Tag Archives: breast augmentation

Permalink to Surprise! Heidi Montag Breast Implants Removal

Surprise! Heidi Montag Breast Implants Removal

Top Heavy Heidi

Top Heavy Heidi Montag

In May of 2010 I blogged about the giant mistake that was reality star Heidi Montag’s choice to have breast implants that were far too large for her frame.  She had 800 cc implants and wanted to go outside the U.S. to get 1000 cc breast implants which are illegal in this country. Well, I hate to say “I told you so,” but I told you so! In a recent interview with ET’s Brook Anderson, she said, “…My new doctor was like, ‘You should never have been allowed by the doctor to get implants this big. … I put my security and sexuality in my breast size instead of my confidence.”

Back in 2010 when she first had the implants placed, I blogged that she would likely suffer from health issues such as back problems, etc., from simply having too small a frame to support those huge implants. Well, surprise, it only took 3 years before she couldn’t handle the “major health problems, including a ruptured disc in her neck, muscular and spinal damage to her back, and numbness in her arm due to pinched nerves.”

This is yet again another reason you must be very careful about choosing a plastic surgeon. I would have never put those implants in her because I know (and knew) exactly what was going to happen.

Permalink to Breasts, Fat, Wired & Cytori

Breasts, Fat, Wired & Cytori

Breast augmenation fat graftingI love Wired magazine. It gives me a window onto the high-tech electronics world, that being in a biologically based profession I might otherwise be disconnected with. So it’s rather exciting when they feature a story about something that I actually do know something about. And when it’s a cover story, well, that’s even better! So I was definitely interested in reading their most recent cover story “Natural Breasts.” Of course, for the magazine it’s a great title because it allows for the rationale to make the cover photo a close-up of a woman’s cleavage which is probably good for a little spike in sales to their predominantly male (and perhaps nerdy) readership.

What is Wired referring to when they refer to “natural breasts?” The story talks about the renewed interest in fat grafting as an option for breast augmentation. Fat grafting for breast augmentation means plumping up a woman’s breasts with her own fat that is transferred from another part of her body rather than using silicone or saline breast implants. Just the other day I posted a press release that highlighted a recent study I took part in that showed the VASER liposuction system is ideal for this very purpose. Essentially, the story is the tale of a bio-tech start-up company called Cytori. This company is getting into the tissue engineering business via stem cells harvested from fat and are doing so by starting with breast augmentation.

Why breasts? Theoretically they are simple to build since they consist of only one type of tissue which is fat. Nobody’s talking about actually building mammary glands that secrete milk. It’s all about form and not function. Attempts were made beginning in 1980s to do augmentation with fat. They had mixed results, mostly due to the fat not surviving and just being absorbed by the body. There were many different techniques and many different technologies applied.

This new story begins with a UCLA plastic surgeon Mark Hedrick who wondered if fat had stem cells. In fact it does. Approximate one stem cell per 100 fat cells versus one per 250,000 to 400,000 in bone marrow. Stem cells are the darlings of cell biology. Theoretically they can be used to make any tissue. They also release substances which improve healing and regeneration. Cytori reasoned that if you separated stem cells from the fat, purify them and added them as a concentrated extract to more fat than the combined stem cell plus fat graft would take better. They ran two successful trials in Japan. One on reconstructing partial mastectomy another on breast augmentation. I actually have the opportunity to hear the investigator Dr. Karushima present his work. He successfully implanted approximately 100 mL per breast for an increase of 1.6 cupsizes his Japanese patients.

The rest of the article talks about the potential for these stem cells including heart and other organs. So is this the next big thing? Well it certainly could be for the hard if their studies continue to pan out.

Why isn’t this a done deal? There are many questions with respect to breast augmentation with fat grafting. The following are just a few:

  1. The results are not significantly different than non-stem cell fat grafting to the breast. I’ve done in the past on selected patients with good results. Dr. Coleman in New York and Dr. Khouri in Florida have achieved excellent results without stem cells. To date I don’t know of any study comparing stem cell fat grafting with non-stem cell fat grafting.
  2. Caution needs to be used for the mastectomy reconstructions. In animal studies stem cells can potentiate cancer growth. Now there has already been a lot of work with fat grafting to breast cancer reconstruction. No problems have been reported. However is there a critical mass of stem cells that might cause a cancer recurrence?
  3. What are the comparative costs going to be? Taking time to remove enough that can be a long procedure, adding to anesthesia expenses and increasing patient risk. As long as we’re taking out these cells and manipulating them why not have an ideal scenario where you take out 10 CC a fat in the office under local and grow to 1000 CC in the lab and then inject?
  4. Who will be doing this? Anybody they can buy cytoris stem cell machine? Building a breast is an art as well as a science we’ve already seen the problems when non-core physicians, that is, family practitioners and gynecologists get into the plastic surgery profession.
  5. There is currently a limit on how much fat can be put in. This is related to the skin tightness and pressure which kills fat grafts themselves when too much is put in. Dr. Khouri has solved this problem for now with skin expansion using the Brava bra but this is time-consuming and burdensome. If the cells are augmented with the Cytori stem cell technique can this be avoided?

So are stem cells really the answer to natural breast augmentation? Cytori is certainly betting a lot of money that it is. Hopefully their studies will show that stem cells and fat grafts will create an easy breast augmentation with minimal downtime and no future complications that is superior to current techniques. If not someone else will eventually come up with the answer. Tissue engineering is already here. It’s just not perfected. So stay tuned it’s going to be a wild ride!

Permalink to Celebrity Plastic Surgery – The Collective Obsession With Youthful Perfection

Celebrity Plastic Surgery – The Collective Obsession With Youthful Perfection

Lisa Rinna Lips

Lisa Rinna Recently Had Her Lip Augmentation Reduced.

Plastic surgery is a part of celebrity culture today. From reality stars like Heidi Montag, Kim Kardashian, Pamela Anderson, and “The Real Housewives of…” to comedians like Joan Rivers and Kathy Griffin, to actors like Lisa Rinna, Nicole Kidman, Meg Ryan, Micky Rourke and of course stage performers like Cher and Kenny Rogers. All of these celebrities and hundreds more like them appear to have had cosmetic work done, and most, save Kim Kardashian and Cher, seem to have gone too far and pushed the limits of what plastic surgery is capable of.

The force behind this Hollywood celebrity trend to use plastic surgery beyond what is rational is a collective obsession with youthful perfection. That is, in American culture, youth is romanticized and physical perfection is idealized. The problem is that we are only young for a brief time in reality. Indeed, this evanescent quality is probably an ingredient of the fuel feeding this obsession. Combine this with the fact that very few, if any of us, are genetically perfect and you end up with a majority of the country somewhat unsatisfied with their appearance. Add to the fire, the pressure celebrities are under to be examples of perfection to those who consume their movies, TV shows, and music videos and you can imagine the desperate feelings these people have to hold on to this image of perfection or lose their celebrity status.

Further complicating the mix is that the personalities who go into that line of work tend to already enjoy some degree of narcissism with their coffee and you have a perfect storm. Nowhere do we see example after example of drastic measures taken by desperate souls to enhance or hold onto any shred of perfect youth that medical science might be able to offer. Likewise, nowhere else do we see so many sad cases of the fuel of this collective obsession with youthful perfection igniting the fire that ends in plastic surgery disasters.

As a plastic surgeon who believes very much that plastic surgery, and other cosmetic procedures such as Botox and facial fillers, can improve a person’s appearance and make them feel more confident, I cringe when I see the next star to step onto the red carpet with lips the size of sausages or faces pulled so tight they look like, as a friend of mine recently described, “a screaming skull.” Likewise, it sickens me to see a breast augmentation disaster such as putting 700cc breast implants in a petite woman of 5 foot 2 inches as was done to Heidi Montag, so she ends up making Barbie look comparatively proportional! These cases are not medical science being used to improve lives, they are a shameful mockery of the fine art of plastic surgery.

The most difficult thing for me to get my head around is the process by which a trained doctor goes through with these surgeries. If he or she is even remotely educated in plastic surgery, or even the pretend plastic surgeons who call themselves, “cosmetic surgeons,” these doctors have to know how awful these results are going to be before they even put the patient to sleep. As a plastic surgeon, my job is to improve on nature while balancing these improvements with aesthetic principles of balance, physical limits, and genetic realities. And a reality of being a plastic surgeon is knowing that some patients will come in with unrealistic expectations. I regularly have to sit down and explain in no uncertain terms, that there is such a thing as “too big” when it comes to breast implant size. It is very common for small framed women who have A-cup breasts to request breast implants that are simply going to make her look very top-heavy, cause stress damage to the skin, and create discomfort to the point that she will need to have them removed. When I explain the physical limits and the reality, most women normally understand and opt for smaller implants. In cases where they are still unconvinced and determined to have the larger implants, I apologize and tell them that as an ethical plastic surgeon, I cannot perform the surgery with the implants requested and we go our separate ways. And yes, occasionally they come back to me to have their “too large” implants removed.

I can feel for these plastic surgeons who have celebrities for patients. I can imagine they hear a lot of desperate stories about needing “that edge” in order to stay relevant in the fast paced world that is Hollywood, where one day you may be the toast of the town and the next you are wondering why you can’t even get an infomercial job. I realize there is tremendous pressure to push the limits because if you don’t someone else will. At the same time, we are doctors first and we have to do what is right by the patient, even if the patient is demanding what is wrong. We know that lips that look like two sausages painted red will look like hell, we know that 700cc implants can not be sustained in a petite woman of 5 foot 2 inches, we know that if you stretch the face back too far you will create a lizard mouth. We know this because it is what we do. Just as an engineer knows what you can and can’t do if you want a bridge to stay standing, a plane to stay in the sky or a computer to crunch ones and zeros and end up with me being able to type this article.

One thing I always stress with my patients is that when all is said and done, a stranger should never be able to look at you and “know” you’ve had plastic surgery. Whether it is breast augmentation, lip augmentation, a tummy tuck or a facelift, all should be subtle enough to look perfectly natural. Sure, if you go from an A-cup to a C-cup overnight, your friends might notice, but to the world, you should just look shapely, balanced and aesthetically pleasing to the eye, not like a freak of nature. Similarly, a facelift should simply take 10 to 15 years off your face, not make you look like a new person. You should look like pictures of yourself from the past. If you look at Joan Rivers now and Joan Rivers from 15 years ago, it is like they are two different people. On the other hand, if you look at Cher now and Cher 15 years ago, she looks the same! That’s plastic surgery done right!

The collective obsession with youthful perfection will probably be a part of the American cultural reality for the foreseeable future. Perhaps, just being a little more aware of it and reminding ourselves and our children to actively work toward being less influenced by it and more happy with our own realities is the answer. Sure, a good plastic surgeon can improve on nature a bit, fix some of the effects of time and make your day-to-day life a little happier because you smile more when you look in the mirror. But youthful perfection is not something we are capable of producing and someone needs to see that Hollywood gets the memo.

Permalink to Bridalplasty – Brides Compete for Extreme Plastic Surgery

Bridalplasty – Brides Compete for Extreme Plastic Surgery

BridalplastyJust when you thought our TV entertainment culture had hit rock bottom, some network executive somewhere comes up with yet another lower level of low! Bridalplasty is that new low. Bridalplasty is a new reality TV show soon to be offered by E! that will show soon to be brides competing in various ways in an attempt to win extreme plastic surgery. I don’t even know where to begin in regard to the obnoxious lack of ethics on every level that this sad excuse for entertainment brings up. Celebrity surgeon Terry Dubrow, who will be performing the surgeries on Bridalplasty, really needs to rethink this.

Part of the Bridalplasty’s concept includes the bride first showing her results to the groom at the “unveiling” during the actual wedding ceremony.

“Viewers will witness his emotional and possibly shocked reaction as they stand at the altar and he lifts her veil to see her for the first time following her extreme plastic surgery,” says E!, according to the Hollywood Reporter.

This, of course just takes the whole idea of the groom not seeing the bride in her wedding dress until the ceremony to a whole new level. A nose job, breast augmentation, lip augmentation and some liposuction and he may not even recognize her! That shouldn’t make an intimidating moment any more difficult, should it? Unfortunately, this is what the network and potentially, the audience,  is after. They are selling the shock of emotional vulnerability.

This concept trivializes plastic surgery, important life decisions, and it makes a mockery of the institution of marriage. It is beyond sad how far entertainment corporations, audiences and participants are willing to go in search of money and the cheap emotional thrills.

Surgery, whether it is cosmetic or otherwise is a serious life and death issue, (although I have personally never lost a patient during cosmetic surgery in 28+ years). Surgery is not entertainment and marriage is not trivial. The very concept of the TV show Bridalplasty trivializes both and knocks our culture down a few more notches in the ranks of civilized societies.

Permalink to Kim Kardashian Fesses to Botox but NOT Breast Augmentation

Kim Kardashian Fesses to Botox but NOT Breast Augmentation


Kim Kardashian says she has only used Botox

Kim Kardashian, of Keeping Up with the Kardashians, admitted to using Botox, in an interview with ABC News show Nightline. However, she says she has not had a nose job or breast augmentation.

“Trust me honey, if I take this bra off you will tell me I need to get them done. I’m totally not against plastic surgery. … I’ve tried Botox before. That’s the only thing that I’ve done.”

Just the way she says that, I tend to believe her and while a great breast augmentation will look very natural, natural, can look natural as well! ;)

However, Kim Kardashian’s sister, Courtney Kardashian says that she has had breast augmentation and seems to be very proud of it!

“I have had breast implants, but it’s so funny ’cause it’s not a secret, I could care less. It’s so funny because the ‘before’ picture that they [In Touch magazine] showed was after I had my boob job, so I’m like, they should have written ‘before Mason’ and ‘after Mason.’ Like my boobs have like tripled since breastfeeding.”

They go on to say that none of the Kardashians have had nose jobs and from looking at pictures on the Internet, even the “before and after” pictures that argue that she has, I tend to believe they haven’t. So much of what you see in those pictures can be explained by lighting and make-up. Kim Kardashian says that she actually did want to get her nose done but decided against it.

“But what’s funny is about my nose, it’s my biggest insecurity. I always want to get my nose done. … I went to a doctor, I had them take the pictures, he showed me what it would look like and it just didn’t– It– I wouldn’t look the same.”

I agree with Kim Kardashian here, if that is her natural nose, she does not need anything done to perfect it. If anything, there is more risk in changing it and it not looking as nice or as individual as it does naturally. Perfection doesn’t have to be generic, people all look different for a reason, plastic surgery is not about trying to make every face look perfectly the same, it is about enhancing what you do have or fixing issues that bother you. In Kim’s case, I would keep that nose, it looks great on her.

Permalink to Cher – Plastic Surgery & The VMA’s

Cher – Plastic Surgery & The VMA’s

CHER- Video Music Awards 2010 - VMAs with Lady Gaga

CHER at the 2010 Video Music Awards "VMA's"

Cher presented Lady Gaga with the Video Music Award for Video of the Year Award last night at the 2010 MTV Video Music Awards. When Cher first walked out wearing a similar or the same outfit she wore for her 1980’s video, “If I Could Turn Back Time,” you could almost hear a collective, “wow,” as the entire country watching realized she is now in her 60’s! Indeed, Cher is 64 years old and looks, even on my high definition T.V., like she’s in her early 40’s. Is plastic surgery the secret? Actually, no… as in, “no, it isn’t a secret.” Cher takes care of herself, but she also has been very open about her use of plastic surgery to maintain her looks.  Make Me Heal reports, “Cher has had a breast augmentation, rhinoplasty (nose job), blepharoplasty (eyelid surgery), and possibly many others including enhancing the appearance of her teeth, liposuction, and a facelift. Although speculation revolved around Cher getting cheek implants, a tummy tuck, and a rib removed, she has completely denied the truth in those rumors. However, Cher openly admits she has become “the plastic surgery poster girl”.

The great thing about Cher is that she doesn’t expect anyone to not realize how old she is, she’s been a celebrity since the mid 1960s! Instead, she’s realistic about her age and the fact that time and gravity tend to be harsh on us all. But this is where great plastic surgery can work. Of course, when we look at Cher we think, “wow, she must have had a lot of work done.” But we don’t think, “YIKES!” like we do with some of the really bad celebrity plastic surgery we are all familiar with. To me, She looks great. She looks like she’s had very talented plastic surgeons and beyond that, she also obviously listened to their recommendations. I’m sure a lot of those scary celebrity plastic surgery cases are more a result of the celebrity insisting on procedures than doctors may have recommended against. At 64, Cher is an example of plastic surgery as an art.

What did/do you think of Cher’s plastic surgery and her overall look? Please weigh in below!

Permalink to World's Largest Breast Implants Removed

World's Largest Breast Implants Removed

Sheyla Hershey‘s famous “world’s largest breast implants” have been removed due to persistent infections that threatened her life, according to the Houston Press Blogger Richard Connelly.

Sheyla Hershey's Largest Breast Implants

Sheyla Hershey's largest Breast implants in the world

According to her official Website, Sheyla Hershey’s breast implants made her a size M (whatever that is), and she was awarded the Brazilian equivalent of the Guinness Book of World’s Records for largest breast implants after her most recent breast augmentation.

In the United States, plastic surgeons are only allowed to place implants up to 800 cc and for her to achieve this size, I’m guessing she was fitted with 4 implants of perhaps 800 cc each? Sheyla Hershey was originally from Brazil and flew back home where the laws are less strict so she could have this breast augmentation done. Since she is only 5’2 she would appear quite lopsided, as the attached picture illustrates.

I’ve blogged before where I discussed Heidi Montag’s breast implants,  about all the reasons why you don’t want to select breast implants that are too big for your body. In the case of Sheyla Hershey, it is even more an indication of likely mental illness than a misdirected attempt at having an attractive figure. Breasts this size are dangerous, painful and will have to eventually be removed 100% of the time, leaving the patient permanently disfigured.

NineMSN reported on the story:

“We’ve already taken her to surgery twice,” said the surgeon in charge of the breast removal, Dr Ron Bucek.

“We needed to open the area up to allow it to drain because we can’t leave an infection in a contained zone.”

According to reporting by the Herald Sun in Australia, many attempts were made to save her from having to remove four implants, TWO in each breast!

“But after the operation, Hershey became seriously ill and has since been closely monitored by a cosmetic surgeon, Dr. Ron Bucek, and an infectious disease expert, Dr. Shazia Gill.

Before yesterday’s surgery to remove the implants, Bucek performed two other operations to help drain the infected areas, and a special vacuum had been suctioning the infection from Hershey’s body 24 hours a day for months.

“It’s the only thing that has saved my life, to be honest,” Hershey said of the device, though she added that it was “annoying” and “heavy.”

My Fox Houston gave the most detailed report:

“None of the bacteria have cultured out. We had to start her on a third antibiotic, because it wasn’t resolving as rapidly as we wanted to see, so she’s on three antibiotics, and she was on an anti-fungal medication during this time as well,” says Dr. Gill.

Because of the severity of the infections, doctors have been closely monitoring Hershey twice a week.

“I look at white blood cell count, I look at electrolytes and inflammation and right now her drug level. She’s on one antibiotic if her levels get too high she can damage her hearing as well as kidneys, she is on very strong antibiotics,” explains Dr. Gill.

Even with all of this medical intervention, Hershey’s body hasn’t been able to ward off the infection. It has been progressively getting worse.

“What’s happening, the skin is opening because the implants, the two on each side, are beginning to open that area up”, says Dr. Bucek. Hershey’s doctors are confident that she will restore her health by removing all four implants.

Dr. Gill showed Sheyla’s CT scan to FOX 26 to demonstrate how the two implants are stacked up on each side. She says there is a lot of inflammation and thickening of the skin.”

Sheyla-Hershey-worlds-biggest-breastsIt amazes me that there are doctors ANYWHERE in the world who would butcher an obviously disturbed young woman. Now she’s had to undergo what is essentially a double mastectomy at age 28 because along with the removal of all 4 implants, she also lost most of her breast tissue and her skin is going to be in terrible shape. I can’t imagine any number of surgeries that will allow her to have normal, attractive looking breasts now.

On the TresSugar blog, “Gigglesugar” asked in her poll:

“Silicone Breast Implants: How Big Is Too Big?

When plastic surgeons tell you they won’t operate on you. (Look around — do those folks say no much?)”

And actually, yes, most plastic surgeons that I know, myself included, regularly say no to all kinds of requests. The reasons range from unrealistic expectations, “can you make me look like “insert hot celebrity of the moment,” to physical limitations and body dysmorphic disorder (BDD). As plastic surgeons, we are in the business of improving lives in realistic terms through enhancing aesthetic beauty, not in creating caricatures of human perfection.

Please weigh in below, I look forward to your comments!

Permalink to Breast Implants, Complications, Capsular Contracture and Singulair

Breast Implants, Complications, Capsular Contracture and Singulair

Breast augmentation, capsular contracture and Singulair were the subject of a recent article in the Aesthetic Surgery Journal that cites a study that shows that Singulair improves capsular contracture in women with breast implants. 19 patients with breast implants were treated. 17 patients presented with capsular contracture from a variety of breast operations. Two patients who had a history of recurrent capsular contracture were given the medication prophylactically. 11% of the patients became worse 16% of patients had no change 26% improved 37% completely improved and 11% were prevented fromgetting capsular contracture. The study showed that Singulair improves capsular contracture in women with breast implants. It appeared to have better results in milder contracture versus more severe contracture. Singulars well-tolerated with minimal side effects.

This corresponds with what I’ve been doing for the last several years. However now there is a published study that shows that Singulair works. This doesn’t make it work any better but it does further legitimize the off-label use.

As mentioned before, many different things can cause contracture after breast implants. Factors like bacterial contamination and hematoma. These can prolong the inflammatory response. A colleague and friend of mine, Dr.Schlesinger, discovered that a drug called Accolate, which is an anti-inflammatory asthma drug, worked in improving capsular contracture and published this. However it was discovered later on that Accolate had a very small incidents of extremely severe complications including hepatitis liver failure and death. This led to the abandonment of the use of Accolate despite the fact that it worked very well. Cingular is a similar type of drug. It is what is called a leukotriene inhibitor. These are factors that are thought to be responsible for capsular contracture.

This particular study on women with breast implants confirms what I have personally noted over the last several years. Cingular can help reverse capsular contracture when it is caught early and just starting. It can also help prevent recurrence. However, if someone comes in with established capsular contracture or extremely firm contracture it has little effect. The repair of very firm contracture is still a surgical procedure

Capsular contracture still continues to be an annoying and expensive problem in plastic surgery. By using techniques like the no touch Keller Funnel while placing breast implants during breast augmentation, see my previous blog about the Keller Funnel, IV antibiotics and antibiotic irrigation weekendreduce the incidence of contracture. However it is good to know that Singulair has been shown to be effective. In my own practice I combine it with cold laser to make it even more effective and see about 4 out of 5 people respond to the combination.

Permalink to Breast Augmentation Takes Mad Skills

Breast Augmentation Takes Mad Skills

Breast augmentation surgery is beginning to pop up in the strangest places!  This includes your ear/nose/throat doctors, family doctors, general surgeons, emergency room doctors, and… just about everybody else who has an MD after his or her name.  Lots of doctors are trying their hand at the procedure as a way of supplementing their bottom line.  And why not?  Constantly in demand, breast augmentation is the number one cosmetic procedure.

There’s even a $7,000 entry-level course being taught for anyone with an M.D. degree to learn how to perform breast augmentation. At the end of this weekend course, someone with only modest surgical skills could learn how to balloon up the breast tissue as you would for liposuction, and do a very limited pocket under the breast and over the muscle for a large incision in the breast fold and then put an implant in and sew it up.

What does surgical judgment, experience and aesthetic judgment count for?  By the time I had started my cosmetic breast practice, I had performed hundreds of a much more difficult procedure: breast reconstruction. This gave me a great deal of experience with the sub muscular pocket and the beginnings of the concept of the muscle brassiere. In addition, with breast reconstruction, you are usually trying to match and adjust the opposite side.

So is judgment and experience important?  Just this last week, among the other cases cited were breast cases: bilateral and augmentation, unilateral augmentation, and then a mastopexy bilateral Salt removal and replacement bilateral implant removal incised exchange.

Just as an outline of the process of breast augmentation and lift:

  1. Preoperative marking
  2. General anesthesia
  3. Incisions
  4. Making the sub muscular pocket with muscle support
  5. Placement of a sizer to expand the pocket to fit the breast implant
  6. Sit the patient up for visual assessment for shape and volume
  7. Make necessary adjustments to the size
  8. Temporary sutur breast lift
  9. Sit up for assessment
  10. Remove sutures
  11. Second temporary breast lift
  12. Sit patient up for assessment
  13. 3rd Temporary breast lift
  14. Set up okay just markings
  15. Remove skin
  16. Suture closures
  17. Set up for final check of finished lift and augmentation to make sure it is aesthetically correct.

These steps were for a complicated major breast lift and augmentation with asymmetry.  There are many different surgical steps with a lot of decisions to be made at every step. The reason you can’t just throw some markings and then cut on the dotted line is for every change in volume, there are changes in dimension according to the skin tension. This is different according to every person.

There’s a lot more to cosmetic breast augmentation, breast lifts and breast surgery than just putting a little bag under the skin. Cosmetic breast surgery has a steep learning curve that takes years to master.  This is especially true if one is performing symmetry surgery or revision surgery, which is complicated three-dimensional surgery.  It is definitely not for the gynecologist with time on his hands who has just taken a weekend course.

Permalink to Breast Augmentation Using The Keller Funnel

Breast Augmentation Using The Keller Funnel

keller funnel

The Keller Funnel Method

Breast augmentation surgery is a safe and effective solution for women who want fuller and larger breasts but one of the biggest problems with breast augmentation has always been the risk of capsular contracture. It has always been a concern with breast augmentation and even now varies from 15 to 30% in some areas. In my practice I have been able to keep it below 5% with a combination of laser and or drug therapy. However, the lower the percentage of contracture after breast augmentation the better. The suspected culprit associated with capsular contracture appears to be bacterial contamination. Despite all our best efforts at sterility with gowns, gloves, masks, sterile prepping solution, and various types of antibiotic irrigation, occasionally there can still be some contamination. A “no-touch” technique that allows you to insert the breast implants with an “introductory device” that is sterile and has been used for years. The plastic introduction sleeves were clumsy to use and not many plastic surgeons use them. For several years I used an introduction device from Europe that looked a little bit like a cannon with a hollow tube and a plunger to push the implants through. Unfortunately it only worked for smaller size implants and one size did not fit all so I gave up on it.

Now there is a very clever funnel invented by Dr. Keller called the Keller Funnel which accomplishes several purposes with something that looks like it belongs on the Food Network’s TV show Ace of Cakes!

First of all, it allows introduction of the implant with a true no touch technique so the implant can be dropped into the funnel and then gently squeezed through like decorating the top of the cake. The surgeon doesn’t touch it and it doesn’t touch the patient’s skin or breast tissue while it is being introduced in the pocket. This eliminates the main source of potential capsular contracture which is residual bacteria on the skin or in the breast tissue of the patient

Secondly, this way of introduction puts less stress on the implant so that is less likely to break during introduction or later due to the stress placed while putting it in

And lastly, this method allows for smaller incisions and faster introduction minimizing scar tissue and lessening the time that the patient is under anesthesia

I am very pleased to now be using the new Keller Funnel that allows us to improve the quality of breast augmentation. At Advanced Concepts in Plastic Surgery we continue to select the best of new technology. The Keller Funnel is an example of this by making breast augmentation better, safer, and minimizing future complications.


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  • Advanced Concepts in Plastic Surgery
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