Last month the American Society for Aesthetic Plastic Surgery (ASAPS) surveyed their member surgeons to get an idea about current trends in breast augmentation, as well as statistical analysis of trends in all procedures. Most of the answers they received are not at all surprising, with one big exception.

The preference for natural looking results continues for the vast majority of plastic surgeons and their patients. For example, the average implant size used by most of the surveyed surgeons is 300 – 400 cc. For most patients, this size will result in full C cup breasts. More than 60% of surgeons place the implants under the chest muscle rather than on top of the muscle, again aiming for a natural appearance to the slope of the chest wall.

An overwhelming majority of ASAPS plastic surgeons prefer round implants as opposed to “anatomical,” or teardrop shaped implants. The survey did not detail the reason for the preference, but the plastic surgeons we’ve spoken with say that implants occasionally rotate and shift inside the breast capsule. Obviously, anatomical implants would look unnatural upside down. Additionally, most plastic surgeons feel that round implants look very natural when the right size and position is selected, and particularly for submuscular placement.

The ASAPS survey also found that 64% of surgeons prefer an incision near the crease underneath the breast. Although there are other options, notably around the areola, an incision under the breast can give the surgeon optimal access with the least amount of visible scaring.

The big surprise, is how many plastic surgeons and patients continue to choose saline-filled implants. The ASAPS survey showed that 60% of their members are still using saline implants, with an overwhelming majority of those selecting saline implants for first time patients. Furthermore, when silicone gel was chosen over saline filling, the reason most often cited was “patient preference.”

So, it would appear that many plastic surgeons still select saline-filled breast implants quite often. The question is, “Why?” Not only has the filling been shown to be safe and unlikely to leak, it both looks and feels more like real breast tissue.

Could it be that even though silicone gel implants were re-approved by the FDA in 2006, there’s still a lack of faith in the devices? Perhaps many patients, and even some surgeons, haven’t done extensive research on the options? Maybe the choice of saline is simply a result of habit?

Whatever the case may be, the president of the ASAPS noted that good results depend more on “patent-appropriate” surgical techniques more than on the type of implant chosen. If the procedure is done correctly, only a defective implant of either type would create a probable high-risk scenario.

by Dr. Gabrielle Young, M.D.

Today, at BreastImplants-Info.com, we’re taking this opportunity to showcase an article written by both a plastic surgeon and former breast augmentation patient, Dr. Gabrielle Young. Given her unique perspective on the procedure, we felt it would offer our readership great insight into the science behind breast implants, having elective cosmetic surgery in a recession and the social pressures of looking “just right” that teenage girls and young women face daily. (Special thanks to TampaBay.com / St. Petersburg Times.)

Here’s one possible upside to the economic downturn: Fewer teenage girls are getting breast implants.

According to the American Society for Aesthetic Plastic Surgery, 4,108 girls ages 18 and under had the procedure in 2008, compared with 7,882 the year before. Given the current economic outlook, 2009 may see further declines.

But as a doctor who has breast implants myself, I find it shocking that so many girls whose bodies are still developing are undergoing major surgery they do not need and may not fully understand. And I’m even more stunned that parents who should know better are indulging their daughters.

The physical risks of the procedure are well documented. Studies by implant manufacturers show that many breast implant recipients have at least one serious complication within the first three years, including infections, bruises, fluid collections, capsular contracture (painful hardening of the breasts), disfiguring scars, loss of nipple sensation, substantial stretch marks, irreversible thinning of the skin and migration of the implant.

Breast implants can interfere with self-examinations and mammograms, making early cancer detection far tougher. Implants also can make breast-feeding difficult or impossible.

Painful Choice to Advance Career

When I was 25, an aspiring model, it became clear that my B-cup breasts weren’t going to get me where I wanted to go in my career. So I opted for a conservative augmentation, to a C-cup.

I was expecting some discomfort after the surgery. No one prepared me for the feeling of constant sledgehammers crushing my breasts.

I had chosen to have my implants placed under the muscle, meaning my pectoral muscle was cut to place the implant in the proper position, to give my breasts a more natural look and feel.

It actually felt like my chest had been placed in a vise and squeezed. I had to be in a cloud of narcotic medications just to make it through the day.

My breasts were so swollen, I looked like I was wearing a personal flotation device for an emergency plane landing. I could not pick up a 3-pound weight, drive to get groceries or even put on lipstick for more than two weeks.

Once the pain ebbed, I was pleased with my new C-size breasts. They were ideal for my frame. But I allowed myself to be convinced by other swimsuit and fitness models that I should go bigger — all the way to double Ds. I was not discouraged by my plastic surgeon, but I don’t know that I could have been talked out of it anyway.

I had the second surgery less than a year later. The pain was worse the second time around. Despite that, I was happy with the results, because I thought it was what I needed to be a model.

Projecting the Wrong Image

Now I am a doctor, and my swimsuit-model figure doesn’t project the image I want to have.

Here’s just one of many stories I could tell: As a resident physician, I was speaking with a terminally ill patient about his treatment options. When I looked up at my attending physician, he was staring at my double Ds, which I had tried to conceal beneath two compressing sports bras and baggy surgical scrubs. The patient asked him if he agreed with my comments, and he could only blush. He had no idea what I had said.

The decision to go bigger was for the short-term goal of advancing my modeling career. I did not anticipate the long-term effects it would have on my professional life. No matter where I go, or what I say, people still look at me like I am a porn star, not a doctor.

And, like all breast implant recipients, I am facing surgery to have them replaced one day, because implants do not come with a lifetime guarantee. But I won’t change sizes, as once an implant is placed it is difficult to change sizes.

It’s Parents’ Job to Say ‘No’

From the time they can turn on the television, our children are bombarded with images of kids growing up too fast, images like Lindsay Lohan, Britney Spears, and My Super Sweet Sixteen. It’s hardly surprising if girls feel like they are waging an internal war over beauty and self-esteem. And if they decide a quick little operation can help, and their parents won’t say no, who will stop them?

Most surgeons won’t perform augmentations on girls. In fact, the American Society of Plastic Surgeons doesn’t even track statistics on implants for girls under 18, since the group has taken a position against the practice. But clearly, not everyone is following suit.

These are our daughters, and the future professional women of our country. They are not specimens to be cut with a scalpel and modified simply to help them gain social acceptance or, even worse, self-acceptance.

If economic reality is helping more parents say no to young girls who want bigger breasts, that’s a good thing. But the economy will turn around eventually. Will parental responsibility turn with it?

Dr. Gabrielle Young recently completed her residency at the University of Louisville and is an osteopath. She plans to practice in the Tampa Bay area. For more information, visit her Web site, www.drgabrielleyoung.com.

Breast augmentation continues to remain one of the most popular cosmetic surgery procedures in our country today. Even recent reports from the American Society of Plastic Surgeons (ASPS) reveal the breast augmentation surgery is now the most popular cosmetic surgery procedure, knocking off liposuction. However, the results of these procedures have always produced mixed reactions from the women who have or want them.

While many women feel younger, sexier, and more alive as a result of their enhanced new figure, others lament about the lack of a natural appearance provided by their breast implants.

Vaser® Hi Def Breast

This struggle to achieve a more natural result has led many cosmetic surgeons to continually improve the procedure in the search of better end results. Recently, a new advancement in augmentation procedures is providing women with breast implants that more closely resemble a natural feeling breast.

This procedure, the Vaser® Hi Def Breast, adds a new twist to the typical enlargement surgery by combining it with liposuction. This advancement has led to a greater satisfaction rate among women opting for surgery, as their new breasts have a more natural and attractive appearance.

Vaser Hi Def Breast employs ultrasonic technology to remove specific fat pockets in the breast tissue, while leaving other fat cells and neighboring nerve tissue untouched. This enables your cosmetic surgeon to more subtly sculpt your breasts, giving them a more youthful, firm, and natural look.

The Ideal Candidate for Vaser® Hi Def Breast Augmentation

This procedure is not right for all women. As with traditional implant procedures, it is important to consult with an experienced cosmetic surgeon to make sure you are a good candidate for Vaser Hi Def Breast. As part of this consultation, your doctor should talk with our about your medical history and your goals for your surgery.

Ideal candidates for Vaser Hi Def Breast are women who:

• Are in good overall health
• Are physically fit
• Have reasonable expectations for the surgery
• Have good overall self-esteem

As with any major surgery, there are risks that accompany this breast augmentation process. A good candidate needs to understand these risks and be willing to accept them. Also, candidates must recognize that this procedure isn’t meant to drastically alter your appearance to make you feel like a completely different person. It is intended to subtly alter your appearance so that you have fuller, more contoured breasts that help you feel younger and more attractive.

Allergan, Inc., a breast implants manufacturer and worldwide leader in the body rejuvenation industry, is reemphasizing assurance in women considering breast augmentation to be highly informed before their first plastic surgery consultation by introducing The Natrelle™ Pre-Consultation Kit. It is an answer for both women starting out, and plastic surgeons that want the right information in the hands of prospective patients.

The kit is a thorough, thoughtful and elegant package for every woman starting the process of achieving a new body image through breast augmentation. It is an intimate, at-home preparation for face-to-face consultations with plastic surgeons, and an ideal resource for patients to set a size goal. The Natrelle™ Pre-Consultation Kit was developed with the help of two of America’s most prominent plastic surgeons, who participated in the kit’s orientation video featuring an informative actual breast exam.

Mr. Jeffrey Moore of communications firm 3v07, and director/producer for the program, established that the Natrelle™ Pre-Consultation Kit’s primary driver must be an elegant approach for selecting what size implant each patient would like to set as their goal.

“This is such a personal, life-long decision that it is hard to believe that until this Natrelle™ Pre-Consultation Kit many women would set a goal for their new profile by filling plastic sandwich bags with rice or hair gel to get an idea of what size they would like to be. A search of the Internet turns up one resource after another recommending this process. At best, some may take 20 minutes in a doctor’s office to determine their goal. Our first principal in development of the kit was to assure that size selection is now a personal, fun, at home experience women could take their time with.” Mr. Moore goes on to say, “The Natrelle™ Pre-Consultation Kit size selection experience is elegant and complete. Women are provided with a beautiful bra and 4 different breast implant-like sizers to assure they are comfortable with their breast enhancement before starting the process. This is a great solution for both women and their doctors.”

Contemporary research clearly shows that practicaly every woman begins her path to breast augmentation by doing some form of research on the web. With the decision to offer this kit prominently through web services offered by Allergan and Natrelle™ patients can be empowered to approach their initial consultation confidently. The kit provides an excellent look at the initial consultation and covers each topic a woman will discuss with her doctor, giving her the perspective to make informed decisions. This includes styles of breast implants, incision choices and profile choices.

The Natrelle™ Pre-Consultation Kit features a DVD orienting patients to the process of getting a new profile, a discussion brochure for the information they will cover with their Plastic Surgeon and a breast sizing system with a special brassiere and trial implants. The kit also includes a $50 rebate for Natrelle™ gel implants and $120 in savings on the Allergan aesthetic products BOTOX® Cosmetic (botulinum toxin type A), JUVEDERM™, LATISSE™ (bimatoprost ophthalmic solution) 0.03%.

The Natrelle™ Pre-Consultation Kit is $39.95 and available to patients only via the Internet at www.Natrelle.com starting April 1, 2009.

Madrid – A Spanish man has been arrested and accused of using veterinary equipment to perform cosmetic surgery.

Catalonian regional police say they arrested the 63-year-old Barcelona native for allegedly practicing medicine without a license in filthy conditions at his home. The police statement says the illegitimate doctor worked in the company of his three dogs, a cat and a parrot.

The police say in a statement released this past Wednesday that the man charged his human patients between €250 and €500 ($330 and $660, USD) to perform breast augmentation and buttock implants, using veterinary tools normally used to inject animals.

It is also believed the man was administering direct injections of liquid silicone, without the benefit of using actual implants.

Police arrested the man on Friday after authorities received a complaint about a defective breast implant.

The latest technology for the detection and diagnosis of breast cancer, the Breast Specific Gamma Imaging (BSGI) system was launched last week in Kingston, Jamaica and is being hyped as the way to help decrease the mortality rate from the disease. The BSGI is a molecular breast imaging system which developers say will be able to diagnose at least 15 per cent of breast cancer cases that are missed by conventional mammograms.

Radiologist at X-Ray and Diagnostic Ultrasound Consultants Ltd. (XDUCL), Dr. Winston Clarke, said doctors have always been aware of the limitations of mammograms, which prompted the search for an alternative. Dr. Clarke explained that for every 100 women tested with mammograms, only about 80 of them will be diagnosed correctly. The other 20% of tests are usually inconclusive and the patients will be asked to come back to do the test at a later date.

Where mammograms are X-rays that examine tissue density, the technology used by the BSGI will detect cancer cells independent of tissue density. The patient will be injected with a small dosage of radioactive Isotopetyechnetium (used similarly to the tissue dyes utilized in X-rays and conventional mammograms) which will be absorbed by the cells. The BSGI will highlight the cancerous cells, similar to thermal imaging, so that cancers as small as three millimetres can be easily detected. The entire procedure can take up to an hour and will be pain-free because no weight is placed on the breast.

Will Breast Implants Affect BSGI Breast Cancer Screening?

The BSGI system will be used in cases where further evaluation beyond a mammogram is needed for the detection of cancer such as cases where the patient has dense breast tissue, multiple and suspicious lesions, post-surgical or post therapeutic masses, breast implants or for women who are taking Hormone Replacement Therapy.

Professor Douglas Kieper, Director of Clinical Research and Education at Dilon Technologies, said the BSGI system will also be able to help doctors predict a patient’s reaction to chemotherapy and will make dealing with breast cancer and subsequent reconstruction (when necessary) less challenging.

“We are actually looking at a phenomenon within itself,” he said. “It is a very specific technique which can contribute in a good way to the patient’s treatment.”

Even though the system is being endorsed by a number of doctors including Chief Medical Officer at the Jamaican Ministry of Health and Environment, Dr. Sheila Campbell-Forrester, Dr. Clarke cites a number of pressing challenges with “bringing first world technology to Jamaica”. Paramount among them is the cost to perform the procedure. Currently BSGI costs between the equivalent of J$80,000-$120,000 in the United States to get the test done. Dr. Clarke, however, wants to find the means to offer it for about $45,000 so that more women can be tested. Currently a mammogram costs around $3,500.

Among the cost-related concerns, the supplies needed to conduct the procedure will have to be imported from the United States every two weeks. This includes the radioactive Isotopetyechnetium, which has a brief two-week shelf life. Dr. Clarke said they are also trying to get the insurance companies to come on board to cover the cost for patients who really need the test. In spite of all these challenges, Dr. Clarke said the possibility of saving a life with the machine is more important.

Researchers in Britain have found a new application for the highly controversial Stem Cell Therapy: Breast Augmentation!

No area of research in the medical and scientific communities has created as much of a debate as stem cell therapy. Despite the positive research results that stem cells have the potential to treat many different types of conditions including stroke, paralysis and birth defects, there is much contention surrounding the use of embryonic stem cells.

More recent stem cell research being conducted, however, is focusing on using (non-embryonic) stem cells derived from the patient’s own body. This research has shown promise for a variety of medical therapy options, including treating brain injuries in rats.

Thus far, scientists in the UK have been working on the new method exclusively for treating women with breast deformities caused by cancer and its subsequent treatment. The process involves harvesting stem cells from fat located around the woman’s stomach or thighs using highly specialized equipment. The stem cells than can then be mixed with another batch of fat from the patient’s body before being injected into the breasts.

The researchers claim that it can take several months before the breast achieves the desired shape and size. Researcher and breast augmentation consultant Professor Kefah Mokbel from the London Breast Institute, who is in charge of the project, will treat 10 patients from May. He predicts private patients will be able to pay for the procedure within about six months, at a cost of about £6,500 (approximately $9500.00, USD).

“This is a very exciting advance in breast surgery,” said Mokbel. “They [breasts treated with stem cells] feel more natural because this tissue has the same softness as the rest of the breast. Implants are a foreign body. They are associated with long-term complications and require replacement. They can also leak and cause scarring.”

Not all medical professionals are in agreement, however, that the new technique is quite ready for public use. Says Los Angeles plastic surgeon, Dr. Steven Teitelbaum, M.D.:

“Everyone expects to see major advances in these areas in the coming years,” “No doubt, this is the future of plastic surgery. But it is not yet the present.”

The use of stem cells in healthy women undergoing cosmetic plastic surgery is controversial, to say the very least. Medical boards and top physicians alike have warned that the breast enlargements should not be offered to healthy women until large-scale trials in cancer patients have shown that the new procedure is safe and effective. The treatment is not yet available to women solely for cosmetic purposes.

Eva Weiler-Mithoff, a consultant and plastic surgeon at Canniesburn hospital in Glasgow, is co-leading the British wing of a European trial of stem cell therapy for women who have been left with post-cancer breast deformities. So far more than a dozen British cancer patients have been treated and Weiler-Mithoff is impressed with the results. She does not believe this justifies offering the treatment to healthy women, however. According to Weiler-Mithoff, while breast cancer patients regularly attend follow-up appointments, young women who have had cosmetic surgery are less likely to do so and complications could be missed.

The same technique, however, has been used in Japan for six years, initially to treat women with breast deformities caused by cancer treatment and, more recently, for cosmetic breast augmentation in healthy women.

Until now, when fat was transplanted to the breast without extra stem cells (a procedure commonly known as fat grafting or transfer), surgeons had difficulty maintaining a blood supply to the new tissue. Surgeons believe the increased concentration of stem cells under this technique promotes the growth of blood vessels to ensure a sufficient blood supply circulates to the transplanted fat cells.

Mokbel is confident the therapy is safe and that, after carrying out about 30 procedures, the London Breast Institute will be able to offer the procedure to private patients. Mokbel says that he believes only modest increases in size can be achieved using the stem cell process and points out that only gains in cup size will be made, no improvement in firmness and uplift will be achieved. Or not yet, at least.