JANUARY 2007 NEWSLETTER

As threatened in last month’s newsletter, plans are to present a new topic each month to keep you informed of the changing practice of plastic surgery as it affects you, my patients. Last month’s biased opinion on lipodissolve versus liposuction were well received with many positive responses. This can be reviewed per our website at www.geraghtymd.com.
January 2007 Subject: Silicon Gel Breast Implants
This month I would like to briefly inform you of the recent approval of silicone gel breast implants for general use in cosmetic breast enhancement. Since we do several hundred breast implant procedures a year, I would like to give you my take on this after several decades of experience.

Please if you do not wish these newsletter rantings, let us know and you’ll be eliminated—so to speak.

Subject: Silicone gel breast implants
In November, 2006 the FDA approved the return of silicone gel breast implants for general use in cosmetic breast surgery after a 15 year hiatus when the FDA restricted access due to safety concerns. Although I have been using silicone gel breast implants for only specific cases since then, i.e. congenital breast problems, patients with failure of saline implants, breast reconstruction patients and those patients needing an augmentation and a mastopexy or lift with very thin tissue. Now these implants can be used in most all cosmetic breast patients with certain conditions. Because I have completed nearly 3,000 operations with breast implants, a third using silicone implants, this is a timely topic.
Silicone gel breast implants have been studied and scrutinized more than any medical device in history. Now plastic surgeons will have a choice in offering silicone gel filled or saline filled implants and the patients will have an informed choice. Literally when shit hit the fan in 1991, the FDA pulled gel implants off the market for general use. At the time the trial lawyers were circling like buzzards allegedly seeking restitution for patients. At that time I was the local president of the Kansas City Plastic Surgical Society and we had to calm my patients and others to ease their feelings that they were sitting on some sort of a time bomb. Granted, the gel implants were not made as well as our new cohesive implants of today and had a very high leakage rate and a high incidence of capsular contraction or firmness. None of this was admitted by the implant manufacturers, most of whom went out of business. These companies went bankrupt and most of the trial lawyers dispersed because of the lack of deep pockets to pick. Subsequently the new implant companies, the FDA and our plastic surgical societies proceeded in a 15 year process of scientific reviews, clinical trials and extensive data collection to determine the benefits and risks of gel implants. Since most plastic surgeons are committed to our patients’ safety and education, these numerous studies have shown that silicone gel implants have a significant psychological and physical benefit for women choosing these procedures and science has won out. All patients need to know of the inherent risks before making a choice. Please refer to www.memorygel.com for more information from the implant company.
My experience still dictates to proceed with caution with my patients’ health and well-being of the utmost importance. So, yes, I’ll be using silicone gel breast implants in my patients, but still the vast majority of my patients will continue to undergo cosmetic breast surgery with saline implants. In my surgical practice in the last 15 years, augmentation with saline implants has reached a reasonable gold standard and are appropriate for most patients. The exceptions, those patients wishing silicone gel implants, will be patients who strongly desire these type of implants after extensive informed consent, patients with failure of saline implants, i.e. frequent ruptures, wrinkling and dislike for the feel, and patients with minimal breast tissue and muscle (very thin chest wall and tissue) and those patients with thin skin and tissue requiring lifts with augmentations.
With the plethora of reported complications from silicone, my personal studies have shown a high satisfaction in those above mentioned patient categories with some accepted drawbacks. Silicone gel breast implants require a longer incision, a higher incidence of capsular contraction or firmness, are more costly and need more follow-up including MRI studies at three and five years to detect rupture. The old silicone implants when ruptured would ooze a liquid gel but now the implants are cohesive and a cut in the implant will not leak throughout the tissue. Even with accepted complications, there is a greater than 95% satisfaction rate with silicone gel implants.
Recommendations to my personal patients who have saline implants would be don’t replace your saline implants if they function well, have no problems and they still look and feel good. If you’re having no problems, leave them alone.
However, if you have silicone gel or saline implants from the past that are too high, too firm, have wrinkling or you do not like their size and feel, then a change may be in order. Patients with silicone gel implants that are older than 15 years (implants, that is) have a high incidence of internal rupture rate and should be evaluated by exam, mammograms and even MRIs. Please look up the following web sites: www.memorygel.com and www.breastimplantsafety.org and even the New Beauty magazine (the Winter/Spring edition of ’07) as there are informative articles throughout regarding breast implants.
Since this office takes care of over 200 patients a year for breast implants, be assured that we will help our patients make informed and healthy decisions. Having the option of gel implants, we’re still proceeding conservatively informing our patients of the pluses and minuses and avoiding all of the media hype.
Sincerely,
Thomas E. Geraghty, M. D.
PS: In the next few months biased thoughts on new face lifts, abdominoplasty and liposuction techniques and overhyped television plastic surgery programs will be faithfully explained to you.
PSS: Remember all women should do monthly breast exams and after the age of 40, yearly mammograms are a must.