New Silicone Breast Implants

As expected, both major makers of the new silicone breast implants have been bombarding us with information and sales pitches for the new silicone implants. I still think that it remains to be seen how successful these will become, given the fact that the companies are requiring so much documentation from the patient as well as the surgeon. Also, the companies want the patients to get regular MRIs, which are very expensive and would have to come out of the patient’s own pocket.

FDA Allows Silicone Implants

As you may have read the FDA has just allowed use of silicone breast implants. I have been in practice for more than 25 years. In the first few years of my practice in cosmetic surgery, silicone implants were the only implants available. At the time I felt that most patients got good results but some had reactions to the implants and ended up hard deformed looking breasts. They were not happy and neither was I.

When silicone was banned, we were left with saline implants and I had fewer problems and the patients were for the most part extremely satisfied. I saw a problem, however, in patients who were thin and had very little breast tissue. Despite placing the implants under the chest muscles to protect the implants from being felt and seen through the skin and to help give the round implants a better shape by having the muscle compress the upper portion of the implant, I found that these particular patients still did not look oe feel normal.

Now with the return of silicone implants, which are now deemed safe by the FDA, I think the this problem will be solved. Patients who want the silicone implants must be aware that the makers of these implants are going to charge more for these and that the costs will be increased for the surgeons and this in turn will mean a steep increase in the costs of the procedure for the patients. Patients should also remember that a larger incision will have to be made to allow insertion of these semi-solid silicone implants. The FDA has also recommended that each patient have close follow up with mammograms and other tests and that the patients should be prepared to have them replaced in ten yrs. They also want patients to be at least 22 years or older. All of these are recommendations that I think are reasonable.

Age not necessarily an obstacle

Recently a 75-year-old, tall, rather attractive lady who did not look her age came into my office for a complimentary consultation. As is usually my habit, I try to guess what the patient wants before I start the interview. This patient, I surely thought, came for a face lift. A.S., as I will call her, totally surprised me by saying that she wanted a breast enlargement! I could not help thinking to myself that perhaps she was a bit demented. Why would a lady her age possibly want a breast augmentation? Even though breast augmentation is usually a very safe procedure free from complications, doing this in an elderly woman has more risks.

After I recovered from my intial shock, I found enough courage to ask her. She told me that she had just started seeing a “new fella” and he liked “boobies.” I began to explain to her that her request was highly unusual and that the risks were greater for a lady her age. She informed me that the 70s are now the new 50s, and besides she was in excellent health. I still was not convinced so I contacted her primary family doctor. He told me that as far as he was concerned she was in perfect health and of sound mind.

I saw her a second time — it is my policy to consult all my cosmetic patients again before scheduling the surgery. Sometimes you get a totally different feel for a patient during that second interview. A.S. came into the room dressed like a diva and with her British accent introduced me to her “fella.” He was a very handsome man of 30. I again was shocked. They seemed to be a very loving and supportive couple, interacting like lovers in my office. We again discussed the operation and potential problems.

She did beautifully. Minimal bleeding, no swelling and virtually no pain. I saw her once after the procedure and never again! I suppose she and her “fella” are enjoying life and he is enjoying her “boobies.”

Making Good Decisions

Having been in practice as a cosmetic as well as reconstructive surgeon for 27 years, I decided to share some of my feelings about plastic surgery, cosmetic surgery, and medicine as a whole. There are so many sites dealing with the technical aspects of various plastic surgery, I decided to talk about my personal feelings as a doctor and a plastic surgeon.

Everyday we are bombarded by images of beautiful people. The American male is obessed with the American female breast. Everyday I see beautiful women who want to look even better. I have to not only help these women achieve their goals but I also have to help them stay healthy and make good decisions. For example, Mary D, a recent patient of mine, came in to see me for breast implants. She was tall and beautiful, with long flowing shining black hair and an athletic build. Her only problem was a -A cup size. She essentially had only nipples!

Because she was tall she wanted to be as big as she could be. She wanted DDD implants. Now, most guys would say what's wrong with that? Well my job was to help her, not hurt her by placing huge heavy implants on this beautiful girl. We spent several consultation sessions discussing the pros and cons of DDD implants. She continued to insist upon this size. I finally decided not to do her surgery and she went somewhere else. I could not get her to realize how heavy these implants would be and the effect they would have with gravity over time.

I am a doctor first of all, and the health and welfare of my patient is what is ultimately important. When a plastic surgeon becomes simply a technican or a pitchman for TV ads or a reality show star he is no longer behaving as a professional — he is a salesman. The customer then is always right. More later.