The nipple can become enlarged and droopy following pregnancy and breast feeding. It may remain in that condition despite a gradual decrease in the size of the breast after nursing is completed. A nipple reduction can both reduce the size of the nipple and make it appear more uplifted. This is especially important to consider when deciding on breast augmentation so that the appearance of the breast will be enhanced by a more proportionate nipple dimension.
Archive for the ‘Breast Augmentation’ Category
Dr. Forley is pleased to introduce the Crisalix 3D imaging simulator tool to assist you in visualizing the potential outcome of a variety of procedures including breast augmentation, facelift, nose surgery, body contouring, and injectable fillers. The simulation can be done remotely or as part of your in-office consultation with Dr. Forley. This imaging tool is also an excellent way of communicating your desires visually to Dr. Forley.
Natrelle INSPIRA™ breast implants were recently FDA approved for enhancing the size of the breasts and are now available as an added choice in breast augmentation surgery. They have a higher fill ratio of silicone gel for a given implant dimension and thereby provide added fullness to the volume deficient breast. During the consultation, Dr. Forley will listen to your desires when discussing size preferences for your breasts. He will carefully measure the dimensions of both breasts to assist in determining which style and size implant will provide the desired outcome. Crisalix, a 3 dimensional simulator tool, will be used to enable you to visualize the possible outcome that can be achieved with each potential implant option to help you in finalizing your selection.
Achieving the most favorable scar appearance after surgery is dependent not only on the quality of the repair performed at the time of surgery but also on the mechanical forces that affect healing during the post-operative period. Control of the natural tension of skin during wound healing has been shown to minimize hypertrophic or thickened scars after procedures such as tummy tucks or breast surgery. Until now, none of the scar treatment modalities commonly used have been able to regulate wound tension in a manner that will impact on the final appearance of the scar.
embrace® Advanced Scar Therapy, a new FDA-cleared technology that helps reduce tension on the healing scar, enables us to enhance the results of surgery for our patients. The treatment involves the application of an adherent, water resistant elastic sheet that is stretched and applied to either side of the scar. Skin tension is actively reduced during the healing process due to the contraction of the device following its application. It is comfortable to use and normal activities, including showering and exercise, can be performed during the 8 week treatment course. Clinical studies have consistently demonstrated the efficacy of this device when compared to untreated scars.
Dr. Forley is now offering embrace® Advanced Scar Therapy to his surgical patients and will discuss its use with you during your consultation.
The Keller Funnel™ is a soft, sterile device made of nylon that plastic surgeons use to deliver silicone gel breast implants into the pocket created for an augmentation or reconstruction procedure. It was launched in 2009 and its addition to breast surgery has enabled the use of a shorter incision due to the ease with which the silicone gel implant can be introduced into the pocket.
Shorter incisions are possible because of the mechanical advantage provided by the lubricated funnel during implant insertion. The Keller Funnel™ gives surgeons the ability to place the incision in a variety of locations including: periareolar (around the nipple), inframammary (under the breast fold), and axillary(under the arm) with less visibility. Longer incisions that might be required for larger size implants can be shortened when the Keller Funnel™ is used.
During your consultation, Dr. Forley will discuss the advantages of using the Keller Funnel™ and how it provides the following benefits:
- Shorter incision lengths
- No touch technique in which the implant does not come in contact with the skin
- More choices for incision placement
- Reduced force on the implant and incision
The purpose of a mammogram is to identify abnormalities or changes in breast tissue. Screening mammograms can detect these abnormalities at an early stage resulting in potentially better therapeutic options and possibly less aggressive treatments.
The Mayo Clinic recommends a three-tiered screening mammogram approach:
- Breast health awareness, which includes a woman becoming familiar with her breasts in order to identify breast abnormalities or changes, and to inform her doctor of any changes that may need further evaluation
- Clinical breast exam performed by a health care provider and recommended annually
- Screening mammography beginning at age 40
This approach is consistent with the recommendations of the American Cancer Society. A 2009 study, by the U.S. Prevention Services Task Force that recommended waiting until age 50 to begin screening mammography remains controversial.
Women with breast implants should continue to have mammograms. It is important to let the mammography facility know about breast implants when scheduling a mammogram. The technician and radiologist must be experienced in performing mammography on women who have breast implants. Implants can hide some breast tissue, making it more difficult for the radiologist to detect an abnormality on the mammogram. If the technician performing the procedure is aware that a woman has breast implants, steps can be taken to make sure that as much breast tissue as possible can be seen on the mammogram. Implant displacement views are used and involve positioning the breast tissue in front of the implant as it is pushed back against the chest wall.
X-ray vs. Digital Mammogram Techniques
All mammogram images are captured using X-ray technology. During a traditional mammogram, the results are then viewed on X-ray film. Digital mammograms rely on those same X-ray images, but they are stored on a computer and are analyzed using specialized programs.
Digital mammograms are said to offer better results for:
Women <50 years of age
Women with dense breasts (more tissue, less fat)
Women before or <1 year into the menopause cycle
With either method, you’ll be put through the same steps. Your breasts will be flattened or compressed. While you stand still holding your breath, a technician will take X-ray images. The entire process should last about 15 to 20 minutes.
A woman’s risk of developing breast cancer increases, as she gets older. The risk of breast cancer, however, is not the same for all women in a given age group. Research has shown that women with the following risk factors have an increased chance of developing breast cancer:
- Advancing age – most important risk factor
- Personal history of breast cancer
- Family history of breast cancer
- Radiation exposure to the chest
- Starting menstruation before age 12
- Beginning menopause after age 55
- Having your first child after age 35
However, a majority of women who develop breast cancer have no family history or risk factors.
If you’re concerned about screening mammograms, talk to Dr. Forley or your primary care doctor and learn what’s right for you based on your individual risks. It’s important that the two of you work together to develop a screening plan.
Revision procedures are sometimes required to improve the results of breast surgery or handle problems that might develop following surgery. Recent clinical evidence has demonstrated the value of using a biologic tissue support layer or matrix to reinforce weakened tissues and enhance natural tissue regeneration. Strattice™, a sterile sheet of porcine dermis from which the cells have been removed, is now being used by Dr. Forley to provide not only the reinforcement of thin, sagging tissues, but a scaffold-effect to support new cell growth. The long-term success of revision procedures of the breast has been enhanced with use of this technique.
Clinical Uses for Strattice™
- Reinforce the desired position of the breast
- Redefine the location of the fold under the breast by providing support inferiorly or laterally
- Correct complications that may occur after breast implant surgery, such as bottoming out, fold malposition, and symmastia
- Minimize the need for the use of additional muscles to provide a supportive covering layer in the breast
- Reinforce thin breast tissue when implant ripples and wrinkles are present
- Correct capsular contracture or hardening of the breast after implant surgery
- Aid in augmentation mastopexy to enable a stable, long term breast lift
In Part 2, we discuss in more detail how Strattice™ has provided a way to handle each of these clinical situations.
The General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee to the Food and Drug Administration (FDA) met in August 2011 to discuss and make recommendations on issues related to silicone-gel filled breast implants. Dr. William Maisel, chief scientist for the Food and Drug Administration’s Center for Devices, re-confirmed the FDA judgment that silicone-gel implants are safe and effective for their intended use in breast augmentation.
The FDA placed restrictions on the use of silicone-gel implants in 1992 due to concerns about a possible link to autoimmune disease such as rheumatoid arthritis and lupus. Clinical trials conducted over the next decade failed to show any evidence of an increased incidence of these conditions in women with breast implants. In November 2006, supported by scientific evidence, the FDA removed the 1992 restrictions on the use of silicone-gel implants made by Mentor and Allergan. As an additional safety measure, the FDA required companies to conduct decade-long studies of their implants’ performance. The FDA has also looked at the studies conducted to gain approval, which have longer and better follow-up than those launched after the 2006 decision. Other studies published in the scientific literature and reports of adverse events helped complete the picture, Maisel said.
When considering both current and future post approval study designs for silicone-gel implants, the panel discussed methodologies and strategies that could increase compliance with follow-up. As discussed in a number of questions about methods and data collection, the panel felt that a breast implant registry of all women who receive the device may provide a means to answering many of the longer term and real world questions, in particular the questions associated with rare adverse events.
The FDA and the Devices Panel consider MRI as the gold standard for evaluating breast implants for evaluation of rupture. However, a 2006 requirement for regular MRI follow up studies following breast augmentation was deemed by the panel to be expensive and unnecessary. Dr. Forley advises his patients to return for annual follow up exams. They are also encouraged to see Dr. Forley in the interim if there is any change in the appearance or feel of the breasts after surgery.
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