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What goes around comes around “ why some people are using smooth implants again

What goes around comes around “ why some people are using smooth implants again
 
I was recently at a meeting in London and I was chatting to some of my colleagues and it is interesting to hear that some people are going back to use smooth silicone implants.
If you look at the history of breast implants, the very first breast implants were smooth silicone implants, but they found that they had a high rate of capsular contracture and polyurethane foam implants were developed which dramatically reduced the risk of capsular contracture.
However, then there was the controversy about polyurethane implants (you can read more about this in my blog here), and so they needed to find a way of mimicking polyurethane foam which is when they came up with textured silicone implants.
In fact Mentor, which is a large American manufacturer of implants, actually make the texturing by making an impression of polyurethane foam onto a smooth silicone implant whilst the silicone is wet to give the texturing effect, which reduces the risk of capsular contracture compared with smooth silicone implants.
Ever since then, the textured silicone implants have been the most commonly used implant and certainly in the UK, smooth implants have hardly ever been used.

However recently a very rare type of cancer called ALCL has been discovered, which is a cancer of the capsule around the implant.
The numbers of described cases are very small in comparison with the number of patients who have breasts implants, but it is clearly something that the plastic surgery community is very concerned about.
One of the statistics of note is that there have been no cases of ALCL reported in patients with smooth silicone implants, and this is the reason that many doctors are now recommending smooth silicone implants for their patients.
The worry however, is that we will start seeing an increasingly high rate of capsular contracture which carries with it its own problems and potential morbidity.

I do not think there is an answer, certainly at the moment, as we do not really know what causes ALCL and so are only speculating that having a smooth silicone implant is protective.

It might simply be that the number of patients with smooth silicone implants is small and so no cases have been described yet.
We have always done our best to try and inform patients as well as we can to make the best options for themselves when it comes to having surgery and this involves giving information.

I really do not know what to recommend because there are pros and cons with smooth implants, textured implants, and polyurethane foam implants.
We are about giving patients the information that is currently available to allow them to make the best decision as to what is right to be into their body.
We tell everybody about the risk of ALCL and perhaps most importantly, anyone with breast implants should look out for any swelling or lumps associated with their breasts and seek help and investigation in order to rule out this rare but potentially serious complication.

It is certainly an option to have a smooth silicone implant if that is your wish and one of the great things about the Staiano Clinic is that we are independent and not tied to any implant manufacturer and so we can use any type of implant that you would like.
Obviously you would have to be aware of the increased potential of a capsular contracture associated with smooth implants, and so this would need to be balanced against the potential benefits.

I am sorry it is not clear cut, but I would be careful of any surgeon who suggests to you that it is clear cut and tries to tell you that one implant is better than another.

Certainly amongst all the major implant manufacturers they are all made to a very high standard of safety and quality and there is no clear evidence that one is safer than other.
I know it is sometimes easier to hear that you should have this implant because it is the best and if you were to have any problems and then researched it and discovered that there is no best, you may have preferred to have had all the information so that you could make an informed decision yourself.
If you have any questions we’d love to hear from you.  You can 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.info@staianoplasticsurgery.co.uk.

When is a Lifetime Warranty not a Lifetime Warranty?

When is a Lifetime Warranty not a Lifetime Warranty?

 It is really important to be informed about what sort of cover you have got if you thinking of having cosmetic surgery and all too often people assume that they are covered, particularly if they see headlines such as lifetime warranty or ten year guarantee

because you need to ask exactly what is covered in that guarantee.

You often find that breast implants have a lifetime guarantee, but it is just the implant that is guaranteed.
This means that if there is a problem with the implant they will give you a new one, but it does not cover the costs associated with surgery which can be significant.
They usually require the implant to be returned to the factory so it can be analysed to check there was a manufacturing defect that caused the problem with the implant (which would usually be a rupture) and then it may be that they will only supply a like for like replacement and so if you wanted to have a bigger or smaller implant that may not be covered, and certainly if you wanted to have a different make of implants then the warranty would be useless.
The question also comes as to whether they will cover surgery for the other side, because if you have had an implant problem with one of your implants, you may choose to have both changed but they may or may not cover replacement of the opposite breast implant.
All the manufacturers vary and some will allow you to change the opposite implant and they may allow you to have a different size, although it may be limited to just one size bigger or smaller.
Most implants are guaranteed for rupture but what about other problems such as capsular contracture?

Some companies such as Nagor do cover for capsular contracture, whereas others do not.

On the other hand, some companies will give you money towards the cost of revision surgery, for instance Allergan, although it does need the implant to be analysed and to be shown to have a manufacturer defect and the rupture needs to occur within ten years of implantation.
POLYTECH who make the polyurethane foam implants also offer an extended warranty through their distributor Q Medical.
This offers two years of cover where they will pay money towards the hospital costs if you were to require revision surgery and this is an insurance backed scheme which is automatically taken out for everybody who has these implants.
This can be welcomed because private hospitals have their own time periods for allowing revision surgery free of charge, but this is often six months to one year.
It is important to be clear what is covered in these policies of revision that is usually a problem such as malposition, seroma, or infection.
If it is a purely cosmetic problem in that the implants are too big or too small, then cover will not be provided and so you need to make sure that you are completely comfortable with the implant choice before having surgery.

This is one of the reasons we encourage our patients to come back to the clinic as often as needed before having to finalise the implant choice.

If you would like breast implants then you really need to think that there may well be further surgery required and the likelihood is the cost of that further surgery will not be completely covered by any guarantee or warranty provided.
For this reason, you should budget for the potential for further surgery and make sure you are fully informed before going ahead.

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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.

Treatment for Breast Asymmetry

Treatment for breast asymmetry

 
All patients have a degree of breast asymmetry to a greater or lesser extent and when performing a breast reduction or a breast augmentation it is often possible to correct minor degrees of asymmetry, but we always warn people that there will be some residual asymmetries as it is quite natural to have differences between the two halves of our body.

It is cases of severe breast asymmetry that can pose a challenge and often require a little more thought and planning.

The first question to ask if you have a breast asymmetry, is whether you are happy with one of your breasts.

If you are happy with one of your breasts then it might be possible to just operate on one side to try and make that breast look like your ‘good’ breast.
If you are unhappy with both your breasts, then you may need surgery on both sides.

The next question is whether it is the size or the shape, or both the size and the shape that you are unhappy with.

If it is just the size that you are unhappy with and both breasts are of an acceptable shape, then it will be possible to make the big one smaller by doing a breast reduction or the small one bigger by using breast implants and sometimes and combination of these is required.

Breast implants are very effective at increasing the size of the breasts and although they come in a variety of different shapes and profiles, they do not have a dramatic effect on the shape of the breast.
If it is the shape that you are unhappy with, then your best option would be a breast lift (or a breast reduction if you wanted your breasts to be smaller).

As you can see, surgery for breast asymmetry can often be complex involving a variety of techniques including breast implants which often have to be of different shapes and profiles to give different effects to each breast, breast lifts, and breast reductions.

Whenever different surgery is done to each breast there is a risk that as you age, the breasts will settle differently.

If one breast is smaller and has an implant in, but the other side does not have an implant, then it is likely to be more pert and have a fuller look than the opposite side which is made up of breast tissue, because breast tissue will naturally droop or sag as the years pass.

This is where conversations come in where some patients might want a reduction of a bigger breast to match the volume of the smaller one and then to have the same size implants put into both so that they age in a similar way.

However, this then does bring in the complications associated with implants into a breast that may not have needed them.  It is swings and roundabouts.

Plastic surgery is really an art more than a science

and so there is often no easy answers in these situations and it requires a full and frank discussion with your surgeon.

You need to spend time exploring all of your options and will often have to accept that there will be a degree of asymmetry whatever surgery you have.

The aim of surgery is usually to restore symmetry as best as possible to make you balanced while wearing clothes and sometimes out of clothes you will still see some asymmetries and these are often magnified because you have lived with a more significant symmetry in the past.

I think it is important to realise at the beginning that all patients have a breast asymmetry to some degree, so it is usually a case of bringing it back into normal limits rather than achieving perfect symmetry.
We look at the consultation as a partnership between us and you and while we will help and guide you through the process, we will always aim to come to a mutual decision as to what might be the best option for you.

Don’t worry if this does not come in the first consultation.

It often takes two, three, or more consultations before you come up with a clear plan and that is why we only charge for the initial consultation because we want you to feel that you can come back as often as you need to go over things and make sure that you are happy with the plan.

As ever, it is always important to wait until your breasts have stopped developing so ideally you should wait until you are at least 18 before having surgery for breast asymmetry and you should also be happy and stable with your weight before having your breast asymmetry corrected.
You will need to be aware that as time goes on, particularly if you put on weight or have children, your breasts can change and so we always offer all our patients unlimited follow ups in the future because we know that life can be unpredictable.

For more information please download one of my guides and if you would like to arrange a consultation with us, the only plastic surgery clinic in the UK that specialises in breast surgery, call us now to arrange a consultation so that we can go over all of the possible options.

Dual plane breast augmentation “ fantastic compromise or marketing gimmick?

Dual Plane Breast Augmentation

One part of the consultation for patients considering breast augmentation is whether to have the implant on top of or underneath the muscle.

Unfortunately there is an awful lot of hype around cosmetic surgery

…particularly breast implants and I will often hear patients say to me they have heard that on top of the muscle is better or that under the muscle is more natural.

It is not really possible to make these sweeping comments, because the fact of the matter is there are good things and bad things about both.
You need to weigh up the pros and cons and take into account your body type and physique and your lifestyle and hobbies, so that you can come to a balanced and informed decision as to what might be right for you.

Sometimes patients will come to the clinic torn between whether to have them on top of or behind the muscle and they are delighted when they hear about the dual plane technique, but surely this is a compromise between the two with all of the benefits of both.

If someone tells you that one way is the best way to do something or if one type of implant is the best implant, when there are lots of other options available I would advise caution in listening to that advice, because if one was the best, then surely there would be no need for all of the others.

I understand that sometimes it is easier to explain things in terms of what we might recommend, but we should really be giving patients all of the available options to empower them to make the decision as to what might be right.

Broadly speaking, implants can either go on top of the muscle or under the muscle.

There are nuances with both planes, but I do not think the average patient needs to get too worried about the specifics. When they go on top of the muscle they can in either be in a subglandular or a subfascial plane and under the muscle can be a dual plane type I, II, or III.

When I teach and lecture plastic surgeons it is not uncommon for trainees to stand up and be unsure about the exact differences between dual plane type I, II, and III, so it is not something I would expect the average patient to know much about.

The important thing is that all submuscular breast implants are in a dual plane

So in terms of cosmetic breast surgery you can use the term submuscular interchangeably with a dual plane technique.

When the implants are placed under the muscle, it is the pectoralis muscle that is used, but this just covers the upper inner part of the implant. The lower outer part of the implant is only ever covered by breast tissue and so there is always a dual plane.

It is possible to put an implant in a total submuscular plane, but this is only used in breast reconstruction when there is no breast tissue to cover the implant, and so other muscles surrounding the pectoralis major muscle are raised and used to get complete muscle coverage, but this is not a technique that is ever used in cosmetic breast surgery.

The dual plane technique and the different types of dual plane are very useful to the plastic surgeon and the types I, II, and III refer to the amount of subglandular dissection that is performed.

For instance, a type III technique involves making a plane on top of the pectoralis major muscle and freeing the breast off the muscle.
This allows it to hang and sit with the implant in cases where patients have a droop or a sag to their breasts, and the dual plane type III is often the most challenging group of patients. A dual plane type I has got only a limited dissection of the breast tissue off the muscle and is what would be referred to as the classical submuscular plane. Whereas dual plane type II is in between the two.

Therefore, I am sorry to say that dual plane is not a compromise between submuscular and subglandular, it is simply submuscular but called by another name. I am not for a moment suggesting that the dual plane technique is a marketing gimmick because it is a very useful technique and is very well established.

However, I do sometimes hear it being used as if it is somehow better than submuscular because it is in ‘a dual plane’ which somehow sounds better.

Alas it is simply the use of terminology and it remains for you to weigh up the pros and cons of the dual plane or submuscular pocket compared to the subfascial or subglandular pocket.
By all means do your research and ask as many questions as you can think of to help you make a decision about whether you should have your implants on top of or behind the muscle, but do not be blinded or seduced by terminology or a slick sales technique that suggests that one is somehow better than the other.

If you have any questions I am on Facebook live every Tuesday at 7 pm but you can comment on the blog below, or e-mail us.

If you would like a guide on frequently asked questions about breast implants, you can download one below.

Our phone number is 0121 454 3680 and we would always love to hear from you.

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Read more about Breast Augmentation here

What Is The Minimum Age For Cosmetic Surgery?

How Young Is Too Young To Have Cosmetic Surgery?

We often get enquiries at the clinic asking what age patients can have cosmetic surgery.
There is a simple answer to that and a more complicated answer.
The simple answer is that we only treat patients who are over 18 due to the strict guidelines and controls over operating on children

…but the real answer is that there is no limit on the age for cosmetic surgery.

One of our surgeons at the clinic, Khurram Khan, is a specialist in paediatric plastic surgery and holds an NHS consultant post at the Birmingham Children’s Hospital.
Children undergo cosmetic surgery all the time.
Cleft lip deformity is primarily a cosmetic problem.  This is performed on babies.
Prominent ear correction is commonly performed around the age of 6.
It is not unusual to treat children with vascular lesions, moles, or birthmarks which are primarily a cosmetic problem.
It comes back to the image of cosmetic surgery – the public has a picture of a glamour model with enormous breasts and huge lips.
We are about improving quality of life and this is what we, as plastic surgeons, are trained to do.
Cosmetic surgery comes in many forms and it may be clearly ethical and justified to perform surgery on a child if it is in their best interest.
However, I think the question is often used when talking about breast surgery and in those circumstances there is a good reasons for waiting before having surgery.
It is important before operating on any growing organ, to wait until it has stopped growing before performing surgery, so it is completely reasonable to wait until around the age of 18 before considering having any breast surgery.
Having said that, there may be an argument to perform surgeries sooner in situations of significant asymmetries or extremely large breasts, but by and large, it is common practice to wait until puberty has finished and in fact, the longer you wait, the better.
This is particularly true if considering breast implants because these can have ongoing issues and the need for further surgery in the future, so will require detailed discussions with the patients and the family before embarking on any surgery.
So whilst the easy answer is that you should wait until you are 18 before having cosmetic surgery, like most things it really depends.
It is not so easy to give blanket answers to all-comers.

It depends on what your problem is, how that problem is likely to develop, and how that problem affects you.

It really requires a conversation, and perhaps several conversations with you and your family so that we can create a plan and give you the best result possible.
We are delighted to have Khurram Khan at the clinic, as he is one of only a very select group of plastic surgeons who specialise in paediatric plastic surgery and so he has experience of operating on children of all ages.
We are also very lucky to have close links with local private hospitals who have facilities in theatres and on the wards to treat paediatric patients.
So the headline answer is that you should wait until you are 18 before having cosmetic surgery, but if you think that you or your child might benefit from surgery before the age of 18, we would be happy to discuss it with you, and we always love to hear from you.
Call us on 01214543680 or e-mail info@staianoplasticsurgery.co.uk.
Our director Jonathan Staiano does a Live Q&A on Facebook every Tuesday at 7pm, so feel free to drop in there.

If You Are Considering Cosmetic Surgery, Download My Guide With ‘5 Questions To Ask Your Plastic Surgeon’ To Make Sure You Are Treated By A Specialist

Do I Need A Mastopexy To Make My Breasts More Perky?

Do I Need A Mastopexy?

A mastopexy is a great way to reshape the breasts but when it comes to achieving a good outcome, it is important for us to communicate what might be possible so that we can align our goals.
Over time the shape of the breasts can change and these changes can be accelerated by having children or losing weight, resulting in a droopy or saggy appearance to the breasts.
Many patients want to achieve a more perky appearance to rejuvenate the breast contour.
The reasons that breasts lose their perkiness is because the skin gradually stretches.
This happens over time in all of us because of the effect of gravity.

The Alternative To Mastopexy

It is not possible to give elasticity back into the skin, and so there are two options to combat the problem.

  1.  To remove the extra skin and tighten the breast.
  2. To add volume to the breast to fill the skin envelope and tighten the skin.

So for this reason, patients often wonder whether it is a mastopexy they need or breast implants; with a mastopexy doing the former, and implants the latter.

Mastopexy

Option 1: Mastopexy to remove the skin and tighten the breast

 

Breast Implants instead of mastopexy

Option 2: Breast Implants to fill the skin (without a mastopexy)

The main difference is the size of the resulting breasts and that will be about the same size after a mastopexy, but bigger after implants.

So it depends on how big you want your breasts to be.

If you want the breasts to be the same size as they are or smaller, then it is a mastopexy or a breast reduction that would restore the perkiness, but if you wanted them to be bigger, then implants might be all that is required.
However, if the breasts have sagged significantly, implants might not be able to fill the skin envelope enough and you may need to combine it with a mastopexy.  You can read more about a mastopexy combined with implants here.
Often if restoring the breasts to a more perky shape is the primary goal, then a mastopexy on its own is the best option. 

The Limitation Of Mastopexy

You will need to be prepared for the sort of shape that you can achieve with a mastopexy.
We always stress that gravity will continue to operate on the breast and so it tends to settle to a more natural shape without the round and full look that is associated with breast implants.
The problem comes when people want the rounded look and do not want to be bigger, because sometimes you may consider having implants just to achieve this look.
This is an option, but does carry with it the potential complications and limitations associated with implants.
This is why an in-depth consultation is always advisory, so that you can discuss your aims and objectives with your surgeon to see if a mastopexy would be suitable for you.
We can discuss whether the shape you could achieve, which can often be quite transformational to the breast, will be in line with what your goals are.
When you have a mastopexy, there will be a full and rounded look in the upper part of your breast to start off with, but over time they will settle to a more natural shape.

Mastopexy settling

After mastopexy, the fullness in the upper part of the breast settles into the lower part of the breast

Our primary goal is to have a happy patient and a happy patient is one who knows what to expect and can make an informed decision as to what might be the right operation for them.
We will not dictate to you what surgery you should have, and we will always inform you of what likely outcome you can reasonably achieve.
There is never any obligation to proceed.
If you have any concerns or doubts, then it is always best to go away and think about things and consider what surgery might be the best for you.
If you would like to come to the clinic for a chat, you can email or call us on 0121 454 3680.

For more information you can download one of our guides below:

Request Our Mastopexy Guide

Request Our Breast Augmentation Guide

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Life After Breast Implant Removal

Are you thinking about breast implant removal?

If you are considering breast implant removal but are worried what your breasts might look like afterwards, you are not alone.
As your body and your circumstances change, you might find that the breast implants that you once loved, become uncomfortable and out of keeping with your frame.
There are many reasons that people want to have their implants removed or you may just be worried and think that your implants need to be changed.

When should you change your breast implants?

If you are concerned, then you can read my blog post about when you should change your breast implants here.
If you are considering breast implant removal, then you may have many questions about what would be involved and what you will do once your implants are removed.
The Staiano Clinic is the only clinic in the UK that specialises in cosmetic breast surgery and is owned and run by a Plastic Surgeon.

Should you have your implants replaced?

If you would like a consultation with one of our surgeons, then we can go over your options for breast implant removal and talk about whether you would need to have implants replaced, or whether you would be happy to be without implants.  If you are having your implants replaced, then you can think about whether you have implants of the same size, or if you have bigger or smaller implants.  It may be that all the options are feasible, but you will need to consider the consequences of changing the size of your implants.
You can read more about what to do if you are considering replacing your implants here.

Will I need a breast lift after implant removal?

If you are thinking of changing or removing your breast implants, then you might be concerned about how your breasts will look afterwards, or more specifically, will you need a breast lift after your implants are removed?
Jonathan speaks about whether you will need a breast lift after implant removal in this video and shows some examples of cases of breast implant removal with and without breast lift:

If you would like a copy of our Frequently Asked Questions Guides, please click the links below:

Breast Lift Frequently Asked Questions Guide

Breast Implants Frequently Asked Questions Guide

If you have any questions you can give us a call on 0121 454 3680 or email us at info@staianoplasticsurgery.co.uk.

Do I need a scan to check my breast implants?

Do I need a scan to check my breast implants?

Patients often come to me to ask ‘do I need a scan to check my breast implants?’.
There are different types of scans that can be done to check on the breast:

Mammogram

This is an x-ray that looks at the density of the tissues and is mainly used for looking at lumps in the breast.
It is not very good at looking for problems with breast implants.
*note: a lot of patients worry about having a mammogram if they have got breast implants in, but there is no need for concern because it is routine to use implants in patients with breast cancer who need regular mammograms. You just need to let the xray doctors know that you have implants in so that they can adjust the way that they do the mammogram.

Ultrasound Scan (USS)

This involves using a handheld probe with gel on the skin to look at the integrity of the implant.
It is the same scan that is used when you are pregnant to get a picture of your baby.
It is often the first test for looking for rupture of breast implants.

Magnetic Resonance Imaging (MRI)

This is a bit more involved than an ultrasound scan.
You lie on a table and a large doughnut passes around you.  The doughnut contains magnets so you must tell the operator if you have any metalwork inside your body.
An MRI scan is more sensitive and specific than an ultrasound scan.  This means that it is more likely to be able to tell if the implant is intact.

Intracapsular Rupture Of Breast Implants

All implants are surrounded by scar tissue, known as a capsule and if the implant ruptures but the capsule stays intact, all of the gel will be held within the capsule.  This is known as an intracapsular rupture and this can happen without you being aware of it, in which case it is known as a ‘silent rupture’.
The cause of this is a constant friction of the implant shell, perhaps because of a fold or knuckle in the implant that might be made worse by some degree of capsular contracture.  Over time there can be a thinning of the silicone shell in areas of wear and this can lead to a gradual break or tear.
It is for this reason that I personally do not advocate routine scanning of patients who have breast implants in.
Scans have a cost, both financially and in terms of your health by exposure to radiation (for X-rays and CT scans) and so should only be performed if they are going to change how you are treated.
While they are very accurate in predicting whether your implant is ruptured or not, no scan is 100% reliable. This means that there is a small chance that the scan could say that your implant was ruptured, yet it might be intact and the scan might say that it is intact and it may be ruptured.
I have seen cases where the scan has been wrong both ways.
My practice is to offer all of my patients a yearly review where they can come back to the clinic for a check-up to see if there are any concerns or questions about your implants.
I would only offer a scan if there was a change in the size or shape of your breast that could indicate a problem with the implants.
If there was a problem with capsular contracture, then this is diagnosed clinically, not with a scan.
We make a decision to perform a capsulectomy and replacement of implants based on how bad the capsular contracture looks and feels, not on the basis of any scan.

Extracapsular Rupture Of Breast Implants

So far I have talked about a ‘silent rupture’ of breast implants, which is usually confined to the within the fibrous capsule around the implants (intracapsular rupture) and you normally do not notice when it happens.
This is different to an extracapsular rupture which is where the silicone shell of the implant ruptures as well as the fibrous capsule around the implant.
This is a different situation to an intracapsular rupture and this is the sort of thing that most people will imagine when thinking about rupture of breast implants.
It takes a significant amount of trauma to forcefully rupture the implant shell and in these circumstances, the capsule may also rupture resulting in a change in the shape of the breast and the presence of free silicone within the breast tissue.
Silicone within the breast tissue can cause lumps and may travel to the lymph nodes in the armpit causing lumps here.
This is something that we saw quite a lot of during the PIP scandal where a French manufacturer was producing poor quality implants with a weak shell and a high rupture rate. These implants were filled with non-medical grade silicone which was irritant to the breast tissue and removal of these breast implants was recommended by the Plastic Surgery Associations.
The situation today is not as desperate as this because modern day implants have a thick shell (we only use premium breast implants which have a double shell).  Also, the gel in implants these days is firmer than it was in the past, this is known as ‘cohesive gel’ and we call the implants ‘form stable’ which means the silicone does not tend to leak like a liquid if the shell ruptures.
It does mean that modern day implants feel firmer than older implants, but they are safer in situations of rupture.
The silicone gel is medical grade and not so irritating to the breast tissue, but nevertheless, if there is an extracapsular rupture with free silicone in the breast, your implants should be changed.
An extracapsular rupture is normally quite obvious.  There will have been some significant trauma, like a road traffic accident with a seat-belt over the implant, and there will have been a change in the shape of the breast.
In these circumstances, a scan would be indicated.
In fact, in any situation where there has been a change in the size or shape of your breast, or if you have noticed a lump, then a scan may we’ll be required to make sure that all is well.

As well as a routine annual appointment, all of our patients have open access to the clinic and can make an appointment to come and see us at any time.

If you have noticed changes in your breast, then you need to get checked out.
This means that you need to see your surgeon, or your GP.  If you have breast implants in, then your surgeon will be able to get an idea by examining you whether you have a problem related to your implants or your breast.
If the problem is related to your breast and your breast tissue, then your surgeon may refer you to your GP to see whether you needed any specialist investigation or referral.
If it is felt that your problem is related to your implant, then a scan can help to delineate this, not only looking to see if the implants are intact but also looking for any suspicious lumps or swelling that could signify something more sinister.
For more information give us a call on 0121 454 3680 or email info@staianoplasticsurgery.co.uk.

Download Our FREE Guide With Frequently Asked Questions About Breast Implants Here

Mommy Makeover, 1 Op or 2?

Mommy Makeover In Birmingham

DOWNLOAD OUR TUMMY TUCK GUIDE

DOWNLOAD OUR BREAST LIFT GUIDE

DOWNLOAD OUR BREAST IMPLANT GUIDE

The Mommy Makeover is a term popularised by our American colleagues (hence the ‘o’ in Mummy) and is used to describe plastic surgery operations of the breast and abdomen combined.
The abdominal operation would usually be a tummy tuck or a mini tummy tuck and the breast operation could be a breast lift, breast reduction, breast implants or breast lift with implants. It is so called because it is surgery that might be needed following pregnancy due to stretching and descent of tummy and the breast.

However, the Mommy Makeover is not limited to post-pregnancy women and may be required by anyone who has had significant weight loss, because this too will cause the tissues to stretch and descend causing a redundant apron of skin in the abdomen and droopy breasts that have lost volume.

A Mommy Makeover is a significant operation, that is something that we quite commonly perform here at The STAIANO Clinic. You would need a full and frank discussion with your Surgeon, in fact you would normally need more than one consultation to go over all the pros and cons of having a Mommy Makeover, rather than having a tummy tuck and breast surgery at different times. As is the case with most things in plastic surgery, there are no right or wrongs. It is a question of weighing up the benefits against the risks to see what would be right for you.

OPERATION TIME

Tummy tuck and breast reshaping operations done separately are relatively major undertakings, and so to combine them does make it into quite a big operation. Either operating time would be longer than either one separately, but it would be slightly less than the time taken for each combined. Much of the time during surgery is involved in setting up, prepping and draping and anaesthetic time, and so there will be economies in performing it all in one go. However, the length of time of anaesthetic for a Mommy Makeover is usually between 5 and 8 hours and so this can knock you back and you will need to factor in adequate time for recovery.

RECOVERY

Again, the recovery following Mommy Makeover is much less than the tummy tuck and breast shaping if performed separately because your abdomen would be healing at the same time as your breasts, so essentially there is only one recovery period which is not much longer than it would be if you were having a tummy tuck on its own. This means that the time off work following a Mommy Makeover would be much less than if you were to have two operations and it might be easier for your employer if you were to take just one period of sick leave.

COMPLICATONS

Tummy tuck and breast reshaping surgery are not without their complications and you must be aware of this before contemplating surgery. There will be several wounds to heal and so the risk of some wound healing problems is greater than each separately, but no more than them combined. In fact, if there is a minor wound healing problem in the tummy or the breast then they can both be healing at the same time and so while the rate of complications might not be less, if you do get a complication in both areas, it can be easier to deal with as complications usually involve things like minor wound breakdown requiring dressing. Clearly, if you had a major complication in both areas it would be difficult to cope with, but fortunately the scenario is rare. As I mentioned the anaesthetic is quite long for a Mommy Makeover, but from an anaesthetic point of view it is safer to have one slightly longer anaesthetic than two shorter ones. It is a bit like air travel where the danger times are take-off and landing, it does not matter that much how long you are flying for. Similarly, for a general anaesthetic, dangerous times are on induction and when waking up from an anaesthetic.

PSYCHOLOGICAL ASPECTS

The psychological aspects of cosmetic surgery should not be under-estimated and any time you are changing the shape of your body there will be an emotional element to deal with. It can be a rollercoaster because in the initial post-operative stages the tissues are swollen, the scars are fresh and it is not uncommon for one side to behave differently to the other giving asymmetry. Most of these things settle but can take many months to do so and so you need to work closely with your Surgeon for the support to get you through this period.

Breast reshaping or a tummy tuck can induce immense psychological and emotional changes usually very positive, but can be difficult to acclimatise to particularly in the early stages. You may struggle to cope physically or emotionally and it is always best to address these issues before surgery and here at The STAIANO Clinic we have dedicated Counsellors who can help to support you, as well as the office and nursing team who will be with you throughout your experience.

If you feel that a Mommy Makeover is too much to take on then do not worry, it is very common to have the procedures in two stages, and to simply deal with the area of most concern in the first instance and recover and then consider having the other area done. This can be months or even years later depending on how you feel.

COST

There is a cost saving to having a Mommy Makeover compared to having the operations separately. It may not be as dramatic as you might think. The time spent in the operating theatre is very expensive and so the fact that the operating time is slightly reduced does have a bearing on the final cost. However, there is often not a dramatic difference in hospital stay as the tummy tuck usually has a 2 night hospital stay and breast reshaping a 1 night hospital stay, whereas a Mommy Makeover would be a 3 night hospital stay on average. And so, whilst there is a reduction in the overall cost this will probably not be the sole reason for choosing a Mommy Makeover. The other thing to consider is that payment is all required up front, whereas if you were to stage the procedures you would have time in between to prepare for the cost, although the hospital’s do provide 12 month interest free credit to help you spread the payments for any cosmetic procedure.

In summary…

I think it comes down to the individual as to whether you think a Mommy Makeover might be right for you. If you want one period of recovery and feel mentally and physically prepared for the changes that will take place, then there are definite benefits in having one period off work and one period of recovery and healing. However, if you are unsure or have one overwhelming area that you would like addressed then it might be worth having this addressed first and seeing how that heals and how you recover from it before considering having the other area dealt with.
If you want more information then please visit our pages on:

Breast Reduction, Breast Lift, Breast Augmentation and Tummy Tucks

Or, if you have any questions, then Jonathan is on Facebook Live every Tuesday night at 7 pm. Or you can email the Clinic or give us a call on 0121-454 3680 with any questions, we would love to hear from you.

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Capsular Contracture After Breast Augmentation.

What is capsular contracture?

Capsular contracture can happen to breast implants over time.

All implants have a capsule that forms around them.

A capsule is made up of scar tissue and it is the body’s reaction to the implant.

It is a normal reaction and it happens to all implants, no matter where they are in the body – in your hip, or your heart, in your chin or your eye.

The capsule is normal scar tissue and is nothing to worry about.

Over time the capsule (like all scar tissue) tends to contract and it is the capsular contracture that is the problem.

The problem is not with the implant, the problem is with the scar tissue that forms around the implant.

If an implant is solid like a hip implant or a chin implant, the contracture of the scar tissue does not have much of an effect on the implant.
However if the implant is soft, like a breast implant, then the contracture does have a constricting effect on the implant and this is what causes the problem.

 

Breast implant having been removed from its surrounding capsule, seen side by side.

Capsular contracture is a progressive condition and over time, the implant can start to feel hard, then it can start to look ’rounded’ and then it becomes uncomfortable.
That is the natural history of capsular contracture.
Capsular contracture is graded according to the following scale (Baker classification):

  1. Grade I capsular contracture: you cannot see or feel your breast implants (i.e. everybody has at least a Grade I capsule)
  2. Grade II capsular contracture: you can feel but you cannot see your breast implants
  3. Grade III capsular contracture: you can feel and see your breast implants
  4. Grade IV capsular contracture: your breast implants feel painful

No matter what the shape or profile of your implant, when the scar tissue contracts around it, it becomes spherical, like a ball.

This can make your breast look unsightly and feel uncomfortable.

For whatever reason, capsular contracture often only happens on one side which can lead to your breasts looking asymmetrical.

 

Capsular contracture is a progressive condition but it is usually very slow to progress.
Capsular contracture does not need to be treated and it is your choice whether you have your implants replaced.

Prevention of capsular contracture

There are a number of potential causes for capsular contracture that we work hard to avoid in order to minimise the risk of capsular contracture.

Small amounts of infection around the breast implant or a collection of blood around the implant (haematoma) can predispose to capsular contracture.

We do everything we can to minimise the risk of infection with breast implants and are very careful to control any bleeding at the time of surgery.

Fortunately the risk of infection and haematoma are very low after breast implant surgery.

Using textured rather than smooth breast implants and placing the implants under the muscle has also been shown to reduce the risk of capsular contracture, but probably the most significant thing that you can do to reduce the risk of developing capsular contracture is to use polyurethane foam coated breast implants.

These implants have not been widely adopted in the U.K. but have a been used in hundreds of thousands of women worldwide.

They are controversial and like most things, they have pros and cons and you can read my blog post about them here.

I think they are good implants and I use them a lot because I do not want my patients to have problems with capsular contracture in the future, but I discuss the risks and the benefits with everyone because ultimately it is your decision as to what type of implant that you have in your body and you need to be comfortable with the choice.

Treatment of capsular contracture

The good news is that capsular contracture is not a harmful condition and it is perfectly acceptable to leave it alone.

It does tend to be a progressive condition and so will probably get worse, but progression is usually slow and it can take many years for it to develop.

The bad news is that the only effective treatment of capsular contracture is surgery.

There are no tablets or creams or any other cures that have been shown to be effective in the treatment of capsular contracture.

Surgery involves removing the capsule (capsulectomy) and replacement of the breast implants.

This surgery is more extensive than the original surgery to insert the breast implants and so it is more expensive and because it is more extensive, it is more traumatic and creates more scar tissue.

Because capsular contracture happens in the first place because of scar tissue forming around the implant, another capsular contracture happens quicker after a capsulectomy and implant replacement than it does after the initial breast implant operation.

For this reason, my advice to patients is always to wait as long as possible before undergoing a capsulectomy in order to minimise the number of operations to your breast in your lifetime.

The type of surgery that can be performed on the capsule could be:

 

Capsulectomy

this is removal of the capsular tissue and can be partial or complete.  This can be quite an extensive operation and there is a risk of bleeding that can form a haematoma and cause the breast to swell up. This would require another visit to the operating theatre to evacuate and wash out the haematoma.

Capsulotomy

this is scoring of the capsule to release it and allow it to expand if a new implant is being placed (note, if you are changing from a silicone to a polyurethane implant, then a total capsulectomy should be performed to allow virgin tissue around the polyurethane implant to grow in to it).  This is usually performed in cases where there is only a mild form of capsular contracture otherwise capsulectomy would be needed.

Capsulorrhaphy

this involves using the thick tissue of the capsule to suture together areas of the breast pocket to manipulate the shape and appearance of the breast.

This is usually required in situations where the implants are being replaced because they are not sitting well in the breast pocket.
They could be:

  • Too high
  • Too low
  • Too far out to the side
  • Too close together in the middle (synmastia)

It may also be required if the implants are being replaced for smaller implants because the breast pocket may be too big.

The other situation where capsulorrhapy is useful is where there is a poor definition of the inframammary fold.  The inframammary fold is a very important feature of the breast as any surgeon who performs breast reconstruction after mastectomy will tell you.

A very important part of breast reconstruction is to recreate the inframammary fold and these techniques used in breast reconstruction can be transferred to cosmetic breast surgery if needed.

The inframammary fold is the part of the breast where a wire of a wired bra would sit.  If you look at the shape of a breast, it is not simply a dome on the chest wall.  In the upper part, there is a smooth transition from the upper chest to the upper pole of the breast, but it is important to avoid this shape in the lower pole.

The lower part of the breast has a defined and crisp fold which gives a natural shape to the breast as it sits on the chest wall.

This is important, not only so that the wire of a wired bra sits comfortably, but also to give a normal and natural look to the breast. If there is blunting of the sharp angle at the inframammary fold, then the breast lacks aesthetic appeal.

It can be difficult to recreate the inframammary fold in situations where it is not well defined, either following breast enlargement surgery or as a result of your natural breast shape.  This can involve a combination of internal sutures and capsulorrhaphy.

Want to know more about Capsular Contracture?

If you have any questions about capsular contracture or if you are worried about your breast implants, then you can get in touch with us here.

If you would like a free copy of our Breast Implants Guide, then you can request one here.

You can also see Mr Staiano, our director, on Facebook Live every Tuesday evening at 7pm, so you can ask questions there or post your questions to laura@staianoplasticsurgery.estaging.co.uk beforehand using the hashtag #AskJJ.