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
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]
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
According to a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS) Patients undergoing cosmetic liposuction and/or abdominoplasty (“tummy tuck”) procedures report significant improvements in self-esteem and quality of life.
Outcomes are especially good with liposuction plus “tummy tuck,” although they include somewhat higher pain scores and longer recovery times,
The study evaluated quality of life and other outcomes in 360 patients undergoing liposuction and/or abdominoplasty to remove excess abdominal fat. About 60 percent of patients underwent liposuction alone, 35 percent underwent a combination of liposuction and abdominoplasty, and the rest underwent abdominoplasty alone.
Patients undergoing abdominoplasty rated their cosmetic outcomes an average score 9 out of 10, compared to 8 out of 10 with liposuction only. Liposuction plus abdominoplasty produced the highest patient satisfaction rate. Ninety-eight percent of patients undergoing liposuction plus abdominoplasty said they would undergo the procedure again and 99 percent that they would recommend it to others.
Overall, 86 percent of patients reported an improved sense of self-esteem after surgery. About 70 percent reported improved quality of life, more commonly after liposuction plus abdominoplasty.
Dr. Catherine Begovic M.D.
The article is entitled “Liposuction: A temporary fix?” In it, I give my critique on a recent article in Obesity magazine online that claimed that fat moves from the thighs to the abdomen after liposuction, and that fat comes back after liposuction. It addresses many issues concerning diet and exercise and what liposuction can and cannot accomplish.
For those of you who have read my blogs on liposuction – you will know the answers to these questions. For those of you who don’t and are curious – I recommend you get the magazine and read the article!
Dr. Cat Begovic M.D.
On Wednesday 6/22/11, the Food and Drug Administration announced that early findings from an analysis of safety issues and adverse events associated with silicone-gel breast implants revealed no new concerns. Therefore, the agency said it will allow the devices to remain on the market.
The Los Angeles Times (6/23, Mai-duc) stated that the FDA said the analysis conducted on more than 80,000 women over 10 years by implantmanufacturers “indicates that they have a ‘reasonable assurance of safety and effectiveness’ when used properly. … ‘What we can say is the current data doesn’t indicate that silicone gel-filled breast implants are linked to breast cancer, connective tissue disease or infertility,’”
However, women considering breast augmentation with silicone breasts implants should discuss the risks, benefits, and alternatives with their plastic surgeon. It is important for women to understand that 20 percent to 40 percent of patients who have implants for cosmetic reasons will need another operation to modify or remove them within eight to 10 years. I always encourage women to do their research and have all their questions answered before proceeding with any cosmetic surgery procedure.
Dr. Cat Begovic M.D.
I got a question today on my site about skincare. I think a lot of people get confused by the different marketing campaigns and don’t know what to use. Ipersonally have been passionate about skin and skincare my entire life. My mother taught me at a young age how to care for my skin – I think I’ve been using sunscreen and skin care products before I could walk!
A few years ago, I got fed up with all the marketing gimmicks and used my Harvard Molecular & Cellular Biology background to actually look at the scientific data and research behind different anti-aging skin care ingredients. My research was published in the Aesthetic Surgery Journal.
The Aesthetic Surgery Journal “The Truth about over the counter topical anti-aging products” http://www.spsscs.org/download/otc.pdf
Dr. Cat Huang Begovic
Breast augmentation research – Recent publication in the Aesthetic Surgery Journal by Dr. Catherine Huang Begovic
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.
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.