WHAT IS IMPLANT BASED BREAST RECONSTRUCTION?

As most people have heard by now, actress, Angelina Jolie reveled recently that she has made the difficult decision to undergo a bilateral nipple sparing mastectomy after finding out that she was positive for the BRCA1 (breast cancer) gene. Angelina disclosed her decision along with a brief account of what the road to reconstruction consisted of for her through an op-ed in the New York Times. Her decision to not only go through these procedures, but to share her experience with the world is courageous and  inspiring to women around the world.

Breast Reconstruction Awareness is on the rise with help from the Plastic Surgery community and ASPS naming a national BRA (Breast Reconstruction Awareness) Day in October, as well as actresses or other people in the spotlight coming out about their experience with either breast cancer or as in Angelina's case, a genetic susceptibility towards breast cancer. With these stories being out there for every day women to read, it opens up the opportunity for them to seek further information. Women who have a family history of breast or ovarian cancer may be more likely to ask their Doctor about BRCA testing and women who are deciding whether or not to undergo prophylactic mastectomy with breast reconstruction may feel empowered and inspired to make that decision after hearing another woman's story.

Angelina opted for an implant based approach to reconstruction which is becoming more and more popular and is quite appealing to most women as it usually means less time in the hospital after surgery and an easier road to recovery. The process of this reconstruction starts at the day of the mastectomy. Most mastectomy's these days are skin sparing, meaning the breast surgeon takes all of the breast tissue along with the nipple areolar complex, but leaves the skin envelope. Angelina Jolie actually had a nipple sparing mastectomy, meaning all of the breast tissue was removed, but the skin and nipple areolar complex was left intact. This may be an option for some women depending what type of breast cancer they have or if they are having prophylactic mastectomies. This is something that should be decided with the breast surgeon. As the skin envelope is left with either type of mastectomy it is easy to fill this up with either a tissue expander or implant immediately after the breast surgeon has finished their part of the surgery. Most commonly tissue expanders as used so that the skin and muscle can be gradually expanded. Tissue expanders are implants that have a metal port so that they can be gradually filled with saline, both in the operating room and in the office after everything has healed. These are placed under the pectoralis muscle as illustrated in the picture below.

Once the tissue expanders are filled to the appropriate size they can then be exchanged for an implant of the same size. This usually happens approximately 3 months after the initial surgery. With the availability of devices such as shaped silicone implants as shown in the picture below, plastic surgeons are able to create a very natural and real looking reconstructed breast.

Dr. Brooks was asked recently to talk about what a Double Mastectomy with reconstruction is, check out this video of his appearance on Mass Appeal regarding this subject!

What is a double mastectomy?

WHAT'S THE RIGHT AGE TO START ANTI-AGING?

Anti-aging treatments start a lot younger than we think! Good parents start their children on an "anti-aging" regime the very first year of their life by making sure their kids are always smothered in sunscreen! People who then avoid the sun or wear sunscreen religiously and avoid things like smoking and a poor diet end up with much smoother, tighter, younger looking skin when they reach their 40s than those on the other end of things. So, anti-aging isn't just about treatments it's about PREVENTION! If you never form those wrinkles than you won't have to do those things to get rid of them! Or more realistically (since we will all form wrinkles eventually) you will be able to get rid of them much easier! 

Patients are frequently coming to the office for a facial rejuvenation consult for either fillers or neuromodulators (botox, dysport, xeomin) and asking us, am I too young to be starting this? How old are most of your patients? Patients are frequently worried that if they start something like Botox or Juvederm early on it will somehow make things worse going forward. This could not be FURTHER from the truth! Botox and other neuromodulators can actually be a form of wrinkle prevention! Yes, they work great as a treatment for wrinkles that are already exist, but they work even better for preventing those wrinkles from ever forming. Neuromodulators work by preventing the muscles from moving, so therefore, if those muscles don't move and then the skin doesn't crunch, well, you never get those wrinkles! So, NO, starting in your 20s or 30s is not too young! 

As far as when to start an anti-aging skin care routine at home, there is no right answer. As mentioned earlier, starting with sunscreen and healthy behaviors should be a life long thing! But when to start things like retinoids and glycolic acid treatments depends a lot on each individual's skin. If you notice fine lines and wrinkles, it may be the time for you to start. Certainly if you are getting fillers or botox you should defnitely be adding in an at home anti-aging regime! If anti-aging is something that crosses your mind when examining your skin in the morning, then you are probably ready! 

For more information on what you should be doing for you skin come to the Spa on the Green for a skin-care consultation with either Jen or Heather (our lovely aestheticians). Call 413-565-2405 to make your consultation today!

THE SKINNY ON FAT GRAFTING

What is Fat Grafting?

 

Fat grafting or fat transfer consists of harvesting fat cells from one part of the body (abdomen, hips, etc) via liposuction and then injecting these fat cells into another part of the body (face, buttocks, hands, breasts). Fat grafting is a technique that has been around for a long time and is commonly used by most plastic surgeons in at least one or two avenues.

Fat Cells

 

What can Fat Grafting be used for?

 

 

Fat grafting can be used for both cosmetic and reconstruction surgery. We commonly use fat grafting as a means of facial rejuvenation, whether alone or in conjunction with a traditional face lift. In this way it works similarly to fillers by helping to give volume to places such as the nasolabial folds, marionette lines, cheeks and lips. Fat grafting is also used commonly to add volume to the buttocks or to help achieve the desired round shape of the buttocks. In our practice we also very commonly use fat grafting as part of our implant based breast reconstruction. We use fat to fill out the upper pole of the breast where there is naturally some concavity after a mastectomy.

 

 

 What are the risks of Fat Grafting?

 

 

Just like any other procedure that we perform, there are certain risks associated with fat grafting. Risks that exist for all of the surgeries we perform include infection, bleeding, poor scar formation, asymmetry and need for revision surgery. Specific to fat grafting, the biggest risk is that the fat may not "take". Some of the fat that is taken from one part of the body and injected into another part of the body may be absorbed by the body, may become liquified and form a cyst, may calcify or may produce scarring within the tissue. On average approximately 30-50% of the fat that is injected will "take" and be incorporated into the body as a living tissue. Usually by 6 months to 1 year from surgery it is apparent how much of the fat that was injected has survived and at this point whatever is there will most likely be permanent. Other risks include the risks associated with the harvesting of the fat such as a seroma (a collection of fluid), hematoma (a collection of blood) or a contour deformity.

There are things that can be done in order to prevent some of these complications. The most important thing you can do to decrease your risk of having a complication (and this is true of ANY cosmetic or reconstructive procedure) is to make sure that you are going to a Board Certified Plastic Surgeon for the procedure. There are many Physicians out there performing cosmetic procedures, liposuction being a very common one, who are NOT Board Certified Plastic Surgeons. In our opinion you are just asking for a complication if you do not seek out a Board Certified Plastic Surgeon to perform your surgery. To avoid some of the risks associated with liposuction your Doctor will have you wear compression to the donor area following the procedure. To ensure that as much of the fat as possible sticks around you should avoid anything that will compromise the blood supply to your newly transferred fat. This means avoid compression in this area as well as ice. For example, when a buttock augmentation is performed using fat grafting the patient must avoid sitting directly on their buttocks for 2 weeks.

 

 

What is Cytori PureGraft?

 

Dr. Brooks uses the only FDA approved fat grafting system, Cytori Puregraft®. Puregraft® is a lipofiltration system that allows for a quick preparation of fat for fat transfer in a single-use, sterile, closed environment. The Puregraft® system drains any excess tumescent fluid, (a fluid injected into the body prior to liposuction) free lipids, and blood from the lipoaspirate and then allows the lipoaspirate to be washed with saline using a sterile technique. This ensures that the fat harvested for grafting purposes is uniform and consistent and prepared in a timely fashion, helping the graft have a greater chance of being viable, i.e. more fat take.

What is the truth about Fat Grafting for Breast Augmentation?

 

Although fat grafting is widely accepted as common practice for things just as facial rejuvenation and adding volume to the buttocks, the jury is still out on using fat for primary breast augmentation, as a substitution for implants. Currently, fat grafting is used to enhance the results of breast reconstruction after mastectomy or lumpectomy and to improve the results of implants by helping to reduce rippling and wrinkling or visibility of implants. Although fat grafting may seem appealing to some patients over an implant, there are some things to consider when making the decision if it right for you. One limiting factor is the volume that can be achieved. Women can expect to achieve less than a cup size in difference with fat grafting, while implants are able to achieve much more volume. The amount achieved is also unpredictable as only 30-50% of the fat injected will establish it's own blood supply and live. The cells that do live also can fluctuate with any weight loss or weight gain causing a difference in breast size with any difference in weight, something that obviously would not happen with a silicone or saline implant. One last consideration is whether or not fat grafting could obscure the readings of future mammograms or be mistaken for early breast cancer. There is not concrete evidence to say one way or the other, but it is a potential risk. Women who have had fat grafting to their breasts or implants should always let the technician know they have had such procedures done prior to any breast studies.

How do I learn more about Fat Grafting?

 

 

If you are interested in learning more about Fat Grafting or are wondering if it is the right choice for you, call our office at 413-565-4400 or visit Our Website to book a consultation with Dr. Brooks.

Disclosure: This post is not sponsored by Cytori.

BREAST IMPLANTS: SALINE VS. SILICONE

As you may have realized from our previous post about sizing for Breast Augmentation, deciding to have a Breast Augmentation is just the beginning of a series of decisions! One of these (very important) decisions is whether to use Silicone Gel Implants or Saline Implants.

left: silicone, right: saline

The majority of our Breast Augmentation patients could go with either Silicone or Saline implants and get a desirable result, however, there are certain patients that we would recommend one vs. the other. Saline implants are more prone to rippling and wrinkling and therefore should be avoided in patients with very little breast tissue as this rippling and wrinkling could be felt and sometimes seen, especially underneath the breasts and laterally along the side of the breast closest to the underarm. Saline is also heavier than silicone and therefore causes more pull on the tissues. This can be a problem if you are going with a very large implant as it can stretch out the tissues leading to premature drooping. Patients who already have some droop of the breast may also want to avoid saline implants as to not increase their problem. The weight of Saline can also be a good thing though, specifically in patients who have tight skin and a tight pectoralis muscle. The weight of a Saline Implant in this body type helps to stretch out the tissues allowing the implant to drop into the bottom of the breast and create a natural shaped breast. Patients who are younger than 22 years old who have never had implants before must also go with a Saline Implant as indicated by law.

A question asked by all of our patients is, are Silicone Implants less safe than Saline? The answer to this is that both implants are equally as safe. Saline Implants actually do have a Silicone hard shell that is then filled with Saline, so in both Implants the Silicone hard shell is what comes in contact with your actual tissue. The issue comes in with the rupturing of the Implants. Silicone and Saline implants, will eventually rupture just as a pair of jeans you wear everyday will eventually get a few holes in the knees. The cause of a rupture is usually not traumatic, but caused simply by wear and tear of the Implant being inside your tissue. That being said, traumatic rupture can occur, particularly with a penetrating trauma. If Saline Implants rupture, the Saline, which is basically salt water will slowly leak out and your body with absorb it and you will notice within a few days that one breast is quite smaller than the other. With Silicone implants, as the Silicone these days is Semi-Cohesive, making it the consistency of jello, the shape/size of the breast will not change. The Silicone will usually create a small bubble at the rupture site and your body may even form a scar around this. Usually this silicone will stay in the pocket where the implant is. This rupture will not cause any signs or symptoms and is therefore referred to as a silent rupture. The FDA recommends that in order to check for this silent rupture patients who have Silicone implants should get an MRI to check for a rupture starting 3 years after implants are placed and continuing every 2 years after that. Unfortunately, the MRI is not covered by your insurance as Breast Augmentation is a cosmetic procedure.

At our practice the majority of our patients end up going with Silicone implants, but as mentioned above, Saline Implants definitely have their place as well! At a consultation with Dr. Brooks he will examine you in order to determine whether a Silicone Implant or a Saline Implant will give you the best result. If you are interested in learning more about Breast Augmentation surgery call the office at 413-565-4400 to make a Consultation with Dr. Brooks.

HOW TO BEAT THE SKIN WINTER TIME BLUES

Does your

SKIN

have the

Winter Time Blues?

It's February...that time of the year when Winter seems to draaag on and we wonder if the elusive sun will ever shine again, or if we will ever see those little green buds appear on the trees ensuring that spring is in fact coming. We tend to find ourselves dreaming of vacations to places looking something like this...

Not only does our head and heart seem to be effected by the dragging on of winter, but our SKIN can also get the blues! Does your skin seem to be crying out for relief from the winter time blues? While we may not be able to wish winter into exiting any faster, we can help cure those SKIN winter time blues! Three easy steps will get your skin back on track and turn that frown upside down!

1. Avoidance

 Sometimes the most important thing you can do is not something you do at all, but something you don't do! 

Avoid long hot showers- As tempting as it may be to turn that dial all the way up until the water is scalding, it is one of the worst things you can do for your skin! Those scalding temps can strip the skin of it's natural oils, leaving you feeling as dry as a desert. Stick to a warm shower instead of a hot one. If you are feeling particularly chilled to the bone and need a little thawing, look to a nice steamy bath. Add a little something extra, such as olive oil, to the water to add some of that natural moisture back into your skin. Or, try some coconut oil and drift off into that daydream again...

Avoid over-cleansing and over-exfoliating. In the summer months foaming cleansers with added exfoliants are excellent (depending on your skin type), but even the oiliest skin can get dry in the winter from over-cleansing and over-exfoliating. This doesn't mean that you necessarily must completely cut out using exfoliating products, such as ones containing Alpha Hydroxyacids, but it does mean that you may want to cool it just a little bit. Instead of using these products daily, or twice daily, try going to to every other day, or every two days. Try using a moisturizing non-foamy cleanser during the off days. This will give your skin a break and help your natural oils to replenish giving skin back some moisture! 

 

2. Moisturize Moisturize Moisturize

 

Finding a good moisturizer that you like is the number one essential step to surviving the winter. Even you oily-skinned folks out there must use a moisturizer on your skin in the winter time. The best time to apply your moisturizer is when the skin is still a little damp so that the water can really get locked-in to your skin and hydrate properly. So, apply your moisturizer right after cleansing for best results. And don't forget the rest of your skin! We focus on the face the most, but your body and especially your hands need a little attention too! Never use the same moisturizer you use on your body on your face or vice versa. The skin on your face is completely different from the skin on the rest of your body, and therefore needs to be treated differently, and with a little more attention. And obviously you don't want to waste that goodness on the rest of your body!

  

3. Protection

Last but not least, don't forget to PROTECT that skin!

Protect your skin from the SUN. Even though the sun doesn't seem to shine quite as brightly in the winter months and you aren't spending as much time basking in it, it is still very important you wear some form of sunscreen every. single. day. Even walking from your house to your car and back again exposes your skin to some rays and those rays can be damaging causing premature aging and skin cancer. We recommend using at least an SPF of 15 for the best protection. Physical sunscreen, containing ingredients such as zinc oxide and titanium dioxide are the best. At Spa on the Green we offer two options for sunscreen, Solar Defense, a physical sunscreen with an SPF of 30 or Solar Defense-E, the same sunscreen with a moisturizer added to it. 

Protect your skin from extreme cold and extreme wind. This one is kind of a no-brainer, going outside in those extreme temps, especially when the wind is howling away will only add to the problem, so avoidance is best. But, if the snow slopes are calling you, just make sure to cover up as much of that precious skin as possible to avoid the dreaded wind burn! If you hit the slopes too hard and forget your protective face mask stop by Spa on the Green to pick up some of our BrookskinMD Rosaluxe Hydrating Balm, a special moisturizer that contains Hydrocortisone for added relief. 

How to Make Rice Breast Implant Sizers

One of the most important steps in a successful Breast Augmentation is deciding on the size of the implant. This decision can be somewhat overwhelming and requires proper sizing. Sizing can be done in a variety of ways, at our office we encourage patients to do multiple forms of sizing.

Prior to surgery when patients come for their pre-operative visit we do sizing with them by having the patient bring a sheer bra in the cup size they are looking to become with a tight shirt, or even a few outfit changes with different color shirts. We then have them try on different sized silicone implants inside their bra in an attempt to mimic what they will look like after surgery. We help make sure that the size or sizes they are looking at are possible with their specific anatomy and are in proportion to the rest of their body. The final decision is made at this appointment.

Before this pre-operative visit occurs we find it very helpful to have patients do some sizing on their own at home. Sometimes the 30 minute appointment in our office is not enough time to make such a big decision, so it is very helpful if the patients comes to that appointment already knowing around what size they would like to be. At home sizing also allows the patient to spend as much time as they need wearing the sizers with multiple style tops to determine what size best suits them. Since most people don't have an array of different sized silicone implants laying around at home to try on inside their bra, the best way to get the same effect is to make sizers using rice and pantyhose- two things that most women DO have hanging around the house!

Supplies:

• Dry Rice
• Measuring Cup
• Pantyhose or Knee Highs
• Scissors

Step One:
If you are using pantyhose, cut the leg of each hose approximately half way down so that they are essentially like knee highs. If you are using knee highs, skip this step! Make sure the pantyhose you are using don't have any holes in them, or else you will end up with quite a mess!

Step Two:
Stretch the opening of the pantyhose where you will be inserting rice as to allow easy insertion of the rice.

Step Three:
Measure out the amount of rice that will be inserted into the pantyhose.

If you are using cups these are the approximate measurements to use for guidelines:
1/4 Cup = 75cc
1/2 Cup= 125cc
1 Cup= 250cc

If you are using ounces, each ounce equals approximately 30cc.

Step Four:
Insert equal amount of rice into each side of the pantyhose. Press the rice down into the toe of the panty hose and sculpt to form a round shape. Then tie off the pantyhose with a knot at the top. Cut off the excess fabric above the knot and voila, you have your sizer!

It should look something like this:

This can be worn inside a sheer cup bra or inside a sports bra. Try a few different sizes making sure to keep track of how much rice you are using and which sizes you liked the most!

HOLIDAY MAKEUP

Four looks to WOW at your Holiday Event!

THE RED LIPPED DIVA

 Picture via Pinterest

 

This looks packs a big punch without taking a lot of time and is perfect for the girl who wants to stand out at her Holiday event! And of course, the red is a great way to get in the holiday spirit! There are a variety of ways to wear this look depending on your personal preference. It can be added to a full makeup look or worn boldly alone. We recommend doing a minimal eye to draw the attention to your lips. A simple thin black eyeliner and black lash with a light to medium color eye shadow complement this look excellently. To give this look an extra oomph try a lip plumping lipstick like Jane Iredale’s Just Kissed Lip Plumper and finish with a gloss to add that kissable look!

THE GLITTER GODDESS

Picture via Pinterest

A sure fire way to get noticed at your Holiday Event is to add a little glitter! What makes a woman feel more feminine than glitter? Ummm…pretty much nothing! We love that sparkly stuff everywhere we can get it, on our clothes, on our handbags and yes, even on our faces! But to avoid being the spectacle of the party instead of the star, make sure to keep it to a minimum by choosing just one area to highlight with glitter. We recommend the eyes! Start with an eye shadow of your choice and then simply add glitter! We recommend using a cream eye shadow so the glitter will be able to stick. Jane Iredale EyeGloss is the perfect example. If you don’t want to use any eye shadow you could also use a primer mixed with a moisturizer. Or you can take your powder eye shadow and mix it with a moisturizer to make it into a cream shadow. Next add a glittery dust, we recommend Jane Iredale 24Karat Gold Dust, and voila, Glitter Goddess!

THE MINIMALIST

Picture via Pinterest

 

Remember those phrases our parents used to say, less is more and a little goes a long way? Well, those are the inspiration behind this look. This look is perfect for the girl who wants to wow at her Holiday party without being too overdone. A great way to get bright glowing skin and cover blemishes without using too much makeup is to use a BB Cream. We LOVE Jane Iredale’s Glow Time Full Coverage Mineral BB Cream. Skip the eyeliner for a truly minimal look, but make sure to add a subtle line of your eye shadow under your lower lash to draw attention to the eyes. A small dab of lighter shadow at the inside corner of your eye will open up your eye and make it pop. Always finish the eye with a curl of the eyelash and a great mascara. That is one makeup product we will never allow you to skip, no matter how minimal you are trying to go! Finish with a tinted lip gloss to complete the look.

THE CAT WOMAN

Picture via Pinterest

You can’t go wrong with the tried and true cat eye look. It adds a little glamor to any look and definitely takes your look from day to night. The cat eye is created by extending both the upper lid liner and lower lid liner to connect in a subtle winged extension from the outside corner of your eye. This look can range from tame to wild depending on the medium you choose to create it and how long the line extends. A softer look can be achieved by using a dark eyeshadow and a tapered eyeliner brush or an extreme look can be made by using a liquid eyeliner. We like this look with a soft eyeshadow such as Jane Iredale’s Wink or Nude Purepressed Eye Shadow and a hint of color on the lip such as Jane Iredale’s Erin PureMoist LipColour.

DON'T FORGET...

The first step to any good makeup is a good skincare routine. The finished piece of art can never be perfect without a good canvas to start with! So, take care of that skin! Make sure to use a good cleanser (see previous post for guide on finding your perfect cleanser) and a great moisturizer.  Moisturizer is especially important in the winter months when we all tend to get a little dry. Check out our BrookskinMD moisturizers, MoistuLuxe and NiaLuxe. For those of you feeling especially dull you may want to try a chemical peel for a quick pick me up: our BrookskinMD Quick Peel is perfect just for that and can be done on the day of your Holiday Event!

The perfect way to complete any of these looks is with a bronze glow! Since we absolutely do not approve of ANY time spent in a tanning bed we recommend a sunless tan using Tan Towels. They are easy to use and create a beautiful bronze without the streaks! Pick them up at the Spa today for 25% off!!