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.
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.
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.
At Waltzman Plastic Surgery in Long Beach, California, you’re in the capable and experienced hands of board-certified plastic surgeon Dr. Joshua Waltzman. A Long Beach native and USC alum, Dr. Waltzman offers both invasive and noninvasive treatments for the face, breast and body. In a recent interview, he spoke with us about his practice, the breast augmentation process from start to finish, and the new IDEAL IMPLANT® Structured Breast Implants.
Why should patients choose your practice over others in the area?
“Women choose our practice because they feel very comfortable here. I’m the only surgeon, and our staff is small. Patients aren’t walking into this overwhelming office with multiple doctors and clinicians and equipment surrounding them. When they walk in, they feel like they’re coming into our family. Patients will talk to the staff and get to know each other’s families. We really do have a sense of community here that distinguishes us from other practices. My staff and I also spend a lot of time with our patients. I am deeply invested in listening to all of my patients’ concerns and goals. When it comes to breast augmentation, there are a lot of specific things women are looking for that are important to hear and discuss before the surgery takes place. So I think taking the time to listen also sets us apart.”
Who makes a good candidate for breast augmentation?
“Someone who is in good health, doesn’t smoke, has breasts that sag or have lost volume, these are all women who are good candidates for breast augmentation. Most women who come in want to have bigger breasts, and I try to explain that an augmentation alone will simply make you a natural, larger version of what you are. So, if your breasts are naturally close together, after an augmentation they will still be naturally close together, just bigger. And on the flip side, if your breasts are naturally spaced a little bit further apart, your augmentation will make them larger, but they will still be spaced the same distance apart.
“If women are desiring to have other changes made, whether it’s making the nipple position higher, making the breasts smaller, or changing the overall architecture or shape, then we have to talk about other procedures in addition to augmentation alone. Typically, my patients are moms who are done having children, they have some volume deflation from the breasts after breastfeeding, which is natural, and also some descent or lowering of the nipple position. And in some of those cases, we have to combine a lift, either at the same time, or before doing an augmentation.”
Can you guide us through your specific breast augmentation process?
“It all starts with a physical exam. Taking really detailed measurements of the patient to customize their augmentation or their implant selection choice is paramount. Beyond that, we talk about implant placement. We talk about why I might choose to place the implant above or below the muscle. Of course, that’s influenced by the patient’s starting breast size and how much soft tissue, or how much breast they initially begin with.
“Another choice we make is the location of the incision. I prefer to do most all of my primary augmentations (meaning first time breast augmentations) through what’s called an inframammary approach, which is a small three- or four-centimeter incision tucked right in the breast fold. There is a lot of data that shows that this approach leads to lower capsular contracture rates, lower infection rates, and it gives the surgeon a much better view of the implant pocket when you’re designing it. It’s really the best approach for breast augmentation. The scar is always there, but it fades quite nicely. And when it’s in that fold, it really is a non-issue. Now, if a patient comes to me and has pre-existing scars from elsewhere on the breast, whether it’s an areola scar or elsewhere on the breast, I’m happy to use those. But my preference is for an inframammary approach.
“We talk about all the different types of breast implants out there, and discuss which one the patient might have a preference for. The patient’s physical measurements will help dictate implant selection to a large extent. We also talk about what their goals are. Are they just looking for a subtle natural enhancement? Or are they looking to revolumize what they have lost after pregnancy and breastfeeding?
“In my office, I like to use a 3D simulation software. I scan all the patients in the exam room during the consultation. It takes about 30 seconds. And on the iPad, right there, we can do a full 3D simulation and start trying on different implant sizes with pretty good accuracy. That’s been a great way for patients to picture how they will look with a certain pair of implants. It’s one thing to see implants on a before and after picture of someone else. You may not know anything about them. They might have a different frame. Before and after photos usually mean very little to a patient, until they see how the implants will look with their own skin markings, freckles, etc. If they have a tattoo, that will also be in the 3D simulation, and that really drives it home for them.”
What are your thoughts on silent rupture with silicone gel implants?
“I’ve had multiple patients who have experienced some type of silent rupture. The more common scenario is that I find the rupture during an implant exchange and/or upsizing or downsizing. I discover it once I am operating on the patient, which is really the ultimate silence. It wasn’t identified with any preoperative imaging, so my patient didn’t even know about it.
“With older silicone gel implants, the gel can be pretty messy. It’s much stickier, it tends to run. Getting all that gel out requires additional time in the operating room. With some of the newer generation silicone gel implants, the gel is more cohesive. If there’s a rupture, the implants tend to come out quite a bit easier. But obviously, with saline implants, that’s not an issue. You know right away if there’s a rupture, and in that case, you’re only spilling a little bit of saltwater into the breast cavity which easily gets absorbed harmlessly by the body.”
Why do some surgeons still push silicone gel implants on certain patients?
“Silicone gel may be the right choice for patients who have very thin tissue coverage. So, either they’re very thin patients, or their breast tissue has been stretched, and their breast tissue coverage is very thin. For women with this thin breast tissue coverage, they may be able to feel a more obvious difference between silicone gel implants, saline implants, and the IDEAL IMPLANT.
“So that’s one thing I bring up for patients that are very thin. But I always try to give my patients the option that they are most comfortable with. Sometimes my patients will say, ‘Oh my sister had saline, my aunt had saline, my mom had saline. I’m having saline,’ and there’s not even a discussion to be had.
“I think educating my patients and presenting all their options, including the risks and benefits of each one is always the way to go. At least that’s how I do it in my practice. And there are certain patients who will push for one direction or the other, but for the vast majority, it really is kind of a decision for both of us.”
What are the the benefits to the new IDEAL IMPLANT technology?
“There are many benefits to the IDEAL IMPLANT. My experience with the IDEAL IMPLANT has been only positive. I routinely present it, during all of my breast augmentation consultations, as a third option. For breast augmentation we have silicone gel, regular saline, and then we have the IDEAL IMPLANT, which is a structured saline implant. The IDEAL IMPLANT is surrounded by a silicone shell, but it’s filled with saline. The inner shells provide more structure to the implant, and the inner baffling on the shells helps prevent that water balloon effect that women with saline sometimes complain about.”
How can a woman know if there is a leak or rupture in her IDEAL IMPLANT?
“With traditional saline, once an implant is popped or ruptured, it’s completely gone. It’s more of an all-or-none type phenomena. That creates some aspect of emotional distress because the woman will have one breast that is fully inflated and the other will be completely deflated. And that could be troublesome for finding bras and clothing, going out, all these things, until you have the implant fixed. The IDEAL IMPLANT brings peace of mind to a lot of women. If there’s a problem with your implant, you’re going to know fairly quickly. You’ll notice some deflation, but due to the dual chamber nature of the IDEAL IMPLANT, it’s unlikely that both the front and the back chamber of the implant are going to become ruptured at the same time, so you won’t lose all of your volume. This can buy the woman some time before she actually needs to have the implant fixed.”
What types of patients can benefit from the IDEAL IMPLANT?
“Patients who are good candidates for the IDEAL IMPLANT are those who are looking for a fuller, rounder breast look. The IDEAL IMPLANT gives women a moderate plus-to-full kind of profile if you equate it to the silicone gel equivalents. If a patient wants to fill out a deflated breast pocket, I also think the IDEAL IMPLANT is a great option.”
What has been your experience in terms of patient satisfaction with the IDEAL IMPLANT?
“Patient satisfaction after IDEAL IMPLANT has been incredibly high. I’ve had no patients come back saying they wish they’d picked another implant. I present data to my patients on the lower rupture rates and lower capsular contracture rate for the IDEAL IMPLANT. This data gives my patients even more peace of mind. I’ve had a number of IDEAL IMPLANT patients who have actually slept good, based on that data alone. I haven’t had anyone complain of the IDEAL IMPLANT rippling like other saline implants tend to do. Overall, I’ve been very impressed with the positive feedback I’ve received on IDEAL IMPLANT. My thought is, since we have this new breast implant technology, why not use it?”
Considering breast implants in Long Beach, CA? Contact Dr. Waltzman today to discuss your options. Simply call (562) 448-6100 or visit www.waltzmanplasticsurgery.com. Dr. Waltzman’s office is located at 3828 Schaufele Avenue, #360 Long Beach, CA 90808. Call today for more information on IDEAL IMPLANT Structured Breast Implants.
Did you know that there is a new type of breast implant available to those seeking a breast augmentation? Now women don’t have to only choose between saline or silicone gel implants. Dr. Thomas Hubbard, a plastic surgeon located in Virginia Beach, VA, and board-certified by the American Board of Plastic Surgery, discussed in a recent interview the differences and advantages of this new, innovative structured implant: IDEAL IMPLANT® Structured Breast Implants.
Can you describe your practice and primary focus as a plastic surgeon?
“I’ve been in practice for 25 years now. Breast enhancement surgery has been a big interest of mine, and a large portion of my practice throughout my career. I’ve always had an emphasis on breast surgery. I joined a surgeon who developed possibly the most important technique in breast surgery – the ‘no-touch technique.’ I was with him almost six years. And with that technique, I’ve got my capsular contracture rate down one in many hundreds. But that’s not the only important thing with breast surgery, there are many parameters that need to be controlled, adjusted, and it’s all about pleasing the patient and getting what she wants.”
How do you help women beginning the breast augmentation process determine implant size, implant placement, and incision location?
“All of my implants are placed beneath the muscle. The advantages are numerous: lower rate of capsular contracture, quality mammograms, more natural appearance. I think with age it works out better in the long run as well. And then a recent study even showed that women with implants above the muscle, when they get breast cancer, it’s more advanced. There are so, so many advantages to going beneath the muscle.
“Regarding the choice about incision, most of mine are inframammary. I use a sleeve, whether I’m using saline or silicone gel, which helps with the capsular contracture rate being extremely low, but especially with silicone gel since it helps with the smaller incision in the inframammary area.
“For all my 25 years, I’ve been using sizing. We have several sets of sizers in the office, and a staff member spends plenty of time with each woman where she tries on different sizers in a bra with a top on, looking in the mirror, until she finds that look that she’s looking for. Now I tell her, ‘I don’t know whether that’s a Double D or a C. In fact, one company’s D is another company’s C. So, that really doesn’t matter. I want you to be comfortable with that look, you’ll find out later what the cup size is.’ We also have the Vector System 3D Imagery that we use. That’s a big advantage. It helps women preview the result. It’s nice to have the 3D imager because all of the implants, all the brands and types are programmed in. Sizing preoperatively is extremely valuable for getting those proportions that you want.”
How do you help women decide between traditional saline implants, silicone gel implants, and IDEAL IMPLANT® Structured Breast Implants?
“I have found that women choose, some with my help and some based on their friends, they choose an implant type and I really don’t see many regrets with the implant type. Maybe because they’ve made up their mind and they’re going to stick with whatever they’ve decided. Maybe because we have done a very good job of educating them about the pros and cons, and they’ve worked it through.
“There are some women who have made up their mind before they come in. I’m happy to go along with their choice. All my implants are smooth. I’ve never done the textured implants, so I don’t have to worry about the lymphoma that is related to textured implants. So if you want silicone gel, fine. If you want saline, that’s fine.
“Now, there is a sizable portion of women who have not made a decision and I’m happy to provide unbiased information. I tell them there is no implant that’s perfect and then I go on to describe the three types of implants – silicone gel, saline, and the IDEAL IMPLANT® Structured Breast Implant. I talk about the pros and cons of all.
“I had practiced many years before silicone gel implants were available, so there was quite a big change when all the silicone gel became available for women age 22 and older. My experience with saline was so good that I didn’t necessarily go to pushing silicone gel, and I still don’t go to pushing silicone gel. I still feel a woman needs to know the pros and cons of all of them, and I’m not going to tell a woman that she needs to go to silicone gel for sure or saline for sure.
“Now some women are better candidates for silicone gel and some women are better candidates for saline. For example, if there is a woman who is 5’10”, 105 pounds, you can see her ribs with very little breast tissue, she’s a Double A or Triple A, I am actually going to suggest to her silicone gel. She has very little padding, so her whole breast is the implant. But a woman who is even a B or a C, even some As, that have enough tissue, they can enjoy the benefits of saline as well. But they need to make that decision.
“If I were to summarize women who are choosing the IDEAL IMPLANT, I’m going to say I think they get it. They get it because they are looking through a lot of hype, a lot of different opinions on the Internet, and they’re seeing that saline has the same happiness rate as silicone gel. There are some long-term benefits of a saline implant: lower capsular contracture rate, less concern over time, and no need to get MRI scans.
“So, in choosing the IDEAL IMPLANT, they get it. The IDEAL IMPLANT is less likely to get visible rippling. It has a more natural feel. And it’s going to have that extremely low capsular contracture rate, which with saline, one in hundreds and hundreds and hundreds gets capsular contracture.”
What if a woman is concerned about implant rupture or wrinkling?
“If you’re really worried about rupture, if it’s something causing your anxiety, if you’re going to find yourself worrying about the silicone gel and “Should I get the MRI?” or wonder if it’s ruptured, maybe you should be considering saline. And if you’re considering saline, look at the rupture rate of the IDEAL IMPLANT. If the leak rate is a concern to you, the IDEAL IMPLANT leak rate is not even half the rate of other implants. So that is a big advantage of the IDEAL IMPLANT.
“As far as rippling goes, I think rippling rates are greatly exaggerated. If you look at the actual studies on rippling rates, the rate is pretty low unless you’re really, really thin. But if it’s a concern and you’re going the saline route, then look at the benefits of the IDEAL IMPLANT as far as rippling rates go.”
Should a woman be concerned about implant rupture?
“I don’t think women that think it’s not a problem are completely informed about the situation. Yes, you can take a ‘gummy bear’ implant, slice it on a table, and really there doesn’t appear to be anything flowing. But then there is an implant that is under the muscle getting squeezed and smashed and squeezed and smashed all day long with all our daily activities. Things don’t stay that way, so the inside silicone gel does get out.
“And in fact, since very few women actually end up getting the MRI scans, there’s a growing number of plastic surgeons who are recommending that a woman just go ahead and switch out her silicone gel implants at 10 years. At that point you probably have about 8% leak rate and with an 8% leak rate, it’s probably time to switch it out and put new implants in.
“Now with silicone gel implants, you’ve got to think about cost. I do inform women that if they’re choosing the silicone gel route, it’s safe and a good implant, but think of long-term cost with the silicone gel as well. Also, there are many of us who believe that it can lead to a capsular contracture at a later time. Women need to consider that you’re not going to know when you have a rupture. A sign that your implant has had a rupture that could have happened years before, is that your breast has turned firm and hard. That’s a capsular contracture. We do everything we can to avoid a capsular contracture.”
How soon after surgery can women return to their regular exercise routines?
“I feel strongly about some recommendations I make. No exercise for three weeks. Why? This goes back to the capsular contracture rate. We want it one in hundreds and hundreds. We don’t want to see capsular contracture more than every few years. And that’s one, and that’s in my opinion, too many. We want it at almost zero.
“How do you do that? Well, a lot is on the surgeon with the technique. I change my gloves multiple times during surgery. I use a sleeve no matter what I do, and you can go on and on with that.
“After surgery though, some woman bring up that their friend did exercise at a week. Well, but up to three weeks you can have a little bit of bleeding. You may not know about the bleeding, but a little around the implant can increase your rate of capsular contracture. This is an investment for the rest of your life. You want it to go extremely well, so we do need to go three weeks without exercise.”
How do women typically feel about the outcome of their breast augmentation?
“I actually do research on satisfaction rates with breast surgery. This is one of the highest happiness rates of any operation out there. Yes, silicone gel and saline have the same happiness rate. It’s very high. So whether you go with silicone gel or saline, you’re likely going to be quite pleased. The bottom line is you’re probably going to be happy with your choice.”
Do you conduct any other research?
“I’m doing research on controlling the settling of implants. I think there are ways to control the settling of implants. Did you know that when a surgeon puts the implants in, they sit a little high initially? They look a little funny initially, since they sit too high. Then they drop for six to seven months. It’s so out of the control of surgeons as to what happens during that six to seven months. Where they’re going to go is where they’re going to go.”
What should women look for in a plastic surgeon?
“I think she needs to make sure that breast surgery is one of the primary focuses of the surgeon that she’s going to see a consultation with. Reputation is very important as well. That makes a big difference. I would pick a surgeon who is offering saline, silicone gel, and the IDEAL IMPLANT. And why is that? Because all women are different. All women have different goals. Why would a surgeon exclude a class of implants that have the same happiness rate. A surgeon should offer all three implants, because all women are different. Their goals are different, and I think it’s important.”
Considering breast implants in Virginia Beach? Contact Dr. Thomas Hubbard today to discuss your options. Simply call 757-687-1900 or visit www.hubbardplasticsurgery.com. Dr. Hubbard’s office is located at 329 Phillip Avenue, Virginia Beach, VA 23454. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.
If you are considering a breast augmentation, it is important to know all your options. Dr. Steven Ringler, a board-certified plastic surgeon, helps his patients understand the different types of breast implants available. In a recent interview, Dr. Ringler outlined how the new IDEAL IMPLANT® Structured Breast Implants are different from saline or silicone gel implants.
Describe your practice and work experience as a plastic surgeon.
“My practice is totally dedicated to cosmetic or aesthetic surgery. I have been in plastic surgery for over 33 years. My practice is divided about a third facial cosmetic surgery, a third breast and cosmetic, and body contouring the remaining third. I see patients from our local community, but I also see patients from out of town. We have a beautiful facility, very private, with a great team of employees and staff to help patients make decisions about what’s best for them. My cosmetic practice patients are happy. They’re treated with respect. We’re good at listening and learning what patient’s goals and expectations are, and trying to meet those with procedures and treatments we have to offer.
“Many years ago, a patient asked me what I would do if it was my wife, and at that time, it was saline or silicone gel. I said saline without hesitating. I made a decision at that time, that I would specialize in saline breast augmentation because I thought it was a better option for women, and I don’t regret that decision. I’ve always done saline and silicone gel, because I’ve always made it a patient’s option. I think that it is important that the patients have options, and that’s why I like to offer options to patients – saline, silicone gel, and now the IDEAL IMPLANT. I think these are three great options for patients. I don’t think any patient that I see now can’t come up with a decision given those options.”
How do you help your patients achieve their goals?
“I try and manage expectations by getting a really clear understanding about what the patient’s goal is, and what their expectation is. Size is a big factor. We use computer imaging to help with that. We also use external sizers and clinical photographs to help with that. Patients will occasionally bring in photos that they think look good, that they’ve downloaded, and I’ll review those with them. I think the most important thing is that the patient has a pretty good understanding about what the size and shape of the breast is going to look like, and if they need a lift or they don’t need a lift. It’s really important that they understand that. I think that if you’re really good at communicating those points with the patient, and have a long conversation about it, they’re going to be happy with the result. I have a very high level of satisfaction in my patients. Very rarely do I have a patient coming back asking for something to be revised, unless they’ve had an issue with scar tissue or implant position, which is a risk of the surgery.”
How do you help women decide between traditional saline implants, silicone gel implants, and IDEAL IMPLANT® Structured Breast Implants?
“I think it’s really important, as a physician, to educate the patient. That’s part of the informed consent process. I think patients need to understand what their options are. It’s their body. They need to make the decision. That being said, I don’t feel that a ‘gummy bear’ implant is a good option really for anybody anymore, especially with the issues that are coming up with the ‘textured’ implants. I don’t use any ‘textured’ implants, and many of my colleagues have stopped using ‘textured’ implants because of concerns over long-term safety.
“If someone comes in asking for a silicone gel, and I think their physical dimensions are a good fit for the IDEAL IMPLANT, then I generally tell them why I think the IDEAL IMPLANT is as good. I let them feel the implant. I show them the differences between the implants, even the same size IDEAL IMPLANT sitting next to a silicone gel implant has a different shape. I explain to them why I think the shape is better, and then I show them clinical photos of patients with standard implants and the IDEAL IMPLANT. The uniform response is, ‘I like the IDEAL IMPLANT results better. Those look better.’ So it’s fairly easy for me to convince patients. They know I think it’s better. I tell them I have a very strong bias that way. But most patients, by the time I’m through discussing the differences, they pretty much agree with me.
“I still have patients that will end up choosing a traditional saline implant. I had one patient with a very broad chest, and as a result, I thought it would be a better fit for her. She wanted a very large implant. I was concerned that the IDEAL IMPLANT might have too narrow a base diameter. But then there are also patients who I recommend the IDEAL IMPLANT, and they make the decision. A lot of patients come in and they say, ‘Well, if you’ve been getting great results with traditional saline, and my girlfriends have saline, I’m good with that. I don’t see the advantages.’ I have others that say, ‘I want the latest, the greatest thing.’ They want the IDEAL IMPLANT. And I do get good results with both. So it’s a little bit of a unique situation for me to come up with a reason why I should switch. But now that I’ve seen the clinical results, I tend to recommend the IDEAL IMPLANT over traditional saline, if all other things are equal.”
Why do you like IDEAL IMPLANT® Structured Breast Implants?
“As soon as the IDEAL IMPLANT became commercially available, I began using the product. It’s a great advancement because it’s really the best design change that I’ve seen in implants throughout my entire career, especially being a big fan of saline implants.
“I’ve done a little over 50 patients with the IDEAL IMPLANT. When I first started using them, my staff that uploads my photos, they started telling me I was getting better results. I always thought I had pretty good results all along, so to find out from my employees that the IDEAL IMPLANT results were better, I started looking at them, comparing them to my saline breast augmentation that I thought were pretty good. But I think what I’ve really noticed with the IDEAL IMPLANT, is I think the shape of the breast is quite a bit better. Patients have had a very high level of satisfaction. I’ve not had anybody come back saying that they weren’t happy with the IDEAL IMPLANT. And now, I’m getting many patients coming in who have heard about the IDEAL IMPLANT. They’ve seen them online. They’ve heard from other patients. They’re starting to ask for the IDEAL IMPLANT by name.
“I like the shape of the IDEAL IMPLANT. I think the clinical results are better, especially in women who have very little breast tissue and have lost a lot of breast volume. Even with a silicone gel or traditional saline, I don’t think I get as good a shape in those patients as I’ve been seeing with the IDEAL IMPLANT. So that’s been very important to me.”
How do you educate women about the advantages and disadvantages between a saline implant and a silicone gel implant?
“When I’m talking to patients about implants, I always talk about silicone gel also. If it’s a silicone gel implant, I tell them that many surgeons are recommending replacement every 10 to 15 years. I also tell them the issues about requiring an MRI. With a traditional saline or the IDEAL IMPLANT, I tell them my 20-year data is 1.8% deflation rate. [Note: For the IDEAL IMPLANT, the seven-year data shows a 1.8% deflation rate.] So I’m an optimist, 98% don’t leak. If the implant doesn’t leak, and they’re not having problems with implant position, there’s no reason to replace the implant. Nobody can guarantee that the implants are going to last their whole life, but I have patients who’ve had saline implants in for 30 years and are doing just fine. At that point, there’s no reason to replace them, unless they’re having an issue. Maybe later in life their breast volume will change, they’ll want a smaller implant or a bigger implant. That’s a possibility. There’s not a long-term necessity to change the saline implant if they’re not having problems.
“Clearly I like the advantages of saline over silicone gel. I like the safety of saline over silicone gel. I don’t think that women are going to get MRI’s every three or four years to monitor their silicone gel implants. I’ve taken out hundreds of ruptured silicone gel implants during my career. It’s a big operation, removing the silicone gel. If I never see another silicone gel implant related problem, I’d be very happy.
“With the saline implant, if it leaks, it’s a very easy thing to change. There’s minimal downtime, and it’s minimal inconvenience to the patient. A saline implant is not subject to monitoring. They come in for an exam, they look at themselves in the mirror, and they can tell if their implant is leaking. I do think that the double-lumen of the IDEAL IMPLANT is nice because it’s never going to totally deflate. Patients don’t have to worry about that. It’s still going to maintain roughly 60% of its volume, even if the outer shell leaks. That seems to be reassuring to some patients. Overall, I’ve just been very happy and find myself more enthusiastic about the IDEAL IMPLANT. As I use the IDEAL IMPLANT, the long-term results I’ve been seeing, they feel natural. I can’t tell the difference between the IDEAL IMPLANT and a silicone gel implant when I examine the patient. I have to look at their chart to know what they have in.”
How do you help your patients determine an incision location and the placement of the implant?
“I see a lot of patients specifically because they want a transaxillary approach. I feel that I can get an optimal result, without a breast scar. This is a cosmetic operation. I don’t see why we should ever put a scar on the breast if we don’t have to. I see patients back for other procedures or for long-term follow up, and I can’t even find their axillary scar. They’re thrilled with that.
“There are some situations, due to the patient’s anatomy or personal preference, where they want an incision in the breast fold. I’m certainly qualified to do it that way, but I just don’t see any advantage, for the majority of patients, to have a scar on their breast. With the IDEAL IMPLANT, I’ve not had any issues using them through the armpit. I know there are some other surgeons in the country that are doing it that way. I actually find it goes really smoothly.
“For patients who need a lift, and we’re talking about an implant, and I’m going to use the IDEAL IMPLANT, I still as a general rule put the implant in from underneath the arm because I feel like I get better muscle coverage of the implant, and I don’t expose the implant to the breast tissue. Many surgeons believe that this is somehow protective, whether it’s low-grade bacteria or what’s called biofilm that might be from exposing the implant by inserting it through a breast incision. That may be reduced. I looked at my long-term data with saline implants, and have had extremely low incidence of capsular contracture. I’ve always attributed that to the transaxillary approach. I can’t prove that because I don’t have a double blind study, but I think many surgeons in the community feel that that does protect the implant, so I still use that approach, even when I’m doing a lift.
“Also, I almost always put an implant underneath muscle. I do only in a very rare situation where the patient insists that it be in front of the muscle, and then it’s a much longer conversation because it’s a higher rate of capsular contracture. I don’t think the results look as natural. I’ve never put the IDEAL IMPLANT or saline implant in front of the muscle. I’ve only used silicone gel in front of the muscle, and that goes back to my earlier career. I don’t really look forward to doing that again, unless a patient really had a unique situation. I think in the last 10 years, I’ve done that once where the patient had insisted on it.”
What should women consider when they are researching plastic surgeons?
“I think the most important thing that any woman can do that is interested in breast augmentation, start by seeing a board-certified plastic surgeon that has extensive experience in aesthetic breast surgery and offers patients options, whether it’s silicone gel, traditional saline, or the IDEAL IMPLANT. They have options and experience to really address patients concerns and meet their needs. That’s the best way to have a good outcome for the surgery, and minimize any risks.”
Considering breast implants in Grand Rapids? Contact Dr. Steven Ringler today to discuss your options. Simply call 616-328-8800 or visit www.stevenringlermd.com. Dr. Ringler’s office is located at 1151 East Paris Avenue SE, #200, Grand Rapids, MI 49546. Call today for more information on IDEAL IMPLANT® Structured Breast Implants.