Jan 30
On January 26th, the FDA issued a Medical Device Safety Communication regarding Anaplastic Large Cell Lymphoma (ALCL) and Breast Implants. The possible connection between the two first came to my attention in the Spring of last year when Dr. Garry Brody presented a review of 34 cases of ALCL at the American Association of Plastic Surgeons meeting here in San Antonio.
The association is not clear cut and is confusing to Plastic Surgeons and the FDA so it must be very confusing to patients. Let me try to explain where we stand now. ALCL is a very rare type of cancer that can be found throughout the body in any person. It is not a Breast Cancer but is a form of Lymphoma that seems to respond well to treatment. Dr. Brody did an exhaustive search of the literature and contacted all of the authors of the reports to see if he could find a common cause among all of these cases, but he could not. The FDA has done a review as well and has even looked at the world wide incidence of this cancer and cannot reach any conclusions other than we should be very vigilant for it in women with breast implants. It is estimated that between 5 and 10 million breast implants have been placed worldwide, but only 34 cases of ALCL have been confirmed in women with breast implants. That puts the odds of having ALCL in women with breast implants at about 3 to 7 in a million. The FDA’s review has not found that there is a specific type of implant or patient involved.
In all cases, the women were having some type of trouble with their implants. Most of them were suffering from a seroma (a collection of fluid). Treatment has varied from simply taking out the implants and the associated capsule to removal and chemo and radiation therapy. The fact that some patients have done fine with mere removal of the capsule suggests that this may not be a cancer at all, but just an intense inflammatory reaction to the implant.
So what should you do if you have breast implants? Close monitoring is all that is recommended at this point. If you develop a fluid accumulation around your implants then we will need to send some of the fluid off for studies. I have always encouraged all of my patients with breast implants to come in yearly for an exam. As far as I know, I am the only San Antonio Plastic Surgeon who provides this extensive follow-up as part of the surgical package. This visit is usually a short one where I do a quick exam and take some photos, but can be invaluable if we find something unusual. I have not seen a case of ALCL yet and I have been looking very carefully since Dr. Brody presented his paper last year. We will continue to monitor the research and I plan to participate in the registry that the American Society of Plastic Surgeons has developed with the FDA.
I want to stress at this point there is no evidence that there is a cause and effect relationship between breast implants and ALCL. The FDA recommends only that women with breast implants should monitor their implants and contact their doctor if there are any changes. The FDA believes that current data supports the continued use of breast implants.
I will continue to ask all of our breast implant patients to follow-up with me annually. I know it may be an inconvenience for your busy schedules, but this quick exam helps me keep an eye on how you are doing and if any special tests may be needed.
Oct 29
In an earlier post, I told you to look for announcements of new additions to our practice. Well, after attending the recent American Society of Plastic Surgeons annual meeting in Toronto, I have decided to add the BREAST-Q© questionnaire. I believe it will be very helpful in treating patients seeking breast implants (breast augmentation), breast lifts, breast reduction or breast reconstruction surgery.
The BREAST-Q helps us measure what patients want and expect and what is important to them through a scientifically based, meticulously researched series of questions. Questionnaires like Breast-Q go a step further to help surgeons track the effects of surgery on their patients’ lives and add much more depth and dimension to the development of surgical procedures than typical reviews and simple before and after photos.
While many questionnaires have been developed for surgeries that involve breast implants and other breast reconstruction, none have been grounded in patient perceptions or undergone the extensive clinical research that the Breast-Q has.
Dr. Andrea Pusic at the Sloan-Kettering Cancer Center of New York led the development of the BREAST-Q, which took more than three years. Research experts conducted extensive interviews with patients and in focus groups, and conducted field tests of more than 2,000 patients across the country, a process that spanned more than 18 months. The BREAST-Q has now been validated by the FDA and is in use internationally as well.
I admire the scientific approach of the BREAST-Q, which lines up with my own clinical research studies. I look forward to implementing the BREAST-Q and using the results to better serve my patients and their families.
Oct 28
I have been using Spanx after Liposuction and to control swelling after surgery for several years, but I would have never thought of this:
Oct 13
I am just back from the American Society of Plastic Surgeons annual meeting, Plastic Surgery 2010. Since I am the President of the San Antonio International Society of Plastic Surgeons, I thought it was important for me to represent San Antonio Plastic Surgery as well as Advanced Concepts in Plastic Surgery at the meeting. This meeting is the largest plastic surgery conference in the world. Membership in the American Society of Plastic Surgeons is restricted to Board Certified/Eligible plastic surgeons and invited international colleagues. This is not just a meeting of Cosmetic Surgeons. The conference had an international flavor this year as it was held in Toronto, Canada. The meeting proved to be very valuable.
The main reason I went to the meeting was to learn the latest in plastic surgery. I went to 7 AM classes every morning about exciting topics like Rejuvenation of the Peri-Orbital area, Liposuction, Improvements in Facial Peels, and Fat Grafting. I was especially interested in the fat grafting sessions, since I have been having nice results in San Antonio fat grafting to the face. Recent reports have shown that fat grafting for breast augmentation can replace breast implants, so I was eager to learn the techniques. However, I was not impressed by the results that I saw at the meeting. Definitely not impressed enough to begin fat grafting breasts in San Antonio just yet. I think further research needs to be carried out in this field before we are ready to begin routinely grafting for larger breasts.
I also had the opportunity to evaluate new technologies. This meeting is an opportunity for vendors to showcase the latest technology in plastic surgery. From the products shown at the meeting, I think Coolsculpting is still the best non-invasive fat reduction method available. I found a few new valuable tools at this meeting and I will be sharing these with you soon. Look for announcements on this blog, via my Twitter account: twitter.com/@drkoneru and in our practice newsletter. If you do not subscribe to our practice newsletter, you can subscribe here, or by going to our website.
One of the most inspirational portions of the meeting was the welcoming ceremony - 2000 plastic surgeons in one room listening to the president of the society talk about the many accomplishments of plastic surgeons around the world. There were very few dry eyes in the room when the president acknowledged the four Patients of Courage Award recipients. These were patients who had undergone multiple plastic surgery operations and had made significant contributions to their community. These patients all showed incredible strength in the face of adversity and had undergone multiple plastic surgery operations by outstanding surgeons.
All in all it was a great meeting. I learned a lot of new techniques, had the opportunity to see old friends and professors, and brought new exciting technology back to San Antonio. I was even able to spare a few hours to see my mother in law! What more could I ever ask for.
Sep 7
Here are the photos of the other 2 Hydrelle patients. These were the first patients in San Antonio to have Hydrelle injected on August 5, 2009.
All of the patients have been quite happy. They have all reported their pain and bruising to be very minimal. None have required a touch-up and have not had any lumps or bumps.
Both of these patients only required 1 syringe of Hydrelle to get the result shown. Both have lost a great deal of weight, the first with diet and exercise and the second with Gastric Bypass.
I apologize for the difference in technique between the photos, these were all shot with my pocket Nikon Coolpix S52c.
We have been more than satisfied with the results and are quite happy to be one of the first Plastic Surgery practices in San Antonio and Texas to offer Hydrelle to our patients! Call the office today to see if you are a good candidate for Hydrelle.
Aug 17
I have finally posted the original photos from our Hydrelle trial on August 5, 2009. All 3 of our trial patients have been very happy with the results thusfar. The benefits of Hydrelle over Juvederm, Restylane, Perlane, Radiesse, and Sculptra as I see it so far:
- Less Pain than with other injections - Most reported discomfort of 2/10.
- Less Product required to achieve same result
- Less Cost
- Easy to inject
- Fewer lumps after injection
The jury is still out on how long the product will last and long term problems, but so far it looks quite promising.
My Plastic Surgery practice was the first in San Antonio to use the product so we will see if others can reproduce the same level of results. I personally perform all injections in my office unlike many who may use a trained nurse injector. This way I can ensure consistent results and can assess the effectiveness of all of the products personally.
I should be seeing the trial patients this week for their 2 week follow-up and will try to post more before and after photos of their filler results.
Sorry for the difference in the poses of the before and after photos. On the later follow-up photos I will try to get similar poses.
If you are interested call Regina in my office to set up a consultation at 210-499-5900. You can also learn more about my Plastic Surgery practice in San Antonio, Texas at:
http://www.DrKoneru.com
Aug 6
Preliminary patient reports from Hydrelle:
- Low Pain on Injection compared to other fillers (2/10)
- Some pain and swelling in the evening
- Minimal bruising
Stay tuned for B&As and more feedback.
