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Memorial Day Ceremony, Veteran's Cemetery

LOWER LIDS REFIRME SKIN TIGHTENING PACKAGE - 3 FOR $200

Memorial Day Ceremony, Veteran's Cemetery

Team Wigod Plastic Surgery before the Komen Race for the Cure

The office staff, patients, and friends formed a 52 person team and took part in the Komen Race for the Cure.  We all had a great time and raised a total of $2350.  Much of the team building and fund raising was accomplished by some very dedicated post mastectomy reconstruction patients.  Because of everyone’s hard work, I had the honor of accepting recognition for forming the largest team and raising the most money in our category (corporate less than 25 employees - and we have fewer than 10).  I feel guilty taking credit for others work, but I did hand out some really stylish team hats that I am sure will soon become a highly sought after fashion accessory.  Thank you to everyone on the team for your help and we hope that this will become a Wigod Plastic Surgery annual tradition.

Dr. Wigod accepting recognition on behalf of the team

A partial team shot

The patient is a young woman with good breast size, but volume loss and ptosis (droop) post pregnancy. Breast Augmentation fills the “empty bag” and provides superior fullness to make attractive cleavage in a bra.  For this approach to work without a mastopexy (lift) with its accompanying scars, two things are necessary.  First, the patient must accept that she will be relatively large as there must be adequate implant weight to get the device to the bottom of the breast (bag).  Second, a bi-planar technique is used.  This keeps the upper part of the implant covered with muscle while allowing the extra breast tissue to distribute over the implant surface.   In patients with good breast volume, saline implants are usually well hidden by this technique as well.  Third, the patient should have downward pressure on the  implant with a bandeau (an elastic strap) for at least several weeks.  The implant usually reaches a good position.  Even if the implant position is not all the way at the bottom of the breast, it nonetheless looks very good and need for a mastopexy is usually avoided.

Pre op anterior view

Post op anterior view

Pre op oblique view

Post op oblique view

Finish line at the Komen Race for the Cure

Add a Facial Wax to any service for $10.

Two of our Staff feeling proud after finishing well ahead of Dr. Wigod in the Race.

Ensenada Coast

Approximately 3 years ago, the FDA released silicone gel implants back onto the market after studying them for greater than a decade.  Their reintroduction has greatly benefited women seeking breast surgery, especially patients with thin coverage over their implants.  I find that I recommend silicone implants for most reconstructive patients as they have thin coverage after their mastectomies.  Silicone helps to minimize rippling and it feels better than saline.  I recommend silicone to augmentation patients about 50% of the time.  Those patients usually have particularly small breasts  and or have thin skin.  In augmentation patients who have a lot of breast tissue, silicone is largely unnecessary as the implant is well covered.  I sometimes cannot tell if these patients have silicone or saline implants when I examine them at their 6 month follow up.

Well conducted studies have concluded that leaking silicone implants do not lead to any diseases, mysterious or otherwise.  It is thought, however, that leaking silicone can put patients at higher risk for capsular contracture.  Therefore, the FDA has recommended that all patients have an MRI at 3 years post op and then every 2 years thereafter to look for leaking.  Those first patients to get silicone implants are now coming due for their MRI’s.  Reconstruction patients should have their studies through their primary care physicians or their oncologists.  Augmentation patients are responsible for arrangement and payment for their own MRI’s.  Local radiology groups offer less expensive MRI’s that are specifically tailored to look for silicone leaks only and not for any breast tissue problems such as cancer.  If a leak is found, implant exchange is recommended.

When the 3 and 2 year MRI guideline was made, there was skepticism on the part of most plastic surgeons. Were so frequent exams really necessary?  We know that leaking gel does not cause systemic disease.  Now that the first 3 year period is up, there has been more push back from Plastic Surgery Leadership and recognized authorities in the field.  MRI is a useful study to detect a leak.  Unlike saline, when a silicone implant leaks, it does not deflate, and is basically undetectable otherwise.  There can, however, be false positive studies.  That is, the MRI can say there is a leak, but there may not really be one.  In that case, an expensive operation with all the usual risks is performed when it did not really have to be done.

So what do I tell my patients?  I’m the type of person who asks permission first rather than forgiveness later, so I dutifully present the recommendations as part of the required additional silicone gel consent document supplied by the manufacturer and mandated by the FDA.  Medicine is no longer as paternalistic as it once was.  Patients demand information and choice.  With these rights, however, come responsibilities. Therefore, it is up to each individual patient to evaluate the science as well as the guidelines and come to her own conclusion.  After all, the FDA will not be organizing shuttles to the MRI machine, nor will they be paying for the studies.