Strattice for Revision Aesthetic Breast Augmentation

We are starting to see many patients come from out of state to have their revision augmentation procedures or capsulectomy surgeries performed at the Roxbury Clinic & Surgery Center. I have been using the Strattice in the manner as taught to me by Neal Handel, M.D. When working through small incisions, I have found the use of appropriately and carefully placed marionette sutures to align the Strattice in correct position while the remaining sutures are performed through the limited incision.

I have found Strattice to be very helpful in the revision breast augmentation patient who has rippling, implant palpability, synmastia, bottoming out, and fold asymmetry. I have also found Strattice to be helpful as a barrier between the nipple areola complex incision and the capsule of the breast implant.

I remember repeatedly, the lessons on tendon healing by one of my great mentors, Malcolm Lesavoy, M.D. He would always describe the "one wound/one scar" theory for tendon healing. I find that the same theory can apply to breast implant capsules.

Frequently, I see patients who present for capsular contracture surgery who have a thickened scar beneath their periareolar incision with a "scar rind" that is aggressively fixed to their underlying capsule. It is my belief that the interposed Strattice may prevent the "scar rind" that I frequently see beneath the periareolar incision that is firmly fixed to the capsule. I hope this has great implications for reducing capsular contracture.

Brian P. Dickinson, M.D.
www.drbriandickinson.com

Breast Augmentation: Testimonial

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Patient testimonials are one of the highest compliments I could ever receive. This happy patient writes in her testimonial:

"This experience couldn't possibly have been any better, and bless Dr. L for referring me to you! You're the best -- Dr L told me you were going to be the next big bev hills plastic surgeon, and I think he's right.... from the first visit I felt comfortable and am soooooo pleased with my results, you have NO idea!

Every visit has been a true delight, and actually fun and entertaining (not usually the case half naked in a dr office!).... I love that I found a Doc that I didn't feel all weird with, and that I NEVER felt judged, and was always treated with the utmost respect. Thanks!;"

No Touch Teqhnique Breast Implant Delivery

I have been using the Keller Funnel routinely for my periareolar and transaxillary breast augmentation cases. The Keller Funnel allows me to deliver larger implants through a smaller incision without traumatizing the breast implant, the skin, or having the breast implant come into contact with the skin.

I believe strongly that this "no touch technique delivery system" can help reduce the incidence of capsular contracture. It is of paramount importance to me that my patients receive great results and that I try to do everything possible to minimize complications.

Brian P. Dickinson, M.D.

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Breast Implants. Saline Implant Valve Failure with Capsular Contracture

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I am seeing more and more women in consultation in my office with deflation of their saline breast implants. In fact, twice this month we had women who presented with the development of pain around their breast implant with an associated distortion of the breast shape secondary to breast implant valve failure.

It has been my experience that the development of a capsular contracture around the breast implant changes not only the shape of the breast implant capsule complex, but may incorporate around the valve of the saline implant (as shown in the image above).

Either continued contraction of the breast capsule resulting in a change in the surface area to volume ratio and/or ingrowth of the capsule to the valve disrupts the valve and allows the saline to extravasate. These women often present with continued pain and the apparent deflation of the implant can be distressing to the patient.

In these cases I recommend that women undergo removal and replacement of their breast implants and capsulectomy. Many women are opting now to exchange their saline implants for silicone gel breast implants.After these surgeries, patients are very happy with the new contour of their implants and their pain is often markedly improved.

Brian P. Dickinson, M.D.
www.drbriandickinson.com

Breast Augmentation Porportion

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I find that the most important aspect of breast augmentation, is that the operative plan needs to be individualized for each patient. I have found that different breast implant profiles work very well and can produce a similar aesthetic look depending upon the anatomic dimensions of the patient and tissue characteristics.

It is important when operating on a patient with a short nipple to inframammary fold distance to select a breast implant that not only is proportionate to the base diameter, but also to the breast height. While it is important to maintain superior fullness of the breast it is important that the "take off" of the breast contour is not placed to superiorly or that the chest to breast angle is not too acute.

This patient is very happy with her breast augmentation as her breast/waist/hip ratio is in better proportion. Selection of appropriate breast implant size and dimension is paramount to an optimal outcome.

There are three different dimensions and profiles of breast implants. Mentor corporation makes a moderate, moderate plus, and high profile silicone gel breast implant. Allergan produces a style 10, style 15, and style 20 for their breast implants. These labels respectively correspond to breast implants with increasing projection to base diameter ratios.

Brian P. Dickinson, M.D.

www.drbriandickinson.com

Capsular Contracture and Saline Implant Valve Failure

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There are an increasing number of patients who come into my office for consultation regarding capsular contracture pain. Recently, I am seeing more patients come to both the Beverly Hills and Newport Beach offices from the South, Midwest, and East Coast with capsular contracture symptoms.

Frequently these patients present with signs and symptoms related to their capsular contracture such as change in shape of their breast, asymmetry, pain, and more frequently I see women who present with malfunction of their saline breast implants. Occasionally if saline implants have been in place for a long period of time, the shell may undergo “fold flaws" and rupture at the weakest location of the shell.

Most recently, I have seen several cases where a capsular contracture has started to cause breast pain and soon after the patient experiences a deflation of their saline implant. While the leakage of saline does not cause any physical harm to the patient, it is nonetheless very distressing and post rupture may cause more pain to the patient.

In a recent case, as depicted above, I noticed that a small portion of the capsule had grown into the saline valve. While I cannot prove this, I believe that the continued pain experienced by the patient is the adherence of the capsule to the chest wall, muscle, or skin and the mobility of the ruptured implant within the capsule lining.

This motion with exertion, movement, etc. can be extremely painful to the patient and warrant surgical removal and replacement of the mammary prosthesis. More frequently, I am seeing more patients from outside of California who present with either Baker Grade IV capsular contracture or Baker Grade III capsular contracture who also have a malfunctioning of their breast prosthesis. Capsular contracture surgery is frequently performed at both the Beverly Hills and Newport Beach, CA surgery centers.

Brian P. Dickinson, M.D.

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Self-Study:Article Review

Review of "Breast Cancer Diagnosis and Prognosis in Augmented Women" Plastic & Reconstructive Surgery 118: 587-593, 2006 by Neal Handel & Melvin J. Silverstein."

Frequently in my practice I am asked by many women who desire breast augmentation or who have already had a breast augmentation and now want a lift, removal and replacement, or surgery for capsular contracture the following question:

Do breast implants impair my ability to detect breast cancer or increase my risk of getting breast cancer?

To answer this question and as part of my own self study, I read and reviewed an article in Plastic & Reconstructive Surgery 118: 587-593, 2006 by Neal Handel & Melvin J. Silverstein. I present here notes which are helpful for my own self study as well as for patient education during consultation:

Background:
--Breast enlargement surgery is popular. More than 334,000 women underwent elective breast augmentation in 2004.
--A woman in the United States has a 1 in 7 (13.4 percent) lifetime risk of developing breast cancer.
--There is no etiologic link between implants and breast tumors. Numerous studies show that the rate of breast cancer is not increased among augmented women, and some studies demonstrate lower than expected rates.
--However, because of the large number of women undergoing augmentation, there have been persistent concerns about possible adverse effects of implants on cancer detection and treatment.

Methods:
The authors reviewed their database of women with breast cancer and determined if there was a difference in breast cancer between augmented and non-augmented women.

Results:
--There was no statistically significant difference in stage of disease between augmented and non-augmented patients. The mean tumor size, recurrence rates, and breast cancer- specific survival were virtually identical in both groups.
--Augmented patients were more likely to present with palpable lesions.

Conclusion:
Augmented and nonaugmented patients are diagnosed at a similar stage of breast cancer and have a comparable diagnosis. While implants may impair mammography, they appear to facilitate detection of palpable breast cancers on physical examination.

Revision Breast Augmentation: Correction of Capsular Contracture & The Double Bubble Deformity

While I enjoy all aspects of Aesthetic Surgery, correction of capsular contracture and revision breast surgery is particularly enjoyable to me. Not only do I enjoy anatomic and aesthetic challenges of these operations, but also the degree of patient satisfaction is high.

This patient had painful capsular contracture and left breast double-bubble deformity. Correction of this asymmetry was done with bilateral "en bloc" capsulectomy, re-set of the inframammary fold, and change of implant profile. I am very thankful to have had such excellent aesthetic surgery training from outstanding mentors in Beverly Hills, Sherman Oaks, Encino, and Valencia. I am truly fortunate.

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