Tag Archives: silicone breast implants


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 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

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 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 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.


Permalink to To Drain or Not to Drain That is the Question

To Drain or Not to Drain That is the Question

In plastic surgery, there are a lot of opinions when talking about drains. Whenever I perform a breast augmentation at Advanced Concepts in Plastic Surgery I use drains, then I leave the drains in.  These are little 1/8” plastic tubes with perforations on the side that pull out fluid from inside the space that was created for the breast implants.  They come out to a tiny 1/8” spot on the side of the breast and are generally removed within 2 days.  The little spot where the drain was removed will seal itself in about  24 hours.

Not all plastic surgeons use drains after plastic surgery, so why do I?

Before I began using drains when performing breast augmentation the breasts would tend to swell more.  When there is more swelling, the breasts will be more sore.  It could take a month or more for this swelling to come down and can be quite uncomfortable. Because I see it as part of my job as a plastic surgeon to reduce as much pain as possible, I began experimenting with drains as a way to relieve this swelling after plastic surgery.

Generally 60 to 200 CC’s of fluid will come out over the course of 2 days.  Some of this fluid is actually blood which would have to be reabsorbed if it is not removed.  Blood gathering around the implants can accelerate infection.  Blood also seems to be a factor in capsular contracture.  Patients that developed hematomas are more prone to capsular contracture.  I have never had a patient develop an infection where I have had to remove a breast implant.

So in my opinion drains speed healing, make people more comfortable, and help decrease capsular contracture.  Seems to be worth the inconvenience of having a tiny drain for a day or two. At Advanced Concepts in Plastic Surgery I really try to make all plastic surgery procedures as painless and as comfortable for the patient as possible.


Permalink to Breast Implants: Saline or Silicone?

Breast Implants: Saline or Silicone?

Breast  implants used in breast augmentation have been around since the 1960’s.  Over the years, breast implant technology has gotten better and better and breast implants have continued to improve.  So the breast implants currently available are the best in history.  But there are still a number of confusing issues.  The first is silicon or saline?

Silicone breast implants were the most common implants for much of the history of breast implants.  Then about 15 years ago Connie Chung ran an expose which claimed that implants were responsible for all kinds of health problems.  This led to lawsuits a huge windfall for lawyers and the subsequent ban on silicone implants.  Shortly after this, the ban became worldwide.  This lasted for years until more than 100 clinical studies showed that breast implants don’t cause cancer, lupus, scleroderma, or a host of other problems.  Eventually, a federal judge threw out the lawsuits, declaring them junk science and sent the lawyers packing.  This led to the present re-introduction of silicone implants and their approval by the FDA.  Interestingly enough, most of the rest of the world re-introduced them many years ago.

Saline breast implants have always been available and continued to be available as a choice.

Apart from the differences in history and reputation, what’s the actual difference between the two?  Both are made of a silicone shell.  One has silicone gel inside; the other one has salt water.  But how do they act in the body?

Silicone breast implants are softer squishier and move better.  They are less likely to cause wrinkling, rippling, malposition, and sagging.  With larger sizes more than 400 cc silicone implants perform better and are less likely to cause severe sagging.

Saline breast implants are more likely to be felt under the skin because the shell is thicker.  This is not a problem for average or slightly heavier women.  In thin women, this can be an issue.  This also applies to wrinkling and rippling.  If there is enough tissue to cover the implant well then said implants do very well.  The other issue is that when the implant fails, as all implants do eventually, saline implants go down completely within a day.  When silicone implants break, the material stays in the pocket or implant space and allows more time until replacement surgery.

Fortunately now the type of  breast implant used is a woman’s choice.  Her body type and her concerns all influence her choice.  In my practice Advanced Concepts in Plastic Surgery in Sacramento, I have performed breast augmentation surgery on many women who made their own choices of either saline or silicone breast implants and were very happy with the results.


Permalink to Capsular Contracture After Breast Implants, What is it?

Capsular Contracture After Breast Implants, What is it?

Capsular contracture is the most common undesired outcome with breast augmentation. The rates are reported to be as high as 30%. In my practice Advanced Concepts in Plastic Surgery of Sacramento this is roughly 5%. Anatomically capsular contracture is the process of shrinkage of the scar tissue that normally forms around every breast implant. This is usually thin, about the thickness of a sheet of paper. Normally this leaves an enlarged pocket in which the beast implant can move around, or with a textured breast implant a smaller pocket that fits the shape of the implant. However when this occurs the scar tissue shrinks, the implants feels hard, looks distorted, and may even be uncomfortable or painful. Nobody really knows the answer to why some people get it and others don’t, and when they do why is it almost always only on one side and not the other? No one really knows the answers but the solution is coming close. One of the working theories deals with possible mild low-grade infection from the patients skin or breasts. This is because bacteria have been cultured or found in the scar tissue of patients with capsular contracture. Despite using sterile gowns and gloves, and sterilizing skin with content microbial soap, all of the bacteria can not be removed. About 99% are removed but sometimes this is not enough.

Over the years at Advanced Concepts in Plastic Surgery of Sacramento various measures to decrease this exposure have been adopted. These includes our state-of-the-art surgery facility strict attention to sterile technique, better skin preparation as well as rinsing the pocket with Betadine, antibacterial solution, IV antibiotics, no touch techniques, (trying to avoid touching skin) and changing gloves for implant insertion. All of these have been beneficial to a certain extent but the percentage of contracture is still never zero. Research goes on.

So what can be done if someone gets capsular contracture? Recent research shows that a class of drugs called Leukotriene Inhibitors which have usually been used for asthma have been effective in reversing these changes. These drugs include Singulair and Accolate. Another method to help reverse this problem is Low Level Laser Light. This activates cellular energy and seems to help soften the scar tissue especially when it is combined with constant pressure during treatment.

As a last resort a second surgery removing the scar tissue and removing the implant can be done with good results. If done early, this is a simple operation and involves less downtime, discomfort, or recovery than the original procedure.

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  • Andrew Kaczynski, MD

  • Advanced Concepts in Plastic Surgery
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