implants?

A variety of factors may indicate that you are a good candidate for breast augmentation. Some of these feelings and/or conditions include:

  • You feel bothered and/or have low self-esteem that your breasts are too small.
  • After giving birth, your breasts have become smaller and have lost their firmness.
  • You notice that clothes that fit well around your hips are too big at the bust line.
  • You feel self-conscious when wearing a bathing suit or other form-fitting apparel.
  • A weight loss/fluctuation or pregnancy has changed the shape and size of your breasts.
  • There is an asymmetry where one of your breasts is noticeable smaller than the other.

How does the procedure work?

Breast implant surgery is accomplished by surgically inserting either a silicone or saline implant (prostheses) behind each breast. The breast implants are placed either in front or behind the pectoralis major muscle and breast tissue. General guidelines suggest that women with larger drooping (ptosis) breasts that do not want a breast lift should have the implant placed above the muscle to prevent contour problems (double contour deformity). Those patients with minimal breast tissue usually have the implants placed beneath the pectoralis muscle for more soft tissue padding. In any case, your plastic surgeon will determine which placement is best for you and explain why. When you come in for a consultation, the different options will be explained in further detail as well as the three choices of implements currently available: silicone, standard saline, and IDEAL® double lumen saline implants (a new double lumen saline implant made to feel like silicone).

Is the procedure safe?

For the vast majority of patients undergoing breast augmentation, the procedure is extremely safe and involves minimal side effects. In my practice using board-certified anesthesiologists and FDA approved prostheses are always employed to ensure a successful surgery. A general anesthetic is used but a local anesthetic is also placed prior to awakening for postoperative pain relief. The implants, breast prostheses, are made of safe, non-reactive silicone material which have been studied by the FDA and worldwide, and used since the 1970’s. So much so, in fact, that they are the most studied medical device in the world. There is no link to date between silicone prostheses to other diseases like auto-immune disease, arthritis, cancer, or other connective tissue diseases. These problems occur to the same extent and at the same rate in women with breast augmentation as those who have not had the procedure. For instance, cancer occurs just as frequently in women with augmented breasts as it does in those with natural breasts.

What choices do I have with my breast augmentation?

Breast implants come in a variety of shapes, sizes, firmness and profiles in order to offer a custom-fit and natural-looking physique. It is also important to consider the substance and texture of an implant. The surface of round implants can be smooth or textured whereas shape implants are all textured to maintain their alignment. In particular, those implants approved by the U.S. Food and Drug Administration (FDA) are filled with silicone or saline. All implants at this time use cohesive silicone gel meaning that the gel maintains its shape like “gummy bear” candy or jello with more anti-leak properties unlike the gel prior to 2006 which was more like honey or molasses in consistency. These materials impact the feel and look of a breast implant, and thus are an important consideration in determining the desired appearance of your breasts.

For example, silicone is most popular world-wide as their feel and appearance most closely mimics the desired breast feel with less rippling. Standard saline implants have a higher rate of becoming hard (capsular contracture) and tend to exhibit more waviness or rippling if there is less breast or fat covering the implant. A newer breast FDA approved saline implant, IDEAL Implant^®^, is a double lumen “hybrid” implant that has the feel close to silicone, less risk of capsular contracture, and the peace of mind of saline; that is, if there is a leak, you can tell, just by looking in the mirror rather than requiring a MRI.

What results can I expect form breast augmentation?

According to studies, more than 90% of women are satisfied with the results of a breast augmentation. This is largely because the procedure often improves a woman’s self-esteem, not to mention quality of life. We aim to custom-tailor your breast augmentation based on your preferences for perkiness, firmness, shape, and size. Our goal is to match the appropriate implant type with the right procedure so that patients with realistic expectations are completely satisfied.

Breast augmentation will enhance the shape of your breasts as well as make them fuller. You may find yourself more comfortable wearing different types of clothing and may enjoy a boost in self-confidence, as is the case with most of my patients.

Usually, you can expect your breast augmentation surgery to have long-lasting effects, unless implant deflation requires surgical replacement with a new implant. Nonetheless, the effects of aging and gravity will eventually alter the shape and size of a woman’s breasts over time. As a result, you may later elect to undergo a breast “lifting” to restore the more youthful shape, size, and firmness. A breast lift of course can be performed at the same time as a breast augmentation or implant exchange.

Prospective patients should know that the final texture, shape, and appearance are not exactly the same as natural breasts. Many patients in fact prefer the firmness and slightly different contours than natural breasts. However, these differences may be more noticeable in some patients than others. The intended result of the procedure is to enhance the size and shape of the breasts to achieve the body image desired by the patient.

What are some considerations I should take into account when selecting a plastic surgeon?

The most popular way to improve breast size and shape is breast augmentation performed by experienced plastic surgeons. Generally speaking, seek out board-certified plastic surgeons by the American Board of Plastic Surgery with a great deal of experience and good reviews for best results. Those plastic surgeons that have specialized in breast and reconstructive surgery including breast revision surgery, such as the surgeons at Pacific Center for Plastic Surgery, are a great fit for your breast augmentation needs.

Larry S. Nichter, MD, MS, FACS

Dr. Larry Nichter featured in Time Magazine’s Article “Nip. Tuck. Or Else.”

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Hitting newsstands today and Monday is an interesting article featuring Dr. Nichter and his patient, written by Joel Stein for Time Magazine, discussing the evolution of cosmetic surgery and it’s undeniable relevance in today’s world. The article titled “Nip. Tuck. Or Else” points out how thanks in part to social media we are now on the red carpet 24/7 posting pictures of ourselves on Facebook, Instagram, SnapChat, Vine, and more, so it’s imperative to look our best at all times. The social media frenzy is one reason why there has been a spike in the number of non-invasive procedures performed on the younger demographic.  It can certainly be said that no longer are cosmetic procedures just for the aging population.

Here is the full article – Nip. Tuck. Or Else.”

by Joel Stein 

Time Magazine Plastic Surgery Shoot You’re going to have to do it. And not all that long from now. Probably not a full-on, general-anesthesia bone shaving or muscle slicing.

But almost definitely some injections into your face. Very likely a session of fat melting in some areas and then possibly moving it to some other parts that could use plumping. Not because you hate yourself, fear aging or are vain. You’re going to get a cosmetic procedure for the same reason you wear makeup: because every other woman is.

No, it’s not fair that–in 2015, with a woman leading the race for the Democratic nomination for President–in addition to dieting, coloring your hair, applying makeup and working out, you now have to let some doctor push syringes in your cheeks just to look presentable. It’s not fair that you have to put your surgery on your credit card just so the other moms on the playground don’t overestimate your age. It’s not fair that you may risk your life going under general anesthesia just to keep up.

Then again, maybe it’s not fair that some women are born straight-nosed and full-breasted. That some people don’t have trouble staying thin. That workers with above-average looks will make $230,000 more over their lifetime than people who are in the aesthetic bottom seventh, as a study by University of Texas economics professor Daniel Hamermesh found. Maybe it doesn’t feel fair that a man is writing about this, even if more and more males are starting to feel the same kind of pressure that women have dealt with for decades.

“It’s becoming harder and harder to say no without being read as irrational or crazy,” says Abigail Brooks, the director of women’s studies at Providence College, who recently completed research comparing women who undergo antiaging interventions and those whom she calls “natural agers.” The former group described the latter using phrases like “let herself go” and “not taking good care of herself.” Brooks worries that that pressure is not only exhausting but also keeps women forever 21 emotionally. Continue reading “Dr. Larry Nichter featured in Time Magazine’s Article “Nip. Tuck. Or Else.””

How to Best Determine the Optimal Breast Implant Size

Dr. Larry Nichter
Dr. Larry Nichter

It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in a bit.

Saline-filled Breast Implants
Image: FDA

Additional critical decisions will also be made by your plastic surgeon such as: whether your implants will be above or below your pectoralis muscle. These choices are recommended to you based on the look you desire, the amount of sagging you may have, and other deciding factors. For more than 25 years, I have tried just about every method to best understand and achieve the patient’s optimal goal. The following is what I have found to be most accurate: To start with, I have found it most helpful for patients to bring in photos from my or other plastic surgeons’ websites to illustrate what they would like to look like. This gives me detailed standardized views and information both qualitative (shape, perkiness) and qualitative (size) and allows me to discuss with my patients how I can best achieve their objectives as well as realistic expectations. For example, though I always tell my patients that I cannot make them exactly the same as a photo because everyone has different anatomical constraints. However, these ”ideal” breast photos are brought to the operating room for reference during surgery so that I have the advantage of “seeing through my patient’s eyes” to best achieve their wishes. Even if the photo does not match their height or weight, I and most plastic surgeons are very good at translating the proportionality of the photo to your features.

I personally order more than one set of implant sizes and use sterile implant “sizers” (temporary implants) placed in the created implant pocket during surgery to know in advance exactly which implant would work best for you in both a sitting and lying down position. This also allows me the opportunity to modify the pocket to meet some of the more subtle shape features desired. This enables me to use my full artistic potential to achieve your desired goals.

Larry S. Nichter, MD, MS, FACS

Fat Grafts to Face, Buttocks, Breast and Elsewhere

Dr. Larry Nichter
Dr. Larry Nichter

A person’s own fat may be used to improve the appearance of his or her body by moving it from an area of excess (or where it is less desired, such as the thighs, hips or abdomen) to an area that has lost tissue volume due to aging, trauma, surgery, certain diseases, birth defects, or other causes.

Ideal candidates are in good health, and have excess fat in some parts of the body and too little in other regions. Fat grafting is most often used for the face, breasts and buttocks. Typically, the transferred fat results in a significant increase in volume of the body site being treated.

Fat for lipoinjection, also called fat transfer, is removed from unwanted areas of the body by a narrow blunt tip surgical instrument with side holes, called a cannula, through a small incision. The fat is then cleaned with sterile saline solution before being restored to the body. The fat is then injected into the desired area using either a smaller cannula or needle, or it may be placed directly through an incision. Since some of the fat that is transferred does not remain over time, your surgeon may inject more than is ultimately needed to achieve the desired end result. Over a few weeks, the amount of transferred fat will decrease.

There is a limit of how much fat can be safely injected into one area. The amount of fat that remains over time is variable from patient to patient. For some patients, more fat or other fillers may need to be transferred in a subsequent surgery to maintain or supplement the desired results.

Fat transfer procedures are performed using a local anesthetic, with or without IV sedation or general anesthesia, depending on the extent of the procedure and recommendations of your surgeon.

Alternative Treatments

Alternative forms of nonsurgical and surgical volume management consist of injections of FDA-approved injectable fillers, or occasionally implants.

Fillers include hyaluronic acid “HA” (Restylane, Juvederm), polylactic acid (Sculptra), calcium hydroxyapatite (Radiesse) and other fillers, use of man-made implants or other surgical procedures that transfer vascularized fat from body tissues nearby (flaps).

In general, injectable off-the-shelf fillers and fat are used for smaller areas such as in the face, whereas only fat is used to inject into larger areas such as the buttocks due to the quantity required to make the desired change.

Specific Risks of Fat Transfer Procedures

Every procedure involves a certain amount of risk. When choosing to undergo a procedure, an individual must weigh its risks against its potential benefits. Although the majority of our patients do not experience these complications, you should discuss all of your concerns with your plastic surgeon.

Infection — Infection may occur after any surgery and may rarely occur after fat transfer. The rate of infection increases with the amount of injected fat, but the overall rate still remains very low due to routine use of sterile technique and prophylactic antibiotics. Complication rates are higher in smokers, those with diabetes, and with multiple procedures.

Excessive Bleeding — Although bruising after surgery is common and occasionally prolonged, excessive bleeding is unusual during or after surgery. Unapproved medications and supplements, or strenuous physical activity too soon after surgery, can increase the chance of bleeding and complications in general. It is important to follow your surgeon’s postoperative instructions.

Change in Appearance — Typically the transferred fat loses some of its volume over time and then becomes stable. It is possible that more fat transfer treatments may be needed to maintain the desired appearance. It is important to understand that more than one treatment may be needed for optimal results. Additional costs are associated with repeated treatments.

Firmness and Lumpiness — While most transferred fat results in a natural feel, it is possible that some or all of the fat may become firm, hard, or lumpy. If some of the fat does not survive the transfer, it may result in fat necrosis (death of transferred fat tissue), causing firmness and discomfort. Oil cysts may also form at the site of the transferred fat. Needle aspiration or surgery may be required to improve such conditions.

Fluid Accumulation (Seroma) — After fat grafting with or without implant placement, body fluids occasionally collect beneath the skin called a seroma which can delay wound healing. If the fluid accumulation is significant, your plastic surgeon may aspirate the fluid with a small needle as an office procedure one or more times.

Fat Absorption Viability — Approximately 20-40% of injected fat does not remain and re-absorbs. Fat survival depends on the location of injection, age, co-morbid disease factors, smoking, weight gain or loss, and technical factors including expertise of the surgeon. Gentle massaging over the buttock area helps even out and smooths these areas during the recovery phase.

Skin Irregularities or Dimples — Contour irregularities, including bumps, dimples, and asymmetric fullness, as well as depressions or fullness in the skin may occur after fat transfer and liposuction. Visible and palpable wrinkling of skin may occur depending on skin elasticity. Postoperative massaging is often helpful in smoothing these areas.

Fat Necrosis — The areas where fat is transferred to and from may experience fat compromise or fat death that can lead to surface irregularities or result in fat calcification and produce areas of palpable firmness, “bumps”. Additional surgery to remove areas of fat necrosis may be necessary. This may result in contour irregularities.

Skin Loss (Skin Death) — This is a rare occurrence. The skin about the site of surgery or at the incision site may become necrotic or ‘die’. When this happens, skin may change color and slough off. If it is not a full thickness injury the skin will grow back, otherwise a wound will form and heal slowly. This may require further surgical and medical management.

Contour Asymmetry — The two halves of the body are never symmetric. Therefore, following fat transfers, these asymmetries may persist and appear as difference between the contour and volume of the two sides.

Long Term Effects — Subsequent changes in the shape or appearance of the area where the fat was removed or placed will occur as the results of aging, weight loss or gain, or other circumstance not related to the fat transfer procedures.

Fatty Cyst Formation — The transferred fat may form small fat clumps or oil cysts. This may interfere with the interpretation of future radiologic studies of breasts, and rarely, may need to be aspirated or removed.

Fat Transfers to Breast — Fat transfers have been widely used to improve the appearance of breast reconstruction. There are some potential concerns with regard to breast cancer detection. Since the transferred fat may become firm and cause lumps, it may be necessary to have radiological studies performed to be sure these lumps are not due to cancer. However, there is presently evidence nor nor reason to believe that fat transfer procedures may cause breast cancer.