Larry S. Nichter, MD, MS, FACS

There are quite a few women facing similar situations and likely more to come down the road. The good news is that the new Serene Breast Implants are offered by a larger company which acquired Ideal Implant, Inc. and are now available for use. These implants provide the same sought-after advantages including a natural look and feel, no risk of silent rupture, and the lowest rate of complications of all implants (both silicone and saline). With these implants, there is no need for MRI or high-resolution ultrasound monitoring to know if your implants are intact. You only simply need to look in the mirror. In contrast, we know most women are concerned about silicone gel implant ruptures, which are silent and require FDA-recommended magnetic resonance imaging or ultrasound scans for detection. As safety and piece of mind should naturally be some of the greatest considerations when choosing a breast implant, we are proud to offer the Serene Implants for patients. Our office was among the largest users in the world of Ideal Implants and I was closely involved in the 10 year study of the Ideal Structured Breast Implants and a key FDA investigator. If you are interested, I will include a link here to the study, which was recently published by Plastic and Reconstructive Surgery, the Journal of the American Society of Plastic Surgeons. For anyone looking to replace their Ideal implants or learn more about Serene by Bimini Health Tech, I invite you to request a consultation, either in-person or virtual with our office in California. I would be glad to speak with you and discuss your options with you, including breast augmentation, breast lift, and breast revision. Visit us online any time: ThePacificCenter.com Dr. Larry S. Nichter, MD, MS, FACS, FAAP

IDEAL implant company voluntarily took their implants off the market without FDA directions to do so as they found a few more ruputures than expected after changing manufacturer plants. They found that the valve assembly varied by a fraction of a millimeter which was the cause. This was corrected and due to increased demand they are back on the market as of November 2020 according to the Company's owner and inventor of the implant. With COVID they have decided to make sure that the supplies are adequate for all plastic surgeons in the US and Canada prior to its re-release. On a personal note, as a lead FDA investigator, I think these are great implants which will likely decrease the number of surgeries in your lifetime and if ruptured do not require a removal of the capsule, capsulectomy, when replaced compared to silicone implants. It is our most popular implant in my practice.

The short answer is yes, you can fix your labiaplasty and keep your sensation. There are different techniques for both labiaplasty and clitoral hood reduction and all most of the time will preserve your sensation.  The technique chosen should be based on your specific anatomical needs and not "one technique fits all". Though an actual exam would be needed photos like yours suggest that a Central "V" resection would be the most  appropriate and beneficial technique as it not just reduces redundancy but also restores a more youthful resting tone. This is the technique that seems to be the most useful and most reliable for most but not all women.  An exam would be important likewise to determine the technique for clitoral hood reduction.  Though gynecologists and plastic surgeons both do this technique, the many more years of training and advanced knowledge of tissue rearrangement and restoration  that a Plastic Surgeon has would likely be the reason to choose a plastic surgeon. No matter the type of technique your surgeon selects the most important choice is a skilled surgeon with long and extensive experience in this technique. For example, I have more than 25 years experience in both procedures and have taught countless residents and fellows the art of labiaplasty and clitoral hood reduction. Always make sure your surgeon is a board certified surgeon to increase your chances for success.

In general if you have saline implants or intact silicone implants especially if made after 2006 (cohesive  silicone gel after that date) then to date there is no data to support doing a capsulectomy which adds time and potential morbidity from the procedure and might change the shape of your breast. On the other hand if this will give you further piece of mind and you feel it is important then you will likely convince your plastic surgeon to do so but in general would not be recommended.

In general your Surgeon most likely gave you the right answer. A capsule takes several weeks to form and a contracture longer. He is correct that your dominant hand pectoralis muscle has more tone and it is likely to be the cause of it being a bit firmer. There is a phenomena of drop and fluff which takes several weeks to a few months in most to see their final result.

Thanks for your question. A traditional tummy tuck typically places sutures in the surrounding fascia that encircles each rectus muscle thereby tightening both the fascia and the muscles.

Both Silicone and IDEAL Saline Structured implants have their pros and cons. As a FDA investigator for the IDEAL implant, I have followed my patients for more than 9 years and have published and reported nationally on the comparison of this implant to silicone gel implants. To begin with IDEAL® implants have 3-6 times less deflation rate than silicone gel implants (2% at 8 years) and significantly lower capsular contracture rate than gel implants ( 6.5% vs 11-16%) while at the same time having the feel of silicone. It is not to be compared with, nor the same, as traditional saline implants which I do not prefer due to increased rippling and unnatural feel. IDEAL Implants® look and feel like silicone in my experience. IDEAL implant® monitoring is simple; just look in the mirror to see if your implant is intact rather than worry about silent rupture and the need, expense and hassle for repeated MRI scans. As the contents are only saline, it is absorbed. Since the shell is smooth, presently there is no risk for ALCL. Although I recommend to my patients with silicone gel implants that they should consider replacing their implants after 10-12 years (as rupture rates are relatively high) or whenever they are told they have a rupture, with IDEAL® implants there is no need to monitor or replace them unless there is a problem which will result in significantly less surgeries in their lifetime. When a silicone gel implant rupture occurs a longer and more expensive capsulectomy procedure is required, vs when simply replacement if an IDEAL implant® ruptures.

Want to enlarge or improve your breasts after explantation with your own fat?This is so common in our office that we coined the term "California Breast Lift" For years, Plastic Surgeons and their patients have desired to transfer unwanted fat from their tummy or thighs to their breasts. We are now are able to do this safely. If you have been considering a Breast Lift or improving your appearance after breast augmentation or Breast Reconstruction but are not comfortable with introducing artificial material into your body, you may want to look into the benefits of breast augmentation with fat transfer. An alternative to breast implants is fat transfer also known as fat grafting or lipoinjection. This technique allows women the option of enhancing the appearance of their breasts without the potential problems of saline or silicone implants such as hardness, rippling or rupture. Who is a candidate?Any woman who is healthyWomen with sufficient body fat for the procedureWomen considering breast augmentation who wish to be one cup size larger or lessWomen who have had breast augmentation or reconstruction but who lack fullness or have contour concerns. Fat transfer can further enhance and reshape your breasts while smoothing out visible or palpable edges of breast implants. This will disguise implant rippling and wrinkling.Women with normal mammographyDr. Nichter has successfully transplanted fat into the face, buttocks and other body areas for decades and are now using this same technology to enhance breast shape and size. Plastic surgeons have been transplanting fat to the breast since 1995 but caution and study were necessary to make sure there were not harmful effects. Furthermore, results in the past were variable, dependent on surgical equipment, technique, surgeon’s skill, and individual patients healing abilities. Since 1995, recent advances have led to the development of special instruments made just for fat grafting.  More and more qualified plastic surgeons are using this technique successfully.   The advantage of this technique is its ability to create a natural augmentation without an implant. Fat grafting (also called lipoinjection or fat transfer) to the breasts is indicated for different reasons: as an alternative to implants for mild to moderate breast augmentations, to provide fullness to the upper part of the breast during a breast lift, after pregnancy, age, or weight loss, following breast reconstruction, or to minimize the visibility or rippling of existing breast implants. Typically up to one breast size enlargement is possible in most patients. Fat transfer to the breast is usually done as a single procedure resulting in approximately half a cup volume increase. In women desiring additional breast enhancement a subsequent procedure can be performed. Each surgery consists of two components: Harvesting the fat: Fat is removed from your abdomen, hips, “love handles” or other areas using a fine cannula similar to the one used for liposuction but skinnier. This fat is rinsed with sterile saline solution and then packaged into syringes and prepared for transfer. Approximately 20% of fat removed is suitable and available for fat grafting.Fat transfer into the breasts: The prepared fat is injected in small amounts at a time and widely distributed within the layers of the breast so that these living fat cells can pick up a healthy new blood supply.Advantages of Fat Transfer to the breasts:Fat cells are natural and you are using your own tissue without any foreign body or implant.Harvesting of the fat by liposuction has the added benefit to enhance your shape by removing unwanted fatty depositsThe breast can be shaped or sculpted in more detail than is possible using implants alone.Minimal incisions reduce the possibility and degree of scarringNo implant is used, therefore there is never a need for replacement, or any potential for capsular contracture (hardening of the implant).Fast Recovery Time: Recovery time is about 1 week and usually less uncomfortable from implants that are placed beneath the muscle.Although, breast augmentation performed with the lipoinjection technique takes longer than traditional breast augmentation (with implants) the benefits are substantial including no need for implant replacement in the future. In the past, significant questions were raised about the ability of Mammograms or MRI to detect breast cancer after injecting fat into the breast. However, there is no evidence that fat transfer to the breast is less safe than any breast surgery. Large studies have begun over the last several years to study fat grafting to the breast. With or without breast surgery, calcifications and lumps can occur. Breast diagnostic studies including physical examination and mammograms should be used to monitor every patient diligently using standard guidelines. As a general rule, surgeons with extensive experience in grafting large volumes of fat to the body are most likely to obtain the best results. We believe fat transfer should only be performed by surgeons certified by the American Board of Plastic Surgery that have experience in  fat grafting. Few plastic surgeons have this experience. This ensures that your surgeon has advanced knowledge and technical familiarity, but also the subtle anatomy and aesthetics of breast augmentation.

The IDEAL Structured implant can be placed from an armpit, periareolar or under the breast in the fold. As the implant is filled once inside the incision is generally less than a silicone implant.Studies have shown that  the risk for capsular contracture is less frequent when the inframammary incision is used.

I am one of the largest users of the IDEAL Structured implant and as a FDA investigator of this device have more than a 9 year experience. To date I have placed these implants  in almost 300 patients with almost all thrilled with their choice. I am not alone and patients have given them to date a RealSelf 99% "Worth it" rating, higher than all other implants available in the USA. See the below Web Reference and Video link to learn more.