EVOLV Medical Aesthetics

Category: Breast Augmentation / Implants

Breast Implant Associated – Anaplastic Large Cell Lymphoma or BIA-ALCL.

As many are aware, there has been much recent publicity and discussion in the news about a rare type of lymphoma associated with breast implants and has been termed ‘Breast Implant Associated – Anaplastic Large Cell Lymphoma or BIA-ALCL.’  On July 24, 2019, Allergan Medical Corporation issued a worldwide recall of all of their textured surface breast implants and tissue expanders per request of the Food and Drug Administration (FDA) because of the association of BIA-ALCL with the ‘macro texturing’ or Biocell texturing on some Allergan devices.  This recommendation was based on recently submitted Medical Device Reports (MDR’s) reporting an increase in worldwide cases of BIA-ALCL associated with these devices compared to other textured surface and smooth surface devices.

As a Board-Certified Plastic Surgeon and member of the American Board of Plastic Surgery (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS), we are committed to patient safety, advancing quality of care, and practicing medicine and surgery based upon the best available scientific evidence.  If you have received breast implants or tissue expanders and have any concerns or questions about this recent information and the Allergan recall and BIA-ALCL, we encourage you to make an appointment or call us at evolv Plastic Surgery and Medical Aesthetics so we can provide science-based and factual information specifically to you.  I have over 30 years clinical experience in the use of various breast implants and tissue expanders in both cosmetic augmentation and breast cancer reconstruction as well as published research studying breast implant biomaterials and their function and safety.  

Most Recent Science-based Facts:

  • BIA-ALCL is extremely rare.  There have been 573 confirmed cases worldwide, and considering the many millions of women with breast implants for both cosmetic enhancement and in breast reconstruction, the incidence is very low although significantly higher in association with deeper or ‘macro’ textured devices like Allergan’s Biocell surface.
  • Because of their significant advantages in some patients, I have used textured breast implants and tissue expanders for over 30 years and have never had a confirmed case of BIA-ALCL in any patient.   
  • BIA-ALCL most always presents with new onset swelling, fluid accumulation around the implant (serum), and discomfort and can be consistently and quickly diagnosed with laboratory studies of the fluid aspirated around the implant.  When detected early, removal of the implant and all of the scar tissue capsule around the device cures the problem. In rare cases left untreated, chemotherapy and/or radiation may be necessary.
  • BIA-ALCL is not breast cancer but is a cancer of white blood cells (lymphoma) and is usually localized only in the scar tissue capsule around the implant and most often can be definitively treated by removal of the surrounding scar capsule (capsulectomy) and implant.
  • Although only recently described and relatively rare, evolving research studies indicate that the development of BIA-ALCL is multifactorial and involves the interaction of 4 factors: textured surfaces, bacterial contamination, genetic susceptibility and time.  It appears that deeper or more aggressive texturing increases risk and that there is no association with smooth surfaced implants.
  • The FDA has clearly stated that if you are a patient with textured surface implants and are not experiencing any symptoms as described above, they are not recommending removal of the implants.  If you have any questions about risk they are suggesting that each patient talk to their health care provider.

For patients in the U.S. who, as a result of the recall announcement on July 24, 2019, choose to replace their Bio cell textured device with a smooth surface device, in consultation with their Plastic Surgeon, Allergan Medical will provide Allergan smooth device replacements of a similar size at no charge to the patient.  This Replacement Program will run for 12 months until July 24,2020.  

Breast implant surgery, whether for cosmetic enhancement or for breast cancer reconstruction, when done by a Board-Certified Plastic Surgeon on the appropriate patient, can have a profound effect on improving quality of life for women of all ages.  The other fundamental goal is long term patient safety and utilizing the best research-proven evidence or breast implants and bio materials. There are several safe choices available to patients when selecting implants. Research on BIA-ALCL is still developing, and it is important to focus on what is proven and scientifically validated.

We are encouraging any patient with implants or any patient considering breast augmentation or implant-based breast reconstruction to discuss these issues with a board-certified plastic surgeon with proven experience in breast surgery.

Links from reputable sources to learning more about these concerns.

If you should have any additional questions or concerns, please feel free to contact our office at 419-720-2008.  We highly recommend annual exams to all our patients. We want everyone to put safety first, regardless of insurance coverage or not, therefore we offer annual complimentary breast exams to all our patients. 

I thank you for your attention.

Frank Barone, MD

Getting the Cleavage You Want with Your Breast Augmentation

One of the most common misconceptions about breast augmentation is that it’s all about size. Although this might be the main focus for some patients, many have some other factors in mind when they come in for a consultation. A good plastic surgeon can guide you to the right implant that can achieve your goals for size, shape, projection, feel, and many other factors. However, it can take a particularly skilled plastic surgeon to achieve beautiful, natural-looking cleavage. As you plan your consultation, here are some things to know about how breast augmentation can achieve your cleavage goals.

What causes cleavage?

Cleavage is the space between the breasts, and it can depend on many different factors like clothing, anatomy, and position. For some women, cleavage is a distinct, wide space through which bone structure and contours are visible. For others, cleavage is a telltale line where the two breasts meet together. Each woman’s cleavage is unique, but breast augmentation can achieve either type (and many different in between) with the right techniques. It’s mostly dependent on your breasts, their position, distance, and amount of skin.

How does breast augmentation adjust cleavage?

This can be a difficult question to answer, since plastic surgeons can utilize many different techniques and assessments to create different kinds of cleavage for each unique patient. Generally, its success can depend on things like the distance between your natural breasts, skin laxity and elasticity, and existing breast tissue. These factors can help your plastic surgeon estimate the right position for your chosen implants to create your desired cleavage. This can mean creating a breast tissue pocket that helps the implants to exist closer together or further apart.

How can I achieve my cleavage goals?

The most important factor in achieving the breasts you want is choosing a board certified plastic surgeon who has plenty of experience in performing breast augmentation. It’s important to seek out before and after photos so you can get an idea of their skills and outcomes, and whether they fit you and your goals. Remember that most photos will show breasts that are unsupported by clothing, so you should be sure to express your goals for cleavage both when wearing a bra or tight-fitting clothing and without. Communicating your goals and ensuring that your plastic surgeon can accomplish them can help you achieve the cleavage you’ve wanted with the right techniques and implants for you.

Schedule a Consultation

There are many different things to consider when it comes to your breast augmentation goals. Your first step in creating the right breast augmentation procedure for you is meeting with a board certified plastic surgeon who can discuss your options. At evolv Plastic Surgery, we seek to provide the best in expertise and patient care when it comes to breast augmentation. To schedule a consultation with our board certified providers, contact our Toledo office by calling or filling out our online form.

Considering Breast Implant Augmentation?

Breast enlargement or enhancement by implants, and more recently fat grafting, is the most popular of all cosmetic surgical procedures.  Last year over 300,000 women in the U.S. had breast implant surgery, and the procedure has nearly tripled in popularity since the year 2000.  The reasons for this dramatic increase are many but improvements in implant biomaterial, advances in operative and anesthesia techniques, and overall patient comfort and safety have resulted in more natural and balanced results with long-term patient safety and high satisfaction levels.

The good news is that when performed by an appropriately-trained and credentialed plastic surgeon in a regulated operative facility, the high patient satisfaction rates and safety have proven in clinical studies to significantly improve patient self-confidence and quality of life.   Unfortunately, when the above criteria and considerations are not followed, complications and costly long-term problems can occur which may not be entirely correctable.  At evolv Plastic Surgery, Dr. Frank Barone and Dr. Peter Koltz believe strongly in the benefits and safety of comprehensive patient education and the importance of making informed choices when it comes to any cosmetic or plastic surgical or non-surgical procedure.  The fact is that the most informed patients generally make the best choices.  https://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation/questions

Because there are so many choices in any elective aesthetic or cosmetic procedure, and especially in breast implant augmentation, we believe it is critical for any woman contemplating breast implant surgery to carefully review the following fundamental considerations.

Goals and Benefits

The goals of breast implant augmentation are consistent with the goals of every properly performed cosmetic or aesthetic procedure – to safely enhance or improve body contour and restore natural youthful features in order to increase self-confidence, enhance self-image and subsequently improve overall quality of life for each patient.  Each patient’s motivation may vary but improving self-image and confidence is not simple vanity but is connected to our evolution and the human desire to improve appearance for ‘survival’ benefits.  Like it or not, appearances matter, and multiple studies have consistently proven that naturally-appearing and enhanced, youthful features provide distinct advantages to quality of life.

Properly done aesthetic procedures should be balanced, safe and natural-appearing, but we have all seen poorly done cosmetic surgery in the news, that is far from ’natural appearing.’  This is especially true with breast augmentation.  Patients and providers who do not respect this fundamental concept will often have unnatural and negative outcomes with the risks of increased complications, additional costs and detrimental long-term results.

What Breast Augmentation Can and Can’t Do

Breast implant augmentation can:

  • safely improve fullness and projection to benefit overall female contour and balance
  • help restore areas, such as the upper pole of the breast, that may have lost fullness after pregnancies or aging
  • help correct imbalance or congenital and developmental asymmetries of the breasts
  • help improve self-image and self-confidence when done properly and for the right reasons in each patient

Breast Augmentation cannot correct significant sagging or laxity of the breasts that may have occurred from weight loss, multiple pregnancies or aging.  In these situations, a breast lift or mastopexy with or without implant or fat graft augmentation may be suggested by your plastic surgeon.

Costs – Price Shoppers Beware

The price of breast implant augmentation can vary widely depending upon:

  • training, qualifications and experience of the surgeon
  • location of the surgery (accredited outpatient facility vs doctor’s office operating room or clinic)
  • type of anesthesia and qualifications of anesthesia provider (certified anesthesiologist vs less experienced staff)
  • experience, training and qualifications of ancillary staff
  • manufacturer, type and quality of breast implant

Surgery is expensive and affordability is a key concern for patients contemplating breast implant surgery; however, ‘price shopping’ can be very dangerous for many reasons including all the above considerations.  The most proven and important consideration is the training and qualifications of the surgeon.  Many consumers do not realize that any physician with a medical license can legally perform breast implant surgery, as well as any cosmetic surgical procedure, in their own clinic or office even if they have not had credentialed training in that surgery or specialty.  Savvy marketing and advertising or attention grabbing ‘deals’ can be difficult to resist for many patients who have limited resources to afford the procedure.  When these ‘bargains’ are carefully analyzed, there is always a reason why the price is considerably lower, and it is no coincidence that these are the situations where more complications and re-operations occur.  It can be very costly to repair complications, and often results are compromised.  In the words of the world’s greatest investor Warren Buffet, ‘Price is what you pay….value is what you get.’

Implant Options

A variety of implant styles, shapes and types are available.  The quality, safety and performance of breast implants has dramatically improved in recent years as have patient outcomes.  All breast implants in the United States must undergo long term and rigorous testing as well as clinical studies to obtain FDA approval, and constant monitoring is done annually.  Some of the considerations in implant choices are:

Fill – Implants may either be filled with either sterile saline (salt water) or silicone gel.  Both have been thoroughly studied and fully approved by the FDA.  Gel is more popular due to its natural ’tissue like’ feel, but a discussion with your plastic surgeon will help determine which option is best for each patient’s goals and concerns.  Recently a form stable gel, often referred to as the ‘gummy bear’ implant, has been approved and has the advantage of holding its shape in anatomic or ’tear drop’ styles and avoiding the chance of leakage.

Shape – Breast implants are available in a round or anatomic (tear drop) shape. Each has a particular advantage, and these options should be reviewed with your surgeon.  Many choices in implant dimensions such as width, heath and projection are also important features in choosing the most appropriate device for each patient’s anatomy, goals and lifestyle.

Surface – Breast implant shells may be smooth or textured, and each choice has a potential advantage depending on the patient’s goals and interests.  Textured surfaces may reduce the possibility of capsular contracture or excessive firmness of the tissue around the implant.  A rare form of lymphoma called implant associated ALCL (anaplastic large cell lymphoma) has been recently reported in approximately 1:50,000 patients with textured implants.  ALCL is usually cured by removal of the implant and the surrounding capsule, but this issue should be discussed with your surgeon if a textured device is preferred.


Risks and Safety

When performed by an experienced, board certified plastic surgeon in a properly credentialed facility, breast implant surgery has a very high (greater than 96%) satisfaction rate and is also safe and effective.  But any procedure has risks, and these should be completely reviewed with the patient in the preoperative examination.  A thorough physical examination and complete medical history are also an essential component of reducing risks and complications. Openly defining risks and benefits along with a comprehensive medical assessment and photographic documentation/imaging are important and integral parts of properly planned aesthetic surgery.

Procedure Steps

Being well informed and prepared for surgery will reduce anxiety and improve the overall experience.  For the breast augmentation procedure, the plastic surgeon will discuss recommended anesthesia options, choice of incision location, location of implant placement (either below or above the chest wall muscle), implant type, volume and dimension, and expected post-operative course and recovery.  At evolv Plastic Surgery, Dr. Barone and Dr. Koltz often utilize the Vectra 3-D, a 3-dimensional imaging system to help predict implant choices and results specific to each patient’s own anatomy and goals.  The implant surgery typically takes less than 2 hours in the operating room.

Recovery and Down Time

After surgery is completed, patients are dressed in a custom post-operative bra and taken to the recovery room.  Because the anesthetic is light, recovery room time is usually less than one hour for most patients.  Patient comfort is a priority at evolv Plastic Surgery and precise and less traumatic dissection techniques, headlight illumination, prevention of bleeding and long acting nerve blocks (Exparel) and post-operative lymphatic massage all play an integral part in minimizing discomfort and downtime and improving the overall experience for our patients.  Each patient will be given specific instructions and advice on resuming activities and return to work.

The Most Important Decision – Choosing a Plastic Surgeon

Breast Augmentation surgery involves many choices.  Studies confirm that the first and most important choice is selecting a qualified plastic surgeon that you can trust and who is a member of the American Society of Plastic Surgery as well as board certified in Plastic Surgery by the American College of Surgeons.  As members, these surgeons must meet the following rigorous standards:

  • Board certification by the American Board of Plastic Surgery (ABPS) or in Canada by the Royal College of Physicians and Surgeons of Canada
  • Complete at least six years of surgical training following medical school, with a minimum of three years of plastic surgery residency training
  • Pass comprehensive oral and written exams
  • Graduate from an accredited medical school
  • Complete continuing medical education, including patient safety, each year
  • Perform surgery in accredited, state-licensed or Medicare-certified surgical facilities

Be wary and cautious of other ‘official’ sounding boards and certifications or by the term ‘board certified’ if it is in another specialty.



The decision to have breast augmentation surgery is a highly personal one, as is any aesthetic surgery or procedure.  Any woman considering breast implant surgery should carefully evaluate their options, take appropriate time to learn as much as possible from reliable sources, and take their time in making a well-informed decision.  The most important decision is choosing an experienced and board-certified plastic surgeon.  Despite the excellent safety and high satisfaction rates in breast implant procedures, it is still a significant surgical procedure and one that can have higher risks and complications if done by a less experienced or non-specialty trained physician in an unregulated clinic or office procedure room.  Aggressive internet marketing and advertising that attracts patient candidates with considerably lower price offers and unrealistic outcomes are not only unethical but dangerous.

Trust is the most important criteria in the doctor-patient relationship and must be earned with honest communication, transparency and dedication to specialty training and ongoing education.  If you are interested in more information or would like to learn more about the many facets and options in breast implant augmentation, please contact Dr Barone or Dr Koltz at evolv Plastic Surgery and Medical Aesthetics.

Thank you for your attention and interest!


Even though it was over 30 years ago, I will never forget her face.

She was a young mother and school teacher with 2 small children and I was a first year plastic surgery resident.  She had a mastectomy for breast cancer and was left with a large and painful tight scar.  The implant that had been placed by my instructor under the scar was hard, unnatural and uncomfortable…..at that time in the mid 1980’s there just were not many options or choices. She looked at me and I did not know what to say to comfort her.  That was the day I decided to seek post graduate training in breast reconstruction and that young mother, with the eyes I cannot forget, changed my life forever.

This year an estimated 230,000 women in the U.S. will be diagnosed with breast cancer but less than 25% of those women will be aware of their reconstructive options before treatment.  The breast cancer experience touches not only those women but also their spouses, their children, their families and their lives for years.  The breast cancer experience involves much more than just removing a tumor or having a mastectomy, it is a journey that can involve medical and other post-operative treatments as well as impact a women’s personal life and self-confidence and relationships at every level.  In short it will someday effect all of us and someone we love.

The really exciting news is that the breast cancer experience is changing significantly for the better for a variety of reasons:

Education and Patient Awareness – public awareness and educational efforts by a number of professional     organizations have resulted in women being more informed and aware of their options.  The American Cancer Society, the American Society of Plastic Surgery, the Susan G. Komen Foundation, The Victory Center and many others are doing an incredible job of communicating useful information to patients and their families.  The best informed patients make the best choices!

Identifying Risks and Cancer Prevention – the most effective way to fight cancer is prevention.  New research on nutrition and life style as well as genetic testing to quantify risk factors have actually made a substantial difference in breast cancer incidence.  Advances in genetic mapping have made great progress and resulted in improved options and treatment outcomes for patients at risk.  Prophylactic mastectomy or removing the breast tissue to prevent cancer in high risk individuals, as popularized by actress Angelina Jolie, can reduce cancer risk by 90-95% in appropriate patients and result in excellent aesthetic outcomes.  We encourage everyone to learn more about these exciting advances in order to protect themselves and their families.

– Early Detection – After prevention, the next most effective way to impact breast cancer is early diagnosis.  Improved patient education and self-exam, consistent doctor’s visits, advances in imaging techniques such as mammography, ultrasound, MRI and other scans have resulted in earlier detection of breast cancer and breast ‘pre-cancers’ which will improve the overall patient experience and outcomes as well as reduce breast cancer morbidity.

– Improved Surgical and Reconstructive Techniques – Significant advances in biomaterials for breast implants and implantable materials (acellular dermal matrix) to help shape breast reconstruction procedures, have resulted in much more natural breast shapes as well as improved safety and less recovery.  Earlier detection and research on tumor biology have resulted in less invasive resection procedures (lumpectomy and mastectomy) and options such as sparing the breast skin and nipple in appropriate patients.  Placement of implants above the chest wall muscle (pre-pectoral reconstruction) and advances in tissue flap surgery reduce recovery time and have improved results for patients dramatically.  Our very own Dr. Peter Koltz, an associate with Dr. Barone at evolv Plastic Surgery, completed advanced training in tissue flap surgery for breast reconstruction last year and has been offering these options for patients in the Toledo area.

Post Treatment Quality of Life Improvementthe consequences of breast cancer treatment do not stop after the procedures have ended.  Many patients taking  estrogen blocking medication or other targeted chemotherapy or radiation deal with side effects such as bone and heart health, hair loss, premature skin aging, tissue dryness and laxity, post-menopausal vaginal dryness and urinary incontinence.  This often results in femininity and intimacy challenges, sexual difficulties and overall loss of self-confidence and intimacy.  New advances in clinically proven topicals, non-estrogen growth factors and other therapies can reduce symptoms and help restore confidence and vitality.  Regenerative treatments with platelet rich plasma (PRP) and other stem cell growth factors as well as collagen stimulating noninvasive technologies have given many patients much improvement in these issues and a better quality of life.

October is Breast Cancer Awareness month and October 17th is Breast Cancer Awareness Day (or ‘BRA Day’).  Please support these worthwhile programs and help bring more awareness, education and encouragement for the many women, men and their families that are dealing with this life changing issue.  We invite you to join myself, Dr. Peter Koltz and the evolv staff at Rosie’s on Wednesday, October 17th to support BRA DAY and spread the word on the improving awareness and quality of life for breast cancer patients and families.  

Yes the breast cancer experience is changing for the better and helping improve the quality of life for many.  Advances in clinical research, cancer biology, genetic testing, surgical and reconstructive option have transformed the breast cancer experience in such positive way.  The quality and safety of new reconstruction choices and postoperative treatment options can restore a patient’s self-confidence and lifestyle. As plastic surgeons we now may often hear a post reconstructive patient say, “Doctor, I sometimes forget I had a mastectomy!”

And I am forever grateful to that young mother and cancer survivor that inspired me with her courage so many years ago.

The Organic Approach

Whether you just received a breast cancer diagnosis or have been living cancer free from your diagnosis for years, every survivor remembers their first consult. Not only the many doctor’s consults but also with family and friends. Everyone tries to piece together all the information they are being told.  Much has changed in breast reconstruction, especially in Toledo over the past year that we want all of our patients and friends to be aware of. We like to think we take a very “organic” approach to breast reconstruction and customize the approach to every patient’s goals and personal situation. Our focus is to give you as natural of a breast as possible while causing as little disruption to your body and your life as possible. 

There are 5 new advances in breast reconstruction that we want to bring to your attention. We would welcome a discussion with anyone who may have questions about these points, which we will only touch on in this newsletter.

1. Autologous Breast Reconstruction
2. New and Improved Implants
3. Breast Sensation Following Reconstruction
4. Save the Pecs!
5. Yellow Gold!

1. Autologous Breast Reconstruction
The prefix “Auto” means “self”. Therefore, reconstruction of your breast with “self”. We think this approach personifies the “organic” breast reconstruction. While traditionally (as well as today) many breast reconstructions are performed with tissue expanders and implants, there are several operative procedures that allow the surgeon to use your own tissues (wherever you have excess, but most commonly the abdomen) to reconstruct your breast. This can take place at the time of your breast removal or even years later, even after you may have already had implants. Through the use of microvascular reconstructive surgery, tissue can be removed from one part of your body and transplanted to your breast with a quicker recovery and with less disruption of where your tissue was removed than autologous operations (TRAM) of the past.

2. New and Improved Implants
If you elect to undergo an implant-based approach to your breast reconstruction, today’s implants have drastically improved. The “organic” approach to implant-based reconstruction is based around the concept that you want your implant to be more “natural breast like” in feel and shape than the implants of the past. Additionally, today’s implants are safer than they have ever been. When the correct implant is chosen for your body there is no doubt that today’s implant breast reconstructions can come closer than ever to your “organic” breast.

3. Breast Sensation Following Reconstruction
So, you have had your breast removed…it frequently is not discussed that you will not feel your reconstructed breast again. This is important to discuss and realize going into your reconstruction. While currently it is not possible to restore sensation if you opt for an implant-based reconstruction, there have been some exciting developments with autologous (auto=self) reconstruction. At the time of transfer of your tissue from one part of your body to your breast, the nerves to your breast can be connected to your tissue that supplies sensation or feel to your abdomen to allow you to regain some sensation to your breast again. We feel like this is an exciting development worth talking about as the “organic” breast is sensate, or able to be felt!

4. Save the Pecs! 
Of Course, we all want to preserve as much of the total breast as possible but cancer removal may not allow.  However, it may be possible to save your “Pec” muscle or pectoralis major muscle at the time of your breast reconstruction. Traditionally in implant-based breast reconstruction, the chest muscle, the pectoralis major, is lifted from the chest wall and the implant is placed beneath. This is not “organic” but was previously thought to give the safest, most reliable reconstruction. However, with advances in implants and other biologic material now at our disposal, we have been able to produce implant reconstruction above the muscle, where the breast “organically” resides. This allows for less pain, a more natural look, and quicker recovery to your normal activities.

4. Yellow Gold!
Yellow Gold! While jewelry was previously a girl’s best friend, we are here to report that the new yellow gold is your own “organic” supply- FAT! With the advent of new liposuction techniques, developments in processing the fat, and injection techniques, it is now possible to deliver a much more natural looking and feeling breast reconstruction. No matter if you choose implant or autologous reconstruction, most people benefit from a touch of liposuction from one part of your body with transfer to the breast. This can happen at any point in your reconstructive journey in order to produce the most “organic” breast reconstruction.

We sincerely hope everyone is enjoying this beautiful (and HOT!) time of year and look forward to welcoming you all to the office in the near future. We greatly value our relationship with each and every one of you.

10 Greatest Myths about Breast Implants

1. Implants will result in breasts that will look and feel fake
2. You have to be a trained and certified Plastic Surgeon in order to perform cosmetic breast implant surgery
3. All approved breast implants are of similar quality and safety
4. With implants a patient can choose to be whatever bra cup size they desire
5. All breast implantation is essentially the same so I should search for the best price
6. Breast implants can cause autoimmune disease and may increase risk of breast cancer
7. Local or ‘awake’ anesthesia is less risky than general anesthesia
8. Breast feeding is dangerous or not recommended if you have breast implants
9. Recovery following breast implant augmentation will be long and painful
10. Sagging breasts can always be corrected by breast implants

According to recent statistics from both The American Society of Plastic Surgery (ASPS) as well as The American Society of Aesthetic Plastic Surgery (ASAPS), the leading and most respected organizations in aesthetic surgery and medicine, breast augmentation is the most popular aesthetic surgery procedure.  This has remained constant for years despite the growth and rise in popularity of other facial and body cosmetic surgeries.  The reasons for this are debated but likely involve the profound physical and emotional benefits that improved breast contour and body image may have on a woman’s self-image, confidence, and quality of life.

Every year in the US nearly 300,000 women undergo breast augmentation with saline or silicone gel implants.  Along with the increasing popularity and interest in this procedure, there are many common assumptions and opinions about cosmetic breast implant surgery that are often NOT based on science or proven data but on misconceptions and unproven public opinion.  If you are one of the many women interested or considering cosmetic breast implant surgery, here are some of the proven facts based on clinical studies that may help clarify common myths about breast augmentation surgery.

10 Common Myths about Breast Implants

1. Implants will result in breasts that will look and feel fake

Board certified plastic surgeons have extensive training in all areas of breast augmentation, including selecting appropriate patients and the right type, style and dimension implant based on each patient’s unique anatomy and goals to result in a balanced and natural breast contour. Determining implant position, either below or above the chest wall muscle, incision placement and many other important considerations are essential to obtaining a harmonious and natural outcome.  Unfortunately, some physicians who are performing breast implant surgery, are not certified or trained in plastic surgery and their outcomes may often result in unnatural appearing and uncomfortable feeling augmented breasts with higher risks and complications.  On the other hand when done properly by a trained plastic surgeon, implanted breasts should be natural appearing and the implants undetectable to the casual observer.

2. You have to be a trained and certified Plastic Surgeon in order to perform cosmetic breast implant surgery

Many people and prospective patients are surprised to learn that any physician with a medical license may legally perform breast augmentation even without any credentialed plastic surgeon training. When considering cosmetic surgery patients should know that ‘cosmetic’ surgeons are NOT the same as ‘plastic’ surgeons.  In order to become board certified by the American Board of Plastic Surgery (ABPS), a physician must complete years (5-7) of rigorous and monitored training and then pass both written and oral examinations.  The designation ‘cosmetic surgeon’ is not recognized or board certified specialty by the ABPS and is not the same as board certified Plastic Surgeon.  Breast augmentation may seem to be a relatively simple operation but achieving safe and natural, long-lasting results requires many decisions and extensive training and experience.

3. All approved breast implants are of similar quality and safety

The FDA has approved two types of breast implants in the U.S.; saline filled and silicone gel filled. Both have a silicone outer shell and vary in size, shape, thickness and design.  Even though FDA approved and available, breast implants are made by different manufacturers and will vary in quality and pricing.  Prospective patients should be very careful of advertising or ‘deals’ for lower cost procedures as they may involve less reputable implants promoted by non-plastic surgeons in less credentialed facilities.

4. With implants, a patient can choose to be whatever bra cup size they desire

There are hundreds of different types and sizes and qualities of breast implants available on the market but the exact cup size that may result from implant surgery is not entirely predictable. This is not only because of the wide variation in what constitutes a certain bra ‘size’ by each manufacturing but also due to variations in each women’s breast shape, available skin and tissue, chest wall size and anatomic variations.  In order to obtain natural and safe results an experienced surgeon will choose implant dimensions that are consistent and respect each patient’s unique, anatomic characteristics.

5. All breast implantation is essentially the same so I should search for the best price

As mentioned above, there are many different types of breast implants supplied by various manufacturers and pricing as well as quality may vary. The total cost for the procedure is also influenced by the location or facility involved for the procedure and the surgeon’s fees.  Non-plastic surgeons or cosmetic surgeons will typically charge less than board certified plastic surgeons and patients should be wary of advertising low rates and ‘discounting’ or ‘deals.’  Warren Buffet’s advice:  “Remember, the price is what you pay and value is what you get.”

6. Breast implants can cause autoimmune disease and may increase risk of breast cancer

Multiple long-term scientific studies including hundreds of thousands of women with implants have clearly proven that there is no association or cause and effect between breast implants and autoimmune disease or risk of breast cancer. There are anecdotal reports and online testimonials which have received medical attention of patients who claim to have developed health problems and diseases as a result of their implants but these claims have never been proven in any validated scientific studies or recognized by the FDA.  It is important to note that all silicone gel and saline implants are cleared by the FDA.  Recently, a rare type of lymphoma called anaplastic large cell lymphoma (ALCL) has been associated with some implants but the overall risk is extremely low (less than 1 in 30,000) and is usually curable by implant and capsule removal.

7. Local or ‘awake’ anesthesia is less risky than general anesthesia

While it was true that in the past general anesthesia carried higher risks than local or ‘awake’ anesthesia, numerous studies confirm that is no longer true for appropriately selected patients with modern anesthesia technique. With the advancement of short-acting anesthetic agents, precise monitoring and training in the specialty of anesthesia, predictable outcomes and speedy recovery are the norm and excellent safety has been confirmed in many clinical studies.  In addition, particularly in submuscular breast augmentation surgery, a light general anesthesia provides greater patient comfort and allows better control of the surgery in most patients.  Be careful of practices promoting local or ‘awake’ anesthesia in their own office setting for breast surgery – the motivation is often pricing and not patient safety.

8. Breast feeding is dangerous or not recommended if you have breast implants

Younger women considering breast implant augmentation may be concerned about unproven statements or potential risks for babies with breast feeding after augmentation. Many peer reviewed studies have confirmed consistently that there is no medical risks for babies who are born to or breast fed by women with saline or silicone implants.  It is also relevant to remember that experienced plastic surgeons will usually recommend an incision that allows dissection avoiding the breast gland as the implant should never touch the breast itself but be placed under it or underneath the chest wall muscle.

9. Recovery following breast implant augmentation will be long and painful

Although there are testimonials, statements and opinions online and in social media regarding length of recovery time and discomfort, properly performed breast augmentation by an experienced plastic surgeon has typically a short and uneventful recovery. With the use of precise and gentle techniques, long acting 2-3 day nerve blocks (Exparel) and appropriate implant selection and post op care, patients are relatively comfortable and returning to normal activities in less time.  When it comes to comfort and safety, it really does matter who is doing your surgery and where it is performed.

10. Sagging breasts can always be corrected by breast implants

Following pregnancies, breast feeding and aging, it is common for the breast tissue and skin to sag or loosen resulting in drooping along with a loss of fullness in the upper breast tissue. While it is true that breast augmentation implants can improve minor amounts of laxity or sagging, a breast lift (mastopexy) is often the best and most effective methods of restoring youthful breast contour.  Combining breast augmentation with a breast lift (augmentation mastopexy) can correct both volume loss as well as breast descent.  For all of the above reasons and due to the technical challenges of augmentation mastopexy, it is especially important to seek out an experienced board certified plastic surgeon in order to review all options and obtain safe and natural results.

Breast Augmentation surgery can provide significant physical and emotional benefits for appropriate women as well as improve quality of life.  Proven improvements in biomaterials and techniques can offer more natural and long lasting results with excellent safety outcomes.  Separating proven facts from fiction is especially essential for patient education prior to surgery along with meeting or exceeding patient expectations.  As with any elective or aesthetic surgical procedure, a physician-patient relationship based on trust, transparency and clear communication remains the most important part of safe and satisfying outcomes.