What happens during Breast Implant surgery?

Breast implant surgery is performed to add volume, restore firmness and add fullness to the breasts. Breast augmentation can also subtly lift the breast but not enough to correct significant droopiness. Dr. Charles Slack, voted one of the best plastic surgeons in Dallas and Collin County by D Magazine, helps women achieve a natural look that is long lasting.

After pregnancy, breastfeeding, and/or weight loss, breasts can lose volume and fullness. On the other hand, sometimes you are just not happy with the size of your breasts. A breast augmentation procedure is obviously intended to enlarge the breasts. However, a great surgical outcome involves much more than simply deciding on the cup size you want to be. It is important to choose a board-certified plastic surgeon who has extensive experience in cosmetic surgery. Also important is to be in good physical and mental health and have realistic expectations. In a cosmetic consultation, Dr. Charles Slack can guide you in achieving your desired look.

There are numerous types and sizes of breast implants to consider. Natrelle®, Ideal Implants®, Sientra, and Mentor are all options that Dr. Slack offers to his patients. Choosing the appropriate implant for your breast is a critical part of the process to help you achieve the breast augmentation results you are looking for. The factors considered in determining the right implant for you include:

  • breast shape
  • breast width
  • desired height of fullness
  • natural or rounded look
  • body type
  • desired increase in size
  • your lifestyle
  • Dr. Slack’s surgical judgment and recommendations

Now through August 31, 2020, Dr. Slack is offering savings on Natrelle® silicone breast implants! After breast augmentation surgery using Natrelle® silicone breast implants, you will receive $250 in credit toward Botox Cosmetic®, Juvederm® or other skin treatments. As an added bonus, you will receive 25 units of Botox Cosmetic® treatment. The best way to consider how you can look amazing is to schedule a private consultation with Dr. Slack. He will discuss your concerns and goals in detail with an explanation of what can and cannot be achieved for you with breast augmentation. Patients find Dr. Slack to be the kind of surgeon whose wisdom and compassion make him easy to talk to about the sensitive topic of breast surgery. Contact Dr. Slack today to schedule a consultation.

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.

New Research Delivers Good News for Breast Cancer Survivors

One thing you can say about breast cancer survivors: they have fortitude. They don’t give up on life, and then after they have beaten cancer, they don’t give up on getting back their quality of life. To retake ownership of their own bodies, their sexuality, and their self-esteem, many women choose breast reconstruction after mastectomy. There were over 100,000 procedures performed in 2016 alone.

Breast reconstruction involves surgery to recreate a breast mound and (optionally) a new nipple. Because all women and all cases of cancer are unique, no two surgeries are the same. However, there are two main ways a breast mound can be reconstructed: using implants or using tissue from another part of the patient’s body (autologous reconstruction). Sometimes a combination of the two is also done.

  • Breast implants can be filled with silicone gel, saline, or a combination of the two.
  • Autologous reconstruction uses tissue usually taken from the patient’s thigh, back, buttocks or abdomen.

There is great debate over which of the above two methods is best. Autologous reconstruction may result in softer more natural looking breasts but a second surgical site is needed for harvesting the graft tissue. Implants may allow for larger breasts, but they may not look and feel as much like a woman’s natural breasts. The choice is personal and should be made with the help of a qualified plastic surgeon experienced with breast reconstruction.

Both options have been studied extensively, are safe, and result in high patient satisfaction scores and improved quality of life. Even so, a small percentage of women who have implant-based breast reconstruction later decide to have their implants removed and change to autologous reconstruction. This may be due to personal choice or complications.

Based on experience, many plastic surgeons will tell you that patients do well after this kind of second reconstruction. However, because it is not so common, there has been little research on how well these patients do statistically as a group. That is until now.

Researchers at Memorial Sloan Kettering Cancer Center collected and analyzed data on women treated at their center between 1997 and 2017. Their results were published this month (February, 2019) in the journal Plastic and Reconstructive Surgery.

The research team found just under 140 women who had undergone autologous reconstruction after what was considered a “failed implant-based reconstruction.” They defined the implant procedure as “failed” if the implant became scarred down and resulted in discomfort and a change in breast appearance.

On average, the women included in the study had the second reconstruction three and a half years after the first one. Analysis of the medical records and patient surveys showed a good success rate, few complications, and “significantly improved patient satisfaction and quality of life.”

This is good news for the few women who experience complications with breast implants following mastectomy. For them, an autologous reconstruction may be a very good option, and these women deserve all the options we can give them.


Dr. Charles Slack completed a plastic surgery fellowship, followed by an additional surgical fellowship in Cosmetic and Reconstructive Surgery of the Breast at Georgetown University.
If you have been diagnosed with breast cancer and are considering reconstruction, it is not too early to talk to an experienced plastic surgeon. Contact our office to schedule an appointment with Dr. Slack today.

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.

Breast Implants and Mammograms

Woman waiting for mammogram

“Mammograms are so fun, I can’t wait to get my next one,” said no woman ever.

Nonetheless, every year millions of women do get them because early detection is one of the keys to surviving breast cancer. So, what if you have breast implants; can you still get a mammogram? Is a mammogram still effective? The short answers are yes and yes.

The American Cancer Society tells us, “If you have breast implants, you should still get regular screening mammograms.” While breast implants can make it harder to see certain parts of the breast, mammograms are still effective.

A 2015 study, published in the journal The American Surgeon, found no significant difference in cancer detection rates between women with or without breast implants. “Because implants did not significantly affect mammogram results,” say the authors. “Women with implants should be reassured that mammography remains useful in detecting cancer.”

That said, if you have breast implants and are going to get a mammogram, there are a couple things you should know.

Your exam will be a little different

Your breast implants are nobody’s business – most of the time. But when it comes to mammograms and issues relating to breast cancer, it is in your best interest to let your doctor and mammogram technician know about your implants. This is because they need to slightly alter your exam.

Four extra pictures (two on each breast) called implant displacement (ID) views will be taken. For these, the implant is pushed back against the chest wall, and the breast tissue is pulled forward. These views are a little tricky to do and they can be uncomfortable, especially for women who have a lot of scar tissue.

Your mammogram technologist should also be aware of your breast implants because, though very rare, implants have ruptured. Further, if you already have any breakage or leaking, a mammogram can make it worse.

The type of implant you have may matter

All breast implants are not created equal. The older they are, the easier they can be damaged by undue force. The materials used and the design of the implant can also impact the risk of rupture. Read more in our post, Saline or Silicone: Choosing the Right Breast Implant for You.

Some radiologists say that mammograms are better and easier for women if the breast implants are under the chest muscles. Others say it has no effect at all. Talk to your plastic surgeon before you have a mammogram if you have any questions or concerns.

“The benefits of getting a mammogram far outweigh the risks of implant damage,” say experts at the University of Texas MD Anderson Cancer Center. If you are considering breast implants, you should get a mammogram before and, as soon as it’s safe, after. This way you will have a baseline for further mammogram comparison.

More than anything it is important to keep the lines of communication open between you, your doctors, and technicians involved in the examination of your breasts. Don’t be shy; before you have a mammogram tell them about your breast implants.

If you are thinking about having a breast augmentation but have concerns about its impact on breast examinations and cancer prevention, Dr. Slack would be happy to answer your questions. Get in touch to schedule your consultation.