Dr. Adam Tattlebaum Reviews Breast Implant Manufacturers

February 22nd, 2013

Implant Update:

While I have contrasted silicone vs. saline implants in the past the purpose of this blog is just to give an update on what breast implant options are out there. At the conclusion I will share my preferences.

Summary:

Three companies are currently are FDA approved in the United States to make Breast implants:

Mentor

Allergan

Sientra

Mentor and Allergan make saline and silicone implants, Sientra makes only silicone.

Each company has its own version of low, moderate and high implants.

Each company offers round or shaped implants.

Each company offers implants that are smooth or textured. Shaped implants are textured so they do not move.

Each company’s implants are cohesive minimizing the risk of leakage.

The “gummy bear” implant is a shaped and coarsely textured implant made by Allergan. As of today, it has not been FDA approved.

Mentor and Allergan offer implants for sizing in the office.  As of this writing Sientra does not have its own sizers, but this should change soon.

 

Opinion:

What do I like and use?

I generally use smooth round implants. The smooth shell lets the implant move around within the implant pocket and I feel this give a more natural motion to the breast. I believe the smooth surface is less noticeable.

Textured implants stick inside the pocket and do not move as naturally.  I believe the texturing is more noticeable to the patient. While there is evidence that a textured implant can diminish the risk of capsular contracture I do not believe it is a large advantage when implants are under the muscle.  I favor submuscular implants, which means, the implants are located under the pectoral muscle.

I don’t favor teardrop implants because they are all textured and can still sometimes still rotate. If a round implant rotates it makes no difference. Teardrops are fuller at the bottom and most of my patients are looking for fullness up top.

I prefer the look and feel of silicone implants but I offer both and always go over the pro’s and con’s in consultation.  Silicone gel implants are softer and more natural looking and feeling and ripples the least, but they require more future thinking and evaluation.

So which companies breast implants do I offer?

I offer all of them; the key is to find which one fits the patients frame and goals the best. I have my patients try on actual implant sizers in a testing bra. I find this to be the most accurate method for choosing a size.

If you are interested in looking at or trying on breast implants just give us a call and we can find the right fit for you.

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Dr. Tattelbaum Discussion on Breast Implant Techniques

February 19th, 2013

An Overview of Breast Implant Techniques

For this article I would like to go beyond the basic facts that are posted all over the internet and give a personal opinion based on almost two decades of experience and thousands of breast implant procedures performed.  This blog covers the most frequently asked breast implant questions:

1)      Under or over the muscle:

I generally favor implants under the muscle because they tend to look more natural.  This is because the muscle gives a gentle slope to the upper breast. When the breast implant lies under the muscle mammograms are easier to interpret.  Infection rate is lower because muscle has a better blood supply and blood supply fights infection, there is also a lower rate of capsular contracture. If you want a breast lift later in life, more of the blood supply to the breast is preserved when under the muscle.

2)      Best sizing method: Trying on implants –

I think trying on an actual implant sizers gives the most accurate information, and allows you to see your whole frame.  Breast Implants relate to the entire body, hips, shoulders and height. Things like magazine pictures, internet photos or computer imaging don’t tell the whole story. You often don’t see the patient’s full stature.  Other options such as rice or water bags have no shape, these methods are very inaccurate.

3)      Incision:

Here are the most common body locations for incision:

  • Armpit- This sounds cool but implants often ride too high, because it’s hard to be precise when you have a limited view inside the breast.
  • Belly button- This technique is done more by feel, therefore it is less precise.
  • Areola – The is the most precise, and allows best visualization inside the breast.
  • Inframammary – This is good for large gels and allows good visualization.
  • TABA (transabdominal  breast augmentation)- Implant through a tummy tuck, for select patients, slightly less precise.

4)      Silicone or saline:  (this could be a blog unto itself)

Silicone implants are softer and more natural feeling, they give a softer transition in the upper breast, and have the least rippling around the edges. Because of these properties they tend to look more natural.

The downside of silicone implants are they sometimes need a longer incision, and the volume can’t be changed.  Surveillance is recommended with an MRI every 3 years.  Silicone implants are generally more expensive then saline implants.

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Plastic Surgery on The Young

January 17th, 2013

Plastic surgery on the very young.

There is no more controversial topic in plastic surgery than plastic surgery on the younger patient.  As a board certified plastic surgeon I feel that younger patients should need us the least. We are not a substitute for a healthy lifestyle, diet and exercise.  There are however certain instances where I find that surgery at a younger age is justified and even beneficial. Here are some examples:

Male breast reduction:

This procedure is indicated in enlarged male breasts or gynecomastia. In certain young men, often for no discernible medical reason, the male breast tissue is enlarged. This can happen even without weight gain. Long lasting gynecomastia leads to stretching of the breast skin over time. When the skin is loose it is often necessary to excise it, leading to more visible scarring.  Early treatment is therefore preferable and can often be done with minimal incisions and visibility.

Rhinoplasty

The majority of nasal growth ends with puberty, so rhinoplasty at this time makes medical sense for an appropriate candidate. The driving force here, though, is social. For many of my patients, the end of puberty, the end of high school and the break before college all coincide.  It is a time when many patients have the support from their families, time off to recover and the opportunity to subtly transition to a new environment.

Otoplasty

Otoplasty is the setting back of protruding ears.  For the child with prominent ears, otoplasty at a young age can save a lot of peer teasing and unnecessary ridicule. Ear cartilage is softer in the younger patient as well, which often leads to a more stable result.

Surgery after massive weight loss

The message is getting out and people are listening. Each year I see more and more people, particularly young people who, through shear perseverance, diet and exercise have lost a large amount of weight. One remnant from massive weight loss is an excessive amount of loose skin that won’t recoil without the help of plastic surgery.  While most of my tummy tuck patients are post partum mothers, it is the most common surgery in the massive weight loss patient at any age.

Breast augmentation for Amastia

Amastia means no breast tissue. Each year I see a number of very young women, often with their mothers, exploring breast augmentation for the sole purpose of feeling “normal.” These are healthy young women who don’t have small breasts; rather, they have almost no breast tissue at all.  These younger patients return to school and life in general with a sense of feeling whole or balanced.

 

If you are a young person or parent reading this, please know that I will never push you or your child into surgery.  The greatest joy in my practice is educating patients and families about the surgeries they are contemplating.  If these are thing you have been thinking about it would be my pleasure to educate you as well.

 

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