By the way that many “cosmetic surgeons” have recently been touting the use of fat grafting to augment breasts, one might think we have blindly wondered into Shangri La!

“No silicone!”

“No implants!”

“No risk!”

But the reality is “No science!”

The existing scientific evidence to support the long-term safety and efficacy of fat grafting the breast is shockingly wanting. While some nicely done studies have been done to support short-term results, the cosmetic surgery community has rushed to implementing this procedure into their practices way before the appropriately designed and completed scientific studies have been done. Many of the existing studies have been done only with laboratory, non-mammalian animal models.

Well-done studies on human subjects are ongoing but it will take years and years to be able to follow these patients long term and establish the legitimacy of the fat transfer breast augmentation. Some of the longer-term studies have been done outside the United States and have yet to be replicated by our own board certified plastic surgery community. Also, the majority of quality studies existing relate to reconstructive breast patients (i.e., breast cancer reconstruction patients) and not to cosmetic elective surgery patients, where the majority of procedures seem to be occurring.

So, what are the risks? Why be concerned?

While many of the early skeptics rightly pointed to the possibility of breast fat injections causing difficult-to-read mammograms, most well done studies show that these concerns are probably unfounded. Radiologists seem to have little difficulty reading mammograms in patients having undergone fat grafting to the breasts.

We do know that fat grafting of the breast has limits and that multiple lengthy surgeries may be required to achieve significant breast enlargement as opposed to a single surgery for breast augmentation with an implant.

The bigger concerns center around whether fat grafting to the breast can possibly be associated with a higher risk of developing breast cancer or even accelerating the growth of a previously undetected breast cancer. Recent rodent model studies seem to prove this to be true, while one international human model study did not show this problem. The concern likely has to do with the ever-popular notion of stem cells.

Stem cells are being recognized as possibly having rejuvenatory properties on human skin. For instance, plastic surgeons who perform fat grafting to the face, as an alternative to a facelift, have noted that the overlying skin seems to look younger and fresher post-operatively. These clinicians are convinced, and may be correct, that stem cells are responsible for this phenomenon. And stem cells have been proven to be in the fat used during fat grafting procedures. So, if these fat grafting procedures are transferring rejuvenatory cells into the areas being grafted, what effect might these same stem cells have on breast tissue which has an extremely high risk of cancerous degeneration already? If a stem cell can “rev up” your skin, will it also “rev up” a breast cancer?

My personal philosophy for fat grafting of the breast is one of patient safety first. Until we have more science to show the long-term safety of this procedure for my Atlanta area plastic surgery patients, I will not offer it or any other poorly understood procedure for a female organ that is already cancer prone. While I do hope that well-done long-term studies show this to be a good and safe option for patients, I do not encourage patients to opt for this procedure at present. Avoid the search for Shangri La. The bite may well be worse that it’s bark!

If you are interested in breast surgery and would like to learn more about a options available for you, contact my Atlanta area practice today to schedule a consultation with me, a Board Certified Plastic Surgeon.

Breast implants have evolved significantly since their inception in Texas in the 1960’s.  From the original Dow Corning silicone filled implant, the stages of development of the breast implant have involved a variety of different implant shell materials and filler substances within the shells.  Some of the new developments have been significant advancements while others have been improvements on a smaller scale or even an occasional poor design change.

The current design of breast implants is a significant improvement on the original implant design.  The current silicone implant was introduced in the 1990’s, even before the voluntary silicone moratorium.  Since the FDA re-approved silicone implants in 2006 this implant has become the dominant implant device placed in the United States by an overwhelming margin.  Depending on whether the original Cronin and Gerow implants are considered a true generation of design, the current design is either the third of fourth generation of silicone implant.

Why does that matter?  It doesn’t – just semantics fore the layperson.  What is important is that a new generation of silicone implants exists and has been in limited trial use for the last several years.  A great deal of data has been collected on this new design and the FDA continues to evaluate the data in consideration of its approval.  This new generation has often been referred to as a “gummy bear” implant due to its firmer feel.  It is also known as the highly cohesive gel implant.  Allergan’s version is the “410” line of implants while Mentor’s design is known as the “CPG”.  The silicone polymer in this new design is highly cross-linked which creates more of a solid gel than the existing cohesive gel device.  The actual chemicals within the gel are identical to current designs.

The new generations implant hopes to provide additional options for breast augmentation patients and for breast reconstruction as well.  The primary advantage may be the ability to create more upper pole fullness, as the gel will not collapse with gravity dependence.  There may also be more peace of mind for the patient who worries that a rupture silicone implant may leach into surrounding tissues.  Plastic surgeons look forward to the FDA’s decision on this design.

To learn more about breast enhancement procedures that are currently FDA approved, contact my office today to schedule a consultation.

Dr. Howard was invited along with a select small group of board certified plastic surgeons across the country to attend an annual training and educational seminar in Dallas, Texas.  The Mentor Masters Series showcased new innovations and technology in aesthetic medicine, specifically toward breast augmentation and liposuction body contouring.  Dr. Howard participated in the two-day event learning about new frontiers in aesthetic surgery. Remaining on the cutting edge of plastic surgery had always been one of the main tenants of Dr. Howard’s practice credo and he relishes the opportunity to explore new innovations in the field of plastic surgery.

Mentor Corporation is one of two worldwide dominant breast implant manufacturers along with Allergan, Inc.  Mentor’s production plant is in the US and Dr. Howard along with the invited physicians was able to get a personal tour of the manufacturing facility.  Seeing the actual process and being able to ask detailed questions about the production process added new depth to his understanding of the devices which make up a large part of his practice.  And, as a fun side opportunity, Dr. Howard was able to make his own personalized breast implant with his business card inside!

 Dr. Howard heard presentations on collected breast augmentation data spanning 15 years of experience from one institution.  This data critically evaluated the safety and risks of the procedure of implantation.  The data was consistent with current knowledge that the procedure is safe, and in fact the revision rate for complications stemming from the implant itself is much lower than previously thought.  Also discussed was cutting edge information on the cause and prevention of capsular contracture.  Capsular contracture is the number one reason that breast augmentation patients require additional surgeries related to the breast implants.

 Ensuring that our Atlanta plastic and cosmetic surgery practice offers the latest and safest methods available to our patients is paramount to our delivery of care.  Educational opportunities such as this are a huge component in that process.  Thanks Mentor!

To learn more about breast augmentation, breast lift, or breast reduction, contact Dr. Brian Howard’s office today.

The media has recently focused on breast augmentations being done with the patient awake, although sedated, and “giving their input” as to what size breast implants they want.   From local sound bites to the New York Times, the concept has gained attention in the press.  Sounds great, right?  Until you really think about it!  Making decisions as crucial as this takes a fully awake, alert, and keenly conscious person – and even in these conditions many patients fret over what size they ultimately want to be.  We cannot legally get a surgical informed consent from a sedated patient; so how can we expect to let a patient select a breast implant size when in an altered state of mind?  Isn’t that akin to letting her make the decision while “drunk?”  Is it even legal?  I’m not sure, but I am not an attorney.  The decision of what breast implant size will be implanted is one that should be made preoperatively – either by getting patient input in the physician’s office while in a clear state of mind (my preference) or by the patient agreeing that she will let the surgeon use their expertise to make that decision during surgery.  How many patients have I seen that have gotten tattoos while out drinking with their buddies – only to come and see me afterward to have them removed after they sobered up?  Too many!

 To be clear, I am a huge proponent of doing surgical procedures under local anesthesia and this makes up a large portion of my practice.  It is one of the reasons many patients seek out my services, in fact.  If a procedure can be performed under local anesthesia with the same results, no unduly patient discomfort, and with at least the same degree of safety for the patient then it is a fantastic option for the patient.  All crucial decisions are made with the patient preoperatively, before any sedation is delivered, so there is no room for “drunk decisions” to be made.

 But sedating patients and then asking for their input on the operation to be performed with the final results at stake is bad medicine and should be avoided. For more information on breast augmenation please contact my office today, to schedule a consultation.

Silicone get breast implants have evolved significantly since their early use in the 1960’s. Advanced technology and decades of experience have allowed monumental improvements in manufacturing, safety profile, and decreased complication rates from breast enlargement with silicone implants. New silicone implants are no longer liquid silicone, so risks to patients should an implant rupture are minimized. Newer silicone implants still under study are actually a semi-solid, and have earned the nickname “gummy bear implants.” These implants have not been FDA approved yet but are available on a special study basis only. Breast augmentation continues to be one of the top two procedures performed in the USA by board certified plastic surgeons.

The Fall rush has begun! Each year we see a huge Autumn demand for breast augmentation in our practice and are happy to accommodate this time frame for our new patients! In fact, we usually offer a Fall pricing special to make it easier for our women to make that final decision. Call Kerry at our office to see if there is a Fall pricing special this year for breast enlargement or any other cosmetic procedure. Happy Fall!

As Moms prepare to get their kids ready for the new school year, they are also beginning planning to treat themselves for a change. Breast enlargement or breast augmentation is always in high demand beginning in September, and our schedule is quickly filling up. If you have been thinking about and want to learn whether you are a good candidate for breast augmentation, make an appointment to see Dr. Brian Howard at 770-619-9566.

Cohesive Gel Silicone breast implants, also known as Gummy Bear Implants, were invented in the early 1990s and have been used throughout the world for over 10 years. We have yet to approve these devices in the United States although studies are underway. In order to be approved, the FDA requires that a prospective large-scale study be done in the United States, adhering to their rigorous guidelines and scrutiny. It is only by enrolling in this current study that these implants are available in the United States. The implants were originally designed to both create a longer- lasting implant and to maintain a more predictable shape. By making the gel thicker or more cohesive the implants are more solid than other silicone gel implants. It is for this reason they are sometimes referred to as “gummy bear implants.” The final approval for these implants is unknown at this time.

What do you think about breast enlargement? It helps many women find true body confidence, and in fact more than 350,000 women will opt for breast augmentation this year alone. Most women have particular body areas that they would love to see improved in some fashion to “put the whole package together.” Many rely on simple fashion tricks to mask those areas. But small breasts are difficult, at best, to disguise. In today’s world, many women opt for cosmetic breast enhancement to achieve their self-transformation.

Breast augmentation is extremely popular for women and one of the most commonly performed surgery procedures in my practice. An implant is most commonly inserted either under the crease in the breast or around the nipple. The implant can be placed under the breast tissue or more commonly beneath the pectoralis muscle. After surgery, breasts will appear more full and shapely. Call the office to find out more specifics and see if you are a good candidate for this procedure!