Your Guide to Breast Augmentation
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Surgical Best Practices: 14-Point Plan William P
Surgical Best Practices: 14-Point Plan William P. Adams, Jr., MD & Anand K. Deva, MBBS (Hons), MS SURGICAL BEST PRACTICES: 14-POINT PLAN William P. Adams, Jr., MD and Anand K. Deva, MBBS (Hons), MS Introduction The 14-Point Plan aims to reduce the number of bacteria present at the time of breast implant placement, thereby reducing the risk of associated infection.1 Each of these steps outlined below is backed by evidence and cumulatively have been shown to reduce the risk of capsular contracture in patients following breast implant surgery. During breast implant placement, if bacteria attach to the surface of an implant and create a biofilm over time, the biofilm becomes almost impossible to remove. If the bacterial biofilm load reaches a certain threshold it can lead to chronic inflammation and known sequelae, including infection, capsular contracture, double capsule, and breast implant-associated ALCL (BIA-ALCL).1, 2 We have performed extensive bench and clinical studies on this topic and are committed to educating plastic surgeons on proven steps that have been shown to reduce the bacterial biofilm load.1 These simple steps have been shown to decrease the risk of developing capsular contracture ten-fold.3-5 Additionally, a wealth of evidence has demonstrated a link between chronic inflammation from bacterial biofilm in the pathogenesis of BIA-ALCL, especially in textured devices where the increased surface area can result in an increased amount of bacterial biofilm.2 A meticulous procedure will help minimize the known and likely sequelae of bacterial attachment including infection and chronic biofilm, which is implicated in the pathogenesis of both capsular contracture and BIA-ALCL. -
Scarless Breast Augmentation by Dr
Scarless Breast Augmentation By Dr. Babak Farzaneh Trans-Umbilical Breast Augmenta- naval, allowing for a virtually undetect- volume adjustment for better symmetry. tion (TUBA), more commonly known able scar - even in patients with darker The path for placement shortly as the “Belly Button Procedure”, is the skin tone. This alleviates the need for heals without visible tracts, providing a most innovative and novel approach any incision on the breast. The incision quick return to normal activity. There is in the long history of breast implant is so minimal that some have nicknamed also no need for sharp cutting or burn- surgery. It has been a long time since a the procedure “Band-Aid Breast Aug- ing of the breast tissue, which mini- new approach has allowed a multitude mentation”. (Naval piercing, if present, mizes bleeding and the need for drains; of desirable additions without signifi- is left undisturbed, and the naval ring is post- procedure numbness; and, more cant drawbacks. Endoscopic surgery has sterilized and replaced at the conclusion tangibly, reduces bruising and swelling, revolutionized medicine and surgery, of the surgery.) allowing for shorter and easier recovery. allowing operations to be performed The highly unique instruments In skilled hands, this approach through smaller incisions. Following this specially manufactured for the TUBA allows for natural and predictable results trend, breast augmentation is comple- technique allow me to implement my through a very small, hidden incision. mented immensely by the introduction artistic vision to produce a natural breast As with most unique and highly special- of the TUBA technique. shape with acceptable symmetry, and ized surgical techniques, most surgeons Using a very small incision create the desirable cleavage. -
Breast Reconstruction with Expanders and Implants
Evidence-Based Clinical Practice Guideline: Breast Reconstruction with Expanders and Implants INTRODUCTION Disclaimer Evidence-based guidelines are strategies for patient management, The American Cancer Society estimates that nearly 230,000 American developed to assist physicians in clinical decision making. This women were diagnosed with invasive breast cancer in 2011.1 Many of guideline was developed through a comprehensive review of the these individuals will require mastectomy and total reconstruction of scientific literature and consideration of relevant clinical experience, the breast. The diagnosis and subsequent process can create signifi- and describes a range of generally acceptable approaches to diagnosis, cant confusion and distress for the affected persons and their families management, or prevention of specific diseases or conditions. This and, consequently, surgical treatment and reconstructive procedures guideline attempts to define principles of practice that should are of utmost importance in the breast cancer care continuum. In generally meet the needs of most patients in most circumstances. 2011, the American Society of Plastic Surgeons® (ASPS) reported an increase in the rate of breast reconstructions, citing nearly 100,000 However, this guideline should not be construed as a rule, nor procedures, of which the majority employed expanders/implants.2 should it be deemed inclusive of all proper methods of care The 3% increase in reconstructions over the course of just one year or exclusive of other methods of care reasonably directed at highlights the significance of maintaining patient safety and obtaining the appropriate results. It is anticipated that it will be optimizing surgical outcomes. necessary to approach some patients’ needs in different ways. -
Breastfeeding After Breast Augmentation Surgery (Implants)
Breastfeeding after Breast Augmentation Surgery (Implants) Can I breastfeed? Breastfeeding after breast augmentation surgery is possible depending on the type of surgery and the original state of the breasts prior to surgery. In most cases it is still possible to breastfeed after having implants but there are some exceptions. What are some of the potential problems? Nipple Sensitivity: If your breasts have been surgically enlarged with silicone or saline implants, your nipples may be more or less sensitive than normal. Exaggerated Engorgement: Once you've delivered a baby and your milk has come in, you may have exaggerated breast engorgement which can cause more intense pain, fever, and chills. Risk for Decreased Milk Production: Most mothers are able to produce some milk after augmentation surgery. Some mothers do not have an adequate milk supply to fully nourish their baby without additional supplementation. Your pediatrician and lactation consultant can help you determine a feeding plan that is best for your baby. Does the type of surgery I had affect my ability to breastfeed? Your chances of breastfeeding improve if your milk duct system is intact. Implants are typically placed behind the milk glands or positioned underneath the chest muscle. Incisions made under the fold of the breast or through the armpit are less likely to cause difficulty. Incisions made around the areola can Department of Obstetrics and Gynecology -- 1 -- increase the risk for problems. Nerves are vital to breastfeeding since they trigger the brain to release prolactin and oxytocin, two hormones that affect milk production. If the nerves around the areola were cut or damaged during surgery, you have an increased risk for low milk production. -
ASPS Clinical Practice Guideline Summary on Breast Reconstruction with Expanders and Implants
CME ASPS Clinical Practice Guideline Summary on Breast Reconstruction with Expanders and Implants Amy Alderman, M.D., M.P.H. Learning Objectives: After reading this article, participants should be able to: Karol Gutowski, M.D. 1. Understand the evidence regarding the timing of expander/implant breast re- Amy Ahuja, M.P.H. construction in the setting of radiation therapy. 2. Discuss the implications of a Diedra Gray, M.P.H. patient’s risk factors for possible outcomes and complications of expander/implant Postmastectomy breast reconstruction. 3. Implement proper prophylactic antibiotic protocols. 4. Use Expander/Implant Breast the guidelines to improve their own clinical outcomes and reduce complications. Reconstruction Guideline Summary: In March of 2013, the Executive Committee of the American Society Work Group of Plastic Surgeons approved an evidence-based guideline on breast reconstruc- Arlington Heights, Ill. tion with expanders and implants, as developed by a guideline-specific work group commissioned by the society’s Health Policy Committee. The guideline addresses ten clinical questions: patient education, immediate versus delayed reconstruction, risk factors, radiation therapy, chemotherapy, hormonal therapy, antibiotic prophylaxis, acellular dermal matrix, monitoring for cancer recur- rence, and oncologic outcomes associated with implant-based reconstruction. The evidence indicates that patients undergoing mastectomy should be offered a preoperative referral to a plastic surgeon. Evidence varies regarding the as- sociation between postoperative complications and timing of postmastectomy expander/implant breast reconstruction. Evidence is limited regarding the opti- mal timing of expand/implant reconstruction in the setting of radiation therapy but suggests that irradiation to the expander or implant is associated with an increased risk of postoperative complications. -
ICD~10~PCS Complete Code Set Procedural Coding System Sample
ICD~10~PCS Complete Code Set Procedural Coding System Sample Table.of.Contents Preface....................................................................................00 Mouth and Throat ............................................................................. 00 Introducton...........................................................................00 Gastrointestinal System .................................................................. 00 Hepatobiliary System and Pancreas ........................................... 00 What is ICD-10-PCS? ........................................................................ 00 Endocrine System ............................................................................. 00 ICD-10-PCS Code Structure ........................................................... 00 Skin and Breast .................................................................................. 00 ICD-10-PCS Design ........................................................................... 00 Subcutaneous Tissue and Fascia ................................................. 00 ICD-10-PCS Additional Characteristics ...................................... 00 Muscles ................................................................................................. 00 ICD-10-PCS Applications ................................................................ 00 Tendons ................................................................................................ 00 Understandng.Root.Operatons..........................................00 -
310-C, Breast Reconstruction After Mastectomy
AHCCCS MEDICAL POLICY MANUAL SECTION 310– COVERED SERVICES 310-C - BREAST RECONSTRUCTION AFTER MASTECTOMY EFFECTIVE DATES: 10/01/94, 11/27/18 REVISION DATES: 10/01/99, 10/01/01, 05/01/06, 10/01/06, 01/01/11, 09/27/18 I. PURPOSE This Policy applies to AHCCCS Complete Care (ACC), ALTCS E/PD, DCS/CMDP (CMDP), DES/DDD (DDD), and RBHA Contractors; Fee-For-Service (FFS) Programs as delineated within this Policy including: Tribal ALTCS, the American Indian Health Program (AIHP); and all FFS populations, excluding Federal Emergency Services (FES). (For FES, see AMPM Chapter 1100). This Policy establishes requirements for breast reconstruction surgery following a Mastectomy. II. DEFINITIONS MASTECTOMY Removal of the entire breast through surgery. III. POLICY Breast reconstruction surgery for the purposes of breast reconstruction post-mastectomy is a covered service if the member is AHCCCS eligible. The member may elect to have breast reconstruction surgery immediately following the Mastectomy or may choose to delay breast reconstruction; however, the member shall be AHCCCS eligible at the time of breast reconstruction surgery. The type of breast reconstruction performed is determined by the physician in consultation with the member. A. COVERAGE POLICIES FOR BREAST RECONSTRUCTIVE SURGERY 1. Reconstruction of the affected and the contralateral unaffected breast following a medically necessary Mastectomy is considered an effective non-cosmetic procedure. Breast reconstruction surgery following Mastectomy for any medical reason is a covered service. 2. Medically necessary breast implant removal is a covered service. Replacement of breast implants is a covered service when the original implant was the result of a medically necessary Mastectomy. -
Breast-Augmentation-Consent.Pdf
BREAST AUGMENTATION-INFORMED CONSENT INSTRUCTIONS This is an informed consent document that has been prepared by Dr. Taylor to inform you about augmentation mammaplasty, the risks, and the alternative treatments. At your first visit we will educate you as completely as possible regarding the procedure. Then, we ask that you think the procedure over so that you feel comfortable with your decision. After your surgery has been scheduled, you will return to the office for a second visit called a “pre-operative visit”. At that time, you will meet with the Patient Coordinator and the Doctor. It is important that you read this information carefully and completely. Please bring these forms with you to your next visit. At that time you will initial each page, indicating that you have read the page and sign the last page, which is the consent for surgery as proposed by Dr. Taylor. GENERAL INFORMATION This operation is totally and purely elective, therefore a long consultation is essential so that you are educated as well as possible about the procedure. Why consider enlargement? The decision must be based on your feelings only. It must be for you, not for or because of anyone else. GOALS • Create more normal proportions • Satisfy psychological needs • Maintain normal softness, sensitivity and function • Re-establish size and contour possibly changed by pregnancy or weight loss LIMITATIONS • Cannot stimulate breast tissue to increase in size • Cannot create young skin or eliminate stretch marks • Cannot eliminate severe sagging. If severe sagging exists, a lift (Samba, Wamba or Mastopexy) may be indicated as well as implants • Cannot eliminate asymmetry in breast shape, position, rib cage irregularities, nipple/areola size and/or position—we emphasize that everyone has asymmetry—some more that others—no one is perfect • Cannot solve personal problems INDICATIONS Augmentation mammaplasty is a surgical operation performed to enlarge the breasts for a number of reasons: • To enhance the body contour of a woman, who for personal reasons feels that her breast size is too small. -
Transumbilical Breast Augmentation a Practical Review of a Growing Technique
ORIGINAL ARTICLE Transumbilical Breast Augmentation A Practical Review of a Growing Technique William A. Brennan, MD, and Jacob Haiavy, MD These complication rates were comparable or less than other pub- Background: The transumbilical breast augmentation procedure lished methods of breast prosthesis implantation. has been described in the literature since 1993. This indirect route Conclusions: Transumbilical breast augmentation is a safe and for implant placement has received both criticism and praise over effective method for breast implant placement in selected patients. the years, without a comprehensive assessment of the procedure Patient satisfaction weighs heavily on implant location and postop- from the perspective of the patient. The growing patient demand for erative firmness and less on other variables. The procedure is the procedure, combined with the increased use by surgeons, associated with a complication rate comparable with other methods prompts a review of the procedure and a discussion of its pros and and finds itself growing in demand and popularity secondary to high cons, including tabulated patient satisfaction data. patient satisfaction. Methods: A retrospective chart review of 245 transumbilical breast augmentations performed by the second author from 2002 to 2004, Key Words: transumbilical breast augmentation, breast including the 1-year patient satisfaction surveys, is presented. Ad- augmentation surveys, endoscopic breast surgery ditionally, complications from the procedure are also tabulated and (Ann Plast Surg 2007;59: 243–249) compared with the complications published by our studies’ domi- nant implant manufacturer in their 1-year follow-up published data. The patients were asked to rate their postoperative pain, numbness, firmness, size satisfaction, rippling, and overall satisfaction. -
Breast Implant Illness - Frequently Asked Questions/Talking Points
Breast Implant Illness - Frequently Asked Questions/Talking Points Q: What is Breast Implant Illness (BII)? A: There are women with breast implants who self-identify and present with various systemic symptoms and believe that these are related to their breast implants. They refer to these symptoms as Breast Implant Illness (BII). Breast Implant Illness (BII) is a term used by women who have breast implants and who self- identify and describe a variety of symptoms including (but not limited to) fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, body odor, anxiety, brain fog, sleep disturbance, depression, neurologic issues and hormonal issues that they feel are directly connected to their saline or silicone, textured or smooth breast implants. The recent increase in patients reporting Breast Implant Illness (BII) symptoms appears to be related to social media. There is one Facebook group alone with more than 50,000 members, all of whom report Breast Implant Illness (BII) symptoms. This is not to say that social media is the cause of Breast Implant Illness (BII) however, it may account for the rapid increases in patient reporting. BII is not an official medical diagnosis. Q: Is there a link between medical grade silicone implants and any disease? A: Silicone is an element that exists in nature as crystalline silica, which has been shown to activate the immune system in conditions such as systemic sclerosis which has been seen in stone masons. Silicone used in breast implants is different and to date has not been proven to cause any disease. This silicone does not exist is nature, it is created by hydroxylating silica to form polydimethylsiloxane. -
Breast Augmentation Surgery: Clinical Considerations
REVIEW DEMETRIUS M. COOMBS, MD RITWIK GROVER, MD ALEXANDRE PRASSINOS, MD RAFFI GURUNLUOGLU, MD, PhD Department of Plastic Surgery, Department of Plastic Surgery, Division of Plastic and Reconstructive Department of Plastic Surgery, Dermatology and Dermatology and Plastic Surgery Institute, Dermatology and Plastic Surgery Surgery, Department of Surgey, Plastic Surgery Institute, Cleveland Clinic; Profes- Cleveland Clinic Institute, Cleveland Clinic Yale School of Medicine, New Haven, CT sor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH Breast augmentation surgery: Clinical considerations ABSTRACT t present, 300,000 US women undergo Abreast augmentation surgery each year,1 Women receive breast implants for both aesthetic and making this the second most common aes- reconstructive reasons. This brief review discusses the thetic procedure in women (after liposuc- evolution of and complications related to breast implants, tion),2–4 and making it extremely likely that as well as key considerations with regard to aesthetic clinicians will encounter women who have and reconstructive surgery of the breast. breast implants. In addition, approximately 110,000 women undergo breast reconstruc- KEY POINTS tive surgery after mastectomy, of whom more Nearly 300,000 breast augmentation surgeries are per- than 88,000 (81%) receive implants (2016 5 formed annually, making this the second most common data). aesthetic procedure in US women (after liposuction). This review discusses the evolution of breast implants, their complications, and key considerations with regard to aesthetic and Today, silicone gel implants dominate the world market, reconstructive breast surgery, as the principles and in the United States, approximately 60% of implants are similar. contain silicone gel fi ller. -
The Decision Guide to Breast Reconstruction
THE DECISION GUIDE TO BREAST RECONSTRUCTION Breast reconstruction is the process of making a new breast after mastectomy (removal of the breast) for breast cancer treatment or prevention (“therapeutic” or “prophylactic” mastectomies). This web site contains information to assist you in making choices related to breast reconstruction following mastectomy. Our goal is to give you understandable, up-to-date facts about reconstructive options. We hope this site answers many of your questions, lets you know what to expect, and helps you make a decision that you feel good about. How to Use This Program This guide can be used in a variety of ways. If you are planning to consult your health care provider about breast reconstruction, we recommend that you spend some time reviewing this information before your provider visit. The basic knowledge included in this guide will help you partner with your surgeon to choose reconstruction options which are right for you. Following your consultation, the web site may assist in clarifying issues raised during your visit. Remember — you and your surgeon are a team, working together to make treatment decisions which fit your values, priorities and lifestyle. The Reconstruction Decision When you lose a breast to cancer, it is comforting to think you can replace it and look and feel almost normal again. However, treating the cancer and getting back to a healthy life should always be your first concerns. If you are able to have breast reconstruction, make your decision about whether to have reconstruction, when to have reconstruction, and what kind of reconstruction to have based on what is best for you.