Question of the week: what are cohesive gel or form stable breast implants?

I know I want silicone implants for my augmentation, but I’m confused about the difference between gummy bears, cohesive gel and form stable implants. How do I choose the safest implants for my breast augmentation? - patient Dr Sharp: It’s good to hear you are thinking about these factors and how they may impact your breast augmentation surgery, as they are important pre operative considerations! Essentially all of the implants you mention come from the same ‘family’ of silicone implants. Implant manufacturers use words such as cohesive gel, form stable silicone and gummy bear implants to describe variants of the same thing; breast implants that contain a silicone that maintains its shape and consistency inside the body - and has a solid (rather than liquid or runny) consistency. This kind of silicone has been successfully used for many years - and in millions of patients. Most specialist plastic surgeons in Australia use modern implants that contain this gel. Breast implants are very strong and ruptures aren’t common, but even when cohesive gel implants do rupture, the gel stays inside the implant - hence the term ‘form stable’. Silicone implants have dramatically changed over the past 40 years; the original silicone gel that was used as early as the 1970s, consisted of a liquid gel. If the outer layer of the implant ruptured, the liquid would leak into the body. In 2006, cohesive gel implants became available in the United States. You may have heard them referred to as the “gummy bear implant”. The big difference between a liquid gel and cohesive gel is that the cohesive gel stays in one solid form...

Question of the week: what is a Keller funnel and why does it make breast augmentation surgery safer?

My friend has had a breast augmentation and said her surgeon used a funnel to insert her implant and make her surgery safer. Does Dr Sharp use a funnel, and if so, how does it make the surgery safer – and does it cost extra? - patient Dr Sharp: It’s great to hear you are thinking about these factors before your breast augmentation surgery, as they are an important pre operative considerations. The Keller funnel is an implant delivery system for inserting breast implants into the surgical pockets; a clear funnel shaped tool that allows for easier insertion of the breast implants into the chest cavity without over-handling of the prosthesis. The Keller funnel was a game-changer in breast augmentation, alleviating the need to insert breast implants by hand, and offering three key advantages: Decreased breast implant contact Being able to use additional anti-bacterial measures with a Keller funnel reduces the risk of breast augmentation complications. It offers less risk of damage to the breast implant during insertion, helping to minimise the risks of pre-insertion damage to the breast implant product by reducing the  need to manually handle the breast implant. Excessive manual handling of implants has been identified as a potential factor in the compromise of the implant shell, reducing the longevity of the implant. Easier breast implant insertion The Keller Funnel’s clear polymeric surface is also believed to help make it easier for the insertion (and potentially orientation) of some types of breast implants. The clear funnel allows for greater visibility of the breast implant at all stages of the implant insertion; assisting surgeons with breast implant placement for cosmetic and plastic surgery breast enlargement procedures. The funnel’s low friction coating allows...

Safe breast augmentation surgery – the 14 Point Plan Pledge

Breast augmentation surgery is a very safe procedure. Statistically it has a low rate of complications and research shows it provides measurable improvements for women’s quality of life and sense of wellbeing. Despite this, safety is at the forefront of women’s minds when considering a breast augmentation - and so it should be! Key considerations pertain to the choice of surgeon, selection of implant, the facility where the surgery is performed and the technique used. It’s important to put your safety interests ahead of finding the cheapest ‘deal’ or a surgeon that can perform your surgery asap! Optimal safety measures take time, and steps such as using an accredited hospital and anaesthetist - or taking extra precautions to avoid bacterial contamination - might add to the costs involved, but they can also significantly impact your short and long term outcomes. Macquarie University has put together a 14 Point Plan which offers proven strategies for surgeons to use when they are inserting a breast implant. Published in 2013, it is now adopted around the world as best practice for plastic surgeons who frequently perform breast augmentation surgery.  Each step aims to reduce bacterial contamination, which in turn minimises the risk of breast implant complications. Dr Sharp is one of the specialist plastic surgeons in Brisbane and Ipswich who has chosen to taken the 14 Point Plan Pledge. This means he has committed to using techniques and practices that help reduce the risk of bacterial contamination (listed below) including the use of a Keller funnel to deliver the implant into the breast pocket, using form stable breast implants and submuscular placement. While it isn’t possible to completely eradicate the chances...

Breast augmentation question of the week: the difference between an augmentation mammoplasty and augmentation mastopexy

What’s the difference between a breast augmentation mammoplasty and breast augmentation mastopexy, or are they both the same thing (BAM)? I’ve been told I might need the mastopexy version with my implants. - patient Dr Sharp: A mastopexy is another word for a breast ‘lift’. A breast augmentation mastopexy is a combined breast enlargement and lifting procedure; it involves the placement of an implant to increase breast size and fill out the skin, while excess skin is removed and the nipple is lifted to sit higher on the new breast shape. Incisions are made around the nipple, with a single vertical incision down the middle of the lower breast, and in the inframammary fold. A breast augmentation mammoplasty, on the other hand, is commonly referred to as a ‘BAM’ involves the placement of an implant, normally using a single incision in the inframammary fold of each breast. Mastopexies can be performed on their own to lift a breast, or in combination with an augmentation to lift and enlarge. There are a few reasons why your surgeon may recommend a mastopexy with your augmentation. For some women, the position of their nipple and areola complex sits lower on their chest. This can be due to weight loss, genetics, breastfeeding or the natural ageing process. If the nipple and areola sits below the inframammary fold (see right), this is classified as ‘nipple ptosis’. There are various grades of ptosis. When seeking breast augmentation, it is often the case that an implant alone will not move the nipple upward enough so that it’s centered on the implant, forming a more pleasing shape. A mastopexy may...

Breast augmentation – question of the week: internal support

I’m worried about the implant slipping or internal structures being weakened by a breast augmentation. One of my friends said her sutures came apart while she was lifting weights in the gym and now one of her implants has moved out of the pocket. Can this happen? - patient Dr Sharp: It’s great to hear you are thinking about these factors before your augmentation surgery, as they are important pre operative considerations. Sometimes due to a patient’s anatomy or previous breast surgery, the surgeon will need to apply additional inframmammary support for the implant. This can come in the form of additional sutures, or even an internal sling using a dermal matrix. It’s important to ask your surgeon should be experienced with these techniques, and will be able to advise upon examination if this was required for your augmentation. An implant will inevitably add additional weight to your internal structures, and that’s why we advocate a very thorough and careful selection process for the right implant, and pocket plane placement, for your body. Lifestyle factors - such as regular weights sessions at the gym, heavy lifting in your job or repeated movements with hefty objects at home/caring for children or elderly need to be considered as well, because yes, in some cases there can be too much pressure on the internal structures and the implant can ‘bottom out’ or migrate. While this is rare, it does happen. There are a number of decisions before your surgery that can help reduce this chance, as well as lifestyle/activity considerations to make after your augmentation that can mitigate the risks of this happening. Ask us your...

Dr David Sharp before and after photos 2017 highlights

This is a small selection of our before and after photos from 2017! Thanks to all the lovely patients who permitted us to share their images this year, to help educate others about plastic surgery and the outcomes that can be achieved. Our patients come in all shapes, sizes and ages - and from the young to the mature aged, we believe it’s important to provide insight into the ‘real’ faces of plastic surgery; everyday patients! Despite the fact that much of what we see on social media probably reflects otherwise, the average plastic surgery patient is not a size 8 model with perfect breasts, a blogger’s body or celebrity with deep pockets; they’re everyday people investing in their health, wellbeing - and aligning how they look on the outside, with how they feel on the inside. This video provides an insight into the spectrum of procedures Dr Sharp performs every week. Happy New Year to all of our amazing patients, and thank you for making us part of your journey in 2017!...

The Aston Baker Cutting Edge 2017 Highlights

The Aston Baker Cutting Edge Aesthetic Surgery Symposium has been running for 37 years and brings together some of the world’s leading aesthetic plastic surgeons. This year, Dr Sharp and practice director Liz Washington joined hundreds of plastic surgeons and their clinic teams to learn more about the innovative techniques for facial and body rejuvenation. The program featured 94 instructive surgical videos, 26 presentations, 13 expert panels and 8 debates. Dr Sharp loves being abreast of the latest advancements in plastic and cosmetic surgery, and these forums provide a valuable opportunity to hear about the techniques, trials, anecdotal experiences and standards from across the world. The overall message from the symposium was: aesthetic surgery has changed, and the over-stretched, over-enhanced, over-done look is a thing of the past. Progressive surgeons are working together to develop new techniques to approach cosmetic surgery to achieve a more balanced, proportionate and natural look than ever before. We thought some of our patients may be curious to hear more about the ideas discussed, so in these videos, Liz briefly covers some of the symposium topics that often arise in our discussions with patients. Fat grafting Fat grafting has been used for reconstructive purposes for many decades, but its use for rejuvenation and enhancement is still a relatively new concept, and something that surgeons are still experimenting with to perfect and hone the right technique for different areas of the body. We saw some exciting results from the panel, and of particular interest was ‘micro’ and ‘nano’ fat grafting for facial rejuvenation, which is providing not just volume replacement, but also dermal rejuvenation. The faculty also addressed the...

The Difference Between Saline and Silicone Breast Implants

Breast augmentation surgery increases the volume of the breast for women with naturally small breasts, as well as replacing depleted volume following breastfeeding or weight loss. It can also be used to change the breast shape for women who have developmental and chest wall deformities, such as tubular breasts or asymmetry. We often get asked about the difference between saline and silicone implants, and their risks and benefits. The ‘shell’ of a breast implant is made from an inert polymer called silicone; this can be either smooth or textured. Smooth walled implants move around subtly in the breast pocket, which means they can mimic the movement of a natural breast - and textured implants encourage soft tissue ingrowth into their small surface interstices, keeping the implant more stiffly in place. Breast implants have a variety of base widths, projection amounts and volumes (measure in ‘cc’). There’s no one size fits all approach to breast augmentation; the best implant for each breast is thoughtfully selected and matched to the corresponding space to achieve the specific goals for each patient; indeed, sometimes two different implants will be selected for one patient, as each breast can be different.   What are breast implants filled with? Silicone gel breast implants Silicone gel is an inert polymer with no known human allergies, sensitivities or reactions. Likened to the consistency of turkish delight or gummy bear sweets, the molecules are stuck to one another in a cohesive matrix. In comparison to saline, it flows differently within its shell and can often create a more natural look and feel to the breast, like breast tissue, while...

BIA-ALCL breast implant associated cancer update – August 2017

Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL) is a very rare cancer that can be effectively treated, when detected early. Recent media reports may have caused confusion amongst women who have - or are considering getting - breast implants for augmentation or reconstruction. This post seeks to clarify what we know about BIA-ALCL. Last year 1.5 million implants were inserted worldwide. The number of people having breast implant surgery in Australia has risen by more than 1,000% since 2005, from approximately 4,000 per year - to over 40,000. More people have implants now than ever before, and so we would expect the number of people reporting complications now to be proportionally higher than what they were 5, 10 or 20 years ago. The TGA has been posting updated information about BIA-ALCL since 2011. As of August 2017, we haven’t seen one case of BIA-ALCL in our clinic, nor amongst our patients. What is BIA-ALCL? It is a cancer of lymphatic cells; a form of Non-Hodgkin’s Lymphoma (not breast cancer). What causes BIA-ALCL? Media focus has concentrated predominantly on implants, but there’s actually 4 unifying factors that contribute to an increased risk of BIA-ALCL: • Textured implants with a high surface area texture • Bacterial contamination at the time of surgery • Patient genetic predisposition • Time for the process to develop How long does BIA-ALCL take to develop? An average of 7-10 years after implant insertion. But women who have breast implants should regularly check their breasts for changes at any stage after breast augmentation surgery - most of all for actual breast cancer, which occurs in 1 in 8 women,...

Researchers reveal the ‘ideal’ breast

Size doesn’t matter, but shape does. Beautiful breasts come in all shapes and sizes, but there is an undeniable, natural tenancy for the human eye - and brain - to register certain proportions as more ideal than others. Scientists now claim to know exactly which breast type the human eye prefers, and apparently it is not only about size. Conducted by British researchers, the population analysis was published in the Plastic and Reconstructive Surgery journal, with the aim to shed light on the size and shape objectives for breast reconstruction surgery after mastectomies and breast augmentations. Researchers found a preference for shapely, perkier breasts - instead of the larger kind.  Of the 1,315 respondents asked to rank the attractiveness of images of four women with varying breast proportions, 87% of women, 90% of men and 94% of plastic surgeons scored breasts with an upper pole–to–lower pole ratio of 45:55 as the aesthetic ideal. The ‘upper’ pole of a breast sits above the areola/nipple complex - with the ‘lower’ pole sitting below. The study confirmed previous research that found the 45:55 ratio had universal appeal in defining the ideal breast. Breast shape and size can vary significantly during a woman’s lifetime as they go through puberty, gain or lose weight, have children, breastfeed, age or fight cancer. The purpose of the study was to define aesthetic ideals and goals, particularly for breast reconstruction following mastectomy surgery, as well as the (increasingly popular) breast augmentation and breast lift/reduction procedures. Modern advancements in breast surgery, including the availability of various flap and implant reconstructions, acellular dermal matrix for inframammary support, a wider range of breast implant profiles and the...

Breast implants: how young is too young for breast augmentation surgery?

Despite the fact that most breast augmentation patients are aged 30-plus, we still receive a lot of interest in this procedure from young women and sometimes teens. During 2015 in the United States, 279,143 women had a breast augmentation procedure - of these, 7,840 were girls and young women aged 13 to 19 years old, with an additional 1,797 teens receiving breast lifts. Although Australian data isn’t available, interest in breast augmentation surgery amongst adolescent females is thought to be associated with increased social media pressure and easier access to cut-price surgery, which places procedures that were once cost-prohibitive, within closer reach of younger people. When considering breast augmentation, Dr Sharp asks young women to think about the following questions: Have your breasts stopped developing? Your breast size should have remained unchanged for 12 months prior to surgery - this can happen anytime up until your early 20’s. Do you have a lack of breast development - or are they a proportionate size for your body, but you’d like them to be bigger? What factors are driving you to have the procedure; is it your own perception of your breasts - or your boyfriend seems to prefer large-breasted women, or your friends have commented about your breast size? How long ago did you start considering plastic surgery? What’s your ideal shape and breast size; what do you hope your body shape looks like in 5, 10 or 20 years? What will happen if you need revisional surgery in the near future? Who will fund this, and will you have private health insurance to cover some of your costs? What are the risks...

What is a dermal matrix and how is it being used in breast surgery?

What is an allograft? Allograft is an organ or tissue donated from one individual to another. What is an acellular dermal matrix? It is an allograft made from donated human dermis (skin). An acellular dermal matrix (ADM) is a soft tissue substitute that can replace or support tissues; in plastic surgery they are increasingly being used for breast implant revision and breast reconstruction surgery. Derived from donated human skin, it looks like a thin layer of white leather. The matrix undergoes a number of processes to remove the epidermis, sterilise the matrix and reduce the likelihood of a rejection response. How does Dr Sharp use ADM? Dr Sharp uses the latest generation of ADM, developed specifically for restorative breast surgery. It provides lower-pole support for women having an implant placed in their breast that may require additional tissue to support the lower portion of the implant - for example, in breast reconstructions or breast implant revision surgery. The mesh is attached to the pectoralis muscle in the chest – increasing the size of the pocket in which the implant is placed - acting as a hammock, cradling the breast implant and helping to create a more natural breast contour. The use of an acellular dermal matrix offers a number of advantages as it provides structural support for the breast, acts as tissue matrix for the body’s own tissue ingrowth, produces consistent results and is available in multiple sizes to meet the needs of each patient’s surgery. How is ADM used in breast implant surgery? ADM can be used as a support ‘sling’ for the breast implant, where natural tissue is lacking or deficient. This is increasingly...