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

Unsafe injection practices – don’t share Botox or Filler syringes!

Posted in: Botox, Filler, Juvederm, Plastic Surgery Safety | August 8, 2012 | Comments Off

I’ve had several patients come into the office asking me if they can share a syringe of Juvederm with a friend. Apparently this un-safe practice of sharing syringes has been occurring in several offices to save money.  However, I want to emphasize to anyone getting injections of any kind that it is unsafe to share syringes even if the needle is changed.

The CDC (Centers for Disease Control) has been investigating potential exposure risks of patients to Hepatitis B and C and HIV due to unsafe injection practices.  Since 1999, more than 125,000 patients in the United States have been notified of potential exposure to Hepatitis B, Hepatitis C or HIV because of syringe sharing.  It is a misconception that changing the needle is sufficient to prevent disease transmission.  Botox and other cosmetic injectables are listed by the CDC as medications commonly misused with syringe sharing.

Please don’t share your syringes or if your doctor appears to be using a pre-filled syringe to inject you, please speak up to make sure it wasn’t already used by someone else.  This will protect you from contracting any potentially harmful diseases.

Dr. Catherine Begovic

Common liposuction questions – from my patients

Posted in: Liposuction, Plastic Surgery Safety, Q&A | April 14, 2011 | Comments Off

With summer coming up – I’ve been performing A LOT of liposuction procedures the last few months!  I’ve had the same few questions come up multiple times from my patients.  Here is a quick Q & A of the most common questions.

Q.   If I gain weight after liposuction will I need it again?

A.   Your body genetically has a certain number of fat cells deposited in particular areas.  Some people are just born with more fat cells in their abdomen, flanks, inner thighs and no matter what they do, they just can’t lose the fat there.  Liposuction removes the total  number of fat cells that has preferentially deposited in these areas.  If you gain weight, each fat cell in the body gets bigger, but because you have fewer fat cells in liposuctioned areas, you should proportionately gain less in the liposuctioned areas.  It is always a possibility that if you gain a lot of weight, you may need liposuction again.

Q.  Can liposuction help me lose weight?

A.  Liposuction is not a treatment for obesity or a substitute for diet and exercise.  It is for re-shaping the body to treat areas that have a dis-proportionate amount of fat.  Liposuction is ideally designed for pockets of fat in isolated areas that do not respond to diet and exercise. Also, the law limits the total amount of liposuction that can be removed at one time to 5L of liposuction for safety reasons.  I always tell my patients to start with diet and exercise and to maintain a stable weight before undergoing liposuction.  However, having liposuction often motivates patients who look better in their leggings or workout clothes, to begin a healthier lifestyle, and many people lose even more weight after their procedure.

Q.   Is liposuction dangerous?

A.    Any surgical procedure has risks of anesthesia, risks of getting a blood clot, and a number of other complications.  Many of the serious complications from liposuction in the past involved cardiac reactions to the local anesthesia injected in the body before the procedure.  Also, procedures involving large volumes of liposuction (> 5L) resulted in fluid shifts that caused cardiac and respiratory problems.  These occurrences are now quite rare.  A safe, well-trained surgeon will carefully calculate and keep track of the amount of local anesthesia used as well as the amount of liposuction removed.  A partnership and good communication with the anesthesiologist will help to ensure the safest conditions possible.

Q.  I’m fit and everyone tells me I’m in shape and don’t need anything done, but I hate the pocket of fat that bulges – am I still able to have liposuction?

A.  I would say that the ideal candidate for liposuction is someone who is of healthy height and weight with small pockets of fat that they just can’t lose despite diet and exercise.  As long as there are a few centimeters of fat present in an area, it can be removed.  Many of my patients are very fit bikini models who don’t like the extra fat bulge or shape of their inner or outer thigh, or feel that they have a “muffin top” making their waistline bigger than desired.  Liposuction is ideal for this type of re-shaping.  I had an extremely small amount of fat removed from my knees and inner thighs over 10 years ago when I was modeling – so I can really relate to wanting removal of these small fat pockets.  On the other hand, I have turned away patients who just didn’t have enough fat to be removed.  In general, if you’re unsure, it’s best to see a plastic surgeon in consultation to evaluate your particular anatomy and decide if you are a candidate for liposuction.

Q.  I’ve seen some bad liposuction – what happened there?

A.   I know exactly what you are talking about – I can spot bad liposuction a mile away.  There is always the possibility of asymmetry, skin dents, wrinkling, or folding.  However, an experienced liposuction surgeon should be able to avoid most of these things from happening.  Most of the really bad liposuction results often come from over suctioning the fat causing the skin to stick unnaturally to the underlying structures.  I always tell patients that I have to leave a small cushion of fat under the skin to keep this from happening.  I do the majority of the fat removal through surgery, and they do the rest with diet and exercise.

Q.  Why do I have to wear compression garments?

A.  The liposuction cannulas make tiny tracks as they remove fat.  I tell patients to imagine a sponge with small holes.  The compression garments help squeeze all the fluid and tissues down to allow for a smooth flat thin contour.  They are sometimes cumbersome to wear, but worth it to have the best possible outcome.  One of my celebrity liposuction patients who had to do several red carpet events soon after her surgery found some compression garments that give a nice smooth contour under clothing.  I now use these often for my patients so the garments are less obvious under clothing.

I hope this helped answer most of your questions!  Please remember that liposuction as well as any plastic surgery procedure should always be performed with a good understanding between patient and doctor of realistic expectations, and with an emphasis on safety.

Dr. Catherine Begovic M.D.

Allergan Confidence Plus and Mentor Standard Advantage – Breast implant warranty programs

Posted in: Breast Implants, Plastic Surgery Safety | January 9, 2011 | Comments Off

Women, who have or intend to get breast implants, should be aware that they are covered by  warranty programs offered by companies who manufacture them.   That means that if you get implants from them, they will help cover fees and give you a lifetime product replacement option.

I have breast implants so this information gives me peace of mind.  Once you get an implant, you will be given a card with information about your implants like the serial number, kind, size, etc.  You should keep this card so when the need for a replacement arises, it will be more convenient for you and the company to facilitate the application of the warranty.

Allergan and Mentor offer free warranty programs and upgrades.  Below is some information that you should know about the warranty they offer patients.

Allergan breast implants are sold under the brand name Natrelle®.  Every implant, be it saline or silicone gel, comes with the ConfidencePlus® warranty upon surgery.  There is also the option to upgrade to ConfidencePlus® Premier warranty.

ConfidencePlus® covers recipients of both NATRELLE™ style saline and silicone filled breast implants instantly, for free.  Coverage is as follows:

• 10 years of guaranteed financial assistance
• Financial assistance of up to $1200 for surgical fees, operating room and anesthesia fees, if not covered by your insurance
• Lifetime product replacement on the deflated side without charge
• Non cancellable terms

If you choose to upgrade to ConfidencePlus® Premiere, you will enjoy more benefits for only $100.  You would have to do this change within 45 days of your surgery.  Coverage is as follows:

• 10 years of guaranteed financial assistance
• Financial assistance of up to $2400 coverage for surgical fees, operating room and anesthesia fees, if not covered by your insurance
• Implant replacement on the opposite (non-deflated) side for 10 years after surgery
• Lifetime product replacement without charge
• Automatic renewal to ConfidencePlus® after replacement, for free.
• Non cancellable terms

Mentor have saline and silicone implants.  The silicone gel implants are branded as MemoryGel®.  Upon getting Mentor breast implants, you instantly get the Mentor Standard Advantage warranty for free, which includes:

• Free lifetime product replacement
• Financial assistance of $1200 for the cost of replacement surgery for 10 years after surgery.
• Implant replacement on the opposite (non-deflated) side for 10 years after surgery.

If you choose to upgrade to Mentor Enhanced Advantage, you only have to pay $100.  You will get to enjoy all the benefits of standard warranty and increase the financial assistance amount from $1200 to $2400.

Since the warranty details do change, make sure to regularly check the details on the manufacturer’s website so that you’ll know your coverage.

Dr. Catherine Huang Begovic

The importance of a pre-op history and physical exam

Posted in: Plastic Surgery in the News, Plastic Surgery Safety | December 15, 2010 | Comments Off

Before performing any procedure, minor or major, my number one priority is the patient’s safety.  An important part of the process is a pre-op medical clearance.

I make sure an internist checks each patient’s complete medical history and physical condition.  I do this to make sure that he or she is healthy enough to undergo general anesthesia.  I also personally communicate with his or her doctor to discuss the patient’s medications, what kind of surgery is to be done, and how long he or she will be under anesthesia.  Based on this information, the patient’s internist can determine the safety of under going surgery, and wecome up with a plan together for any medical issues that may arise.  I believe good communication is essential for the patient’s safety.  I also personally review the pre-op history and physical exam results with my anesthesiologist to make sure that he/she is 100% comfortable and well prepared.  I consider the three of us a team and this pre-surgery safety check helps ensure that the patient will have a safe and positive experience.

Sometimes patients feel that it is inconvenient to go through all the tests and lab work, but without proper pre-operative evaluations, there can be serious consequences.  There was a bill signed in 2009, the Donda West Law that mandated all patients undergoing elective cosmetic surgery have a medical history, physical exam and signed clearance from all doctors concerned before the procedure.  This bill was created after the passing of Dr. Donda West, the entertainer Kanye West’s mother, who underwent surgery without proper clearance and died.  The bill has since then been vetoed, but that doesn’t take away the importance of medical clearance.

This is just the first step in the process to having a safe and positive plastic surgery experience!

Dr. Catherine Huang Begovic

Do breast implants need to be changed every 10 years?

Posted in: Breast Augmentation, Breast Implants, Plastic Surgery Safety | | 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