Information for our Patients on BIA and ALCL

Monday, March 27th, 2017 by doctor

Information on BIA-ALCL

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare and treatable type of lymphoma that can develop around breast implants. According to the most recent data available, the risk of association between breast implants and ALCL is extremely low. A March 2015 study published in the journal Plastic and Reconstructive Surgery identified 173 individual patients presenting, via a world literature review, with BIA-ALCL since the initial case report in 1997.

Most of the patients who have developed BIA-ALCL receive an excellent prognosis following surgical removal of the breast implants and the surrounding scar tissue capsule. Continued follow-up after any breast implant surgery is suggested and important for patient health, but patients who notice pain, lumps, swelling, fluid collections or unexpected changes in breast shape, including asymmetry, should contact their plastic surgeon. In most cases, women observed changes in the look or feel of the area surrounding the implant after their initial surgical sites were fully healed.

Patients undergoing plastic surgery procedures, aesthetic or reconstructive, should be thoroughly informed of the potential risks and possible complications known to be associated with the procedure, and any device used in that procedure. In the very rare cases where a diagnosis of BIA-ALCL is made, surgical treatment is essential for the management of the disease.
ASPS/ASAPS joint advisory: FDA updates website on BIA-ALCL

The American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) would like to make members aware of a recent safety communication update to the Food and Drug Administration (FDA) website regarding breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

The March 21 website update acknowledges that while it remains difficult to determine the exact number of BIA-ALCL cases, there have now been 359 medical device reports (MDR) reported to the FDA Manufacturer and User Facility Device Experience (MAUDE) database as of Feb. 1, 2017. Of these MDRs, the FDA reports that 232 included information on the breast implant device, with 203 identified as textured, 28 smooth and one identified as “another surface.” The update also confirms that both silicone gel and saline implants have been reported in cases of BIA-ALCL.

It’s important to note that the MAUDE database may contain limited and potentially inaccurate adverse event reports, and does not represent the true number of U.S. cases, as some entries are duplicates and not all cases are confirmed as ALCL. To date, there has been no confirmed smooth surface-only case of BIA-ALCL reported. As of March 21, 2017, 126 unique confirmed U.S. cases of BIA-ALCL have been reported to the Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma Etiology and Epidemiology (PROFILE) database, a joint collaboration between ASPS, PSF, and the FDA.

The FDA’s website update confirms previous ASPS/ASAPS communications, noting that BIA-ALCL remains a rare condition that occurs most frequently in patients who have breast implants with textured surfaces. The report also reiterates that patients should discuss with their health-care provider the benefits and risks of textured-surface versus smooth-surface implants. The FDA highlights the World Health Organization recognition of BIA-ALCL, and standardized diagnosis and treatment guidelines established by the National Comprehensive Cancer Network (NCCN).

The FDA recommends that all cases of BIA-ALCL be reported to the FDA and to the PROFILE registry.

For more information on BIA-ALCL, visit plasticsurgery.org/alcl or the FDA website.

ASPS and ASAPS are committed to patient safety, advancing quality of care, and practicing medicine based upon the best available scientific evidence. We will continue to monitor and review all new information as it becomes available to keep the plastic surgery community informed.

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Male Cosmetic Surgery- Body Contouring

Monday, March 27th, 2017 by doctor

Men and Plastic Surgery
Male-Specific Considerations

Information for men contemplating plastic surgery for cosmetic reasons.
Find a Plastic Surgeon
Patient Safety
Liposuction and body contouring

The ideal male body shape is considered to be trim and athletic-looking, with broad shoulders and chest, a flat abdomen, and a narrow hip-thigh area. However, as men age, areas of fat tend to accumulate around the abdomen, the flanks (“love handles”), the breast area (a condition called gynecomastia), and along the chin and neck. Men sometimes seek liposuction to remove these fatty areas that are resistant to diet and exercise.

In many cases, liposuction alone can effectively correct these problem areas. Men retain their skin elasticity longer than women do, and the areas of fat beneath the skin tend to be firmer and more vascular than those in women. Because of these and other factors, liposuction in men is usually very effective.

Men who have some loose, hanging skin, as well as areas of excess fat, may opt for a traditional excision procedure (surgical skin removal) in addition to liposuction. An excision may also be performed on gynecomastia patients whose breast enlargement results in excess skin.

Abdomen reduction: A full abdominoplasty (or “tummy tuck”) may be chosen by men who have hanging abdominal skin (usually the result of massive weight loss), loose abdominal muscles, and/or neglected hernias. It is a major surgical procedure that removes excess fat, tightens the muscles of the abdominal wall, and trims the waistline. Men who have a full abdominoplasty are often surprised at the long recovery period. Some patients aren’t able to return to work up to 4 weeks after surgery.

Men with good skin elasticity who have only a moderate amount of excess abdominal fat may benefit from liposuction alone. Muscle-enhancing surgery: In recent years, plastic surgeons have developed ways of improving muscle contour with cosmetic implants and “sculpting” techniques.

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2016 Plastic Surgery Statistics

Thursday, March 2nd, 2017 by doctor

New Statistics Reflect the Changing Face of Plastic Surgery
American Society of Plastic Surgeons Releases Report Showing Shift in Procedures

ARLINGTON HEIGHTS, IL – New data released by the American Society of Plastic Surgeons (ASPS) show continued growth in cosmetic procedures over the last year, and a shift in the types of procedures patients have chosen since the start of the new millennium. According to the annual plastic surgery procedural statistics, there were 15.9 million surgical and minimally-invasive cosmetic procedures performed in the United States in 2015, a 2 percent increase over 2014.

Since 2000, overall procedures have risen 115 percent, but the types of procedures patients are choosing are changing.

“While more traditional facial procedures and breast augmentations are still among the most popular, we’re seeing much more diversity in the areas of the body patients are choosing to address,” said ASPS President David H. Song, MD, MBA, FACS. “Patients have more options than ever, and working closely with their surgeon, they’re able to focus on specific target areas of the body to achieve the look they desire.”
Lifts Lead the List

It used to be that the term plastic surgery was nearly synonymous with facelifts, and while they remain a popular option among patients, other types of lifts are surging.

Since 2000, ASPS statistics show considerable growth in:

Breast lifts, up 89 percent (99,614 in 2015, up from 52,836 in 2000)
Buttock lifts, up 252 percent (4,767 in 2015, up from 1,356 in 2000)
Lower body lifts, up 3,973 percent (8,431 in 2015, up from 207 in 2000)
Upper arm lifts, up 4,959 percent (17,099 in 2015, up from 338 in 2000)

Top 5 Cosmetic Surgical and Minimally-Invasive Procedures

While procedures like upper arm lifts and lower body lifts have shown substantial growth, for the first time since at least 2000, facelifts slipped out of the top 5 most-performed procedures last year, giving way to tummy tucks.

Of the 1.7 million cosmetic surgical procedures performed in 2015, the top 5 were:

Breast augmentation (279,143 procedures, down 2 percent from 2014, up 31 percent from 2000)
Liposuction (222,051 procedures, up 5% from 2014 but down 37 percent from 2000)
Nose reshaping (217,979 procedures, unchanged from 2014, down 44 percent since 2000)
Eyelid surgery (203,934 procedures, down 1 percent from 2014, down 38 percent since 2000)
Tummy tuck (127,967 procedures, up 9 percent from 2014 and 104 percent since 2000)

Among the 14.2 million cosmetic minimally-invasive procedures performed in 2015, the top 5 were:

Botulinum Toxin Type A (6.7 million procedures, up 1 percent from 2014 and 759 percent since 2000)
Soft Tissue Fillers (2.4 million procedures, up 6 percent from 2014 and 274 percent since 2000)
Chemical Peel (1.3 million procedures, up 5 percent from 2014 and 14 percent since 2000)
Laser hair removal (1.1 million procedures, unchanged from 2014, but up 52 percent since 2000)
Microdermabrasion (800,340 procedures, down 9 percent from 2014 and 8 percent since 2000)

“The number of available providers, lower costs and the less-invasive nature of these procedures obviously appeal to a much broader range of patients,” said Dr. Song. “However, we urge anyone who is considering a minimally-invasive procedure to consult with a board-certified, ASPS-member surgeon.”

Many of these minimally-invasive procedures are performed by a variety of providers, and not all of them have the expertise or rigorous training of ASPS-member surgeons. “It may not be surgery, but there is still a lot at stake,” said Dr. Song. “Before you undergo any procedure, do your homework and make sure you’re putting yourself in the hands of only the most most qualified and highly-trained expert available.”
Bottoms Up!

New ASPS stats showed that 2015 was another year of the rear, as procedures focusing on the derriere dominated surgical growth. Buttock implants were the fastest growing type of cosmetic surgery in 2015, and, overall, there was a buttock procedure every 30 minutes of every day, on average.

Here are the top procedures related to the bottom in 2015:

Buttock augmentation with fat grafting (14,705 procedures, up 28 percent from 2014 to 2015)
Buttock lift (4,767 procedures up 36 percent from 2014 to 2015)
Buttock implants (2,540 procedures up 36 percent from 2014 to 2015)

For the First Time, Men Account for More than 40 Percent of Aesthetic Breast Reduction Surgeries

There were 68,106 aesthetic breast reduction surgeries in the United States in 2015, and for the first time men accounted for more than 40 percent of those procedures.

A total of 27,456 breast reduction surgeries (Gynecomastia) were performed on men, representing a 5 percent increase over the previous year and a 35 percent growth since 2000.

“As plastic surgery is becoming more common and accepted in men, we’re seeing more of them undergo procedures to tighten and tone problem areas, like the breasts,” said Dr.Song. “This procedure is often done in younger men who face genetic challenges with the size and shape of their breasts, and when appropriate, surgery can make a big difference in their lives.”
More Breast Cancer Patients Aware of Reconstruction Options

In 2012, ASPS launched a national Breast Reconstruction Awareness Campaign to educate, engage and empower women to make informed decisions about their healthcare following breast cancer diagnosis and mastectomy. We’re happy to report that in 2015, the number of reconstruction procedures increased another 4 percent to more than 106,300, and since 2000, the numbers are up a remarkable 35 percent.

“That’s encouraging, and we hope to continue to get the word out to all women who are facing breast cancer, so they will be well aware of all their reconstructive options from the outset of diagnosis,” said Dr. Song.

Breast reconstruction may be performed using several plastic surgery techniques, depending on which is most clinically appropriate for the patient, and is important to restore the breast to near normal shape, appearance and size following a lumpectomy or mastectomy.
About the ASPS Annual Procedural Statistics

ASPS members may report procedural information through the first online national database for plastic surgery procedures, Tracking Operations and Outcome for Plastic Surgeons (TOPS). This data, combined with an annual survey sent to American Board of Medical Specialties’ certified physicians most likely to perform these procedures, results in the most comprehensive census on plastic surgery.

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