Dr. Larry Fan is a Harvard educated, Board Certified Plastic Surgeon in San Francisco, CA. He is a Master Artist who is known for creating beautiful, stunning, and natural results. Dr. Fan has been named One of America's Top Plastic Surgeons for the past 10 years running and has received several national awards for his work in Plastic Surgery. He has successfully performed more than 10,000 cosmetic procedures of the face, breasts, and body over a 20 year period. Dr Fan has been an invited speaker at the American Society of Plastic Surgeons and the American College of Surgeons, and has been featured in national media outlets such as CNN, NBC, and ABC.
There are two types of breast implants approved by the Food and Drug Administration (FDA): silicone-filled and saline-filled. They come in various sizes and shapes, and with two types of shells: textured shells and smooth shells. A type of silicone-filled implant with a thicker filling, called a form-stable highly cohesive implant, or "gummy bear" breast implant, is currently under investigation and may one day provide another option for women undergoing breast augmentation with implants.
“The old saline implants offered peace of mind but a less realistic result; silicone gel implants offered a more realistic look and feel but with concerns about silent rupture as well as long term safety and complications. The timing could not be better for the structured breast implant, which uniquely offers women the benefits of natural look and feel in addition to an unparalleled safety profile and peace of mind. This would be my personal choice for breast augmentation and has become the choice the majority of informed women in my practice are making for themselves.”
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.
Case 71: Tip and nostril width and overall nasal projection made the nose feel dominant for this young woman. Rhinoplasty involved making her whole nose smaller by deprojecting, refining the tip, and removing some nostril flare. At the same time, a nasal fracture and breathing concerns were addressed. Neck Liposuction also helped to define and re-balance her jawline to create the improved facial proportions that she desired.
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.
In 1988, twenty-six years after the 1962 introduction of breast implants filled with silicone gel, the U.S. Food and Drug Administration (FDA) investigated breast implant failures and the subsequent complications, and re-classified breast implant devices as Class III medical devices, and required from manufacturers the documentary data substantiating the safety and efficacy of their breast implant devices. In 1992, the FDA placed silicone-gel breast implants in moratorium in the U.S., because there was “inadequate information to demonstrate that breast implants were safe and effective”. Nonetheless, medical access to silicone-gel breast implant devices continued for clinical studies of post-mastectomy breast reconstruction, the correction of congenital deformities, and the replacement of ruptured silicone-gel implants. The FDA required from the manufacturers the clinical trial data, and permitted their providing breast implants to the breast augmentation patients for the statistical studies required by the U.S. Food and Drug Administration. In mid–1992, the FDA approved an adjunct study protocol for silicone-gel filled implants for breast reconstruction patients, and for revision-surgery patients. Also in 1992, the Dow Corning Corporation, a silicone products and breast implant manufacturer, announced the discontinuation of five implant-grade silicones, but would continue producing 45 other, medical-grade, silicone materials—three years later, in 1995, the Dow Corning Corporation went bankrupt when it faced large class action lawsuits claiming a variety of illnesses.
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.
The presence of radiologically opaque breast implants (either saline or silicone) might interfere with the radiographic sensitivity of the mammograph, that is, the image might not show any tumor(s) present. In this case, an Eklund view mammogram is required to ascertain either the presence or the absence of a cancerous tumor, wherein the breast implant is manually displaced against the chest wall and the breast is pulled forward, so that the mammograph can visualize a greater volume of the internal tissues; nonetheless, approximately one-third of the breast tissue remains inadequately visualized, resulting in an increased incidence of mammograms with false-negative results.
Recovery from fat transfer to the breast is relatively short. Patients will be advised on post-procedure bras and will have regular follow up with Dr. Mess. There will also be some recovery from the liposuction part of the transfer. In general, patients can return to normal activities in 2-3 weeks but are advised to avoid strenuous activity and any “fat burning” exercises for up to 6 weeks.
Breast reconstruction with fat grafting: If you have breast defects following lumpectomy for breast cancer, fat grafting is an effective method for filling in these defects. Fat grafting is also an option for total breast reconstruction following mastectomy; however, to achieve sufficient breast volume, this is usually a multistage process that requires at least two to four sequential fat grafting procedures.
Case 22: This young woman was happy with her profile but wanted to reduce nasal width, tip boxiness, and nostril flare on front and three-quarter views. The combination of narrowing her bridge, tip refinement, and nostril reduction helped bring her nose into balance. At the same time, fat transfer to the under eye hollows did a fantastic job of brightening her eyes and giving her a more youthful look.
The morning of surgery, I was definitely feeling nervous, but the jitters had actually set in full force the week before. I was mostly anxious about getting everything together and making sure I was as prepared as possible for the recovery period. My biggest worry was the unknown: How would I look and feel? How would others react to seeing me? And there were, of course, some second thoughts, like, Do I really need this? Is this actually going to make me happier and more self-confident? I was even feeling a little guilty about the superficial nature of the whole thing — like, a nose job is not something I truly need. But I knew if I decided, last minute, to pull the plug on the operation, I'd regret it, because I'd still be unhappy with my nose — and that realization outweighed all of my fears.
Case 16: A crooked and overprojected nose draws the eye away from other beautiful features. In this pretty young woman, you can see how rhinoplasty transforms her face. Even at this early 3-month point, we see that her nose is more feminine and no longer dominates her otherwise delicate features. And, at the same time, it is balanced and ethnically-appropriate.
Fat transfer surgery is a hot topic among today’s elite plastic surgeons. Dr. Mess researched and trained in fat transfer during her six-year residency at Georgetown University Hospital and incorporated the procedure early in her practice. She has refined her technique to offer the advantages of fat transfer to augment and reconstruct. Dr. Mess performs fat transfer to the face, breast, hands, and buttocks to add volume and fullness and restore a youthful and vigorous appearance.
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. 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. 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."  Diagnosis and treatment of breast implant associated ALCL now follows standardized guidelines established by the National Comprehensive Cancer Network.