The Best Plastic Surgeons Weigh in on the Top 3 Cosmetic Surgical Procedures

In an ever-changing world, we have the ability to change what we do and don’t like about our physical appearance and many Americans are taking advantage of all that cosmetic plastic surgery has to offer. In the 2017 Plastic Surgery Statistics Report, The American Society of Plastic Surgeons reported that 1.7 million cosmetic surgical procedures were performed in the United States. But who is having what done and why? Some of the best plastic surgeons from around the nation weigh in on the top three cosmetic surgical procedures of 2017. Find out more about what the procedure accomplishes, what you can expect to pay, and how satisfied patients are after undergoing surgery.

Top Procedures in the United States for 2017

  1. Breast Augmentation: 300,378
  2. Liposuction: 246,354
  3. Nose Reshaping: 218,924

Breast Augmentation: Satisfaction Ratings and More

Women who want to increase the fullness and projection of their breasts and achieve a more proportionate look to their body can benefit from a breast augmentation. The average cost of breast augmentation surgery is $3,824, according to 2018 statistics from the American Society of Plastic Surgeons, but that price tag doesn’t include the type of breast implants used, anesthesia, operating room facilities or other related expenses, surgeon’s fees, or geographic office location. The total amount could be anywhere from $3,500-$9,200 depending on what you choose. A lot of plastic surgeons don’t expect you to pay the whole thing upfront and can create an individualized financing plan for you.

Typical recovery from a breast augmentation takes about a week. The best plastic surgeon will spend ample time with you evaluating your goals and expectations for a breast augmentation. In McKinney, TX, board-certified plastic surgeon Dr. Naveen Setty explains what a typical breast augmentation consultation at his office entails:

“I sit down with them, talk to them, find out their reasons for doing this and what their goals are. Then after we’ve taken pictures and I’ve examined them, I go through a full presentation on the pros and cons of getting a breast augmentation, the different kinds of implant choices, incision locations, where we put the implants, and why we put them there. We talk about the risks involved and the recovery. It’s one of our longer consultations because of all the education and detail that’s involved.”

The three breast implant types currently available are silicone gel implants, saline implants, and IDEAL IMPLANT® Structured Breast Implants. No matter which implant type you choose, breast augmentation satisfaction ratings are some of the highest on Realself.com, with 98% of patients saying their breast augmentation was “worth it”. Breast augmentation patients on Realself.com say they “couldn’t be happier”, are “extremely satisfied”, and “VERY VERY happy with the outcome” of their surgeries.

Sculpt Your Body with Liposuction from the Best Plastic Surgeon

Men and women who are tired of stubborn fat pockets that just won’t go away can improve their body contours with liposuction. “When I do liposuction I take it very seriously,” says Beverly Hills-based board-certified plastic surgeon Dr. Vishal Kapoor. “With the power assisted cannula [a thin medical wand] the actual machine provides vibrations . . . so it actually mechanically breaks up the fat . . . in terms of end results I think they’re better because there’s less surgeon fatigue, it’s much easier to extract fat in difficult areas, and it also minimizes bruising because there’s less in and out with the cannula. With one pass you can more efficiently extract more fat cells than with a non-power assisted cannula.”

The #2 procedure in 2017, liposuction carries a $3,000-$5,500 price tag, significantly less than the total most patients pay for a breast augmentation. Satisfaction among liposuction patients is also high, with 88% of patients saying this procedure was “worth it” on Realself.com.

“Ever since I was 15…yes 15, I have wanted lipo of my inner and outer thighs. I have always been self conscious of my upper legs, avoiding shorts or tight pants that accentuate the obvious. Over the years I have been to consultations but never decided on a doctor. After having 2 kids . . . I decided it was time for action. . . I only wish I made this choice years ago . . . ” – Realself.com review from sapplesmith

Reshaping Your Nose Can Restore Your Confidence

The third most popular cosmetic surgical procedure in 2017 was nose reshaping, also known as rhinoplasty. A rhinoplasty can perfect the proportions of your nose, correct impaired breathing caused by structural defects, get rid of visible humps on the bridge of your nose, reshape your nasal tip or nostrils, and provide more nasal symmetry. On Realself.com, 92% of patients say their nose reshaping procedure was “worth it”. The typical cost for nose surgery averages $7,300 according to reviews on RealSelf.com.

The best plastic surgeon should be able to tell you what they can and can’t do for your nose and face, and help you set realistic expectations. In Dallas, TX, board-certified plastic surgeon Dr. Gregg Anigian says, “Listening and asking questions is what I do. When the expectations that you, the patient wants, and the result that I think I can get mesh together, is when I think we both become comfortable with proceeding.”

One patient of San Antonio board-certified plastic surgeon Dr. Constance Barone said they were, “amazed and over joyed” with the results of their rhinoplasty. Another patient of Beverly Hills-based board-certified plastic surgeon Dr. John Diaz says her “dorsal hump and slightly bulbous droopy tip” just didn’t match the rest of the delicate features on her face and shecould not be more pleased” with the results from her rhinoplasty.

Picking the Right Surgeon for Your Procedure

Whether you choose to have a rhinoplasty, liposuction, or a breast augmentation, satisfaction during and after surgery can be greatly impacted based on the plastic surgeon you choose.

Newport Beach-based board-certified plastic surgeon Dr. Larry Nichter says, “The most important decision you can make is to pick your surgeon.” You deserve a surgeon who can help you feel beautiful about yourself and every aspect of your body. It’s imperative that before you have any kind of cosmetic surgery, you pick a surgeon who is board-certified by the American Board of Plastic Surgery, and also someone with whom you feel comfortable.

“For the few patients that just don’t want to travel and want to go to somebody local I think board-certification is always at the top of the list,” says Newport Beach board-certified plastic surgeon Dr. Jed Horowitz. “At least it’s a starting point to make sure your doctor has had appropriate training and has gone through appropriate testing to make sure that they have the correct information, the ability and the skill sets to do the correct operation. The next thing of course is experience, because with time and experience, most doctors get better at what they do.”

The best plastic surgeons should communicate clearly with you, educate you about your choices during every step of the plastic surgery process, and provide you with compassionate, quality care from start to finish.

After Plastic Surgery Most Patients Enjoy a Boost in Self-Esteem

Cosmetic plastic surgery is not for everyone, but in a recent study by the University of Basel:

“the vast majority of patients who undergo procedures report that they “felt healthier, were less anxious, had developed more self-esteem and felt more attractive.” Because having a positive association with self-imagine, higher confidence, and healthy self-esteem are linked to an increased level of happiness and life satisfaction, it is by no means a stretch to suggest that high quality cosmetic procedures can improve someone’s life.”

Change your life today! To find a board-certified plastic surgeon in your area, go to www.abplasticsurgery.org. For more patient reviews on specific cosmetic surgical procedures, including breast augmentation satisfaction ratings, visit www.realself.com.

Dr. Constance Barone Explains How To Pick the Best Breast Implant

We asked San Antonio plastic surgeon Dr. Constance Barone to explain what options women have when choosing breast implants. Dr. Barone is a board-certified plastic surgeon with over 30 years of experience. She is a respected member of the medical community and known for her work as an innovator in plastic surgery, an author, and a teacher. Her extensive background, training, and work has resulted in her designation as one of America’s Top Doctors by multiple professional organizations, patient review sites, and media outlets. Recently she was named an Ideal Implant Premier Surgeon because she is one of the most experienced surgeons performing breast augmentations with the IDEAL IMPLANT® Structured Breast Implant.

Dr. Barone is dedicated to providing the safest and most efficient procedures for her patients. She also believes each patient should have access to a variety of choices in order to reach their goals. She offers every type of breast implant at her plastic surgery center and works to educate each patient about the benefits and compromises of each. Read below to learn what Dr. Barone has to say about choosing the best breast implants for you.

Dr. Barone is dedicated to providing the safest and most efficient procedures for her patients. She also believes each patient should have access to a variety of choices in order to reach their goals. She offers every type of breast implant at her plastic surgery center and works to educate each patient about the benefits and compromises of each. Read below to learn what Dr. Barone has to say about choosing the best breast implants for you.

What Breast Implants are Available?

The FDA has approved 3 types of breast implants: saline breast implants, silicone gel breast implants, and IDEAL IMPLANT Structured Breast Implants. At Dr. Barone’s plastic surgery center, you can see and feel each implant to help you make your choice. Before and after pictures are also available so you can see what the final results will look like.

  • Saline implants are filled with saline (sterile saltwater), which is naturally and safely absorbed by the body if the implant ruptures. Saline has many medical uses, including IV fluids to keep patients hydrated.  A rupture can be detected immediately because the implant will deflate as the saline flows out of it and is absorbed by the body. These implants tend to visibly ripple and women complain that they feel unnatural, especially if they do not have much breast tissue or fat covering the implant.
  • Silicone gel implants have silicone gel inside the shell for a smooth and attractive result, but can give some women anxiety about potential complications. Silicone gel is not absorbed by the body, and it can be difficult to know if the implant has ruptured. Silicone gel has more recommended maintenance and a higher rate of rupture and capsular contracture than some other breast implant types. Many surgeons recommend replacing silicone gel breast implants every 10 years to avoid complications.
  • The IDEAL IMPLANT Structured Breast Implant is the newest breast implant type. Dr. Barone tells us, “it consists of a saltwater-filled structured breast implant. There is an outer fill valve, which covers the outer area, and then there’s an inner fill valve that covers the inner lumen. So, there’s actually two fill sites, which allows this implant to have a very natural feel, as opposed to saline implants, which felt hard and like a balloon.” The saltwater inside gives women peace of mind in the event of a rupture. Based on 8-year clinical trial results, it also has lower complication rates for capsular contracture and rupture compared to silicone gel breast implants.

How Does the IDEAL IMPLANT Structured Breast Implant Compare to Silicone Gel?

The IDEAL IMPLANT Structured Breast Implant was created to address common concerns with saline and silicone gel breast implants. Women should know about these concerns before they choose their breast implants. Dr. Barone explains the benefits and compromises of silicone gel breast implants, and how the IDEAL IMPLANT Structured Breast Implant compares:

“We like the feel of silicone gel implants. We just don’t like the fact that we should be getting MRIs at three years and every two years thereafter. That’s an out-of-pocket expense, which can be quite expensive. The other thing is, sometimes there’s silent ruptures. What’s that mean? That means it ruptures without you knowing it and silicone gel leaks out. And what happens when that happens? Well, you can get a hard, calcified capsular contracture, and silicone gel can migrate. There have been studies that show silicone gel has been found in the livers of people who’ve had a silicone gel breast implant augmentation. The IDEAL IMPLANT is called a structured implant because it has little sleeves in the shell, which allows it to have a buoyancy to it, so it feels more natural. It comes with a lifetime warranty. It also comes with a warranty for capsular contracture. We like the fact that this is a very, very user friendly implant. And do you have to exchange it out? No. If you’re having no problems, it’s intended to be kept in place for a lifetime.”

Overall, Dr. Barone believes the IDEAL IMPLANT Structured Breast Implant has many advantages over silicone gel breast implants and recommends them to women who want beautiful, natural looking results with peace of mind.

What Happens If a Breast Implant Ruptures?

What exactly is “implant rupture,” and how does it affect women? An implant can develop a small hole in the shell and begin to leak. In silicone gel breast implants, women may not notice a difference in their breasts, meaning the rupture is “silent,” as Dr. Barone described above. Or they may feel a hardening or tightening, or feel lumps. As Dr. Barone mentioned, the silicone gel may migrate out of the breast capsule and into other parts of the body. In a recent survey of over 900 women 98% reported they would be somewhat concerned to constantly concerned about silent rupture with silicone gel implants. Before the IDEAL IMPLANT Structured Breast Implant was introduced many women felt they had to make the difficult choice between constant concern with silicone gel breast implants, and the unnatural feel of saline breast implants.

The IDEAL IMPLANT Structured Breast Implant can also rupture, but there is no risk of a silent rupture. The saline inside begins to leak out of the implant and is safely absorbed by the body. A saline implant will deflate completely, leaving just the shell behind. Dr. Barone explains what happens when an IDEAL IMPLANT Structured Breast Implant ruptures, “one of the advantages of the IDEAL IMPLANT is that, if you get a deflation, it probably just deflates the outer sleeve so it’s not as obvious of a deflation.” This means that although you will notice a difference in your breasts, it will not be as obvious as with saline breast implants. You have the ability to plan a revision surgery around your life and your schedule.

The FDA recommends every type of implant be removed and replaced if a rupture occurs. The IDEAL IMPLANT Structured Breast Implant can easily be removed and replaced by your plastic surgeon. Silicone gel breast implants can be more complicated to remove after a rupture, especially if the silicone gel has migrated into the body tissues away from the breast capsule. The FDA explains what happens if silicone gel begins to travel outside the breast capsule, “The leaked silicone gel may cause lumps to form in the breast or in other tissue, most often the chest wall, armpit or arm. It may be difficult or impossible to remove silicone gel that has traveled to other parts of the body.”

How Do Breast Implants Compare Aesthetically?

Saline breast implants are often compared to water balloons because they are simply a silicone shell filled with saltwater. They are not as dense as breast tissue and may ripple under the skin. This can especially be a problem in women without much breast tissue or fat to cover the implant. Dr. Barone tells us “I was very excited when the IDEAL IMPLANT came out because one of the things I hated, and most women hated, about the saline implant was just the unnatural feel. They felt like balloons underneath the chest wall.” The internal structure of the IDEAL IMPLANT Structured Breast Implant gives it a smooth, natural looking result that many compare to the look and feel of silicone gel breast implants.

Dr. Barone tells us about the aesthetic benefits of the IDEAL IMPLANT Structured Breast Implant as compared to silicone gel breast implants. “One of the other advantages of the IDEAL IMPLANT is the fact that it’s got a nice contour to it. It’s not super high profile, so you don’t get that real full upper pole, but it’s a more natural look. The other advantage is that there’s less rippling associated with IDEAL IMPLANT. I know everybody says that silicone gel implants don’t ripple, but guess what? They do. There’s rippling associated with both types of implants, but I feel far less with the IDEAL IMPLANT.” Aesthetically, the IDEAL IMPLANT Structured Breast Implant gives women the natural, beautiful results they want.

How Does Dr. Barone Present Choices to Patients?

Patient choice and education are very important. No patient should ever feel pushed into a decision they feel uncomfortable with. Dr. Barone tells us how she presents breast implant options to her patients:

“When people make their selection in my office, I present all types of breast implants to them. I present to them the adjustable breast implant. I present to them the silicone gel breast implant. I present to them the IDEAL IMPLANT. And I present to them the saline implant. Why do I do that? I think that’s an important part of an informed consent. So a woman can make their own decision as to what type of implant they want. I give them brochures on all different types of breast implants so that they can do their homework and they can study on it. I’m an investor in IDEAL IMPLANTS because I believe in this implant. I think it’s a great choice for women who want a breast augmentation. Because, if it does leak, it’s only saltwater. I don’t try to influence my patients. I let them make the decisions as they feel and look at the implants. But I also tell them the pros and cons of all the implants. For breast augmentation, I think the IDEAL IMPLANT Structured Breast Implant is the choice today.”

How Should Women Choose a Plastic Surgeon?

Women should know it is important to choose an experienced board-certified plastic surgeon to perform your breast augmentation. A board-certified plastic surgeon has spent years training and performing plastic surgery procedures, learning about every complication and how to get the best possible outcome. Additionally, to maintain board-certification by the American Board of Plastic Surgery physicians must meet continuing education requirements and take exams periodically.

Dr. Barone is board-certified in plastic surgery, so her patients know from the first meeting that she is dedicated to providing safe and effective medical care. Her patient reviews reflect her level of professionalism and her compassion. Read what some recent patients had to say about their experiences below.

“I was very satisfied and comfortable discussing my options with the doctor. She was very attentive to my needs and met all expectations, always very friendly and professional. I love the new me and highly recommend her to make you happy.”

www.RealSelf.com user liviaodabachian

“Excellent doctor and staff! Very caring, they take time to answer questions and follow up. Would recommend to anyone! I have been coming here for years. What a difference it has made in my life and confidence.”

www.Google.com user Ruby Rupprecht

“Dr. Barone is the best of the best and I am very happy with my results. I highly recommend her to my family and friends. Go see her!”

www.Facebook.com user Carmen Pazmino

If you’re curious about plastic surgery, visit Dr. Barone’s website to see what procedures she offers in addition to breast augmentations. She is trained in “awake” surgical technique for patients who feel uncomfortable with full sedation. Dr. Barone’s office is a state of the art plastic surgery center and features a spa facility, a laser center, an outpatient center for cosmetic surgeries, and rooms for treatment and recovery. Her patients enjoy a relaxing environment that allows them to discover their full potential. Don’t wait to start on your journey to a new you, your only regret will be that you didn’t start sooner!

Considering breast implants in San Antonio? Contact Dr. Constance Barone today to discuss your options. Simply call 210-614-0400, or visit https://www.baroneplasticsurgery.com/. Dr. Barone’s office is located at 9502 Huebner Road, Building 2, Suite 202, San Antonio, TX 78240. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.

Dr. Leong on Breast Augmentation, Silent Rupture, and why she Likes the IDEAL IMPLANT®

At ZENA Medical in Newport Beach, California, you can be positive that you’ll receive the best care by Dr. Karen Leong. She understands what women look for when it comes to treatments for their face, breasts, and body. We recently interviewed Dr. Leong to learn more about a typical consultation and her thoughts on the new IDEAL IMPLANT® Structured Breast Implants.

Tell us a little bit about you and your practice.

“I have been in practice for a couple years now. I am an East Coast girl at heart but I love it here in California and I’m very excited to speak with you today.”

Can you tell us a little bit about what areas you focus on?

“In my practice, my philosophy is to journey with you throughout your life. I’m a woman, which means I’m going to go through the same body changes as you, and I want to be with you every step of the way. Your passions are my passions. I care about my face and my breasts and that’s what I want to focus on with you.”

Can you walk us through a typical consultation?

“When a woman comes in for a breast consultation, she usually has something in mind. Whether she wants to go bigger, perkier, smaller, or change the implants she currently has, she has an idea of what she wants. She tells me what she’s aiming for, and I work with her to achieve those goals. I talk with her through all the breast implant options. They may have concerns about ruptured implants, how silicone gel compares to saline, or the feel of the implant. We talk about what’s possible and make a plan together.”

How did you hear about the Ideal Implant?

“I heard about the Ideal Implant a couple of years ago. I was intrigued because if I were going to choose an implant for myself, I would want the security of knowing that if it were to burst, I don’t have to worry about silicone gel in my body. The fact that the burst rate of the Ideal Implant is less than 1.8% is amazing. The fact that if I have to worry about scar forming around the implant, that the rates are lower than both traditional saline and silicone gel implants. Plus, if I can have an implant that feels and acts like a silicone gel implant without the risks, I’m in.”

What’s been your overall impression of the Ideal Implant?

“After having Ideal in my practice, I find that I have pretty much gotten rid of traditional saline implants. I just don’t see any benefit in a water balloon when you can have something that looks and feels natural, lasts a long time, and has fewer complications. My patients feel the same way. Their biggest desires are to have a natural feeling implant with fewer complications, which this is. When we talk about price point I think it’s comparable. It’s an investment because if you’re looking at this in the long term, 10-30 years, is $200 a big difference? No. Think about what you’re buying and getting out of it and it’s worth it every time.”

How long can a woman expect her breast implants to last?

“If a woman has a silicone gel implant, my personal recommendation is to replace them every 10 to 12 years. They tend to break around that time and the FDA recommends that you have an MRI to look for ruptures. With the Ideal Implant, because it’s filled with saline, which is just salt water, you don’t have to worry about MRI’s and you save on that additional cost. If it breaks it’s not dangerous to you. Because of that, you don’t have to replace the Ideal Implant every 10 years, you can keep going as long as they do.”

What has been your experience with the Ideal Implant as far as patient satisfaction?

“For people who switch from their old implants to the Ideal Implant, it’s a world of difference. They’re just softer, more natural, they don’t ripple, and they have peace of mind. They’re very happy.”

What would you tell other surgeons about the Ideal Implant?

“It’s very easy to use. You can use a smaller incision than you would with the silicone gel implants. In terms of wound healing, lower rates of capsular contraction, and an almost non-existent rupture rate, it’s a really nice addition.”

Could you give us a quick sum up of your thought and feelings on Ideal?

“This is the implant I would choose for myself. It’s natural feeling. It’s filled with saline, so I don’t have to worry about rupture, complication rates are low, and satisfaction is really high. Plus it’s only offered by board certified surgeons. For me, the choice is pretty easy.”

Why do patients choose you over other surgeons?

“Well, I think I have a gender bias. I can relate to women on many levels, from insecurities about body image, the way they feel in their relationship, their sex lives, how they feel about having children, and everything in between. I also hope that the genuineness of my personality and the fact that I truly care are winning factors.”

Anything else you want to mention about your practice?

“Being in Southern California, I know you have a lot of choices. We are a dime a dozen in this field. I want you to make the choice that’s best for you and find someone that you’re very comfortable with because to be honest this is a relationship that I’m hoping we’ll have throughout your lifetime and throughout mine. I think my practice is special because we are a group of female physicians and we love the patients that we treat. We try to meet all your needs in a very welcoming and comfortable atmosphere. We want to make you feel the best you can about yourself.”

Considering breast implants in Newport Beach? Contact Dr. Leong today to discuss your options. Simply call 949-200-8222 or visit www.drkarenleong.com. Dr. Leong’s office is located at 359 San Miguel Drive Suite 300, Newport Beach, CA 92660. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.

Get to Know Atlanta Plastic Surgery Expert, Dr. Colgrove, and His Thoughts on the New IDEAL IMPLANT®

At Vinings Surgery Center in Atlanta, Georgia, you can be positive that you’ll receive the best care by Dr. Robert Colgrove. He understands what women look for when it comes to treatments for their face, breasts, and body. We recently interviewed Dr. Colgrove to learn more about a typical consultation and his thoughts on the new IDEAL IMPLANT® Structured Breast Implants.

Tell us a little bit about you and your practice.

I’ve been in private practice here in Atlanta since 1986. I’m board certified by the American Board of Plastic Surgery. We are located near the new stadium at interstate 285 and interstate 75.”

Why do you think women choose you?

“Women mainly choose our practice because of my extensive experience. I’ve done several thousand breast augmentations and breast lifts. Many patients that come in don’t realize they need a breast lift to get the correct result.

“We also offer the latest Vectra 3D simulation, which helps a patient visualize and understand what the various implants are going to look like. I also have an excellent staff, who’ve been with me for many years. Many of my staff have had plastic surgery, including breast implants. They’re very understanding and helpful as far as answering questions and getting you to feel comfortable with the process.”

Can you walk us through a typical consultation?

“When a woman comes in for a breast consultation, we begin with the Vectra 3D simulation. Vectra pictures will be taken, they’ll come back to the consultation room, then the nurse and I will go over the measurements and what we feel is going to be the definitive plan for this particular patient. We show them the various types of implants, along with the breast lift if necessary. Then my office manager will go over pricing, scheduling, the required blood work, and a preop visit can be scheduled if they so desire.”

Why is a breast lift only necessary in some cases?

“On the breast lift, we have measurements on the Vectra equipment that gives us a guideline. It’s just a guideline, we still have to look at the patient and see where they’re at. But typically if there’s a measurement of eight centimeters between the breast crease and the nipple, that’s typically too much for the implant to provide the necessary lift. Occasionally you can get away with it. Of course, I still have to see the patient in person and make a decision on that. But there’s the measurement, and then there’s also the elasticity of the patient’s skin. Obviously you have to examine the patient in person to determine that.”

How do you know which insertion approach to take?

“When a patient comes in we go over the various options for the insertion of the implant, you do have the axillary approach through the armpit, the areola approach, and the approach through the crease at the bottom of the breast. For most patients the crease incision is the favorable one. It heals the quickest, has the least amount of complications, and the quickest recovery. If you go through the areola area, obviously you have to go through some milk ducts, which could increase your risk of infection.

“Same with the axillary or armpit incision; there is a higher chance of infection. More pain, because you have to tunnel across from the armpit over to the breast. It’s a little harder on the patient because it takes more time for the patient to heal. Also, if they have an undesirable scar in the armpit, it’s impossible to conceal if they’re wearing a tank top or swimsuit.

“We’re certainly open to patients if they have a strong desire for one incision over the other. Some of our patients don’t scar well. Many of our Asian patient like the areola incision, because the scar is less detectable than the other areas.”

What are the long-term factors breast implant patients should consider?

“We tell the patient that they may need another procedure some point in the future, depending on several factors. Such as if they have a pregnancy after the procedure, that’s going to affect their breast. It may necessitate a breast lift at a later time. Also, the pocket of where the implants sit may change and have to be corrected.

“There’s a difference, we feel, between saline implants and silicone gel implants as far as the longevity and then need for further surgery. I tell my patients if they choose a saline filled implant and it doesn’t deflate, that they won’t have to change it. That’s assuming they don’t have a pregnancy, or rapid weight gain, or weight loss that would cause another problem.”

Why did you choose to offer the IDEAL IMPLANT as part of your practice?

“I’ve been doing this for 32 years and I’ve seen the pros and cons of the various implants. I think the IDEAL IMPLANT is going to cut down the need for future surgeries.”

How do saline and silicone gel implants compare with the structured IDEAL IMPLANT?

The typical saline implant is basically water inside a bag and it tends to be causing more ripples and wrinkles for the patient. The silicone gel implants are softer and more natural, but then you have to deal with the silent rupture issue.

“That means that the patient and I don’t know if they have a rupture or not, unless we do an MRI or actually open the patient and look at the implant. We prefer not to do that if we don’t have to. The FDA has recommended that patients with silicone gel implants have an MRI after three years and every other year after that. It’s very expensive. I don’t think most insurance companies pay for it, therefore a lot of patients are more likely to go with a saline implant.

“The IDEAL IMPLANT offers the advantages of feeling more natural than the typical saline implant and feels a little bit more like the silicone gel implants without the drawbacks of silent rupture and the frequent MRI’s.”

Do you do any saline implants anymore, or do you mainly use the IDEAL IMPLANT? 

“Well, patients will still sometimes use the regular saline implant just because of the cost situation. The IDEAL IMPLANT is going to cost more, but you’re going to get a better product.

“I think if they cost the same they’d probably go with the Ideal Implant every time, but we can’t really do that just because it is a more expensive implant. It’s a more complicated implant and it deserves to cost more.”

What has been your experience with silicone gel implant rupture?

“When silicone gel implants rupture, it becomes a very complicated procedure. Particularly, if they’ve been ruptured for a long period of time. I have seen patients that have had silicone gel implants for 30 to 35 years and probably been ruptured for many years. That takes several hours to take out the capsule and the silicone gel, which is basically free floating in the pocket.

“The capsule becomes very calcified and very painful for the patient. So, it’s a bigger surgery for the patient. You have to take out the capsule along with the implant, which means that there’s a need to put drains in for the patient and a longer recovery time. That’s the issue with a silicone gel implant that has been ruptured for a long period of time.

“Say you were getting the MRI for some other reason and you identified a rupture early. Then, you would still do a capsulectomy, but you probably wouldn’t have the calcification and the painful contractures.”

How does that compare to a leak with the IDEAL IMPLANT?

“With the IDEAL IMPLANT, if you need to change that out, you typically just remove the implant and put a new one in if the patient so desires. You don’t have to go through the process of cleaning up silicone gel because it’s filled with saline which is harmlessly absorbed by the body.”

How does this compare with handling a saline or IDEAL IMPLANT rupture?

“It’s a sterile saline that’s there and is easily absorbed by the patient. Most of the time there will be nothing there but the implant, which is easily removed. If you are changing the pocket, you may have to put a drain in.

“If there’s a deflation, patients usually call us on the phone and say, ‘Well, I was changing my clothes or putting my swimsuit on and noticed that my left breast or my right breast is smaller today. I need to come in and have it replaced.’

“They don’t have to spend money on an MRI, which is nice. It’s an easy diagnosis for them and for me. Again, it’s picked up early, not late.”

What would you tell other surgeons about the IDEAL IMPLANT?

A plastic surgeon in Ohio who was my mentor called me up and said, “I see you’re using these IDEAL IMPLANTS. How do you like them? What kind of problems have you had with them and so forth?

“I told him the experience has been very good, it has been very positive for both the patient and me. I feel good about putting the implant in, because I know I’m helping these patients in the long run avoid issues down the road. They’re not perfect. Nothing is perfect, but I would say that when you look at them long-term and the patient is not having to worry about the silent rupture, I think it’s worth it to both them and me.”

How do you help women make their implant choice?

When we’re doing the consultation, some patients come in and they think that they want silicone gel, but then we show them the IDEAL IMPLANT and explain to them the problems with silicone gel’s silent rupture and MRI’s. Most patients go with the IDEAL IMPLANT after they hear that. They like the safety aspect of it and they like the fact that they don’t have to come in every so many years to have the implant replaced.”

What has been your experience with the IDEAL IMPLANT as far as patient satisfaction?

“The patient satisfaction has been very good across the board. We haven’t had to go back in and remove them because they didn’t like them. I would say at this point it’s been very positive for the patient and the surgeon and continues to grow. It has basically overtaken my practice as the number one choice for breast implants.”

Anything else you want to mention about your practice?

“In summary I would like to say, here at Vinings Surgery Center, we have an accredited office surgery center where procedures can be done onsite. This makes it more private and confidential for you than going to the hospital. It’s going to be easier for you psychologically to have caregivers that understand why you’re here. A lot of my staff have breast implants so they won’t be judgmental. They will be supportive, which is helpful as far as giving you a positive experience.”

Considering breast implants in Atlanta? Contact Dr. Colgrove today to discuss your options. Simply call 770-955-9000 or visit www.colgrove.com. Dr. Colgrove’s office is located at 1900 The Exchange SE, Bldg. 300, Ste 300, Atlanta, GA 30339. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.

A Plastic Surgeon’s Perspective On Breast Augmentation

Dr. David Creech has been a board-certified plastic surgeon for 30 years. In his Chandler, Arizona, practice he has performed hundreds of breast augmentations. We sat down to ask him about his experiences and why he is excited to offer the latest breast implant technology, the IDEAL IMPLANT® Structured Breast Implant.

The IDEAL IMPLANT® Structured Breast Implant From a Surgeon’s Perspective

We asked Dr. Creech how he feels about the IDEAL IMPLANT® Structured Breast Implant, how it compares to saline implants and silicone gel implants. With 30 years of experience Dr. Creech has seen the good and bad of what breast implants have to offer. This gives him a unique perspective on the benefits and compromises of breast implant types.

“What I’ve found through the years is my lack of content with the implants available prior to IDEAL IMPLANT® Structured Breast Implant. Silicone gel implants are soft, but the IDEAL IMPLANT is also soft and has turned out to be a really good alternative to silicone gel. This is because you don’t need an MRI or a surgery to determine if the implant is leaking. With the IDEAL IMPLANT, if it leaks you’ll lose volume in the upper part of your breast, so when you look in your mirror you can tell that there is probably something going on. Through clinical exam I can determine whether there’s a leak or not.

“The other advantage of the IDEAL IMPLANT® Structured Breast Implant compared to saline implants is, it has very minimal wrinkling and very natural feel. That is in direct contrast to the older saline.

“I can also adjust the volume on the IDEAL IMPLANT to get more symmetry between the two breasts. With silicone gel, it comes pre-filled, so whatever size you choose is what you get. There’s no adjustments with that.

“Complications are low with the IDEAL IMPLANT® Structured Breast Implant. So far I’ve only had one capsular contracture with the IDEAL IMPLANT® Structured Breast Implant. I’ve had many more with the other implant types.”

The IDEAL IMPLANT® Structured Breast Implant vs. Silicone Gel Implants

One goal of breast augmentations is to make your breasts look as natural as possible. This is one reason women choose silicone gel implants and the IDEAL IMPLANT® Structured Breast Implant over saline implants. But how does silicone gel compare to the IDEAL IMPLANT in terms of softness and similarity to natural breast tissue?

“I have two implants here. One is the silicone gel, this is the softest implant on the market. The other is the IDEAL IMPLANT® Structured Breast Implant. The beauty of this implant is with the way it was designed, the IDEAL IMPLANT® Structured Breast Implant has two primary chambers. In between the inner chamber and the other chamber are multiple sub-chambers which have baffling between, so it allows the saline to go in and out between that outer chamber. That creates softness and diminishes wrinkling. I think with diminished wrinkling you also diminish the risk of rupture.

“When you squeeze an IDEAL IMPLANT it is very similar to silicone gel without the disadvantages that I think silicone gel has. The IDEAL IMPLANT company has shown statistically, for the first six-to-seven years, it has a much better track record versus the silicone gel and the saline implants. That’s a huge advantage.

“In terms of scarring, the two primary incisions that I use are the areola approach and through the inframammary crease approach. The scar for the silicone gel has to be a certain size to get it into the space. With the IDEAL IMPLANT® Structured Breast Implant, I can typically get the implant in safely, deflated, through a four centimeter incision. With the silicone gel implant, it could be as much as five or six centimeters, depending on the size and the projection of the implant. silicone gel implants go in already pre-filled, so you have to adjust the incision to allow for that to go through the incision.”

Breast Implant Surgery Tips

With so much information available on the Internet it is important that women follow the instructions given by their board-certified plastic surgeon. You may hear an anecdote about a woman who started exercising 3 weeks post-op and did fine! But is that woman putting herself at risk? Here, Dr. Creech discusses what recovery will be like and how women can ensure they get the best results from their breast implant surgery so they don’t find themselves back on the operating table.

“When I prep the patient, I want her to know that there are certain things I don’t want her to do prior to the surgery. One is taking non-steroidal pills, which can increase the risk of bleeding. In my career, I’ve had maybe three or four over the last 20 years. Every time a patient has been on Ibuprofen or a non-steroidals. That also increases bruising, which is not a problem as long as there’s no blood around the implant. Anti-inflammatories that are touted for good health can also cause a problem. In lay terms, they thin the blood, I want them to avoid that.

“Post-operatively is another thing. When you go below the muscle, the edge of the muscle is very fragile. I want the patient to take it easy. Don’t pull down a hatchback on a truck or a car, don’t do heavy lifting, don’t reach up high, don’t pull yourself up on a ledge, no working out. The working out part, depending on the type of workout, is going to be limited until four-to-six weeks. After that I don’t mind them doing a treadmill or something that does not use the chest muscles. The chest muscle can get back to a full workout at eight weeks. The reason for that is that muscle that has been divided at the bottom part isn’t strong enough to tolerate exercise for about eight weeks.

“Once the skin is healed, it’s like armor, it protects your implant from getting an infection. If you have an infection around the implant, the implant has to be removed for up to three months before a new one can be put in. I don’t want my patients to go through that, and I don’t want to have to replace an implant. I want a perfect result every time we do these operations.”

Considering breast implants in Chandler, Arizona? Contact Dr. David Creech today to discuss your options. Simply call (480) 899-3737 or visit www.davidcreechmd.com. Dr. Creech’s office is located at 485 S Dobson Road, #217, Chandler, AZ 85224. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.

Virginia Breast Implants: Why Dr. Michael Lofgren Says, “The IDEAL IMPLANT® is Fantastic”

At Plastic Surgery Center of Hampton Roads, you’ll find board-certified plastic surgeon Dr. Michael Lofgren to be professional, experienced, and compassionate. A New York native, Dr. Lofgren has been in the Virginia area for over 20 years. He specializes in cosmetic surgery, focusing primarily on breast and bodywork. In a recent interview, he spoke with us about his breast augmentation process, silent rupture, and the new IDEAL IMPLANT® Structured Breast Implants.

Why should patients choose your practice over others in the area?

“When a person is looking for a practice to go to and they’re considering having any type of breast surgery done, I think it’s important to make sure that they go to an accredited facility. They should look for plastic surgeons that are board certified. They should also be sure that the practice they’re looking into has a wide variety of experiences in dealing with the specific type of surgery they’re seeking. We’re fortunate in our practice that we have a quad-ASF certified facility. All of our surgeons are board certified and we do extensive breast and bodywork here.”

How do you guide women through the breast augmentation process?

“When we have a patient first come to us considering breast augmentation, we try to break down all the components that are important in making that decision. The first is, how are we going to place the implant? Where will the incision be? There’s a wide variety of ways to do that. We can make inframammary incisions, where we place the incisions underneath the breast, we can go with a transaxillary incision in the armpit, or we can make an incision around the areola or even through the belly button. Secondly, we look at exactly where we are going to place the implant. We decide if it’s going to be under just the breast tissue itself, or actually under the muscle, which is more common these days.

“We also look at the type of implant that’s going to be used for the breast augmentation. We used to be quite limited in that, with a traditional saline implant or a silicone gel implant as the only options, but thankfully now we have the IDEAL IMPLANT that offers a lot of tremendous advantages. Finally, we’ll talk about the overall size and type of look that the patient’s going for. That’s where we really get involved with the patient and help them determine what is going to fit their body the best and get them the results that they really desire.”

In your years of practice, have you noticed any trends over time in terms of breast implant size?

“In breast augmentation surgery, I think a lot of it is regionally dependent. I’m originally from the Northeast, where I tended to see much smaller breast augmentations, much more of a natural look. I did my training in Miami, Florida, and down there the overall size was a bit bigger than we see on a daily basis. And then here in the Mid-Atlantic, I think we fall somewhere right in the middle. Most women want an average size in the upper 300s to low 400 range, and I think that size still gives a very nice, more natural look.”

How did you hear about the IDEAL IMPLANT and when did you start using it in your practice?

“We had the opportunity to learn about the IDEAL IMPLANT very early. We started to hear rumors about the implant soon after it was developed, and we actually sought out the implant and did some research to find out more about it. Very quickly we saw the advantages of it, and we contacted the company. They had one of their sales reps come to us and spend some time with us, and so we’ve been offering the IDEAL IMPLANT as an option to our patients for a few years. It’s worked out tremendously for us.”

What are the advantages of the IDEAL IMPLANT to both the patient and the surgeon?

“The first advantage is the feel of the implant. Its overall feel is much improved compared to a traditional saline implant. I think that also translates into the appearance of the implant in the body. You see much less rippling, and you get a much more natural feel. I think the higher fill volume that’s achievable with the IDEAL IMPLANT also gives women a much nicer, fuller appearance. And then most importantly, when women select a structured saline implant over a silicone gel implant, it alleviates a lot of the fears they have about the risks of silent rupture, and having to perform routine monitoring of the implants and eventual replacement or removal.”

Are your patients satisfied with the IDEAL IMPLANT?

“When it comes to our satisfaction rates with IDEAL IMPLANT, I think it’s well above what our normal satisfaction rates are with other implants. I’ve found personally in my practice that I have much fewer women who complain about either visible or palpable rippling of the IDEAL IMPLANT. Years after women have breast augmentation surgery, they don’t have to worry about checking the implants or deal with the hassle of obtaining MRIs. That just makes for a more happy, satisfied patient in general.”

Complications are inherent to any surgery and breast surgeries have their sets. What has been your experience in complications with the IDEAL IMPLANT?

“When it comes to complication rates and the IDEAL IMPLANT specifically, in my practice I’ve seen a significant decrease in the rates of capsular contracture. As far as rupture is concerned, I think it’s also less than our traditional saline implants that we had used previously. And when compared to silicone gel implants such as the gummy bears or the anatomically shaped implants, we don’t run into the problems with malposition and shape issues that we had with those implants. Overall, I think the IDEAL IMPLANT has the least complications out of any of the implants that we currently use today.”

How do you educate your patients about the realities of silent rupture?

“When it comes to silent rupture in breast implants, I think that a lot of women are inherently concerned about it. Here at the practice we have a typical cohesive silicone gel implant that we’ve intentionally ruptured that we keep in a plastic bag to show patients what it’s going to look like in their body if their implant has a silent rupture. And honestly, even though it’s a cohesive silicone gel implant, it’s still just a gooey mess! People are absolutely amazed that that would be in their body. With the rates of silent rupture in silicone gel implants as high as they are, (and in my own practice I was quite surprised to find that there’s more silent ruptures than even I had suspected), the IDEAL IMPLANT is a great option for patients to alleviate that fear.”

What is it like to clean up a silent rupture?

“It depends on the generation of the implant. There are several different generations of silicone gel implants. Some have a more cohesive gel than others. I’ve found personally that when I have to go in and remove an early generation silicone gel implant, (or a non-cohesive gel implant), the tissue reaction can be profound. Cleaning out one of those pockets often requires complete capsulectomies. Quite extensive surgery. When it comes to the later generation silicone gel implants, even though they are a cohesive gel and the majority of the implant stays together, there is still significant leakage within the pocket that does require significant work to remove it, just not quite as much as the earlier implants.”

What is surgery like if an IDEAL IMPLANT ruptures?

“In the event of a rupture with IDEAL IMPLANT, it has several advantages over older silicone gel implants. The ability to detect the rupture is much easier. It’s just a simple change in shape or overall fullness of the breast, and you know quite readily that that implant has a problem with the shell. And as far as repairing it or managing that issue, it’s extremely easy. It’s just a simple 20 minute surgery to basically go in, remove the shell, place a new implant, refill it and close the incision. It’s much less invasive, much faster recovery, and much less of a headache compared to a traditional silicone gel implant.”

Are more women asking about IDEAL IMPLANT than just a few years ago?

“In my practice here, we’re very excited to have the IDEAL IMPLANT as an option for our patients. I think we’re truly at the cusp of seeing it absolutely explode as far as popularity is concerned. People are starting to come in asking for it by name. When women understand the inherent benefits of it and the decreased risks, the decreased rupture rates, the decreased risks of capsular contracture, and just the overall peace of mind, the implant really speaks for itself. I think we’re really at the very early stages of that. I know in my personal business, I’ve gone from doing 80% silicone gel implants now to doing about 35% silicone gel implants with almost all of that being a change into the IDEAL IMPLANT market.”

No other breast implant company besides Ideal Implant Incorporated can manufacture or sell the IDEAL IMPLANT. What has been your experience working with them?

“In looking at the company overall, they’re incredibly responsive to the individual surgeons and their patients. They’ve been very receptive to ideas as far as improving the implant and making adjustments to things. Just as an example, the enhancement of the warranty that’s now available with the implant is tremendous. We’ve actually gone so far as to package that as part of our normal breast augmentation package. It gives women an added reason to really trust in their product, something that’s going to be in their body for many years and it gives them that extra little bit of satisfaction and peace of mind.”

Any other thoughts about the IDEAL IMPLANT?

“The IDEAL IMPLANT is fantastic. Once I express to my patients the different characteristics of the implant and the natural advantages that it has over some of the other implants, women just naturally recognize it as the great choice that it is. I don’t think that there’s anything specific about the other implants that necessarily make them bad, it’s just that the advantages of the IDEAL IMPLANT are really head and shoulders above some of the other choices that are available.”

Considering Virginia breast implants? Contact Dr. Lofgren today to discuss your options. Simply call 757-873-3500 or visit www.PSCHR.com. Dr. Lofgren’s office is located at 895 City Center Boulevard Suite 300 Newport News, VA 23606. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.

Your Breast Surgery Questions Answered by Dr. Jed Horowitz

Dr. Jed Horowitz is a board-certified plastic surgeon at Pacific Center for Plastic Surgery in Newport Beach California. Dr. Horowitz has been practicing since 1985 and has expertise in many different areas of plastic surgery. We recently asked him about his experience in plastic surgery, what he thinks about the IDEAL IMPLANT® Structured Breast Implant, his breast enhancement recommendations, and more. Read below for his expert answers then visit his website to schedule a consultation.

How many breast enhancements do you perform and what is the breakdown of breast implant types?

“Breast enhancement has always been a big part of plastic and cosmetic surgery in general and, in our practice, it’s always been a large part. Along with breast enhancement, which is basically breast enlargement and breast augmentation, we also do breast lifts and breast reductions.

“Our practice probably 50% revision or secondary breast surgery because we have patients who have breast implants for 10, 15, 20, 30 years. Their bodies have gone through changes, their breasts have responded through their lives to all of these changes. Now maybe their breasts are sagging a little bit. Maybe they’re emptying in their upper part. Maybe the implants are too large, maybe they’ve gained weight and their breasts are just too large. Or they’ve had their breast implants for 20 years and it’s time for a change. Implants still play a large part in those changes.

“When I started doing the surgery a long time ago, the only implants that are available were silicone gel implants and traditional saline implants. We have silicone gel that’s more cohesive, more gummy bear or like jello, and some that are more liquidy. Then we have the IDEAL IMPLANT® Structured Breast Implant. The IDEAL IMPLANT is a structured implant filled with saline as opposed to silicone gel. It feels more like a traditional silicone gel implant because of the way it’s structured.

“The company spent more than ten years in developing and testing this implant. The idea was that if you put in inner layers into this outer silicone shell, it would slow down the flow of saline when you would touch the implant. It’s the way the saline flows through the implant that makes it feel more like a silicone gel implant. The saline doesn’t just slosh through the implant as in a more typical saline implant. It has a much more natural feel. It feels more like breast tissue. It feels more like silicone gel. It’s a great option for the women who has concerns about a silicone gel implant that still wants to have a breast implant. It’s just a great alternative for those reasons and several other reasons.”

How does IDEAL IMPLANT® Structured Breast Implant compare to traditional saline implants? Do incisions play a role in determining which implant you recommend?

“In my practice, I’ve been doing this long enough that I’ve used pretty much every implant that’s available and has been developed. We’ve used all the different incisions that are available. That includes incisions under the breast (inframammary), incisions around the nipple (periareolar incision), and incisions in the armpit (transaxillary). For many patients, we used to do a TUBA or transumbilical breast augmentation. The only scar is in the belly button. That’s the only time that we’ll use a standard traditional saline implant. The saline implants roll up very thin so can roll them up like a cigar when you insert them. You can make a small incision in the belly button, roll this up, make a small tunnel from the belly button to the bottom of the breast and then insert the implant in that matter. Currently the most commonly requested incision is actually under the breast. If I’m making an incision under the breast, there’s no benefit of using a traditional saline implant. It doesn’t feel as natural as breast tissue.

“The IDEAL IMPLANT® Structured Breast Implant is just a much better implant. We have now more than ten years of follow up. The complication rate for IDEAL IMPLANT® Structured Breast Implants is very, very low. When I say complication, in particular we’re talking about deflation of the implant where the saline just leaks out, and capsular contracture where you develop firmness around the implant. IDEAL IMPLANT has better statistics right now in their six year follow up then traditional saline implants and even traditional silicone gel implants. Those are other reasons why the IDEAL IMPLANT is just a better choice for many patients.”

How does the IDEAL IMPLANT® Structured Breast Implant compare to silicone gel options available?

“Even with a silicone gel implant, it’s still possible to see some of these same problems of rippling, wrinkling, waviness of the implant. And there are some women that still have concerns about silicone gel. Some women have had silicone gel implants for many years and have had what’s called “silent rupture” where the implant can actually leak and break and you don’t know it until you have a mammogram or an MRI. The recommendations are to remove all of the silicone gel, remove the capsule, and start fresh. A woman who has experienced that and now needs to have a new implant frequently will be concerned about having another silicone gel implant. That’s one group of women that frequently will switch to the IDEAL IMPLANT® Structured Breast Implant. Another group of women are women who know women who’ve had that problem and are concerned because their best friend had to have repeated breast implant surgeries because of problems with their silicone gel implant. They feel more comfortable having saline. When an IDEAL IMPLANT® Structured Breast Implant leaks, it doesn’t happen frequently and it happens less than silicone gel. But when it does, our bodies just absorb the saline, which is a natural part of our body. There’s nothing that’s fearful about that.”

How do you help patients who are trying to determine the best implant size for them?

“I think I’ve done pretty well on sizing over the years because I haven’t had anybody request a change in size for a long time. The number one cause for a secondary breast operation is for a women to change the size of her implant.

“The conversation starts off with education. I have to explain the difference between cup size and bra size and patient size. Their height and their weight and their size. A zero size versus a six or eight and what that all means relative to cc’s of volume of the implant. For some reason, this is just not intuitive to many patients when they come in. That’s a long discussion as part of the consult.

“Another part of the consult may involve a patient bringing in photos taken usually from a website of what she would like to look like. Then we have to look at the photos and see if her before photo looks anything like the patient. You need to look at the patient’s height and weight and see if they’re similar. If the patient brings in an image of a patient who is 5 foot ten and 145 pounds and she’s 105 pounds, the implant is going to be very different. We have to digest all of that information, then have a long discussion with a patient so she understands why we’re choosing a certain size. It’s confusing for the patients because the patients will go to three different doctors and they’ll come and see me. They’ll say, ‘I just saw doctor so-and-so down the street and they say I need 450cc.’ I say, “That’s great. That’s gonna make you a 32F cup. If that’s what you would like to be, that’s fine. That’s not what I think you want.’ It’s difficult for the patients sometimes. They get a lot of different information and it’s not always correct.”

What advice do you give to patients who are concerned about scarring?

“Most patients coming in for cosmetic surgery are concerned about the incisions or placement of the incisions. I always ask the patient what they’ve been thinking of because they’ve absorbed a lot of information from social media, the Internet, previous consults, what their friends have told them, so I always ask if they have ideas in mind.

“I spoke a little bit earlier about the incisions that are available. Most typically now, we’re not using the belly button incision. They’re through the armpit, around the nipple and under the breast. Some women are fearful now about the incision around the nipple or the areola because there’s some information saying there’s more bacteria and a higher risk of encapsulation. There’s some literature available to that, but I’m not sure it’s concrete. My personal experience, I think my rate of capsular contracture has been the same, regardless of the incision that we use. I personally think that there are good options for each patient.

“A patient who has a very small areola . . . they’re not a good candidate for an areola incision at all, it’s just too small. If we try to make the incision under the breast, if they’re very small and they’re very flat chested, they don’t have a good fold, and that scar will be more visible. For that patient, a transaxillary incision is a great option. Doctors who don’t do a transaxillary incision will frequently have bad things to say about it. They’ll say, ‘You can have bleeding, you can have nerve damage. You can’t place the implant correctly,’ and that’s all nonsense. Any doctor who has done that operation consistently knows you can get the same result with any of the incisions that I spoke about.

“For another woman that comes in and already has had children, maybe she has some laxity of her skin, she already has a well-defined fold under her breast, an incision under the breast is great. It’s going to be hidden no matter what, we don’t have to cut any of the breast tissue. When we do a periareolar incision, usually we’ll cut through the lower part of the breast tissue to get to the muscle or to go under the breast, so you’re disrupting a little bit more of the glands of the breast. When you make the incision under the breast in the fold, you’re immediately under everything. If a woman has more breast tissue, more gland, then going underneath the breast in the fold might be a better operation for her.”

How do you advise patients who aren’t sure which implant type to pick?

“Every woman is different, their breasts are different, their needs are different. I try to educate my patients and tell them what I think is best for them given all of the options. In my practice, silicone gel implants are still probably 85% of the implants that I use, but every year we’re putting in more of the IDEAL IMPLANT® Structured Breast Implants. Because patients now are becoming more aware of IDEAL IMPLANT and they are more readily available.

“When patients come in, before they just sit down and we start talking about silicone gel implants, I will give them a sheet of paper that discusses IDEAL IMPLANT, because they may not be familiar with it. It will outline why the IDEAL IMPLANT® Structured Breast Implant might be a better choice for them compared to the silicone gel implant, so at least it’s in their mind. They’ve had the ability to at least read about it and know that that’s an option. Then we’ll continue with the rest of the consult I’ve just discussed. At that point we’ll say, ‘What do you think about the IDEAL IMPLANT? Are you set on having a silicone gel implant? Is this of interest to you? Do you want more information?’ Then we’ll go from there. I like for my patients to make educated choices, to make their choices for good reasons.

“If they say, ‘I want this silicone gel implant,’ I ask, ‘Well, why are you choosing that?’ They’ll say, ‘I’ve been told that it’s this and this and this. I’ve felt them, I’ve read about it. I just think it’s a good choice for me.’ That’s great. Then if a patient is just reading about the IDEAL IMPLANT® Structured Breast Implant for the first time, I’ll say, ‘How do you feel about the IDEAL IMPLANT?’ They’ll say, ‘It’s the first I’ve heard about it.’ I’ll say, ‘Good. Why don’t you take home the information, here’s a website. Think about it. We’re not doing the surgery for six weeks. See if this is a good option for you and we’ll go from there.’

How long can women expect their breast implants to last?

“The longevity of an implant is something we’ll discuss at a consult. It’s an important discussion because the party line right now for most implants has been that implants will last about 10 years. That’s just all implants across the board, different companies, different styles of implants. Now there are doctors who’ve told patients, ‘You need to come in and replace your silicone gel implants at 10 years, you have to do that.’ Again, there’s no statistic, there’s no literature that supports that. I tell my patients that implants become weaker over time and at 10 years, you need to think about possibly having to replace them and it would be a good time at that point, if you haven’t already had mammograms and ultrasounds, to at least get that as a starting point, and if there’s any concern, to get an MRI, which is recommended by the FDA for a silicone gel implant.

“Now our own bodies don’t last a lifetime. We get arthritis, our knees give out, our shoulders give out, we get neck pain or back pain, so our bodies don’t last a lifetime. There’s no man-made device that lasts a lifetime. It would be great if our cars would last forever but they don’t. Man-made devices wear out. When you put a breast implant into a woman’s body, her heart is beating, she’s breathing. If she’s athletic she’s moving, her breasts are moving, there’s constant motion. If you think about taking a paperclip and bend that paperclip back and forth and back and forth and back and forth, you develop a weak spot in that paperclip, and at some point, it just breaks. Implants are no different, just like every other device, so over time, they will wear. Now some of the companies have been really good about warranting their implant, at least for 10 years, as IDEAL IMPLANT does. They will replace the implant if they become defective before that 10 year period.

“I have patients coming in that have implants that are 30 years old. I have patients coming in for their light lift facelifts and I’ll go through their medical history and they’ll say they had breast implant surgery 25 years ago. I’ll say, ‘Oh, that’s great. When did you replace them?’ They’ll say, ‘I haven’t replaced them.’ I’ll say, ‘Have you thought about it?’ They’ll say, ‘They’re fine.’ We’ll talk a little bit about that and why it might be a good idea to do a little bit of research on that and think about it, but there are a lot of patients, they just come in, they’ve had their implants for 10, 15, 20, 30 years and they’re good, they’re fine.”

Through your years in practice have you seen any trends in cosmetic surgery?

“I’ve been in practice for a while now and I’ve seen all the changes that have occurred with breast implants, breast sizing, types of surgery. Breast implants initially were pretty much mostly silicone gel. We had traditional saline implants then, but almost everybody had silicone gel placed. There were all almost always placed through an incision in the mammary fold. In the United States, they were almost always placed under the muscle. Since that time, we’ve gone through smooth implants, we’ve gone through textured implants. We’ve had textured implants with different types of texturing. Minimal texturing, coarse texturing, and all of that was focused at cutting down on scar tissue or the rate of encapsulation. We’ve gone through shaped implants, we had saline shaped implants, we’ve had silicone gel shaped implants.

“Those are trends with implants and now we have the IDEAL IMPLANT, of course, a much better structured saline implant, so it’s rare to use a traditional saline implant at all. I’ll just go to the IDEAL IMPLANT, and it’s a great name. It’s the ideal implant for that patient. The other big change, the other really big change in breast surgery has been, again, it’s called hybrid or composite breast surgery, there may be some other names that doctors use. It’s using a combination of your own tissue, your own body fat, and an implant or no implant.

“The hybrid operations are usually a combination of an implant, whether it’s an IDEAL IMPLANT® Structured Breast Implant or a silicone gel implant, and, again, the body’s own fat. You put the implant in and, if it’s just a breast augmentation, we may decide the patient needs a little bit more fullness in one part of the breast or the other, and because the implants are a fixed shape, they can’t take a customization of the contours. Most women have breasts that are unequal, they’re asymmetric, so the ability to correct small asymmetries by adding their own fat is a great advance. That’s a big change.”

Have size requests changed much over time?

“Size requests for implants go a little bit like fashion. When I started, Twiggy was really popular. Twiggy was a model back in the early ’70s and she was very young and she must have been like a size double zero, very flat chested, and that was the image of a model at that point in time. Women just wanted a little bit of breast enhancement. I mean, a typical breast implant volume in the late ’70s was probably 240cc for an average size woman. Then we got into the 1980s and 1990s, and everything got bigger, the world got bigger, breasts got bigger. We got to a point where the average size implant probably went up to about 375cc, 390cc.

“The average cup size, the average bra size sold was a 36C. If you went to clothing manufacturers, I think that’s what they would gear most of their clothing towards. Either a 34 or 36C was the average size. Along with that, that became the average size breast implant, and there were always extremes. Most women did not want smaller, larger sometimes.

“Now I think it’s going backwards. I think women now are coming in, some women are having their implants removed. A lot of those women are having a small lift, maybe they’ve had children. Maybe their bodies have changed a little bit. Maybe they’ve gained a little bit of weight. They’re now in their 40s or 50s. They’re beyond having that 375cc implant.

“Smaller implants also have less complications. Smaller implants have less problems of stretching of the skin, stretch marks, dropping into a low position below the fold. I think in general, smaller implants, they’re more modest, you’re placing less of a demand on the woman’s body. I think they heal better, longevity is probably better. Bigger breasts sag, whether you have implants or natural breasts. More weight and gravity is a bad combination, so it’s not just implants.”

As a surgeon, what do you like about the IDEAL IMPLANT® Structured Breast Implant? Why should women be aware of this option?

“First of all, I want to give my patients options, so it’s good having choices for my patients when they come in. For the patients that are concerned about silicone gel, and they’re concerned about the safety of silicone gel, I am happy to give them an alternative. And the only alternative I had before was the standard saline implant. And the standard saline implant doesn’t feel as natural as breast tissue or as natural as silicone gel, and has greater problems with rippling, wrinkling, or waviness for many patients. So for me as a surgeon, I like having the IDEAL IMPLANT as an option for all those patients, particularly the ones that have safety concerns.”

What is your advice for women who aren’t in Newport Beach to find the right plastic surgeon?

“For the few patients that just don’t want to travel and want to go to somebody local I think board-certification is always at the top of the list. At least it’s a starting point to make sure your doctor has had appropriate training and has gone through appropriate testing to make sure that they have the correct information, the ability and the skill sets to do the correct operation. The next thing of course is experience because you have young doctors. That’s great, when I was a young doctor, I felt I knew everything, and I knew a lot and I was good then. But with time and experience, most doctors get better at what they do. Also, I think the experience of the doctor who has used different types of implants, different incisions, different type of breast enhancement, I think it’s important because they’re not just choosing the one operation that they’ve learned how to do well.

“Because every patient is different. And one incision may be great in one patient, but the other incision might be better for the next patient. So to go to a doctor who has experience in doing the different techniques, the different placement of implants. Who has used the different types of implants. I think if you can get to a surgeon who has that experience, that’s a plus for that patient. It’s not always possible if you live in a geographic area where you have limited number of doctors. But that’s when it pays sometimes to travel.”

What information do women need for a successful outcome?

“We give our patients maybe too much information. There’s a lot of information that they get to prepare for surgery. And then a lot of information about what they can expect after surgery and the things they need to do. For a breast augmentation, it may be as simple as wearing a tape over the incision. All the stitching is always done underneath the skin, so there are never any stitch marks. But we want to support that initially, so we may use tapes.

“Now, full on activity, if we’re going underneath the muscle for a lift or an augmentation, we want to let that pectoralis muscle mend a little bit. So I may start to increase their activity over two to six weeks for full on activity. At six weeks we cut them free to do whatever they want. But again, things that they can do: taking care of the incisions with the products that we give them, wearing their sports bra or whichever bra that we feel is necessary for them for their particular operation, sometimes we use a support strap that goes over the top of the breast, if we need the bottom parts of the breasts to stretch a little bit. And that goes on over about two or three months. And those are most of the things we ask our patients to do.”

Why should women choose Pacific Center Plastic Surgery in Newport Beach?

“I think Newport Beach has many, many plastic surgeons. They have many well-trained plastic surgeons. I think what’s different about our practice, Dr. Nichter and I have performed surgery for many years now. We’ve done these operations every way they could be done, used every implant. And I think our experience is very important to patients coming to visit us. I think right now there are not many doctors in this area that have that level of experience with all the incisions, all the devices, different types of anesthesia, different operating room settings. Outpatient, inpatient, you know, we’ve done this surgery pretty much every way it could be done.

“Dr. Nichter and I also spend a lot of time researching products that are available to our patients. We were on the first group of people to start using IDEAL IMPLANT® Structured Breast Implants. We won’t do anything that is not safe, anything that we don’t believe in, anything that we feel has not been researched and studied. But as soon as we get to that point, we will get that device, that product, and make it available to our patients, if we think it’s something our patients will benefit from. Like the IDEAL IMPLANT® Structured Breast Implant. IDEAL IMPLANT and Sientra are the only two implant companies that will sell implants only to board-certified plastic surgeons. And I think that speaks volumes to the integrity of both of those companies. And it speaks volumes to our practice. Because a lot of doctors will continue to use the other implants because for whatever reason, they’re part of a buying program. If you buy Allergan products, use their Botox, get their implants, you have a better arrangement with that company. But we told that company, unless you sell only to board-certified surgeons, we will stop using your product. And now that we have two alternatives, that’s what we’ve done.”

Considering breast implants in Newport Beach? Contact Dr. Horowitz today to discuss your options. Simply call  949-720-3888 or visit www.PacificCenterPlasticSurgery.com. Dr. Horowitz’s office is located at 3991 MacArthur Boulevard, Suite 320/340, Newport Beach, CA 92660. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.

Dr. Larry Nichter on the Benefits of the IDEAL IMPLANT® Structured Breast Implant

Dr. Larry Nichter is a board-certified plastic surgeon in Newport Beach, California. A formerly tenured professor at the University of Southern California, Dr. Nichter now runs a successful private practice, Pacific Center Plastic Surgery in Newport Beach, with fellow surgeon Dr. Jed Horowitz. Dr. Nichter is a lead FDA investigator for IDEAL IMPLANT and has presented reports on the success of this new technology to the American Society for Aesthetic Plastic Surgery and American Society of Plastic Surgery. After nine years and over 100 cases using the IDEAL IMPLANT® Structured Breast Implant, Dr. Nichter has a unique point of view. We asked Dr. Nichter about his thoughts and experience with breast implants. Read below for his expert opinions.

What are the benefits of using the IDEAL IMPLANT® Structured Breast Implants?

“Well from a surgeon’s perspective, the best thing involved is you don’t really have to worry about silent ruptures. So silicone gel implants have a rupture rate that’s pretty high from 9% – 24% at 10 years. If silicone gel implants are ruptured, it’s not simply removing the silicone gel, you usually have to remove the capsule around the gel, the lining around the gel, called a capsulotomy. And that takes extra time, that can take half an hour to an hour per breast to do that.

“That’s in comparison to the IDEAL IMPLANT® Structured Breast Implant where if it leaks, you just simply remove it. Because of the high rupture rates, I tell my patients for silicone gel implants, just plan on removing them every 10-12 years, because after that the rupture rate is so high. You don’t have to do that with IDEAL IMPLANT® Structured Breast Implants. You can just leave them in until there’s a leak because it’s just simple saline, the stuff that’s in an IV solution. It’s incredibly safe and so there’s far fewer lifetime surgeries with an IDEAL IMPLANT® Structured Breast Implant, compared to traditional silicone gel implants.

“There are also many uses for the IDEAL IMPLANT® Structured Breast Implant. For example, it’s not just for primary augmentations, you can also use it for revision work, especially if the patient has had problems in the past with capsular contracture. In fact, the IDEAL IMPLANT® Structured Breast Implant has this incredible guarantee that they will give you in terms of replacing implant and helping the patients should a complication occur. It can be used not just in revisional surgery but at the same time as we do a breast lift.

“And lastly, although it’s not FDA approved for reconstruction during mastectomy, I do think in the future, once it’s FDA approved, this will be a great addition to our arsenal for reconstruction after breast cancer.”

Have you had to deal with many ruptured silicone gel implants in your career? What other complications could lead to a revision surgery?

“Oh yes. Ruptured silicone gel implants are just part and parcel, what we call bread and butter surgery for a plastic surgeon because of the high rupture rate. The other reason we operate on patients with silicone gel implants, and saline implants for that matter, is capsular contracture, that is, the hardening of the implant. The implant actually is soft, but the membrane around it, called the capsule, gets very thick and can actually squeeze the implant, distorting the way the breasts look, so making it quite hard.

“We were very surprised, in the FDA study looking at more than 500 woman, how low the capsular contracture rate was for IDEAL IMPLANT. In fact, it was significantly lower than silicone gel implants, which in the past had some of the lowest rates. So, that’s a huge advantage, another advantage of the IDEAL IMPLANT® Structured Breast Implant.”

How is patient satisfaction with the IDEAL IMPLANT® Structured Breast Implant?

“Part of the FDA study is looking at satisfaction. The women’s satisfaction is somewhere between 92- 94%, almost identical to what the surgeon’s satisfaction rate is. So they’re extremely thrilled with the results.

“My patients in general are thrilled about IDEAL IMPLANT. In fact, they tell their friends and their friends come in for it and so on. It’s very interesting that two studies were done last year. One of which looked at a very large volume of woman, more than like 930 woman. And they did a study and wanted to know, ‘Would you be concerned if there was a silent rupture of an implant, say a silicone gel implant? Or any type of implant. But if so, would you want it removed?’ Overwhelmingly, more than 90% said absolutely we would want it removed.

“I’m not sure if you’re aware of this, but the FDA has guidelines for silicone implants, their guidelines are very specific. They would like you to have an MRI scan at three years, and then every two years to see if you have a rupture because if you have a rupture of silicone gel implant, typically you don’t see any difference with your breasts so you would not know this. Women are very concerned about that fact. They don’t like having it and this survey, done by a third party, show that over 90% of the women, if it was a silent rupture, they wanted the implant removed.

“With an IDEAL IMPLANT® Structured Breast Implant, since it’s just saline that fills it, it’s wonderful. Instead of an MRI scan, you just simply use a mirror. But you can keep your implant not just 10-12 years, which is what I recommend for silicone gel implants, but for 20 years, 25 years. As long as it’s intact and okay. If there are no silent ruptures, that’s a huge advantage.”

Have you noticed any recent trends in plastic surgery?

“Well certainly the time is right to consider a more advanced breast implant. Women are health conscious, they’re looking for things that are natural and very healthy. There’s nothing more natural or healthy than saline. That’s what your body is filled of. So, that’s one of the reasons why I think the IDEAL IMPLANT appeals to many people.

“Many people are looking for organic foods and things, again, that have very low health risks. They don’t want to have to have lots of studies, like the MRI scan. For example, you have to make an appointment. It’s expensive. It’s not covered by insurance. You have to take time out of your life. And there’s worry. What are the results? What happens if it’s ruptured? The peace of mind factor is huge for patients, for women in particular. And here you have a natural product that’s just saline. If it ruptures, it’s just like getting an IV, you’re hydrated.

“But the bottom line is, it fits all the criteria of a more natural, healthy alternative to a silicone gel implant. And I see that as a huge trend.”

Have you noticed a change in the size breast implant women are requesting?

“Yes. So I’ve been doing breast augmentation surgery, using breast implants for reconstruction, lifts with reconstruction, mommy makeovers, for 30 years. During my first 10 years, every year implant size seemed to get larger and larger and larger in terms of requests by my patients. The middle 10 years, it seems like they mostly, slowly got a little larger. But the last 10 years, clearly women are moving towards smaller implants.

“They want something that’s proportionate. They either want to dress up and look very sexy or they would like to get in business clothes and be taken very seriously. They’re more athletic, again, health conscious and they want something that will fit many different aspects of their life. Again, the IDEAL IMPLANT is great because one advantage of the IDEAL IMPLANT, for example, is you can adjust the volume. So if you have breast asymmetry, you can get more symmetrical breasts. You can affect the profile.

“So you could have a more aggressive, more sexy looking sort of profile if you wanted to. Or you can have a very natural appearance. You have all the advantages of this, unlike silicone gel implants where you have to be very specific on which implant you pick. So you have the options on the operating table of changing the characteristic slightly to both match in size and shape, and also patient’s desires.”

Do your patients have any concerns about scarring after surgery?

“One advantage of the IDEAL IMPLANT® Structured Breast Implant is the implant is placed into the body deflated and then once it’s in the pocket, it’s inflated and filled. Because it’s deflated, you can use a much smaller incision, so therefore, there’s less scarring involved with the IDEAL IMPLANT. A silicone gel implant, in comparison, is factory-filled without seams and so in order to have an implant that’s sizeable, unfortunately, we need to make an incision that will accommodate it. So that’s a big advantage, there’s far less scarring with the IDEAL IMPLANT.”

What are your views on implant placement (above or below the muscle)?

“We take every patient on an individual basis. We ask them a lot of detailed questions. We have them bring in pictures of what they would like to look like. So a lot of women that have very little breast tissue, for example, and would like to be subtly improved, or to increase the fullness on the upper part of their breasts, which in general is the place where you lose volume with aging and, especially after pregnancy, we oftentimes will put it beneath the muscle.

“But there are other reasons. If someone has a little bit of sag and does not want a lift, putting the implant above the muscle or splitting the difference in what’s called a dual plane, where it’s partially under the muscle and partially over, can help augment and lift the breast a little bit. So there are many nuances and that’s why it’s really critical that you got a board-certified plastic surgeon such as myself, that has this experience and all the nuances in order to do the best job.

“The IDEAL IMPLANT company, I have to give them tremendous credit. The IDEAL IMPLANT company is [one of] the only implant companies that will sell to only board-certified plastic surgeons. So you know if you’re choosing IDEAL IMPLANT, just by choosing it, you know you’re at least going to someone with significant training and experience to get the results you want. And they will spend a lot of time with you and, hopefully, as we do, to make sure that you know all the choices, nuances of where to place the implant. Above or below the muscle and so on. Where scars will be. Whether you need a lift at the same time. And so forth.”

What complications do women need to be aware of before getting breast implants?

“So, when we’re looking at implants and you’re comparing different types of implants, in particular, let’s compare IDEAL IMPLANT® Structured Breast Implants to silicone gel implants. First of all, if you’re under the age of 22, only saline implants are FDA approved, so that would limit it to IDEAL IMPLANT. Virtually no one uses the traditional, old fashioned saline implants because the waviness or rippling and so on.

“But in terms of risks we already went through, there’s two to four times less risk of rupture and again, at least a two-fold decreased risk of capsular contracture with the IDEAL IMPLANT. Those are the two main complications.

“There are some rare, or I should say uncommon complications that are making the news. One of which is ALCL: Anaplastic Large Cell Lymphoma. It’s a cancer that’s not very aggressive, but the point is, although it’s been linked to several types of implants, it’s my understanding that approximately 80% or more are only found in textured implants. There’s a rough surface around the implant and that’s of interest. It’s the most common implant used outside the United States, especially in Europe, South America, and Central America. This form of cancer, especially with certain brands of implants can be significantly high. As much as 1 in 5,000, or less as time goes on, because it takes many years, at least eight to ten years or so, for most of these to develop.

“But the IDEAL IMPLANT® Structured Breast Implant is a smooth implant, so that would put you at the least possible risk. To my knowledge, there’s never been a report of ALCL with any implant by the IDEAL IMPLANT Company. We’re now up to year nine in our study, which will end at 10 years. So it’d be the lowest of all the rates in developing this unusual type of problem.”

How do you help women choose the right breast implant?

“Choosing implants is a difficult choice and we understand that. We’ve made a pretty simple chart comparing, on one side, silicone gel implants, and saline implants, particularly the IDEAL IMPLANT® Structured Breast Implant, on another. So, for example, incisions are smaller with the IDEAL IMPLANT® Structured Breast Implant. There is less risk of capsular contracture (that’s the hardening of the implant). And less risk of rupture, significantly between the two. There’s no silent rupture. You don’t have to worry about, ‘Is it ruptured or not?’ You know immediately. Therefore, we don’t recommend that the IDEAL IMPLANT® Structured Breast Implant is replaced 10-12 years, unlike a silicone gel implant. You can keep them in as long as you want. So therefore, there’s less lifetime surgeries.

“Then lastly, again, we just let them know that the contents are just saline. It just leaks out. If there was a rupture with a silicone gel implant, chances are you would need to remove the outer lining around it, which is a much larger procedure and may require drains and so on. That’s just not required with the IDEAL IMPLANT® Structured Breast Implant.

“But it used to be that about 90% of my patients, up to 95%, would pick silicone gel implants, and maybe only 5% saline. Now, it’s easily the majority of my patients pick IDEAL IMPLANT® Structured Breast Implants after I present that information and allow them to read about it. And I’m thrilled.

“Here you have something with all the advantages of a silicone gel implant, without the disadvantages. So, it’s a win-win situation. My patients usually are very well educated. Many of them find me because I have some of the largest experience in the country placing these. And they come to me with that specific reason. If they haven’t heard about them I just mention, ‘why don’t you do some research? Here’s some scientific articles reviewing it.’ They make the decision really quickly and they’re in a very informed way. Invariably, the majority now pick IDEAL IMPLANT® Structured Breast Implants.”

Do you have any advice for women who are considering breast enhancement surgery?

“Well first of all, the most important decision you can make is to pick your surgeon. The second most important choice you can make is to pick the safest product to use, or one that matches your wishes, goals, and ideals.

“So one, you have to pick a board-certified plastic surgeon. But I have to tell you, I work in Newport Beach, Orange County, Southern California. And I would think that at least half of the implants placed in my area are placed by non-board-certified plastic surgeons. What do I mean by that? Ear, nose, and throat doctors are doing it in this area. OBGYNs are doing it. General surgeons are doing it.

“And doctors don’t know. They say very truthfully, ‘I am a board-certified surgeon, doing plastic surgery.’ Dermatologists are even starting to do these. A plastic surgeon trains longer than just about every speciality out there with the exception of a few, like neurosurgery, cardiothoracic surgery. They train about the same length of time.

“So you really want someone who is skilled with both the anatomy and function, and all the potential problems that could go wrong, which fortunately are very few. But in terms of getting a result that’s excellent, you just need to pick that right person.

“The second thing is that many surgeons feel comfortable with what they trained with. The IDEAL IMPLANT has only been around for just under five years. So although there is a very large experience which is growing significantly and dramatically, sometimes surgeons are set in their ways. So it behooves patients to sometimes even educate their doctors. Say, ‘I’ve been reading about this implant. I think I would like to use it.’ And to encourage their doctors if they don’t know about it, to find out about it. It’s very simple to use. But I think that I can just see the rate of which the growth is happening with the IDEAL IMPLANT, and my personal prediction is within the next 5-10 years, it’ll be one of the more popular implants in the U.S. and Canada.”

What can you tell us about your plastic surgery practice?

“I’m part of a two plastic surgeon practice in Newport Beach, California, called Pacific Center for Plastic Surgery. In this office, we place more IDEAL IMPLANT® Structured Breast Implants than, I believe, just about any practice in the United States. As one of the lead FDA investigators, I’ve read through most of all the peer reviewed journal articles on the IDEAL IMPLANT, and that takes everyone’s experience, all the 45 investigators of all the women patients across the country, and I have access to the data that’s been published. I’m just thrilled with the results.

“I think that going to someone who has lots of experience is always one of the best choices you can make. Fortunately there are plastic surgeons across the entire United States that have that experience. We of course would welcome anyone to our practice, to educate them about their choices, and in particular about the IDEAL IMPLANT.”

Considering breast implants in Newport Beach? Contact Dr. Larry Nichter today to discuss your options. Simply call 949-720-3888 or visit www.PacificCenterPlasticSurgery.com. Dr. Nichter’s office is located at 3991 MacArthur Boulevard, Suite 320/340, Newport Beach, CA 92660. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.

Dr. Joshua Waltzman on Breast Augmentation, Silent Rupture, and Why He Likes IDEAL IMPLANTS

At Waltzman Plastic Surgery in Long Beach, California, you’re in the capable and experienced hands of board-certified plastic surgeon Dr. Joshua Waltzman. A Long Beach native and USC alum, Dr. Waltzman offers both invasive and noninvasive treatments for the face, breast and body. In a recent interview, he spoke with us about his practice, the breast augmentation process from start to finish, and the new IDEAL IMPLANT® Structured Breast Implants.

Why should patients choose your practice over others in the area?

“Women choose our practice because they feel very comfortable here. I’m the only surgeon, and our staff is small. Patients aren’t walking into this overwhelming office with multiple doctors and clinicians and equipment surrounding them. When they walk in, they feel like they’re coming into our family. Patients will talk to the staff and get to know each other’s families. We really do have a sense of community here that distinguishes us from other practices. My staff and I also spend a lot of time with our patients. I am deeply invested in listening to all of my patients’ concerns and goals. When it comes to breast augmentation, there are a lot of specific things women are looking for that are important to hear and discuss before the surgery takes place. So I think taking the time to listen also sets us apart.”

Who makes a good candidate for breast augmentation?

“Someone who is in good health, doesn’t smoke, has breasts that sag or have lost volume, these are all women who are good candidates for breast augmentation. Most women who come in want to have bigger breasts, and I try to explain that an augmentation alone will simply make you a natural, larger version of what you are. So, if your breasts are naturally close together, after an augmentation they will still be naturally close together, just bigger. And on the flip side, if your breasts are naturally spaced a little bit further apart, your augmentation will make them larger, but they will still be spaced the same distance apart.

“If women are desiring to have other changes made, whether it’s making the nipple position higher, making the breasts smaller, or changing the overall architecture or shape, then we have to talk about other procedures in addition to augmentation alone. Typically, my patients are moms who are done having children, they have some volume deflation from the breasts after breastfeeding, which is natural, and also some descent or lowering of the nipple position. And in some of those cases, we have to combine a lift, either at the same time, or before doing an augmentation.”

Can you guide us through your specific breast augmentation process?

“It all starts with a physical exam. Taking really detailed measurements of the patient to customize their augmentation or their implant selection choice is paramount. Beyond that, we talk about implant placement. We talk about why I might choose to place the implant above or below the muscle. Of course, that’s influenced by the patient’s starting breast size and how much soft tissue, or how much breast they initially begin with.

“Another choice we make is the location of the incision. I prefer to do most all of my primary augmentations (meaning first time breast augmentations) through what’s called an inframammary approach, which is a small three- or four-centimeter incision tucked right in the breast fold. There is a lot of data that shows that this approach leads to lower capsular contracture rates, lower infection rates, and it gives the surgeon a much better view of the implant pocket when you’re designing it. It’s really the best approach for breast augmentation. The scar is always there, but it fades quite nicely. And when it’s in that fold, it really is a non-issue. Now, if a patient comes to me and has pre-existing scars from elsewhere on the breast, whether it’s an areola scar or elsewhere on the breast, I’m happy to use those. But my preference is for an inframammary approach.

“We talk about all the different types of breast implants out there, and discuss which one the patient might have a preference for. The patient’s physical measurements will help dictate implant selection to a large extent. We also talk about what their goals are. Are they just looking for a subtle natural enhancement? Or are they looking to revolumize what they have lost after pregnancy and breastfeeding?

“In my office, I like to use a 3D simulation software. I scan all the patients in the exam room during the consultation. It takes about 30 seconds. And on the iPad, right there, we can do a full 3D simulation and start trying on different implant sizes with pretty good accuracy. That’s been a great way for patients to picture how they will look with a certain pair of implants. It’s one thing to see implants on a before and after picture of someone else. You may not know anything about them. They might have a different frame. Before and after photos usually mean very little to a patient, until they see how the implants will look with their own skin markings, freckles, etc. If they have a tattoo, that will also be in the 3D simulation, and that really drives it home for them.”

What are your thoughts on silent rupture with silicone gel implants?

“I’ve had multiple patients who have experienced some type of silent rupture. The more common scenario is that I find the rupture during an implant exchange and/or upsizing or downsizing. I discover it once I am operating on the patient, which is really the ultimate silence. It wasn’t identified with any preoperative imaging, so my patient didn’t even know about it.

“With older silicone gel implants, the gel can be pretty messy. It’s much stickier, it tends to run. Getting all that gel out requires additional time in the operating room. With some of the newer generation silicone gel implants, the gel is more cohesive. If there’s a rupture, the implants tend to come out quite a bit easier. But obviously, with saline implants, that’s not an issue. You know right away if there’s a rupture, and in that case, you’re only spilling a little bit of saltwater into the breast cavity which easily gets absorbed harmlessly by the body.”

Why do some surgeons still push silicone gel implants on certain patients?

“Silicone gel may be the right choice for patients who have very thin tissue coverage. So, either they’re very thin patients, or their breast tissue has been stretched, and their breast tissue coverage is very thin. For women with this thin breast tissue coverage, they may be able to feel a more obvious difference between silicone gel implants, saline implants, and the IDEAL IMPLANT.

“So that’s one thing I bring up for patients that are very thin. But I always try to give my patients the option that they are most comfortable with. Sometimes my patients will say, ‘Oh my sister had saline, my aunt had saline, my mom had saline. I’m having saline,’ and there’s not even a discussion to be had.

“I think educating my patients and presenting all their options, including the risks and benefits of each one is always the way to go. At least that’s how I do it in my practice. And there are certain patients who will push for one direction or the other, but for the vast majority, it really is kind of a decision for both of us.”

What are the the benefits to the new IDEAL IMPLANT technology?

“There are many benefits to the IDEAL IMPLANT. My experience with the IDEAL IMPLANT has been only positive. I routinely present it, during all of my breast augmentation consultations, as a third option. For breast augmentation we have silicone gel, regular saline, and then we have the IDEAL IMPLANT, which is a structured saline implant. The IDEAL IMPLANT is surrounded by a silicone shell, but it’s filled with saline. The inner shells provide more structure to the implant, and the inner baffling on the shells helps prevent that water balloon effect that women with saline sometimes complain about.”

How can a woman know if there is a leak or rupture in her IDEAL IMPLANT?

“With traditional saline, once an implant is popped or ruptured, it’s completely gone. It’s more of an all-or-none type phenomena. That creates some aspect of emotional distress because the woman will have one breast that is fully inflated and the other will be completely deflated. And that could be troublesome for finding bras and clothing, going out, all these things, until you have the implant fixed. The IDEAL IMPLANT brings peace of mind to a lot of women. If there’s a problem with your implant, you’re going to know fairly quickly. You’ll notice some deflation, but due to the dual chamber nature of the IDEAL IMPLANT, it’s unlikely that both the front and the back chamber of the implant are going to become ruptured at the same time, so you won’t lose all of your volume. This can buy the woman some time before she actually needs to have the implant fixed.”

What types of patients can benefit from the IDEAL IMPLANT?

“Patients who are good candidates for the IDEAL IMPLANT are those who are looking for a fuller, rounder breast look. The IDEAL IMPLANT gives women a moderate plus-to-full kind of profile if you equate it to the silicone gel equivalents. If a patient wants to fill out a deflated breast pocket, I also think the IDEAL IMPLANT is a great option.”

What has been your experience in terms of patient satisfaction with the IDEAL IMPLANT?

“Patient satisfaction after IDEAL IMPLANT has been incredibly high. I’ve had no patients come back saying they wish they’d picked another implant. I present data to my patients on the lower rupture rates and lower capsular contracture rate for the IDEAL IMPLANT. This data gives my patients even more peace of mind. I’ve had a number of IDEAL IMPLANT patients who have actually slept good, based on that data alone. I haven’t had anyone complain of the IDEAL IMPLANT rippling like other saline implants tend to do. Overall, I’ve been very impressed with the positive feedback I’ve received on IDEAL IMPLANT. My thought is, since we have this new breast implant technology, why not use it?”

Considering breast implants in Long Beach, CA? Contact Dr. Waltzman today to discuss your options. Simply call (562) 448-6100 or visit www.waltzmanplasticsurgery.com. Dr. Waltzman’s office is located at 3828 Schaufele Avenue, #360 Long Beach, CA 90808. Call today for more information on IDEAL IMPLANT Structured Breast Implants.

Picking the Right Implant: Knowing Your Options with Dr. Paul Zwiebel

Board-certified plastic surgeon Dr. Paul Zwiebel has over 30 years of experience in cosmetic surgery. At his private practice,the Zwiebel Center for Plastic Surgery and Skin Care in Denver, Colorado, he has performed thousands of breast augmentations, along with many other types of cosmetic procedures. Dr. Zwiebel is committed to helping his patients achieve beautiful outcomes by providing quality care for each individual. We’re talking with him today about all the options out there for your breast augmentation, including the types of implants, scarring, selecting a plastic surgeon, and the new IDEAL IMPLANT® Structured Breast Implants.

Why should patients choose you over the other surgeons in your area?

“Over the years, we have refined our consultation process for breast augmentation so that it is  really driven by each individual’s priorities and needs. In my opinion, the consultation experience should be an educational experience. Patients should become educated about the procedure, the techniques, and in the case of breast implants, the technology. We have a three-dimensional imaging system which my patients really appreciate. Women can see their own image with the various types of breast implants, both in terms of shape as well as volume. It’s a tremendously beneficial tool for a lot of women, to help them understand the implications breast implants will have on their figure.

“During the consultation, we discuss all the breast implants out on the market today in terms of size, shape, and material: saline, silicone gel, smooth or textured, round or teardrop, etc. I discuss the trade-offs among the implants and the advantages and disadvantages to each one. We pride ourselves in being one of the few practices that really offers every option out there to our patients, and I try to make sure they understand all their different choices.”

How do you help women decide on the right breast implant size specifically?

“I have my patients try on implants so that we can get a sense of what look they want, and then we build on that. During the examination, I take specific measurements of each person to make sure that we’re selecting an implant that will fit anatomically. Then, from there, we’ll go on to some of the aesthetic considerations. We discuss how much volume it’s going to take to create the appearance that an individual woman is looking for and if that’s achievable or not.

“We then go on and do the three-dimensional imaging, which is, again, tremendously helpful for women to get a better sense of proportionality and balance in their figure. Proportion is really what most women are trying to achieve. We strongly encourage our patients to then sign out the implants that they’ve chosen, in the specific size that they like, and actually take them for a test drive. I want my patients to wear them home, try on different clothes with them, make sure that the implants are giving them the balance to their figure that they really like. I even suggest bra shopping with the implants on to see if they fill out the bras in the way that they want to fill them out. We don’t want any surprises post-op that the implants are a little bit too big or a little too small for the bras that they would like to wear.”

What type of incision should a woman choose for her breast implant surgery?

“Data has continued to show that incisions placed in the breast crease produce a very high level of patient satisfaction. This is because the scars are hidden in the crease, but just as importantly, these incisions have the lowest incidence of complications like capsular contracture and interference with nipple sensitivity. We’ll usually encourage the approach through the breast crease. Other options can include going in through the armpit or going in through the areola, but they do carry higher complication risks.

“The size or the length of the incision is going to depend on the type of implants you choose. With silicone gel implants, the length of the incision is proportionate to the volume, so the bigger the implant, the bigger the incision we need for placing the implant. That’s not the same with saline implants. Because we place the saline implant deflated, and we actually inflate the implant once it’s inserted in the breast, we can make a small incision, typically an inch or slightly less in size for almost any size implant. A smaller incision is one of the advantages of saline implants.”

If a patient has to have a breast implant revision due to a rupture, is there any benefit to having a saline or structured implant versus silicone gel?

“One of the classic advantages of saline implants and why women have selected them in the past is that saline implants are filled with salt water, a natural occurring substance in the body. So if the saline implant were to leak, that salt water is absorbed and doesn’t harm the woman. Many women find that very comforting from the standpoint of a margin of safety. In comparison, silicone gel is not absorbed into the body.

“If somebody were to develop a leak with a saline implant, they’ll notice some degree of deflation. With regular saline, the implant will completely deflate, typically over a period of two to three days. With the new IDEAL IMPLANT, which are structured saline implants, only the outer shell of the implant deflates. A woman will notice the change, but it’s not going to be as dramatic.

“When we’re replacing a saline implant, whether it’s the classic or the structured saline, one of the great advantages in the replacement is its simplicity. We typically use a local anesthetic and just inject the same incision that was made before. Through that incision, we’re able to remove the old implant and replace it with the new one in a procedure that typically takes about half an hour with no downtime. Most of the time, when patients have a replacement, they can just continue with their daily activities, so there aren’t any special recovery issues.

“A disadvantage of silicone gel implants is that if they do develop a leak, there is the issue of detection. Unlike the saline, it becomes a little less obvious to detect a leak with silicone gel, because the silicone gel can’t be absorbed by the body. It doesn’t go anywhere. Those leaks are usually detected with studies likes mammography, ultrasound, or even MRI. Clinical symptoms of a deflation with silicone gel implants or manifestations might be a new mark or bump or, perhaps, the development of capsular contracture. When we’re replacing a silicone gel implant, we have to remove the old gel. Sometimes that can be done through the incision or through the old scar and the use of a detergent rinse to remove the old silicone. Other times, however, particularly if there’s been capsular contracture, we have to remove the old capsule as well. With silicone gel implants there is a potential risk in delaying the diagnosis and not appreciating that a leak has occurred, and there is also a potential that the operation to replace the implant may be a little bit more involved and a little bit more lengthy.”

How can women make sure they are getting an excellent plastic surgeon for their breast augmentation?

“Fortunately, there are a lot of very highly qualified plastic surgeons out there. You should start out by finding someone who is certified by the American Board of Plastic Surgery. The next thing you should look at is years of experience. You should choose a surgeon for whom breast augmentation is a very significant part of their practice and who’s been doing it for a long time. The surgeon’s reputation is going to be very, very helpful, as well.

“But, keep in mind that it’s not just the surgeon that you’re choosing. You’re choosing a practice. You want to be in an environment where you can feel well taken care of. You should feel as though you can trust your doctor and his staff completely. As much as surgeons are very prideful about our work, we depend very heavily on our staff. Having a great staff that’s going to be available to answer your questions and help you through the surgery and healing process is key.

“During the consultation, too, you want to make sure that you feel the right kind of rapport or relationship with the surgeon. Is the surgeon really listening to what it is that you want to achieve? You need a surgeon who really understands what you want and how to help you meet your goals. You should be able to go into surgery not worrying that the doctor may do what they want to do rather than what you really want to have happen.

“You also need to have that expert who’s going to help you sort through the many, many different options that are out there. Your surgeon should talk to you about the selection of the right implant for you, what’s going to fit your body well, the right size, the right shape, the right type of implant, all the factors that will ultimately go into your decision.”

How long can women expect their breast implants to last?

“Many women ask about the the durability of the implant or whether or not they’re going to have repeat operations in the future. For years, there’s been kind of an urban myth out there that implants have to be replaced at 10 years. That’s not the case. Implants don’t really have an expiration date. However, even the latest data does show that there’s a high likelihood that anybody who chooses to have a breast augmentation will probably have another operation sometime during their lifetime. Some data shows that it could be 30% of people. Other data shows as many as 70% of women who have surgery will have another one for a breast augmentation. I think the most important thing women can do is to go into surgery emotionally and financially prepared for the likelihood of another operation at some point in the future. While we always hope that the implants will last forever, realistically, doctors and patients have to be prepared for the eventuality of some additional surgery in the years to come.”

What trends have you noticed in breast augmentation over the course of your practice?

“I’ve been in practice now for about 34 years, and I can say that there was definitely a period of time where we saw a pretty steady increase in the size of the implants that women were choosing. More recently, we’re seeing that trend change a little bit in the opposite direction. The average size breast implant is a little bit smaller than it might have been three or four years ago. Those trends do have a tendency to change, but popular trends don’t necessarily apply or make sense for certain individuals. Again, that’s why it’s so important during the consultation that a patient make it very, very clear what it is that they’re trying to achieve. For example, during a consultation in my office, we’ll make use of different diagrams that help to illustrate the overall shape of the breast that somebody’s trying to achieve. We don’t just look at the overall volume. Oftentimes, volume and shape may be related. It can take a certain amount of volume to fill out a person’s chest, but the shape that somebody wants, I think in recent years, has become as big if not a bigger concern than the overall size.”

How long have you been using IDEAL IMPLANT Structured Breast Implants?

“In my own practice, I don’t have any particular incentive with any manufacturer, and I offer all of the implants that are currently manufactured in the United States. The IDEAL IMPLANT was available to a core group of plastic surgeons as part of the seven year study that IDEAL IMPLANT submitted to the FDA. Unfortunately, I was not part of that core group, so the IDEAL IMPLANT has only been incorporated in my practice just in the last few months.”

What do your patients think about the IDEAL IMPLANT?

“For the patients who have chosen IDEAL IMPLANT Structured Breast Implants for their breast augmentation, the satisfaction has been unanimous. Women love the appearance and the feel of the IDEAL IMPLANT, as well as the peace of mind that it carries fewer risks and complications than most alternatives.”

If a woman wants to do her own research about different types of breast implants, what resources would you recommend?

“I refer my patients to the IDEAL IMPLANT website, because it contains very helpful information about the advantages and disadvantages of the IDEAL IMPLANT in comparison with other implants. There’s a very handy chart that’s available on the IDEAL IMPLANT website that I encourage all of my patients, during the consultation, to go home and take a look at to help them in their decision-making.”

When it comes to your patients, have your methods changed over the years?

“Now that I’ve been in practice for a little bit over three decades, what has become increasingly obvious to me as a doctor is that it’s important to counsel my patients much like I would counsel a family member. As I think about choices in breast augmentation, that’s a very conscious part of my decision-making. During a consultation I’ll think, ‘What would I advise if this person were my wife?’ Part of that consideration does have to do with safety issues and the latest data that is coming out from recent studies. There are certain implants that, quite honestly, I tend to steer my patients away from, because the complication rates tend to be a bit higher than the implants made by other manufacturers. Lately, I’ve been very pleased to add the IDEAL IMPLANT to the armamentarium of choices, because they carry a lower safety risk and lower complication rates. This puts me in a position to be very comfortable in recommending the IDEAL IMPLANT for most of my patients when I see them in consultation.”

Considering breast implants in Denver, Colorado? Contact Dr. Zwiebel today to discuss your options. Simply call 303-470-3400 or visit www.drzwiebel.com. Dr. Zwiebel’s office is located at 2050 E. County Line Road, Highlands Ranch, CO 80126. Call today for more information on IDEAL IMPLANT Structured Breast Implants.