Birmingham Breast Augmentation: American breast implant data shows more then 300K surgeries in 2009. Picking a quality surgeon.

According to recent data from the American Society of Aesthetic Plastic Surgery (ASAPS), breast implant surgery was the top cosmetic surgery performed in 2009 with close to 312,000 procedures done. Despite it's popularity, the seriousness of these operations should not be minimized. If you're choosing breast augmentation make sure your surgeon is board-certified by the American Board of Plastic Surgery (ABPS) and member of the American Society of Plastic Surgeons (ASPS). These are the benchmarks to ensure your surgeon is fully trained and qualified to perform this type of procedure.

There are many fringe organizations (a charitable description) and providers who claim they are as qualified or (shockingly) even more qualified to do breast augmentation surgery then a plastic surgeon. It's both a lie and a disservice to patients to suggest as much, but desperate times lead to desperate measures for providers trying to reinvent themselves as a nebulously described group of "cosmetic surgeons".

Quite frankly, if someone operating on your breast is not fluent or trained in techniques to do complex reconstruction or revision of the tissue they are going to leave a trail of mutilated patients trying to do operations involving breast implants as the skills and judgement for breast augmentation are learned and polished on these more complex cases. In my practice, we do hundreds of complex breast procedures annually ranging from breast augmentation to nipple sparing mastectomies for cancer. Each of these operations is individualized and brings to bear the combination of advanced surgical training and experience. To suggest that someone like the aforementioned "cosmetic surgeon", who thinks they have found a short-cut through long and difficult training, is qualified to do your surgery is wishful thinking.

The best results with cosmetic and other surgery types are when the operation is performed right the first time, while revision and redo surgery is fraught with much more unpredictable results. You owe it to yourself to research the most qualified providers for your care which will be a board certified plastic surgeon.

Rob

Birmingham Breast Implants - What's the role of textured implants versus smooth devices?

There are several distinct types of ways we classify breast implants.

1. silicone or saline filled
2. round or anatomic shaped
3. smooth surfaced or textured

For the material and shape issues, there clearly are performance characteristics that differ. As to the issue of the implant shell surface, it gets a little more confusing. The routine use of rough or textured surfaces on breast implants in the prevention of capsular contracture has been debated for nearly 20 years.

In the early 1980's we first read in the literature that the surface texture of an implant is an important variable in determining the soft-tissue response to an implant's capsule surface and experiments suggested that texturing resulted in tissue ingrowth and adherence to the implant surface.

These observations were first made with polyurethane-coated breast implants which had rough surfaces and almost no observed capsular contractures in patients with breast implants. Texturing was then quickly translated to contemporary silastic (silicone rubber) covered implants, but whether or not the same effect was maintained has been a little murky.

If (a big if) there's a protective effect from texturing, the best data I've seen suggests that it's gone as you get closer to a decade out during surgery. If I had to guess why that's so, I'd say that reflects the ruptures starting to show up in those 4th generation implants at a decade out.

It's kind of interesting to see the split between the United States and the rest of the world on this issue. Our singular experience with saline implants from 1990-2006 led many surgeons to abandon textured implants for smooth round devices as they're less likely to show visible wrinkles or ripples thru the skin. The "velcro-like" effect of the implant on it's surrounding tissue causes these ripples when the implant shifts. The rest of the world has a strong preference for textured devices as they never went through dealing with the limitations of saline implants. Philosophically, those doctors made the decision that they're willing to accept more rippling as a trade off for (possibly) less capsular contracture (implant hardening).

I personally am kind of ambivalent on this. Being an American-trained surgeon, I saw mostly round smooth implants placed partially under the pectoralis muscle during my residency. Over time, I've come to believe there's a role for "subfascial" implant techniques(over the muscle, but under the muscle fascia) with smooth implants. Looking ahead, I think we're poised to see a lot of plastic surgeons getting reacquainted with textured implants with the new shaped "gummy bear" implants which are all textured to help prevent rotation of the implant in the body.


Dr. Rob Oliver Jr.