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Since 1997,
Dr. Benjamin Gelfant
has been a leader in the
development and practice
of endoscopic (minimum scar)
Breast Augmentation!
Since he opened his Vancouver clinic in 2000, this approach has been refined and improved and continues to be the preferred approach for many women. |
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| Over the years, through breast augmentation with placement of implants, Dr. Gelfant and his Vancouver based team of professionals has helped women lead happier, more fulfilling lives. Now, almost two hundred women per year entrust him to either perform their breast surgery or to treat problems arising from surgery elsewhere. |
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| Although breast augmentation surgery has been done for over forty years, improvements in the implants, in the surgical technique, and even in anaesthesia, have all contributed to making this a safer, more predictable, and ultimately more satisfying operation. |
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Your
Breasts May Be Small…
Because they never
developed to the extent
you would have liked |
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42
years old, 5'6 120lbs,
2 Children, Pre Surgery:
34A
Implants: R 325cc filled
to 350cc, Post Surgery:
34C |
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after pregnancy, breast
feeding and weight loss: |
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25
years old, 5'7.5 130lbs,
1 Child, Pre Surgery:
36B
Implants: R 425 to 450cc,
L 350 to 400cc, Post Surgery:
36D |
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In any case you may be helped by breast augmentation with implants to fill them out. |
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| Incisions may vary depending on surgeon and patient preference: |
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For minimal incision surgery, either the armpit approach or the umbilical (belly button) approach is used. Dr. Gelfant is a leader in the use of the armpit approach, having used it almost exclusively since 1997, and has taught many surgeons this technique.
The armpit is one of the best areas of the body for scars. Most patients eventually have invisible scars with this approach, even in skin types who often get poor scars elsewhere. |
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| Post
Breast Augmentation through
armpit - Scars nearly
invisible |
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Belly Button (TUBA) approach:
While the umbilical technique may appear attractive, it has the disadvantage of not being a gentle, refined operation done with the excellent visibility of the endoscopic armpit approach, in which cutting is precise and pinpoint control of bleeding is maintained at all times. The TUBA technique tends to be done “blindly” , that is, without seeing what is actually being done, using the telescope only later, to ensure there isn’t active bleeding before stitching the incision closed. It has the disadvantages of inaccuracy and roughness, and all the consequences. |
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Placement
of the implants can be
above or under the pectoralis
major muscle…
But our experience has shown that if you want a long-lasting, natural-looking and feeling result, placement under the muscle produces the breast augmentation results you want far more predictably. |
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| Placement
above muscle |
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Risks
of Surgery
All surgery carries risks of problems. We have continuously assessed the quality of our results to try to minimize risk. The following is a summary of both Dr. Gelfant’s experience at his Vancouver clinic and the general experience with breast augmentation
Capsular
Contracture:
Whenever a foreign material,
whether it is a sliver,
a piece
of glass, shrapnel, or
a breast implant is placed
under the surface of the
body, the body recognizes
it as not part of itself,
and if it cannot digest
the foreign substance,
reacts by forming a wall
around it. This wall,
which we call a capsule,
is very much like scar,
and may be thin and soft,
or tough and thick. In
the early phases of healing,
all scars contract.
If the capsule contracts
around the implant and
the space available to
the implant becomes tight,
the implant comes under
pressure, is forced into
a more rounded shape,
and becomes firm or even
hard. |
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| Capsular
Contracture of the right
breast on our left. |
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This
condition, which we call
capsular contracture,
is by far the most common
problem for both plastic
surgeons doing breast
augmentation and our patients.
We cannot explain why
one patient will get contractures
and another will not,
nor why in some patients
one side will develop
a contracture and the
other will not. Nor can
we predict who will get
the condition. It poses
no major health risk to
the patient but may cause
enough firmness on occasion
to be uncomfortable or
even painful and certainly,
the more severe, the less
natural they appear and
feel.
Our
experience parallels the
experience of the plastic
surgery community in general
on the issue of contracture.
Placement of the implants
above the muscle results
in contracture rates of
roughly 25% by three years
and this number continues
to increase with time.
Beginning in late 1996,
we began placing all implants
beneath the pectoralis
muscle, and the contracture
rate dropped profoundly,
to less than 1% at three
years, in almost 500 patients
reviewed. While this has
not eliminated the problem,
it has reduced it to a
rare occurrence.
Infection:
Infection is a rare occurrence
in breast augmentation.
If it occurs, it is usually
present in the first week
after surgery and almost
always requires removal
of the affected implant,
cleansing of the space,
and antibiotics. The implant
can later be replaced
once infection has completely
settled. The risk
of this occurring is less
than 1/2%.
Post-operative
bleeding:
Bleeding inside the implant
space can accumulate as
a hematoma
and this requires urgent
re-operation. Prior to
our change to under the
muscle with endoscopic
assistance (through the
armpit) the risk was about
2%, the same as most plastic
surgeons report. This
has been reduced to once
in the past 650 patients
(less than 0.1%). While
this is a profound reduction,
bleeding can still occur.
We also warn patients
that if uncontrollable
bleeding during surgery
occurs, obscuring the
lens of the telescope
repeatedly, an incision
in one of the traditional
locations on the breast
would be made, but
this has never yet been
needed.
Loss
of feeling:
or reduced feeling of
the breast and nipple
can occur. It used to
be said this was in about
15% of patients. Although
this appears to be far
more than we usually see,
it still occurs periodically.
Although feeling usually
gradually returns, it
may not, or it may result
in increased sensitivity
for several months.
Pain:
Sub or under the muscle,
placement has a reputation
of producing far more
pain and a prolonged recovery.
This is FALSE. If careful,
GENTLE surgical technique
is used, aided by the
magnified view of the
operation we have with
endoscopic guidance, bleeding
is minimized, the implant
space is carefully prepared,
and all factors are working
in favour of rapid recovery.
Most patients return to
work within five to seven
days.
Secondary surgery, bleeding
postoperatively, pain,
time away from work and
from social activities
are all minimized. Most
patients are able to take
only mild pain relievers
by the second post operative
day.
Scar:
Most incisions are 1"
to 1-1/2" or less.
It is rare for the scar
to be visible once complete
healing has occurred. |
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SILICONE IMPLANTS ARE NOW FREELY AVAILABLE IN CANADA!
As of October 2006 the 14 year ban and limited use of silicone gel filled implants is over. Surgeons and their patients may now freely choose the implants which best fit their needs, without requesting special approval
Silicone
Versus Saline
Silicone gel filled implants were taken off the market except for investigational purposes in 1992 by the US Food and Drug Administration and Canada’s parallel body, the Health Protection Branch, soon followed with a similar ruling.
There were several concerns which prompted these rulings: possible risk of cancer,
a possible link to immune related diseases, and leakage of the implants.
Since 1992 much research has been done to study the effects of implants on the health of women with implants. All the available evidence, which is now very powerful, suggests there is no link between the use of silicone gel filled (or saline filled) implants and increasing risk of development of breast cancer or any of the chronic diseases which were responsible for the controversy.
From April 1992 until October 2006 use of silicone gel-filled breast implants was restricted at first to an outright ban and later to permission from Health Protection in Ottawa after a request from the surgeon. In October 2006, after years of considering all the evidence presented at multiple hearings, permission was granted to the manufacturers to sell the implants to surgeons without restriction. Continued research into health and safety of these devices is a condition of this approval.
What is good about silicone gel implants? There is no question gel feels more natural when the implants are picked up from a desk top. Gel can be varied in its consistency and can be made to feel very much like breast tissue. Cohesive Gel is now being advocated as the best filler for implants. Cohesive gel is said to be more stable so that in the event of a leak or rupture, the gel will be confined to the capsule and more easily removed. It is said to cause less visible rippling, waviness in the implant which may be visible through the skin.
We are pleased to now be able to offer these implants to our patients as one of the choices available.
Although we are now using silicone gel filled implants in many cases, we continue to use saline filled implants in up to half of our cases. Why? Saline is the most natural filler. Our bodies are over 70% saline (salt water. Rippling is more of a problem with implants which are above the muscle. Since all of Dr. Gelfant’s implants are now placed under the muscle, this is much less of a problem, and is mainly seen in patients who have almost no breast tissue and minimal body fat. In patients with minimal breast tissue and fat, we will usually suggest silicone as a possible option, to help minimize visibility and rippling.
You should be aware, that despite claims to the contrary, gel can still result in some visible rippling. Generally speaking, this is less than in saline filled implants, in women with lower body fat and less breast tissue.
Cohesive gel implants must be placed through more generous incisions or tearing of the cohesiveness ( fracture of the filler) can result, and this normally prevents their safe insertion through the minimal incisions used in the armpit approach. Usually an incision under the breast is needed.
For these reasons, we continue to consider saline filled implants to be an excellent choice for many patients, but use gel filled implants under the right circumstances. |
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Sizing
Historically there
were many methods used
to determine breast implant
size, but these were,
surprisingly, usually
dependent more on the
surgeon’s sense
of balance and esthetics,
than on the patient’s
desires. Our aim in sizing
patients is to try to
satisfy the patient, while
not compromising safety.
First, we ask the patient
to buy a bra of the size
she wants to be by trying
bras on wearing a sheer
blouse or T-shirt, stuffing
the bra cup with tissue
of other fillers. She
then comes in to the office
and we have her put the
bra on and place a device
in the bra. The device
is a temporary type of
implant which can be filled
with water until the bra
cup is filled to the desired
volume with implant plus
her own breast. |
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At
this point, we examine
the dimensions of the
patient’s chest,
and if she has sufficient
space on her chest to
allow the placement of
an implant of the size
she desires (which is
usually the case) we simply
use that size of prosthesis.
Sometimes this may require
a High Profile Implant.
Adjustments can be made
for differences in size
between the two sides.
Most important, the patient
determines the size, with
my help. However, no
guarantee of size can
be made. |
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What
is overfill?
Inflatable implants
are supplied empty, and
have a range of fill volumes.
For a 325cc Mentor implant,
for example, this is from
325 minimum to 375cc maximum.
There is a feeling, among
experienced plastic surgeons,
that underfilling implants,
something that was done
before capsular contracture
was understood, increases
the chance of the implant
shell breaking and leaking,
simply because over time
there is more folding
of the shell over and
over again. There is also
likely to be excessive
rippling visible through
the skin. There is also
the feeling that maximally
filling (to the maximum
recommended volume), reduces
this risk, and that overfilling
may also be worthwhile.
Excessive overfill, however,
leads to the edges of
the implant distorting
and being easily felt.
We usually fill implants
to as near to maximum
recommended volume as
possible, and don’t
overfill by much, if at
all. In 494 patients
operated on in a recent
series from our clinic,
the re-operation rate
for size was less than
4% overall.
After
Surgery
Stitches:
There are no stitches
to be removed. Stitches
are absorbable and buried
under the skin. You may
begin showering the day
after surgery at which
time the small band-aid-type
dressing is removed and
not replaced.
We usually see patients,
in our Vancouver clinic, the first working day
after surgery day and
check carefully for any
problems, discuss how
you are feeling, and review
any concerns you may have.
Activity:
We encourage you to start
using your arms within
twenty-four hours
of surgery. You
may return to most normal
activity within twenty-four
hours.
You may begin riding a
stationary bike, walking
on a treadmill or outdoors
or other gentle aerobic
activity within a few
days. Aggressive sports
and exercise should not
resume for two weeks.
If you work out regularly
in a gym with weights,
you may not feel comfortable
with “lat pull-downs”
“pec fly’s”
or “chest press”
exercises for six weeks.
Our studies have shown
our patients to be back
to near normal muscle
strength by six weeks.
Exercises to keep the
implant soft and mobile
are reviewed after about
one week. Barring any
problems or concerns,
we usually have another
visit six weeks later
and at six months, and
then annually if possible. |
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Breast
Feeding
With placement
of the implants under
the muscle, especially
when the armpit incision
is used, the breast itself
is not disturbed. There
is usually no interference
with the function of the
breast gland, and as long
as there is some sensation
to the nipple (it is rare
for complete loss of sensation
to occur) nursing is possible.
However, not all new mothers
are successful at nursing
even without implants,
so no guarantees can be
made. |
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Mammograms
and the detection of breast
cancer
Saline filled implants
placed under the muscle
interfere least with examination
of the breasts by mammography;
although there is still
some reduction in how
well the breast can be
seen, this is much less
than with silicone gel
filled implants placed
under the breast. Detection
of cancer by self examination
is not made more difficult
by augmentation. |
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Droop?…
Or Loss of Volume
One of the most
common questions we are
asked is “DO I need
a lift??” and this
is important because a
breast lift is quite different
from augmentation and
involves more incisions
and therefore more scar
than a breast augmentation.
Plastic surgeons think
backwards about this.
Some patients feel they
have developed droop but
the nipple and areola
are still above the level
of the fold under the
breast; in this type of
case, the cause is generally
loss of breast volume
alone and placement of
an implant is the usual
recommended treatment.
In most cases when the
patient complains of drooping,
the nipple and areola
are still above the level
of the fold, but the upper
breast has lost its fullness
so the breast looks collapsed.
This requires filling
out the breast volume,
an augmentation, not a
lift. |
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| Pseudo
Droop: A lift not needed: |
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26
years old, 5'7 148lbs,
2 Children, Pre Surgery:
34B
Implants: R 425 to 450cc,
L 425 to 450cc, Post Surgery:
34D |
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Droop (Ptosis) |
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If
the nipple and areola
are below the level
of the fold a lift is
usually required.
How much droop is described
by the plastic surgeon
by the distance from the
level of the fold to the
level of the nipple.
More on
Breast Lift Surgery
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| Further
Examples of Breast Augmentation |
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27
years old, 5'1 105lbs,
No Children, Pre Surgery:
32A
Implants: 325cc filled
to 375cc, Post Surgery:
32C |
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20
years old, 5'6 115lbs,
No Children, Pre Surgery:
34B
Implants: R 425cc to 450cc,
L 425cc to 475cc |
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27
years old, 5'9 115lbs,
No Children, Pre Surgery:
34B
Implants: R 325cc to 375cc,
L 325cc to 350cc, Post
Surgery: 36D |
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27
years old, 5'9 115lbs,
No Children, Pre Surgery:
34B
Implants: R 325cc to 375cc,
L 325cc to 350cc, Post
Surgery: 36C |
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Deciding whether Breast Augmentation is right for you starts with a personal consultation with Dr. Gelfant.
You are invited to contact us at our Vancouver offices to arrange a meeting.
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