As a top female plastic surgeon in Miami, Dr. Rotemberg, understands how important every person’s decision is to choose cosmetic surgery. She encourages an open-door policy, in which all of your questions and concerns are addressed, before, the day of, and after the procedure. It is imperative that patient is aware of all their options in order to make the right decision for their body.
The FDA has identified that breast implants may be associated with a rare form of cancer called anaplastic large-cell lymphoma, believed to be associated with chronic bacterial inflammation.[69] Similar ALCL phenomena have been seen with other types of medical implants including vascular access ports, orthopedic hip implants, and jaw (TMJ) implants. As of February 1, 2017, the FDA has received a total of 359 medical device reports of breast-implant-associated ALCL (BIALCL), including 9 deaths.[70] Most cases of breast implant-associated ALCL had implants in for many years prior to the condition, and are usually treated successfully by simple removal of the implant and the capsule surrounding the implant without the need for chemotherapy if no evidence of systemic disease exists. If women with implants present with delayed swelling or fluid collection, cytologic studies and test for a marker "CD30" are suggested. The American Society of Plastic Surgery (ASPS) states, "CD30 is the main diagnostic test that must be performed on the seroma fluid as routine pathology or H&E staining can frequently miss the diagnosis." [71] Diagnosis and treatment of breast implant associated ALCL now follows standardized guidelines established by the National Comprehensive Cancer Network.[72]
The study Safety and Effectiveness of Mentor’s MemoryGel Implants at 6 Years (2009), which was a branch study of the U.S. FDA's core clinical trials for primary breast augmentation surgery patients, reported low device-rupture rates of 1.1 per cent at 6-years post-implantation.[49] The first series of MRI evaluations of the silicone breast implants with thick filler-gel reported a device-rupture rate of 1 percent, or less, at the median 6-year device-age.[50] Statistically, the manual examination (palpation) of the woman is inadequate for accurately evaluating if a breast implant has ruptured. The study, The Diagnosis of Silicone Breast implant Rupture: Clinical Findings Compared with Findings at Magnetic Resonance Imaging (2005), reported that, in asymptomatic patients, only 30 per cent of the ruptured breast implants are accurately palpated and detected by an experienced plastic surgeon, whereas MRI examinations accurately detected 86 per cent of breast implant ruptures.[51] Therefore, the U.S. FDA recommended scheduled MRI examinations, as silent-rupture screenings, beginning at the 3-year-mark post-implantation, and then every two years, thereafter.[22] Nonetheless, beyond the U.S., the medical establishments of other nations have not endorsed routine MRI screening, and, in its stead, proposed that such a radiologic examination be reserved for two purposes: (i) for the woman with a suspected breast implant rupture; and (ii) for the confirmation of mammographic and ultrasonic studies that indicate the presence of a ruptured breast implant.[52]
From your description, you seem to be a very good candidate for this new technique and should really get the look that you are desiring without implants or any unnecessary visible scars. I would recommend that you search for an ABPS board certified plastic surgeon who is also a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons in your area or an area that you would like to travel to on holiday who offers the Bellesoma technique to discuss your breast reduction and possible results.  You've provided great information - the only thing that would be more helpful in order to give you the best advice about your options would be an in-person exam.
Since the mid-1990s, the fifth generation of silicone-gel breast implant is made of a high-strength, highly cohesive silicone gel that mostly eliminates the occurrences of filler leakage (“silicone gel bleed”) and of the migration of the silicone filler from the implant pocket to elsewhere in the woman's body. These implants are commonly referred to as "gummy bear breast implants" for their firm, pliant consistency, which is similar to gummy candies. The studies Experience with Anatomical Soft Cohesive Silicone gel Prosthesis in Cosmetic and Reconstructive Breast Implant Surgery (2004) and Cohesive Silicone gel Breast Implants in Aesthetic and Reconstructive Breast Surgery (2005) reported low incidence-rates of capsular contracture and of device-shell rupture; and greater rates of improved medical-safety and technical-efficacy than that of early generation breast implant devices.[94][95][96]

In surgical practice, for the reconstruction of a breast, the tissue expander device is a temporary breast prosthesis used to form and establish an implant pocket for the future permanent breast implant. For the correction of male breast defects and deformities, the pectoral implant is the breast prosthesis used for the reconstruction and the aesthetic repair of a man's chest wall (see: gynecomastia and mastopexy).

I awoke from surgery feeling just as overwhelmed and then crying happy tears. I blame the drugs...in part, anyway. I was in the recovery room with a splint on my nose. I had to go to the bathroom, and I remember feeling sort of drunk as I walked down the hall (again, drugs). When I got to the restroom, I thought, Should I look in the mirror? I did, very quickly, and what a relief! I could see the tip of my nose, and it already looked different. I figured if the splint was any indication of my new shape, I'd be thrilled, as it resembled a very smooth ski slope.
Case 29: Major concerns for this patient were widening of the tip with a marked lack of projection which made his nose feel flat and washed out. Nostril thickness and rounding was also something he wanted addressed. In this case, irradiated donor rib cartilage was used to project and support the tip along with alar base reduction removing a significant amount of nostril flare to create a natural tip and nostril contour that is ethnically appropriate. Fat transfer to the cheeks helps to balance out his flat mid-face to strengthen the cheek contour which can be seen nicely on the profile view.
The surgical scars of a breast augmentation mammoplasty develop approximately at 6-weeks post-operative, and fade within months. Depending upon the daily-life physical activities required of the woman, the breast augmentation patient usually resumes her normal life at 1-week post-operative. Moreover, women whose breast implants were emplaced beneath the chest muscles (submuscular placement) usually have a longer, slightly more painful convalescence, because of the healing of the incisions to the chest muscles. Usually, she does not exercise or engage in strenuous physical activities for approximately 6 weeks. During the initial post-operative recovery, the woman is encouraged to regularly exercise (flex and move) her arm to alleviate pain and discomfort; if required, analgesic indwelling medication catheters can alleviate pain[80][81] Moreover, significantly improved patient recovery has resulted from refined breast-device implantation techniques (submuscular, subglandular) that allow 95 per cent of women to resume their normal lives at 24-hours post-procedure, without bandages, fluid drains, pain pumps, catheters, medical support brassières, or narcotic pain medication.[82][83][84][85]
There are a few alternatives to breast augmentation with implants. Fat grafting breast augmentation involves harvesting fat via liposuction from another area of your body and injecting it into your breasts. Fat grafting is typically used to improve the appearance of your breasts after surgery to treat breast cancer, to correct a congenital breast deformity or to even out any imperfections occurring after breast augmentation with implants, such as wrinkles or ripples. The long-term effects of fat grafting to a normal breast are not fully understood, and the degree of augmentation possible via grafting is only modest at best. For these reasons, fat grafting for cosmetic breast augmentation is still considered experimental by many plastic surgeons.
“I’ve found that sometimes MRIs are not actually very reliable. In some instances, a patient’s MRI said the silicone gel implant had ruptured, and then when I went in to operate on it, it actually hadn’t. I’ve had one or two patients where an MRI showed the implant wasn’t ruptured, but based on my clinical exam I really thought there was a concern, so I went in and it turned out it was ruptured.”

There are four general types of breast implants, defined by their filler material: saline solution, silicone gel, structured and composite filler. The saline implant has an elastomer silicone shell filled with sterile saline solution during surgery; the silicone implant has an elastomer silicone shell pre-filled with viscous silicone gel; structured implants use nested elastomer silicone shells and two saline filled lumen; and the alternative composition implants featured miscellaneous fillers, such as soy oil, polypropylene string, etc. Composite implants are typically not recommended for use anymore and, in fact, their use is banned in the United States and Europe due to associated health risks and complications.


Since the mid-1990s, the fifth generation of silicone-gel breast implant is made of a high-strength, highly cohesive silicone gel that mostly eliminates the occurrences of filler leakage (“silicone gel bleed”) and of the migration of the silicone filler from the implant pocket to elsewhere in the woman's body. These implants are commonly referred to as "gummy bear breast implants" for their firm, pliant consistency, which is similar to gummy candies. The studies Experience with Anatomical Soft Cohesive Silicone gel Prosthesis in Cosmetic and Reconstructive Breast Implant Surgery (2004) and Cohesive Silicone gel Breast Implants in Aesthetic and Reconstructive Breast Surgery (2005) reported low incidence-rates of capsular contracture and of device-shell rupture; and greater rates of improved medical-safety and technical-efficacy than that of early generation breast implant devices.[94][95][96]
It is certainly possible to lift a breast without changing the volume or removing any tissue, however, the breast will sometimes appear smaller after this procedure due to its position. It is also possible to reduce breast volume without lifting the tissue (usually via liposuction) but all reductions that are performed by making incisions will also include a lift.
When the patient is unsatisfied with the outcome of the augmentation mammoplasty; or when technical or medical complications occur; or because of the breast implants’ limited product life, it is likely she might require replacing the breast implants. Common revision surgery indications include major and minor medical complications, capsular contracture, shell rupture, and device deflation.[44] Revision incidence rates were greater for breast reconstruction patients, because of the post-mastectomy changes to the soft-tissues and to the skin envelope of the breast, and to the anatomical borders of the breast, especially in women who received adjuvant external radiation therapy.[44] Moreover, besides breast reconstruction, breast cancer patients usually undergo revision surgery of the nipple-areola complex (NAC), and symmetry procedures upon the opposite breast, to create a bust of natural appearance, size, form, and feel. Carefully matching the type and size of the breast implants to the patient's pectoral soft-tissue characteristics reduces the incidence of revision surgery. Appropriate tissue matching, implant selection, and proper implantation technique, the re-operation rate was 3 percent at the 7-year-mark, compared with the re-operation rate of 20 per cent at the 3-year-mark, as reported by the U.S. Food and Drug Administration.[64][65]

Dr. Rotemberg will not only explain to you what to expect during the recovery process, will also detail the recovery process in take home instructions for you. She wants her patients to know that recovery is not a one size fits all, and while she creates an individualized program for recovery for each patient, she knows that questions and concerns may come up during this period. She would prefer if you have any questions or concerns at any time during the recovery process that you contact her or her friendly and knowledgeable staff.
Your medical history. The most important question your doctor will ask you is about your motivation for surgery and your goals. Your doctor will also ask questions about your medical history — including a history of nasal obstruction, surgeries and any medications you take. If you have a bleeding disorder, such as hemophilia, you may not be a candidate for rhinoplasty.

A fat grafting procedure, or fat injection, transfers fat from areas in which you have excess fat, such as the outer thighs, and injects it into areas that may be lacking in volume, such as your face, hands, breasts or buttocks. This safe, long-lasting, well-tolerated procedure produces natural-looking results. Every year, thousands of people undergo successful fat grafting and are pleased with the results.
If you’re considering breast lift surgery, choosing a cosmetic surgeon is the most important decision you’ll make. When you visit potential surgeons, ask how frequently he/she performs breast lift surgery and how many total procedures that surgeon has performed. View before and after photos, not just on a surgeon’s website but also during your consultation, paying close attention to the results of patients whose breasts before surgery look similar to yours—this will help you get a feel for a cosmetic surgeon’s aesthetic style.

Potential candidates should also have adequate fat reserves for transfer. This becomes especially important when one considers the anticipated rate of fat resorption and graft loss. I typically recommened patients aim for at least 500 cc transferred per cheek. This would amount to 1 liter of fat (not lipoaspirate) after processing. Candidates with inadequate fat reserves are likely to be disappointed with their ultimate volume once healing is complete. 
Breast implants are not lifetime devices. The longer a woman has implants, the more likely it is that she will need to have surgery to remove or replace them. The most frequent complications and adverse outcomes experienced by breast implant patients include capsular contracture, reoperation, and implant removal (with or without replacement). Other common complications include implant rupture with deflation, wrinkling, asymmetry, scarring, pain, and infection. In addition, women with breast implants may have a very low but increased likelihood of being diagnosed with anaplastic large cell lymphoma (ALCL).

Before surgery, friends and family would say they didn't see anything wrong with my nose, but to have something that's so personal and integral to you feel so wrong...it's exhausting and disheartening. Now I feel not only more beautiful but way more comfortable in my own skin — just like my mom. And now those same friends see the difference and compliment me.
They are essentially very similar procedures. The difference is in the amount of breast tissue removed. In a breast lift procedure, the nipple areolar complex is lift to a better position on the breast, and some breast tissue is removed and the breast envelope tightened. In a breast reduction, the nipple areolar complex is also lifted, but much more breast tissue is removed. 
Unfortunately, as time goes on it is often difficult for patients to remember the specifics of the type of breast augmentation surgery and implants that they had.  Your are not alone!  The easiest way to determine what type of implant you had is to request a copy of the operative report from either the hospital, surgery center or your surgeon's office.  The implant specifics are recorded on this document.  Your office record also includes this information.  If it has been over ten years since your procedure, sometimes these records are no longer available.  Ultrasound or MRI can help to answer this question but it is an expensive way to solve the mystery and not an indication for these procedures.  If you registered your implants with the manufacturer at the time of surgery, the company will have a record of this information.  Fortunately, this inforation is not absoltely critical to your health unless you are having a problem with your implants.  Your surgeon can often develop a reasonable treatment plan even without this information.  I would strongly recommend that you register your implants and purchase the affordable insurance program if you have surgery again.  These programs are helpful in storing vital information regarding your implant type, size, filler, model and lot number.  Should there be a recall or long term problem requiring additional surgery, this information is readily available.  There is often also some fiancial support to offset costs.  Investigate the options available by contacting your surgeon or the implant manufacturer's websites.

They are essentially very similar procedures. The difference is in the amount of breast tissue removed. In a breast lift procedure, the nipple areolar complex is lift to a better position on the breast, and some breast tissue is removed and the breast envelope tightened. In a breast reduction, the nipple areolar complex is also lifted, but much more breast tissue is removed. 
Dr. Mess typically harvests fat from the abdomen through a tiny incision in the belly button using state-of-the-art cannulas specifically designed to create small particle size for greater accuracy and for maximal fat cell viability. If the patient does not have adequate abdominal fat she may harvest from the thighs, love handles or other sites. The fat will be placed in a centrifuge where the fat will be separated from fluids and non-essential elements. The fat will then be transferred to the recipient site using precisely placed injections on multiple plains to achieve the structure and look you desire. On the day of the procedure, donor and graft sites will be laid out and marked following the plan designed during your consultation.  Dr. Mess uses markers to map the surgery and distinguish between donor and recipient sites.
Case 39: The facial plastic surgeons at PROFILES Beverly Hills tailor every Rhinoplasty to achieve just what you are looking for. Sometimes, the most subtle of changes take just as much effort as the most dramatic ones. This pretty model didn’t want to drastically change her look. Her Los Angeles Finesse Rhinoplasty gave her the refinement she wanted, especially on her front and three-quarter views. Along with fat transfer to the lower eye area, her overall look was softened to make her that much more camera ready.
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