Why do Breast Implants Leak?

The manufacturers list the chance of a breast implant leaking as about 1% a year. That means the longer the implant is in your body, the higher the possibility of it leaking. For example, at 10 years, the risk is 10%. Some last forever, others leak in the first year.

Why do implants leak? There are two main reasons, and one rare occurrence. The most likely event is called “fold flaw fatigue.” This occurs at the edge of the implant, and is caused by a small folding of the implant due to muscle movement which causes the two edges to rub against each other and over the course of years wears a hole in the implant. The second big cause is a valve malfunction, or some tissue growing into the valve if it is a saline filled implant. It is rarely the result of a car accident or falling on your chest. Even rarer are manufacturer’s defects.

When an implant leaks, there are costs associated with replacing it. You have to realize it is not the fault of the surgeon when an implant leaks. It has nothing to do with technique. You need a surgery with a new implant, anesthesia, supplies and recovery, all of which cost money. Sometimes the manufacturers offer a replacement implant at no charge, and some offer you insurance that you have to buy before surgery to cover this type of occurrence.

When a patient of mine has a leak within the first year, I do not charge to replace it and cover the costs out of my pocket, as even though it is not my fault, I feel badly. After a year, I charge less than if you had the implant done elsewhere and came to me for replacement.

While I hope that none of my patients ever have an implant leak, I know that this is not possible. I put in hundreds every year, and have been in private practice over 21 years. This means I have about 10,000 implants floating around the world. Even though it is unpleasant, I hope that if any of them leak, the patient would return to me so I have the chance of helping them again.


Last Blog of 2016

Another year of blogging is now complete. I hope to those who read it, it has provided some valuable information, some amusement, and a little insight into what makes me who I am. Intentionally, and often unintentionally, my personality will leak out in my writing.

Even if no one ever read these pages, it was still worth it to me writing. It is an excellent exercise in thought. Each blog takes me about 10 minutes to complete. I sit down with no topic or notes and then just flow with an idea of the moment. I do no drafts or revisions. I have no editor or assistant. It is often fascinating where my mind decides to go.

2017 will be a year of major changes at Yager Esthetics. Our nonsurgical services are booming, and more technology is on the way. Stay tuned here for what is next. At least 2 will launch in January. Both are long overdue and will be much in demand.

We are going full electronic records and eliminating paper. Get ready for iPads and laptops, as well as a video revamp of the website. Technology cannot be stopped. We will continue to set the bar for plastic surgery in the Hispanic community.

I wish you all a very happy and Healthy 2017. Thank you to all who have supported me over these 20 years, and know I will continue to support you for as long as you will have me.


A December to Remember

It is already the last month of 2016- where did the year go? The older I get, the faster time seems to speed by. Yager Esthetics is charging ahead in our 20th year as the Latina beauty experts. With all of the imitators popping up, we are certainly flattered, but be sure to be safe and do your homework.

December is a funny month, in that we tend to hold a few extra surgery days aside for the “last minute shoppers” of our practice. All of a sudden, people start realizing the holidays are coming, and there is time off from school and work. Gift money comes in, and all of a sudden they want to finally have that cosmetic plastic surgery procedure they have been thinking of.

If that is you, realize that surgery should not be rushed. Testing needs to be done beforehand to insure you are healthy and safe. Implants, girdles, and special order items need to be secured ahead of time, and all of the preop and postop visits need to be coordinated. You need to think about child care, who will pick you up from surgery and care for you, and who will cover you at work.

Of course we offer nonsurgical treatments and injections, such as Botox, fillers, skin tightening, laser hair removal, Silk Peel and skin care, for those who can’t quite get a surgery together. The results are amazing and can get you ready for a holiday party, family gathering, or New Year’s Eve celebration.

If you want this to be your December to remember, be efficient, make an appointment with your general medical doctor for right after your visit with me so testing will not be delayed. Patients aren’t the only ones who take off time around the holidays, doctors do as well. Except for me- I am here to serve you.


The BRA- Thinking Big While Going Smaller

One of my favorite operations in plastic surgery has always been Breast Reduction.  It is the only operation I still do that is not purely cosmetic.  It has been done for over 100 years, though techniques have changed.

I had always been very happy with my results, and still think my traditional breast reduction results compare to any I have seen.  The one thing I did not like, and is a limitation in breast lifts as well, is the lack of fullness in the upper part of the breast to make it seem more full and youthful.

Patients come to me because they have very large and heavy breasts, and want to remove the extra weight, and lift them so they appear more attractive.  What they want to look like is someone who had breast implants.  That’s when I got inspired.

Why not do a breast reduction and put in an implant at the same time? Breast Reduction Augmentation- BRA.  Of course, you need to be very careful technically to insure you preserve sensation and blood supply to the areaola and nipple.

I have performed the BRA about 30 times now, and have been more than thrilled with the results.  Implant selection and care with the size is crucial. I hope to publish my series soon.

So, going smaller does not mean it is necessarily a reduction alone.  Sometimes you need to go back a little farther to move ahead..


Early Results With Inspira Breast Implants

Another breast augmentation blog!  Whenever something new comes out, I do my due diligence and report back to my patients.  When I was informed of the Natrelle Inspira line, I naturally read all I could and spoke to my implant people. I have been using these implants for 6 months, not exclusively, and find that they are not the only answer, but a very helpful tool in my implant arsenal.

Inspira is a silicone gel based breast implant of the traditional type.  It is not a highly cohesive gel, or gummy bear type.  What distinguishes it from the standard or classic gels is that the same dimension shell is filled to a higher percentage.  This results in a bit more fullness.

Inspira implants come in different profiles, which further adds to the options for custom tailoring each procedure to each patient.  I can select many different implants for the same size breast and create different looks depending on the personality and desires of each patient.

I find that for the patient who wants that little bit more upper pole fullness without looking fake, it is an excellent option.  My patient satisfaction has been extremely high so far, and I have not yet had a capsular contraction.  This most likely will happen at some point.

I would be happy to offer my advice to those of you who are considering breast augmentation.  Inspira may not be right for you, but it is worth considering.  The search for the perfect implant continues.


Aug August

It is August already, and as Summer marches on, I am reminded of the Summer of 1998.  It was my second year in practice, and I was not as well known as I am now.  For some strange reason, I got an influx of patients for breast implant surgery.

I was so excited that my practice was growing, and that I was making it happen for myself.  With no real money and a lot of school loans, I had managed to survive a whole year as a solo plastic surgeon in Manhattan.  I could feed myself and afford rent on a one bedroom apartment outside the city.  Sadly, this was similar to when I was a resident in terms of my disposable income.

I had always been very good at selecting breast implant sizes, even as a student.  Spatially, I could see a woman and a photo of what she wanted in terms of breast size, and instantly know the implant size required.  I never use sizers during surgery, nor do I order multiple sizes for a single patient.  I had been fortunate to have a patient or two who didn’t mind sharing the fact that they had surgery with me.

It came to pass that in that month, I had a string of days where nearly all the cases were breast augmentations.  At that time, it was far and away a record for most implants in a single month.  We called it “Aug August.”

Now, I sometimes do that many implant cases in a week.  Don’t worry, the breast is yet to come.


Size Does Matter

As I finish my 18th year in private practice at Yager Esthetics, one of the procedures I do most is breast augmentation (implants). I have placed many thousands of them, and I feel it is a procedure I do very well. Patient satisfaction is extremely high, but it is not 100%. Unfortunately, it is not due to what I do in the operating room. That would be easy to address.

While I make every effort to educate patients as to the full range of options, the risks and benefits of the surgery, and demonstrate my style of a natural looking breast in proportion to the body, some patients do not listen as well as I think they do.

I spend a long time at the initial consult informing the patient of all the approaches and implant types, as well as pointing out asymmetries and differences between the existing breasts. I let the patient make all the decisions, and then we decide if I am comfortable with those choices. At the preoperative visit, we go over all of this again, and really get into the size.

I have found the best way to gauge size is to show a series of before and afters of patients with similar bodies, and not reveal the bra size. I simply ask if they like the size, prefer bigger or smaller. Once we find this information, I tell them the approximate size they have chosen. I stress the fact that the bra size is not important, it is how they feel when they look in the mirror. With this approach, 98% of my patients are happy.

The 2% who want something else are usually not truly unhappy with the size, but unhappy in life. When the implants do not fix life’s problems, it is easier to blame the surgery than face the issues of bad relationships and personal issues. Even still, I try to help them.

Breast implant surgery in the right patient can transform your physical being, and even lift your self esteem. Size does matter, but being happy with yourself is more important.


Breast Reduction with Implants?

When I first opened my private practice in 1997, the thought of putting breast implants into a woman who was having a breast reduction was ridiculous, bordering malpractice. If you have more than enough volume, just leave the right amount behind and avoid the potential complications of breast implants altogether.

As regular readers of my blog know, I am constantly reevaluating my results, in the attempt to further enhance what is possible while remaining safe. The only disappointment in breast reduction results has been a lack of fullness in the upper part of the breast, the same as in breast lift surgeries. What could I do?

I have, over the years, found that adding an implant to breast lifts increased patient satisfaction, as the breast appeared more youthful with the extra volume up top. I had corrected old overreduced breast with implants before as well. Why not add an implant to the reductions, just reducing a little more to achieve the same volume in a different distribution?

There are technical considerations, as you have to be careful with the blood supply to the nipple, and the surgery needs experience and careful planning. It costs more, and you have to consider the additional risks of having breast implants, such as leakage and hardening.

Just like in life, the things that sound crazy to you when you are young sometimes make a lot of sense as you get older.


Santa Claus and Plastic Surgery

Almost all little children look forward to xmas, a time when good behavior is rewarded with family time and the fulfillment of wishes for presents.  It is a happy holiday, but one in which many lose the true meaning of sacrifice for others, and instead focus on themselves.

Sometimes, cosmetic plastic surgery patients act the same way.  They see their plastic surgeon as a type of Santa Claus, who can magically grant every wish for physical improvement with the wave of a scalpel.  The bandages are like the wrapping paper, which when removed reveals the wonderful gift within.

Many times, patients are thrilled with the results, and understand the work that went into creating them.  All the training and sacrifices made by their doctor to acquire his or her techniques and esthetic eye are evident.  Some, however, like spoiled children, can never be satisfied or have enough.

I always meet with my patients several times before performing a surgery upon them, so that I may review the risks and alternatives of each procedure, and try to give them a realistic idea of what to expect.  Unfortunately, not all patients listen well.

Over 99% of my patients are quite satisfied with their care and results of treatment at Yager Esthetics, but that 1% is what makes my life difficult.  If everything is done well and the results are excellent, and the patient is unhappy, there is very little that can be done.

If plastic surgery is under your tree this year, don’t be naughty.  Listen to your doctor, try to have realistic goals, and all will turn out nice.  Happy Holidays!


3 Myths of Breast Lifts

Many women, especially after the birth of children, notice a change not only in their stomach area but in their breasts as well. They can be bigger, smaller, or the same size as before pregnancy, but they are often looser.

The two factors that are most important in breast esthetics are size and shape. For my money, the more important of the two is shape, because if you have a small or large well formed breast it is still pretty and youthful. Bigger is not always better.

There are many techniques of breast lift, or mastopexy. Some use just an incision around the areola, others a lollipop, and others an anchor type scar. The deciding factors are the laxity of the skin and how far down the nipple has fallen. When done properly, the results are rewarding.
I wanted to touch on the myths and truths about the procedure to better inform my patients.

Myth 1- You will lose sensation if you do a breast lift. It is possible, but very unlikely that nipple sensation is permanently lost with mastopexy
Myth 2- You will be smaller if you do a breast lift. Only skin is removed, so no significant size change is likely.
Myth 3- You have to remove the nipple to lift the breast. No, you are cutting around the areola, but the nipple stays attached to the breast tissue below at all times.

Truth- In many cases, the very full upper part of the breast can only be achieved with the addition of a breast implant. Many women do not have enough breast volume to have a very round breast after lift without an implant. They do look pretty and natural, but if you are going for the push up bra look without a bra, this is not possible without adding an implant.
Hope this helps