When To Change Breast Implants

I’d like to talk to you about the “shelf life” of breast implants. My Delaware breast augmentation patients know that even though “diamonds are forever", breast implants aren’t.

Why Should You Replace Your Breast Implants?

Here are a few reasons you might decide to change your breast implants.

1. You want to be either larger or smaller than you are now;
2. You want to change the shape or projection of your implants;
3. You want to switch from saline-filled to gel-filled (or vice versa);
4. You have a capsular contracture (painful hardening around the implant pocket);
5. Your saline implants (one or both) have deflated;
6. You see wrinkling, rippling, bottoming out or a“double bubble”
7. You had a breast aug several years ago and now you want a breast lift because your breasts are sagging. Note that it's not always necessary to replace your implants during a breast lift. If you're happy with the size and just want to eliminate the sagging, so long as the implants are still in good shape, they won't need to be replaced with new ones.

How Long Should My Implants Last?

While most breast implant manufacturers suggest that implants will last about ten years, some women never need to replace them. Some women need to replace them within 7 years. It varies.

Will I Have New Scars if I Replace My Breast Implants?

Not usually. Unless your scars from the original breast augmentation procedure are hypertrophic, the same incisions are used.

How Will I Know If My Breast Implants Are “Too Old?”

If you don't have one of the problems in the list above, don't worry. It's a case of "if it's not broke, don't fix it." However, if you have any concerns about your implants, set up a time to come in and see me. Keep in mind that, while saline-filled implant rupture is obvious, gel-filled implant failure isn’t. So, if you have women's intuition that your breast implants need some attention, just set an appointment. I’ll examine you and tell you if I think there's anything to be concerned about. Until then, enjoy your beautiful figure!

To your health and beauty,

Joe Danyo, MD

Change Your Implants In A Timely Manner

Gel-filled implants are fast becoming a favorite among breast enhancement patients, including the patients in my East Coast plastic surgery office. Due to their consistency, a gel-filled implant gives a more life-like feeling to the breasts compared to other implants. But before you choose an implant simply for its life-like feeling, you may want to know what comes with getting this gel-filled kind.

First, gel implants are entirely safe and effective. They wouldn’t be FDA approved if they weren’t. However, it is important to know that gel implants are not the forever kind. The FDA recently released a report saying that gel implants could have the need to be replaced, or even removed, within a ten year period under certain circumstances.

As the years progress, women with gel-filled implants, especially those who have suffered from breast cancer and have undergone breast reconstruction, could develop some problems. Most specifically, gel implants can rupture, but scarring, asymmetry and infection have been known to occur as well. A rupture especially will lead to surgery.

So how do you combat this potential problem if you still want gel implants? MRIs are one the best ways of detecting a problem with your implant. Going once every two years is a must if you have gel-filled implants.  If you haven’t detected any problems, but have had the implants in for a while, or close to ten years, your best option may be to simply replace them.

Like any type of surgery, there is always a risk, but by knowing the risks you’re already ahead.

Would you still consider gel-filled implants even though they eventually have to be replaced? To my readers that have them: Do you have an MRI every two years to detect problems?

To your health & beauty,

Dr. Joe Danyo

Finding the best bra after breast enhancements

Whether you like racy, lacy or plain, buying new bras after your breast enhancement procedure is supposed to be fun! Sadly, according to my wife and the women in my office, bra shopping is often not fun at all! Whether you have had a breast lift, breast reduction or breast implants here in our Delaware plastic surgeon’s office, wearing well-fitting bras afterwards is very important. Even if you haven’t had a breast enhancement, finding bras that fit correctly can be a challenge.

Wearing a poorly fitted bra can make you look older, because your breasts will sag. It’s true that breast sagging can indicate the need for a breast lift, but when wearing a properly fitted undergarment, your breasts should not sag.

Here are some indications that your bra doesn't fit well:

§  It hikes up in the back.

§  You’re often tightening the straps but it still doesn’t fit.

§  When you bend over, your breasts fall out of the bra and when you’re standing, your breasts don’t fit well in the cups.

§  Your bra bags in the nipple area or it squeezes your breasts too tightly.

§  You see red marks, irritation and/or rashes on your skin after wearing the bra.

Bra Sizing Tip #1:

Bra sizes can vary a great deal from one brand to the next. There is no standard 34B, 36C or any other size for that matter. A 36C in a Lady Madonna bra may not be the same size as a 36C in a Bali bra.

Measuring “band size” is the first step in finding your correct bra size:

The band size of a bra is the number part of the size. In a 38C, the number 38 stands for a band size of 38”. In European bras, band size is measured in centimeters and in the US it’s measured in inches. To identify your band size, take a measuring tape and measure around your ribcage, making sure the tape doesn’t ride up or down in the back—it should be even all the way around. Measure right under the breasts, around the ribcage. Write down that number.

Now that you have your rib measurement, do the following:

·       Add 4” if your rib measurement was an even number, like 36 or 38

·       Add 5” if your rib measurement was an odd number, like 33 or 35, etc.  

·       Example: If your measurement was 36”, add 4” and your band size is a 40. If you measured 27”, add 5” and your bra size is a 32.

Note: Your band size doesn’t change after breast augmentation, lift or reduction because your rib measurements remain the same.

How to determine your correct cup size

Using the same measuring tape as before, measure over the fullest part of your chest and around your back, making sure the tape is level all the way around. Next, subtract your band size from your bust-size measurement. Ex: if your final band size is 34” but the measurement around the bust is 37”, you are likely to be a 34C according to the chart below.

Use this chart to determine cup size by subtracting the band size from the bust size. The difference in inches will reveal your cup size.

If you used this method but you still experience sagging, you probably need a larger cup size than shown on the chart. If the cups are loose, however, try going to a cup size one letter smaller, and see how if that works. Sometimes you need a little trial and error. Although your bra should fit snugly, it shouldn't be too tight when you fasten the bra with the hooks closest to the bra itself, ie, away from the end of the tab. That way, when it stretches with wear you can still fasten it and enjoy that garment longer. Remember, once you find a great-fitting bra, you might do well to buy only that brand, choosing other styles from their line to suit your mood and garments. As previously said, a 34B in a Goddess brand is a 34B across all of the Goddess styles, but a 34B in a Bali bra may be another size altogether.

Bra Strap Basics

Bra straps should not ever be uncomfortable. If they dig into your shoulders or leave your skin red, they’re too tight. Bra straps aren’t intended to be the main support for your breasts. The bra itself, including the cups, should be the main support, not the straps.

More Tips Bra Care

After all the time you spent finding the right size bra, be sure to hand wash and line dry your bras. If you must machine wash your bras, fasten them before washing and put inside a mesh bag. Don’t put bras into the dryer—it will loosen the elastic and the bra will wear out faster.

We hope you have found this blog post helpful! 

To your health and wellness,

Dr. Joe Danyo 

FDA Intends to Speed Up Approval of Medical Devices

The FDA conducts studies and grants approvals for innovative medical devices in much the same fashion as it does for new drugs. Although the approval process for a new drug can take up to 12 years in research and development and cost well over a billion dollars before the FDA gives its approval, the approval process for devices used for cosmetic enhancements like liposuction technology, lasers and the like, tends to be even longer, requiring at least 10 months just for the first round of investigation by the FDA, that of confirming that the device is a “first-of-a-kind,” and not just a slightly-altered version of another device.  

An article in Bloomberg Businessweek reported on a new system at the FDA, called the Innovation Pathway, that intends to shorten the time for first-of-a-kind devices from 10 months to 5 months. The first product assigned to this new system is a brain-controlled, prosthetic arm created by the military.

Alhough th US is considered a powerhouse in the development of new drugs and other technologies, our country is the 7^th slowest nation when it comes to approving medical devices, lagging way behind Israel, India and European countries like France and Germany. Unlike the US, most European countries’ regulatory processes are much more supportive of innovation, while still ensuring consumers that what they approve meets the tests of safety and effectiveness. The Innovation Pathway program is the first attempt in 35 years to shorten the approval time for devices.

Technology will continue to move as quickly as the FDA will allow it, bringing us newer and better devices for liposuction, breast reconstruction and breast enhancements, and all kinds of laser skin treatments. I’m delighted that the FDA has taken this step and look forward to faster approvals for medical devices of all kinds, both for reconstruction and for cosmeteic purposes. It’s a needed step in the right direction.

To your health & beauty,
Dr. Joe Danyo

Cosmetic Surgery is No Cure for Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) has been getting a lot of attention in the media recently.  The condition, which drives people to constantly alter their appearance in a desire to be perfect, is oftentimes linked to plastic surgery. But do BDD sufferers actually benefit emotionally by undergoing plastic surgery? A new study’s says ‘no’. Despite these findings, there are surgeons who still provide requested surgeries to BDD sufferers.

The study, which was recently published in the Annals of Plastic Surgery, was spearheaded by Katharine A. Phillips, MD, is the director of the body image program at Rhode Island Hospital. Phillips defines BDD as “a psychiatric disorder characterized by preoccupation with an imagined or slight defect in appearance which causes clinically significant distress or functional impairment. A majority of these individuals believe they have an actual deformity that can be corrected by cosmetic treatments to fix these perceived defects rather than seeking psychiatric intervention."

Phillips co-authored the study with Canice Crerand, PhD, of the Children’s Hospital of Philadelphia. The researchers reported that previous studies showed BDD to be relatively common among individuals who underwent plastic surgery, accounting for roughly 7-8% American plastic surgery patients. The duo retrospectively studied 200 individuals with BDD. Of the group, 31% sought and 21% received surgical or minimally invasive treatments to remedy their BDD symptoms.

The study found that almost all of the individuals still experienced BDD symptoms, while some even developed new appearance fixations. The researchers also surveyed 265 cosmetic surgeons, of which 65% reported treating patients with BDD symptoms. Only one percent of the reported cases that were treated resulted in symptom improvement.

The most common surgical procedures among the patients were rhinoplasty and breast augmentation, while the most popular non-invasive treatments were dermal fillers and microdermabrasion. Three-quarters of all the desired procedures involved the face, and more than a third of the patients studied underwent numerous different treatments.

In the long-term, only 25% of patients with BDD showed a more positive appraisal of their treated body parts. Not only that, only two percent of treated patients saw a lasting improvement of their overall BDD symptoms.   

Of the patients who sough treatment, 20% did not receive a procedure. Surprisingly, patients with BDD were turned down more often due inability to pay for a procedure than they were for their symptoms. Thirty percent of patients could not undergo their procedure due to financing, while 26% were refused treatment by a doctor. The researchers also found that surgeons were significantly less likely to refuse a cosmetic treatment than other procedures, such as dermatological, dental or otherwise.

"This suggests that many surgeons were not aware of the patient's BDD or do not consider BDD a contraindication to treatment,” says Phillips.  “In a survey of 265 cosmetic surgeons, only 30 percent believed that BDD was always a contraindication to surgery."

While some cases of body dysmorphic disorder are easy to recognize, other cases are not so clear-cut. This study is an indicator that there should be more training and sensitivity in the aesthetic plastic surgery industry to the symptoms of BDD.  While most patients have a healthy desire to simply enhance their features, the crippling symptoms of BDD could be the motive for patients to undergo cosmetic surgery.

2009 International Aesthetic Trends Now Available

For the first time ever, accurate aesthetic plastic surgery statistics are available to the public. The International Society of Aesthetic Plastic Surgery (ISAPS) issued the "ISAPS Biennial Global Survey™" to surgeons in order to gauge aesthetic trends in the top 25 countries and regions for plastic surgery. The Survey represented 75% of all procedures performed in 2009.

Although the ISAPS Biennial Global Survey™ confirmed that the United States remains the country with the most procedures performed annually, there are some countries that are emerging as major centers that may be surprising. Making the top ten list are a few other countries that are not always associated with plastic surgery:
1.    United States
2.    China
3.    Brazil
4.    India
5.    Mexico
6.    Japan
7.    South Korea
8.    Germany
9.    Turkey
10.    Spain

The Survey also revealed that, contrary to popular belief, breast augmentation is not the most popular invasive procedure performed internationally. The top 5 invasive aesthetic procedures are as follows:
1.    Liposuction-18.8%
2.    Breast Augmentation-17%
3.    Blepharoplasty-13.5%
4.    Rhinoplasty-9.4%
5.    Abdominoplasty or Tummy Tuck-7.3%

As for as non-surgical procedures go, neuromodulators like Botox® top the list in popularity. Not only that, the overall number of non-surgical cosmetic treatments performed surpassed the number of surgical procedures. The top 5 non-invasive aesthetic treatments for 2009 were:
1.    Neuromodulators such as Botox® and Dysport®-32.7%
2.    Hyaluronic acid injections such as Juvederm and Radiesse-20.1%
3.    Laser hair removal-13.1%
4.    Fat grafting-5.9%
5.    IPL treatments-4.4%

Amongst other things, the Survey established that there are approximately 30,817 board certified (or national equivalent) plastic surgeons currently practicing. The number of surgical procedures performed globally in 2009 was 8,536,379, while the number of non-invasive treatments was 8,759,187.

The ISAPS Biennial Global Survey™ was created and proctored by Industry Insights, Inc., an independent research firm from Columbus, OH.  Scott Hackworth, a CPA who, along with the firm, has 15 years of experience in researching trends in aesthetic plastic surgery, led the Survey. The two-page, English-based questionnaire was administered to different international plastic surgery societies and focused on the aesthetic procedures performed in 2009.

Japan Makes Sizable Advances in the Use of Stem Cells During Fat Grafting

Fat grafting is an alternative used during soft tissue augmentation that has grown in popularity over the past few years. Although this technique has been around for over a decade, recent international advancements and the use of stem cells have dramatically increased the presence of fat grafting in the plastic surgery industry.

Fat grafting is beneficial in that it only leaves incisional scars and often has less complication then injecting dermal fillers and other foreign substances into the body. Although doctors around the world have been working hard to improve the final result of fat grafting, physicians in Japan have recently made the most important headway

Kotaro Yoshimura, M.D., associate professor of plastic surgery at the University of Tokyo, is leading the investigation into the use of stem cells of aesthetic applications. The doctor and his team recently developed a strategy called cell-assisted lipotransfer (CAL) to overcome some common issues with traditional fat grafting such as unpredictable results and low fat cell survival rates due to necrosis.

How CAL Works:
Stem cells found within adipose (fat) tissue are combined with traditionally lipoinjection. The fat removed after liposuction is split in half and stem cells from one half of the fat are removed and added to the other part of the fat. This process creates stem cell-enriched fat. Dr. Yoshimura and his colleagues found that after grafting fat, some of the cells die off and are replaced by new fat generated by the stem cells. The amount of stem cells contained in the graft is crucial in determining the final results following lipoinjection.

Dr. Yoshimura has tested the CAL process on more than 450 breast augmentation and restoration patients since 2003. The results demonstrated CAL as a safe and effective alternative for soft tissue augmentation.

How Stem Cells Are Isolated:
There are three basic steps executed during CAL: fat and stem cells are extracted from a donor site, the soft tissue is purified, and then the tissue is injected elsewhere into the body. The most difficult step in the process is isolating the stem cells from the rest of the fat cells. This can be done manually using a cell-processing room or automatically using Tissue Genesis technology.

According to Dr. Yoshimura, using stem cell-enriched fat during grafting may boost the safety and effectiveness of the traditional methods. The fat stem cells may even have a therapeutic effect, similar to bone marrow-derived stem cells, which can aid in the healing process following lipoinjection.

These advances in stem cell technology are certainly promising, however, Dr. Yoshimura stresses that the long term safety and efficacy of CAL still needs to be studied. Patients with a low BMI may also be poor candidates for fat grafting as issues may arise in harvesting enough fat and stem cells to make the procedure successful.