Breast augmentation is one of the most popular cosmetic procedures out there. And since cosmetic surgery is real surgery, some complications are inevitable. Breast augmentation revision is a specialty unto itself within plastic surgery. One such complication that requires a breast augmentation revision is bottoming out of the implant as shown above.

What is ‘bottoming out’ in breast augmentation?

In an ideal situation, a breast implant sits behind the breasts in perfect symmetry. However, if the fold under the breast, the inframammary fold, is disturbed, the implant can bottom out. The fold is usually very adherent to the chest wall.

Bottoming out can occur if the fold is inadvertently released from the chest wall. This can occur if the implants are too large and put too much pressure on the fold, such that it pulls away from the chest wall. And sometimes the fold must be lowered to accommodate a larger implant. If that’s done, the fold will bottom out if the fold is not affixed back to the chest wall with a suture.

If bottoming out occurs, there are several options. One option is to create a new pocket. However, two things are important when doing this. First, the implant should remain under the muscle so the implant continues to be camouflaged and look as natural as possible. Secondly, the pocket needs to be strong to minimize a recurrence of bottoming out.

Neosubpectoral pocket video

That’s where the neosubpectoral pocket technique comes in. This is a confusing concept so the video below will help. But essentially, the physician uses the naturally occurring scar tissue around the implant (the capsule), to help make the new pocket. A new pocket is made between the muscle and the capsule and the implant is placed here. That way, the implant is still under the muscle and on top of the capsule.

Using mesh to treat a bottoming out breast

The alternative, is to use mesh or some other material to secure a new inframammary fold. In this particular case below, GalaShape from Galatea was used to secure the new fold for a very robust repair.

To check pricing on a breast augmentation revision, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Breast augmentation revision first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

How is the IDEAL implant different?

As you’ll see in the video below, the IDEAL implant isn’t just another saline implant. It has “structure” to it. In this case, it means that in addition to a silicone shell, there are additional silicone shells inside that give the saline implant a feel closer to a silicone implant. Even though there are multiple silicone shells, there is no silicone liquid or gel inside.

While the 5th generation silicone implants are more like gels and less likely to leak like the original silicone implants, some patients have concerns. So if you’re worried about silicone gel implants, also called gummy bear implants, you have another option.

The concerns about silicone implants – risk of lupus or cancer – are not substantiated in many studies. And the recent concern about ALCL is associated with implants that have a textured surface. Most silicone implants do not have a texture on their surface and neither does the IDEAL implant. In the end, if you still have concerns about a silicone implant but still want the natural feel of a silicone implant, the IDEAL implant is for you!

Video on the IDEAL implant

To check pricing on breast augmentation with the IDEAL implant from Dr. Kaplan, click here.

Other resources for the Ideal Implant;

https://idealimplant.com/press-releases/

https://idealimplant.com/10-year-study/

https://idealimplant.com/advantages-2/

https://idealimplant.com/medical-futurist/

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Breast augmentation with the IDEAL Implant [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

The details in a mommy makeover

The breast augmentation portion of the procedure typically consists of a small incision either in the inframammary fold, around the areola or in the armpit. There are pros and cons for each choice, but the choice is yours depending on your case and what type of incision that you want to live with after surgery.

A gummy bear silicone implant is then inserted to give the perkiness patients desire. They can also choose between shaped or round implants depending on the look they’re going for. In some cases when there is excess droop in the breasts, a lift may be necessary. Depending on how much lift is required, it is performed with an anchor, lollipop areolar (donut) or crescent incisions.

The tummy tuck part of the procedure begins with liposuction of the abdomen and flanks. This extra step can really maximize the results of the tummy tuck. Then, a long incision across the abdomen is made, just below the panty line. The skin is elevated towards the breastbone and then the excess skin is removed. If the patient has any rectus diastasis or abdominal separation that typically results from multiple pregnancies, this is corrected by rectus plication wherein sutures are used to pull the muscles back together. Lastly, in an ideal case, progressive retention sutures are used so that drains are not required.

And wham bam, thank you ma’am, you’re all done! Checkout this video below and to check pricing on a mommy makeover from Dr. Kaplan, click here.

Mommy Makeover: The video

Oh, and for the ladies out there who haven’t had kids – if this combination surgery sounds like what you are looking for, don’t be shy in asking for the Mommy Makeover! Andon’t let the name scare you away; it’s just a name. Getting the combined procedure not only gives you one recovery period, but doing so will also save you money compared to going under for two separate procedures.

Click here for the original blog post written by @japsiecam for BuildMyBod.

The post What exactly IS a Mommy Makeover? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

It’s a totally reasonable thing to do. Patients, when going in to see their plastic surgeon, bring “wish pics.” That is, a photo of someone (doesn’t have to be famous), that’s had the operation and the results they’re looking for. But reasonable intent can translate into unreasonable expectations.

What’s wrong with wish pics?

Patients bring in their wish pics all the time. It’s definitely helpful to see where they are and where they’re trying to go. This exercise also provides insight as to their expectations and self-image. Some patients have reasonable expectations. Whereas others have an inaccurate self-image preop and an inaccurate appreciation of what’s possible.

Wish pics therefore give an opportunity to have a frank and honest discussion. Sometimes they’ll bring in photos of celebrities that are of a different ethnicity and body shape that is physically impossible to emulate. However, I recently noticed an unexpected pitfall, especially in the case of breast augmentation –  they bring photos of clothed patients.

In some cases, when patients see themselves in the mirror, they view themselves naked. Then they look at a photo of someone else with a breast augmentation and say, “I want to look like that!” But the person in the photo is clothed, which covers up issues of asymmetry, stretch marks, lack of cleavage and other natural imperfections.

So you have to prepare the patient that they can’t conflate how good the breasts look in the photos and how they will look naked. In other words, don’t focus on how “perfect” the breasts look clothed. They may not look that perfect postop when looking in the mirror without clothes on.

One classic example is a patient wanting the cleavage present in a photo of a clothed person. It’s unclear if that cleavage is due to a push-up bra (which wouldn’t be utilized when naked) or if it’s au natural.

Don’t put the breasts on a pedestal

It’s also important that the patient doesn’t “put the breast on a pedestal!” Patients need to be reassured that everyone, even those in the photos, have imperfections when naked.

To discuss further with Dr. Kaplan and to check his pricing, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Pitfalls of breast aug wish pics! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Like movies? Biofilm is the most important film you’ve never heard of! Biofilm is the technical name for the slime that bacteria secrete. It’s a problem in the case of breast implants and fillers. We generally worry about blatant infections from bacteria but in the case of implants and fillers, biofilm can cause problems other than a frank infection. Curious? Keep reading.

Biofilm and how it affects you

Obviously your doctor knows about the risk of infection anytime they inject a filler into your face or place a breast implant during breast augmentation. That’s why the doctor cleanses the skin with alcohol (in the case of fillers) or betadine (in the case of breast augmentation). But with billions and trillions of bacteria on the skin, it’s not always possible to get rid of 100% of the bacteria.

That doesn’t mean we just give up when it comes to cleanliness and good surgical technique. That’s still critical. We just have to understand the potential risks. Even if there are a few bacteria still present during surgery or non-injectable treatment, your body does a pretty good job neutralizing most of them. However, some bacteria can attach to the filler or implant after placement. The bacteria then secrete a slime that all together, represents biofilm.

With biofilm present, it’s harder for antibiotics to kill the bacteria with their protective slime covering. This doesn’t result in infection. In the case of fillers this can result in granulomas and nodules. In the case of breast augmentation, this can result in a thickening of the scar tissue around the implant. If the scar tissue around the implant is thick enough to distort the implant and breast, that’s capsular contracture.

So how do we reduce the risk. First let’s discuss fillers. As the image above shows, the more needle sticks into the skin to inject fillers can potentially bring more bacteria from the skin surface and into the filler. By using the blunt cannula technique, your doctor only makes one needle stick, rather than many. In other words, the treatment can be performed with one entry point rather than five or ten. You can see an example of the blunt cannula technique in the video below.

Blunt cannula technique video

In the case of breast augmentation, protecting the implant from any skin bacterial contamination is beneficial. For example, inserting the implant without the implant touching the skin or covering the nipple, and it’s bacteria hidden within the nipple milk ducts, can help. You can see an example of “nipple shields” in the video below.

Nipple shields video

To check pricing on any of these procedures from Dr. Kaplan, click here.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

The post Considering breast aug or fillers? You need to know about biofilm! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.