This week a California woman was sentenced to six months in jail and required to pay monetary reimbursement for ‘stealing’ breast implants as well as other cosmetic surgery back in 2008. Under an assumed name, the 30 year-old woman used a credit line in someone else’s name to obtain $12,000 in plastic surgery which included breast implants and liposuction at a plastic surgery center in Huntingdon Beach California. She pleaded guilty to burglary, grand theft and identity theft for using another woman’s personal information to obtain the surgery. How did she get caught you may ask? Police tracked her down using the serial numbers from her old implants, which she had removed when the new ones were put in.

In a similar scenario, but much more tragic, you may remember the murder of model Jasmine Fiore last August in California. The Playboy model mysteriously disappeared and was later found mutilated. With missing teeth and fingertips, she was initially unable to be identified as was the intent of the murderer. She was later identified by something her assailant had overlooked…literally…the serial numbers on her breast implants.

Proving that many criminals are dumb, most implantable medical devices today have serial numbers for tracking purposes as an FDA requirement. Usually the benefit of them on breast implants is for replacement and warranty reasons, but they also serve nicely as a human identification method that is more precise than fingerprints or dental records.

On a happier note, it was reported that a silicone breast implant saved the life of a California woman who was shot in the chest.  A woman working in a Beverly Hills dental office last July was struck by a bullet after one of the employee’s estranged husband entered the office and killed her with a handgun. On exiting, the gunman ran into another employee and shot her in the chest. Unlike her co-worker, she miraculously survived. According to the Los Angeles Times, one of her breast implants stopped the bullet and prevented any fragments from getting as far as her heart. A physician who took care of her at the hospital stated that the bullet fragments were just millimeters from her heart.

A forearms expert was later quoted as saying that the breast implant probably slowed down the bullet enough that it caused it to stop short of the heart. While its an appealing story, that is not likely. A silicone gel or saline breast implant would not slow any bullet fired at close range. Breast implants have the stopping power similar to that of Jell-O. More likely her sternum or ribs was the reason that the bullet was deterred from going any deeper. The intervening breast implant, however,  is happy no doubt to take the credit.

Breast augmentation and the implants needed to do them have weaved their way into the mainstream of American society, sometimes in ways not exactly as intended.

Dr. Barry Eppley

Perhaps terrorists are getting their noses reshaped and other facial reshaping surgeries, but that is not the association that is currently news worthy. It is now reported that female suicide bombers are being fitted with breast implants containing explosives which are all but impossible to detect by current airport scanning machines. Similar approaches are apparently being also considered for men by using buttock implants The discovery of these methods was made after the recent airliner incident on Christmas Day where a Nigerian had stuffed explosives inside his underpants.MI5, the famous British spy unit, has reported that such movie-like plots for bringing down airliners do really exist.

While breast implants do have  a controversial material history, it has never been one of a lethal and nefarious nature. Explosive experts say that an implant containing as little as five ounces of certain explosives (a B cup breast size) can open a hole in the skin of an airplane that can take it down.

While an exploding breast implant is not a concern for the typical woman in the U.S.  who undergoes breast augmentation, understanding implant rupture is. Implant rupture is not the same as an ‘exploding breast implant’. This is the one lifelong implant-related risk which every breast implant patient should know. While the bag or shell of a breast implant does not explode, it can develop a tear or hole in it over time. Such an implant defect is not the result of anything the patient does, it is the result of natural fatigue of the implant material as it flexes and folds over time from external displacement forces. It is always best to not think of breast implants as permanent although we all hope that they are.

Patients of course want to know how likely is implant rupture and what happens if it does. The true incidence of breast implant failure is really only known from past history with older device designs that are no longer used. While the manufacturers provide statistics of a 1% risk per year for the lifetime of the implant, numbers are just…numbers. That statistic is meaningless when it happens to you. You just have to know that it can happen and the longer they are in place, the more likely it can occur. Rupture of saline implants are immediately obvious, like a flat tire. Silicone implant failure usually never results in any external change and may only be found on a routine mammogram.

The good news is that breast implant rupture is medically harmless, no scientific evidence has ever linked a medical disease with implant filler materials. Rupture is an issue of inconvenience and economics. For saline implants, it will be a cosmetic ‘emergency’. For silicone implants, it is more of a dilemma of whether anything needs to be done at all if the breast feels and looks fine.

While terrorists might come up with lots of different ways to try and kill US citizens, using breast implants against us is definitely not one that we might have expected.

Dr. Barry Eppley

Botox as a non-surgical procedure and breast augmentation as a surgical operation have begun to acquire many retail product characteristics over the past decade. Both are highly marketed and promoted, so much so that few people in the world would not recognize what they are. From billboards to magazines, and endless exposure on the internet, the offering of services and the recruitment for paying customers is extensive. Some of these are from the commercial product suppliers on a national front and many others are from physicians on a local basis. Such enticements are right in line with what has also occurred in the pharmaceutical industry by the manufacturers for certain prescription medications.

Unlike most drugs, however, Botox and breast augmentation largely targets the fee-for-service customer.  These are cosmetic services which are either paid for at the time the treatment is done (Botox) or some time in advance. (Breast Augmentation) With the allure of immediate cash payment comes the inevitable price war and the potential slide into a commodity service. Ads are a plenty for Botox at specific per unit prices and flat low-end fees for breast implant surgery. Dysport, the recent competitor to Botox, has offered incentives if you are unhappy with your Botox results. Breast implant manufacturers have lifelong replacement warranties and even $3500 cash for surgical costs should an implant need to be replaced in the first ten years after surgery.

But unlike most commodity services or pure retail products, these medical procedures do have other intrinsic values. It is obviously important to be able to receive these services with the lowest risk possible and be able to get the desired outcome. The intrinsic value is in the expertise and experience of whom is performing it. Lowest price for medical services is not always the best value. Price alone is not the best barometer to judge whom and where these services should be received.

Competition amongst cosmetic providers has fueled the reduction of services like Botox and breast augmentation into partial commodities. Prices amongst them in any community usually stays within a fairly narrow range as a result. Such competition is not necessarily bad. It keeps all providers sharp and makes sure that their prices, no matter how much intrinsic value they may have, stay within a reasonable range. Be wary, however, of really low prices that are different from the community average. There may be a good reason why they are priced that way and it is not usually for your benefit. You do not want inferior quality medical services when it comes to having something injected or implanted into your body.      

Dr. Barry Eppley

When considering breast augmentation, most women today opt for silicone gel breast implants. Since they have become available again for human use in late 2006, they rapidly have become the preferred implant for many breast augmentations. Yet, despite FDA-approval, many patients understandably ask about their safety. Even if one was not old enough to even be aware of what transpired in the early 1990s with the previous generation of silicone breast implants, there remains some lingering concerns that are easy to find on the internet.

Since silicone gel breast implants are FDA-approved, and they would not be available if they were not, that speaks to their safety. But most do not know the extent of information that goes into that type of approval process. And because of their history, silicone gel breast implants have become the single most studied implantable device in the world. As a result, the most common questions that women may have about this type of breast implant has well known answers.

Can breast implants make me sick? In 1997, the Federal government (Department of Health and Human Services) appointed the National Academy of Science to study the likelihood of medical complications after breast implant surgery. After reviewing years of evidence and research concerning silicone gel-filled breast implants, they found that health problems such as connective tissue illnesses, cancer, and other diseases were no more common in women with breast implants than in women who had never had the surgery.

 In the 1990s, thousands of women claimed that they had become ill from their implants. Some studies around that time suggested that these health symptoms of women with implants may improve when their implants are removed. We now know conclusively that this is not true. The relationship between autoimmune diseases and breast implants is coincidental…both largely occur in women between the ages of 20 to 50…but one does not lead to the other. The FDA has even gone so far as to conclude that there is link between fibromyalgia and breast implants either.

Will breast implants cause cancer? Reviews of research and medical studies on silicone breast implants show that breast cancer is no more common in women with silicone breast implants than in those without. In fact, for reasons different than one may think, women with breast implants actually have earlier breast cancer detection. This has nothing to do with the implant per se, it is a function of breast awareness. Women with breast implants are more likely to be ‘attuned’ to their breasts and how they feel.

 Can I breast feed with breast implants? For the younger women, this is a frequent question. The issue is not whether one can physically do it, but will any harm come to the baby by doing so. The American Academy of Pediatrics concluded in 2001 that having silicone breast implants is not a contraindication to breastfeeding nor does it pose any health risks to the infant. Similarly, epidemiological investigations have not found any increased risk of health problems in children born to women with silicone breast implants.

Dr. Barry Eppley

 Breast augmentation is most commonly done today by placing the implant under your big chest muscle known as the pectoralis. (although there is a recent trend back to above the muscle for some plastic surgeons as silicone gel implants have become available again) By putting the breast implant under the muscle, it is stretched, bruised, and even some fibers are cut. This makes the muscle sore, swollen and difficult to stretch. This also makes the upper arm hard to lift up very far. In essence, breast augmentation makes the muscle stiff and sore. It is not the incision that causes any discomfort, it is the muscle.

While breast augmentation can not be completely pain and recovery free, rebounding from the surgery and getting back to normal activities definitely can be accelerated. This is made possible by doing something to the muscle after surgery…early and aggressive physical therapy. Breast augmentation physical therapy starts the night of surgery and consists of range of motion exercises of the arm. By early stretching of the arm in circles and by raising the arm from one’s side to the level of the shoulder and above, the pectoralis muscle is mobilized. Stretching helps loosen up the injured muscle fibers and prevent restrictive scar formation. The more you move, the quicker you will recover. Just like pulling a leg muscle, the earlier you begin to stretch and use it the quicker you will get over it.

This form of pectoralis physical therapy, combined with anti-inflammatory drugs such as Alleve and Ibuprofen, allows one to get moving very early. While swelling, a little bruising, and some pain can be expected, early physical therapy can lessen its effects to just a few days. Even in the worst-case scenario, one should have a significant recovery by one week after surgery.

One other helpful recovery aid I use in my Indianapolis plastic surgery practice is the ActiPatch anti-inflammtory device. This is a small battery-operated battery device that emits pulsed electromagnetic fields  that penetrate the breast tissue and help reduce swelling and inflammation. I have started my patients wearing it for the first 36 hours after surgery. It is easy to wear it inside one’s bra as the loop fits over much of the breast  mound.

Rapid recovery breast augmentation is a reality through a combination of early physical therapy, anyi-inflammatory medications, and the ActiPatch device. Significant recovery should now be a matter of days not weeks.

Dr. Barry Eppley

A recent manufacturer survery that I read has indicated that the number of cosmetic procedures were up during the fourth quarter of 2009 since the downturn in the economy began in mid-2007. Manufacturers of Botox, injectable fillers, and lasers have reported that their sales increased in the fourth quarter of 2009 for the first time in years, up anywhere from 2% to 8% depending upon the product.

Are these survery results a sign that the economy is really improving? Luxury and discretionary spending are often viewed as a sign of renewed consumer confidence. But I would take these apparent positive signs with a grain of salt. These numbers are likely up for a different reason.
As the most expensive plastic surgery offering…operations…are being temporarily (and maybe permanently) shelved by some, patients and cosmetic doctors are turning their attention to lower-priced treatments. One may have to pass on that facelift or eyelid tuck, but Botox and fuller lips remain within the budget. Consumers appear to be still trying to hold on to their cash in these troubling economic times, but haven’t given up completely on some more economical forms of feeling and looking better.
A better yardstick of economic recovery as viewed from a plastic surgery perspective is in the number of breast implants being sold. Larger amounts of discretionary spending are a better indicator of how people are really feeling about the economy. When these elective medical device sales, which remain down in 2009, returns to more familiar territory of brisk double digit growth, we will have more than one reason to be optimistic.

The use of Botox and injectable sales as a gauge of economic recovery is just one way that numbers and statistics can be twisted to support one’s perceptions…and hopes. They are up because the bigger ticket items that often come with them are done. This is like saying the economy is improving because Starbucks coffee sales are up… while customers frequenting Ruth Chris’s is down.
While the government may be hinging optimistic forecasts on upswings in graphs and charts, I will look for more familiar enlargements in different indicators before feeling better about where the economy is headed.

Dr. Barry Eppley

Dr. Barry Eppley discusses Breast Augmentation