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Peña Plastic Surgery - Cosmetic Surgery for Naples, Fort Myers, FL
Individual results may vary.

More than 300,000 women and teenagers underwent breast implant augmentation surgeries in 2017 (ASPS 2018). In addition, approximately 106,000 women underwent breast implant surgery for reconstruction after mastectomy.  A concern of some women who have had breast implants and women interested in breast augmentation is the possible rupture of the implant. I advise my patients that rupture is an important consideration and a serious but not a common complication of breast implants. The longer you have a breast implant, the greater the chance of implant rupture.



What is a rupture? A breast implant rupture is a tear or hole in the outer shell of the breast implant. If you have saline implants you won’t have to wait long to get your answer.  Usually the change in size as the saltwater bag deflates is rather quick.  It may take a few days and in some cases the valve is the culprit and sometimes only a partial deflation is noted.  Usually it will feel looser and often you will get a crinkly sensation. There is no need for alarm as it is just saltwater that your body will be shedding.

More stressful and more recently confusing are the individuals that believe they have a ruptured silicone implant. Silicone gel is thicker than saline, so when a silicone gel-filled implant ruptures, the gel may remain in the shell or in the scar tissue that forms around the implant (intracapsular rupture).

The concern is fueled by the 1992 implant scare where the FDA called for a stop on the use of silicone gel until safety concerns could be evaluated.  It turns out that the silicone implant manufacturers failed to produce evidence of their safety when there were approved in the1960’s.

There was great concern that these were causing problems anywhere from autoimmune diseases such as Lupus, rheumatoid arthritis, and fibromyalgia, as well as the possibility of them causing many other symptoms such as loss of libido, loss of hair, GI disturbances and even the possibility of cancer.

From 1992, to 1997 a large number of retrospective and prospective studies were made involving huge numbers of women that have received implants.  Statistically, NO correlations were made between the implants and these diseases and symptoms. However, it should be noted that on an individual basis, a foreign body of any type is possible to affect a person’s well-being. If you believe this to be the case, whether or not you believe them to be ruptured, I advise you to consult your physician and surgeon.


Peña Plastic Surgery - Cosmetic Surgery for Naples, Fort Myers, FL
Individual results may vary.

My recommendation in these cases is to call your plastic surgeon and get an evaluation as soon as possible.  While there is no health issue you do not want to let the capsule shrink up too much because it will make the replacement a little bit harder.  This is simply because the capsule or the room in which the implant has lived will need to be re-enlarge so that the implant was replaced can be filled to full capacity.  This is often a good time to change sizes or even consider silicone implant.

Now back to what to do with the possible ruptured implant…Sometimes a ruptured silicone implant will cause the body to create a capsular contracture.  This simply means that the capsule, the space where the implant resides is now contracting and tightening making the breast firm.  A long-term capsular contracture can also contribute to increase incidence of implant rupture as the continuous pressure on the implant can affect the shell or the bag of the implant.  Diagnosis can be done with an MRI of the breast and most recently with 3-D ultrasound.  They both have false positives and false negatives, but they have given us a tool to peek inside the breast and get an idea of the implant status.

Okay let say that we find a ruptured implant with free silicone inside the pocket!  what is the implication?  First of all, there is no capsular contracture, then the simple removal of the implant and the material and replacement is indicated.  When the implant rupture is caused by significant trauma the capsule can be torn and the free silicone can leave the confines space.  It is usually walled off by the body and can mimic a breast mass that will require biopsy and pathological examination.  In these cases, removal of all the material including the capsule will be necessary.

Sometimes the silicone will be felt and a lymph node in the armpit.  The lymphatic system which makes up the series of lymph nodes is simply cleaning up the silicone.  Silicone in the lymph node by itself does not appear to be a problem.  After the removal of the ruptured implant and material.  A decision should be made on whether a replacement implant is desired or whether options such as breast lifts, fat grafts, or simply leaving the breast alone should be all entertained.

When I was training in 1988, we believed the implant manufacturers reports that these implants should last forever. Not so. I tell my patients to expect between 15 and 20 years of implant life.  This does not mean that all implants rupture. Rupture after this point make it 15 or 20 years.  I am simply giving patients the average time period based on my experience.  Probably around 10 years after implantation one should consider a 3-D ultrasound or an MRI to ascertain that the implants are intact.

Usually the implant manufacturers have a warranty on the implants for 10 years.  They will actually replace it now for the life of the patient, but they will help pay for the operation just for the first 10 years.  A few are switching from saline to silicone, the manufacturers will pay the cost of the saline implants and pay you the difference.  Still not a bad deal since they will often do it for the opposite side that is not ruptured as well.

I hope this has shed some light on your questions.  If you have any concerns that were not addressed, please call my office for consultation.

Is There a Danger in Having Cosmetic Surgery If I Feel a Cold Coming On?

You are already to go with a cosmetic surgery procedure, had your consultation, gotten the necessary medical clearances, and have arranged for your pre- and post-operative care. You are eager to proceed but feel like you might be catching a cold. Should you postpone? Should you advise your cosmetic surgeon? Surprisingly this is a very common question I hear from my patients, “I have surgery in four days and I feel a cold coming on!” I get this call several times a month.

My general answer is, “when caught about 4-5 days before surgery, we can proceed with surgery in around 80 percent of cases.” There are steps you can take if you feel a cold coming on. Below is what I advise my cosmetic surgery patients:

    1. Colds are caused by viruses therefore traditional antibiotics will not help you.
    2. Colds are dealt with by your body’s own immune system so we can boost it!
    3. I recommend starting an over-the-counter immune boosting supplement called “WELLNESS FORMULA” some are called WELLNESS BLEND. Available at Whole Foods and Health food stores 4-6 capsules a 4 times a day. This blend has a combination of most immune boosters.
    4. Vitamin C also help. Use high does 3-6 grams (3000-6000 mgs), with lots of water.
    5. Only if the sore throat gets really bad or phlegm turns green or if I prescribe antibiotics, will we have to postpone surgery.
    6. Muscle aches indicate a Flu syndrome and you need to get on a prescription of Tamiflu. Preferably during the first 12-24 hours.

Be sure to talk to your cosmetic surgeon. Hope this helps get you to your scheduled surgery!

If you have any questions or are interested in learning more, please contact my office.

That Fighting Spirit

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:

Dr. Manuel Peña Featured in Augusta University Magazine

Naples Plastic Surgeon Dr. Manuel PenaDr. Peña Manuel received his medical degree from the Medical College of Georgia (MCG) in 1981. After completing his general surgery residency and fellowship at Charity Hospital, Tulane University and Jackson Memorial Hospital, University of Miami, he would return to MCG to complete his plastic surgery residency. While a good student and a now a well-respected alumnus, an article featuring Dr. Peña in the latest MCG magazine focuses not on his professional accomplishments as a plastic surgeon, but on his mission trips and philanthropy.

Dr. Peña came to the United States with his family in 1964. Leaving Cuba just a few years following Castro’s rise to power, the Peña family spent several months in Mexico waiting for visa approval before finally landing in Miami, where Dr. Peña and his parents were reunited with his sister who had earlier been sent to live with godparents.

Life in those early years was not always easy for the Peña family, but all the same, Dr. Peña remembers the newly free family being together and supportive. All of these things – leaving Cuba, finding a new home, adjusting to a new county, dealing with economic and social disparity – likely played a role in Dr. Peña’s desire to help, serving to fuel his mission work later in life.

 “We were together, we were free, and the world was there for the taking.” – Dr. Peña

Dr. Peña has completed nine mission trips and provided surgical care for over 250 patients who otherwise would have gone without assistance. In addition to his mission trips to Africa, Burkina Faso, Jamaica, and South America, Dr. Peña routinely hosts fundraisers in and around Naples to raise money for the equipment and supplies needed on these trips.  Contact our office to learn how you can help support these mission trips.

“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.” – Dr. Peña

Dr. Peña is a board-certified plastic surgeon serving Estero, Ft. Myers, Bonita Springs, and surrounding areas from his office in Naples. If you are looking for an experienced, dedicated, and caring plastic surgeon in Florida, give us a call at 239-348-7362 to schedule a consultation today.

Hair Growth Stimulation using Microneedling and PRP

The more we learn about our body's ability to stimulate healing and regenerate itself,  the more we find innovative ways to restore the failing parts of her body.  Platelet rich plasma also known as PRP is a highly concentrated suspension of our own bodies healing triggering bodies known as platelets.  They contain a myriad of hormones or 'factors' that begin and stimulate the process of 'wound healing' and repair in many different ways.  For hair stimulation the epithelial growth factors are the most valuable.  The stimulate the hair follicles in 2 ways.  First is  to increase the circulation to the follicles  at critical moments in the development of the hair thus making the hair thicker (up to forty percent)  and 'waking' up some of the hair follicles that were in the resting or dormant phase. 

The Platelet Rich Plasma (PRP) is made by drawing your blood and centrifuging or spinning this blood to concentrate the platelets and remove the red blood cells.  This allows only the stimulating platelets without the remaining parts of the blood which can have an irritating the effect.

So what is the process to get the platelet gel to the targeted hair follicles.  One way to admisnister it is to inject the scalp or any other area in which you want to stimulate hair growth at a level where these hair follicles are (between 2 and 3 mm deep)  or we can use a micro-needling device which essentially pokes tiny needle holes to the same level.  The needle holes themselves will stimulate a similar response from the hair follicles and this is only augmented by the application of the platelet gel that trickle down into these holes while they are still open.  This is usually combined with an injection of the remainder of the platelet gel deep to the hair follicles after the micro-needling.Thus the term Microneedling with PRP

                                 Microneedling with PRP

Individual results may vary.

This process is not only for male pattern baldness but also useful for the thinning hair experienced by more and more women these days.  Recent studies have  shown this to be highly effective in treating alopecia areata which appears to have an autoimmune component.  The process is repeated an average of 3 times about 6 weeks apart.  We start seeing significant improvement at the 3-4 month stage after the initial treatment.  And it is recommended that once a year  another session of micro-needling plus PRP is used as a booster to keep the hair growth.*  We often combined this with topical applications which work in many different ways.  The most common affect is to block the testosterone effect on the hair follicle itself and other parts of these formula help keep the scalp cleaned by turning over the new cells and clearing the path for the hair follicle growth.  Please call La-Piel Spa at 239-352-5554 for your evaluation and to get you started on stimulation of your own lush beautiful hair.

*Individual results may vary. Consult with Dr. Peña to see if you are a candidate.