M. Hugh Bailey, M.D., F.A.C.S., Plastic Surgeon

"If you think health care is expensive now, wait until you see what it costs when it's free." ~ P.J. O'Rourke

Surgeons have used silk for thousands of years, generally as a stitch material. This month I travelled to New York, as a guest of Allergan, to attend a workshop about their silk mesh product - Seri. The silk is specially treated to reduce allergic reactions, and as it absorbs, the body replaces it with a layer of fibrous tissue. I have previously used Seri successfully for difficult revision breast augmentations and breast lifts, but I learned new techniques to use Seri in ...breast reduction and abdominal bulging as well. Part of the time was spent demonstrating surgical methods on bodies donated to Cornell’s anatomy laboratory. This was very helpful, and we held a moment of silence to honor those people’s final gift. Seri is an alternative to so-called dermal matrices (Alloderm, Strattice, XTC, etc.) which are processed skin from people who died or animals, and synthetic polypropylene mesh in the abdomen. There have been some problems with these products, and it is good to have another choice. Seri may help in these situations: - Reconstruction after breast cancer - Visible irregularities from your breast implants - Spreading of the pigmented area around the nipple - Bulging of the area around the nipple - Failure of a breast lift - Unusual bulges in your abdomen after previous surgery.

I visited Mentor's breast implant manufacturing facility in Dallas, TX last month. Their non-disclosure agreement limits what I can say, but seeing the production lines, and talking to the engineers and employees responsible was fascinating. It reinforced my feeling that the new generation of shaped, "form stable" breast implants are the biggest step forward in 20 years for both breast reconstruction and breast augmentation. I have been using both Allergan's and Mentor's shaped implants for several months now, and my patients are also really liking the results - one 70+ year old revision patient called them "my new 16 year old breasts"!

Here is another link that a patient sent me, with a thoughtful discussion of risk: http://www.sciencebasedmedicine.org//breast-implants-and-/ When your read all these articles, look at the dates, and remember that our knowledge is evolving. I expect bigger and better studies will be published within the next year.

A paper on the American Society of Plastic Surgeons' website - a polling of breast implant experts by the Rand Institute about the ALCL issue, shows that plastic surgeons agree that patients with implant problems should have further testing, but do not agree on what the risk factors are: http://www.plasticsurgery.org//k/Rand-2-article-041911.pdf

The FDA continues to update its general information page on breast implants too - and links to their current position on breast implants and ALCL - www.fda.gov/breastimplants

Textured breast implants and ALCL are reported in an Australian paper published this month - http://journals.lww.com//Anaplastic_Large_Cell_Lymphoma_an

3 per 100 million women get ALCL of the breast yearly. Some have implants. I treated a patient with ALCL of the breast, identified in scar tissue around the implant. The FDA does not advise removing problem-free implants. ALCL is very rare, but problems such as implant rupture are more common, and need prompt treatment. If you have implants and problems such as swelling, pain, hardening or lumps, see your surgeon.

Free Latisse - we are signing up new or redo breast augmentation patients for Allergan's current promotion which gives you a free prescription of Latisse. The feedback on Latisse has been over 90% positive - patients love their longer, thicker lashes.

Taking care of those beautiful breasts includes NO PUSH UPS (or other frequent heavy upper body work-outs) unless your implants are above the pectoral muscles. I have seen several patients recently who ruptured or moved their implants years after surgery, but soon after starting new workout programs. People often forget that push ups are the same as lifting 60 or 80 lbs.

Watch those kids! This past month, two of my patients have hit their new nose on a child's head. One patient was injured enough to need a second surgery.

Patients are really noticing that the new Juvederm XC (which contains local anesthetic) is more comfortable for them. Strange that the website doesn't mention this....

Injecting fillers safely takes training, knowledge of anatomy and a safe FDA approved injectable!