About Dr. Brooke Seckel

Dr. Brooke Seckel is a Boston Plastic Surgeon who has special expertise in Breast Augmentation, Facelift, Tummy Tuck and Eyelid Surgery. He has been named Top Plastic Surgeon in Boston by Boston Magazine, Best Doctors in America, and Top Surgeons in America. His offices are at 170 Commonwealth Avenue, Boston Massachusetts 02116 and at Emerson Hospital in Concord, Massachusetts 01742.

Breast Augmentation with Breast Asymmetry

Almost all my Boston breast augmentation patients are surprised to learn during their initial consultation that they have breast asymmetry. I reassure my patients that 88% of women have different sized or asymmetrical breasts and it is normal to have breast asymmetry.

 I believe that most patients are not aware of their breast asymmetry because women do not study their breasts visually carefully.  However once patients have breast implants especially in the first weeks after surgery they study their breasts carefully in the mirror. It is important that they know ahead of time to expect to see the normal minor asymmetries that they had before surgery.

What are the most common breast asymmetries?

  • Most common breast asymmetry is difference in the inferior level of the inframammary crease-the fold under the breast = 55%
  • Nipple position asymmetry-53%
  • Breast volume/size asymmetry 44%
  • Breast base constriction causing a triangular shaped breast 29%
  • Chest wall asymmetry 9%

When is minor modification of one breast needed during breast augmentation with breast asymmetry?

  • When there is asymmetry of the level of the fold underneath the breast careful lowering of the higher fold can be done.
  • Minor asymmetry of nipple position does not require modification. However, a major asymmetry may require lifting as described later.
  • Breast volume asymmetry if significant for example one breast is 100cc smaller in some cases a larger breast implant is placed on the smaller breast side.
  • Breast base constriction causing a triangular shaped breast can be corrected by a procedure to release constricting bands in the lower pole of the breast during breast augmentation. This allows the breast implant to expand the constricted breast and create a rounded breast shape.
  • Chest wall asymmetry occurs usually when one side of the chest or rib cage is higher than the other side. This can push the implant more forward and make the breast on that side look larger. Usually if the patient agrees the same size breast implants are used on both sides. However, if intraoperative sizing with saline filled breast implant sizers demonstrates that a smaller implant on the higher side of the chest creates better symmetry then a smaller implant can be used on that side.

When is major modification of breast augmentation needed to correct a breast asymmetry?

Some patients present with a major breast asymmetry. In my experience this involves one breast sagging much further down on one side of the chest. The sagging breast is called mammary ptosis. In these cases the lower breast is lifted with a procedure called a dermal mastopexy and implants are usually placed on both sides. See below:

Before and after Breast Augmentation with lift of lower breast to correct breast asymmetry

Bilateral breast augmentation with lift of lower breast to correct breast asymmetry

Most breast asymmetries do not require modification and same size breast implants are used during breast augmentation.

In most patients the degree of asymmetry is mild, and most patients are used to their minor asymmetry and the same sized breast implants are used.

However, I use saline filled breast implant sizers to check the position and adequacy of the breast implant pocket before inserting the final implant. With permission from the patient I can evaluate whether a larger implant in the smaller breast looks better and use the larger implant if it looks better if the patient requests that I make this judgement.

Mentor® Memory Gel® Xtra Breast Implants

My Breast Augmentation patients often request a fuller breast profile with volume above the nipple areola when considering breast implants. This is especially true in patients who have had children and feel that their breasts look empty and sagging after breastfeeding. The new Mentor® Memory Gel® Xtra Breast Implants are precision-filled with a proprietary cohesive gel that provides increased breast projection above the nipple areola with a soft natural feel.

Mentor® Memory Gel® Xtra Breast Moderate Plus Breast Implant

Mentor® Memory Gel® Xtra Breast Moderate Plus Breast Implant

Mentor® Memory Gel® Xtra Breast Implants give more fullness above the nipple areola.

Mentor® Memory Gel® Xtra Breast Implants with Breast Projection and fullness above the nipple

Memory Gel® Xtra Breast Implants provide fullness above the nipple areola and project the breast

Many women who choose to have breast augmentation today request that extra fullness above the nipple areola be achieved after breast implants. In time some standard breast implants drop to a point where much of the implant rests below the nipple areola. While this creates a nice sloped natural look from the side view, today’s women often request more cleavage and a fuller look above the nipple areola. The Mentor® Memory Gel® Xtra Breast Implants with their special cohesive silicone gel and specially designed implant shell provide a breast shape that has more fullness above the nipple areola and more projection of the breast. These breast implants are still very soft and natural feeling.

Mentor® Memory Gel® Xtra Breast Implants improve projection of sagging breasts.

Mentor® Memory Gel® Xtra Breast Implants enhance fullness above nipple

Mentor® Memory Gel® Xtra Breast Implants enhance fullness above nipple

Many women report that, after breast feeding or weight loss, their breasts feel empty and sag. In these patients if the nipple is at or above the level of the Inframammary Fold, which is the fold underneath the breast, the Mentor® Memory Gel® Xtra Breast Implants increase the projection of the breast. This can create a lifting appearance, and also restore volume to the breast. If, however the nipple lies below the level of the fold underneath the breast then a formal breast lift is needed in addition to an implant to restore the breast after breastfeeding.

Mentor® Memory Gel® Xtra Breast Implants provide more natural breast firmness.

Mentor® Memory Gel® Xtra Breast Implants are soft and create a Natural look

Mentor® Memory Gel® Xtra Breast Implants are soft and create a Natural look

The cohesive silicone gel used in these new breast implants feels soft and natural. However, the gel also has more firmness than other implants to help hold the desired breast shape over time. This contributes to both the fullness and projection above the nipple areola which enhances cleavage.

Mentor® Memory Gel® Xtra Breast Implants cohesive gel stays in place in case of implant rupture.

MemoryGel-Xtra breast implant cut in half

MemoryGel-Xtra-cut in half-note cohesive silicone gel does not run out but stays in place in case of implant rupture

Cohesive silicone gel breast implants, sometimes called Gummy Bear Implants, are constructed of a silicone gel that feels soft, but unlike the older liquid silicone implants, stays in place if the implant ruptures. This is an important safety factor.

Mentor® Memory Gel® Xtra Breast Implants have a lower chance of capsular contracture.

These new breast implants have a lower chance of hardening or capsular contracture than many similar breast implant brands. When combined with the No Touch Breast Augmentation Technique and the use of the Keller Funnel for implant insertion this rate of capsular contracture can be reduced to less than 2%.

Mentor® Memory Gel® Xtra Breast Implants are made in the USA

I have used Mentor Breast Implants exclusively for thirty-six years and have been very happy with the quality of these implants. The fact that they are made in this country is an extra benefit.

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SecretRF™ Radiofrequency Microneedling Skin Rejuvenation and Wrinkle Removal

SecretRF™ Radiofrequency Microneedling is an exciting new non-surgical method for skin rejuvenation including wrinkle removal, skin firming, pigment removal and acne scar improvement.

How to rejuvenate facial skin without surgery

All non-surgical skin rejuvenation methods rely on stimulating the formation of new skin collagen to firm, plump, and tighten the skin and remove wrinkles. Examples are lasers, IPL Photofacial, Surface Radiofrequency devices and other types of heat producing energy machines. These devices are designed to heat the deep skin collagen and stimulate the production of new collagen to rejuvenate the skin. Only deep new skin collagen produces effective skin rejuvenation.

To get heat energy deep enough to stimulate new collagen with lasers and other skin surface devices the skin surface must be cooled so the heat can get deep into the skin without burning the skin surface. Cooling the skin and the risk of burning the skin limits the effectiveness of laser, IPL, surface RF(Radiofrequency) and other devices applied to the surface of the skin.

What is different about SecretRF™ Radiofrequency Microneedling Skin Rejuvenation? 

Before and after photo of SecretRF Microneedle handpiece on patient's facew

SecretRF Microneedle Handpiece On Patient’s Face(Photo Courtesy of Zarin Medical)

SecretRF uses minimally invasive gold-plated microneedles to deliver RF energy directly into the deeper layers of the skin dermis avoiding injury or burn to the skin surface. This produces a controlled thermal injury to deep dermal tissue causing new collagen production which plumps and tightens the skin more effectively than surface treatments. Unlike lasers and RF applied to the skin surface, there is less risk of burning the surface of the skin which results in a safer treatment with less down time. The clinician can control the depth that the needles penetrate (from 0.5mm to 3.5mm) and the amount of the energy, thus, treatments can be customized for the individual patient and treatment goals.

Diagram showing how SecretRF Microneedles interact with the skin to promote new collagen formation

Diagram showing how SecretRF Microneedles interact with the skin to promote new collagen formation(Photo Courtesy of Zarin Medical)

What are the benefits of SecretRF™ Radiofrequency Microneedling for skin rejuvenation?

Before and after photo of skin wrinkle removal using SecretRF Microneedling

Before and After SecretRF Microneedling Treatment of wrinkles-after 6 treatments 4 weeks apart(Photo Courtesy of Zaren Medical)

  1. SecretRF microneedling is used to treat loose skin and wrinkles on the face, around the eyes, the cheek, jowls, neck, décolletage, arms and hands. It is also excellent on acne scars and other scars.
  2. Secret RF is safe for most skin types.
  3. There is low risk of hyperpigmentation.
  4. Secret RF Microneedling is usually well tolerated by patients requiring only topical numbing cream
  5. There is reduced down time, 6-24 hours of pink appearance like a sunburn and most patients will return to work the next day.

Why is SecretRF™ Radiofrequency Microneedling better than RF alone or Microneedling alone?

There is a big difference in the way that RF energy is delivered into the dermis between traditional RF and SecretRF microneedling.

Traditional RF therapy transmits RF energy through a handpiece sitting on the skin surface. This method delivers RF at a lower energy level (to avoid a burn) producing less collagen stimulation and the risk of thermal injury to the skin.

SecretRF microneedling uses the microneedles to deliver the RF energy directly into the deep dermis where maximum stimulation of new collagen can be produced for effective skin rejuvenation without burning the skin surface.

What to Expect during SecretRF™ Radiofrequency Microneedling Treatment

  1. Topical numbing cream will be applied to the treatment area which takes 20-30 minutes to take effect
  2. During the procedure the handpiece is moved over the treatment area, stamping the skin with the fine microneedles and delivering the RF energy. Each time the skin is stamped you might feel a prickling sensation and warmth lasting a fraction of a second.
  3. The treatment takes 10-45 minutes depending on the size of the area to be treated.
  4. Your skin will be pink, warm and tingling immediately after the treatment (like sunburn) and sensitive to sunlight, but there will be no significant pain. Pink color will settle over 3-24 hours.
  5. RF microneedling does break the skin surface, so minor pinpoint bleeding can occur. Significant bruising is very rare.
  6. Mild swelling might be noticeable immediately after the procedure but settles within 12- 72 hours.
  7. Most patients will return to work the next day without any obvious effects.

When will I see results after SecretRF™ Radiofrequency Microneedling?

Before and After Photo of SecretRF Microneedling Treatment to Improve Skin Texture

Before and After SecretRF Microneeedling to Improve Skin Texture(Photo Courtesy Zarin Medical)

Collagen production and remodeling takes time. The beneficial effects of SecretRF microneedling can be seen after 4-6 weeks and continue to develop for up to 4 months after each treatment.

At least 3 treatments are recommended, each spaced 3 to 4 weeks apart. Most patients will see significant improvement after 4-6 treatments. The more treatments you have the more improvement you will see.

References:

  1. ©2017 Zarin Medical: SecretRF FAQ (All rights reserved): http://www.zarinmedical.com/products/product/24/secretrf-rf-microneedling
  2. Photos courtesy of Zarin Medical

 

Remove Dark Circles Under Eyes

Eye Circles: Cause and Cure

 

What Causes Dark Circles Under Eyes?

Dark circles under the eyes caused be a deprssion underneath the lower eyelid

Dark circles under the eyes. Notice the depression underneath the lower eyelid caused by the attachment of the skin to the bone underneath and the overhang of loose skin above creating a shadow in the dark circle

Dark circles under eyes are the second most common concern that people have about facial aging, second only to skin wrinkles.  Many people seek advice on how to remove dark circles under eyes. Dark circles under eyes are caused by the attachment of the skin beneath the lower eyelid to the underlying bone of the eye socket by a structure called the arcus marginalis. As the lower eyelid skin ages above this depression it becomes loose, eyelid fat pushes out on the eyelid and an eye bag is formed. This eye bag creates a dark shadow in the depressed attached skin below the eyelid, called the dark circles under eyes. 

How do you remove dark circles under eyes?

transconjunctival lower eyelid bleharoplasty incision location

A laser incision is made on the inside of the lower eyelid to avoid a visible eyelid scar

A small transconjunctival laser blepharoplasty incision is made on the inside of the eyelid so that there is no visible scar on the outside.  The arcus marginalis which is holding the dark circles tight to the bone is released from the bone to remove the depression that is causing the dark circles under eyes.  A small piece of fat is custom carved to a shape and size that will plump the dark circle depression. No fat is injected. I never use fat injection in the eyelid as most of the injected fat dissolves and can cause lumps!

A laser transconjunctival blepharoplasty incision is made in preparation to remove dark circles under the eyes

The actual laser transconjunctival blepharoplasty incision is made in preparation for removal of dark circles under the eyes. Notice the incision is bloodless


What is the dark circles under eyes surgery like?

The dark circle removal surgery using the transconjunctival blepharoplasty with a fat graft takes only 30-45 minutes.  I use general anesthesia so that you are asleep and not aware of the procedure being done on your eyes.

transconunctival blepharoplasty fat graft to remove dark circles under the eyes

A custom sculpted whole piece of fat is prepared to place underneath the dark circle to remove dark circles under the eyes

placing a fat graft into the eyelid to remove dark circles under the eyes

The fat graft is placed into the lower eyelid to plump the depression causing the dark circles under the eyes and remove the dark circles under the eyes

What is recovery from dark circle under eyes surgery like?

removal of dark circles in the eyes with transconjuunctival blepharopalsty with arcus marginalis release and fat grafting

Before and after removal of dark circles under the eyes with transconjunctival blepharoplasty with arcus marginalis release and fat grafting in a young person

There is no pain during recovery.  I use frequent eye drops for comfort and to avoid the eye becoming dry.  Because of the drops and ointment, it may be difficult to read or use a computer the first 2-3 days after surgery.  You will keep your head elevated when in bed with pillows for the first week after surgery.
The main recovery time is the time it takes for bruising to go away.  This can take 2-3 weeks but makeup and colored glasses can cover bruising.


Is removal of dark circles under eyes permanent?

Removal of dark circles under the eyes using this procedure which is called a laser trans-conjunctival lower eyelid blepharoplasty with arcus marginalis release and fat grafting is permanent.

 

Textured Breast Implants Health Risks

Recently the Federal Drug Administration (FDA) released information on breast implant associated anaplastic large cell lymphoma (BIA-ALCL) a rare tumor associated with textured breast implants used in breast reconstruction and cosmetic  breast augmentation. This rare tumor has been studied and updates provided since 2011.

What is BIA-ALCL?

Breast implant associated anaplastic large cell lymphoma is a rare form of lymphoma that develops adjacent to textured breast implants. Only about 300 cases have been reported in an estimated 5,000,000 patients with breast implants. An estimated risk in patients with textured breast implants is 1 in 30,000. BIA-ALCL has never been reported in patients with smooth walled silicone or saline breast implants. BIA-ALCL is NOT BREAST CANCER.

What is a textured breast implant?

Most silicone and saline breast implants have a smooth outer silicone rubber shell that contains either silicone gel or saline. Textured breast implants have a rough, irregular pebbly surface that is not smooth. See the image below: to compare textured breast implant with smooth walled breast implant.

Textured breast implant shaped – Boston Plastic Surgery Specialists

Textured breast implants shaped

 

smooth walled silicone gel breast implant not associated with BIA-ALCL-breast implant associated anaplastic large cell lymphoma

Smooth walled cohesive silicone gel breast implant

Why were textured breast Implants used?

Textured breast implants were developed because studies showed that textured breast implants were less likely to develop hardening of scar tissue around the breast implant, a condition called capsular contracture.

In addition, the wall of the textured breast implant is thicker, more rigid and allowed for the production of specially shaped, tear drop shaped breast implants which had advantages in breast reconstruction after mastectomy and in some cosmetic cases.

What are common problems with textured breast implants?

While textured breast implants have been used successfully, mostly in breast reconstruction, there are some issues unique to textured breast implants that have made widespread use in cosmetic breast augmentation less common than smooth walled breast implants.

First, because the textured implant wall is thicker oftentimes the textured breast implant does not feel as soft as a smooth walled breast implant. In addition, because of the adherence of the textured implant wall to the surrounding tissues, the textured breast implants do not move as naturally with the body, and are not as freely movable within the breast implant pocket as are smooth walled breast implants.

Finally, if implant removal becomes necessary for any reason, the textured implant is adherent to the surrounding tissues and can be difficult to remove.

How often are textured breast implants used for cosmetic breast augmentation?

At a recent meeting of the American Society of Aesthetic Plastic Surgeons (ASAPS), a society of Board Certified Plastic Surgeons with experience and expertise in Aesthetic Plastic Surgery a survey was held in a course on breast augmentation/lift. The result of the survey was that 83% of these experienced surgeons present use smooth walled cohesive silicone gel breast implants.

 

What are the signs or symptoms of BIA-ALCL?

  1. Swelling of the breast due to fluid accumulation called a seroma.
  2. A palpable lump on the implant usually attached to the breast implant capsule, a membrane that forms around all breast implants normally but when abnormal, thickens and tightens around the implant.
  3. Average onset of symptoms is 8 years after implant placement but the range is 3-14 years.

How is BIA-ALCL diagnosed.

Physical exam by your plastic surgeon especially if you develop swelling or a lump in the breast and have textured breast implants.

If fluid accumulation is expected an ultrasound exam is done to confirm the presence of fluid, and fluid is drained to examine the fluid for presence of cells associated with breast implant associated anaplastic large cell lymphoma.

What should I do if I have textured breast implants?

BIA-ALCL is a rare occurrence even in patients with textured breast implants and fortunately produces detectable symptoms of seroma and can produce a lump or mass that can be felt on breast exam.

First be aware of whether you have textured breast implants by contacting your plastic surgeon or the facility where the implants were placed. Be conscious and aware of your breasts and if you develop swelling, especially on one side, or detect a lump, see a board certified plastic surgeon for an examination and possible ultrasound.

What if I develop BIA-ALCL?

Fortunately, BIA-ALCL is curable. The implants and implant capsule around the implants are removed completely. All known cases where diagnosis was not delayed have been 100% cured to date.

Can I have new breast implants after textured implants and BIA-ALCL is removed?

Yes, after an appropriate time for healing new smooth walled cohesive silicone gel or saline implants can be used to replace the previous textured breast implants.

What type of breast implants are used by Dr. Brooke Seckel for cosmetic breast augmentation?

We do not use textured breast implants for cosmetic breast augmentation. We use only smooth walled cohesive silicone gel or saline breast implants made by Mentor. Mentor breast implants are the only brand made in America and I have been using them successfully for 37 years.

Where can I find more information about Breast Implant Associated Anaplastic Large Cell Lymphoma occurring with textured breast implants?

Further information on breast implant associated-anaplastic large cell lymphoma can be found online at:

https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm241086.htm

https://www.plasticsurgery.org/patient-safety/information-on-bia-alcl

https://www.plasticsurgery.org/for-medical-professionals/quality-and-registries/bia-alcl-summary-and-quick-facts

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Breast Implant Capsular Contracture Prevention

A serious concern for many breast implant patients is the risk of the development of a breast implant capsular contracture. A breast implant capsular contracture can cause the breast implant to be hard, painful and the implant to be displaced upward. Fortunately, today we have a greater understanding of what causes breast implant capsular contracture and how to lessen the chance that this complication of Breast Augmentation with breast implants will occur.

Before and after breast implant capsular contracture with snoopy deformity front

Before and after bilateral capsular contracture around breast implants front view.Implants are hard and have moved up causing a Snoopy Deformity

What is breast implant capsular contracture?

A capsular contracture is the occurrence of excessive abnormal constricting scar tissue which forms around a breast implant. A normal breast implant capsule forms around all breast implants. However, a normal breast implant capsule is soft and flexible enough that it allows the breast implants to be soft and movable. When this normal capsule scars excessively and tightens around the implant making the implant hard and immovable a capsular contracture has occurred.

What Are the signs of breast implant capsular contracture?

The clinical signs of a capsular contracture are firmness or tightening of the implant which can be painful and can cause upward displacement of the breast implant. Breast implant capsules are categorized according to a Baker classification as follows:
Baker I-the breast is soft, movable and appears normal
Baker II-the breast is slightly firm but looks normal
Baker III-the breast is significantly firm but still appears normal
Baker IV-The breast is hard, looks abnormal, is often displaced upward and is painful(see photos below)

Before and after breast implant capsular contracture on right side with snoopy deformity

Before and after capsular contracture around breast implant, right view. Notice implant has moved up and is hard. Has also caused a Snoopy Deformity.

How often does breast implant capsular contracture occur?

Prior to the introduction of cohesive silicone gel or gummy bear breast implants in 2006 the rate of breast implant capsular contracture was often reported in as high as 30% of breast implant patients. However, the initial studies of the cohesive gel or gummy bear breast implants revealed a capsular contracture rate of 9.5% in Mentor breast implants and 14.8% of patients with Allergan breast implants.
More recently, with significant improvements in breast augmentation techniques including the no touch technique and the use of triple antibiotic irrigation the incidence of breast implant capsular contracture has been reduced to 1.8% in 1 study.

What causes breast implant capsular contracture?

The most likely cause of capsular contracture around the breast implant is the occurrence of a bacterial biofilm which forms around the breast implant during surgical insertion. Bacteria that are normally present in the nipple and areola are accidentally shed during surgery and contaminate the implant.
In addition, a hematoma or excess bleeding if not treated with surgical removal of the blood, can increase the chances of a capsular contracture.
However, in some cases there is no obvious explanation of why excessive scar tissue and capsule formation occurs.

How can the risk of breast implant capsular contracture be reduced?

Currently recommended guidelines to reduce the risk of capsular contracture following breast augmentation are the following:
1. Intravenous prophylactic antibiotic at the start of surgery
2. Avoid the incision through the areola
3. Cover the nipple areola with Tegaderm™
4. Inframammary crease incision underneath the breast
5. Dual Plane breast augmentation-placement of breast implant underneath the chest muscle
6. Careful dissection to avoid bleeding–meticulous hemostasis
7. Avoid dissection into the breast gland
8. New surgeon’s gloves, patient drapes and instruments prior to implant insertion
9. Implant pocket, surgeon’s hands, the breast implant and surgical field irrigation with triple antibiotic solution
10. Implant introduction sleeve or Keller Funnel for insertion of implant
11. No touch technique, do not touch the implant before, during and after insertion
12. Close the incision with multiple layers and avoid the use of drains
13. Prophylactic antibiotics in the future for dental work and other surgical procedures

How is breast implant capsular contracture treated?

Treatment of Baker III and Baker IV capsular contracture requires surgical removal of the capsule and implant. Insertion of a new implant wrapped in a bio membrane called Acellular Dermal Matrix such as Belladerm™ can reduce the chance of recurrence. There is some evidence that the use of an oral Asthma medication called Singulair™ can reduce the recurrence of capsular contracture after revision surgery.

A Better Outcome After Breast Augmentation

With the advances in Breast Augmentation techniques over the past ten years the chance of capsular contracture has been greatly reduced from over 30% to possibly as low as 1.8% under ideal circumstances. The use of the new cohesive silicone gel or Gummy Bear implants, the no touch technique, the use of the Keller Funnel™and triple antibiotic irrigation greatly increase your chances for a soft natural looking breast after Breast Augmentation.

Before and after breast augmentation with soft moveable breast implants without capsular contracture

Before and after breast augmentation with soft moveable breast implants without capsular contracture

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Do I Need a Breast Lift and Implants or Breast Implants Alone?

The most common question my breast augmentation patients ask me is whether they need a breast lift or mastopexy in addition to breast implants. This is especially common after patients have had children or have lost weight. The key factor in answering this question is whether you have mammary ptosis or sagging of the breast. If you have significant mammary ptosis then you will need a lift in addition to implants.

What is Mammary Ptosis or Sagging of the Breast?

The diagnosis of mammary ptosis depends on the position of the nipple relative to the inframammary fold or the fold under the breast also called the inframammary crease. If your nipple or a significant amount of breast tissue is hanging below the inframammary crease then you have mammary ptosis and will need a lift in addition to implants. Breast shape as relates to ptosis or sagging is categorized as follows:

1. Normal breast-The breast shape and position is considered normal if the nipple and breast gland is above the inframammary fold, the fold under your breast.

normal breast shape side view

Side view of normal breast shape

2. Pseudo ptosis – The breast gland is below the inframammary fold but the nipple is still above the fold.

3. Grade 1 ptosis– The nipple is at the fold under the breast but still above the breast gland.

4. Grade 2 ptosis– The nipple lies below the fold under the breast but still lies above the lowest point of the breast gland.

5. Grade 3 ptosis– The nipple lies below the fold under the breast and below the breast gland.

Different degrees of mammary ptosis or breast sagging

Different degrees of mammary ptosis or breast sagging

The Pencil Test for mammary ptosis

One test you can do at home is called the pencil test. To do the pencil test place a pencil into the fold under the breast and drop your breast. If the pencil stays in place you may have significant mammary ptosis or sagging and may need a lift in addition to implants. If the pencil drops to the floor you likely do not have mammary ptosis and will likely be able to have implants alone.

Implants alone without a breast lift for normal breast shape

If your breast and nipple is above the fold under your breast then you can have implants alone without a lift.

Implants alone without a breast lift for breast pseudo ptosis

If you have Pseudo ptosis you often can have implants alone without a lift. Often the implant can be placed under the chest muscle, called a sub muscular breast augmentation. However in some cases the implant must be placed under the breast gland, a sub glandular breast augmentation.

Implants with a breast lift for Grade 1 breast ptosis

Patients with grade 1 ptosis may be able to have implants alone if the implants are placed under the breast gland, a sub glandular breast augmentation. However if a lift is needed it is often possible to do the lift with an incision only around the areola, a Periareolar mastopexy or breast lift.

Implants with a breast lift for Grade 2 breast ptosis

When the nipple is below the fold under your breast you will need a breast lift in addition to implants. Usually a lift with a scar around the nipple and under the breast is required. This can be a Lollipop lift or and Anchor lift.

Implants with a breast lift for Grade 3 breast ptosis

Grade 3 mammary ptosis almost always requires an Anchor breast lift in addition to implants.

Why a breast lift is needed in addition to implants when you have ptosis-The Snoopy Deformity

When a breast implant is placed under the breast or chest muscle the implant is positioned above the inframammary crease or fold under the breast.

Breast implants can be placed under the breast or under the muscle

Breast implants can be placed under the breast or under the muscle

If the nipple is below the inframammary crease the implant can push the nipple further down. The result is that the implant causes a bulge or mound above the nipple and the nipple appears lower. The side view of the breast then resembles the profile of the cartoon character Snoopy as shown in the drawing below:

Snoopy deformity occurs when a breast implant is placed into a sagging breast without doing a breast lift

The Snoopy deformity can occur when a breast implant is placed under the muscle in a sagging breast without also doing a breast lift

In summary if you have significant mammary ptosis or breast sagging that causes your nipple to be below the fold under your breast you will likely need a breast lift in addition to implants. The pencil test descried above can help you determine if you may need a breast lift in addition to implants. Please consult an experienced board certified plastic surgeon with experience in breast implant surgery for an examination and consultation.

Mentor Breast Implants

Why I Use Mentor Breast Implants

Before and After 300cc Mentor Breast Implants front View

Before and After 300cc Mentor Breast Implants

At our plastic surgery practice we use Mentor Breast Implants exclusively for breast augmentation. I have used these implants for the past thirty-one years. During my Harvard plastic surgery residency at Brigham and Women’s Hospital I had the opportunity to use breast implants from 3 different breast implant manufacturers. What I noticed was that many silicone implants had a greasy film on the outside which represented silicone gel that had leaked through the implant shell, something referred to as implant “sweating.” This greasy material had to be wiped off with alcohol before the implant could be placed into the patient.

When Mentor implants became available in 1984 I noticed that the outer shell of the implant was dry with no greasy film on the outside. My interpretation of this experience was that the Mentor breast implant shell was better and prevented leaching of significant amounts of silicone gel to the outside of the implant and into the patient. I have no scientifically controlled study to prove my theory however it made sense to me that preventing leakage of silicone gel into the patient was beneficial to my breast augmentation patients. Since that learning experience in 1984 I have only used Mentor breast implants for my patients.

Mentor Breast Implants Are Made in the USA

Mentor breast implants are the only FDA approved breast implants made in the United States. The United States imposes strict quality control standards for manufacturing that often exceed those of other countries. Recently a manufacturer in Brazil that supplied implants to the United States market has been closed down due to the discovery of microscopic “particles” on the outside of the implant shell. This event left surgeons who use those implants in “limbo.” In the past there have also been implant manufacturers in Europe that have had to close down due to lack of FDA approval for use of their implants in the United States.

In my opinion, using a product made in the United States which meets FDA standards is not only the best option for my patients but also patriotic, just my personal opinion.

Mentor Breast Implant Sizing System

The Mentor Breast Implant Sizing System has greatly improved our ability to help our patients choose the properly sized breast implant for their desired breast augmentation result. We have a set of specially shaped Mentor breast implant sizers designed to mimic the shape of a breast implant once it has been placed into the body. These sizers are used during patient consultation to estimate the proper size of implant for each individual patient.

Many factors go into the breast implant sizing decision. During sizing, measurements of the patient’s breast base width are taken. Using this measurement a chart provided by Mentor is used to find the proper breast implant diameter to fit the patient’s breast.

Next breast implant sizers of the appropriate size are placed into a non-padded sports bra so the patient can see how they will look with that sized implant both in a bra and in clothing.

Using this system has significantly improved patient satisfaction with the size of implant chosen for breast augmentation. In years past before we had this system some patients would say at a year after surgery they wished they had chosen a larger implant. This rarely, if ever, occurs now with use of the Mentor Breast Implant Sizing System.

Before and After 300cc Mentor Breast Implants Side View

Before and After 300cc Mentor Breast Implants Side View

Mentor Breast Implant Extended Warranty

Mentor provides a lifetime warranty for replacement of a deflated saline implant or ruptured silicone implant which is standard for the implant industry. However coverage for capsular contracture or seroma is not provided.

Recently Mentor has offered an Enhanced warranty which can be obtained by the patient for a fee of $200 and enrollment before 45 days after surgery. This new enhanced warranty provides up to $3500 in financial assistance for surgery required to treat Baker 3 and 4 capsular contracture, double capsular contracture and late occurring seroma for up to ten years. This warranty also provides free replacement of the second or opposite side implant.

This is an extremely important warranty protection against a serious, but fortunately unusual complication of breast augmentation.

FDA Approved Breast Implants

Both implants made by Mentor and Allergan are FDA approved for use in the US. Both implants made by Mentor and Allergan are excellent safe breast implants. Your plastic surgeon will have his or her own personal choice and personal reasons for choosing one implant over the other. I have chosen to use Mentor Breast Implants exclusively for breast augmentation during my thirty-one years in my plastic surgery practice. I have been happy with this choice. I have described above the factors which have led to my personal preference for Mentor breast implants. The new extended warranty to me demonstrates Mentor’s own confidence in their product and is likely based on their own clinical studies on the safety and durability of their product.

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Laser Labiaplasty, A Gentler Approach

At Boston Plastic Surgery Specialists we use the laser to perform Labiaplasty or Labioplasty for our Boston patients. The laser is a much gentler method for removing excess labial tissue than traditional surgical methods.

What Is Labiaplasty?

Labiaplasty or Labioplasty is a plastic surgery procedure done to reduce the size of the Labia Minora, the thin vaginal lips between the fuller, thicker Labia Majora. Many patients choose to have this procedure to improve the cosmetic appearance of the labia. Other patients have Labiaplasty to reduce irritation of the labia caused by tight clothing chaffing the long labial tissue.

Traditional Labiaplasty

Traditional older labiaplasty involves clamping the base of the excess labial tissue with a surgical clamp, cutting the excess away and suturing the tissue once the clamp is released.

One problem with this method is that the surgical clamp crushes the delicate labial tissue which is left behind when the suturing is done. Crushed or damaged tissue interferes with and delays healing. Crushed tissue can also increase scarring.

Benefits of Laser Labiaplasty

During Laser Labiaplasty the delicate labial tissue is not clamped with a surgical clamp thus there is no crush injury to the labial tissue left behind.

After surgical marking of the excess labia to be removed the tissue is grasped with a forceps and the laser incision with the CO2 laser is used to remove the excess tissue. Following removal of excess tissue, the wound is then closed with dissolving sutures.
This method produces excellent Labiaplasty results.

How Does Laser Labiaplasty Avoid Surgical Clamping?

Because the Laser Labiaplasty incision seals and closes blood vessels as the incision is made there is minimal to no surgical bleeding. Thus with Laser Labiaplasty, blood vessels are closed without the need for surgical clamping.


Why is Laser Labiaplasty Better?

Surgical wounds heal better when there is less tissue trauma. Crushing labial tissue with a surgical clamp leaves damaged tissue behind which slows the healing process. Avoiding the surgical clamp during Laser Labiaplasty leaves healthier less traumatized tissue behind which speeds and improves healing.

Studies have shown that laser surgical incisions heal with less inflammation than traditional scalpel incisions. Less inflammation during healing can also lessen scarring.

The Labia Minora are one of the most delicate and sensitive tissues in the body and deserve to be treated with the most gentle surgical technique. The Laser Labiaplasty avoids the crushing injury caused by the clamping technique and is my preferred method for my Boston Labiaplasty patients.

Better Breast Implant Results with the Keller Funnel

The Keller Funnel 2 is an important device that we use at our practice to achieve better breast implant results for all of our breast augmentation patients. In my opinion the Keller Funnel 2 is the most important advancement to improve results of breast augmentation and breast implant surgery in the past ten years.

Before and After Breast Augmentation with Breast Implant Insertion using the Keller Funnel

Before and After Breast Augmentation with Breast Implant Insertion using the Keller Funnel

What is the Keller Funnel 2?

The Keller Funnel 2 is a medical grade sterile silicone breast implant sleeve, designed like a pastry bag or cake decorating bag, that is used to insert silicone breast implants into the body during breast augmentation. Using this device eliminates the trauma to the skin and breast implant that was caused by the older technique of forcing the implant directly through the skin incision with the surgeon’s gloved finger. This newer less traumatic technique leads to better breast implant results in our plastic surgery practice.

Photo of Breast Implant In Keller Funnel Ready to Insert Into Breast Augmentation Patient

Breast Implant In Keller Funnel Ready to Insert Into Patient

The Keller Funnel Technique

The device is first soaked in triple antibiotic solution. The breast implant is then dropped into the funnel after the implant has been soaked in triple antibiotic solution. The breast implant is never touched.

Photo of Keller Funnel being soaked in triple antibiotic solution before placing the breast implant into funnel

The Keller Funnel is Soaked in Triple Antibiotic Solution Before the Breast Implant is Placed Into the Funnel

Photo of breast Implant being placed into the Keller Funnel without touching the implant, the no touch breast augmentation technique

The Breast Implant is Placed into Keller Funnel Without Touching the Implant, the No Touch Technique

The mouth of the funnel is then placed into the breast augmentation skin incision and the silicone implant sleeve or funnel is squeezed to direct or push the implant into the breast implant pocket beneath the breast gland or chest muscle. The implant never comes in contact with the patient’s skin or gloved surgeon’s hand or finger.

Photo of squeezing the keller funnel with breast implant inside to insert into breast implant pocket in the patient

The Keller Funnel with Breast Implant Inside is Squeezed with Two Hands to Insert the Breast Implant Into the Breast Implant Pocket

How Does the Keller Funnel 2 Technique Produce Better Breast Implant Results

Less Capsular Contracture or Hardening of Breast Implant using the No Touch Technique

The traditional method of inserting the breast implant involved pushing the implant through the skin incision into the breast implant pocket with the gloved surgeon’s finger. This technique allowed bacteria containing skin cells to contaminate the implant pocket. This bacterial contamination is believed to be a significant cause of capsular contracture or hardening of the breast implant.

The No Touch Technique involves soaking the implants in triple antibiotic solution, irrigating the implant pocket with triple antibiotics, and not touching the implant during insertion.

Using the Keller Funnel 2 and the No Touch Technique for breast augmentation reduces potential bacterial contamination of the breast implant. This reduces the chance of capsular contracture of breast implants in my opinion.

Easier Breast Implant Insertion

This new technique allows the implant to easily glide through the funnel into the patient. This is a much gentler and less traumatic technique than the older method. Less trauma to the tissues leads to less scarring and better recovery.

Faster Breast Implant Procedure

The ease of implant insertion reduces the time it takes to complete the breast augmentation procedure.

Smaller Breast Implant Scar

Because breast implant insertion is so much easier a smaller skin incision can be used. A smaller skin incision produces a smaller scar.

Less Chance of Breast Implant Rupture

The amount of force needed to insert the breast implant is greatly reduced with this technique when compared to the traditional manual insertion technique. Less force on the implant reduces the risk of rupture of the implant during insertion.

Before and After Photo of Breast Augmentation Using the Keller Funnel Technique for Breast Implant Insertion Side View

Before and After Photo of Breast Augmentation Using the Keller Funnel Technique for Breast Implant Insertion Side View

This new device has led to a very significant improvement in breast augmentation technique and has led to better breast implant results for our plastic surgery patients. We use the Keller Funnel 2 and the No Touch Technique on all of our breast implant patients.