As a plastic surgeon with an active practice in body contouring, it is very clear to me that one size does not fit all. Many women seek consultation for removal of excess breast tissue, as do more and more men, and many women are desirous of breast augmentation. In the buttock area, my practice is divided between those who seek reduction of excess tissue and people who desire augmentation, typically with fat or implants. Breast reduction surgery in women has a significant functional component as well as being a cosmetic procedure. I will review this topic in greater depth in my next column. For the other topics, let’s begin.
Breast reduction surgery in men, or excision of gynecomastia (Latin for “women-like breasts”), is one of the most common procedures that men undergo. For men with excess breast tissue, often the extra skin needs to be excised and while we try to hide the scars under the areolar area, this can lead to more visible scars on the chest after surgery. With the advancement of techniques such as tumescent liposuction (a type of local anesthesia in which the medication and fluid are injected in the treated area) and combined laser and liposuction procedures such as SmartLipo, we can achieve equal or better results with less extensive scars. In particular, the capability of SmartLipo to help contract the skin after liposuction (an effect of the laser used to great advantage in resurfacing procedures), has been particularly helpful in the treatment of gynecomastia. The decrease in downtime following surgery is also important for many men.
Breast augmentation in women is commonly performed using silicone gel implants, placed through an incision just under the breast, on the bottom of the areolar complex, through an underarm incision, and for saline implants, even through an umbilical incision. Breast implants consist of a soft silicone outer shell and are filled with silicone gel or saline. After extensive studies over 12 years, the Federal Drug Administration in 2006 approved two silicone gel-filled implants for use in cosmetic augmentation. The basis of the FDA’s decision was a series of studies done over those years. Since then, many women have chosen silicone gel implants for their augmentation. Despite the widespread acceptance and use of these devices, the FDA continues to monitor their safety, and, in their post-approval study plan, to enroll and follow more than 40,000 silicone gel-filled breast implant patients.
Through the studies, most women reported high levels of satisfaction with their body image and the shape, feel and size of their implants. Answering the initial question that led to the moratorium a decade earlier, there is no apparent connection between connective tissue diseases and silicone gel-filled breast implants. Further, there is no evidence connecting implants with an increased risk of cancer, no effect on pregnancy or fertility and no problem with breast-feeding. Based on the totality of currently available evidence, the FDA believes that “silicone gel-filled breast implants have a reasonable assurance of safety and effectiveness when use as labeled,” and that an MRI continues to be the most effective method of detecting silent (asymptomatic) ruptures of silicone gel-filled breast implants.
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