Bioengineered Breast: Hybrid Breast Reconstruction

 
 
 
 
 
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𝘋𝘦𝘷𝘦𝘭𝘰𝘱𝘪𝘯𝘨 𝘢 𝘩𝘺𝘣𝘳𝘪𝘥 𝘤𝘰𝘯𝘤𝘦𝘱𝘵 𝘪𝘯 𝘪𝘮𝘮𝘦𝘥𝘪𝘢𝘵𝘦 𝘴𝘵𝘢𝘨𝘦 𝘣𝘳𝘦𝘢𝘴𝘵 𝘳𝘦𝘤𝘰𝘯𝘴𝘵𝘳𝘶𝘤𝘵𝘪𝘰𝘯. ⁣⁣⁣

I was first introduced to the concept of “bioengineered breast” in 2009 by Dr. Pat Maxwell and colleagues. He originally coined this term to describe an enhanced breast form consisting of a combination of cohesive gel breast implant, regenerative scaffold, and regenerative cells. ⁣⁣⁣

The implant and the soft tissue covering it can both be enhanced to achieve the optimal female breast form.

Enhancing the soft-tissue cover not only supplements volume and shape but also further alters how the recipient’s host tissue responds to the foreign body implant. ⁣⁣⁣

This powerful combination of constructs better allows us to achieve the ultimate goal of breast reconstruction: to recreate a breast that appears and feels like the natural breast. ⁣⁣⁣

This patient had large breasts and underwent bilateral skin-sparing mastectomies. She opted for one-stage reconstruction to minimize downtime. This was achieved using a hybrid concept after the mastectomy flap perfusion was evaluated. ⁣⁣⁣

I was able to pair an anterior acellular dermal matrix sheet with a posterior stable Galaflex base to provide the patient with both softness and stability. ⁣⁣⁣

She plans on having fat grafting during her nipple-areolar reconstruction to further augment her soft tissue envelope and soften her breast borders.⁣⁣⁣
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Can I Still Breastfeed with Implants?

You can still breastfeed after breast augmentation surgery. A typical breast implant surgery involves an incision made in the inframammary fold (crease under your breast) to place the implant behind the pectoral muscle which is below the breast tissue. With this procedure, the implant is away from the breast tissue and does not interfere with breast ducts or mammary glands that produce milk. Even in cases where some glandular tissue is removed, enough tissue is left to facilitate milk production after the procedure.

Incision site

If you intend to breastfeed after breast implant surgery, the location of the incision matters. An incision made under the breast, in the armpit, or in the belly button is less likely to damage your milk ducts, nerves or glands.

But an incision made across or around the areola is more likely to damage nerves, affect the sensation of your nipple, interfere with the signals necessary for the letdown reflex, and reduce milk supply. Speak with your plastic surgeon about whether you might still have children so that an incision site is chosen that reduces the need for future adjustments to facilitate breastfeeding.

Implant location

Since breast implants can alter breast tissue, change the sensation of the nipple area, pinch or damage milk ducts, nerves, and milk glands, or reduce milk availability and release from glands, the location of the implant is critical. If you still want to breastfeed after breast implant surgery, you should make this clear to your plastic surgeon. To ensure implants do not interfere with breastfeeding, they can be inserted between your breast tissue and chest muscle or placed under your chest muscle.

Breast implants and milk safety

Breast implants do not make breast milk unsafe for your baby. Saline breast implants are filled with saline water, but there is no significant harm involved if the saline water mixes with breast milk. Likewise, silicone gel-filled implants are not harmful because the gel does not leak outside the implant shell.

There is no need to worry about chemicals in the implants mixing with the milk and making breastfeeding unsafe for your baby. Whatever implants are used, be sure to ask your plastic surgeon if it is safe for you to breastfeed after your implant surgery.

Reason for the surgery

Whether you can breastfeed after breast implant surgery also depends on your reason for the procedure. If your breasts are fairly symmetrical and regularly shaped and you only want a small boost, you are less likely to run into difficulties breastfeeding. But if you have flat or tubular shaped breasts before the procedure, you may already be at risk of low milk supply even without breast implants.

At Politis Plastic Surgery, we generally advise our patients to wait until they have had children before undergoing breast implant surgery. However, we do evaluate and recommend the procedure on a case-by-case basis after a personal consultation with each patient. If we find the procedure ideal for you, even when you still plan to have children, we will ensure that the incision site and implant location have the least possible effect on breastfeeding.

Would you like to enlarge your breasts and enhance your self-confidence but worry that it will affect you in other ways? Consider a private consultation with Dr. Effie Politis to discuss your specific goals and concerns. She will listen and guide you in making an informed decision about the procedure. For more information about breast augmentation and other cosmetic surgery procedures, visit the Politis Plastic Surgery website.

Removing Ruptured Historic Dow Corning Implants

 
 
 
 
 
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Removing ruptured historic Dow Corning implants in my patient after 30 years. She presented clinically with hardening of her left breast (capsular contracture). ⁣⁣
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Further workup including clinical and imaging examinations revealed extracapsular rupture which means the implant and the shell surrounding were compromised and needed to be removed. ⁣⁣
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These implants were taken off the market by the FDA in the 1980s. After the silicone implant moratorium in 1991, extensive premarket approval studies were required by the implant companies prior to the ban being lifted. This has resulted in extensive research and also produced much higher quality silicone cohesive or “gummy” implants with a much more stable shell and gel to shell fill ratio. ⁣⁣
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Today’s implants no longer demonstrate “gel bleed” and the increased silicone crosslinking adds stability and a higher safety margin. ⁣⁣
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The companies also provide short and long term warranty coverage and as board-certified plastic surgeons, we enter all implantable devices into a databank for better tracking. ⁣⁣

See a board-certified plastic surgeon to discuss treatment options regarding breast implants and safety profiles.⁣⁣
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#tbt #implantremoval #explant #capsularcontracture #siliconeimplants

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Implant Removal with Auto Augmentation

 
 
 
 
 
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Liposuction of the pre-axillary and axillary fat as well as lateral chest for better definition after removal of implants and mastopexy with auto augmentation. ⁣

This pleasant 39-year-old patient had previous dual-plane saline (300cc) augmentation and felt her breasts were large, heavy, and cumbersome, after having 3 children. ⁣
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Her desires were to be smaller and lifted. She underwent explantation of her implants with a simultaneous mastopexy and auto augmentation to restore upper pole fullness. She also underwent Lipo contouring of her axilla and lateral chest wall for a better definition.⁣

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Breast Augmentation and Cancer: Is There a Link?

Breast implants do not cause or increase the risk of breast cancer, but they have been linked with Anaplastic Large-Cell Lymphoma (ALCL), a rare cancer of the immune system. According to the Food and Drug Administration (FDA), the use of breast implants with textured surfaces and polyurethane outer shells has a very low but increased risk of ALCL. The cancer is also called Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) because of its link with certain breast implants.

What is BIA-ALCL?

Breast Implant-Associated Lymphoma is not breast cancer. It is a type of non-Hodgkin’s lymphoma, a cancer of the immune system. Most cases of the cancer occur around the scar tissue and fluid near the breast implant. However, in some cases, it can spread throughout the body. Though the risk of developing BIA-ALCL is very low, the cancer is serious and can lead to death, particularly if not treated early.

How is BIA-ALCL associated with breast implants?

While the link between breast implants and Anaplastic Large-Cell Lymphoma is still unclear, it is believed that the growth of bacteria on the surfaces of breast implants can, eventually, result in increased stimulation of lymphocytes. The stimulated lymphocytes may then trigger an immune response that leads to BIA-ALCL.

Since only 1 in 50,000 women with breast implants develop the disease, the chance of BIA-ALCL being triggered by implants is considered very low. Also, the risk does not increase with either silicone or saline-filled implants.

Because the immune response that causes BIA-ALCL depends on the growth and proliferation of bacteria, the risk of cancer is related to the surface area of the implant. Textured implants and expanders have a higher surface area compared to smooth implants, resulting in a higher risk of BIA-ALCL compared to smooth surface implants. In fact, up to 96% of cases of the cancer are reported in patients with breast implants with textured (bumpy) surfaces and polyurethane outer shells.

What are the warning signs?

When BIA-ALCL occurs, it tends to arise more than one year after breast augmentation surgery. Patients develop chronic swelling, a mass (lump), pain, or fluid buildup around the implant. The breast may harden, have new scar tissue, or may be painful around the vicinity of the implant. Plus, there may be hair loss, skin rash near the breast, and exhaustion (a sign of a weakened immune system).

Is BIA-ALCL curable?

ALCL is curable, particularly when discovered early. To diagnose ALCL, the doctor will perform a needle biopsy and an imaging test (mammogram or ultrasound). Early treatment typically involves the removal of the implant and the surrounding scar tissue. But, in some cases, chemotherapy and radiotherapy may be necessary.

What should you do?

If you are considering breast augmentation, reconstruction, or replacement (revision) with breast implants, you should discuss your goals and expectations with your plastic surgeon. Your surgeon will also explain the benefits and risks of having breast implants, the need to monitor implants for complications, and their eventual replacement or removal.

If you already have breast implants, concerns related to BIA-ALCL should not mean you remove them. If there are no symptoms, no need to worry. Instead, you should speak with your plastic surgeon about the risk of developing the cancer. But if you do have symptoms, talk to your doctor about further evaluation, confirmation, and treatment of the cancer.

At Politis Plastic Surgery, we do not use breast implants and tissue expanders that the FDA has listed as a potential cause of BIA-ALCL. During the consultation, we inform our patients about the risks associated with breast implants, including BIA-ALCL. When treating patients with suspected BIA-ALCL, we develop individualized treatment plans in coordination with experts in the diagnosis and treatment of the cancer.

Do you have questions or concerns about the use of breast implants in breast augmentation or reconstruction? Dr. Effie Politis will answer your specific questions and help you make an informed decision about cosmetic surgery. For more information on breast implants and associated risks and complications, visit the Politis Plastic Surgery website.

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Reconstructive Surgery on Cutaneous Malignancies

 
 
 
 
 
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As plastic surgeons, dermatologists typically refer us cases involving skin cancers dealing with the head/neck which require advanced closure techniques to minimize scar burden and resulting deformities. ⁣⁣

We are trained in “cutaneous oncology” in terms of evaluation and treatment of skin cancers, as well as coverage of resulting defects. ⁣⁣
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Micrographic surgery (Mohs surgery) is performed by our dermatology colleagues and is a technique based on complete tumor excision with maximal normal tissue preservation. ⁣⁣
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We often work with Mohs trained dermatologists who remove skin cancers that meet requirements. ⁣⁣
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We assist them in covering the resulting defect after tumor excision with margin clearance. Mohs surgery ensures margin and tumor clearance in areas requiring maximal tissue preservation (nose, lips, eyelids). ⁣⁣
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In some cases, Mohs is not indicated and we are able to perform the oncologic portion as well as the reconstructive portion. ⁣⁣
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In this patient, I was able to visualize tumor margins and perform a margin analysis (to ensure negative margins) prior to central tumor removal. ⁣⁣
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Once the margins were deemed negative via a pathologist on site who performs frozen sections, the remaining tumor is removed and the defect can be closed in the same setting. ⁣⁣
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Please note this patient did not receive Mohs surgery. ⁣⁣
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I performed the excision, achieved margin control, and then also performed
the reconstruction with local tissue rearrangement.

 
 
 
 
 
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Previously, we presented an example of reconstructive surgery I perform for cutaneous malignancies (skin cancers) involving face, scalp, and neck. ⁣
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Removal of cancer in an aesthetic unit (with margins) and closure of the defect with scars in an inconspicuous location. ⁣
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Principal in replacing like tissue with like tissue (color match and tissue thickness are taken into consideration) and tissue is moved or rotated or advanced with its corresponding blood supply. ⁣
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This is where the art of plastic surgery comes into play. We are trained to respect aesthetic subunits and cover like tissue with like tissue to ensure minimal distortion, and best color match and thickness. ⁣
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When considering coverage options, we need to be aware of how to best rotate or re-arrange adjacent tissue to cover the defect with a design that respects blood flow or tissue perfusion to ensure healing. ⁣
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Sometimes adjunct procedures are needed to get the best results (eg. revisions including debulking, dermabrasion, etc). ⁣
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This lady underwent partial chin defect coverage with bilateral V-Y advancement flaps and a single revision. ⁣
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Healing time is 4-6 weeks. ⁣
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Revisions are small office procedures with minimal downtime and healing in 1-3 weeks. ⁣
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Additionally, I advise my patients on sun avoidance and scar maturation postoperatively. ⁣
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It can take 6-8 weeks for scars to regain most (but never all) of their tensile strength. Scars often look worse before they look better. ⁣
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We recommend sun avoidance or covering the scar for 1 year (physical block or sunblock and physical block).⁣
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No scar revisions prior to one year. It usually takes one year for scars to really settle and look as close to normal as possible. ⁣
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I also remind patients there is no “scarless” surgery but we try to optimize the size and placement of scars according to local and aesthetic units.

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Breast Augmentation Risks and Complications

Breast augmentation is a surgical procedure to make breasts appear larger and fuller. Performed using either special implants or by fat transfer from a different area of the body, the procedure helps to restore breast fullness after pregnancy or weight loss, correct asymmetrical breasts, or enlarge smaller breasts. It is also valuable as reconstructive surgery after a mastectomy or other breast surgery.

A safe, effective procedure

When done by a skilled and experienced board-certified plastic surgeon, breast augmentation is a safe and effective procedure. The surgeon takes the necessary measures to minimize the risks of the operation, and the majority of women have no issues after the surgery. In fact, among millions of women with breast implants, complications have been observed in fewer than 1% of patients.

However, like every surgery, the procedure has general surgical risks, including temporary pain, swelling, bruising, tightness in the chest, bleeding, infection, poor scarring, allergic reaction to anesthesia, hematoma, changes in breast or nipple sensation, or need for revision surgery.

Besides, breast implants are designed to be temporary devices which wear out, degrade chemically, and release their content. So when getting breast implants, women should know that they are temporary devices that will need removing or replacing at a later date—the longer you have the implants, the higher the chances of complications.

What are the specific risks and complications of breast augmentation?

1. Pain

You will experience some pain or contraction for a while after the operation. Your surgeon can prescribe pain-relieving medication to help you manage pain which should be gone after 7-10 days. Do not take any other medication apart from the painkillers and additional medications prescribed by your doctor.

2. Seroma

Seroma — a buildup of fluid under the skin surface—may occur after the procedure, often at the site of the incision. The fluid is called serum and may begin to accumulate soon after surgery or several weeks later. Seromas pose a risk of infection and are resolved by draining the fluid buildup, especially when they are large.

3. Breast Implant-Associated Illness

Breast implant illness (BII or BIAI) is a self-reported complication and not an official medical diagnosis. Patients who believe they have the condition have reported a number of common symptoms, including fatigue, chest pain, hair loss, chills, headaches, chronic pain, rash, anxiety, photosensitivity, brain fog, and sleep disturbance.

There is still a need for research to find out why the symptoms occur and how they can be remedied. Many patients reporting these symptoms have also reported that the removal of breast implants alleviates the symptoms.

4. Implant rupture and deflation

Although breast implants have changed significantly since their inception and are now more durable than before, they can still rupture or burst under trauma or extra pressure. Most implant ruptures occur between 10-15 years after initial surgery, but this depends on the type of implant.

Silicone gel-filled implants have thicker liquid, so they do not deflate completely after rupture. But a hole or tear in saline-filled implants can cause a complete deflation, as the fluid escapes into the surrounding tissue.

Silicone implant rupture comes with risks such as pain, lumps, tenderness, and swelling. The breasts are also deflated in a manner visible to the eyes. Therefore, for patients with silicone gel-filled implants, it is advisable to have regular MRI scans after the procedure to detect possible rupture. If rupture is found, the implants are removed and replaced to prevent infections, discomfort, and cosmetic deformities.

5. Capsular contracture

The natural tissue of the body may react to the breast implants through an immune response. When this occurs, the collagen fiber around the implant forms a scar tissue (membrane) around the implant, resulting in hardening, stiffness, implant deformity, and pain in the breast over time.

Capsular contracture is classified into four grades: I to IV. Grade I contracture can go away with massaging and usually does not need treatment as it causes minimal problems. Grade II contracture creates more firmness in the breast and requires ultrasonic massage instruments. Grade III and IV contracture makes the breast hard and unnatural and requires surgery to remove and replace the implant.

6. Hypertrophic scarring

Breast augmentation is associated with a severe form of scarring, called hypertrophic scarring. It is a small but notable risk—only observed in 5% of patients. It is characterized by a thick, red-colored scar that is raised above the skin. Surgical scars tend to occur around the nipple and the lower part of the nipple. Your plastic surgeon may carry out renovation procedures to eliminate or reduce these scars.

7. Breast Implant-Associated Anaplastic Large-Cell Lymphoma

Though there is a low risk of Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL) occurring after breast augmentation, patients should still be aware of the risk. BIA-ALCL is a cancer of the immune system and is not related to breast cancer.

The condition is curable, with early detection offering patients the best chance for a quick recovery. Women considering breast augmentation should speak with their plastic surgeons about the risk of BIA-ALCL.

8. Surgical site infections

Infection may develop in or around the surgical site if bacteria enter the surgical wound either from the skin or in a contaminated saline solution or implant. The infection may be mild or severe, with the potential of infiltrating into deeper layers of the skin. Symptoms include pain in the surgical area and high fever. The implant may need to be removed to allow for the treatment of the infection before it is eventually replaced.

At Politis Plastic Surgery, we understand that the possible risks and complications of breast augmentation vary depending on your medical history, body type, allergies, medication, and other individual factors. We uphold the highest standards of medical care and take the necessary steps during the procedure to minimize the risks associated with the surgery. And after the procedure, we will keep in touch with you to ensure that any issues are promptly resolved.

Want to meet with a plastic surgeon to have your specific questions and concerns addressed? Dr. Effie Politis will listen to your cosmetic goals, explain available options, and guide you through your preparation for the surgery and your post-surgical journey. For more information on breast augmentation, visit the site Politis Plastic Surgery website.

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How to fix a displaced fold (inferior fold displacement after breast reconstruction)?

This lovely lady had the unfortunate diagnosis of breast cancer found on her annual screening mammogram. ⁣
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She underwent bilateral nipple-sparing mastectomies through an inframammary approach. She then underwent bilateral immediate breast reconstruction with silicone implants and acellular dermal matrix. ⁣

Because of the elastic properties of the acellular dermal matrix (its ability to stretch over time just like skin), she suffered from an inferior displacement of her fold (descent of her native inframammary fold) resulting in device malposition. This descent of her right inframammary fold created an increased lower pole breast skin out of proportion to her upper pole. ⁣
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I always tell my patients that during the mastectomy, the primary role of the breast surgeon performing the mastectomy is to act as an oncologic surgeon and safely remove all of the breast tissue to increase disease-free survival. ⁣
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During the mastectomy, all the natural landmarks and ligaments of the breast are removed with the actual breast tissue and this includes obliteration of the inframammary folds as well as the medial and lateral borders of the breast. ⁣
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It is our job as plastic surgeons to reconstruct these with suture techniques and also with adjunct materials that inherently have properties to support the missing ligamentous structures. ⁣
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The soft tissues are variable in every patient according to their age, weight, and subcutaneous tissues as well as fascial tissues. ⁣
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She was brought back to surgery for revision and stabilization of the fold with GalaShape. Again, this material provides a scaffolding and support to counteract increased downward pressure from the implant in a patient with low body weight and minimal subcutaneous fat.⁣

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What to Expect During Breast Augmentation Recovery

Breast augmentation is a great way to regain breast fullness, enlarge smaller breasts, or correct asymmetrical breasts. If you are healthy, you will tolerate the surgery quite well and enjoy more self-confidence after the procedure.

Good rapport with your plastic surgeon

A successful recovery begins with a good relationship with your plastic surgeon. Like any other surgery, breast augmentation has risks and possible complications. As a patient, you need as much support and information as possible to minimize the risk of complications after the procedure.

Finding a skilled and experienced board-certified plastic surgeon is advisable. You should also look for a surgeon with whom you feel comfortable so that you can communicate honestly and know what to expect. At Politis Plastic Surgery, we have a compassionate, patient-centered approach to breast augmentation. This allows our patients to quickly establish a good rapport with their surgeon, something that is valuable during and after the procedure.

What should you expect soon after surgery?

Breast augmentation is typically an outpatient procedure. You can expect it to be completed within 1 to 3 hours. Once the surgery is done, you will be moved to the recovery area and monitored for a while. If your plastic surgeon is satisfied with your response to the procedure, you will be allowed to go home the same day.

You can expect some pain and soreness after the anesthesia wears off. Gauze, a surgical bra, or an elastic bandage will be wrapped around your chest. You may also have drainage tubes attached to your breasts for three days. Prescriptions for pain-relieving medication help ease the pain, and antibiotics can prevent infection. You will be provided with instructions to follow during the recovery period until the follow up visit.

How long will it take to recover?

The recovery period varies from one person to another. Generally, if you do not experience complications after the procedure, then you should expect a full recovery in six weeks, but your plastic surgeon will assess your overall health and give you a personalized recovery timeline. Make sure to speak with your surgeon about this before the procedure. At home, eating a balanced diet and drinking plenty of water is essential for good healing and faster recovery.

How much discomfort occurs during recovery?

It is normal to have some discomfort and disrupted sleep during the first few days or weeks after breast augmentation. Actually, the first three to five days can be quite uncomfortable, and you may need prescription pain medication. After the first week, the discomfort should be minimal, allowing you to slowly ease back into a normal daily routine with light exercise.

While residual discomfort and breast scar incisions may take months to improve, be aware that severe pain, redness and swelling need immediate medical attention. To minimize post-surgical pain and speed up your recovery, avoid strenuous or jarring activity such as running or rigorous workouts. If you have a labor-intensive job, you should remain out of work for at least three weeks.

Follow your surgeon’s instructions

The incision wound will need proper care. During the first week after surgery, all bandages and dressings remain intact, and you will need to follow your surgeon’s instructions on caring for the wounds. At Politis Plastic Surgery, we remove dressings to check your healing progress after one week. At that time, we will show you how to care for the wounds to achieve the best healing and minimal scarring.

As you follow these instructions, make sure to listen to your body, particularly to warning signs. For instance, a manageable amount of pain and nausea tend to occur after breast augmentation, but extreme pain and nausea may be a warning sign of complications. Make sure to always speak with your surgeon whenever something unusual or extreme occurs.

When should you expect to resume normal activities?

Two weeks is the usual amount of time away from work, but that depends on the physical demands of your job. Speak with your surgeon for details on what you can do to speed up your recovery. As a rule, it is best to have your surgeon’s approval before resuming normal activities, especially strenuous exercise, high-impact sports or saunas.

At Politis Plastic Surgery, we will customize your breast augmentation procedure to best suit your needs and desired surgical outcomes. Working with Dr. Effie Politis, you can expect natural-looking cosmetic surgery results and a comprehensive guide to recovery.

If you are considering breast augmentation, we encourage you to schedule your consultation session well in advance. The one-on-one session with a plastic surgeon allows you to discuss all of your concerns and become informed about what to expect. For more information about breast augmentation, visit the Politis Plastic Surgery website.

How do you treat a cyst on your jaw?

 

 
 
 
 
 
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This young lady presented with a 5-year history of a mobile subcutaneous mass along her mid-right mandible.⁣⁣⁣⁣

She opted to have her cyst removed because it was enlarging and more noticeable. She also found good timing given most are wearing masks during the current pandemic.⁣⁣⁣⁣

When evaluating the subcutaneous masses, we do a careful head and neck examination of the patient to rule out a possible cutaneous malignancy. This includes a careful history as well as a lymph node evaluation and intra-oral evaluation. She denied any trauma to this area or any drainage.⁣⁣⁣⁣

 

 
 
 
 
 
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After careful evaluation, the area is numbed with local anesthesia, and then the cyst removed with sharp dissection followed by a layered closure to ensure a fine, hidden scar.

Sebaceous cysts may develop as a result of trauma or blocked glands in the skin and rarely cause pain or other symptoms. They’re most commonly found on the face, neck, and trunk. ⁣

Many patient prefer the removal of any lesions or cysts on the face to be performed by a plastic surgeon to ensure optimal scar healing and placement along with aesthetic units.⁣

 

 
 
 
 
 
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This is the defect after the entire cyst including sack and contents are removed.

Important structures in this area are the facial artery and vein and marginal mandibular nerve. ⁣

These structures were abutting the cyst but knowledge of anatomy helps us dissect them away without damaging them. ⁣

The defect was cleaned with betadine and peroxide and saline prior to layered closure for a nice fine scar.⁣⁣

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