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.