Tag Archives: Breast augmentation

Customized Breast Enhancement

Remodel – Customized Breast Enhancement – Let the Lucas Center, Plastic Surgery offer you a customized approach.

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Are you a breast augmentation patient who either had surgery in the late 1990’s during the silicone false claim crisis or a patient who was misled into thinking that saline is an equivalent to the modern silicone gel implants? Or you were a fan of the 1990’s Bay Watch series and at the time felt that Pamela Anderson’s breast shape and size was the ideal standard. Just like houses with bathrooms and kitchens that seem dated after ten to fifteen years, requiring attention to remodeling to keep the house fresh and modern, so are breast enhancements. Stylistic changes and technology advancement of breast implant materials and fat grafting have come a long way, making your old decisions for your breast enhancement seem out of date and behind the times. Just like clothing styles and cars from the 1990’s seem dated now, so is the oversized sagging breast with saline implants, complete with rippling and pleating requiring an industrial strength bra to keep them in place. Ladies you don’t have to compromise any longer. Does your kitchen and bathroom still have brass fixtures? Then you should not have to put up with these heavy oversized misshapen breasts that are neither comfortable nor stylish. Consult a board certified plastic surgeon to review your options today.

Options not available 10-15 years ago.

First and foremost a modern plastic surgeon who has kept up with the current techniques and evidence based medicine related to breast enhancement will perform a complete tissue based diagnosis of the breast. Gone are the days hopefully of a surgeon standing in front of you without any measurements and eyeballing a one size fits all approach and telling you he or she will make you a “D” cup and you will love it. The facts are the 1990’s approach of shoving in multiple sizers or placing the largest possible smooth round saline implant under the breast without individualizing fit based on the patients breast tissue parameters lead to a revision rate of breast enhancement of 25% which manufacturers submitted to the FDA in the early two thousands. If gallbladders and knee replacements had that high of a revision rate insurance companies and Medicare would have a moratorium on the procedures. Fortunately our though leaders in plastic surgery have evaluated and re-engineered the procedures to minimize complications of capsular contracture, incorrect size placement, and avoidance of soft tissues being permanently thinned and distorted requiring complex revision procedures to correct poor outcomes. Most importantly the surgeon needs to determine the correct diameter of the devise both in width and height. The soft tissue thickness of the upper and lower pole (area above and below the nipple) is important as well as the tissue length from the fold to the nipple-areolar complex. The overall geometry of the chest and breast bone need to be noted requiring modification of procedures. It does not take an engineer to understand a women who is five feet tall and one hundred and ten pounds with a relatively short breast fold to collarbone and narrow chest with minimal breast tissue cannot have the same implant placed as a five feet, nine inch tall female with one hundred and sixty pounds with a wide frame and a large “B” cup breast. Unfortunately some surgeons did feel this way and some still do detracting from a customized approach that minimizes revision rates and unhappy patients.

Three dimensional imaging such as the Vectra has revolutionized my patient education and consultation for breast enhancements.  We can produce a very representative imaging of a women’s breast and torso and with computer simulation can demonstrate how any implant available in the United States can appear with your tissue parameters and allow the patient to see the proposed outcomes before a decision is made. This avoids wrong size surgery and allows patient expectation to be matched thus avoiding revision surgery. However the technology does not exist to provide this information if a breast already has an implant. This simulation also allows patients to see the limitations of an implant alone based on enhancement depending upon the individual’s soft tissue or bony deficiencies. This is where the discussion of fat grafting can be very beneficial to hiding the anatomic variances such as wide sternums that produce wide cleavages to provide an improved outcome and patient satisfaction. We can also demonstrate using a slightly smaller implant which has less weight and drag on poor quality soft tissue and supplementing the overall volume with large volume fat grafting to minimize implant malposition due to failure of soft tissues holding the implant in place.

Breast implants themselves have evolved over the last few decades. Today plastic surgeons can offer patients more options in size, shapes, and types of silicone than ever before also allowing for a more customized approach. I particularly have found the fifth generation silicone gel implants (Gummy Bears) to be particularly useful in petite women and very tall, thin women to exploit the positioning of the implant with differential heights and widths to maximize outcomes. I never use saline implants because they put too much strain on tissues, have excessive rippling, only can function as a round devise and can spontaneously deflate creating emergency surgical situations for patients. Based on clinical evidence, texturing of the implant can reduce capsular contracture, minimizing migration of the devise laterally over time and can maintain pocket size better than a smooth devise. Downsides include late seromas (fluid collections) and possible linkage with a very rare but easily treated form of implant related lymphomas. In my mind the benefits outweigh the small risks with texturing.

Lastly, the techniques of the actual surgery have evolved in the last ten years. These techniques include more precise, less traumatic dissections of the breast pocket, avoiding biofilm (a leading cause of capsular contracture) by minimizing the manipulation of the pockets with implants, and no touch techniques with the surgeon’s hands or patients’ skin on the devises that can minimize revision rates and improve outcomes.

In conclusion if you are a breast enhancement patient and are less than satisfied with your outcome don’t learn to live with compromise explore the modern day breast augmentation procedures available at board certified plastic surgeon’s offices around the country. Remember cell phones, cars, computers and styles have all rapidly evolved for the better compared to the 1990’s refresh yourself you will be glad you did.

For further information into customized breast enhancement procedures please visit www.thelucascenter.com or contact The Lucas Center, Plastic Surgery, PLLC in Knoxville, Tennessee 865 218 6210.

 

State of the Art of Breast Reconstruction Techniques

When I think back to my first plastic surgery rotation as a medical student in the early 1990’s breast reconstruction was performed much differently then. During this time period the silicone implant crisis was at its peak, women were skeptical of breast implants, and the majority of reconstruction surgeries were with TRAM (Transverse Rectus Abdominus) flaps requiring large skin paddles because the breast surgeons were much more invasive in the way breasts were removed. Today silicone breast implants are safe and available in many sizes and shapes, providing patients and surgeons many more options than ever before. The technique of breast removal (mastectomies) have become much more selective, even being able to spare the nipple-areolar complex in many cases; therefore the need to transport new skin into the area is less often required in primary reconstruction. The advent of soft tissue regeneration with the addition of bio-matrices such as Acellular dermal matrices and guided tissue regeneration materials such as textile silk meshes have revolutionized the outcomes in prosthetic reconstruction. Without question one of the greatest advances in breast reconstruction is the art and science of fat grafting which can augment selected areas of volume deficiencies, improve the overall shape, and restore the health of the overlying tissues which has been previously damaged by radiation therapy.

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Dr. Pat Maxwell coined the term “the bio-engineered breast” which utilizes acellular dermal matrix grafts and fat grafting to rejuvenate the soft tissues surrounding breast implants after mastectomies. I have been modifying these two techniques in my practice since 2004, which has vastly improved outcomes in both primary and revision breast reconstruction. Fat grafting has provided plastic surgeons the ability to selectively sculpt and shape breasts like never before. Implants can only occupy and provide shape and volume in specific locations on the chest and breast. Fat can influence any area desired to be modified similar to photo shopping in pictures. Fat already occupies the majority of a natural breast volume therefore restoring a reconstructed breast to normal form and function with less donor site morbidity is seen with harvesting large flaps from the abdomen and buttock region. This truly is an exciting time in plastic surgery to provide excellent results with less invasive techniques, especially compared to the past.

In addition to the soft tissue restoration procedures the new silicone gel implants have also contributed to better outcomes. The fifth generation silicone gel implants (Gummy Bear Implant) are a very cohesive polymer which maintains three dimensional shape. This for me has two advantages; the first is that we can offer implants which can more easily match a patient’s unique chest wall architecture such as creating an implant narrower in width and taller in height (for a tall thin lady) or shorter and wider for a small wide chested woman combined with a fuller projection in the lower half of the breast mirroring a normal breast shape that will have adequate volume but will not encroach on the arm pit region or have an over expanded upper pole appearance. The second advantage of these implants are the result of a stiffer polymer which resists forces of capsular contracture that have been demonstrated to be a major cause of revision breast implant surgery. With the use of bi-dimensional conceptual planning through meticulous measurements we can offer a more customized approach to reconstruction and we can educate patients on their options with a three dimensional imaging system (Vectra) to demonstrate the effect of different shapes and volumes on their potential outcomes.

Even women who have been diagnosed with breast cancer and elected to undergo “breast conservation techniques” with a lumpectomy and radiation therapy can frequently experience distortions of the breast. The affected breast can shrink in volume and change in shape compared to its baseline and with the opposite breast as a result of surgical removal of tissue coupled with imposed radiation fibrosis changes to the tissues which are permanent and progressive. In my practice I see a number of these women and have been successful in reducing deformities and restoring shape and volume with the use of internal scar release combined with fat grafting. The amount of hard woody scarring of the overlying skin can often be suppler after treatment. Contour deformities which often occur directly in the surgical field where tissue was removed can be restored in shape and volume leaving a softer breast that is more symmetric with the opposing side.

I am very proud of my field of plastic surgery which by its very nature attracts thoughtful and innovating disciples of this surgical specialty leading to a continuous evolution of scientific insights that opens the door for continuous improvements in the care we can provide patients. Breast cancer reconstruction is just one small piece that is being tackled by our field of study.

Why less is more: the trend toward natural looking breast enhancement

Fashion trends change, and so do accepted ideals for body appearance. The influences of Latin culture on American norms have triggered an explosion in the demand for buttock enhancement with fat grafting, which was first popularized in Brazil. Another trend patients are requesting is a more conservative and natural looking breast enhancement. A recent survey in California found that women are not looking for an oversized breast enhancement and desire a more subtle appearance. This is a healthier choice for women to choose.

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Due to the prevalence of evidence-based medicine and FDA demand for data on silicone gel breast implants, findings indicate that revision breast surgeries after a primary augmentation mammoplasty are as high as 25 percent. The main reason for these revisions is capsular contracture, but size change is a factor. Thanks to the work of Dr. John Tebetts, Bill Adams and Dr. Dennis Hammond, the concept of calibrating the correct implant size for a given individual based on breast tissue characteristics allows for customization and has reduced revision rates for surgeons who incorporate these findings into their practices.

The idea of putting the largest possible implant into a women’s breast is fraught with potential complications including excess stretch on the tissues leading to thinning of the breast which may result in increased prominence of rippling of the implant, as well as mal-positioning of the device either laterally or inferiorly. This causes an unsightly aged appearance of the breast. The cost of revision can be high if treatment plans include the need for added soft tissue support utilizing acellular dermal matrices or a silk textile mesh to restore soft tissue support of the implants.

Today is a very exciting time in the field of augmentation mammoplasty, because we surgeons have a wide variety of shapes and sizes and silicone gel consistencies to choose from to provide customized results for our patients.

I strive to deliver a primary augmentation of the breast with a correct implant that is sustainable by the body to provide a long-lasting aesthetic result free of revision until the integrity of the implant has failed.

I think in terms of the height and width and projection of the breast independently and choose styles and shapes to match my patient’s desired outcome. I never want people to say that all my breast augmentations look the same. Just as all faces are unique and different, so are breasts. I want to make an individual’s breast look and feel as attractive as possible with long-lasting results. Proportionate breast enhancement is key to achieving these results.

Furthermore, now fat grafting can be performed simultaneously with implant placement, allowing surgeons to correct volume and shape asymmetries, as well as fill in spaces where an implant cannot be placed, such as the cleavage region and the chest wall/implant interface.

If you’re considering an augmentation mammoplasty, take a look at a three-dimensional analysis imaging of yourself. Then discuss your tissue type and pre-existing breast tissue with your surgeon, who will devise a plan to make a customized result that will look attractive and proportional with your frame. A skilled board-certified plastic surgeon will choose an appropriate implant with or without fat grafting to highlight your own unique figure with long-lasting results.

The Lucas Center Announces TLC Rewards Program to begin 3-1-2016

We are pleased to present our new TLC Loyalty Rewards Program. This program lets you earn TLC Reward Points that can be redeemed for any of our products and services.*

HOW DOES THE LOYALTY REWARDS PROGRAM WORK?

For each $1 spent on ancillary services and products, you will earn 1 Point. You can earn bonus points during promotions advertised in our emails, Facebook page or special events. Be on the lookout for these promotions and accumulate your Points faster. For a complete listing of point opportunities, please see our list below.

How can I earn points?

  • 1 TLC Point for every $1 spent on products, injectables and peels
  • 500 bonus TLC Points for scheduling cosmetic surgery
  • 500 bonus TLC Points for referring friends and family members who have cosmetic surgery or ancillary procedures (make sure the person you refer has your references you so we can add your points as required).
  • 500 bonus Points for purchasing gift certificates for friends and family valued at $400 and up
  • 100 bonus Points for attending our bi-annual events (Spring and Holiday)
  • TLC Points for special promotions will vary and will be specified with each special.
  • A minimum of 1000 TLC Points are required to redeem your rewards.
POINTS REWARD
1,000 $50.00
1,500 $75.00
2,000 $100.00
2,500 $125.00
3,500 $175.00

Remember to bring your card with you to our office so we can credit or redeem your points. Simply hand it to us any time you make a purchase. TLC Rewards do not expire and are not transferrable. TLC Reward cannot include any retroactive transactions and must be accumulated as a result of new purchases.

*Points are not redeemable for cash, may not be used for outstanding balances, and are accrued on pre-tax amounts. If a product is returned, any points accrued will be deducted. Points are not redeemable for gift card purchases. Points are not earned on dollar amounts for cosmetic surgery procedures. Points are not earned on any insurance procedures. The Lucas Center may, at its discretion, terminate or change the TLC Rewards Loyalty Program.

TLC Rewards

Enhance your confidence and self-esteem with chin-implant surgery

Chin blog
Have you ever looked in the mirror and felt that your lower face or jaw line seemed out of proportion with the rest of your face? Do your lower chin and neck look older than your chronologic age? Compared to others, does your nose appear to be overly prominent despite being otherwise attractive? Have you had braces previously to correct an underbite? If the answer is yes to any of these questions, then you may have an underdeveloped lower jaw and/or chin.

Symmetry matters. Our eyes and brain are trained to recognize symmetry and harmony of the face. If one part is out of alignment, our brain makes a subconscious decision that a face is less attractive. It may sound silly, but people who have corrected chin positions after surgery project more confidence without undergoing drastic changes to the face. In fact, patients who undergo a procedure to provide enhancement to the chin are often asked questions such as, “Did you lose weight?” or “Did you change your hairstyle?” The improvement is so subtle, people are unable to pinpoint exactly what you had done, only that you look better than ever.

Preview your results. During your consultation I’ll analyze your face and also have you undergo a Vectra 3D facial analysis that will allow you to see yourself from all angles and help you understand what I’m seeing. We can simulate very closely what surgery is best for you, and you can decide if you are happy with the results in advance of your procedure (no buyer’s remorse should ever happen).

Chin implant surgery is relatively painless. In most cases there is little pain. Your chin and lips may be temporarily numb after the procedure. You’ll wear a compression garment for a few weeks for two reasons: to control swelling and to enhance a tighter smoother neckline that can provide a more youthful appearance. Your treatment might include liposuction of the chin and upper neck.

If your chin is less prominent with respect to your upper jaw and nose, then a chin implant can provide excellent results. I use an implant material made of a very dense polymer that can be trimmed and adapted to the exact dimensions of your jaw; it’s attached to the bone with two tiny screws. This is vastly better than silicone gel implants that can’t be modified or stabilized and are only placed in a superficial plane around the chin, potentially causing erosion of the bone over time. Because of my background in craniofacial surgery, I’m very comfortable operating on the jaw.

You have options. If your chin is less prominent horizontally and is either too long or too short vertically, then shortening or elongating the bone is possible by cutting the lower part of the jaw and sliding the bone forward. This procedure is a little more involved than the implant surgery, but the recovery time is the same, and it is an outpatient procedure. Both surgeries are performed through a small incision at the bottom of the chin, and the scar is very inconspicuous with time.

Other options include making a more powerful looking lateral jaw line with angle/ body implants. This can be helpful for patients possessing a steep jaw angle with lack of lateral definition to the jaw line. In this situation an implant can be placed through the mouth to enhance the jaw angle and lateral jaw allowing a stronger appearance which males in particular desire.

There are many options for chin enhancement surgery. I look forward to finding the right treatment for your needs. Call 865.218.6210 today or go online to thelucascenter.com to schedule your consultation.

Fat grafts and textured implants enhance breast augmentation

Dr. Lucas

I recently attended the 2015 Atlanta Breast Symposium sponsored by the Southeastern Society of Plastic and Reconstructive Surgeons. This annual conference is the premier event for new products and technology specific to breast surgery. The symposium features live procedures, scientific paper presentations and follow-up exhibits from the previous year’s live surgeries. Each year, I spend time with industry colleagues exploring what’s on the horizon, so I can implement what’s immediately applicable to my practice.

Takeaways from the 2015 Symposium:

Surgeons are seeing increased efficacy and safety of simultaneous breast augmentation using implants with fat grafting. This composite augmentation of the breast yields both improved aesthetic outcomes as well as enhanced long-term results. Fantastic breast augmentation is created when there’s appropriate soft tissue coverage and support of the implant. I was already an advocate of fat grafting to revise existing implants. Going forward, I’ll offer implants with simultaneous fat grafting to my patients for an even more natural silhouette and better support.

Textured, shaped highly cohesive silicone gel implants were a hot topic at this year’s symposium. I was an early adopter of these breast devices and continue to expand their use on a case-by-case basis. They’ve proven to be very beneficial in providing optimal results in certain circumstances for both primary and revision surgeries in aesthetic and reconstructive procedures.

The debate over the use of smooth versus textured implants continues. Many surgeons prefer a smooth round silicone implant, because the experience with textured saline implants was not favorable. However, European surgeons have utilized textured silicone for many years with good success. My experience with the textured, shaped highly cohesive gel devices has been very rewarding. It’s my opinion that the texturing may benefit women who might be at risk for the implants drifting from their ideal position. Several papers were presented that support my clinical opinion.

The future is bright for women who choose breast augmentation or reconstruction after breast cancer. There are more options available than ever before to achieve your desired aesthetic. I look forward to discussing these exciting new techniques and products with you.

Call 865.281.6210 or visit thelucascenter.com to schedule your personal consultation.