Dr Brown was one of the invited international faculty and gave several presentations that included topics on breast implant selection, the use of fat in aesthetic breast surgery and, developing a successful transgender breast program.
One of the most unique aspects of this meeting is the live surgery component, in which surgeons are invited to perform surgery that is broadcast in to the auditorium to the symposium participants. This year, Dr Brown was asked to perform a trans gender breast augmentation on a trans female patient who came to Atlanta with Dr Brown from the TRS (transition related surgery) Program in Toronto. The surgery was very successful, but most impactful, our wonderful patient was able to share the important moments in her transition story with the surgeons in attendance and explain some of the unique challenges that exist during the journey.
If you are a trans female thinking about breast augmentation, here are some things to consider:
- The rib cage and breasts of a trans woman are usually wider than that of a cis woman of similar height and weight. To create an ideal breast shape and to have that breast fit on the chest wall means that the surgeon must take multiple, precise measurements, and select from a wide range of implants. While this “dimensional planning” is important in all breast augmentations, it is particularly important in the trans female patient.
- A trans woman’s nipples are usually situated more to the outside of the breast mound. This affects where the implant should be placed so that the nipple ends up relatively centered on the breast mound.
- A trans woman’s nipples are also usually situated low on the breast mound. The ideal breast has about 55% of the breast volume below the plane of the nipple and 45% above. While sometimes the implant needs to be placed below the natural crease of the breast in a cisgender woman to achieve that balance, it is necessary far more often in the transgender patient. That position is critical to the result and must be planned exactly. Failure to properly determine where to situate the bottom of the breast and to keep the implant in that position are the two factors that account for most of the suboptimal results in transgender breast augmentation.
- Trans patients usually have thicker and tighter skin. Years of fluctuating breast size from monthly periods, weight changes, gravity, genetically thinner skin, and of course the substantial stretch with pregnancy can all thin skin further. This tighter skin often results in breasts that are somewhat fuller and perkier, especially in the upper portion of the breast.
- The pectoralis major muscle is often (but not always) thicker in a trans woman. Rarely is it thick enough to create a problem; it just requires a greater level of attention to anesthetic and technical considerations during surgery. There may be a greater tendency for the muscle to push the implants slightly down and out over time, though this also can be an issue for cisgender patients.
For more information about transition related surgery please visit Transition-Related Procedures.
Dr. Mitchell Brown and Dr. Ron Somogyi, Toronto Plastic Surgery
Recently, there has been a surge in media attention regarding implantable medical devices. Coverage has focussed on regulatory agencies, the process for device approval, device safety as well as the importance of collecting accurate post-approval data on adverse events and outcomes. Many devices were discussed including pacemakers, hip and knee implants, cardiac stents, pelvic meshes as well as breast implants. One area of discussion has centered around breast implants and a possible link to a type of lymphoma called ALCL.
A great deal of research has been published regarding breast implants and cancer. We can say quite conclusively that breast implants do not cause breast cancer. For the past several years there have been published cases of women diagnosed with a rare type of lymphoma in the fluid or tissue surrounding a breast implant. This entity has been named BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma). ALCL itself is a cancer of the immune system and more commonly occurs in people who have never undergone breast implant surgery. Estimated rates of ALCL is approximately 1 in 10,000 people in the general population.
At present, there are approximately 600 cases of BIA-ALCL reported worldwide and it is estimated that more than 10 million women have undergone breast implant surgery. To date, all cases of BIA-ALCL have been in association with breast implants that have a textured surface. The current lifetime risk with a textured implant is estimated to be 1:3800 – 1:30000. There is no risk of developing BIA-ALCL with smooth surfaced implants. It is important to know that all implants used at Toronto Plastic Surgery are fully approved by Health Canada as well as the FDA in the United States.
In the majority of reported cases, the initial presenting symptom is a distinct swelling of the affected breast. You would notice this as a substantial size change on the affected side. The breast might feel tense and firm. Usually the swelling comes on fairly rapidly, over several days or weeks, not over months or years. Typically, this occurs on one side only, but in exceptional cases, it can occur in both breasts.
If a person with breast implants notices any of these changes or symptoms, the appropriate action is to contact their surgeon for a follow-up visit. There are some very simple investigations that can be done to determine whether or not a person has BIA- ALCL. When detected early, it is very treatable.
It is important for you to know that both Dr. Somogyi and I have collectively been involved with the use of breast implants for over thirty years. We have followed our patients carefully and have published our experience on the safe use of breast implants and breast implant outcomes. We both attend medical conferences regularly and often participate as educators at these events. We want you to know that we stay up to date on the latest literature surrounding breast implants and breast implant safety.
In addition, it has always been our practice to encourage patients with any breast implant to return for regular follow up at least every 2-3 years. This is important so that we may inform you about new information or changes regarding breast implant technology and safety. Occasional assessment is recommended.
As new information becomes available regarding BIA-ALCL and breast implant safety, we will do our best to keep you informed. If you have any questions regarding breast implant surgery at Toronto Plastic Surgery, please feel free to contact us directly.
Dr. Brown attended the Advanced Aesthetics in Breast and Body Contouring meeting in St. Petersburg, Russia, from Oct 11 to 14, 2018. He was part of the international invited faculty and had an active role in the meeting with the following on his agenda:
- Moderated the live surgery sessions on breast lift and augmentation
- Presented a video of surgery to correct breast sagging
- Gave a presentation on correcting the tuberous breast using fat
- Gave two presentations on how to prevent and manage complications in breast augmentation
During down time, Dr. Brown met with colleagues in plastic surgery and aesthetic medicine from around the world.
Highlights included a visit to the world famous Hermitage Museum as well as the Peter and Paul Cathedral.
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Dr. Ron Somogyi discusses your body contouring options at Toronto Plastic Surgery.
If you’re considering surgery to address excess fat or sagging skin on your abdomen, you might be wondering if a tummy tuck or liposuction at Toronto Plastic Surgery is the best option for addressing your concerns.
A tummy tuck—also known as abdominoplasty—is a surgical procedure designed to remove excess skin and fat from the abdomen and to tighten the underlying abdominal muscles, whereas liposuction is a procedure that removes localized deposits of fat from specific areas of the body. Both surgeries are effective in achieving a more contoured mid-section, but the underlying issues they address are actually quite different.
Every patient is unique, and we always spend as much time as necessary to understand your goals and desires before making a recommendation. That said, here are some general guidelines that might provide some insight about which surgery is right for you.
Liposuction is right for you if …
…. you have areas of fat that do not respond to diet and exercise, but skin elasticity is not an issue.
Liposuction uses a vacuum-suction tube inserted under the skin to permanently remove localized deposits of fat to reveal beautiful, sleek body contours. Although there may be some tightening of the skin due to natural skin elasticity, liposuction is not a tightening procedure. For this reason, it is usually recommended for patients with good skin quality and reasonable expectations; older patients who may have less skin elasticity may not achieve the same results as younger patients with tighter skin.
Ideal candidates for liposuction are healthy women and men who are relatively close to their ideal body weight, but have stubborn pockets of fat that are resistant to diet and exercise. Liposuction can also address areas of the body besides the abdomen, including hips, buttocks, thighs, knees, back, upper arms, breasts and neck.
The surgery itself is an outpatient procedure, which means you’ll return home the day of your surgery, though we normally recommend taking a few days off from work to give yourself some time to rest and heal. You’ll likely experience mild to moderate pain, bruising and mild swelling immediately after surgery, so make sure you have someone to help you around the house in your first few days of recovery. After surgery, you will wear a custom-fit compression garment for 3-4 weeks to reduce swelling, optimize tissue recovery, and help retain your new shape. Most patients are back to normal daily activities within a few days and back to full exercise within 2-3 weeks. Results from liposuction are gradual. Initial swelling will hide the true extent of the improvement for the first 3-4 weeks. Over the subsequent months, you will continue to see ongoing improvement in contour as the final swelling resolves and the skin tightens. Liposuction scars are usually minimal, since the fat is suctioned away through several small incisions in hidden areas.
A tummy tuck is right for you if …
… you have excess or sagging skin in addition to excess abdominal fat.
In addition to removing excess skin and fat from the abdomen, a tummy tuck can address a protruding abdomen, abdominal muscles weakened by pregnancy, loose skin from weight loss, and a loss of definition or shape of the belly button. It also allows for the possible elimination of stretch marks, especially if they are located in the lower part of the abdomen.
The best candidates for a tummy tuck are close to their ideal body weight, but have experienced changes to their body following weight fluctuation, pregnancy, surgery, or simply as a result of the natural aging process.
A tummy tuck surgery is usually an outpatient procedure, meaning you’ll return home the day of your surgery. Some patients choose to stay one night in our facility and return home the next morning. It’s normal to experience mild to moderate pain, bruising, and mild swelling immediately after surgery, but we will discuss pain management options with you, and explain how to care for your surgical incisions to ensure optimal recovery and comfort. We recommend taking about 2 weeks off from work to give yourself time to rest and heal. Most patients are back to normal daily activities within 2 weeks, but are asked to avoid heavy physical activity and heavy lifting for 6 weeks.
A tummy tuck does result in a larger scar than that of liposuction, though you can rest assured that every effort is made to ensure incisions are made precisely and that scars heal as fine lines easily covered by bathing suits or undergarments.
A perfect pairing.
In some cases, if you’re concerned about both excess fat and loose skin, liposuction and abdominoplasty can be performed during the same procedure for optimal results.
If you’re interested in learning more about tummy tuck or liposuction at Toronto Plastic Surgery, including which procedure is right for you, schedule a private consultation with Dr. Somogyi today.