COSMETIC PLASTIC SURGERY TRENDS & INSIGHTS FROM DR. ZUCKERMAN

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Capsular contracture involves the hardening of the fibrous tissue that surrounds all breast implants after implanted in the body, for example during breast augmentation surgery or breast reconstruction. It is quite rare, and something most patients will never experience. It can occur in the tissue surrounding one or both implants. Capsular contracture varies in its severity, and the most severe type can be painful. Myofibroblast cells, which make up a component of the capsule, the same cells that cause wounds to contract as they heal, will also contract to varying degrees inside your body.

There are four grades of capsular contracture, known as Baker Grades:

Grade I: Breast is normally soft and looks natural

Grade II: Breast is a little firm but looks normal

Grade III: Breast is firm and looks abnormal

Grade IV: Breast is hard, painful, and looks abnormal

Grades III and IV capsular contracture are considered severe, and may require reoperation or implant removal. Capsular contracture, whether mild, moderate or severe, may occur more than once in the same implant.

The incidence of capsular contracture is quite low: between 4%, as estimated by Ideal Implants in their FDA Patient Labeling, and 8%, as estimated by Mentor in its FDA Patient Labeling, primary breast augmentation patients.

We aren’t sure why capsular contracture occurs, but there is some thought in the scientific community that it is correlated to bacterial contamination during the initial breast implant insertion. This postulated bacterium is normal skin flora and lives in the milk ducts. As a board-certified plastic surgeon, Dr. Zuckerman is very familiar with the latest protocols to minimize this risk. For example, during the procedure, Dr. Zuckerman irrigates the breast pocket where the implants will be placed three times with triple antibiotic solution. He then repreps and redrapes the entire sterile surgical field and changes his gloves prior to insertion of the implants. In addition, to place the breast implants, he uses an implant delivery device called a Keller funnel, which allows him to insert the implants without ever touching them.


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<p>The actual term "Rapid Recovery Breast Augmentation" was originally coined by Dr. John Tebbetts of Dallas in 2002 and referred to a specific technique designed to limit bleeding intraoperatively but is mostly a marketing term. However, recovery after breast augmentation is limited by the body's ability to heal.  As such, recovery can only be so "rapid". However, my patients can have surgery on Friday and return to work Monday or Tuesday.</p>


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<p>The breast lift, or mastopexy, and breast reduction are two of the least-discussed cosmetic surgery procedures, but they are two of the most important. My patients, and indeed patients in general, are overwhelmingly satisfied with their results. And, these two operations are among the fastest growing plastic surgery procedures, with the number of procedures performed up 70% in the period 2000-2014 according to the American Society of Plastic Surgeons (ASPS).</p><p>Now, as more celebrities discuss their plastic surgery procedures openly, we are seeing public figures also beginning to discuss these breast procedures, including a very recent post by <a target="_blank" href="https://www.instagram.com/p/BXOCj7ghkCw/?taken-by=amberrose">Amber Rose</a> on Instagram, <a target="_blank" href="http://people.com/archive/cover-story-making-it-big-vol-68-no-19/">Queen Latifah's interview to People</a>, and <a target="_blank" href="http://hollywoodlife.com/2015/05/12/kris-jenner-plastic-surgery-secrets-boob-job-good-work/">even Kris Jenner</a>.</p>


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<p>I am often asked by patients about changes due in the breasts due to pregnancy and breastfeeding. In fact, a significant portion of cosmetic plastic surgery of the breast and body can be linked back to pregnancy, childbirth, and breastfeeding. Unfortunately, pregnancy is tough on a woman's body, and many changes are irreversible and unavoidable.</p>


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The above image was taken from Dr. Zuckerman’s office while the plastic surgery video feature filming about Dr. Zuckerman’s approach to “Mommy Makeover Surgery” was in progress.

Mommy Makeover surgery is among the most significant cosmetic surgery procedures that I perform, because it is really a combination of two procedures: one breast and one body. Generally speaking, patients who undergo this surgery have had adverse, irreversible effects from a previous pregnancy(s) and breastfeeding such as excess skin, stubborn pads of fat, deflated or sagging breasts, etc. The surgery consists of a breast procedure, either a breast augmentation, a breast lift, or a breast reduction depending on the patient’s needs, and a body procedure either liposuction only or more commonly a tummy tuck.

Although I’ve now been filmed several to many times for various news programs and television shows, I never find it boring or too easy. It’s still a challenge to speak fluidly without interjections and to make eye contact with a machine! While I am completely at home at the operating table or talking to a patient one on one, I always get a few jitters before going on camera. Here, we are filming a new segment describing the experience of one of my Mommy Makeover patients. The feature follows her from the beginning of the plastic surgery procedure, the consultation, to the end. She described her experience at each step, and I described from a medical perspective how I was going to approach the surgery. This patient underwent two surgeries done at the same time: a breast augmentation to raise breasts deflated after bearing a child and a tummy tuck, or abdominoplasty, to remove the stretched out skin and stubborn pad of fat left over from pregnancy. For the feature, she discussed why she wanted the procedure, her expectations of the surgical outcome, and her biggest “must haves”. I then talked about a couple of tricky bits of the surgery particular to this patient and how listening to her desires and questions led me to the approach I will take in the operating room.

If you visit the Mommy Makeover Surgery page, you can take a look at the video as it’s now up!


Copyright 2017 Joshua D. Zuckerman, MD, FACS, P.C. All rights reserved.