Doctor Paul Loewenstein practices in Brookfield, a suburb of Milwaukee, Wisconsin. With over 34 years of experience in the plastic surgery industry, Dr. Loewenstein’s current practice is devoted mostly to aesthetic surgery, including but not limited to face lifts, nose jobs, eye lifts, breast augmentation, breast lifts, breast reduction, tummy tucks and liposuction. Here, we discuss his practice, breast augmentation, and all the breast implant options available.
What are the advantages of your practice over the other options women might have in your area?
“I have a broad training in plastic surgery. I had six years of training in general surgery and plastic surgery combined. At our office, we don’t specialize in one part of the body, so if a woman comes in and she wants to have a breast augmentation and a nose job, we can do both. We have the flexibility of being able to approach different parts of the body all at once, which is something that my patients find convenient.”
Over your 34 years of practice, what trends or changes have you seen in breast enhancement and with silicone gel-filled implants in particular?
“Breast implants over the years have undergone a lot of changes. Silicone gel-filled implants have undergone three or maybe even four or five generations of shell and filler material. In the early 1990s the FDA put a moratorium on the use of silicone gel implants for breast enhancement. This was based on some claims patients made (mostly in the state of Texas) that the silicone gel implants were causing them to have diseases such a rheumatoid arthritis, scleroderma, lupus, or what we call connective tissue diseases.
“After thorough research was completed using large populations of women and extensive analysis, those studies showed there was no statistical association between silicone gel-filled implants and those diseases. So the silicone gel implant came back on the market and the companies have improved those implants over the years. The current generation has a little bit thicker shell, a more cohesive gel, but they still haven’t been able to get around the fact that the body builds a shell around the implant. If there’s a break in the silicone shell it’s going to be contained by the bodies’ scar tissue layer, so women don’t know if they have a leaking silicone implant. They have to get an MRI to detect a leak.”
How have saline implants changed over the years?
“Traditional saline implants haven’t really changed much at all in 30 plus years, with the exception of the IDEAL IMPLANT. The old saline implants were basically a bag of salt water, and they sloshed around like a bag of salt water. Now, once it was in the body, there wasn’t as much of a problem with that, but you could still tell the difference in most patients. The IDEAL IMPLANT is made up of baffled shells nested inside of each other so that the saline doesn’t slosh, it sort of flows more gradually, similar to what a silicone gel-filled implant does. So the one big change with saline has been the advance of the IDEAL IMPLANT.”
Do women come in to see you already aware of the different types of implants?
“Women are a little bit more health conscious overall than maybe they were 30 years ago when I started. They’re certainly more educated, they spend time on the internet doing their research. They know a lot more about what is available, what is out there, and the pros and cons of each type of implant. So they come in much better educated, but yet they know enough to know that sometimes the Internet isn’t 100% accurate, and almost all the time they’ll say, ‘well, what’s your opinion, Doctor?’ They may have a preconceived notion of what they want when they come in, but they’re willing to listen in spite of the fact that they’re much better educated than they were 20, 30 years ago. They’re still willing to get a professional opinion.”
Have women’s preferences shifted when it comes to breast size?
“When a patient comes in for a breast augmentation consultation, we take measurements of the patients’ chest width, the base diameter of the breast, the amount of skin elasticity, and we determine how much the skin will stretch. We look at the overall shape of the breast. Is it a little bit droopy? Is it perky to begin with, but small? All these different measurements and parameters are put into our computer and help us make the decision as to what size implant would work best. I think in the last 5 to 10 years I’ve seen a shift from women coming in saying, ‘I want 500 or 600cc implants’ to, ‘What do you think would work for me, Doctor?’
“There are anatomic limitations as to how big you can go, and I think again women appreciate a professional who has experience and knowledge and can give them advice. I think size preferences are also somewhat regional in terms of the United States. Maybe even worldwide, where it’s said in South America men prefer small breasts, and large rear ends. Different parts of the country where women are going to be wearing swimsuits more during the year may put an emphasis on a larger size. In some of the conservative North Eastern states, the overall implant size tends to be less from what I’ve heard, while the Midwest tends to be somewhat conservative. In California, Texas, or Florida the sizes may average a little bit higher.”
How can a woman know if she is or is not a good candidate for breast implants?
“The people who are not good candidates are generally the ones that have unrealistic expectations. If a patient comes in and they want to have a 600cc implant and they’re five feet, 100 pounds, that is probably not a good option for them. If they’re insistent on that, I will tell them, ‘I can’t give you that kind of a result just because of the limitations of your anatomy.’ Someone who has an active infection is also not a good candidate.”
Should a woman be finished with her childbearing and nursing years before she has a breast augmentation?
“Not necessarily. I see women who are single, young, and flat-chested, and want to enhance what they have. I think they’re perfectly good candidates for breast augmentation, and there’s no reason to tell them to wait 15 years before doing it. Then there are the women I see who are done having children. Some of them have nursed and what they used to have in the chest area has been deflated. So they’re another group of people who are very good candidates for breast augmentation.”
What would you tell a woman who is worried about scars from her breast enhancement surgery?
“Certainly it’s a cosmetic operation and both the patient and I myself are concerned about the scars. There are three different areas of the body where breast implants are usually inserted. There’s the inframammary crease under the breast, there is the areola or nipple approach, and then there’s the armpit, the axillary approach. Of those three options, I do about 80% of my incisions in the crease, 15% in the armpit and about 5% around the areola.
“If the patient is really concerned about having a visible scar, or a scar on the breast I will recommend the axillary approach. That is done endoscopically. The axillary approach got a bad reputation before the advent of the endoscope because it was a blind operation and it was generally done under the muscle. With endoscopy, you can look to see the extent of your dissection and make sure that you have done an adequate job so that the implant rests low enough and it doesn’t look too high. Having said that, there is a noticeable scar for a period of time while it’s red, and if you’re wearing a sleeveless top or a tank top, and you raise your arm up that’s going to be noticeable. On the other hand when it’s all said and done, that scar is very imperceptible, it looks just like a wrinkle in the armpit.
“The one around the areola seems to be popular in some parts of the country. I certainly will do that if that’s what the patient wants. Sometimes those scars depending on the pigmentation of the areola can be even more noticeable. They are on the front part of the breast. I have never had to do a revision of an inframammary crease incision in all my 34 years. They tend to heal with a very fine line. So the inframammary crease under the breast gives you the most flexibility if you have to go back down the road 10, 15, 20 years later and do something else.”
Should implants go in over or under the muscle? Do you have a personal preference?
“I find it’s very difficult to do on top of the muscle unless you make a large incision, which then sort of defeats the purpose of going through the axilla and having a very small, inch long scar. So when I go through the armpit, I virtually always go under the muscle. However, there are a lot of factors that come into play when you’re trying to decide to go over versus under the muscle. If a person has a really physical job, or if they’re really into weight lifting and bodybuilding, going under the muscle may not be the best approach. I’ve done some placements on top of the muscle in those situations. For a person who’s really thin, the edges of the implant may be more visible going over the muscle, so it may be better to go under the muscle in those situations.
“If I’m seeing a patient with a family history of breast cancer, I’d prefer to go under the muscle because it should be easier to perform a good mammogram with the implant under the muscle. The majority of the implants I put in are done under the muscle.”
What is your advice to help women ensure that they have the results that they want?
“In order to ensure a successful operation, patients should have in mind what their goals are. I don’t mind having a patient bring in pictures of other people, of what they think looks good. It may be unrealistic, but at least I can have a visual sense what they’re looking to accomplish. I’m in the Midwest and some women say, ‘I don’t want to look like Dolly Parton. I don’t want to look like a Barbie doll. I just want to restore what was there before I got pregnant and had children.’ while other women have different goals in mind.”
What should a woman do to ensure she’s getting a great plastic surgeon?
“I think communication is all important. If you don’t feel comfortable with your plastic surgeon, no matter what their credentials, see someone else! If you don’t feel like you’re communicating on the same page, see someone else! Of course a woman should seek out a board-certified plastic surgeon, preferably one who does a fair number of breast augmentations in their practice. He or she should have an open approach to different types of implants. I know some of my colleagues tend to steer their patient in one direction or the other because of deals they may have with certain companies.
“Doctors need to be forthright about what each implant can and can’t do for the patient. They should present it in an honest and open fashion. In some cases, if the patient feels like they’re being steered one way they should say, ‘Is there a reason you’re trying to talk me into this? I came in asking for one implant and you’re trying to talk me into a different implant.’ If you don’t feel comfortable with that situation, get another opinion from another plastic surgeon.”
What kind of complications should women be aware of when it comes to breast enhancement surgery?
“Capsular contracture (or the buildup of scar tissue around an implant) has bothered us plastic surgeons over the years, because no one has been able to figure out a true solution to it. There are a lot of theories as to why it happens. Those theories change about every five or ten years. The current theory is that there is a biofilm formation of bacterial slime around the implant. So some doctors irrigate the pocket with antibiotic solutions and put the patient on antibiotics for a period of time. Most surgeons try a “no-touch” technique where there’s only one person that contacts the implant and that’s the surgeon.
“I use, for example, a barrier film over the skin called IOBAN, which is impregnated with iodine that prevents bacteria from being dragged in the pocket. Having said that, capsular contraction still exists. It’s graded one, two, three, and four. One and two are mild, and probably aren’t going to require additional surgery, but the three and four capsular contractures may cause visible distortion of the breasts to the point where additional surgery is necessary.
“There’s another problem called BIA ALCL, which is Breast Implant Associated Anaplastic Large-Cell Lymphoma, because it is associated with and occurs around a breast implant. It’s a type of lymphoma or blood cancer that can occur around breast implants. To my knowledge, that has been described and confirmed only with textured implants. With so-called “fuzzy” implants, or implants that don’t have a smooth surface. IDEAL IMPLANT, for example, has a smooth surface. With most silicone gel-filled implants you can choose between a smooth or textured surface depending on the shape. The tear drop shapes are pretty much all textured, and the round tend to be smooth. The incidence is extremely low, maybe as low as one in a million, but it is a real entity, something to be aware of.
“Probably the most common complication would be a hematoma, or a bleeding issue that occurs after the surgery is over. I find that my incidence is extremely low, especially since we’ve been emphasizing avoiding medications that can contribute to bleeding. For example, I tell all my patients, no aspirin for two weeks, no ibuprofen, Aleve, etc., for at least a week. Also things like fish oil and vitamin E and many of the herbal supplements can cause prolonged bleeding. A lot of people don’t consider those drugs I listed as medications, but they are. They have side effects, known side effects that can cause problems with bleeding or even prolong the effects of anesthesia.
“It’s important to communicate to your plastic surgeon what medications you’re taking in all regards, not just prescriptions. I would say my hematomas have gone down significantly since emphasizing the importance of avoiding certain medications. If an infection occurs around the breast implant, the body’s immune system can’t function properly without having to remove the implant. I, for one, have never had to do that in my 34 years of practice, but infections do happen and they have been reported.
What should women do to avoid any complications post-surgery?
“Your plastic surgeon should give you a definite set of printed instructions on what to do after the surgery. Pay attention to that. Don’t ask your girlfriend, ‘What do you think I should do in this situation?’ Your girlfriend hasn’t done hundreds and hundreds of breast augmentations, she’s maybe had one herself, but every person’s experience is different. I just can’t emphasize enough that women should listen to the advice of their plastic surgeon. They are the best person to tell you what you should and shouldn’t be doing.
“Activity does have to be restricted afterwards, particularly if you go under the muscle. There are certain exercises like push ups and bench presses that I don’t want my patients doing for at least three months after the surgery. If your surgeon has a longer period of time where they restrict your activities, there’s probably a reason for that. So listen to your doctor, they’ve got the experience, they’ve got the knowledge.”
How long have you been using the IDEAL IMPLANT?
“I was first introduced to the IDEAL IMPLANT at one of our national meetings by the inventor, Dr. Hamas, and I had no knowledge of it prior to that time. He lined up an IDEAL IMPLANT next to a traditional saline implant and a silicone gel-filled implant and covered them with a cloth, and had me feel each implant through a cloth. I could tell an obvious difference between the traditional saline and silicone-gel implants. Then when I felt the third implant, which was the IDEAL IMPLANT, I thought it felt very similar to silicone gel. I could tell a little bit of a difference but it felt very, very close. So I started using IDEAL IMPLANT as soon as it became available to the general plastic surgery community around 2014.”
Have you noticed more women asking specifically for the IDEAL IMPLANT?
“As time has gone on and women have heard about it, more and more people come in requesting it. In the beginning I would present all the different types of implants to my patients and sort of let them decide. When patients would ask my opinion I tried not to say, ‘Go with this one for sure,’ but I would try to present the pluses and minuses and ask them what their concern was. If their concern was silent rupture and having to get MRIs to determine if they had a rupture, I would steer them more toward the IDEAL IMPLANT or the traditional saline implant. But after showing them the difference physically by having them examine each with their own hands, 100% choose IDEAL IMPLANT over traditional saline implants. Some patients and some husbands actually thought IDEAL IMPLANT felt more natural than a silicone implant. Not everybody chooses it, but a larger and larger percentage of my practice has been devoted to inserting IDEAL IMPLANT as time goes on.
What can you tell us about IDEAL IMPLANT and silent ruptures?
I’ve used IDEAL IMPLANT in my practice for at least three and a half years. I see people coming in with silicone gel-filled implants and something may have happened. Maybe they got into a car accident. They’re worried if they have a leak or not. If they have silicone gel, you may have to tell them, ‘The only way to know for sure is to have an MRI.’ But with my IDEAL IMPLANT patients, you can tell whether you have a leak or not by just looking in the mirror. I don’t have to send them for additional x-rays or studies. I can tell when they walk in the office if they have a leak or not. Women who want to have peace of mind about knowing whether they have a silent rupture are not stressed after surgery when they choose the IDEAL IMPLANT.”
What else do you like about the IDEAL IMPLANT?
“It has a very natural look and feel. The rippling that you sometimes see with the traditional saline implants just hasn’t been an issue. There are a lot of advantages. So far I haven’t seen capsular contracture as a major problem. Now that may change 15 years from now, but for now, the incidents of capsular contracture are extremely low. It’s lowest among all the different types of implants available. I just find that there’s a lot of reasons to have peace of mind when using the IDEAL IMPLANT.”
Do you feel like your IDEAL IMPLANT patients are satisfied with their results?
“Yes, our IDEAL IMPLANT patients are very happy, very satisfied. It really is, I think, the ideal implant.”
Considering breast implants in Brookfield, WI? Contact Dr. Paul Loewenstein today to discuss your options. Simply call 262-717-4000 or visit www.drloewenstein.com. Dr. Loewenstein’s office is located at 13800 West North Avenue, Suite 110, Brookfield, WI 53005. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.
The IDEAL IMPLANT is a new, innovative breast implant option that offers the benefits, without the drawbacks, of both traditional saline and silicone gel implants. Dr. Benjamin Gelfant is a board-certified plastic surgeon in Vancouver, BC,who is part of an exclusive group of surgeons eligible to offer the IDEAL IMPLANT® Structured Breast Implant to their patients. During a recent interview, Dr. Gelfant discussed how he helps women decide between these three breast implant options.
Describe your work experience as a plastic surgeon.
“I started in practice in 1989, shortly before the moratorium silicone gel implants came into place in April of 1992, although I had a brief experience with polyurethane foam covered textured implants in 1990-91. So, from ‘92 until 2006, with very limited exceptions, my practice was exclusively saline filled breast implants and I was one of the first, and certainly the most prominent person, to use transaxillary endoscopic approach to breast augmentation, which became a very big part of my practice success. When silicone gel implants came back onto the market, it was clear that, except with using small implants, transaxillary augmentation was not going to be a viable approach, so I went back to using inframammary incisions for the next few years until the advent of the Keller Funnel.
“I had probably in the range of 1,500-2,000 patients with saline filled implants from the era of 1992 forward. My experience was that women were coming back occasionally for check ups, 5, 10, 12, 13 years after augmentation, with actually excellent results long-term and extremely low rates of capsular contractures, well under 1% and the high rates of complete non-concern.”
How do you help your patients choose between the different types of breast implants?
“My responsibility, as a doctor, is to give patients treatment options, including no treatments, and that’s what I’ve done. I’ve always said to patients, ‘Here’s what you’ve got available to you. Here are the pros and cons of each of them. It’s your choice.’ My role has been to be a learned intermediary, in other words, to learn and to nurture, to have my own experience and to present the patients with the information that they need in order to make an intelligent decision. That seems to work for the kind of patients that I want to have. There’s a large standard practice of, ‘Leave it to me, I’m the doctor; trust me, I’m the doctor.’ That just doesn’t fly with a lot of women. It doesn’t fly in society in general. As we know in many sectors of society, a lot of people have a lot of catching up to do.”
How have your patients responded to the IDEAL IMPLANT?
“When the IDEAL IMPLANT came out in 2014, we figured we would capture almost all of the saline market and maybe a nibble of the last part of the silicone gel market, and that’s really happened. I get a lot of patients who come in here and they look at all the different options and say, ‘I like that one, I like the new one.’ It’s been very favorably received.”
For your patients that choose silicone gel breast implants, what are their main reasons?
“Patients are subject to peer influence and say, ‘My girlfriend got these.’ So there are a significant number of patients that want what their girlfriends have. They come in asking for ‘gummy bear’ implants and they’re confused about that. They think that silicone gel is ‘gummy bear’ and the Gans Marketing term of cohesive gel. Well, they’re all gels. It all comes from the same company in California and is sold to different implant companies. If I see a patient who’s got a generous amount of breast tissue to begin with, yet she’s got a drooping breast, then she has got to have a breast lift. It doesn’t matter what implants she has put in. They’re going to feel fine, as long as they don’t get a contracture. So, I don’t try to convince those patients that saline implants are better. It’s up to them to make a decision. But I make a strong point to them that maybe you don’t want to monitor your implants long-term with either MRI’s or ultrasounds. From there on, it’s up to them.”
How do you help reduce the rate of capsular contracture among your patients?
“I do all my implants under the muscle. I have since 1997. It’s the only effective means that we have of reducing capsular contracture. From the time I went to strictly submuscular, my contracture rate has plunged to less than 1%. I had a bit of a run of contractures in 2017, certainly nothing like what they were subglandular. I changed a little bit in my protocol, and it’s dropped back off again. I think so much goes into the way we go until we get something that doesn’t develop contractures.”
Considering breast implants in Vancouver? Contact Dr. Benjamin Gelfant today to discuss your options. Simply call 604-874-2078 or visit www.drgelfant.com. Dr. Gelfant’s office is located at 1333 West Broadway #100, Vancouver, BC, V6H 4C1 Canada. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.
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.
IMPORTANT NOTE: Below you may find untouched before and after photos of patients who have granted permission to their surgeon to show them anonymously. While we protect the identities of our patients, please be advised that by their nature, these photos contain sensitive content. Read more
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.
Board-certified New Jersey plastic surgeon Dr. Larry Weinstein has over 30 years of experience in cosmetic surgery. He has conducted extensive research on breast implants and breast tissue expanders. Dr. Weinstein helps his patients achieve their optimal results in breast augmentation and breast enhancement. His patients appreciate his professionalism, his thoughtfulness, and his kindness. We recently sat down with Dr. Weinstein to discuss breast augmentation and what to expect from a consultation, different breast lift options, and IDEAL IMPLANT® Structured Breast Implants.
Why should patients choose your practice over others in the New Jersey area?
“When it comes to performing breast augmentations, I have 32 years of experience. Not every surgeon can say that. My goal is to help my patients achieve a natural, proportional look to their bodies. I strive to never rush my patients, so I’ll spend quite a bit of time discussing the procedure and answering any questions they might have. I do everything I can to make my patients’ expectations a reality.”
What is a breast augmentation consultation like in your office?
“The first thing I do is ask my patient what their goals are. I talk to them in terms of cup size and volume. Then I’ll examine the patient to check and make sure that they don’t have any breast abnormalities. My examination also helps me determine if they would also benefit from a breast lift. The patient can then try on different sizes of breast implants in a tight fitting sports bra so they can get an idea of what they will look like when everything is said and done. Once the patient and I are on the same terms as far as volume is concerned, my Vectra 3D imaging machine can also project a 3D image of that breast size. I try to help my patients achieve a natural and balanced look. I check the breast diameter, the tummy diameter, and the hip diameter so their body can be as close to proportional as possible.
“After we’ve established what the patient wants, my computer can also show them what a breast lift might look like if they need it. We’ll also look at their photographs and compare those to previous patients I’ve operated on. I show them patients who are 18 years old and I show them patients as old as 69. These before and after pictures help the patient determine to what extent they want to be enhanced.”
Do a lot of your patients get a breast lift in addition to a breast augmentation? Can you talk about the different breast lift options?
“Many people think that breast implants will correct saggy breasts. Certainly an implant can help with that, but if a patient’s entire breast is below the inframammary fold, they are going to need some type of lift in addition to an augmentation. With a lift, excess breast skin is removed and then the nipple and areola are lifted to a higher position. The skin that surrounded the areola is then brought down and met together to reshape the breast.
“I perform four different types of breast lifts. It depends on the volumetric difference. The simplest lift I do is called a Crescent lift. The Crescent lift is where I take a little ellipse of skin above the areola and I bring the areola up and that brings the breast up a good half of an inch or 3 centimeters. That allows us to bring the areola into a better position rather than it hanging too low.
“The other technique is a periareolar approach which I do with patients who have laxity in the breast and sagginess. With the periareolar approach, I make an incision that goes all the way around the areola to lift the location of the nipple. I use a permanent suture in order to maintain the areola diameter. A dissolvable stitch in that area tends to cause an increase in diameter over time because of the implant play on it.
“I also do what’s called the lollipop lift. This is where I make an incision that goes around the areola and straight down to the fold underneath the breasts. Many patients benefit from that. I have done that a number of times when doing a full mommy makeover. We’ll do a tummy tuck, breast augmentation, and a little lollipop lift.
“Another common technique for a breast lift is the anchor-shaped incision. This is where I make a small incision underneath the inframammary fold or an inverted T that follows the natural contour of the breast. I’m very careful in terms of suturing. That’s really the key whenever you do any procedure. It’s not about how fast you do it, but how well you do it. Each procedure has to be individualized and each wound has to be treated appropriately and carefully. By having that careful and gentle approach, you tend to get a very nice result.”
What can you tell us about the difference between silicone gel implants, saline implants, and the IDEAL IMPLANT?
“When my patients are trying to decide which breast implant they want, I have them look at and feel silicone implants, regular saline implants, and the IDEAL IMPLANT. Most of my patients describe the IDEAL IMPLANT as very soft and pliable, with a similar feel to the silicone gel implant. Because the IDEAL IMPLANT has a double chamber, we can also give it more projection, which can sometimes avoid the need for any breast lift procedures. The other nice thing about the IDEAL IMPLANT is that it allows me to make smaller incisions in surgery, which I prefer to do. Of course each patient is an individual and can decide which breast implants are right for them. We tailor each procedure to that individual and if they want to use the IDEAL IMPLANT, then I am happy to do that.”
How can women ensure they have a successful recovery after surgery?
“In preparation for surgery I always make sure that my patients understand that they should stop taking any sort of NSAIDs [nonsteroidal anti-inflammatory drugs], such as aspirin, Motrin, Advil, Clinoril. These medicines can affect the plated adhesiveness and you run an increased risk of having a clot or hematoma. We also explain to our patients that they won’t be able to exercise for several weeks afterwards. I usually recommend waiting three weeks to exercise again. I do encourage and appreciate patients who exercise regularly, but you have to give your body some time to rest and heal from a procedure like this. You can’t expect to go out and conquer the world in the first three weeks. Most patients can go back to work in four or five days, but you shouldn’t try to do every activity that you would normally do.
“I also tell my patients to take a multivitamin everyday, to eat healthy, and to not smoke. It’s very important they don’t smoke for at least two weeks before surgery because it affects their ability to recover from surgery. Also, the problems with anesthesia are greater with smokers than non-smokers and the healing process is different with smokers versus non-smokers. I’ve done research on the effects of smoking on wound healing and smoking does not contribute toward the healing process. We want the wounds to heal perfectly, as beautiful as possible, and we want our patients to have the easiest recovery. So I think if you avoid alcohol, avoid smoking, avoid the sun after surgery, and avoid exercise for about three weeks after surgery, you’re going to have a very smooth recovery.
“Before surgery, we also have our patients wash with special soap. We use the Hibiclens soap, which keeps bacteria from growing for about 48 hours on the skin. When using the Hibiclens shower, our incidents of infection are zero. We want to keep our infection rate for breast augmentation at zero so we always ask our patients to wash with a microbial soap, to shower the night before surgery, and the morning of surgery. I ask my patients to keep certain areas dry immediately after surgery, and to only shower after an appropriate amount of time.”
Can you share any stories of successful past procedures?
At one time, three sisters came in and they all wanted a breast augmentation. One sister was married with children and had slightly saggy breasts. She wanted to be a B-cup, but she had almost no breast tissue. She had what’s known as postpartum involution when the breasts sort of go away after you’ve had children. So in her particular case, I was able to use a slightly wider implant with low projection. She did extremely well, she got her B+ cup and she was really excited to go to the beach after that.
Her other sister was younger but she was very thin and delicate and had almost no breast tissue whatsoever. So I used a moderate plus profile and an IDEAL IMPLANT, which gave her nice cleavage and some volume and a little more projection. Then the third sister came in and she was a little bit heavier, slightly more stocky than the other two. So I selected an implant that was perfect for her and we were able to achieve a result that was very proportional for her body. She had nice cleavage and superior fill.
Though these sisters had some genetic similarities, I customized all their breast augmentations to meet their different goals. I used three different types of implants of varying sizes and volume with distinctive projections in order to achieve ideal results. My goal in every breast augmentation I perform is to make sure I gave my patient what they wanted, and that they are thrilled with the outcome.
Considering breast implants in New Jersey? Contact Dr. Weinstein today to discuss your options. Simply call 908-879-2222 or visit docweinstein.com. Dr. Weinstein’s office is located at 385 State Route 24, Chester Township, NJ 07930. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.
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 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.