Update from Dr. Brown on Breast Implant Safety and ALCL – August 2019

On July 24, 2019, Allergan announced that they were issuing a voluntary recall on their BIOCELL textured breast implants and tissue expanders. This announcement by Allergan has added to the concern and worry being experienced by many women with breast implants.

In Canada, Health Canada had taken action in advance of this decision by Allergan when they announced the suspension of Allergan’s license for its BIOCELL breast implants on May 28, 2019.

The primary reason for this suspension and recall has been a recognized association between a rare type of lymphoma and textured surface medical devices. We initially wrote about Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) in our blog post of December 12, 2018.

See blog post: Update on Breast Implant Safety and ALCL – Dec 2018

It is important to know that to date, due to the low risk of developing BIA-ALCL, there has been no recommendation from regulatory agencies including Health Canada and the FDA to remove or replace textured breast implants or tissue expanders in women who are asymptomatic and have a normal examination.

I would like to provide some background and share some information regarding these recent events. In Canada, most breast implants and tissue expanders have been made and distributed by two companies (Allergan and Mentor). Both companies make implants and expanders that have one of two surfaces: smooth and textured.

Why might you have a textured surface breast implant?

There are several advantages to a textured surface implant. When using a shaped (teardrop, anatomic) implant or expander, the texturing assists in holding the implant in position so that it does not rotate. In fact, all shaped implants are textured. In the past, texturing has also been felt to decrease the incidence of some of the more common complications associated with breast implants including hardening (capsular contracture) and implants shifting out of position (malposition).

The actual cause of BIA-ALCL remains unclear but one of the most accepted theories is that bacteria may find their way into the crevices or spaces within the textured surface and stimulate an inflammatory response that in a small number of patients may eventually lead to lymphoma.

What do we suggest for our patients?

Late in 2018, our office began a process of trying to contact all of our patients with textured surface breast implants to notify them of this new information, explain what patients should look out for and to suggest that they contact our office to come for a follow-up visit that would include a discussion of patient options. This approach has been helpful in allowing us to speak to and assess many of our previous patients dating back to 2002.

If you are a patient of Dr. Brown and you have not received an email from us, it may be because you have smooth surfaced implants or it may be that we were unable to find updated contact information for you.

We encourage all of our patients to contact the office so that we can confirm for you the type of implant that you have. If you have a textured surface implant we would like to assist you in arranging a follow-up visit or if not possible for you to attend in person, then it will give us an opportunity to provide you with necessary information and to answer your questions. Additionally, all women with breast implants, regardless of the type, benefit from ongoing follow-up of their medical devices and we hope that you will continue to come for complimentary annual or biannual assessments at our office.

Please contact us with any questions or to arrange an appointment.

Dr. Mitchell Brown

Links

Allergan Voluntarily Recalls BIOCELL® Textured Breast Implants and Tissue Expanders
https://www.allergan.com/news/news/thomson-reuters/allergan-voluntarily-recalls-biocell-textured-brea

Health Canada suspends Allergan’s licences for its Biocell breast implants after safety review concludes an increased risk of cancer
https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2019/70045a-eng.php

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Dr. Brown Talks About Cellulite and Cellfina

In this video, Dr. Mitchell Brown discusses cellulite: how it is formed, whether lifestyle changes can help, and surgical treatment options, including Cellfina.

Cellfina is an FDA and Health Canada-approved treatment for cellulite that has been shown to produce results that last for at least two years. Book a consultation with Dr. Brown to determine if you are a candidate for Cellfina.

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All about BRA Day in Toronto with Dr. Brown & Dr. Somogyi.

Toronto Plastic Surgery, Breast Reconstruction TorontoBRA (Breast Reconstruction Awareness) Day is an initiative founded by Toronto Plastic Surgery’s own Dr. Mitchell Brown, that promotes education, awareness and access for women considering post-mastectomy breast reconstruction.

BRA Day events are held in communities across Canada in October. This year’s Toronto event takes place on October 17th, 2018. Dr. Brown, Dr. Somogyi, and the Canadian Cancer Society are also hosting a free BRA Day event at Toronto Plastic Surgery on October 24th, 2018.

During these events, leading plastic surgeons have the opportunity to provide breast reconstruction education and answer patient questions. Attendees are given the opportunity to hear patient stories and connect with women who have been through it, and in the Show & Tell Lounge, volunteers share the real-life results of their breast reconstruction.

Leading up to this year’s BRA Day event, Dr. Brown and Dr. Somogyi have taken the time to answer some common questions about this event and why it is so meaningful to them.

1. First, what is BRA day?

Breast Reconstruction Awareness Day is an initiative that promotes education, awareness and access for women considering post-mastectomy breast reconstruction. Today, hundreds of educational events are held across the world on and around BRA Day, which typically occurs on the third Wednesday of October. These events bring physicians, surgeons, nurses, support staff and, especially, patients together to improve education and awareness around options for breast reconstruction.

2. Why is this event so important to you both?

We are so lucky to have many great reconstructive options for breast cancer patients. Unfortunately, there are still far too many women that are never presented with these options. Education and awareness are the first steps to ensure that women with breast cancer can make the best choice about whether or not to undergo reconstruction and what type of reconstruction is best for them.

3. Dr. Brown, tell us a bit about why you founded the event.

Breast Reconstruction Awareness Day was founded in 2011 to address a clear need for better access, education and awareness for options related to breast reconstruction. Over the many years of my career, I had been meeting with women who had previously undergone mastectomy and went years without knowing that breast reconstruction was even an option. To me, this was unthinkable, especially in an advanced country like Canada. The message certainly has grown and since 2011 BRA Day is now celebrated in over 30 countries worldwide.

4. Who can benefit from this event?

Breast cancer patients, their families and support networks, physicians, surgeons and other healthcare workers that look after breast cancer patients can all benefit from BRA Day events. This event will provide an overview of current options for reconstruction both in the immediate (same time as mastectomy surgery) and delayed (months or years later) settings. It will provide an opportunity to ask questions of the surgeons involved as well as from recent patients that have undergone reconstruction or even those that have chosen not to.

5. What effect have you seen the event have on attendees over the years?

Feedback from the BRA Day events has been excellent. Women frequently report having had an opportunity to be educated in an environment that is comfortable and safe. The ability for women to network with their health care professionals as well as other women who have undergone the reconstruction process is unique and incredibly beneficial. Attendance has continually increased over the years and this has stimulated educational events that are now held throughout the year.

6. What can people expect at this year’s event?

This year, in an intimate, informal setting, we will review current options for breast reconstruction, provide a list of questions for patients to consider while deciding on options for breast reconstruction and spend as much time as possible answering questions from patients and families. We have a number of excellent patients attending who will be able to share their story and answer questions first hand.

7. If someone cannot attend this year’s BRA Day event, but is interested in learning more about breast reconstruction options, what do you suggest?

Fortunately, through the efforts of BRA Day around the world, more and more resources have become available. First, there is likely another event near you that you may be able to attend. Most events are listed here. You can find excellent comprehensive information on the Toronto Plastic Surgery website, or from organizations such as the Canadian Cancer Society, and the Canadian Collaboration on Breast Reconstruction. Finally, don’t be afraid to ask your healthcare provider to organize a consultation with a plastic surgeon that performs reconstructive breast surgery.

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The truth about tummy tuck scars: Dr. Ron Somogyi sets the record straight.

Toronto Plastic Surgery, tummy tuck scars  

A tummy tuck—also known as abdominoplasty—is a surgery designed to remove excess skin and fat from the abdomen and to tighten the underlying abdominal muscles. Tummy tucks are common following weight fluctuation, pregnancy, surgery, or simply to address the natural aging processes. The procedure also allows for the possible elimination of stretch marks, especially if they’re located in the lower part of the abdomen. The end result is a firmer, flatter abdominal shape.

When a patient is considering a procedure like abdominoplasty, we spend as much time as necessary to understand their goals and desires and to make sure that all questions are answered. Not surprisingly, one of the most common hesitations when considering a tummy tuck surgery is related to scars.

As with any surgery—cosmetic or otherwise—a tummy tuck will involve an incision, which inevitably heals as a visible scar. While 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, it’s impossible to avoid scars altogether. The size and appearance of the scar, however, is often dependent on the approach chosen for surgery: a standard tummy tuck, or a mini tummy tuck. This decision is made based on a number of factors, including the amount of excess skin and fat, as well as its location on the abdominal wall.

Standard tummy tuck.

A standard tummy tuck—often referred to as a full tummy tuck—is the most common abdominoplasty option. This approach is ideal for patients who have loose skin, excess fat, and muscle laxity both above and below the belly button. This procedure enables the surgeon to excise tissue in both areas, as well as tighten underlying abdominal muscles. A standard tummy tuck is performed through an incision that is placed along the bikini line, and extends horizontally towards both hips. The length of the tummy tuck scar depends on the amount of excess skin being removed. Often, a second incision is made around the navel, which allows loose skin to be pulled downward. This second scar is hidden within the belly button.

Mini tummy tuck.

The mini tummy tuck is ideal in cases where there is a relatively small amount of excess skin located below the belly button, often associated with a protruding lower abdomen. This approach does result in a shorter tummy tuck scar (similar to a cesarean section scar), and there is no secondary scar hidden within the belly button, since this procedure does not involve the navel.

Your surgeon will discuss these approaches in great detail during your consultation. Together, you will decide which option is best-suited to your condition, goals, and expectations. No matter the approach, proper care of the incisions according to our comprehensive post-operative instructions will go a long way to ensuring the scars heal and fade quickly. As experts in scar management working within a full-service plastic surgery practice, we can also offer topical and/or laser therapy to further improve tummy tuck scars when necessary.

No matter the choice you make, remember that scars fade over time, but your new found confidence will last a lifetime. If you’re interested in learning more about tummy tucks, schedule a consultation today.

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Can You Really Get Rid of Cellulite with Cellfina? Dr. Brown Says Yes

A new treatment could leave you bump-free for life in just an hour

by Katherine Lalancette

I’m shuffling down the hallway of a posh plastic surgery clinic in white socks and a paper gown, clutching the back slit so I don’t inadvertently moon anyone. Stephanie, the doctor’s assistant, directs me toward a pedestal in the photography room where I turn to face the wall, relieved I don’t have to make eye contact for this next part. She proceeds to give my behind a full-on photo shoot, capturing it from every angle and dimming the lights midway to emphasize each lump and bump.

The only thing getting me through this festival of awkwardness is a glimmer of hope I’m holding onto with the same tight grip that kept my gown closed. At the end of this humbling tunnel lies the possibility that I will be cured of that most pesky of female ailments, cellulite.

Too good to be true?

Toronto Plastic Surgery is one of only four Canadian clinics offering Cellfina, a cellulite-banishing treatment launched in the U.S. about three years ago. With the help of a tiny blade, it slices the bands that pull down on skin and create the divots known as cellulite. It requires a single hour-long procedure, involves zero downtime and smoothes dimples for at least three years.

“That’s how long the FDA trials ran, but my particular feeling is it that it should be a pretty permanent result,” says Dr. Mitchell Brown, a plastic surgeon and the clinic’s co-founder.

He first heard of Cellfina a few years ago and immediately reached out to its makers to bring it up north. For years, his patients had asked if there was anything he could do to iron out the dents that made them self-conscious at the beach or sometimes peeked through their skinny jeans.

“Everything else previously didn’t work well,” he says. “This works.”

Unfortunately, it doesn’t work for all women. Cellfina treats only a very specific kind of cellulite, namely localized dips, like those of a golf ball, rather than what is charmingly called “a generalized cottage cheese appearance.” Because of this, almost 60 per cent of patients who come in wanting the treatment get turned down.

“At the end of this humbling tunnel lies the possibility that I will be cured of that most pesky of female ailments, cellulite.”

As Stephanie shows me photos of my bum in a hot pink thong (should have thought my underwear choice through), she announces that I am unfortunately of the untreatable cottage cheese variety. My hopes are as crumpled as the skin on my thighs.

Who does it actually work on?

Ann Spenceley*, on the other hand, was one of the lucky few to get the green light. She flipped through a Cellfina pamphlet one day while waiting to get another procedure in Brown’s office and was instantly intrigued. Following a consultation shortly after, she decided to take the $4,500 plunge toward smoothness.

“I’m 54 years old and have probably had cellulite for 40 years, just like my mom,” Spenceley says. “I work out avidly five days a week. You know when they say in Pilates ‘What area do you want to work?’ I’m always the one who says ‘glutes!’ I eat extremely well. I’ve had the same body weight most of my life, and I’ve never found anything made a difference. It was still always there and always embarrassing in a swimsuit.”

The morning after the procedure, Spenceley gingerly rolled down the compression shorts she was instructed to wear overnight and was amazed to find the dimples already seemed lifted. Her bum was bruised for about two weeks and she had some trouble driving, likening the pain to “a very bad sunburn,” but says she’d do it all over again in a heartbeat.

“All those years tugging my swimsuit bottoms down to hide the cellulite…I don’t think I’ll be doing that this summer,” she says. “I wish I could have done this earlier.”

What about the rest of us?

The figures vary, but most studies estimate between 89 and 98 per cent of women will have cellulite at some point in their life, a fact attributable to the way fat attaches to our muscles, says Brown. So what can my cottage cheese sisters and I do about it?

“Other solutions that I believe as a clinician are worth the money and are likely to work? None,” declares the doctor. “It’s like asking for a solution for stretch marks. We haven’t figured that out yet.”

Perhaps sensing my despair, he offers up some reassurance. “Genetics and the way we’re made are what make us unique. We’ve figured out so far how to change certain things and not others. Five years ago, Cellfina didn’t exist, so we have to hope that five years from now, someone will come up with a good idea that will treat other types of cellulite.”

Until then, every time I feel that urge to tug on my bikini, I’ll try to remember I’m far from alone in this predicament. And since there’s nothing to be done, there really is no use obsessing about it. Here’s to enjoying the summer, dimples and all.

*Name has been changed

Original publication: https://thekit.ca/beauty/body/get-rid-of-cellulite/

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Which breast implants are best?

Dr. Ron Somogyi addresses some common questions regarding breast augmentation.

Toronto Plastic Surgery, Which breast implants are the best

There are many reasons a woman might choose to undergo breast augmentation.

Some women experience changes after pregnancy and breastfeeding, others feel their breasts are too small, uneven, misshapen or disproportionate. No matter the reason, the impact of this procedure on a woman’s self-image and confidence can be dramatic.

Breast augmentation surgery involves placing an implant behind each breast to increase its size and shape, always with the goal of creating breasts that look natural and fit with the overall proportions of a woman’s body. Choosing to undergo this procedure is a big decision, and one that comes along with many questions. One of the most common: which breast implants are the best?

Breast implant material.

When patients ask “which breast implants are best?”, they’re usually referring to breast implant material. There are two breast implant materials approved by Health Canada: silicone and saline. Ultimately, the choice you make along with your surgeon will depend on a number of factors including your cosmetic goals and body type.

Silicone breast implants are made up of a silicone elastomer shell, filled with soft, cohesive silicone gel. Available in a wide range of shapes and sizes, silicone implants closely mimic the feel of a breast, and are often considered to look more natural.

Saline breast implants have the same silicone elastomer shell as silicone implants, but are filled with sterile saltwater during surgery. The size of the implant shell as well as the amount of saline that is used to fill it will ultimately determine the look and feel of your breast. Because these implants are inserted into the body while empty and filled once in place, saline implants may sometimes allow surgeons to use smaller incisions.

What size suits you best?

The size of your breast implants is another important consideration when deciding whether breast augmentation is right for you. This is a highly personal decision, and in order to ensure natural, proportionate results, your height, body type, cosmetic goals, and the amount and quality of your natural breast tissue must be considered. These measurements and this discussion will usually be the more important part of your consultation and surgical planning.

At Toronto Plastic Surgery, Vectra XT 3-Dimensional Simulation will be used during your consultation, allowing you to visualize how breast augmentation is likely to appear on your own body. This is a very exciting and useful way to talk about what you like and what you don’t like about your breasts, and to ensure that your surgeon shares your vision.

Breast implant shape.

Not only are breast implants available in a variety of sizes, they come in different shapes too. The right choice will depend on your native breast shape and your aesthetic goals.

Round implants are just that – round. They add an equal amount of volume around the entire circumference of the breast, providing a significant boost in cleavage and fullness for a youthful final result. Properly sized, round implants can provide a natural breast contour. Shaped implants—sometimes called “anatomic” or “teardrop” implants—create results that mimic the shape of natural breast tissue with more fullness in the lower portion of the breast. 

Incision location.

Another question that many of our patients ask during consultation is “will there be a scar?” With all options, incisions are very inconspicuous, and scars normally fade over time. That being said, there are a few options for incision location: periareolar (along the lower edge of the areola), inframammary (at the base of the breast, in the crease where the breast connects to the chest wall), and transaxillary (within the armpit). The location of your incision is often a personal choice, but can also be influenced by the type of implant and placement you select.

Implant placement options.

Many patients don’t realize that there is more than one option when it comes to the placement of your new implants. In fact there are two unique options: subglandular (above your chest muscle), and submuscular (below your chest muscle). With subglandular placement, the implant is positioned between the chest muscle and the existing breast tissue.  Since the muscle is left untouched, recovery time is often slightly shorter. Patients with little existing breast tissue may not be good candidates for this technique as implant visibility with an unnatural appearance can occur. With submuscular placement (often referred to as “dual plane”), the implant is positioned under the chest muscle. This technique often results in more natural-looking results, though the recovery time can be slightly longer.

As you can see, there are many factors to consider when choosing to undergo breast augmentation, but don’t be overwhelmed. During your consultation, your surgeon will walk you through your options to help you make the decision that is right for you. If you’d like to schedule a surgical consultation, contact us today.

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