Fitness Model Revsion Aesthetic Breast Surgery

Revision breast augmentation in Fitness Models possess unique challenges to the surgeon. Aesthetic results are usually quite optimal after complete capsulectomy, but the thinning tissue often allows implant visibility or rippling. I often choose to perform complete capsulectomy to allow the breast to re-drape over the implant. It is important for the surgeon to have a thorough knowledge of the previous operations, as implants may have been in prior planes, or neosubpectoral pockets may have been created from prior capsules and have subsequently contracted. I have used the neosubpectoral pocket on many occasions for revision aesthetic breast surgery and have found it useful. However, in women who present with recurrent capsular contracture, it is important to remove the capsules to allow the breast to re-expand and produce an optimal aesthetic shape.

Often in patients who have undergone previous revision aesthetic breast surgery and who are competitive athletes, fitness models, or clothing models, the breast and surrounding subcutaneous tissue is thin. To prevent implant visibility or palpable rippling in this population, I have found Strattice to be quite useful.

The Roxbury Clinic & Surgery Center continues to grow as a center for capsular contracture as well as revision aesthetic breast surgery. An increasing number of women choose to undergo their mastopexy/augmentation, capsular contracture surgery, breast augmentation, removal and replacement, as well as second stage breast reconstruction surgery at the Roxbury Clinic & Surgery Center.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

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.

http://www.drbriandickinson.com/

Revision Augmentation Mastopexy Surgery

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I have found an increasing number of women who present to my office in consultation who had saline breast implants placed ten years ago and who are now requesting removal and replacement of their mammary implants for highly cohesive silicone gel mammary prosthesis.

Often these women underwent reduction mammoplasty with an implant to maintain upper pole fullness, but now want to change to an implant with a slightly higher profile to deliver more breast projection.

We are seeing more women present from out of state who come to Newport Beach and Beverly Hills who have capsular contracture and who now want to have their breast implant capsules removed, saline implants replaced for silicone gel implants, and a simultaneous breast lift.

These operations are challenging to preserve the blood supply to the nipple areola complex as previous operations contribute to scarring and necessitate experience with these cases to deliver consistent results.

Bilateral capsulectomies, implant exchange, and mastopexy are commonly performed operations in Newport Beach and Beverly Hills.

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

Strattice in Aesthetic Breast Surgery. Self-Study. Conference. LifeCell-Strattice

I had the great pleasure of attending the LifeCell educational forum this past weekend in Las Vegas, Nevada. The meeting was very helpful to solidify my experience with regenerative tissue matrices.

This conference came at a timely fashion for me as it reinforced my educational experience on the use of Strattice for revision aesthetic breast surgery in women with thinning tissues.

I have seen many women in consultation recently with fitness model physiques and a history of recurrent capsular contracture and severe thinning tissues.

As was taught to me by my mentor, the reinforcement of the thin lower pole skin with Strattice can help visible and palpable ripping in this population. The Strattice held in by marionette sutures and then sutured with long-acting absorbable will decrease the incidence of palpable rippling and may reduce the rate of capsular contracture.

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

The Keller Funnel for Silicone Gel Implant Delivery

Today was truly a great day of cases. As the breast augmentation, revision breast augmentation, and capsular contracture surgery practice grows, I continually look for ways to improve patient outcomes, reduce patient recovery time, reduce incision length, and prevent capsular contracture.

I have found that the Keller Funnel facilitates delivery of silicone gel implants through smaller incisions and allows me to employ a no-touch delivery technique whereby the gel implant does not come into contact with the nipple areola complex or the axillary skin when placing implants. I found that the Keller Funnel greatly facilitated today's cases and I will use it for the breast augmentation cases later in the week.

I anticipate that the no-touch delivery technique is one method to further reduce the prevalence and incidence of capsular contracture. I look forward to continued success with is device.

Brian P. Dickinson, M.D.

Capsular Contracture: Reconstructive Breast Surgery or Revision Aesthetic Breast Surgery?

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As I continue to learn about both aesthetic and reconstructive breast surgery, I find that the same tools, skill sets, and planning that I use for aesthetic breast surgery apply to reconstructive breast surgery and vice versa.

Frequently, I see many women in consultation who have undergone first a breast augmentation, second a breast reduction, and often present desiring further reduction of their breasts or require surgery for capsular contracture.
I enjoy these challenging cases as it is important to be knowledgeable of the blood supply of the nipple areola complex, the prior surgeries, and how to most effectively manage the capsular contracture.

Women who present after numerous operations often have thinning skin or breast tissue, asymmetry, capsular contracture, or unwanted motion of the implant, and desire correction.

I have found that the breast surgery techniques taught to me by Handel have been very effective for identifying, addressing, and managing these difficult cases. Capsular contracture can be very painful for the patient and interfere with daily activities and be psychologically distressing.

The patient in the above photograph is happy with her removal of her saline implants in exchange for silicone implants, change of implant plane, nipple areola reduction, and mastopexy. The scars are still hyperemic in this early one month post-operative result. I routinely educate patients that scars tend to be the most indurated and red approximately one month after surgery and then soften as the collagen in the scar remodels.

I have found that as larger saline implants are removed and exchanged for smaller lighter silicone implants, it is easier for patients to excercise, return to the gym, and loose weight.

Brian P. Dickinson, M.D.

http://www.drbriandickinson.com/

Capsular Contracture Treatment

Capsular contracture symptoms usually begin with the patient noticing a distortion of their breast implant shape or the beginning of an occasional pain around the implant or the breast.

To explain the changes in the shape of the implanted breast with the development of capsular contracture it is important to understand the following:

Most breast implants while they may vary slightly depending upon profile are the shape of a disc. When the lining around the implant starts to aggressively contract symmetrically, the shape that forms is a sphere. Now the breast implant which was once a fixed volume in a defined surface area is now changed to the same volume being compressed into a smaller surface area by the capsular contracture. This change not only distorts the augmented breast, but the augmented breast also becomes firm. This firmness can cause capsular contracture symptoms such as sharp pain, dull pain, pain with movement of the breast, or with exercise. When the capsule implant complex becomes painful, the patient has developed a Baker IV capsular contracture.

Typically in these patients, my preferred method of capsular contracture treatment is total "en bloc" capsulectomy so that the entire capsule and implant contents can be removed in their entirety. Removal "en bloc" allows for an optimal plane with which to attempt implantation.

In the picture shown above, the one appreciates the spherical shape of the hard capsule lining which has compressed the discoid silicone implant. In this case the silicone implant shell was ruptured with the silicone remaining within the capsule.

I will continue to research capsular contracture treatment and prevention.

Brian 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.

http://www.drbriandickinson.com/

Capsular Contracture & Capsular Contracture Surgery

Capsular contracture is common sequelae of breast augmentation surgery. When a breast implant or other medical device is placed in the body a lining may form around the device. The lining that is created is the body's natural response. In some individuals or in some scenarios the lining that forms can contract or thicken aggressively which is an unnatural or undesirable response of the body to the breast implant. When the lining contracts around something that is soft, such as a breast implant, the surface area: volume ratio of the lining: implant changes.

When the surface area lining decreases around the fixed implant volume, the construct becomes hard. This hardening of the implant can cause significant pain to the patient and may temporarily disfigure the breast until the capsule is released or removed. There is a four grade classification scale, the Baker Grading Scale to describe capsular contracture:

Grade I - The breast is soft, and appears natural.
Grade II- The breast is firm, but still appears natural.

Grade III - The breast is firm, and is beginning to appear distorted in shape. Grade IV- The breast is hard, distorted in shape, and is painful.

Typically patients present to our office when a Grade III or Grade IV capsule has developed. Often patients choose to undergo surgery for their capsular contracture for these grades secondary to pain or because the distortion has changed the appearance or begins to interfere with mammography.

The above patient presented with bilateral painful Baker Grade IV capsular contracture that was surgically corrected with bilateral "en bloc" capsulectomy, change of implant plane, and replacement of the breast implant.

Capsular contracture surgery is commonly performed in both the Beverly Hills and Newport Beach, CA locations.

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.

http://www.drbriandickinson.com/