The question many women ask me is which implant should they choose in their breast reconstruction. The choice is between a saline filled implant versus a silicone gel filled implant. The advantages of the saline implant are obvious: if it ruptures, it deflates. The saline is absorbed and the breast literally “deflates.” As for silicone gel devices, the advantages are the more natural feel of the implant and a lower tendency to “ripple.” The concerns about silicone devices stem from the late 1980’s and the moratorium on the devices. In 2006, the FDA approved the current silicone gel devices for general use. The new silicone gel devices have a cohesive (ie. sticky) gel which is less likely to migrate from the implant or through the implant capsule if there is a rupture. In fact, a rupture is so difficult to detect, it is recommended that women undergo an MRI 3 years after surgery and every 2 years after that to evaluate whether the implant has ruptured. This satisfaction study showed that more women prefer the look and feel of the silicone gel implants for reconstruction than the saline implants. Here are two links: FDA site for silicone gel implants and Satisfaction Study of Silicone Implants.

Some interesting articles have come out in the last few months concerning breast reconstruction. The first is not very surprising, but has been a hot-button issue for many years. How significant are prophylactic antibiotics in preventing infection after the surgery is over? Well, it seems that the “standard” single dose or 24-hour antibiotic is not enough in patients undergoing tissue expander placement. The study showed a significant increase in the number of severe infections (those requiring removal of the expander) when only a single dose of antibiotic is used. This seems inherently obvious, but at last we have some data to back up our practice. Here’s the link: Antibiotic Use in Breast Reconstruction.

Obesity and breast reconstruction has traditionally been considered less satisfying for patients and plastic surgeons. However, a recent study looking at satisfaction rates showed that obese women (defined by a Body Mass Index of > 30) had as high a satisfaction rate with their reconstruction as did normal-weight and over-weight women. Obese women did have a slightly higher rate of autologous tissue reconstruction (meaning, no implants), likely due to the difficulty in matching a large, pendulous, contralateral breast. Although complication rates are higher, thankfully this population of women is receiving the same rate of reconstruction as normal and over-weight women. The key is in the consent process where discussions regarding the impact of weight and surgical operating time, risk factors, and outcomes is addressed. Also, knowing that a reduction or lift of the contralateral breast is an option can remove a lot of the fear in breast reconstruction. Here’s the link: Obesity is No Barrier to Breast Reconstruction.

As I mentioned a few weeks ago, I would try to bring back some interesting information from the meeting. The national American Society of Plastic Surgeons meeting in Toronto definitely did not disappoint. Of the many things I learned (including that I am fortunate to live in sunny South Florida!) was the impressive capsular contracture numbers in patients treated by acellular dermal matrices (Alloderm in specific).  Although most of this data is retrospective data or animal models, it does provide a clear hope to patients and plastic surgeons that another option exists in the treatment of this difficult complication. The basic takeaway from these studies appears to be a differential inflammatory response between the generation of the regular capsule in areas where the Alloderm is not present and the lack of a direct inflammatory response in the region of the Alloderm. Also, the sling effect of the Alloderm may allow for better implant support and less tension on the forming capsule. It will be interesting how this progresses, and how the recommendations for revisional breast surgery due to capsular contracture changes.

Also of interest was an epidemiologic study reviewing breast cancer reconstruction and breast cancer survival. Essentially this study was more of a referendum on improving access to care for women across socioeconomic levels. This article can be found here - Breast Reconstruction Immediately after Mastectomy Linked to Increased Survival.

And in the ongoing struggle to define appropriate postoperative antibiotic prophylaxis, another study to reinforce the need for longer treatment. This study evaluated the difference in tissue expander patients treated with either a single dose of antibiotic therapy versus a longer (7 or 10 day) course. The single dose group had a 4 four higher rate of expander removal due to infection. Here’s the article – One-Dose Antibiotic Prophylaxis is Inadequate after Breast Reconstruction.

In scanning the recent articles from the world of plastic surgery, I was pleased to see that the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS) both commended the LA Times article regarding stem cells for looking at the science of stem cells rather than just the marketing potential. A link to this review is here: ASPS Commends Balanced Reporting on Stem Cells.

In other news, the annual meeting for ASPS is this weekend in Toronto. Every year, plastic surgeons from around the world meet to discuss the state of plastic surgery, advances in technology and surgical technique, and to debate the key issues facing aesthetic and reconstructive surgeons everyday. Certainly stem cells and fat transfers will be covered in excrutiating detail. There will be plenty of sales reps pushing lasers and “non-surgical” facelift technologies. I’ll be travelling up to Toronto for the meeting this year and will post next week the interesting advances in regards to breast reconstruction and aesthetic breast surgery. Until then, have a great week!

Stem Cells. Yep, the little cells without a preordained future that reside all over our body. In fat, in bone, in muscle. For years, they have been considered the panacea of medicine. A single cell that can (with a little help) turn into any cell in the body. They have long been touted as the cure for Alzheimer’s, Parkinson’s, lymphoma and leukemia. Well, never missing a beat, cosmetic surgery has grabbed hold of this marketing gold-mine and are promoting it in ways the actual science never meant. Stem-cell facelifts! Yes, I realize the irony of posting this as one who performs cosmetic procedures, but surgeons making unsubstantiated claims to the public (and charging $25000 to do it) always ruffles my feathers. This article is an excellent read for those who remain skeptical. Kudos to Dr. Ruben for keeping his mind rather than his wallet on the study of these fascinating cells.

Stem Cell Fillers are Unproven, Scientists say…

September is here and the new specials have arrived! Please check our “Specials” page. This month is all about Mommy Makeovers. Check it out at www.drbogue.com!

When you think of breast cancer, you likely think of the family members and friends who have been affected. There are fund-raisers, marathons, 5K’s , bike races, and pink ribbons galore. Words such as mastectomy, lumpectomy, chemotherapy, and radiation come to mind. Unfortunately, for far too many women, they never hear one of the most important words of all – Reconstruction. The State of New York is working to rectify this lack of access for breast cancer patients and will hopefully pave the way for women all over the US. Breast reconstruction is a cornerstone of my practice here in Florida and thankfully our community has lots of opportunity for breast cancer education and information for reconstruction. Please take a moment to read this article… and forward to anyone you know who has been recently diagnosed or is a survivor!

NY Times Article:

Before Breast Is Removed, a Discussion on Options