breast reconstruction with alloderm

When it comes to breast reconstruction, there are many options for patients and their surgeons to consider. For instance, breast reconstruction technique will often depend on the type of mastectomy (or other breast procedure) that was performed in order to adequately remove the initial breast cancer. Some women choose to have no breast reconstruction at all. However, for those that do they must decide (in conjunction with their plastic surgeon) which options suits them best: tissue-expander/implant-based reoconstruction, pedicled latissimus dorsi muscle flap reconstruction, pedicled TRAM flap reconstruction, free flap reconstruction, etc. Further, in recent years there have been two growing trends that have changed the manner in which breast reconstruction occurs. The first increasing trend has been seen in performance of skin and nipple-sparing mastectomy procedures. This is particularly true for the growing number of prophylactic mastectomy for BRCA gene positive family members of cancer patients. The second increasing trend has been seen with respect to the use of acellular dermal matrices and other regenerative matrix products. These graft materials have become very helpful during breast reconstruction procedures (and breast revision surgery) since they allow coverage of the lower pole of the breast implant or tissue expander, where there is an anatomic deficiency of native muscle coverage. Further, when sewn in and placed properly, they help to reduce tension on the mastectomy flaps that can be created by the sheer weight and mass of the breast implant device.

A new study has reviewed one institutions experience with use of Acellular Dermal Matrix (i.e. Alloderm) in patients undergoing immediate single stage, direct to implant breast reconstruction(Colwell, et al. Plas Recon Surg, Vol 128, No 6, p1170, Dec 2011). The authors reviewed the charts of 211 patients who collectively underwent 331 direct to implant reconstruction procedures using Alloderm (one-stage reconstruction) following nipple-sparing  or skin-sparing mastectomies for cancer (216) or breast cancer prophylaxis (115). They reviewed the total number of complications which included 10 infections (3%),  five seromas (1.5%), four hematomas (1.2%) and 30 cases (9.1%) of skin necrosis (loss) which resulted in five implant losses (1.5%). They compared these statistics to 158 similar reconstruction for patients who underwent tissue expander reconstruction (two-stage reconstruction) without the use of Alloderm. They had similar complication rates which included: nine infections (5.7%), three seromas (1.9%), three hematomas (1.9%)  and 16 reconstructions (10.1%) with skin necrosis leading to 11 implant losses (7.0%). In their experience over the three year study period, the total number of complications did decrease in each subsequent year as total experience increased. Further, there was also noted to be a higher complication rate in both groups for patients that required external beam irradiation.

No more taxes on Plastic Surgery

Governor Chris Christie signed into law a bill that will phase out (and eliminate) an eight year old state tax on cosmetic surgery in New Jersey.  The original law from 2004, imposed a gross receipts tax on many plastic surgery procedures including cosmetic surgery, cosmetic injections and fillers, dermabrasion, laser hair removal and hair transplantation. This repeal is a big win not only for plastic surgery patients in New Jersey, but also for plastic surgery patients nationwide.  The bill’s sponsors, Senator Joseph Kyrillos  and Senator Paul Sarlo, say the eight-year-old tax was not only a “burden” to patients, but to the medical offices that had to collect the tax and state agencies that enforced it.  Repealing this law has sent a message to lawmakers across the country that these types of taxes not only increase the financial burden on patients seeking elective plastic surgery care, but also that they are ultimately biased against women. The tax is scheduled to drop from 6 percent to 4 percent in the first quarter after the bill’s enactment, then to 2 percent from July 1, 2012 to July 1, 2013, then disappear after July 1, 2013. (Source: ASPS)

Breast Implant Rupture

In a follow-up to new guidelines issued by the British government earlier this year, the French government recently advised about 30,000 women to remove PIP implants that may possibly be defective. PIP implants, manufactured by French company Poly Implants Protheses, are thought to contain a type of non-medical industrial silicone. Although the dangers of non-medical grade silicone are well known, the risk to patients in these cases is very low. For women who received these implants during reconstructive breast procedures for breast cancer, the government will pay for the cost to remove and replace the PIP style implants. However, for women who received PIP breast implants for cosmetic purposes (aesthetic breast augmentation), the cost of removing and replacing the implants will be incurred by the patients. A panel of French researchers, in combination with the National Cancer Institute, noted that there currently is no increased risk of cancer for women with PIP implants in place.  However, they note that PIP implants have an outer shell that has an increased risk of rupture and therefore are encouraging all women to have them removed. If you currently have PIP implants and are considering having them removed, contact the office of Dr. Brenner soon for a consultation.

Breast Reduction for Juvenile Breast Hypertrophy

Juvenile Breast Hypertrophy is a relatively rare, benign (non-cancerous) disorder of the breast in which one or both of the breasts undergo a rapid, massive increase in size during adolescence. This condition is also commonly known by the names  Juvenile Gigantomastia, Juvenile Macromastia,  Virginal Macromastia, and Virginal Mammary Hypertrophy. Prepubertal Hypertrophy is usually bilateral; Virginal Hypertrophy (which develops after the onset of puberty), may be either unilateral or bilateral. Due to the rarity of this condition, there historically have been  no evidence-based guideline for the treatment of this condition. A recent study by Hoppe et al (Plast Reconstr Surg, Vol 127, No 6, p2224, June 2011) reviewed the various case reports in the past plastic surgery literature to help create a more cohesive set of guidelines for treatment of these patients. Here is a summary of what was found:

1) CAUSE: An exact cause has not been determined.  Hypersensitivity of the breast tissue to normal levels of circulating estrogen is one hypothesis for this “dysregulated breast enlargement.” Estrogen levels have been measured in patients with Juvenile Breast Hypertrophy and have not been significantly elevated compared with unaffected patients.

2) DIAGNOSIS: Juvenile Breast Hypertrophy is a diagnosis of exclusion. Other conditions such as Virginal Fibroadenoma, Fibrocystic Disease, Phyllodes Tumor and Endocrine Conditions may need to be excluded. Ultrasound or mammography may be indicated as part of the work up. Symptoms that occur are often similar to adults who present with macromastia; namely bra strap grooving, back pain and intertriginous rashes.

3) SURGICAL TREATMENT: In some cases, surgical breast reduction alone is sufficient treatment for Juvenile Breast Hypertrophy. However, this is not always adequate, as is evidenced by the high rate of recurrence. Subcutaneous mastectomy (with subsequent tissue expansion and implant placement) has also been used with success, with a decreased chance for recurrence. Unfortunately, subcutaneous mastectomy with complete removal of breast tissue often has an inferior aesthetic result compared with breast reduction. Some surgeons feel that surgery should be delayed until the end of puberty (when breast growth is complete) if possible. All breast tissue that is removed should be submitted to a pathologist and then tested for the PTEN gene mutation and distribution of estrogen and progesterone receptors.

4) MEDICAL MANAGEMENT: Dydrogesterone (a medication similar to progesterone) and Tamoxifen (a medication that modulates estrogen receptors) have been the most popular medications used to control Juvenile Breast Hypertrophy. Tamoxifen has been used successfully pre-operatively to arrest breast growth as well as post-operatively to inhibit further breast growth. Typical doses range from 10 to 40 mg per day and may continue for 4 months. Potential side effects of Tamoxifen are real and may include: endometrial hyperplasia (with increased risk for endometrial cancer), hot flashes, increased risk for venous blood clots, and changes to bone density.

Juvenile Breast Hypertrophy is a complex condition, and usually requires a coordinated and long term management effort between the patient, the plastic surgeon and the endocrinologist.

Unsafe Plastic Surgery

As a board certified plastic surgeon, I see patients every week who are seeking either functional or cosmetic improvements for their body parts. This includes procedures such as breast augmentation, tummy tuck, liposuction, rhinoplasty, and fat injections (fat transfer). These are all excellent procedures that are very safe when performed by a well trained, board-certified plastic surgeon.  Unfortunately, there are many non-plastic surgeons out there who continue to try and perform plastic surgical procedures. The results can be disastrous and sometimes even fatal. There really is no substitute for safe plastic surgery.

Pictured to the left is Oneal Ron Morris, a male to female transgender patient who has been posing as a Florida plastic surgeon and administering toxic chemical injections (glue and Fix-a-Flat) to unsuspecting patients.

Florida authorities note that one victim who was looking to get a nightclub job sought treatment with Morris in order to achieve a curvier figure. This victim paid Morris $700 for the injections in 2010.  Practicing illegally, and within an un-sterile environment in her home, Morris allegedly used some type of tubing and inserted the toxic chemicals into her buttocks and abdominal soft tissues..

The victim, who has not been  identified due to HIPPA laws suffered very serious infections which resulted in permanent scarring around the injection sites. The victim required multiple operations in order to treat the infections and also required a prolonged period of home health nursing visits.

Don’t miss Dr. Brenner discussing this story and plastic surgery safety on Entertainment Tonight.

Surgical Friends Foundation at UCLA

After a long day of operating yesterday, I woke up this morning to find the most amazing thank you letter in my email. As a member of The Surgical Friends Foundation, I not only have the opportunity to help patients who lack access to plastic surgical care, but I also have the chance to mentor and teach UCLA undergraduate students. Yesterday I had a wonderfully enthusiastic pre-medicine student observe one my skin cancer reconstruction cases. This student is a member of the Surgical Friends Foundation at UCLA club, and is clearly destined to become a plastic surgeon. Here is her letter:

November 16, 2011

Dear Dr. Brenner and Roxbury surgical team,

Once again, I take this opportunity to thank you guys for having me at the skin cancer reconstructive surgery on Wednesday, November 16, 2011 at 7:30AM. I am thankful to Surgical Friends Foundation at UCLA for providing undergraduate pre-med students with such opportunities, but more importantly, I’m thankful for Dr. Brenner and his surgical team for working in tandem with Surgical Friends Foundation and permitting students to monitor their hard work and surgical cases.

During the two hours I spent observing Dr. Brenner’s surgery, I learned many important topics that will come in handy in the future, either in medical school, the field, and/or in my future studies. Dr. Brenner talked me through his surgery and explained each and every step, as well as the reasons for each step. He began by marking the area he was reconstructing, the nose, and explained each parts of the nose: the dorsum, root, lateral sides tip, alae, nostril, and columella. His goal for this surgery was to reshape the alae that had previously been affected with basal carcinoma. Dr. Brenner’s method of teaching was clear, precise, and simple, which made it so much easier to remember later on.

Furthermore, Dr. Brenner’s chemistry with his staff was wonderful. The whole team connected like a family and helped each other throughout the surgery. A memorable moment was when Dr. Brenner literally called “time out” prior to starting the surgery to re-check with his anesthesiologist the patient’s prior history of diseases/conditions and any allergies the patient might have to certain products/medications used throughout the surgery. The entire surgery was videotaped and is available for streaming online on Dr. Brenner’s website. This tool is very helpful for students who were not able to observe the surgery and gives them the opportunity to watch the entire surgery on their own time.

In addition, Dr. Brenner showed me before and after pictures of the patient who was affected with basal carcinoma. Dr. Brenner explained that the dermatologist had already removed the tumor on the patient’s alae. It was now up to Dr. Brenner to fill the hole that was left from removing the tumor by excising tissue from the adjacent cheek, flipping it over, rotating it, and attaching it to the lateral side of the nose. This step had already been performed in the prior surgery; however, during this second surgery (which I observed), Dr. Brenner just had to reshape and contour the alae on the patient’s right side to match the healthy alae on the patient’s left side.

When I asked about the complications of this surgery, Dr. Brenner ensured me that there would be none and that the patient would be able to breathe normally, have a normal looking and functioning nose, and even be scar-free.

It was amazing to see the outcome of this surgery: a perfectly contoured nose with both alaes matching and the lack of a scar! The patient’s nose looked so good, real, and healthy that no one would have been able to tell she had every received reconstructive plastic surgery. If I had seen the patient for the first time after her surgery, I wouldn’t have had the slightest clue that she had skin cancer reconstructive surgery done. The patient is now tumor-free and has her great-looking, natural nose back. I’m so happy for the patient and this awe-inspiring, eye-opening experience.

All my thanks and appreciation goes to Dr.Brenner, nurse Ryan, surgical assistant Jose, and anesthesiologist Lisa for all of their hard work and kindness.
Wish you all the best and good luck with your future surgeries!

Sincerely yours,

Gilda Djabarzade
Surgical Friends Foundation at UCLA

WEIGHT LOSS PATIENT BEFORE BREAST REDUCTION

WEIGHT LOSS PATIENT AFTER BREAST REDUCTION

Frequently, breast enlargement (macromastia) and morbid obesity are related entities, occurring simultaneously in some patients. There certainly are many patients who only have enlarged breasts without also being obese. In fact, in 2009 over 78,000 breast reduction procedures were performed in the United States.

The reasons to consider breast reduction include:

1) back pain

2) skin rashes under the breasts

3) pain from bra strap grooving

4) inability to exercise.

5) feelings of unattractiveness

Previous reports have shown that for many patients, breast reduction surgery can become a stimulus for further weight loss. However, many obese patients who do have severe breast enlargement are now considering both massive weight loss surgery (gastric bypass, lap band, etc.) and breast reduction. In these patients the question arises: Which operation should I have done first…breast reduction of gastric bypass?

Commonly the answer lies in the severity of symptoms related to breast enlargement. There is no question that breast reduction surgery provides almost instantaneous relief of most of the symptoms related to having severely enlarged breasts, namely back pain, shoulder pain and rashes. However, when plastic surgeons perform breast reduction surgery, we are aiming to provide the best shape possible for the new, smaller, reduced breast tissues. Rarely considered, is what will happen to the volume and shape of the breast tissues when breast reduction patients then go on to lose massive amounts of weight. Since breast tissue is comprised of significant amounts of fat, subsequent weight loss will certainly result in a further decrease in breast volume.

A recent study looked at just this issue (Plastic and Reconstructive Surgery, Breast Reduction and Massive Weight Loss, Vol 128, Number 3, p643, September 2011). The investigators noted that the majority of patients were glad that they underwent breast reduction surgery prior to undergoing surgical weight loss. However, most of the breast reduction patients reported a decrease in the satisfaction with the appearance of their breasts following massive weight loss. Some patients may have medical problems resulting from their enlarged breast that dictate breast reduction surgery be done early. However, if some morbidly obese patients with enlarged breasts can wait to have their breast reduction surgery until after their post-weight loss surgery weight loss, they may ultimately be more satisfied with their breast aesthetic.

Skin Anatomy

A recent study from a comprehensive Dutch national cancer registry showed that almost 30% of patients diagnosed with a first pathologically confirmed basal cell carcinoma will develop one or more additional primary basal cell carcinomas within 5 years. During 5 years of prospective follow-up in PALGA, the Dutch nationwide network and registry of histology and cytopathology, 29.2% of the patients (2483 patients were studied) were diagnosed with one or more additional primary basal cell carcinomas. More than one-third of patients who developed a second primary basal cell carcinoma within 5 years did so during the first 6 months after diagnosis of the first.

These results would seem to indicate that aggressive annual follow-up with full body examinations should continue for a minimum of 3 years after a patients first basal cell carcinoma diagnosis.
The cumulative risk during the first 6 months of follow-up was extraordinarily high at 11.2%, as compared with 13.9% through 1 year, 18.5% after 2 years, 22.1% at 3 years, 25.5% after 4 years, and 29.2% after 5 years. This translates into an incidence rate of 25,318 cases per 100,000 person-years during the first half-year after diagnosis of a first primary tumor. In an analysis of this study, men had an adjusted 30% increased risk of developing one or more subsequent basal cell skin cancers, and patients aged 65-79 years had an 81% greater risk than those under age 50.

How the results of this study translates to Los Angeles skin cancer patients remains to be seen. In the meantime, continue to wear your sunscreen and maintain close follow-up with your doctor. If you think you have a suspicious skin lesion, contact your dermatologist or Dr. Brenner.

This patient previously underwent closed rhinoplasty several years prior to presenting to my office for corrective nasal surgery. Specifically, this patient’s complaints involved the following:

1) Unattractive appearance of the nasal tip: She did not like the visibility of her nasal tip cartilages through her skin.

2) Retraction of the nostril rims: She did not like the appearance and position of her nostrils and felt that others could see up her nose in photographs.

3) Inability to breath through her nose: She related a history of progressive nasal airway obstruction since her last operation. The patient is quite athletic, and noted an inability to move air through her nose all the time. This was particularly troublesome during exercise.

Operation in detail:

1) Open approach, revision rhinoplasty. The correction of the internal airway and complex nasal tip reconstruction required an open approach via a transcolumellar incision.

2) Correction of alar malposition & nasal tip reconstruction. The orientation of the nasal tip cartilages was incorrect and resulted in a very unnatural tip appearance.  Further, the cartilages had been asymmetrically trimmed  and over-reduced during the primary operation. Reconstruction required alar extension grafts made from septal cartilage. The native weakness of the left ala required placement of a small PDS rhinoplasty plate.

3) Correction of alar retraction. The nostril rims were lowered by placement of composite ear cartilage grafts on both sides.

4) Correction of tip position. The nasal tip lacked support and had an unnatural orientation. This was corrected with placement of an angled columellar strut between the medial crura (tip cartilages).

5) Correction of nasal airway obstruction. The patient had internal valve collapse as a result of her primary operation. The was corrected by reconstructing the middle vault with placement of spreader grafts.

6) Correction of dorsal inclination and irregularities. The patient’s bridge was lowered, and the both visible and palpable bony irregularity was removed.

7) Correction of nasal skin scarring. The patient had an incredibly thin skin envelope that was scarred down to the underlying bones. This was corrected by placing a lining graft along the nasal bridge of deep temporal fascia.

Revision Rhinoplasty Before

Revision Rhinoplasty After

Revision Rhinoplasty Before

Revision Rhinoplasty After

Revision Rhinoplasty Before

Revision Rhinoplasty After

Revision Rhinoplasty Before

Revision Rhinoplasty After

Before Breast Implant Removal

After Breast Implant Removal

Before Breast Implant Removal

After Breast Implant Removal

Occasionally, I will have patients come to me and request breast implant removal without replacement.  Many women are hesitant to do so for several reasons. For one, they have all already gone through the cost and effort that was involved with their breast implant placement operation. However, foremost among these reasons is that they are afraid that their breasts will look bad after their breast implants are removed.

The patient pictured above underwent breast augmentation with saline implants along with a circumareolar breast lift (aka Benelli Mastopexy) by another surgeon several years prior to presenting to my office. Although she was happy with result from her primary operation, she simply just did not want her implants any longer. This patient underwent removal of her breast implants along with a partial anterior capsulectomy. She ended up with a good result. The only appreciable difference is a clear loss of  breast volume.

I usually recommend that when women decide to have their implants removed, that they also have the surrounding capsules removed as well (capsulectomy). Although this decision may differ amongst patients, if the capsules are left in place there is a distinct risk of developing a seroma in the old implant space.

Rox Center to Sponsor STOP CANCER RUN

Thank you to all of my patients, colleagues, family and friends who have already lent their support for the 2011 STOP CANCER walk. This Sunday, my colleagues will be joining me for the STOP CANCER walk at Woodley Park. ROX Center is an official sponsor of the event this year.  If you would like to support me, or even better join me in this most worthy charitable endeavor, please visit the respective links to learn more.

Information about STOP CANCER and the race:

In partnership with STOP CANCER, I.C.O.N./Cure for a Cause and Krav Maga Worldwide/The Marni Fund will be holding a a charity run. In 2011, we have increased the stakes and added a 10K run to the 5K Run/Walk from last year with proceeds benefiting cancer research at UCLA, USC and City of Hope Comprehensive Cancer Centers.

Join TEAM ROX for the STOP CANCER 5K/10K Run.

The collaboration of a rapidly growing international hair care products company, a unique and world-renowned self-defense organization, all in partnership with STOP CANCER, serves as an extraordinary demonstration of the success of fundraising partnerships to accomplish an enormously important mission: developing new therapeutics, diagnostic procedures and the ultimate goal … a cure for a disease that touches so many lives.

As part of STOP CANCER’s unique arrangement with the three NCI-designated Comprehensive Cancer Centers, each Research Award granted to scientists is matched by each of these institutions in the form of in-kind support, effectively doubling its value.

Your charitable donation can help amplify my hard work.

Thank you,
Kevin Brenner, MD, FACS

Techniques in Revision Rhinoplasty

When it comes to rhinoplasty surgery, choosing the right surgeon is crucial.  After completing his residency in plastic surgery, Dr. Brenner devoted another year to specialized training in rhinoplasty surgery. This specialized training, along with an extensive interest in advancing the field of rhinoplasty surgery have opened the opportunity for Dr. Brenner to publish his knowledge on advanced techniques in rhinoplasty in a wide range of surgical journals and books. Most recently, Dr. Brenner wrote two new chapters, along with co-author Dr. Jay Calvert, in the surgical textbook Master Techniques in Rhinoplasty (Azizzadeh, Murphy, Johnson and Numa, editors, copyright 2011). The first chapter, Rib Grafting Simplified, reviews the techniques that Dr. Brenner uses to harvest rib cartilage for use during revision rhinoplasty. The second chapter, Saddle Nose Deformity, reviews Dr. Brenner’s approach to correcting a formidable problem in revision rhinoplasty patients; namely the saddle nose deformity.

Rox Center to Sponsor STOP CANCER RUN

As a Board-Certified Plastic Surgeon, every week I enjoy helping cancer patients rebuild and restore their lives through reconstructive plastic surgery. I am proud to be a member of STOP CANCER, a wonderful organization that is helping attack cancer on a whole new level.  This year, I have enlisted the help of my surgical colleagues from ROX Center to join me in this race, and help me to sponsor the event. If you would like to support me, or even better join me in this most worthy charitable endeavor, please visit the respective links to learn more.

Information about STOP CANCER and the race:

In partnership with STOP CANCER, I.C.O.N./Cure for a Cause and Krav Maga Worldwide/The Marni Fund will be holding a a charity run. In 2011, we have increased the stakes and added a 10K run to the 5K Run/Walk from last year with proceeds benefiting cancer research at UCLA, USC and City of Hope Comprehensive Cancer Centers.

Join TEAM ROX for the STOP CANCER 5K/10K Run.

The collaboration of a rapidly growing international hair care products company, a unique and world-renowned self-defense organization, all in partnership with STOP CANCER, serves as an extraordinary demonstration of the success of fundraising partnerships to accomplish an enormously important mission: developing new therapeutics, diagnostic procedures and the ultimate goal … a cure for a disease that touches so many lives.

As part of STOP CANCER’s unique arrangement with the three NCI-designated Comprehensive Cancer Centers, each Research Award granted to scientists is matched by each of these institutions in the form of in-kind support, effectively doubling its value.

Your charitable donation can help amplify my hard work.

Thank you,
Kevin Brenner, MD, FACS

Dr Kevin Brenner New Office Location Encino/ Sherman Oaks

In an effort to better serve the patients of our growing practice, we are excited to announce that we are moving to a new location in the Sherman Oaks/ Encino area. The new office location is one half block west of our old location, but is now in Encino, California.

Dr. Brenner will continue to provide comprehensive patient care in the near valley including Tarzana, Encino and Sherman Oaks.  Plastic Surgery services will still include Mommy Makeover, Breast Augmentation, Revision Breast Implant Surgery, Tummy Tucks, Rhinoplasty (Nose surgery), Repair of Lacerations and Soft Tissue injury and Repair of Skin Cancer Defects.

Kevin Brenner, M.D., F.A.C.S
15503 Ventura Blvd., Suite 370
Encino, California 91436

(just 6 blocks west of the 405 on Ventura Blvd.)

Sherman Oaks Plastic Surgery    Encino Plastic Surgery   Tarzana Plastic Surgery

Los Angeles Mommy Makeover

When evaluating patients for a Mommy Makeover (or for post-bariatric body contouring surgery), I spend a great deal of time planning the correct and most effective breast operation.  The correct operation is directly related to the extent of the breast deformity or abnormality that exists prior to surgery. This can include breast augmentation with implants,  breast lift (mastopexy),  breast reduction, or breast lift with breast augmentation (mastopexy-augmentation). Each of these operations has inherent benefits and risks and potential complications. However, amongst leading plastic surgeons the topic of one stage breast lift and breast augmentation with implant is the most controversial. Some plastic surgeons feel that these two procedures should not be performed together in one operation. However, in my experience these two operations can be performed together safely and effectively. I feel so strongly about this operation that I routinely use this technique for my Los Angeles Mommy Makeover patients.

Since the plastic surgery literature offers conflicting views on this issue, my plastic surgery colleagues (at The Rox Center) and I decided to publish our very positive experience using this technique with our patient base.  In our article (Calvert, JW, Dickinson, BP, Patel, A, & Brenner, K.,  Lateral Breast Flap With Superomedial Pedicle Breast Lift,  Aesth Surg Journal, 31: 658. August, 2011), we detail the use of this technique in our series of  Los Angeles Mommy Makeover patients and Los Angeles Massive Weight Loss patients. In short, this new technique is very useful since it allows auto-augmentation of the breast while providing total breast implant coverage and additional breast implant support. We believe that this technique will prevent a significant number of revisional breast surgery cases for problems such as “bottoming-out,” and late breast implant malposition that can occur with some one-stage mastopexy-augmentation operations.

Have you considered switching to Mentor Silicone Implants?

If you have previously undergone breast augmentation with saline breast implants, and are considering changing to silicone implants, this may be your best opportunity. Mentor corporation (the manufacturer of Mentor Memory Gel Breast Implants) has launched their “Feel The Difference” campaign to help promote the comfort, natural feel and safety of silicone gel breast implants. While in effect (through August 31, 2011), any patient who chooses to switch her saline implants out for silicone gel implants will receive a $250.00 American Express Gift Card. Call Dr. Brenner’s office now to learn more.

Beverly Hills Breast Augmentation Saline Implants Before

Beverly Hills Breast Augmentation Saline Implants After

This patient is a 25 year female who presented for breast augmentation surgery. Her primary goal was to feel more confident when wearing a bra, bikini and low-cut tops. She underwent breast augmentation with Mentor Smooth Round Moderate Plus Saline implants in the sub-muscular position.

This patient chose saline breast implants for herself and had a great result with them. Many of my patients choose saline breast implants for their augmentation surgery. The most common reason that women choose saline implants is due to their fear of silent rupture, which can occur with silicone gel breast implants. However, saline implants also cost less and can easily be placed without the help of a Keller funnel. Further, saline implants can be monitored over time without the need for MRI.  Silent rupture almost never occurs with saline implants. Should the saline implant shell suffer a breach, they commonly deflate completely (symptomatic rupture). The saline will then leak into the breast capsule, and slowly absorb into the patient’s bloodstream over time. Less commonly, a saline implant can have a slow leak (usually from the area around the fill valve) whereby the implant will slowly lose volume over a period of weeks or months.

Pre-operative photo demonstrates severe inferior breast implant malposition.

Post-operative view after breast implant revision shows improved implant position.

This lovely patient presented to me for revision breast surgery with the complaint that her breast implants were “bottoming out.”  The patient was particularly distressed with this result (breast implant malposition)  since she had already undergone two previous breast operations with another surgeon.

Her previous operative sequence was the following:

1) Bilateral mastopexy 7 years prior to this presentation.

2) Breast augmentation with 475 cc Moderate Plus style saline implants, filled to 550 cc, two years prior.

The patient’s desires in this case were twofold:

1) To make her breasts look ‘perky’ again.

2) To downsize her implants slightly.

The patient underwent the following operation during her revision breast surgery:

1) Revision mastopexy

2) Removal & Replacement of Moderate Plus saline implants, with reduction of 50 cc volume from each side.

3) Inframammary fold creation with COOK Biodesign sling for implant support.

4) Reinforcement with a caudally-based autologous breast flap.

Sun exposure while driving can increase skin cancer risk.

Let’s face it. If you live in Los Angeles, there is a very good chance that you drive a car on a daily basis.  Although automotive windshield glass can effectively block UVA and UVB sun rays, untreated side windows  still allow UVA rays to penetrate though to your skin.  As a result, car drivers in the United States tend to develop significantly more sun damage on the left side of their faces. Cumulative sun exposure (even in the enclosed space of your car) can result in an increased amount of wrinkle formation, skin sagging (due to a loss of elasticity), brown “age” spots, and even skin cancer formation. This can include an increased risk for Basal Cell Carcinoma, Squamous Cell Carcinoma or even pre-melanoma (i.e. melanoma in-situ).

So what can you do to reduce your risk?

1) Apply sun-screen (with SPF 15 or higher) to any sun-exposed skin areas. To make your life easier, and increase your own compliance, keep a bottle of sunscreen handy in your car’s glove box.  It will be helpful to check your sunscreen and make sure that it contains one or more ingredients that block UVA rays…such as zinc oxide, titanium dioxide, avobezone and ecamsule. You may have to reapply sunscreen several times over the course of the day, depending on your activity level and the amount of sweating that you do.

2) Wear protective clothing when possible. This can include long-sleeved shirts, sunglasses (with UV protection), and brimmed hats. Hats are particularly important for patients with thinning hair or who are bald so that the scalp skin remains protected as well.

3) Tint your windows…when possible…and if legal. There are window tints that will block UVA rays.  In California, it is legal to have a light tint on the side windows. However, you should check with your local law enforcement agency to make sure that your tinting will be in compliance with local laws so that you do not receive a ticket.

4) Pixel laser resurfacing. Although having a Pixel fractionated erbium laser treatment will not prevent any sun exposure that you have already had, it can reduce the visible signs of sun damage on your face and hands. Pixel treatments will smooth out many fine lines, and can completely resurface your skin. However, Pixel treatments will not reduce your relative risk of developing skin cancers.

Moh's Surgery for removing Skin Cancer on the face

Today Mohs Surgery or Moh’s Micrographic Surgery is a well-established technique for removing skin cancers. The basic premise is that the skin cancer can be excised directly under local anesthesia. The tumor and surrounding tissue are oriented, mapped and then sectioned for evaluation under a microscope. In this manner, the tumor can be evaluated microscopically in real time. When tumor cells are identified at the border of the excised specimen, additional tissue can be removed in a very precise manner, since the location has been previously mapped. The advantage of this techinque is that it hopefully minimizes the size of the resulting defect, by keeping to a minimum the amount of “normal” surrounding skin (i.e. the margin) that is removed with the specimen.

In general, the indications to proceed with Moh’s Surgery (as opposed to traditional tumor excision) are the following:

1) Recurrent Skin Tumors

2) Tumors >0.6cm on the face (or >2.0 cm on the body)

3) Tumors in high-risk anatomic or cosmetically sensitive locations (eyelids, nose, ears, lips, fingers)

4)Tumors with indistinct clinical margins (or with a positive margin after a surgical resection)

5) Tumors arising in sites that had previous radiation or chronic scars (i.e. marjolin’s ulcers)

6) Aggressive Tumor types (micronodular, infiltrative, & morpheaform BCC,  & invasive SCCA)

7) Tumors in immunosuppressed patients