Do you want a breast implant that allows you to achieve a natural look and feel, similar to a silicone gel implant, but also comes with peace of mind of a saline implant? The IDEAL IMPLANT® Structured Breast Implant is a new, innovative choice available to women seeking the advantages, without the drawbacks, of those traditional types of breast implants. In a recent interview, board-certified plastic surgeon Dr. Adam Hamawy of Princeton, NJ, talked about this unique option.
What do you discuss with women that are considering a breast augmentation?
“I spend a lot of time with my patients. If someone’s coming in for a breast augmentation, they’re here for at least an hour. For the first part of it, we are just talking, seeing what you’re trying to achieve, where you’re at, what’s bothering you. But the next part is the education. I always like to talk about five decisions you need to make with the breast augmentation. We need to decide, is it just a breast implant that we’re looking after or do we also need to do a lift. We also talk about where we are going to put the incision, where we are going to put the implants, what size of implant, and what type of implant.
“Those are five things everyone has to decide, and in order to decide them properly, you need to be educated even if you think you’ve done all your online research. There are so many different things out there. Even if the patient has seen other surgeons, I like to cover everything to make sure we are complete. Once you have all that information, the pros and cons of each one of them, then you can make a proper decision.
“I always tell everybody, ‘You have a lot of tools, and you have to be able to use all these tools to get the best results.’ It’s usually not just one surgery or one technique or one device that will get you to your goals. And by being a plastic surgeon, I have access to all of these and can do a surgical procedure. I have access to different breast implants. We could do fat grafting in addition to implants. If we’re doing breasts, same thing with devices. I don’t have one device that does everything. That’s why I love being a plastic surgeon. We get to talk and tailor results, really tailor them, to what you actually need for your body and your goals.”
How do you help your patients decide on the type and size of breast implant that will be best for them?
“I have a silicone gel implant, I have a saline implant, and then I have the IDEAL IMPLANT. I give them those in each hand, and then say, ‘Feel this.’ Feeling it in your hands is one thing, having it behind your skin and your tissues is a completely different thing. So I apply something over them and say, ‘This is what it is going to feel like in your body.’
“As part of every visit, there is an examination. During the exam, I’m looking at a few things. I’m looking at dimensions, how wide the chest is, how wide each breast is. I’m looking at asymmetry. Everyone’s asymmetric, but some are more asymmetric than others. So if it is within physiological limits, where you can’t really tell unless you look closely, then we’re talking about putting the same size implants in.
“Also, we’re looking at how much skin and breast tissue we already have that you could cover an implant. So someone who is very thin with very little breast tissue, that will factor into our decisions like whether we are going to go over or under the muscle and what kind of implant we are going to place. We’re looking at your actual muscle there, that pectoral muscle. Some people are doing these really hard workouts in the gym, and we’re going to start considering going above the muscle rather than below. These are all individual things that we have to take into account when we are deciding what kind of implant to place and where to place it.
Some patients will choose one or the other based on how they feel. But if I give them all that information, then together we can make a decision, rather than me telling them, ‘This is what I want to do for you.’ We are making that decision together.”
What do you tell your patients about the IDEAL IMPLANT?
“I’ve been working with the IDEAL IMPLANT maybe two or three years. I came across it at a plastic surgery meeting, and they were talking about a better saline implant. Initially I said, ‘Well, who needs another saline implant when everyone’s going with silicone gel.’ But when you place them side-by-side, it’s definitely an option that fills in a gap.
“I tell everyone who’s coming in, if they’re worried about breast implants, ‘This is the most studied device that the FDA has ever looked at, more than anything else.’ But there’s still a certain sense of security when telling someone that we’re going to put in a saline implant that’s going to feel almost as good as the silicone gel, and also give the security of being able to know if it’s ruptured right away. So the IDEAL IMPLANT fills in that gap for people who are still worried about silicone gel, want a natural result, and don’t want the rippling that comes with a traditional saline implant. I tend to find that although most people are happy with traditional saline implants, it does have some issues with rippling and a little bit less natural look in some patients. I haven’t found that to be at all a problem with the IDEAL IMPLANT.
“Plus, the safety record that the IDEAL IMPLANT has so far has been excellent from what I’ve seen personally, as well as in the plastic surgery community.”
What is your advice to women after they receive a breast augmentation?
“Follow your recovery instructions, and follow up with your surgeon. Don’t disappear. Your body heals and changes over time, so I usually like to see people one week later, one month later, and three months later. Then an annual check up with your regular physician, as well as your plastic surgeon, is important as well. You should be doing your self-breast exams. You should be doing mammograms if you’ve reached that age where it’s recommended. You should be taking care of your breasts just like you would if you didn’t have implants.”
What are the potential complications women should be aware of following a breast augmentation?
“The most common complication we see with breast implants is mal-position; this is when one’s a little bit higher or a little bit lower than the other side, something called capsular contracture. Capsular contracture is basically a capsular around a breast, scar tissue that forms around the implant. Just like you can have a scar on the outside, you’re going to have a scar on the inside, and most of the time this is not something that you can see or feel. Everyone has that. But just like some people have poor scars on the outside, you can have a poor capsular on the inside, and that’s when there could be a problem. That’s when it could be a little bit tight, it could be a little bit painful, and it could often move the implant from where it’s at. So, if we notice that two or three months later, that the implant has shifted or there’s a tightness that shouldn’t be there versus the other side, that’s something that can often be fixed, either in the office or in the operating room. We remove the capsule and things are made normal again.”
What should women know about the possibility of implant rupture?
“If an implant ruptures, then we need to change that. One good thing about the IDEAL IMPLANT is that if it’s ruptured, you know right away. You’ll look like you have a deflated implant, a flat tire on one side. It’s filled with saline, and your body will absorb that. You go to your doctor, and he’ll schedule to have that removed.
“With silicone gel implants, it’s a little bit different. They can rupture, but it doesn’t go everywhere, it doesn’t go anywhere at all. What it tends to do is stay in that space. It might cause that capsule we were talking about to form a little bit harder, so it might feel a little bit different, it might look a little bit different, or might be a little bit painful. There’s nothing specific in that case. You actually have to get either an MRI or an ultrasound to confirm that there’s a rupture there.
“The newer silicone gel implants are a lot better than the earlier generation. So right now, if I have a ruptured silicone gel implant, it’s easy to take out. You go in there and pull it out, and there is very little residue that’s left over depending on how old it is. If you have a silicone gel implant that’s over ten years old, it’s a little bit more difficult, especially with the older generations. It could take sometimes hours to get all that leaked silicone gel out.
“Really the issue comes down to detection. Is it ruptured or not? You could have a fall or an accident, something feels different, and there’s a lot of worry that goes with that. Is it ruptured or not? And having a saline implant eliminates that. There’s really no question. I get women who say they have a saline implant, and they come in and say they are worried that it’s ruptured. I just look at it and I can tell them yes it is or it’s not. I don’t need anything more than that. With silicone gel implants, it does take more than that.”
What characteristics should women look for in a plastic surgeon?
“You want someone that is going to give you options, not someone that’s telling you, ‘This is what you have to do and that’s all I do, all the time. I just do silicone gel implants. Or I just do implants that go under the arm.’ If someone does just one thing, then they’re probably not tailoring it toward you. So one consideration is to see how many options they are giving you.
“Two, see how much you are being involved in the conversation. Are they actually sitting down with you, talking to you, giving you different choices and educating you so that you are coming to a decision together?
“And, three, I encourage people to shop around. I don’t think you need to see a million doctors, but I think maybe two or three. It gives you a sense of perspective and even if you like your first doctor more than anybody else. When you go to someone else, it’ll secure your decision and you’ll know, ‘I like that person, and now I know why.’ When people come and tell me I’m going to see a few more other people or I’m seeing someone else, I encourage that. It makes me secure that you’re a little bit more educated, that you know what’s out there, and what you are getting.
“So, go look around. Find a plastic surgeon that is board-certified. Find someone who offers the IDEAL IMPLANT, even though you might not want one. For example, if you wanted the silicone gel implant and you know you don’t want the IDEAL IMPLANT, well maybe it’s at least worth a feel. If they are giving you the choice, even if you don’t choose it, that’s a good thing. Look for choices, and make sure you are looking around at other doctors. Make sure you are comfortable. This is someone that you’re not just going to be seeing at the surgery, but afterwards. You want that relationship, that bond, to be there. That’s very important as well.”
Considering breast implants in Princeton? Contact Dr. Adam Hamawy today to discuss your options. Simply call 609-301-0760 or visit www.drhamawy.com. Dr. Hamawy’s office is located at 106 Stanhope Street, Princeton, NJ 08540. 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.