Breast Surgery Archives - Weinstein Plastic Surgery Center

Archive for September, 2011

The Best Candidates for Breast Augmentation

Breast augmentation can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Weinstein.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

Breast augmentation is usually done to balance a difference in breast size, to improve body contour, or as a reconstructive technique following surgery.

Rare tumor easily treated associated with breast implants.

“Risk of this new cancer about equal to being struck by lightening.”

However, this is yet another reason, as rare as it is, that breast implants are not recommended for women under 18 and silicone implants for women under 21.

The FDA says breast implants may be linked to rare form of lymphomatous cancer.

ABC World News (1/26, story 7, 2:10, Sawyer) reported, “An important health warning tonight from the FDA about a possible link between breast implants and a rare form of cancer.” ABC (Stark) added, “The government says they may be linked to a rare form of lymphoma. … There are 60 cases worldwide, in as many 10-million women with implants.”

The Washington Post (1/27, Stein) reports that the FDA on Wednesday announced it had “detected a possible association between saline and silicone gel-filled breast implants and anaplastic large cell lymphoma (ALCL)” The agency said most women with implants “do not have to have them removed or take any other steps,” but they should “immediately seek medical care” if they develop “unusual problems,” such as “swelling or pain around the implant.”

According to the AP (1/27), the FDA based its warning on a review of “scientific literature going back to 1997 along with information provided by international governments and manufacturers.” Most of the cases were “reported after patients sought medical care” for problems “around the surgical site.”

The Wall Street Journal (1/27, Dooren, Mundy, subscription required) reports, FDA has identified 60 ALCL cases in women who had breast implants, of which 34 cases have thus far been verified, according to a statement released by the agency. HealthDay (1/26, Reinberg) noted that 24 of the cases were “related to silicone implants, seven to saline implants and the type of implant in the remaining three cases are not known,” according to the FDA. The agency also said that “19 of the implants were inserted for cosmetic reasons and 11 were used in reconstructive procedures. The reasons for the other four procedures are not known.”

The New York Times (1/27, A18, Grady) reports that in some cases, simply “removing the implant and scar tissue gets rid of the disease, but some women might need chemotherapy and radiation,” said Center for Devices and Radiological Health Deputy Director Dr. William Maisel. He noted that although 60 cases is “a tiny number compared” with the number of women who have implants, it is an excess when “compared with the usual incidence.” ALCL in the breast is “normally found in only three in 100-million women who do not have implants.”

Bloomberg News (1/27, Larkin) says, “Allergan Inc. and Johnson & Johnson” breast implants were linked to ALCL by US investigators. Allergan, the “maker of Natrelle gel and saline breast implants,” and J&J’s “Mentor division each control about half the market for breast implants.” Dr. Maisel told Bloomberg News that the agency is “working with manufacturers to revise their product labeling and plans to release an analysis of company-sponsored studies ‘later this spring.'”

According to MedPage Today (1/26, Bankhead), Allergan released a statement, saying “company officials support the FDA recommendations” and advising all physicians to “remain diligent in their monitoring” for ALCL symptoms. A statement from the J&J Mentor division says the “company concurs with the FDA’s position that the body of evidence supports the safety and efficacy of approved implants when used as labeled.”

The Boston Globe (1/27, Kotz), the Louisville (KY) Courier-Journal (1/27, Carter), Medscape (1/26, Lowes), WebMD (1/26, DeNoon), the Time (1/27, Melnick) “Healthland” blog, and CNN (1/27, Young) in its “The Chart” blog also covered FDA’s warning regarding ALCL in women with breast implants.

Breast Reconstruction should be discussed
when Breast Cancer Diagnosed

Recently New York State has mandated a discussion of options for patients with Breast Cancer. Since my training at Sloan Kettering in New York I could not conceive of a woman not being offered the options of breast reconstruction when told of their diagnosis. A New York Times excerpt follows.

Before Breast Is Removed, a Discussion on Options
Published: August 18, 2010

After her mastectomy in April, Alantheia Pena cried for the loss of her breast. Her partner told her not to worry about the flat spot on her chest, but she could tell it bothered him when he looked away as she took off her shirt.

It was a kindly secretary at the place where she went to get her prosthesis, an artificial breast to fill out her clothing, who noticed her crying and told her that she could have her breast reconstructed, with health insurance covering the cost. Ms. Pena said her cancer surgeon had not told her.

Now a state law signed on Sunday by Gov. David A. Paterson will require New York hospitals and doctors to discuss the options for breast reconstruction with their patients before performing cancer surgery, to give them information about insurance coverage and to refer them to another hospital, if necessary, for the reconstructive surgery.

The law came about largely through the efforts a plastic surgeon at Montefiore Medical Center in the Bronx who gave Ms. Pena, who will turn 48 next week, a new breast, which made her so happy she wore a bikini last month for the first time in her life.

“It gave me back my life, Ms. Pena, who runs the H.I.V. ministry at Friendship Baptist Church in Brooklyn and lives in the Bronx, said on Wednesday. “It’s like my own breast. It’s beautiful. It’s perfect. It’s a perfect breast.

Dr. Garfein, who specializes in reconstructive surgery after breast, head and neck cancer, said he had pushed for the law after a friend of his, Dr. Caprice Christian Greenberg, co-wrote a paper showing that poor, minority women were much less likely to receive breast reconstruction after cancer than more affluent women.

Congress guaranteed universal coverage for breast reconstruction after cancer surgery in 1998. Only 30 percent to 40 percent of the women who had mastectomies now received breast reconstruction.

The number would be closer to 75 percent if more women were informed of their options. Ms. Pena, had her surgery at North General Hospital in Harlem, which is defunct, but she said her doctor there had never discussed breast reconstruction with her.

One reason for the low rate of reconstruction, Dr. Garfein said, may be the lack of plastic surgeons outside of large academic medical centers, and another may be financial.

Ms. Pena is still recovering from cancer, but with her new breast, she said, “at the end of it, you see some kind of rainbow.

Available every week to fit in breast reconstruction consults to discuss options. Larry Weinstein MD FACS

Silicone gel implants prefered over saline – the people speak

Patient Satisfaction and Health-Related Quality of Life Following Breast Reconstruction: A Comparison of Patient-Reported Outcomes Amongst Saline and Silicone Implant Recipients
Macadam, Sheina A. MS; Ho, Adelyn L. MD; Cook, E F. Jr SD; Lennox, Peter A. MD; Pusic, Andrea L. MHS
Published Ahead-of-Print


Background: In recent years, there has been a growing acceptance of the value of breast reconstruction. The majority of women who choose to proceed will undergo alloplastic reconstruction. The primary objective of this study was to determine if the type of implant used in alloplastic breast reconstruction has an impact upon patient-reported satisfaction and quality of life.

Methods: Patients were deemed eligible if they had completed alloplastic reconstruction at least one year prior to study initiation. Patients were contacted by mail: two questionnaires (BREAST-Q(C) and EORTC QLQC30 (Br23)(C)), a contact letter, and an incentive gift-card were included. Scores were compared between silicone and saline implant recipients.

Results: 75 silicone implant recipients and 68 saline implant recipients responded for a response rate of 58%. BREAST-Q(C) responses showed silicone implant recipients to have higher scores on all 9 subscales. This difference reached statistical significance on 4 of 9 subscales: overall satisfaction (p=0.008), psychological well-being (p=0.032), sexual well-being (p=0.05), and satisfaction with surgeon (p=0.019). Regression analysis adjusted for follow-up time, timing of surgery, unilateral vs. bilateral surgery, radiation and age. Results from the EORTC QLQC30 (Br23)(C) showed a statistically significant difference on 2 of 22 subscales: silicone recipients had higher overall physical function and saline recipients had higher systemic side effects.

Conclusions: This study has shown higher satisfaction with breast reconstruction in silicone gel implant recipients compared to saline recipients using the BREAST-Q(C). There was no difference in overall global health status between the two patient groups as measured by the EORTC-QLQC30(C).

(C)2009American Society of Plastic Surgeons.

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