Ask Dr. Barber

Every month Dr. Barber answers questions submitted by readers of Guilford Woman and Kernersville Living magazines.  If you’re interested in reading past articles, click here.

July 2017

Q. I would like to know when I should replace my breast implants.  I had an augmentation about 10 years ago in another state.  I know that I have saline implants but do not know anything else about them.  When should I plan to replace these implants?

A. This is a good question and one that I face every day in my practice.  Before I answer your question about when to replace a breast implant, let me say that you should make an effort to get as much information as you can about your implants from the doctor that placed them.  Most plastic surgeons will keep breast implant records for many years.  It is always good to know the manufacturer of your implants, the size of the implants, the date of placement of the implants, and whether the implants are under or on top of the muscle.  This information will be of great benefit to the plastic surgeon who may be replacing them in the future.  Also, if the implant is leaking, the manufacturer will often provide new implants at no charge, so knowing the manufacturer is beneficial to you.

Now, let’s get to your question.  The following advice is what I tell my patients regarding when to replace implants.  If you have saline implants, you can simply wait until one of the implants begins to deflate.  Deflation is usually fairly slow (not always however), and once you notice that one breast is starting to get smaller than the other, it is time to visit your plastic surgeon.  As a general rule, you can expect that your saline implants to last about 15-20 years.  Replacing saline implants is a surgical procedure that is relatively simple compared to the original augmentation surgery.  The surgery typically takes about an hour and you can expect to return to most activities in less than a week.  The most common sign that a saline implant is leaking is that one breast no longer fits the bra as it used to because the breast is getting smaller as the implant deflates.  The other sign that is sometimes seen in slowly deflating implants is a new onset of rippling on the outside (lateral) portion of the breast.  This rippling looks like waviness on the skin.  If in doubt, see a plastic surgeon who can help make the diagnosis.

Silicone gel implants have different recommendations than saline.  It is now recommended that silicone gel implants be replaced about every 10-14 years.  This recommendation is very different that what used to be told to patients, which often was that implants will last forever.  This advice is absolutely not true.  All implants will eventually fail.  There are many women today that have implants that are more than 20-30 years old and likely have leaked.  Mammograms are not a very accurate tool to diagnose a leaking silicone implant unless it is obvious.  An MRI of the breast is the most accurate diagnostic toll for detecting a leaking silicone gel implant, however, MRI’s are expensive.  My recommendation is to save your money on an MRI and plan on replacing the silicone implant electively about every 10-14 years.  The goal is to replace the implant before it leaks, not because leaking silicone is dangerous to your health, we do not believe that is the case, but the surgery to replace a leaking implant is more complicated and expensive than replacing a non-leaking implant.  There are no definitive physical signs that a silicone gel implant has leaked.  Sometimes there can be a gradual change in the shape of the breast or new onset of hardness of the breast.  Other than these two occurrences, which are very nonspecific changes, there are really no definite signs of leakage.  Gladly, we are not aware of any diseases that may occur because of a leaking implant.  But still, the recommendation is to remove a broken silicone implant and replace with a new implant, if you want.  My recommendation for anyone with older silicone implants is that you visit a board certified plastic surgeon to evaluate your implants and formulate a plan for taking care of the implants in the future.

 

June 2017

Q: I had a breast augmentation with silicone implants about 2 years ago. My right side is perfect, but my left side is very hard and does not look natural. My surgery was done in another state and I have moved to the Triad area and do not have a plastic surgeon. What can be done to improve the appearance of my “bad side”?

A: What you describe is called a capsular contracture and is caused by aggressive scarring that has formed around your implant. It is not known exactly why contracture forms in a woman’s breast but it is postulated, and evidence is beginning to support, that hardness is caused by a bacterial infection around the implant. The infection is sub-clinical, meaning that it does not cause any symptoms such as fever, swelling, redness, or pain. (Read More)

 

May 2017

Q: I am 42 years old and have fine lines on my cheeks and around my mouth. I do not have any saggy skin on my face but I do hate the fine wrinkles. I grew up on the coast and abused my skin when I was a teenager. Now it seems that I am paying for this mistake. Is there anything that works to smooth fine lines on the cheeks and around the mouth? 

A:  It is difficult to completely eradicate fine lines on the face, but there are certainly some non-surgical options that will improve the skin. First and foremost, start protecting your skin against further damage with regular application of a good broad spectrum higher SPF (above 35) sunscreen. This one step in your daily skin care regimen is the most important thing that you can do, both to reduce additional premature aging and to protect your skin against skin cancer, which is epidemic in the South. (Read More)

 

April 2017

Q. Is there any way to get rid of the signs of aging on my upper chest? I have brown spots, red spots, and wrinkles. I confess I do go into the sun a fair amount.

A. First, let me say that it is OK to go into the sun but you must protect yourself with a good sunscreen. It is so common for me to hear how careful patients are protecting their face, but they forget to put sunscreen on their chest. So as a result, some of the worst sun damage I see in my practice is in the décolletage area. (Read More)

Q. I would like to have some filler like Juvederm® injected into my cheek folds that run from my nose to my mouth. These folds have progressively gotten more noticeable as I have aged. I read online that one of the complications of filler to the face is blindness, so I have held off doing the injection. Is this true and if so, is it very common?

A. Online sources of information can sometimes be misleading, but in this case the information that you read is correct. Blindness is a potential, albeit rare, risk with any injectable into the face. It is most associated with hyaluronic acid fillers, such as Juvederm® and Restylane®. (Read More)

 

March 2017

Q. I recently had the breast cancer gene test and was found to be BRCA2 positive. My mother died of breast cancer at 40 and I am now 36. My mammograms are clear so far but I have been advised to consider removing both of my breasts to protect myself from the disease. What is the best form of reconstruction for double mastectomy if I chose to go this route?

A. I applaud you for having the gene test for breast cancer. You now can take some control over the disease rather than the disease having control of you. As you have probably been informed, there are two genes that are commonly evaluated to see if a patient has an increased risk of breast cancer, BRCA1 and BRCA2. BRCA is an abbreviation for BReast CAncer. (Read More)

 

February 2017

Q. I recently moved to the Triad area after living in the Northeast for most of my life. I am interested in having some plastic surgery on my eyes but I do not know how to find the right plastic surgeon since I am relatively new here. Can you give any advice on making sure I pick a good doctor?

A. There is no absolute science to picking a good doctor in any specialty. Fortunately, in plastic surgery most everything is somewhat elective and you at least have time to investigate your choices and visit several plastic surgeons before making a decision. You did not say what kind of eye surgery you are contemplating, so I am assuming that it is some type of cosmetic surgery of the eyelids. My suggestion is to first ask your primary care doctor to give you a list of 2 or 3 plastic surgeons who he/she would recommend. (Read More)

 

January 2017

Q. A few years ago I had a facelift. Most everything went well except where the facelift scar went into my hair in the temple area. I now have a bald spot about the size of a nickel, but only on one side. It is not that noticeable except when my hair is wet. Is there anything that can be done to get hair to grow back? My plastic surgeon basically told me that it is not noticeable and not to worry about it.

A. It is not unheard of to have some loss of hair in the temple area after a facelift. The hair loss is generally due to tension caused by the pulling of the skin when doing the lifting of the face. If the tension at the incision is significant enough, it can reduce the circulation of blood to the skin around the incision. Hair follicles are very sensitive to reduced blood flow and can result in the hair bulb, where the hair grows, dying. This leads to a bald spot. (Read More)

Q. The hole in my earlobe where my earring sits has gotten progressively larger over the years. My earring now does not sit nicely against the earlobe but hangs down. Can the hole in the earlobe be made small again?

A. Yes, it can. It requires a small surgical procedure to remove the enlarged hole and suture the skin back together again. The repaired earlobe hole is allowed to heal for about three months, then the lobe can be re-pierced. The procedure is performed under local anesthesia and has no down time after the repair. The key in the future after re-piercing is to not wear heavy earrings that pull on the hole causing it to elongate again.