Sunday, December 4, 2011

Breast Feeding After Breast Implants

Breast Feeding After Breast Augmentation

   There are two main types of implants being used for breast augmentationsilicone gel and saline implants.  Neither silicone gel nor saline implants interfere with breast-feeding.  Although there have been concerns about passing the silicone into breast milk during breast feeding if the implants were to rupture, studies have shown that silicone molecules are too large to pass into the milk ducts and breast gland tissue. Surprisingly, silicone levels were found to be higher in commercially available infant formulas (4402.5 ng/mL)  than those found in women with silicone breast implants (55 ng/mL).

Photograph from Alliedhealthblog

     Although there are no guarantees that one would be able to breast-feed whether you undergo breast augmentation or not, the type of incision may affect one's ability to breast-feed.  There are few choices for incision location for breast augmentation:  periareaolar incision (around the edge of the nipple), inframammary incision (incision underneath the breast), axillary incision (along the arm pit), and periumbilical (around the belly button). 
     A periareolar incision may interrupt or disturb the lactiferous/milk ducts of the breast. Previous clinical studies have shown that women who had breast surgery through a periareolar incision were five times more likely, when compared to women without breast surgery, to have insufficient milk during breast feeding.  A periareolar incision may still be used with minimal damage to the lactiferous/milk ducts depending on the technique used by your surgeon to place the breast implant.  A recent study showed that there was no difference (p>0.05) found in the breastfeeding experience between periareolar and inframammary approaches in women with hypoplastic breasts (small breasts) who underwent a breast augmentation.  This study, however, showed that the success rate of breast feeding decreases by 25% in women with hypoplastic breast who previously underwent breast augmentation. According to the study, the need to supplement breastfeeding increases by 19% in these women.

Fast Facts on Breast Feeding and Breast Surgery
  • A Brazilian study has recently shown that the probability that a woman will be able to breastfeed exclusively after breast reduction was 29%; after breast augmentation was 54%; and in women who had no breast surgery was 80%.
  • The risk of not being able to breast feed in women who had breast reduction is 5 times greater than in women who had no surgery (p=0.002).
  • The risk of not being able to breast feed in women who had breast augmentation is 2.6 times greater than in women who had no breast surgery (p=0.075).

Although the clinical evidence is not as strong for a physician analyzing this data (not a Level I evidence), there is indeed data to suggest that breast surgery, such as a breast augmentation, may affect one's ability to breastfeed.  I recommend discussing your concern and your plans to breast-feed with one of your Houston cosmetic surgeons when you decide to have a breast augmentation procedure (breast implant placement.)  The type of incision that your plastic surgeon uses may vary based on individual considerations. 

Andrade RA, et al. Breastfeeding pattern in the first month of life in women submitted to breast reduction and augmentation. Jornal de Pediatria. 2010 May-Jun;86(3):239-44
Cruz NI and Korchin. Breastfeeding after augmentation mammaplasty with saline implants. Annals of Plastic Surgery. 2010 May; 64(5):530-3
Hurst N.  Breastfeeding after breast augmentation. Journal of Human Lactation. 2003 Feb;19(1):70-1
Semple JL, Lugowski SJ, Baines CJ, et al. Breast milk contamination and silicone implants: preliminary results using silicon as a proxy measurement for silicone. Plast Reconstr Surg. 1998 Aug;102(2):528-533.

Date Article Updated: 6/1/2011

Friday, November 18, 2011

Breast Lift with Breast Augmentation

Although many women who wanted to have their breasts enlarged prefer larger breasts with minimal scarring, some women want a combination of both a breast lift (mastopexy) and breast augmentation.  For the woman seeking a breast augmentation, often the surgical decision process is more complex.  Your plastic surgeon will evaluate you whether a breast lift  may be necessary or not.  If one would need a mastopexy, the degree of ptosis (sagging of the breasts) will determine what kind of breast lift procedure would be necessary.   The kind of mastopexy procedure would affect the degree and extent of scarring one would have.  
Another question one should ask would be "when should the breast lift be performed?" Should it be performed before or after you undergo breast augmentation?   These are questions that one should ask your plastic surgeon before you undergo your breast surgery.
Red Brassiere (Courtesy of Wikimedia Commons)

Fast Facts about Breast Lift with Breast Augmentation
  • The complication rate of primary breast augmentation (1st time one is having breast augmentation) is approximately 1.7% over a three-year period (Scott Spear's study).
  • The complication rate of a revision or re-do breast augmentation is ~ 21.6%.
  • The complication rate of a simultaneous primary breast augmentation with mastopexy (1st time of having breast implant surgery with a breast lift performed at the same time) is approximately 17.4% over a three-year period (Scott Spear's study).
  • The complication rate of a revision breast augmentation with a breast lift is ~ 23.3%.
  • Simultaneous breast augmentation/mastopexy (breast augmentation & breast lift done at the same time) has an early revision rate (need to revise the surgery) of approximately 8% in one study. 

Potential Complications of a Breast Lift
  • Wound separation/dehiscence
  • Partial or total nipple loss
  • Need for further surgery (Revision)
  • Undesirable/unattractive scarring
  • Inadequate ptosis correction (correction of sagging of the breasts) and recurrent ptosis
  • Breast asymmetry and malposition of the nipple
  • Loss of nipple sensibility
  • Infection

Even though a simultaneous breast augmentation/breast lift procedure is an elective operation, this procedure carries a risk that is higher than a simple breast augmentation.  Moreover, the risk and type of complications may vary based on the type of mastopexy technique used and performed concurrently with the breast augmentation.  Being aware and informed about these potential complications are critical before undergoing this kind of procedure.  Your plastic surgeon will determine if you are a good candidate for a simultaneous breast augmentation/mastopexy since not everyone is a candidate to have these procedures done at the same time.

    Emmanuel De La Cruz M.D.
    Houston Plastic Surgeon

    Atlanta Breast Symposium 2011
    Rancati, et al. Simultaneous augmentation and periareolar mastopexy: selecting the correct implant. Aesthetic Plast Surg. 2010 Feb;34(1):33-9;
    Spear et al. Augmentation/Mastopexy: A 3-Year Review of a Single Surgeon’s Practice.  Plast. Reconstr. Surg. 118 (Suppl.): 136S, 2006
    Spear, Scott. Augmentation/Mastopexy: Surgeon Beware. Plast. Reconstr. Surg. 118 (Suppl.): 136S, 2006

    Date updated: 2/10/2011

    Monday, November 7, 2011

    BOTOX Injection for the Wrinkles Around Your Eyes (Crow’s Feet)

    BOTOX Injection for the Wrinkles Around Your Eyes (Crow’s Feet)
    Fast Facts about Botox Treatment and Crow's Feet

    • Wrinkles around your eyes that are present in motion only are ideal for treatment with BOTOX.
    • If your Crow's feet (wrinkles around your eyes) are present at rest, they may not eliminated with a BOTOX injection.   
    • If your Crow’s feet wrinkles extend toward your cheekbone, and if this increases with smiling, a BOTOX treatment may cause an incongruous appearance.  This can create a “Mickey Mouse” appearance in which one may have a flat area around the eyes that is surrounded by extended lines around the mouth.
    Hooding of the Side of the Brows (Lateral Brows)

    Hooding of the Lateral Brows

    •  If you have hooding of lateral brows which is usually from the loss of tone and descension of the lateral brow, the wrinkle under the hood will likely remain after a BOTOX injection treatment. 
    • Other plastic surgery procedures, such as endoscopic brow lift or Laser resurfacing may be needed, and BOTOX may likely not remove this particular rhytid (wrinkle).
    I recommend asking one of your Woodlands plastic surgeons if you are a good candidate for BOTOX treatment for your Crow's feet.  Being an informed patient is critical prior to undergoing any treatment, even a minor procedure such as BOTOX.

    Emmanuel De La Cruz M.D.

    P.S.  Feel free to read more about BOTOX.  

    Other articles related to BOTOX
    1) The Truth About Botox
    3) BOTOX treatment for your Glabellar Frowns (Wrinkles in Between your Brows)

    Thursday, October 27, 2011

    Exercise after Breast Augmentation

    Exercise after Breast Augmentation

    There has been several athletic women who undergo breast augmentation, and one of the important questions they typically ask is "when can I go back to the gym and exercise?"  One of the key elements is that one must not exercise immediately after any type of procedure, including breast augmentation.  

    To understand why one would be careful when it comes to working out a few weeks after surgery, one should understand how the body would heal after surgery.

    Photograph Courtesy of

    Fast Facts about Wound Healing & Breast Augmentation
    • Maximum tensile strength of a wound is achieved after approximately 3 months.
    • Around 3 months, the strength of the wound is approximately 90-95% of the original strength of the wound.
    Pectoralis Muscle (Chest wall muscle) Strength after a Breast Implant
      • For implants placed underneath the muscle, especially total submuscular placement such as found in breast reconstruction for breast cancer patients, it was found that there was a decrease in torque strength of the pectoralis muscle by 20.1% after surgery.

    Exercise Recommendations

    3rd Week
    • Stationary bike is appropriate, except for the Spinning Stationary bike.
    • Minimize any activities that would involve bouncing. 
    4th Week
    • Stair stepper would be appropriate since there's minimal "bouncing" involved.
    • I don't recommend an elliptical machine at this time since some athletic women could be aggressive with this exercise.
    • One can start leg, thigh and buttock exercises.
    • For the first 8 weeks, no upper body weight lifting at all.  I recommend to only work out the lower extremity.
    • Working out should be every other day if you're an avid athlete to avoid injury and fatigue.
    6th Week
    • The tensile strength of the wound is approximately 60%. 
      8th Week
      • At this time, the tensile strength of the wound from surgery would be approximately 70 to 80%.
      • I would continue using the stair stepper and still avoid running aggressively that would involve a lot of bouncing.  
      • The elliptical machine can be started as long as there's minimal "bouncing" action.  I would stress a forward gliding motion on the elliptical instead of vertical bouncing (more resistance can aid with this).   If one start having pain over the chest, I recommend to stop doing this particular exercise. 
      • After eight weeks you can start biceps and triceps exercises with light weights and low repetitions (slowly incorporating these into the workout so as to not injure the weak and healing area.)
      12th Week
      • The tensile strength of the wound is approximately 90-95% at this time.
      • You can slowly start running on the threadmill.
      • At 12 weeks you can start a regular workout routine, BUT TAKE IT SLOW.   We recommend 35-50% of the weight and reps you were using for upper extremity prior to surgery.

        Signs that You Have Workout Too Much
        • According to some of my athletic patients who have worked out beyond their limits after surgery, one of the signs that you have "worked out too much" is the "feeling of soreness & hardness above the incision." 
        • Pain or soreness over the breast/chest area
        • Worst scenario:  wound breakdown and implant extrusion.
        Potential Consequences if One Works Out Beyond Their Limits after a Breast Augmentation
        • Bottoming out and sagging of the augmented breast.
        • Early wound complications, such as wound breakdown (can occur during the first several days after surgery.)
        • Implant extrusion (implant exposure) which is a surgical indication to remove the implant and replace it with a new one.
        • Re-do surgery may need to be done.  Without a cosmetic insurance, this can be very costly!
        Resuming exercise after breast augmentation can be particularly challenging.  One should ask your plastic surgeon for any advice regarding their exercise protocol after a breast enhancement procedure.  If one experiences pain after a particular exercise activity, I recommend to stop performing that certain activity and resume 1-2 weeks later. 

        Emmanuel De La Cruz MD, PLLC
        Houston Breast Augmentation

        Brooke Dickinson, DC
        Former College Football Exercise Trainer

        Anglin C, Wyss UP. Arm motion and load analysis of sit-to-stand, stand-to-sit, cane walking and lifting. Clin Biomech (Bristol, Avon). 2000 Jul;15(6):441-8.
        de Haan A, Toor A, Hage JJ, et al. Function of the pectoralis major muscle after combined skin-sparing mastectomy and immediate reconstruction by subpectoral implantation of a prosthesis. Ann Plast Surg. 2007 Dec;59(6):605-10.

        Monaco JL, Lawrence WT. Acute wound healing: an overview. Clin Plast Surg. 2003;30:1-12.

        Wednesday, October 19, 2011

        Saturday, October 15, 2011

        Mesotherapy and Liposuction

        Mesotherapy versus Liposuction

        What is Mesotherapy?
        • Mesotherapy involves the injection of medications into the skin and is used as an alternative to liposuction.
        • Currently, mesotherapy is NOT an effective alternative to liposuction when it comes to reduction of fat in the body.
        • Mesotherapy is NOT approved by the US Food & Drug Administration (FDA)
        • In mesotherapy, a variety of medications are injected into the skin mesoderm, which is the layer of fat and connective tissue underneath the skin.
        • The most common medications injected utilized for lipolysis are phosphatidylcholine and isoproterenol.
        • Currently, there are no clinical reports demonstrating the effectiveness of mesotherapy in body contouring.
        Emmanuel De La Cruz MD, PLLC

        Park et al.  Effectiveness of mesotherapy on body contouring. Plastic Reconstructive Surgery. 2008 April; 121(4):179e-185 e
        US Food & Drug Administration (FDA)
        Before and after liposuction

        Wednesday, October 5, 2011

        Pippa Butt Lift

        Pippa Butt Lift

        Emmanuel De La Cruz MD, PLLC
        Houston Brazilian Butt Lift

        Monday, September 26, 2011

        Smile Train Cambodia & China

        Smile of the Month:  Cambodia & China

        Lets help support Smile Train & Operation Smile.

        Emmanuel De La Cruz MD, PLLC
        Houston Plastic Surgeon

        Wednesday, September 21, 2011

        The Woodlands Plastic Surgeon

        My Secret Wives

        Like playing the piano, there are two sub-specialties of Plastic surgery that I am passionate about: Aesthetic (Cosmetic) Surgery and Hand Surgery.  Mastering the smallest detail in anatomy is one aspect that I love about Aesthetic and Hand Surgery.  The meticulous dissection required in a facelift,  rhinoplasty and peripheral nerve surgery is exciting as it is related to the mastery of anatomy and innovative plastic surgical techniques.  The finesse and creativity involved in both cosmetic and hand surgery, such as creating a new thumb or making someone look 20 years younger, are exhilarating.  So what is my secret?  Hand and Aesthetic Surgery are my secret wives.  


        Alaskan fisherman who had an amputation of his thumb from a work-related injury.
        New thumb that Joel Solomon M.D. and I reconstructed using thepatient's toe.

        Emmanuel De La Cruz M.D.

        Friday, August 26, 2011

        Longer Eyelashes with Latisse? Is It Safe during Pregnancy?

        Longer Eyelashes with Latisse?  Is It Safe during Pregnancy?

        Longer eyelashes have been the universal symbol of beauty, especially since a woman's eyes greatly affects her whole appearance.  Thicker and longer eyelashes enhance one's beauty, and it's no secret that men find women's eyes as one of the most important features of a beautiful face.  Some women would take bold steps to acquire that beautiful, luscious long eye lashes no matter how uncomfortable they may be whether it involves placement of fake eyelashes or application of eyelash extensions.

        Longer Eyelashes (Photograph Courtesy of Wikimedia Commons)

        What is Latisse?
        Latisse, a prostaglandin analog, was previously used as an eyedrop to treat glaucoma.  The patients being treated for glaucoma with Latisse were found to have thicker and longer eyelashes.   After this discovery, several cosmetic companies started adding this prostaglandin analog to their mascaras illegally and touted them as eyelash-lengthening products.  The FDA subsequently banned these companies from the illicit use of this prescription medication in cosmetic products.   Allergan, the maker of BOTOX, received FDA approval in 2009 to manufacture Latisse as prescription medication to lengthen eyelashes.

        Is Latisse Effective in Lengthening your Eyelashes?
        • Clinical studies have shown that after 16 weeks of use, there's a 25% increase in eyelash length, and 106% increase in lash fullness.
        • Improvement of eyelash length can be seen as early as 8 weeks, and may continue to improve up to 16 weeks.
        Is it Safe to Use Latisse?
        • It's safe to use Latisse but there are precautions that need to be taken.
        • Latisse cannot be use when one is wearing their contact lens since one of the ingredients in Latisse (benzalkonium chloride, a preservative) may be absorbed into the contact lens.
        • Patients with glaucoma who are already undergoing prostaglandin analog treatment should take extra precaution since Latisse may bring their "eye pressure down" lower.
        Is Latisse Safe During Pregnancy?
        • The use of Latisse has not been tested during pregnancy.
        • Animal studies have shown an increase in miscarriage if taken in higher doses.  
        • Studies have also shown that bimatoprost (Latisse) was also detectable in breast milk.
        • Thus, Latisse is not recommended during pregnancy and after pregnancy when one is still breast feeding. 
        Side Effects of Latisse
        • Increased brown coloration of the iris of the eye may occur, especially in patients with hazel eyes.
        • Mild itching of the eyes
        • Redness of the eyelids
        • Bloodshot eyes
        • Brown discloration of the skin where the Latisse is applied.

        Emmanuel De La Cruz M.D., PLLC
        The Woodlands Plastic Surgeon

        Tuesday, August 16, 2011

        Breast Implant Placement: Above or Below the Muscle?

        Where Should One Place their Breast Implants? Above or Under the Muscle?
        Implant Pocket Selection

        One of the most important decisions prior to a breast augmentation procedure is the selection of the breast implant pocket.  The clinical manifestations of this may not be apparent for several years since the effects of the implant on your breast tissue may occur gradually.   Sagging of the breast may inexorably worsen, especially after giving birth and with aging.

        Different Breast Implant Pocket Selections

        • Total Submuscular (behind the serratus and pectoralis muscles of the chest)
        • Partial Submuscular (behind the pectoralis muscle of the chest with its origin from the ribs left intact)
        • Subglandular (above the pectoralis muscle of the chest)
        • Dual Plane (partial submuscular and partial subglandular/submammary)

        Total Submuscular

        • Mostly a reconstructive technique
        • Less commonly performed for a breast augmentation
        • More painful
        • More bloody due to the dissection during surgery
        • The breast implant may have a tendency to rise superiorly
        Submuscular Placement of a Breast Implant (Courtesy of Wikimedia Commons & Inamed)
        Partial Submuscular (Under the Muscle)

        • Breast animation and distortion may occur when the pectoral muscles contract.
        • Lower incidence of capsular contracture.
        • Risk of double-bubble deformity of the breast.
        • More painful than a subglandular breast implant placement.
        • Decreased risk of the palpability of the implant edges 
        • Decreased risk of rippling
        • It allows for better view during mammography.
        • It's associated with a longer period of recovery, and more post-operative discomfort. 

        Subglandular (Over the Muscle)
        Subglandular Placement of Breast Implant (Courtesy of Wikimedia Commons & Inamed)

        • Usually reserved for patients who have a substantial breast tissue or mild degree of ptosis (sagging of the breast.)
        • May be the ideal choice for patients who are avid bodybuilders.
        • The benefits of this position is the anatomic placement of the breast implant that is not affected by contraction of your chest wall muscles.
        • A more natural appearance results with the placement of the implant subglandularly.
        • There may be an increased risk for capsular contracture
        • Implant palpability may occur when the soft tissues are very thin.  Thus, it is very important that the plastic surgeon assess the soft tissue of the breast before deciding to place the implant subglandularly.
        • Faster recovery
        • The cleavage is narrower with this technique.
        • Larger implants may be able to be placed above the muscle.
        • There’s a reduced tendency for the breast implant to ride high, and higher risk of seeing ripples (especially with saline breast implants.)

        Dual-Plane Placement
        Dual Plane Technique (Courtesy of Wikimedia Commons & Inamed)

        • The breast implant is partially covered by the chest wall muscle.
        • It allows for a more natural appearance while keeping the benefits of having the muscle cover the implant.
        • The implant is less palpable and less rippling is observed.
        • Pectoral muscle contraction may still occur with the dual-plane placement of the implant.
        • There’s also a reduced tendency for the breast implant to ride high, as well as reduced tendency for the implant to lateralize.
        • This technique has the benefits of both the subglandular and partial submuscular breast implant placement.
        • The technique is more complicated than the subglandular and submuscular implant placement. 

        Being a fully informed patient prior to your breast augmentation procedure is critical.  Learning the advantages and disadvantages of the techniques for breast implant placement are important, and this should be discussed with your plastic surgeon. 

          Houston Breast Augmentation

          Sherrel Aston's Aesthetic Plastic Surgery 2009.
          Hidalgo DA.  Breast Augmentation: Choosing the optimal incision, implant, and pocket plane.  Plastic & Reconstructive Surgery. 2000; 105 (6): 2202-2216
          Takayanagi, et al.  Where should the implant be placed? Aesthetic Plastic Surgery. 2004; 28:83-88
          Tebbetts JB.  Dual plane breast augmentation:  Optimizing implant soft tissue relationships in a wide range of breast types. Plastic Reconstructive Surgery. 2001; 107 (5): 1255-1272

          Saturday, August 13, 2011

          Smile of the Month ~ Ethiopia

          Smile Train & Operation Smile of the Month
          Thousands of volunteers around the world donate their time and skill to help these children with cleft lip and/or palate.  Operation Smile and Smile Train have helped over two hundred thousand children all over the world.  These non-profit organization have trained medical professionals around the world enabling them to treat these children with cleft deformities in their own countries.  Lets help support Smile Train and Operation Smile.


          Emmanuel De La Cruz M.D., PLLC

          Saturday, August 6, 2011

          Teen World 2012 ~ Gabriele Marinho ( Miss Brazil )

          Congratulations to Miss Brazil !!! 2012 Teen World!
          As with the other judges, we are very proud of all the contestants of the Teen World Competition.

          Miss Brazil, Gabriele Marinho. Teen World 2012

          Emmanuel De La Cruz MD, PLLC

          Sunday, July 31, 2011

          How to Choose a Breast Implant Size?

          What is the Right Breast Implant Size for You?
          When choosing the appropriate breast implant size, it is important to balance your own desires with that of your tissue and body characteristics.   Often, the desired breast implant size is simplified into a bra cup size or volume by both you and your plastic surgeon, and this should be avoided.   An overzealous attempt to achieve the desired cup size or volume without regard to the characteristics of your tissue can lead to an unnatural result that may leave one unsatisfied with your breast augmentation.
          Amanda Seyfried (Photgraph Courtesy of Wikimedia Commons & Daniel Åhs Karlsson)

          Breast Asymmetry
          A majority of women would have some sort of breast asymmetry, which could either be the size of one’s breast, the nipple location or the size of the nipple-areolar complex.  After a breast augmentation, this asymmetry will become more prominent and more noticeable.  Thus, one should be aware of this prior to a breast augmentation.
          Can the Asymmetry be Corrected or Minimized?
          Your plastic surgeon will determine if one would need a much larger breast implant on one side of your breast to minimize the size discrepancy of one’s breasts. One may need a larger implant on the smaller breast as compared to the other.  This is determined by your plastic surgeon before and also during your plastic surgery.  Your plastic surgeon may use a “sizer”, which could be an implant series of different sizes or an inflatable breast implant that is inflated with saline or air during your surgery to determine the right breast implant size.  This enables your plastic surgeon to minimize the breast size discrepancy  that one previously have by being able to choose the right breast implant before finally placing them during surgery .
          Choosing the Correct Breast Implant Size
          The desired breast size is determined by multiple factors, such as desired breast size of the patient, breast measurements, and the characteristics of one’s breast and chest wall.  The breast width is one such measurement that a plastic surgeon utilizes to determine the correct implant size.  The selection of the implant is combined with your desired projection which allows your plastic surgeon to choose the appropriate size of breast implant.  Using implant and breast dimensions rather than the desired volume will yield for a more natural result. 

          Friday, July 29, 2011

          Breast Augmentation ~ Houston | The Woodlands

          TOP 5 Things to Know Before Getting a Breast Augmentation

          Breast augmentation (breast enlargement) is one of the most common cosmetic procedures performed in the United States. Most patients who undergo a breast augmentation are very satisfied with their results. However, being an informed patient is critical prior to having any surgery. The following facts are important information that all patients should know before having a breast augmentation.
          (Courtesy of Wikimedia Commons & Studio Harcourt Paris)

          1)Implant lifespan:  Like any other medical device, breast implants can not be guaranteed to last an entire lifetime. Any patient who undergoes breast augmentation should know that at some point in their life, the implants will most likely need to be replaced. This would require further surgery.

          2)Need for further surgery:  A recent clinical study had shown that up to 25% of women who had a breast implant may need further surgery within 5 years of the initial surgery.  Another study showed that about 1 in 8 women who received breast implants for augmentation needed another surgery within 5 years.  One should note that the surgical revision rate among different studies, however, varies which ranges from 8% to 25%. 

          The need for revision breast augmentation may be due to several reasons.  The most common reason according to a recent study at UCLA was malposition (62%) followed by capsular contracture (hardening of the implant due to surrounding tissues.)  However, a different study showed that the most common indication for revision breast surgery was patient desire for implant size change followed by capsular contracture.  Other reasons for revision breast augmentation include: drooping of the breast, change in breast shape or volume from aging or pregnancy, implant rupture (0.5% at 3 years), and unwanted implant movement.  Regardless of the difference of results from clinical studies, most women with breast implants will most likely need to have further surgery at some point during their lives. 
          Kim Kardashian (Courtesy of Wikimedia Commons &
          3)MRI and Implant Rupture:  MRI (Magnetic Resonance Imaging) is the study of choice for women with silicone gel breast implants and a history of cancer.  The US Food & Drug Administration recommended regular MRI screening for silicone implant rupture three (3) years after a silicone gel breast augmentation.  The FDA also recommended to repeat the MRI every 2 years subsequent to the initial MRI of the breast.  The evidence for this, however, is lacking.  It is unclear whether the benefits of obtaining an MRI outweigh the risks and potential costs for the patient.  I recommend a shared medical decision making with your plastic surgeon regarding this issue.

          4)Breast feeding: Although the ability to breast feed is not guaranteed whether one would have breast augmentation or not, the ability to breast feed may be affected depending on the surgical technique used for breast augmentation . The periareolar incision (nipple approach) may disturb the milk/lactiferous ducts of the breast which may lead to problems with breast feeding.  You should express your concern to your plastic surgeon prior to any breast surgery if you have plans of breast feeding in the future.

          5)Alteration of Nipple and Breast Sensation:  The feeling in your nipple and breast may change following breast implant surgery.  The sensation may increase or decrease after a breast implant is placed.  This can range from intense sensitivity or pain, to no feeling at all.  Note that these changes may be temporary or permanent, and may affect ones ability to nurse a baby as well as your sexual response.

          Making an informed decision about your surgery is a critical aspect of being happy and satisfied with the results of your breast augmentation.   No article can substitute the valuable information you will receive during your consultation with your plastic surgeon.  I recommend asking one of your Houston plastic surgeons any questions or concerns regarding your surgery prior to undergoing any procedure.

          Emmanuel De La Cruz M.D.
          Houston Breast Augmentation


          Please take the poll after reading this blog article.  Thank you.

          Monday, July 25, 2011

          Asian Eyelid Surgery ~ Houston

          Asian Eyelid Surgery:  Westernization of the Asian Eyelid?

          Beauty has been shaped to a Eurocentric point of view when it comes to the Asian eyelid.  To create that Asian eyelid crease, tape or glue has been used by many Asian women who desire that upper eyelid crease.  There is indeed an obvious influence of the Western culture over several Asian countries, and the overtones of cultural rejection still exist when it comes to discussing Asian blepharoplasty.  But do these women really desire to have a more Occidental look?  In fact, in Asian women who were born without a crease who later desired to have double eyelid surgery, very few sought to look Western.  Interestingly, the double eyelid surgery was first described in the Japanese medical literature in the 1800s long before the Westernization of Japan.  
          Asian with an Upper Eyelid Crease (Courtesy of

          Fast Facts about The Creaseless Eyelid
          • Approximately half of the Asian population of Chinese descent possess an upper eyelid crease.  
          • Approximately 1/3 of Asians of Korean descent possess an upper eyelid crease.
          • 10% of Asians from the Far East or South East Asia show a natural eyelid crease on one of their eyelids, and the other eyelid creaseless.
          • Some native North & South American lineage possess traits designated to be "Asian." These native Americans may have the heavier "creaseless" upper Asian eyelid and an inner epicanthal fold (a skin fold of the upper eyelid  overlapping the corner of the eye near the nose.) 
          The Beautiful Eyelid 

          Although the standards of physical beauty may be variable across cultures, the qualities of what constitutes beautiful, especially the upper eyelid, transcends racial boundaries.  Large eyes, a well-defined nose and a smaller chin are standards of beauty in women of various cultures.  An upper eyelid is  considered attractive when it lacks excessive skin and fat.  The presence of an upper eyelid crease is also considered beautiful since it creates the illusion of making the eye appear bigger, which is a universal sign of youth.    This upper eyelid crease also serves as a platform of exposed skin for a more effective application of makeup.

          The Epicanthal Fold

          The epicanthal fold is the skin fold of the upper eyelid that overlaps the nasal corner of the eye.  In the Asian population, it is present in approximately 40 to 90%, depending on the region in Asia or the study one would read.  There have been numerous procedures developed and described in the medical literature to eliminate the epicanthal fold.  However, most procedures are flawed by creating an unsightly scar in the area of the eye near the nose.  

          The Goals of the Double Lid Surgery for the Plastic Surgeon
          • To maintain the natural beauty of the opening of the eye (palpebral fissure).  Being overly aggressive with making the Asian eye appear Western would be a mistake since the new crease that will be created will appear unnatural and look "surgical."
          • To improve the beauty of the eyes by giving an illusion of a larger, more open eye.

            Fast facts about the double eyelid procedure (Excerpt taken from Dr. Magana's article)
            • The prominence of the epicanthal fold is decreased by doing local flaps
            • A lid fold is created by applying parallel sutures that create a new crease which is parallel to the edge of the eye lid
            • In expert hands the procedure takes around an hour
            • There is a "non-incisional" method for Durable Suture Technique (DST). Long term follow up results on this  technique are not yet available.

            Potential complications:
            Before one undergoes any procedure, one should be informed about its potential complications.  It is not uncommon that one would have some asymmetry of the upper lid crease (1-2mm difference) that is created after an Asian double lid surgery.  Scarring may occur as well as disappearance of the upper lid fold.  Moreover, blindness after an eyelid surgery is a very rare complication (1 in 30,000 patients).  Severe pain and a pressure sensation on the eye are common symptoms for an impending visual loss after a blepharoplasty procedure, and one should be aware of these symptoms so that immediate evaluation and treatment can be performed by your plastic surgeon. 


            Emmanuel De La Cruz M.D., PLLC

            Recommended reading:

            Kruavit, Arthi.  Asian Blepharoplasty: An 18 Year Experience in 6215 Patients.  Aesthetic Surgery Journal.  2009; 29; 272
            Mejia, Ergo and Foad Nahai. Visual Loss After Blepharoplasty: Incidence, Management, and Preventive Measures.  Aesthetic Surgery Journal.  January 2011;31(1): 21-29  
            Meronk, Frank. Double eyelid surgery for the Asian eye.
            Park, Jung. Modified Z-epicanthoplasty in the Asian Patient.  Archives of Facial Plastic Surgery. 2000; 2 (1):43-47.

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