Pectus excavatum (PE) chest deformity Breast Augmentation Before and After
Breast Implant Specialist
Recent concerns about safety issues surrounding breasts implants are primarily trying to reignite issues that pretty much had been resolved in the late 1990s after the 1992, so called, ” Breast Implant Scare”.
However, there i one new concern that has come forward that merits a discussion. This concern is ALCL or anaplastic large cell lymphoma1. This is rare type of non-Hodgkin’s lymphoma that has been associated with breast implant augmentation. This rare type of cancer has primarily been associated with highly textured implants (rough surfaced) which are believed to cause a chronic irritation. In some women, who are genetically susceptible the chronic irritation can occur along with the presence of certain bacteria has recently been implicated. Please be advised that ALCL is a cancer of the immune system, not a type of breast cancer.
These ALCL cases – which I have NEVER seen one after performing over two thousand breast augmentations-. present with an accumulation of fluid around an implant. The diagnoses are made by sending samples of the tissue and fluid for pathological examination. The treatment which is usually curative is removal of the “capsule” around the implant.
According to patient safety guidelines from the American Society of Plastic Surgeons, “the current lifetime risk of BIA-ALCL (BIA, Breast Implant Associated) is estimated to be 1:3817 – 1:30,000 women with textured implants based upon current confirmed cases and textured implant sales data over the past two decades”. Only 16 people worldwide have died from breast implant associated ALCL! As you can compare this number of cases to the total number of augmentations and reconstructions ALCL is EXTREMELY RARE. When caught early, BIA-ALCL is usually curable.
However, this does not mean we can take it lightly however. First of all, highly textured implants are rarely used in augmentation in the US and one manufacturer (Allergan) voluntarily removed them altogether from the European Market.
For my breast augmentation/implant patients, I personally used smooth implants in over 98 percent of my cases. I did see a patient that had been reconstructed elsewhere with a textured implant and had recurrent collections of fluid around the implants. The biopsy of the capsule and the fluid submitted were both negative for ALCL.
Concerns about “Breast Implant Related Disease” encompasses most of the concerns that were investigated in the 1992-1999 period that ultimately resulted in a lift of the ban of using silicone implants by the FDA in 2007. While statistically these concerns were not proven to be associated, many individuals still worried that their implants were causing some of their illnesses or at least the symptoms.
These included Auto-Immune illnesses such as Lupus, Rheumatoid Arthritis, Fibromyalgia, and other chronic maladies of unknown origin. Some that were explanted in the early 90’s got improvement of the symptoms. These improvements were also often correlated with the administration of steroids that are by themselves a treatment for the Autoimmune Diseases. There were, however, cases that improved without the use of steroids but the majority saw little or no improvement with explanation.
We did learn a lot about Implants in this period of research and introspection!
No! implants have a finite life regardless if they are saline or silicon. On average around 15- 20 years. I have seen some rupture at one two years and some perfect at thirty years.
Why Do Some Breasts Get Hard After Augmentation or Reconstruction?
The body makes a “room” for implants when they are inserted and this is lined with special cells. As long as this “room” or “CAPSULE” is bigger than the implant then the breast feels soft. Sometimes an event (could be inflammation/infection of breasts during breast feeding) can trigger scar tissue to form and tighten around the implant causing a “CAPSULAR CONTRACTURE”.
These can also occur gradually, years after the implant was placed without any known “event”. Studies over the last ten years have implicated bacteria in their cause. Not enough bacteria to cause an infection but enough to irritate the body. The bacteria form a barrier around the implant to protect themselves and this is called a BIOFILM.
Treatment includes removal of this scarred capsule with its BIOFILM and a change to a new implant. We often change the “site” from above the muscle placement to below the muscle or vice versa. Recurrence of the Capsular Contracture is always a possibility and can range from 20-60 percent depending on the number of times this has occurred. (Note: The treatment of recurrent Contracture is beyond this blog).
I hope this shed some light on current thoughts and concerns about Breast implants/ augmentation. Bottom line over 90 percent of individuals that have a breast augmentation are glad they had it done.
1Anaplastic large cell lymphoma (ALCL) is a rare type of non-Hodgkin lymphoma (NHL), and one of the subtypes of T cell lymphoma. ALCL comprises about one percent of all NHLs and approximately 16 percent of all T cell lymphomas. (Source: Lymphoma Research Foundation)
The young Maya woman was pregnant and had walked four hours over the mountains of Guatemala with her husband and child.
After Dr. Manuel Pena (’81) and his mission team had repaired her child’s cleft lip, through her husband, who could speak Spanish, she asked softly, “Now, can you fix mine?”
With her husband standing next to her and watching, Pena gently numbed her lip, opting out of general anesthesia due to her pregnancy, and performed the repair.
The next day, the family began the long climb back up 9,000-plus feet to their mountain home. “I thought, I’m never going to see them again,” says Pena. “But at the end of seven days, they were back so I could take out their stitches. I thought, this is incredible. This is why I was put here.”
The mountains of Guatemala might have seemed a far cry from the norm for Pena, a Naples, Florida-based plastic surgeon who specializes in aesthetics. But not if you know Pena’s background and childhood. He grew up just across the Caribbean Sea, on the island of Cuba.
A young Pena (left) soon after moving to the United States A young Pena (left) soon after moving to the United States
While those early years before the rise of Fidel Castro were ones of luxury – Pena was the son of the head of trauma surgery at the hospital in Camaguey, one of the island’s largest provinces – it changed “seemingly overnight,” he recalls. Gone were the cook and the nanny. Gone were the properties, even the family home that had been owned by Penas for over 300 years.
The noose was growing tighter in Cuba. Young Manuel remembers waiting in line with his mother for a ration book that would allow the family to buy basic staples like bread, eggs, sugar or meat as the country’s rich resources were being spent on weapons and elsewhere. Out of fear for their family’s safety, his parents sent Manuel’s sister, then 11, with her godparents to the United States.
The rest of the family fled soon after. “My father and mother and I left Cuba in September of 1964,” says Pena, flying to Mexico where they waited three months for a visa. Then 7, Pena remembers his father taking him to the local pool to swim every day, not knowing that his father wanted him to practice in case they would need to swim the Rio Grande. “He didn’t know how deep it was,” says Pena. “But it didn’t come to that.”
The Penas would land in Miami where the family was reunited. But then came the hard work of rebuilding their lives. His father began the process of being recertified as a physician to work in the United States. And his mother, who had never had to cook or take care of a home and had instead spent her days drawing and playing tennis or canasta, used one of her hobbies to keep the family afloat: sewing.
“She was making shift dresses for $1.50 apiece,” says Pena. “It was a sweat shop, but that’s what kept us going.”
It was a tough mountain to climb, but “we were together, we were free and the world was there for the taking,” says Pena.
With the help of friends and the local Boys Club (predecessor to today’s Boys & Girls Clubs), Pena mastered English. After some time in Alabama, the family moved to Milledgeville, Georgia, where his father – now recertified – worked for Central State Mental Hospital and where a large population of Cuban physicians lived. Pena had started working too – even at that young age recognizing the sacrifice his parents had made to ensure their children had a better life.
After majoring in chemistry and biochemistry at the University of Georgia, Pena joined the first-year class at MCG, part of a large UGA contingent at Georgia’s public medical school. There was still that college feeling: keggers every Friday night at the cafeteria and raucous homecoming parades (Pena was head of MCG’s Entertainment Committee), but very quickly, he found his life’s work.
The first week of medical school, Pena sat in on a talk by Dr. Kenna Given, who had just been named section chief of plastic surgery. The lecture ranged over everything from congenital defects and trauma to microsurgery and aesthetics. “I didn’t know one field could be that broad,” says Pena. “So after the lecture, I followed him back to his office and said, ‘I want to do this. Will you be my clinical advisor?’ And he said, ‘Sure, I just took over so I don’t know exactly how this works, but we’ll figure it out together.’”
Pena with his parents at his 1981 MCG graduationPena with his parents at his 1981 MCG graduation
After graduation, Pena completed an internship in New Orleans at Charity Hospital, Tulane University, followed by a general surgery residency at Jackson Memorial Hospital, University of Miami (where he met his wife, Regina) and a plastic surgery residency at the Medical College of Georgia. He also began to start a family, which would grow to two daughters and two sons. Next came fellowships focusing on congenital defects, facial reconstruction and cosmetic surgery at the University of Miami and the Manhattan Eye, Ear and Throat Hospital, an affiliate of New York University.
Pena went home to Florida after his training, choosing Naples as the location for his private practice in 1990 after a chance vacation there and a friend who shared that there was a need for a plastic surgery practice in the area. Life was good, and Pena had already begun giving back to the Boys & Girls Club, which had been so instrumental to him as a new immigrant struggling to learn English. Then Guatemala came calling, thanks to another physician friend who encouraged Pena to clear his schedule and join him for an upcoming mission trip, after the original plastic surgeon had to back out. “I went and couldn’t stop,” says Pena.
Since 1997, Pena has completed nine mission trips, providing major surgical care for more than 250 patients. Along with countries in South America, he has traveled to Jamaica, and Uganda and Burkina Faso in Africa. Back home, he has hosted regular fundraisers such as crawfish boils to raise funds to cover all the equipment and supplies needed. (The boils are ongoing and are now benefiting the Boys & Girls Club of Collier County.)
It’s a need that hits close to home for Pena, who will never forget leaving Cuba, the sacrifice of his parents and the helping hands of so many who have brought him to where he is today. “There’s a great old Chinese proverb. It’s better to light one candle than to curse the darkness. You do just a little bit. That’s all you can do. You can’t fix the world, but if something comes up and you can fix it, you do it.”
The Pena family—Manny, Pena, Regina, Savannah Rose, Athens and Monica—during a trip back to Cuba in 2006The Pena family—Manny, Pena, Regina, Savannah Rose, Athens and Monica—during a trip back to Cuba in 2006.
Originally published: http://magazines.augusta.edu/