“Fat is the new filler” and uses you may not have known about.

Posted in: brazillian butt lift, Breast Augmentation, Fat grafting, Filler, Hand cosmetic surgery, Liposuction | November 19, 2012 | Comments Off

Fat is an extremely versatile filler.  It is easy to harvest through liposuction and it material that comes from your own body.  Thoughsome of it is absorbed by your body, whatever becomes incorporated is permanent and is living tissue, just transplanted to a new part of the body.

I use it in almost all my facelifts to fill in hollows of the cheeks and to plump up the cheekbones since aging is not only a result of gravity, but also fat loss.  Fat contains stem cells, and though it hasn’t been scientifically proven – anecdotally, many of my patients see restorative effects on the skin.

I also use fat in large volumes for Brazillian Butt Lift.  This enhances the shape of the buttocks and provides more volume and creating a lift.  I also use fat grafts to fix dents and irregularities on poorly done liposuction – almost 20% of my practice is repairing liposuction on patients who come to me after having liposuction done elsewhere.

Fat is also used for natural breast augmentation.  It creates a natural look and can help patients who don’t want implants to achieve about a cup size increase.

One of the places you might not expect fat to be placed is the hands.  Fat transfer to the hands helps fill out the hollowing that occurs with age and smoothes out the appearance of veins.  Patients feel it improves the appearance of the skin.

Fat grafting takes a high degree of technical skill to ensure that the grafts take and to minimize complications.  Each micro-droplet of fat must be placed in a different layer of tissue and in even, small amounts to survive and get it’s own blood supply.  Improper placement can result in fat necrosis or poor take.  However, when properly done and shaped, fat can be used in many different places in the body to create lasting effects.

Dr. Cat Begovic



Keller funnel and other steps to prevent capsular contracture in breast augmentation

Posted in: Breast Augmentation, Breast Implants, Plastic Surgery Studies, Scientific Studies | October 31, 2012 | 1 Comment »

In 2009 the FDA approved the Keller Funnel – a sterile funnel (looks like a pastry funnel) used to insert silicone breasts implants in a“no-touch” technique. I use a Keller Funnel for all my breast augmentation surgeries.  The implant goes from it’s sterile container, into the sterile funnel, straight into the pocket without contacting skin or any other surgical instruments.  Studies have shown that there is at least half the amount of bacterial contamination from breast tissue when using the funnel.

The reason why this is important is because capsular contracture – scar tissue formation around breast implants is one of the most problematic complications of breast augmentation surgery and it occurs in 10-15% of all women usually resulting in reoperation.  Capsular contracture has been in part attributed to a biofilm of bacteria formed around the implant.  Therefore minimizing bacterial contamination should help prevent capsular contracture.

Also use of Adam’s solution – a triple antibiotic solution of cefazolin, gentamamicin and bacitracin – has been shown to decrease capsular down to 1.8 % in study groups.² I use Adam’s solution to clean out the breast pocket, clean all surgical instruments involved in implant placement, clean the breast skin, soak the implant, and also fill the Keller funnel with it.  I use it everywhere I can.

It has also been shown that exposed nipples are sources of implant bacterial contamination during breast augmentation.³ The terminal ducts at the nipple and areola are colonized with bacteria.  Therefore, I cover the nipples with a Tegederm nipple shield during the surgery to decrease the chance of bacteria from the nipple spilling into the surgery site.

I also make sure the breast pocket is completely free of any blood and minimize any instruments used and don’t put gauze or lap pads into the pocket during surgery even though there haven’t been any good clinical studies to prove that these steps help.  I may be excessive and obsessive about all these little things, but as a woman with implants myself – my greatest fear is capsular contracture, which can occur even years after the surgery – so I try to do everything possible to try to prevent it’s occurrence.

- Dr. Catherine Begovic

References:

1.  Moyer HR, Ghazi B, Saunders N et al., Contamination in smooth gel breast implant placement:  testing a funnel versus digital insertion technique in a cadavar model.  Aesthet Surg J. 2012 Feb;32(2):194-9.

2.  Adams W, Rios J, Smith S et al.  Enhancing Patient Outcomes in Aesthetic and Reconstructive Breast Surgery using Triple Antibiotic Breast Irrigation:  Six-Year Prospective Clinical Study.  Plast Reconstr Surg. 2006;118(7 Suppl):45S-52S.

3.  Wixtrom R, Stutman RL, Burke RM et al., Risk of Breast Implant Bacterial Contamination from Endogenous Breast Flora, Prevention With Nipple Shields, and Implications for Biofil Formation.  Aesthetic Surg J.  2012: Sept 10 [epub ahead of print]

Breast feeding and breast implants

Posted in: Breast Augmentation, Plastic surgery and Pregnancy, Plastic Surgery Safety, Plastic Surgery Studies | October 27, 2012 | Comments Off

I recently spoke with a friend who is a newborn ICU nurse who asked me whether or not woman were able to breast feed after breast augmentation surgery.  She told me that the nurses in her hospital were not encouraging post breast augmentation patients to breastfeed because they thought they weren’t able to.  In a study performed by Mentor as part of their FDA post-approval study, only 8% of women who had breast implants had trouble breast feeding.  Although I always tell my patients there is a possibility their breast augmentation surgery can impair their ability to breast feed, most women are able to breast feed after their surgery (including myself!), so they should definitely be encouraged to try.

Another study presented at the American Society of Plastic Surgeons annual conference found that many women who had breast augmentation surgery were concerned that breast feeding may alter the appearance of their breasts and this contributed to their trouble with and reluctance to breastfeed.  However, although breasts generally sag with each pregnancy, there is no evidence that breastfeeding worsens these effects in women whether or not they have implants.

Also, for women with silicone implants, there is a concern whether the silicone passes orally to their child in breast milk.  Multiple studies have shown that the amount of silicone in breast milk from women with silicone implants is not statistically significantly higher than breast milk from women without implants.  In fact, the levels of silicone found in grocery store cow’s milk (709 ng/ml) and infant formulas (4402ng/ml) was significantly higher than breast milk even from women with implants (55ng/ml)!

Dr. Catherine Begovic

50th anniversary of silicone breast implants – 1st ever breast implant recipient shares her experience.

Posted in: Breast Augmentation, Breast Implants, Plastic Surgery in the News | June 8, 2012 | Comments Off

Timmie Jean Lindsey is now an 80 year old great grandma.  She was the first patient to receive silicone breast implants in 1962 from the surgeon who invented them.  Amazingly enough, her original implants have never leaked or ruptured, but she does have some scar tissue.  She said that her breast tissue only started to sag when she turned 70.

She feels fortunate to have participated in the evolution of breast implants especially when one of her granddaughters had to have breast reconstruction after a double mastectomy for breast cancer.  She was happy that her granddaughter and other breast cancer survivors are able to feel whole again after breast cancer surgery.

As with any medical device, the current silicone breast implants have undergone extensive testing and FDA approval.  They have undergone major improvements since their first appearance in 1962.  We have to thank Great Grandma Timmie for being the first one to undergo this surgery which has allowed so many women to enjoy a fuller, more feminine shape.

Dr. Cat Begovic

Breast implant operations have increased 40% in the last 10 years

Posted in: Breast Augmentation, Breast Implants, Plastic Surgery in the News | March 25, 2011 | Comments Off

New data from the American Society of Plastic Surgeons show that breast enhancement surgery continues to increase.  Last year, surgeons performed 296,203 breast implants – a 2% increase from 2009 and a 39% increase since 2000.

Overall, doctors performed 13.1 million cosmetic procedures in 2010, a 5 % increase compared with 2009.

How does this relate to you?  If you are considering a plastic procedure you likely know someone who had it done.  I always recommend patients get as much information as possible before proceeding with a procedure. Sometimes it’s helpful to talk to friends who had the procedure done to get their perspective.

Regardless, you should always feel comfortable talking to your surgeon and asking as many questions as possible about results, recovery, and what to expect.

Do breast implants need to be changed every 10 years?

Posted in: Breast Augmentation, Breast Implants, Plastic Surgery Safety | December 15, 2010 | Comments Off

Just last week, at least 4 or 5 of my girlfriends who have breast implants asked me this question.  I’m not sure how this idea started, but most women think that their breast implants need to be changed routinely.  This is not the case – really, implants only need to be removed and replaced if there is a problem.  In most cases, the problem involves implant leaks or scar tissue forming around the implant, known as “capsular contracture”.  This scar tissue makes the breast feel firm, distorted, or uncomfortable.  In the surgery, the scar tissue, or capsule, will also be removed.

Leaks are another reason to replace implants.  If a woman has saline implants, it will be obvious if there is a leak.  The implant slowly deflates as the saline solution leaks out.  If a woman has silicone implants, it is sometimes difficult to detect a leak.  This is why the FDA recommends screening for silicone leaks 3 years after implant placement and then every 2 years. Sometimes there are symptoms such as hard lumps, distortion of the breast or implant, swelling, burning, or hardening of the breast.  If that happens, the implant should be removed.

Before getting a breast augmentation surgery, ask your doctor about the pros and cons of the procedure.  Women who are considering implants should know that they are committing themselves to multiple surgeries over their lifetime.  The good news is that if an implant needs to be replaced, the manufactures currently provide new implants for free and often cover part of the surgery fees as well.

Dr. Cat Begovic

Breast augmentation research – Recent publication in the Aesthetic Surgery Journal by Dr. Catherine Huang Begovic

Posted in: Breast Augmentation, Breast Implants, Dr. Cat in the media, Plastic Surgery Studies | September 4, 2010 | 3 Comments »

One of the most common and disfiguring complications of breast implants is capsular contracture.  This is scar tissue that forms around the implant and causes discomfort or distortion of the breast.  No one knows what predisposes certain women to develop this scar tissue.  There have been different theories such as a genetic predisposition to inflammation forming scar, a small amount of blood around the implant that causes increased inflammation, or a bacterial film that forms around the implant causing an inflammatory response.  In surgery I do everything possible to decrease any of these factors – making sure there is absolutely no bleeding or oozing before placing the implant, washing the implant pocket multiple times with saline, antibiotic solution, and betadine to clear out any debris, bacteria, or blood, and changing to new clean and sterile gloves before touching each implant.

I am committed to research to battle the problem of capsular contracture.  My latest research has just been published in the Aesthetic Surgery Journal.  I’ve copied the abstract below.

Aesthet Surg J. 2010 May;30(3):404-8.

Effects of Singulair (montelukast) treatment for capsular contracture.

Huang CK, Handel N.

Abstract

BACKGROUND: Capsular contracture (CC) is one of the most common complications of breast augmentation surgery. Leukotrienes are implicated in the inflammatory cascade and have been postulated to be involved in the formation of CC. Therefore, leukotriene antagonists Accolate and Singulair have been prescribed by plastic surgeons off-label to treat and prevent CC. To date, there are no studies investigating the efficacy of Singulair on CC.

OBJECTIVE: The authors retrospectively review a series of patients treated with Singulair to determine whether it improves CC after breast implant surgery.

METHODS: Nineteen patients treated with Singulair by the senior surgeon (NH) after implant placement from March 2006 to November 2009 were included in this study. Follow-up on Singulair efficacy was obtained by a combination of office chart review and standardized telephone questionnaire. Results were characterized as complete improvement, improvement, no change, or worse.

RESULTS: Seventeen patients presented with CC resulting from a variety of breast operations. Two patients who had a history of recurrent CC were prescribed Singulair prophylactically immediately after surgery. Twenty-one breasts with existing CC were included in the total. Two (11%) patients became worse, three (16%) patients had no change, five (26%) improved, seven (37%) completely improved, and two (11%) were prevented from having CC formation.

CONCLUSION: Our preliminary study shows that Singulair improves CC. Breasts with mild CC (Baker score < III) appeared to have better improvement with Singulair compared to those with more severe contracture (Baker score III and IV). Singulair is well tolerated with minimal side effects and can be administered to patients after breast implant surgery to improve CC.

Breast Augmentation 101

Posted in: Breast Augmentation, Q&A | July 18, 2010 | 8 Comments »

I’ve recently had several girlfriends of mine come in for a breast augmentation consultation.  Even in this day and age where information about anything can be found on the internet, it is often still confusing for patients.  I remember when I got my breast implants, I felt a little overwhelmed by all the information that was out there.  Therefore, I use a simple algorithm for my patients to help them through the process.

1)   Saline vs. Silicone

Silicone breast implants have recently been FDA approved. Whether a woman undergoes augmentation with saline or silicone implants is a personal choice.  The benefits of saline are that if there is a rupture, saline is absorbed by the body.  The downside is that they feel less natural than silicone, especially if the patient has little breast tissue.  The implants feel quite different – in my office I have my patients feel both a saline and silicone implant to help them make a decision.   I also have a silicone implant where I’ve poked a small hole so they can see how the cohesive nature of the gel helps contain the leak

2)   Incision

Breast implants are placed through three different incisions.  Inframammary fold (in the crease beneath the breast), periareolar (around the nipple), trans axillary (through the armpit).  This decision will be made on an individual basis and depends on each patient’s anatomy and the implant size.  Overall, all heal well.  My implants were placed around the nipple and are barely perceptible.  Many of my patients have an inframammary incision and their scar is barely visible.

3)   Size

Most of my patients come in and tell me they want to be a “full C”.  However, because bras are sized differently, distorted by padding, and the cup size varies based on the chest width a “full C” is often not what most women think.  In general, because I’m a women, I can get a good idea of what my patients are visualizing and it’s easy for me to estimate what size implant they want.  We then do the fine-tuning by trying different implants in the office.  This is the fun part – to see what you will look like with implants!

4)   Implant placement

Implants can be placed under or over the muscle.  In general, studies have shown that implants placed under the muscle have decreased incidence of capsular contracture (hard scar tissue forming around the breast causing distortion) but sometimes implants are placed over the muscle create a little breast lift in patients who have mild droop.  The decision where to place the implant is made on an individual basis based on the patient’s anatomy.

When you come in for a consultation, I’ll take you through a hands-on, step by step process.  There is nothing like feeling the implants in your hands or seeing how they look under your clothes.   I personally feel that having breast augmentation was one of the best decisions I ever made.  I loved not having to wear padded push up bras under EVERY outfit and even as an active person I actually felt MORE comfortable running and working out in a sports bra not being so flat chested.  Living in LA where the average woman spends more time than most in a bikini, tank top or halter dress, I felt so much more versatility in my wardrobe.  Honestly, I could talk about breast implants for hours and I truly love being part of this life-changing experience for my patients.

Dr. Catherine Huang-Begovic