Saturday, July 22, 2006

Bad celeb breast surgery on display

As I've mentioned before, some of the sites featuring celebrity plastic surgery are guilty pleasures. I saw two good examples of complications in high-profile women (the names are unimportant) that are a little instructive.

I just saw this celeb photo recently with perhaps about as visible a capsule irregularity from breast implants as you will see (especially in public). What can you do for something like this? To camouflage this you need COVERAGE, COVERAGE, & more COVERAGE.

1. Change this (presumably) subglandular implant to below the pectoral muscle to give more soft tissue coverage
2. Switch from saline to silicone implants (which "ripples" less)
3. Use a spacer like Alloderm (a cadaver skin product, see earlier post on one stage breast reconstruction) if a site change is impossible
4. Consider a smaller implant & capsulectetomy
5. Preferably use a form-stable cohesive gel implant like the Inamed 410

This public nipple slip is a slightly different problem that can be described in mathematical terms.

Periareolar mastopexy + big implants - good tissue quality = Franken-nipple

How do you fix this?

You're going to have to start all over here with a complete redo of the mastopexy while downsizing the implants. Depending upon her skin quality you may no longer be able to get away with just a peri-areolar incision and may have to take this vertical or a full inverted-T incision. I've seen a lot of bad scars from these full peri-areolar mastopexies under tension. If you don't close with a permanent suture, or close it slightly oval-shaped you can get some really unsatisfactory nipples which are stretched, irregular, or both (as this picture shows).

There's a really nice trick I was taught by Dr. Pat Maxwell called a "pinwheel" which is a modification of how you close this incision in a circle with permanent sutures. It makes all the difference in the world for predictability. However, the inherent competing interests of augmentation-mastopexy operations makes many authorities recommend against doing them routinely.


1 comment:

Tara Tainton said...

Rob, your blog's refreshingly professional and insightful while your open and light-hearted writing is a real treat. Just wanted to stop in and say "thank you" for providing additional information on my Sexy Scoop blog where I posted an excerpt from an article about the dangers of silicone implants. I greatly appreciate your offering the additional education and facts for my visitors. I'm going to try to remember to point to your blog when posting anything on the general topic of plastic surgery in the future...a topic that definitely comes up often related to the theme of my site. :)

More practicing professionals, in any trade, should make their own opinions and knowledge accessable by all as you have with your blog. It's a pleasure to meet you.