LIVING WELL By Nicholas Leonardi, D.O.
TOP 5 Most Pressing Plastic Surgery Questions Do breast implants have to be changed out after 10 years? Unlike many parts on your car, you do not need your implants replaced every 10 years. However, for those that research the subject online, many sources have historically recommended replacing silicone or saline breast implants every 10 years. So where did this magic number come from? Ten years after an initial cosmetic breast augmentation, roughly 1 out of 5 patients need some sort of revision procedure. That means 20% of patients need another operation due to excess scarring of the implant capsule (capsular contracture), ruptured implant, or implant malposition (pocket stretch). An issue requiring revision that is related to the implant itself is a reasonable indication to exchange the implants. Many people also use that opportunity to increase or decrease the volume of their implants or pursue a breast lift to address normal breast aging. On the contrary, 80% of the patients are doing fine at 10 years. The “10-year rule” was based on some older data with implants that had a thinner shell and more liquid inner gel. We now have 5th8th generation gummy bear implants and these newer implants appear sturdier than the implants previously studied. Implants used for breast reconstruction differ. Because of radiation and thinner breast skin after mastectomy, implants for breast reconstruction tend to have a higher percentage that requires exchanging every 10 years. I always tell patients, “If it ain’t broke, don’t fix it.” Many of the routine breast surveillance imaging techniques like a
12
mammogram, ultrasound, and MRI can easily identify a ruptured implant. If something seems abnormal, consult your Plastic Surgeon or Breast Surgeon. If a ruptured implant (gel or saline) is identified, there is no need to panic. It will cause your body no harm and can easily be replaced or removed at your convenience. So the bottom line is, with proper monitoring (self-exams, physician exams, and routine breast cancer screening), you don’t need to automatically replace your implants every 10 years.
Can fat grow back after liposuction? Liposuction is a popular procedure that instantly removes unwanted body fat in isolated areas of the body to create an improved silhouette. While there are several different liposuction techniques commonly used today, all variations focus on the goal of removing fat cells from a targeted area of the body or stubborn pockets of fat. One of the more common questions I get as a Plastic Surgeon is will the fat come back or show up somewhere else on my body. Liposuction permanently removes fat. But, it is possible for fat to return after liposuction if you gain weight following the procedure. Similar to a water balloon filled with a little water or a lot of water, we have a fixed number of fat cells that swell when filled with more lipid (gain weight) or shrink when filled with less lipid (weight loss). Even if a patient has minor weight gain after liposuction, the overall improved body shape provided by a liposuction procedure will still be visible as treated body areas have fewer fat cells compared to surrounding areas. The exception to this rule is in cases of considerable weight gain (i.e. 10% of their
body weight). In this case, new fat cells can develop in all areas of the body, including treated areas. However, since new fat cell creation typically occurs in an even manner throughout the body, fat often accumulates less in treated areas compared to untreated areas. Thus many liposuction patients who gain considerable post-procedure weight tend to still look better than if they did not undergo liposuction. These principles also apply to fat grafting procedures like the Brazilian Buttock Lift in which the body is sculpted and the buttock augmented with living fat cells. Since the fat has been more ideally distributed surgically, the results tend to grow or shrink with the patient, but in a well-proportioned manner.
Can a tummy tuck be used for weight loss? Both liposuction and tummy tuck (abdominoplasty) are frequently combined procedures, but neither is a weight loss procedure in combination or alone. These procedures are used to improve the shape and appearance of the abdomen and address issues like excess skin of the abdominal wall or stretched abdominal wall muscles (rectus diastasis) as a result of pregnancy or weight fluctuations. The amount of tissue removed averages around 4-5 pounds, often less. There is no significant research to support weight loss as a result of having a tummy tuck. Furthermore, when used for this purpose, not only are patients disappointed but they also put themselves at significant risk for complications, like wound healing issues and other adverse outcomes. Each surgeon has his or her own criteria when assessing if someone is a suitable candidate for a tummy tuck and if a surgeon suggests that it is not in your better interest, heed their advice.
Dr. Nicholas Leonardi is a dual board-certified Plastic and Reconstructive Surgeon at the Plastic Surgery Group of Memphis. His practice has a broad scope with a focus on breast and body contouring, skin cancer reconstruction, and breast reconstruction.
