Plastic Surgery Insights from Dr. Slack

Breast Reduction Age

How Old Do You Need to Be to Have a Breast Reduction

Unfortunately, there is not a “textbook” answer to this question. There are many different factors that come into play when deciding with the patient and her parents whether a breast reduction procedure is warranted, including age, but this is not the only factor. The age of a patient most commonly comes into play when considering future breast growth.  The patient’s mental and emotional maturity are also important as they relate to how they will handle post-surgery scars as well as any potential complications should they arise.  If there isn’t enough of either, then I would recommend they wait a little longer before making the decision to have a breast reduction.

An understanding of the time frame of breast development in young girls is an important first step in determining the timing of surgery. Waiting until after breasts have stopped growing is preferable to performing a reduction procedure while they are still enlarging. Breast growth typically stops around 2 years after the onset of menstruation. Exceptions do exist in which the breasts are so large before they are fully developed that they are causing significant physical and psychosocial issues for a young woman. This does present a dilemma about what to do for everyone involved (patient, parents, and plastic surgeon).

Other important things to discuss during all breast reduction consultations with any woman of child-bearing age but particularly a younger woman is that her breasts will likely enlarge again when she becomes pregnant and may remain enlarged after pregnancy. Further, breast reduction surgery can result in the inability to breastfeed. The scars that are created after a breast reduction are also important to go over. I emphasize that they are permanent. They do fade over time but that does not mean that they fade away or completely disappear. The availability of information on the internet has created many problems for doctors in managing patients but for me it has been helpful in counseling young women considering breast reduction because they have usually already read about breast reduction but more importantly have seen pictures of the scars and even video of the procedure.

The youngest woman I have ever done a breast reduction on was 13 years old. I am not sure I would consider doing a breast reduction on anyone younger but that would depend on the individual circumstances surrounding the patient. As you can imagine, large breasts in an adolescent girl can be a significant problem, limiting her ability to participate in physical activity or the sports she loves as well as exposing her to potentially hurtful comments about her appearance from other, not so, sensitive adolescents. The ability to wear the styles of clothes other teens are wearing is also a consistent source of embarrassment and frustration. Trying to cope with all these issues during this delicate time of psychological development often leads to self-esteem issues and depression.

The 13-year-old girl who I referenced had 6 pounds of breast tissue removed from EACH breast. Her parents and I were couldn’t believe t her metamorphosis just two weeks after surgery, as she went from being a shy person with low self-esteem into an outgoing young woman without the physical limitations caused by large breasts that made it difficult for her to run or buy clothes off the rack. She felt so much better about herself. You could see it not only in how she carried herself, but you also saw it in her eyes. Her true bright, happy personality blossomed. It was truly life changing for everyone involved. 

I cannot explain to you how gratifying it is to be able to do that for someone and how reaffirming it is to me personally that I am doing the right thing for them.

If you or your daughter have questions about breast reduction procedures, please reach out to us, especially if you are in Allen, Plano, McKinney, or Frisco, TX, or the North Texas area.  We would be glad to help you as well.  Call or contact us HERE.

Will Breast Density Limit My Plastic Surgery Options?

Getting good news about breast density and plastic surgery options

The last time you got your mammogram results, did you notice a little note about your breast density? If you are like 40 percent of women, it might have said something like, “Your breasts are heterogeneously dense, which may obscure small masses and may put you at greater risk of developing breast cancer in the future.” Though this may sound a bit scary, it’s actually a normal reading.

Normal breast density exists on a spectrum from not dense at all to extremely dense. Knowing this information is important; it helps women and their doctors decide which breast screening methods are best, and how often they should get them. According to the American Cancer Society, whether a woman has dense breasts or not, regular screenings (mammograms in particular) are still the best way to find cancer early.

Because of the relationship between breast density and cancer risk, it is now the law in many states that breast density information be conveyed to each woman who has a mammogram. You may have seen talk of this newer legislation on the news.

What this means is that more women than ever before know that breast density matters, and many can tell you just how dense their own breasts are. Knowing this has also left some women wondering if their breast density will affect their options when it comes to cosmetic breast surgery.

To help answer this question, it will help if we first explain what doctors mean when they talk about breast density.

Breast density is a radiologic (mammogram) finding that has nothing to do with how breasts look or feel from the outside. The classification of density has to do with the ratio of fat (not a dense tissue) to everything else that makes up the breast, including glandular and fibrous tissue. On a mammogram, the fat shows up dark and the other stuff shows up white. The more white seen on a mammogram, the more dense the breast classification. The breast density classifications that may be assigned are – from least dense to most dense – the following:

  1. Fatty
  2. Scattered Fibroglandular
  3. Heterogeneously Dense
  4. Extremely Dense

Only about 10 percent of women are categorized as having extremely dense breast tissue. You can learn more about these breast density types, and see images too, at the American Cancer Society.

Here at North Texas Plastic and Reconstructive Surgery, Dr. Slack performs a wide range of cosmetic breast procedures including breast implants, liposuction, breast lifts, and breast reductions. In some cases, he may perform a combination of one or more of these procedures, depending on the goals of the patient. Here is how breast density may come into play with each of these procedures:


Breast implants are placed underneath the breast tissue not within in. This means that the breast tissue itself, no matter how dense, sits on top of the implant and therefore has little bearing on whether a breast implant is possible.


Liposuction alone is sometimes an option for women who are looking for a mild reduction in breast size. It is possible that a woman with extremely dense breasts, which means they have a lower ratio of fat to other tissue, may have a limit as to how much fat can be successfully removed using this method.

Breast Reduction or Lift

A breast reduction or lift sometimes includes liposuction, and the limitation just mentioned may come in to play to some degree. However, because these procedures also include an open surgical component, the goal of the reduction usually isn’t limited by breast density.

Here is the big takeaway: None of these procedures are off limits to a woman simply because she has higher breast density.

There are many factors that will limit a person’s plastic surgery options, including poor health, weight instability, and a bad smoking habit, but breast density usually isn’t one of them. That said, every person who walks into our clinic has their own unique anatomical identity, and that includes breast density. Dr. Slack takes all of this (and more) into consideration when advising each patient and planning their surgery.

If you have more questions about breast density and which breast procedures might be right for you, call our office today and schedule a consultation with Dr. Slack.

Listening to Your Concerns about Breast Implants

It’s a unique kind of double-punch to be told something is “all in your head,” especially when it comes to your health. When this happens you still have the problem you came in with, and now you have the pain of feeling unheard. The FDA recently did something to remedy this for a group of women who have concerns about the safety and relative risks of breast implants—they listened.

In late March the FDA held a public hearing to address concerns about breast implant safety. Women who have had breast implants, physicians, and manufacturers were allowed to speak openly before a panel of experts over the course of two days. “We do not feel we have been effectively and appropriately informed,” said one of the women at the FDA hearing. Attendees asked for increased transparency by manufacturers and improved patient access to information on risks associated with breast implants.

Two primary health and safety issues were raised, one of which was the subject of our recent blog post, Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). BIA-ALCL is a rare complication associated with some textured implants that was identified in 2017. At the time of discovery the FDA issued a warning, and we also wrote a post to help our patients understand BIA-ALCL.

The other issue is also rare. It is a difficult to describe condition called Breast Implant Illness. The problem, which includes a variety of vague symptoms like joint pain and fatigue, has often been dismissed by doctors and manufacturers. This is largely because the condition is poorly understood, and no definitive cause is known. Some research has suggested that the symptoms may be associated with an autoimmune reaction, but the authors of these studies concede that their findings show association but not causation.

Breast implants are not the only thing associated with these kinds of symptoms. The FDA recently released a statement warning that a small number of patients may have similar biological reactions to a wide array of implantable devices. As with breast implants this is also in need of much more study.

“Although there is no scientific evidence to date to support diseases/illness being caused by breast implants,” says Dr. Slack. “I don’t think it is unreasonable to believe that there are some people whose immune systems react strongly to having a breast implant or an implanted device in place. This is a very small number and is certainly not a common occurrence; nonetheless, it should be discussed when considering breast augmentation along with the other potential risks of breast augmentation surgery.”

A big takeaway here is that if you have had any adverse reaction to a surgical implant or have a history of an autoimmune disorder or allergies, it is important to discuss this with your surgeon. It is also important to follow your surgeon’s instructions regarding long term follow up after getting breast implants.

Despite the risks, the news at the FDA hearing wasn’t all bad. Decades of research has also shown breast implants to be safe for most women, and complications are rare. One cancer survivor relayed how her breast implants hadn’t been problematic and were, in fact, integral to her recovery after a double mastectomy. She hopes implants can remain an option for future patients like her.

“The meetings concluded with the panel recommending that the FDA require manufacturers to provide simpler and clearer health warnings to all patients,” according to this Atlantic article “but stopped short of encouraging a ban on any particular type of implants.”

The FDA hearing underscores the notion that good medicine requires a careful and well informed balance of risk and reward. In addition to finding a physician who is highly qualified, you also need one who is up to date and can adequately explain the risks of any procedure or treatment. On top of that, you need someone you can really talk to. Someone who knows that hearing what you have to say is an integral part of the equation.

If you are considering breast implants and want to know more about these issues, make an appointment with Dr. Slack today. He will be glad to give you the answers you need, and if you have concerns, he’s ready to listen.

Breast Implant Associated Cancer (BIA-ALCL) in the News Again

woman thinking about BIA-ALCL

Most of our life choices carry a certain amount of risk. Each time we get behind the wheel of the car or sign a form allowing our child to participate in sports, we accept a basic level of risk.  We do this because we feel the reward outweighs the potential downside. When choosing to have a plastic surgery procedure, we do the same thing. All surgeries carry the risk of complications, but we choose the path that makes the most sense based on our goals, lifestyle, and comfort with risk.

Most of the more common complications associated with cosmetic procedures are relatively mild and can be avoided with proper preparation before surgery and care after surgery. But occasionally a rare complication arises that has more serious repercussions. In the case of breast implants, Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is one of those rare complications.

BIA-ALCL has predominantly occurred in patients who have, or at one time had, textured breast implants. Reports of the disease developing in patients who have only had smooth implants lack adequate patient history for confirmation, but even so, the unconfirmed reports make up a tiny fraction of the cases.

This unusual cancer is a cancer of the immune system (called a lymphoma) not a cancer of breast tissue itself. It occurs in people without implants but is exceedingly rare. Why it can develop around a breast implant not clear, but it is thought to be related to how a person’s immune system reacts to the implant surface, specifically a textured-surface implant. It typically occurs within the natural scar tissue (capsule) that forms around the implant but can develop as a mass within the breast.

According to the FDA, BIA-ALCL has been reported 457 times in association with breast implants since 2010, but it appears that some of these reports are duplicates. Either way it is quite a rare complication. In fact, the risk of developing the disease for women with textured implants is somewhere from 1 in 3,817 to 1 in 30,000. For perspective, the overall risk of developing breast cancer due to all causes is one in nine. Even though the numbers are small, the association with breast implants is clear. Most cases are caught early and cured with the removal of the implant and the scar tissue surrounding it. Three-year disease survival is reported to be 93 percent. More advanced cases with cancer spread have been reported, and these cases do require chemotherapy. The nine reported deaths in the US from the disease occurred in patents who did not receive these recommended treatments.

We first updated you on BIA-ALCL in 2017, when the FDA announced the association between breast implants and the cancer had been identified. More recently, the FDA has addressed primary care physicians about the issue. As most women don’t see a plastic surgeon for routine health care, it is more likely to be a primary care physician (PCP) who will detect a lump or other change in the breast. This means PCPs must be aware of the special attention a woman with breast implants requires when providing her ongoing care.

As a patient, it pays to be proactive as you think about potential complications of breast implants. Below you will find concrete actions you can take that will give peace of mind about choosing a procedure and living with the results for years to come.

  1. Prior to surgery, discuss all possible complications with your plastic surgeon, including the possibility of BIA-ALCL. Compare the risks and benefits of different types of surgeries and implants to make the decision that is right for you. If your surgeon isn’t up front about potential risks, he or she is not the right surgeon for you.
  2. Do everything your surgeon recommends to prepare for a successful surgery – quit smoking, exercise, eat a well-balanced diet, and limit your alcohol intake.
  3. After surgery, strictly follow the post-operative instructions your surgeon provides for you.
  4. Have a frank discussion with your PCP about your breast implants and ask them to brush up on the latest research on BIA-ALCL. You might even share the FDA letter with them to be sure you are on the same page. Follow-up with them as recommended so they are able to detect any changes over time.
  5. The most common symptoms of BIA-ALCL are the development of fluid (seroma) around the implant several years after surgery, lumps, swelling or pain within the breasts. If you have any concerns at all about your breast implants, always contact your surgeon. He or she is in the best position to evaluate any symptoms that are bothering you.

If you are thinking about getting breast implants or have concerns about the implants you already have, Dr. Slack is your best local resource. Not only is he a member of the American Society of Plastic Surgeons, he completed a fellowship in breast surgery at Georgetown University Hospital in Washington D.C. He would like to discuss your questions with you and help provide a clear view of the risks and benefits of any procedure you choose. Contact our Collin County office to schedule a consultation.

The Three Things You Need to Know About Plastic Surgery After Weight Loss

The new year is right around the corner, which for many of us means it’s the time we start thinking about New Year’s resolutions. Perhaps you want to lose weight, stop smoking, or save money. Whatever it is, the new year offers a kind of reset button on life. For some, plastic surgery also offers this opportunity for a reset. Though it can’t fix everything, it can give you the confidence boost to start making other changes.

In this post we will be talking about plastic surgery after weight loss, which is an especially good example of this kind of reset. But, unlike many other changes you might choose to make in the new year, plastic surgery requires an especially large amount of thought, research, and preparation. It’s surgery, after all.

Plastic surgery after weight loss can feel like a huge reset because, for many, it is the last step in a long journey to remake their lives. Losing a large amount of weight (say, 50 to 100 pounds or more) takes time, effort, and in some cases weight-loss surgery. It is arduous, no matter how you get there. Weight loss alone changes lives in a big way, giving people more energy, improved health and self-esteem, and greater mobility. But, like most things in life, it isn’t always a perfect solution.

After significant weight loss, some people are left with excess loose skin. This affects people differently; for some it is a minor cosmetic issue and for others the loose skin itself diminishes mobility, causes rashes and infections, and impacts their sense of wellbeing. This 2018 study of nearly 1200 people (80% were women) who underwent gastric bypass surgery, found a link between excessive skin and poorer psychosocial functioning.

Unfortunately, the loose skin that follows a large loss of weight won’t go away no matter how many sit ups you do or expensive creams you buy. For this reason some people turn to plastic surgery for a permanent solution.

This kind of surgery is generally referred to as body contouring, and it can include a whole host of different procedures including the following:

While these procedures can restore a more youthful and toned appearance to the body, they come with some risk, especially when more procedures are performed at once. For this reason there are three things you need to consider if you are thinking about plastic surgery after massive weight loss.

It’s not an option for everyone

Obesity is a well known health risk and the medical conditions (called co-morbidities) that can go along with it include diabetes, heart disease, stroke, high blood pressure, sleep apnea and other breathing problems. These are serious health issues and they are often the reason someone undertakes an extreme weight loss effort. Sometimes those co-morbidities don’t completely go away, even after a large weight loss, making it too risky to undergo cosmetic surgery.

Plastic surgery for weight loss also won’t be an option for you if you are unwilling to change unhealthy habits. For example, you have to be willing to quit smoking, as it can get in the way of healing.

You have to wait a while after weight loss

Most plastic surgeons will require you to wait at least six months after reaching your goal weight before considering plastic surgery. This gives your body time to stabilize. Many of the health conditions associated with obesity will improve or go away during this time, and good long term eating and exercise habits will get established. This waiting period also gives some of the extra loose skin time to shrink down on its own.

It isn’t a panacea

Plastic surgery is the only permanent way to remove the large amount of loose skin that follows significant weight loss. It can improve your appearance and mobility and even your health. But it will not turn back the clock to a time before you had any weight to lose, to the body you had, say, at 16. Your body will also continue to be subject to the effects of aging after the surgery.

Though there are ways to minimize the appearance of scars, scarring is inevitable as well. (Learn how Dr. Slack keeps scar visibility to a minimum). Take a look at our before and after gallery so you know what to expect, at least in the first months after surgery as scars will continue to fade.

Also, it is important to know that no plastic surgery is a panacea for all of life’s problems; it won’t save your marriage, make you smarter, or get you that promotion. Being realistic and specific about the problems you want to solve will take you a long way toward a more satisfying result.

If you are considering plastic surgery after weight loss, it is important to take your time thinking about it, do your research and find the right surgeon for you. It has taken you a while to get where you are so a little more won’t hurt. Call our office today and make an appointment with Dr. Slack to get that process underway.

Am I Too Old for Breast Augmentation?

Senior Woman On Running Machine In Gym

The common conception about breast augmentation is that it’s a younger woman’s procedure. A woman who is a bit more mature may wonder if she is too old to pursue a breast augmentation, breast lift, or both.

But when you dig a little deeper, what most women probably want to know when they ask if they are “too old” for the surgery, is really this: Are they too old to have the surgery safely?

The good news is that age is indeed just a number. The healthier you are going into surgery, the better the outcome you can expect, and there is no reason a woman in her 50s or 60s can’t be just as healthy going into elective surgery as a woman in her 30s.

If you are free of underlying health concerns and you eat a healthy diet, exercise regularly, stay close to your ideal weight, and don’t smoke, chances are surgery will be safe for you. Your surgeon will perform a thorough physical exam to be sure there are no underlying issues that could complicate your recovery.

There are actually quite a few reasons a woman who has crossed the half-century mark might choose breast surgery.

Plenty of Time to Enjoy the Results

As time marches on, so does life expectancy. This means a woman in her 50s or 60s may have 30 years or more of an active lifestyle ahead of her. Enjoying those years may include doing things that boost your self-image — such as cosmetic surgery.

Having Children Later

Many women today choose to postpone having children to accommodate their careers or other interests. Rather than have breast surgery that may be affected by subsequent pregnancy and breastfeeding, they put off the surgery until later.

Menopause and Aging

The declining hormone levels of menopause along with the inevitable effects of time can conspire to cause breasts to lose their youthful firmness and lift. This can cause dissatisfaction with the appearance of the breasts with age. Surprisingly, breasts may also increase in volume with age due to increased fat deposits. Sadly, this does nothing to help lift the breast.

They Can Afford It

For many women, this is a time in their lives where their disposable income allows them to pursue a procedure they couldn’t afford a decade or so earlier. Since breast augmentation isn’t covered by insurance, this is an important factor in choosing to have the surgery.

While age alone is not an impediment to cosmetic breast surgery, age may play a role in choosing which procedure will best achieve the results you want. Women who have had children and gone through menopause may find that their breast have not only lost fullness, but they are beginning to sag. Implants alone will not rectify this issue and an augmentation combined with a breast lift will be needed to achieve the best results. Or, it may be the case that a breast lift alone will restore the appearance of your breasts without implants. A board-certified plastic surgeon is best qualified to listen to your wishes and make the most appropriate recommendations to achieve them.

If you’ve reached a “certain age” and feel that you would like to restore a more youthful appearance to your breasts, there is no reason to let your birth certificate dictate your options. Why not schedule and appointment for a consultation to discuss what will and will not work for you? The sooner you have the surgery, the longer you will have to enjoy the results.

What About the Nipples?

What happens to the nipples during breast surgery?It might seem like a little bit of a mystery. What exactly happens to the nipples during breast augmentation, breast lift, or breast reduction? And what if I don’t like my nipples? Can something be done about that?

Those are great questions, because the focus for many people interested in breast surgery is on size, or maybe sagging. Since the nipples do play an important role in the look of the breast, it’s important to consider how any surgery will affect them. But before we talk about how surgery can impact them, let’s dig into a little anatomy.

When someone says “nipple” what exactly are they referring to? Not everyone uses the same terminology, but there is a technical definition.  

The central, circular area on the breast that is pigmented is called the areola. The color can vary from light pink to dark brown – all normal. The size can vary widely, too, and that’s normal. On some women, small bumps on the areola are obvious. These are called Montgomery glands. They are normal.

In the very center of the areola, the nipple projects outward. The milk ducts exit through the nipple. Like the areola, there are lots of variations that are normal for the nipple. They can be large or small, project a little or a lot, or even be inverted.  

Together, the areolae or areolas (either way you want to pluralize the word is fine) make up the nipple-areolar complex, or NAC. Sometimes people refer to the nipple, but what they are really talking about is the NAC.

What If I Don’t Like My Nipples?

Even though there is a wide range of normal, not everyone feels comfortable with the way their nipples look. They wonder if there is something that can be done to change that.  

The answer to their question is yes. There are procedures that can change the appearance of the nipple, areola, or both. Often this is done in concert with a breast lift or breast reduction surgery, where the NAC can be repositioned or resized – often correcting a low or sagging appearance. Asymmetry, where the areola is larger on one side than the other, can also be addressed in these surgeries. Take a look at Dr. Slack’s before and after galleries for breast lift, breast lift with augmentation, and breast reduction to see some ways the nipple can be changed in these surgeries.

Less frequently, a procedure may be undertaken that just addresses the nipple or areola. For example, inverted nipples are caused by the milk ducts pulling the nipple inward. The connection between the ducts and the nipple can be removed by a plastic surgeon so that the nipple protrudes outward in a more typical way, but it may affect the ability to breastfeed. Size, shape, or symmetry issues with the areolas may also be addressed separately from other surgeries.

What If My Nipples Are Fantastic Just Like They Are?

Other people may see no reason to mess with a good thing, so they are concerned the appearance of their nipples might change as a result of breast surgery. The good news for these folks is that breast augmentation doesn’t have to have a dramatic affect on the appearance of the NAC, although adding the extra volume of an implant can spread out a loose areola making it look larger. If you take a look at the Dr. Slack’s before and after gallery for breast augmentation, you can get a feel for how the procedure affects the nipples.

Even with breast lift or reduction, it’s up to you how much the size of the areola will be reduced, though the location will necessarily be different in these procedures.

How Do I Learn More About How Breast Surgery Affects the Nipples?

It’s best to have this conversation with your plastic surgeon to get a clear picture of how a procedure will or will not affect the appearance of your nipples and areolas, and if it will have a negative effect on sensation or your ability to breastfeed. Each person is different, and a consultation with an expert will give the best picture of what to expect.

In addition to his residency in plastic surgery, Dr. Slack completed a fellowship in Cosmetic and Reconstructive Surgery of the Breast at Georgetown University Hospital in Washington, D.C. He is an expert in understanding exactly how a surgery will affect the nipple, areola, and breast overall. If you have questions about any type of breast surgery, contact our Allen office to schedule a consultation with Dr. Slack.

Patient Story: Laura’s* Tummy Tuck

Love your tummy - try reading this tummy tuck patient story.Laura’s body had worked hard for her and her family. So, after giving birth to two children, she was planning to have a breast lift and implants. But she also realized that, after the breast surgery, her tummy would not match her new breasts. Even after working hard to lose the baby weight, there was loose skin she couldn’t seem to diet or exercise away.

That’s why Laura decided to add a tummy tuck to her breast surgery. We asked Laura to tell us about her tummy tuck experience, and she offered some sage advice.

Finding the Right Surgeon for a Tummy Tuck

Once Laura decided she wanted to have the surgery, she got recommendations from friends for a surgeon. The surgeon they suggested had a lot of accolades, but Laura felt uncomfortable with him. This surgeon wanted to use a procedure for her breasts that she felt was too new, and there wasn’t enough data to support using it.

Laura, explains, “I found Dr. Slack online and read all the reviews. After the consultation with him I felt he was more thorough and cautious of any new things where he didn’t have a ten-year outcome and research. I liked that he was more careful and cautious, and also he took a lot of time in the consultation to explain all the complications and considerations, not just trying to tell me, ‘Yeah, we can fix this for you.’”

Preparing for Tummy Tuck Surgery

Once Laura found her surgeon, she focused on preparing for the surgery and recovery ahead. As the mother of two young children, there were quite a few preparations to make. She made sure to have help lined up for them, and that her husband understood that she wouldn’t be able to manage her usual tasks during her recovery.

She spent time reading online patient stories and talking to friends who had had tummy tuck surgery previously. This gave her an idea of what to expect from the patient’s perspective.

“I had a good friend who had just had it, so she was able to help me get some ideas of how much time for recovery and what was needed. So researching helped and asking friends helped.”

Laura is a healthcare professional, so she was already living a healthy lifestyle. But she made extra efforts in this area as she prepared for surgery. “Before the surgery I was extremely clean on my diet, making sure I didn’t have too much caffeine or any red wine for two weeks prior. Things like that, just to make sure I was just very healthy before I went in.”

Tummy Tuck Recovery

After surgery, Laura saw immediately just how great her results were going to be. “You could immediately say it was awesome. It was so flat and so perfect, so I could tell that it would be good.” But she was a bit surprised at the level of pain immediately after her tummy tuck. “Everybody told me it was really tough, and [Dr. Slack] even was honest that it was extremely difficult. And it was extremely difficult for the first three or four days.

“I just want people to know the first three days are going to be really, really tough. But it’s amazing, because you feel like you’re never going to get there, and every day is a little better. And then in six weeks you’re like, “Oh, wow, I did it!”

Tummy Tuck Results

Laura was very pleased with her tummy tuck results, and her good first impression was confirmed by those around her.

“Of course I had a friend with me, supporting me there, and she said, ‘Oh my gosh, your abs are amazing.’ And even with me scrunched over and all bandaged up… my husband is like, “Wow, you look amazing.’”

Now that nine months have passed since her surgery, Laura is even more pleased.

“I mean I love it. I’m very glad that I did it. I would do it again, even with all the recovery and time. I just feel more… I guess more confident in how I look, you know? I’m more confident with my husband, being intimate, because I feel more comfortable about myself.”

Final Words of Wisdom

Laura wants people considering a tummy tuck to be prepared for the difficult few days after surgery. She compared it to waiting at a restaurant. If you have to wait for less time than the host tells you, you are pleasantly surprised. So when you go into surgery, “you want to expect it might be really hard. Then when it’s not so bad, it’s a pleasant surprise.”

Finally, Laura explains that tummy tuck surgery is worth the investment in yourself, if you are living with a tummy that bothers you.

“I would just say if someone feels that’s bothersome to them … It’s totally worth it. It’s totally worth the recovery and the time that you’re going to put into it, not to live with that.”

*The patient’s name has be changed to protect her privacy.

Breast Implant-Associated Lymphoma: Know the Facts

Update: The American Society of Plastic Surgeons provided an update on BIA-ALCL in January of 2018. Please follow this link to read more.

If you haven’t already heard, you should know that there is a rare cancer associated with breast implants (both saline and silicone gel). It’s called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). It occurs mostly with implants that have a textured surface, though there have been cases with smooth-surfaced implants. As of March 21, 2017 there have been 126 confirmed cases of BIA-ALCL reported in the United States.

A possible association between this cancer and breast implants was identified by the U.S. Food and Drug Administration (FDA) in 2011, but there wasn’t enough solid evidence to confirm a connection or make any recommendations at that time. The following year, the Plastic Surgery Foundation collaborated with the FDA to create a patient registry called PROFILE (Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma, Etiology and Epidemiology).

PROFILE was created to better understand the relationship between breast implants and ALCL, to find risk factors, “diagnostic predictors, and the best ways to manage this disease.” During that time, researchers also began to double down on their efforts to understand this disease and any association with breast implants.

In 2016 the World Health Organization officially recognized a link between breast implants and ALCL, and the FDA agreed:

“All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants.”

By this time, the research had also revealed that the cancer was most often associated with implants that had a textured surface. ALCL is not a cancer of the breast tissue itself, but occurs in the capsule that forms around the implant. It usually develops between two and 28 years after a patient gets implants and occurs with the onset of symptoms like swelling of the breast or lumps in the breast or armpit.

Fortunately, BIA-ALCL is not only rare but also has a very good prognosis. The National Comprehensive Cancer Network says the best treatment is to completely remove both implants and the capsules that have formed around them. Ninety-three percent of patients who undergo treatment are disease free within three years.

In March, 2017, the FDA updated their website to include more information on BIA-ALCL, including their current recommendations and a number of patient and physician resources. Here are their most current recommendations:

Before you have surgery: Educate yourself about BIA-ALCL before having surgery, and talk to your surgeon about the risks and benefits of textured versus smooth-surfaced implants.

If you already have breast implants: If you don’t have symptoms, there is no need to change your routine medical care and follow-up. However you do need to be sure to follow the standard recommendations given by your surgeon for routine care.

If you have breast implants, it is important that you follow all of your surgeon’s instructions in the early days and months after surgery but also in the years thereafter. Your surgeon will likely want to follow up with you each year to examine and discuss your implants. It is also important that you continue with routine cancer screenings including self exams, physician exams, and mammograms as recommended by your doctor.

If you have had breast implants, keep an eye out for any changes in your breast size or symmetry, rippling or hardness around your implant, or lumps in your breast or armpit. If any of these occur or you are simply concerned about your breasts for any reason, don’t hesitate to make a follow-up appointment with your plastic surgeon.

If you want to know more about BIA-ALCL, the risks and benefits of textured versus smooth implants, or whether breast implants could be right for you, contact our office in Collin County, Texas for your consultation.