You may have heard news about a recent decision by the French authorities to withdraw certain types of breast implants from the market.

The implants affected are textured silicone and polyurethane foam implants.

The decision has been made because of a link between this type of implant and a rare form of cancer called ALCL.

Because the risk of ALCL seems to be related to the textured surface of the breast implants, they are suggesting that smooth implants should be used instead.

ALCL is not breast cancer and I wrote a blog post about it two years ago.

Our plastic surgery associations have produced a press release that you can read here.

There is no suggestion that anyone with breast implants should have the implants removed but they do say that patients should be informed of the symptoms of ALCL, which are a lump or swelling of the breast and if this occurs, to seek the help and advice of the implanting surgeon.

I would always encourage our patients to keep under regular follow up with us and if you have any symptoms or concerns, please get in touch as we would be happy to see you.

We have known about ALCL for some time and you may ask

‘why do we continue to use textured and polyurethane foam implants?’

This is a question that I will talk about in person on my Facebook Live broadcast at 7pm, so please join me and feel free to ask me any questions directly, or email me back and I will be happy to discuss this.

My personal view and the view of ISAPS (the International Society of Aesthetic Plastic Surgeons) is that it is the wrong decision to withdraw these implants from the market because they have well proven benefits over smooth implants.

 

“We believe that this is the wrong approach and less satisfactory for our patients”

Dirk Richter, MD, ISAPS President

 

Smooth breast implants were the first generation of breast implants and since their development, they have undergone many generations and improvements, largely in terms of their texturing and coating.

Textured and polyurethane foam implants have proven benefits in terms of greater stability, less chance of movement and rotation and less chance of capsular contracture.

These benefits should be weighed against the risk of ALCL, which is extremely small and studies have shown that the risk of ALCL is much less than risks that we all take daily like driving a car or going skiing on holiday.

We constantly weigh up risks in our lives and should be given enough information in order to make a balanced decision.

This is the basis of informed consent.

UK and the rest of Europe will continue to offer textured and polyurethane foam implants as well as smooth implants to patients and this is the practice we will follow at The STAIANO Clinic.

I believe that we should offer all options to our patients and allow them to make a balanced decision about what is right for them.

I hope that we can maintain an educated and informed response to this situation and not lose sight of the tremendous benefits associated with breast implants and the extremely low risk of ALCL as well as its very good prognosis in the rare cases where it is diagnosed.

I will keep you informed of any updates or developments as I hear about them.

There has just been a Panorama documentary on about the ‘scandal around breast implants‘.

This is obviously of great interest to us because we specialise in cosmetic breast surgery and use a lot of breast implants.

I certainly do not want to appear that I am trying to play down any adverse reports or cover up what is purposed to be issues associated with breast implants.

However, as someone who is closely involved with both the science and the practical aspects of breast implant technology, I want to ensure you that we are up-to-date with the latest information and that we are not doing anything to put patients in harm’s way.

I am constantly trying to combat the stereotype of the plastic surgeon who is arrogant and does not care about his patients’ wishes.

This is not a stereotype that I recognise in my own practice or my colleagues.

They have to remember we are doctors first and most of us went into medicine because we want to help people.

I find plastic surgery an immensely rewarding speciality, and now that I sub-specialise in cosmetic surgery rather than reconstructive surgery, I do not find it any less worthwhile or indeed challenging.

The goal is, and always has been, to have a happy patient and I would never do anything if I thought that the patient be anything less than completely over the moon with the results that I have given, and so the suggestion that there is some kind of scandal or cover up about harmful effects of breast implants, is something that I find difficult to reconcile.

We frequently turn patients away who come seeking treatments if we do not feel that they would benefit from them.

There is no doubt that there are risks with breast implants as there are with any surgery, and these are fully discussed at the consultation and in the literature that we give the patients at every step of the proceedings.

The issue of ALCL, a type of breast cancer associated with breast implants has been raised and this is something that we have known about for some time and we discuss fully with patients during the consultation.
The concept of breast implant illness has also been highlighted, and this is something that has been talked about ever since breast implants came out, and there has not been any scientific backing found to support the causation of systemic illnesses due to breast implants.

However, there is no doubt that there is anecdotal evidence and patients coming forward saying that their implants have made them feel ill and they feel better with their implants removed.

There is also now some statistical evidence to suggest there are increased rates of some illnesses in patients with breast implants (there are also significantly decreased rates of other illnesses in patients with breast implants), but these are difficult to interpret because there may be other variables, such as an increased risk of melanoma in patients with breast implants, which may be due to an increased tendency to sunbathe in the population of patients who have breast implants.

I have been asked about breast implant illness in the past and I give my honest answer, which is that I have never experienced it in a patient of mine having done hundreds of breast implant operations, but I have one patient who has had her implants removed due to pain and the pain was relieved with the implant removal.

I have also seen patients who have had surgery by others surgeons who have described feeling unwell and then feel better when the implants are removed.

However, this evidence has to be taken on the background of the many hundreds of patients in my practice, and many thousands, and tens of thousands of patients world-wide who have experienced tremendous benefits from having implants, which outweigh any small risks.

There is no doubt that we have to give information to patients so they can make a balanced and informed decision, but I am concerned that patients may feel that the risks are greater than they are, so a balanced and informed decision cannot be made.

There are risks with everything we do from crossing the road to frying an egg, which need to be balanced against the benefits so we can make our own mind up as to whether the risk is worth taking.

It is important that we put statistics in ways that people can understand, but at the same time we need to avoid putting them in a way that serves our own needs.

For instance, I hear that the risk of having rheumatoid arthritis in patients with breast implants is seven times that of the normal population which is alarming, but in fact the risk of getting rheumatoid arthritis is a fraction of a percent in patients with or without breast implants, so it is all a question of context.

The risk of developing lung cancer is nine times lower in patients who have breast implants in.

Again I do not think there is any suggestion that breast implants are protecting patients from lung cancer, more that the demographic of people having breast implants, may be inherently somehow the less likeliest to develop lung cancer, and so it is not an effect of the implants themselves, just of the type of person who has breast implants.

It is a difficult area because we have not found any cause or relationships and it is not that we are covering anything up, it is that we do not know.

Only recently has a National Implant Registry been re-introduced.  Before then, it was hard to get a handle on what was happening to patients with breast implants.

As doctors we are here to serve patients and improve quality of life and there is no way we would be doing things if we thought patients were going to come to harm or be unhappy.

It is a testament to the huge success of cosmetic surgery because it does, by and large, create a huge amount of happiness, self-esteem, and self-confidence, despite the media trying to portray it as being unnecessary and unsuccessful.

There is no question that we need to continue researching different ways of doing things and making sure that the things that we are doing are safe and effective.

As plastic surgeons we will be at the forefront of that research and will inform patients as and when we know the results, but we will try to avoid making alarmist conclusions on complex data and continue to do what is in the best interests of the patient.

If you have breast implants, whether you are a patient of mine or not, we would be very happy for you to get in touch if you have any questions or concerns.

You can also join me on Facebook where I do a live Q and A on Facebook every Tuesday at 7 p.m. where I will be available live to interact and discuss any issues and to answer them to the best of my knowledge and abilities.

Feel free to leave a comment below, or drop us an e-mail.

If you want to come for a free no obligation consultation with one of our plastic surgeons, please call or email us or fill in the on-line contact form.

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What is nipple reduction? 
We often get patients enquiring at the clinic about nipple reduction and it can mean a number of things.
What is commonly referred to as the nipple, in medical terms it is made up of what we call the nipple areolar complex (NAC).

This comprises the actual nipple itself which is the bit that sticks out in the middle and the areola which is the pigmented area around the outside.

When patients talk about a nipple reduction it can mean different things for females and males.
For a female, it can often mean areolar reduction where the pigmented area around the nipple is too large, and so this can be reduced by removing a doughnut of skin, and in fact it is not the nipple itself that is the problem at all.

It is less common for the actual nipple to be enlarged.

Of course, it is possible to reduce the nipple if this is the problem. 

Men who complain of enlarged nipples are often suffering from gynaecomastia which may manifest itself as puffy nipples, and again it is usually the areola that is being referred to.

However, an areolar reduction is not normally the best treatment because it is caused by the tissue behind the nipple pushing the nipple forward and making the areola look more prominent, and the best way to address this is by gynaecomastia correction which will remove that puffy tissue and once the tension has gone from the nipple it will shrink back and look normal again.

Again it may actually be an enlarged nipple that can be a problem, although this is less common, but if this is the case it can be addressed by taking a small piece of it away so that it is not so prominent.

When people talk about a nipple reduction it is important to be clear about what part of the nipple areolar complex needs to be reduced and what is causing the enlargement, so that this can be addressed.
A picture tells a thousand words and you are always welcome to send us a photo if you are not sure what the problem is, and of course, you would be welcome to come to the clinic for a consultation to speak to one of our surgeons in order to get an more accurate idea about what treatment might be right for you.

Don’t forget that our Director, Jonathan Staiano, does a live Q and A on Facebook every Tuesday at 7 p.m. and please go over to our Facebook page if you would like to put a question directly to him.  Feel free to leave a comment or drop us an e-mail.
If you want to come for a free no obligation consultation with one of our plastic surgeons, please call or email us or fill in the on-line contact form.

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The problem with mastopexy

…and why the internal bra mastopexy is good

The biggest problem we have with mastopexy (breast lift) is maintaining stable upper pole fullness in the breast.

This is because over time natural tissues will always tend to sag and descend, and so whilst when you first do a mastopexy you can achieve quite significant fullness in the upper part of the breasts, as everything settles that fullness becomes less prominent and turns the initial convexity into a concavity in the upper pole and a softer look, which I often describe as being more natural but patients sometimes do not like it in preference for a fuller look which is after all what most patients are after when they are having a mastopexy.

This fullness can be achieved with breast implants and sometimes patients prefer the look that is achieved with a lift combined with implants, it is not without its potential complications.
Obviously, your breast would be bigger with implants and not all patients want to be bigger.

There has been a lot of research into the possibility of techniques to achieve a more stable fullness in the upper pole and this is always something that I am keen to look into and explore, because if someone can come up with a good solution then that really would be solving a very common problem.

The problem with the internal bra mastopexy

…and why we don’t use it

There has been an internal bra around for some time in various forms and what this involves is using some form of prosthetic mesh which helps to support and hold the breast tissue up to create a more stable fullness in the upper pole.

The science behind it is sound and it seems to give good results which can be stable over the long term.

However, it has not been widely adopted and it is not something that we use regularly here in the clinic because while it can give good results, it does increase the risk of complications.

Whenever a prosthetic material is used, if there is any infection, then the prosthetic material needs to be removed.

The problem with an internal bra mastopexy is that the mesh is incorporated into the breast tissue and so it is more difficult to remove in situations of infection.

Furthermore, the mesh needs to be anchored securely because if it is not securely anchored then it will just drop with the breast tissue.

For this reason they are usually anchored into the bone of the ribs and so this can cause discomfort and again, any infection around the bony fixation can be troublesome.

By definition the mesh has to be placed relatively close to the skin because if there is too much breast tissue on top of it this tissue will sag and defeat the object, and so there is a risk that you might be able to feel the mesh or see it, and the possibility of extruding through the skin can cause problems with the healing of the skin, which is already compromised by virtue of the mastopexy surgery itself.

Personally, I feel that the balance is weighed against these meshes at the moment, but I am excited to see how things develop.

The problem we have here at the clinic is that people will read headlines or see the latest developments being advertised and think that they are the solution to their problems, but when you get down into it and really analyse the science and look at the facts and figures behind these devices being used, rather than just looking at the headline cases, you will see that there is usually no easy solution for these difficult problems.

I find the best thing is to give people a realistic expectation of what can be achieved with mastopexy and then they can make a decision on whether it is right for them or not and perform the surgery in the safest way possible giving the most predicatable outcomes that we can achieve.

At the moment we are not using the internal bra mastopexy, but we will continue to keep at the forefront of the literature and available science and aim to give you the best advice and outcomes that we can.

If you have any questions about the use of prosthetic meshes and the internal bra mastopexy please e-mail us or call us.
Or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.

When it comes to gynaecomastia surgery cost, we do have a price range

I am very keen that we are transparent with our fees here at the STAIANO Clinic and I do not want patients to feel like there will be lots of add-ons or hidden costs.

For that reason we only ever charge for the initial consultation and make it clear that we will never charge for a follow up consultation whether it is before or after the surgery.

Gynaecomastia Surgery Cost

When it comes to the cost of gynaecomastia surgery, we do quote a ‘from‘ price and I know that this makes some people suspicious, but the vast majority of patients will be paying the baseline price.

REQUEST A PRICE FOR GYNAECOMASTIA CORRECTION

The reason we have a ‘from’ price is because the more severe cases of gynaecomastia may be more expensive.

The treatment of gynaecomastia is aimed at targeting the three areas that can be affected:

1. Fatty tissue.
2. Glandular (breast) tissue.
3. The skin.

Each of these areas are targeted separately.

1. Fatty tissue

The fatty tissue can be targeted with liposuction and this allows the contour of the chest to be improved through very small stab incisions as seen in the example below:

 2. Glandular tissue

In most cases there is some dense glandular tissue just behind the nipple which is not removed through liposuction and so a small incision is required on the edge of the areolae to remove this dense tissue.

The vast majority of cases of gynaecomastia can be treated through a combination of liposuction and excision and this is the price that we quote when people enquire.

The patient below is shown 6 months after having liposuction and excision of gynaecomastia:

3. The Skin

The reason there is a ‘from’ price is because some cases require skin excision and this is a much more involved (and expensive) undertaking.

If there is only mild excess, then by removing the fatty and glandular tissue the skin may recoil and may not need to be removed, particularly if you have good quality skin, as is the case in young patients who do not smoke.

However, in cases of significant skin excess the skin may need to be removed in order to give an acceptable chest contour.

Not only does this create extra scarring, but it is a bigger operation with more potential for wound healing problems, and so is more expensive.

The patient below had excision of the skin excess as well as removal of the gynaecomastia:

 

It is only really by examining you and talking you through all the options that we will know what will be the best option for you, which is why whenever we quote, we give the price for liposuction and excision which will suit the majority of patients.

Once you have been to the clinic and we have had the chance to meet and examine you and talk through your goals and wishes, then we can provide you with an accurate quote which will include our complete aftercare package, and the opportunity to come back to the clinic to go over things as often as you like.

And remember we have our satisfaction guarantee

…which means that if we have been unable to help you then we would be more than happy to refund the full consultation fee.

You can find out more on our gynaecomastia page, or you can download our guide , e-mail us or call us.

For further information please feel free to contact us or you can ask our director, Jonathan Staiano, a question LIVE on Facebook at 7 o’clock every Tuesday evening, so feel free to drop in.

REQUEST A PRICE FOR GYNAECOMASTIA CORRECTION

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