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A Plea to Women with Textured Breast Implants: Talk to Your Doctor Today

Note: The article below originally appeared in Cure on November 25, 2019.

As a plastic surgeon, patient safety is my top priority. I want anyone with breast implants to be aware of a recent recall linked to a rare lymphoma that may affect them.

BY VALERIE LEMAINE, MD, MPH, FRCSC

As a plastic surgeon, patient safety is my top priority. I want anyone with breast implants to be aware of a recent recall linked to a rare lymphoma that may affect them.

In July of 2019, the breast implant maker Allergan issued a textured breast implant recall following safety concerns about the implant and its link to a rare type of lymphoma. These textured implants have been linked to breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), which can develop around saline and silicone breast implants with textured surfaces.

There have been 13 deaths in the U.S. and 33 deaths worldwide linked to this lymphoma. Depending on the study or region, incident estimates range from one in 1,000 women to one in 30,000 women. This lymphoma develops anywhere between two years and 28 years after the implant surgery, with an average of eight years. 

The Food and Drug Administration is taking action. In October, it announced that surgeons should discuss the serious risks of these implants with women and that manufacturers should print bold warnings on the device packaging.

While there are many uncertainties about BIA-ALCL, we do know that the women who have developed this lymphoma exclusively had textured breast implants. It does not matter if the implants are saline or silicone; it’s all about the surface of the implant being textured. It is also important to note that it is not a cancer of the breast tissue itself.

Though this cancer is rare, it is important for women to recognize the signs. The main symptom of BIA-ALCL is a swelling of the affected breast. The swelling is caused by fluid that builds up around the implant. It is not a subtle amount of fluid; the breast will look visibly larger and it can be a drastic change. This swelling will occur relatively rapidly in a matter of days or weeks, so women should know that something is wrong. Less common symptoms include a lump in the affected breast or in the armpit, hardening of the breast, an overlying skin rash and associated pain.

To diagnose this lymphoma, the first step is usually to do an ultrasound of the breast. The treatment for this lymphoma would be to surgically remove the implant and the scar tissue around it. Typically, that is the only course of treatment needed for people who seek care in a timely manner. In cases where the disease is more advanced, additional treatment may include chemotherapy or radiation therapy.

Women who have died from this lymphoma did not seek care in a timely manner, so I urge women with textured breast implants to do regular self-breast exams and visit their plastic surgeon annually at the very least. Staying informed, in tune with your body and in touch with your doctor will give you the best chance for an early diagnosis and positive outcome.

Dr. Valerie Lemaine is a leading plastic surgeon in Minnesota. She practices with Plastic Surgery Consultants/Minnesota Oncology.

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Tummy Tuck #101: What you should know

Note: The article below originally appeared in Minnesota Spokesman Recorder.

by Valerie Lemaine, MD, MPH, FACS

Dear Dr. Lemaine, at our family picnic this past Memorial Day, my aunt announced that she was going to have “tummy tuck surgery.” What is that?

Tummy tuck surgery is a cosmetic surgery that involves removal of excess skin and fat in your abdomen, and, in most cases, tightening of weakened or separated abdominal muscles (that famous “six pack”). The medical name of the procedure is “abdominoplasty.”

After the abdomen has been stretched, it is more likely to protrude. This protrusion is caused by the loss of elasticity of the skin, excess skin, and stretching of your abdominal muscles.

With tummy tuck surgery, your abdomen will look firmer, flatter, and smoother. Tummy tuck surgery is not the same as liposuction. Liposuction removes flab or excess fat only. It does not take care of excess skin. You may choose to get liposuction along with a tummy tuck.

Who should consider surgery?

A tummy tuck is suitable for men and women who are in good health. Good candidates are those who have lost a lot of weight and still carry excess fat and loose skin around the belly. Also, women who have been pregnant may want a tummy tuck to get rid of the loose skin and to tighten their abdominal muscles.

A tummy tuck isn’t the right surgery for you if:

  • You plan to lose a lot of weight. A tummy tuck is not a substitute for weight loss and a healthy lifestyle that includes regular exercise. It should be done as a last resort after you have tried regular exercise and weight control.
  • You plan to get pregnant. It is advisable to postpone your surgery until after you’re done having children.
  • You are a smoker. Smoking increases your risk of complications and slows healing. If you smoke, your plastic surgeon will recommend that you stop smoking before your surgery and during your recovery.
  • You have major health problems. If you have health conditions, such as heart disease, irritable bowel syndrome, or diabetes, tummy tuck surgery may not be safe for you.

Also, note that health insurance generally does not cover cosmetic surgery that is performed without a medical reason.

How a tummy tuck is done

During a tummy tuck, your plastic surgeon will cut your stomach skin — from hip bone to hip bone — to remove excess skin and fat from your abdomen. If you previously had a C-section, your plastic surgeon might be able to incorporate that scar into your tummy tuck scar. If you have stretch marks below your belly button, there is a good chance that those stretch marks will be removed with surgery.

In most cases, the abdominal muscles are then tightened with sutures during surgery. The remaining skin is then repositioned to create a more toned look. Your belly button will also be moved during surgery.

After surgery, your plastic surgeon will recommend how long you will stay in the hospital. In some cases, it is possible to go home the day of surgery. You will need ice packs and to wear loose, comfortable clothing that is easy to put on and take off.

What can you expect after surgery?

Your abdomen will be swollen and tender. Your plastic surgeon will prescribe pain medication. You will also wear special dressings on your scars, and a compression garment.

You may have a surgical drain coming out of your abdomen. If your abdomen feels tight, you should sleep in a beach chair position, with pillows under your knees. You will have to limit physical activity for at least six weeks after surgery. You may need to take up to one month off work, depending on the type of work you do.

Surgery risks

In addition to the standard risks of surgery, for example, the risks associated with general anesthesia, your plastic surgeon should discuss other risks associated with tummy tuck surgery, such as:

  • Infection
  • Bleeding
  • Wound healing problems, including slow healing and loss of skin
  • Numbness
  • Fluid accumulation beneath the skin (also known as “seroma”)
  • Scarring
  • Loss or malposition of the belly button
  • Blood clots

By removing excess skin and fat, and tightening your abdominal muscles, a tummy tuck can improve the appearance of your abdomen. Results are usually long lasting as long as you maintain a stable weight after surgery.

If you are considering tummy tuck surgery to improve the appearance of your abdomen, you should meet with a skilled board-certified plastic surgeon.

Dr. Valerie Lemaine, M.D., M.P.H., is a board-certified plastic surgeon in private practice in Edina, MN. She received her M.D. from the University of Montreal, Canada, and her M.P.H. from Columbia University, NY, USA. She also completed a reconstructive microsurgical fellowship at Memorial Sloan-Kettering Cancer Center in New York City. Dr. Lemaine then accepted a staff position at the prestigious Mayo Clinic, where she taught, practiced, and published clinical research until 2018 and now has a clinical practice in Edina, MN. Dr. Lemaine can be reached at PlasticSurgeryConsultants.net.

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Breast reconstruction surgery: For some women undergoing mastectomy, it’s a great option

Note: The following article originally appeared in Minnesota Spokesman-Recorder

by Valerie Lemaine, MD, MPH, FACS

October is National Breast Cancer Awareness Month. Did you know that breast cancer is one of the most common kinds of cancer in women? Today, about one in eight women born in the United States will get breast cancer at some point in their lifetime. The good news is that if the cancer is found and treated early, most women can survive breast cancer.

But did you know that for women who need a mastectomy, breast reconstruction is an option that is covered by your health insurance provider? In the United States, there are two laws you should know about that protect you if you are considering breast reconstruction after mastectomy:

  • Women’s Health and Cancer Rights Act (WHCRA) was signed into federal law in 1998. It requires most group health insurance plans that cover mastectomies to also cover breast reconstruction.
  • Breast Cancer Patient Education Act (BCPEA) was signed in 2015. This law requires that if you are diagnosed with breast cancer, you should be informed about the availability of breast reconstruction and breast prostheses.

Breast reconstruction options

Breast reconstruction is serious surgery to rebuild your breast(s), and it should only be considered with a skilled, board-certified plastic surgeon. You need to find a plastic surgeon who makes you comfortable, who listens to you and explains the surgery in ways you can understand.

It is your right to make an appointment with another plastic surgeon to get a second opinion if you aren’t comfortable with the first one you meet. Reconstruction usually involves more than one surgery, so you want to choose a plastic surgeon you really get along with!

When is breast reconstruction done?

Breast reconstruction can be done at the same time as the mastectomy (we call this “immediate reconstruction”), or in a separate surgery done several months or even years after the mastectomy (we call this “delayed reconstruction”).

Types of breast reconstruction

There are two types of breast reconstruction surgeries you need to know about:

  1. Breast reconstruction using breast implants
  2. Breast reconstruction using your own tissue (also known as “autologous breast reconstruction” or “tissue flap reconstruction”)

Breast reconstruction with implants

If you choose implant reconstruction, your plastic surgeon may use a temporary device called a tissue expander at your first surgery. The tissue expander is used to create a breast shape under your skin or under your chest muscle, where the future permanent breast implant will go. Sometimes, the permanent breast implant can be placed at the first surgery, which means that your reconstruction can be completed in one step.

Breast reconstruction with implants usually requires less surgery than if you choose the tissue flap. The length of surgery and the amount of time you need to recover are also usually shorter with breast implants than with a tissue flap reconstruction.

Still, you may require more than one operation to build your breast(s) with implants. Also, keep in mind that you may need more surgery in the future to change your breast implants because they don’t last a lifetime.

Breast reconstruction using your own tissue

If you have a tissue flap reconstruction (also called “autologous reconstruction”), your plastic surgeon will take tissue (skin, fat and sometimes muscle) from one part of your body to build a breast shape. Most of the time, the tissue is borrowed from your belly, but it can also be taken from your buttocks, your inner thighs or your back.

Tissue flap reconstruction can be done in two ways: Sometimes, the tissue will be completely detached from your body and placed on your chest. We call this a “free flap.” Your plastic surgeon may choose to leave the tissue flap attached to your body and move it under your skin to your chest. We call this a “pedicled flap.”

To do a free flap reconstruction, your plastic surgeon needs to have trained in microsurgery, which is a specialized skill that not all plastic surgeons have. With microsurgery, your plastic surgeon will reconnect the blood vessels from the tissue flap that was detached from your body to blood vessels in your chest area, so that the tissue flap can receive blood flow and stay alive.

Because those blood vessels are pretty small, your plastic surgeon will use a microscope to reconnect the blood vessels, hence the name “microsurgery.” Because of this, free flaps are a longer and more complex surgery than pedicled flaps.

Breast reconstruction using your own tissue has one major advantage over breast implants: It usually lasts a lifetime. Also, it feels more natural than breast implants because the tissue flap is mostly made of fat, just like our breasts.

Related storyBreast reduction surgery: for some, it’s a good option with exceptional results

It is important to know that flap reconstruction involves a longer surgery, and also a longer recovery, because you are healing more than one body part at the same time: Your breast needs to heal, but so does the area where the tissue was borrowed from. Because of this, tissue flaps are not a suitable option for everyone

It’s a personal decision

Whether you were diagnosed with breast cancer, or if you are at very high risk of developing it in the future (remember Angelina Jolie’s story?), if you need a mastectomy, breast reconstruction surgery may be an option for you. Keep in mind that no matter which type of breast reconstruction you choose, there is no “one and done” option.

Rebuilding a breast often requires more than one surgery. Also, in the future your breast reconstruction may need adjustments because our bodies change over time.

Women who have had breast reconstruction report improved self-esteem and body image. Having said that, some women choose not to have breast reconstruction because they don’t want to have additional surgery.

The decision to reconstruct or not is very personal. You can’t predict how you will feel after losing a breast. Some women feel sad and anxious, while others don’t.

Talk to your doctor and request a consultation with a board-certified plastic surgeon. Many of my patients have told me that having breast reconstruction was one of their best decisions.

Dr. Valerie Lemaine, M.D., M.P.H., is a board-certified plastic surgeon in private practice in Edina, MN. She received her M.D. from University of Montreal, Canada, and her M.P.H. from Columbia University, NY, USA. She also completed a reconstructive microsurgical fellowship at Memorial Sloan-Kettering Cancer Center in New York City. Dr. Lemaine then accepted a staff position at the prestigious Mayo Clinic where she taught, practiced and published clinical research until 2018. 

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Information about textured implant and tissue expanders recall

An important message from Dr. Valerie Lemaine:

I would like to remind all of our patients who have had breast surgery with implants, either reconstructive or aesthetic – to maintain regular, yearly follow-up appointments with Dr. Valerie Lemaine.

On July 24, 2019, the implant device company Allergan issued a recall on BioCell textured implants and tissue expanders. This was done based on concerns that textured implants are associated with a very rare type of cancer called BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) that can occur in and around the tissues around a textured breast implant.

It is important to stress that BIA-ALCL is extremely rare, even if someone had a breast reconstruction or a breast augmentation with textured implants or tissue expanders. To date, 573 cases of BIA-ALCL have been described worldwide, which includes 33 deaths. This is out of approximately 25 million women in the world who have breast implants. Fortunately, if caught at the first sign of swelling, BIA-ALCL is curable by removing the implant and the connective tissue capsule that forms around the implant.

So what does this mean for you? Currently, given how rare BIA-ALCL is, the U.S. Food and Drug Administration (FDA) does not recommend removing textured implants for prevention only. Instead, it is important to follow-up regularly with your plastic surgeon; either with Dr. Lemaine, or another board-certified plastic surgeon.  (If you need help finding a board-certified plastic surgeon near you, please visit the American Society of Plastic Surgeons website at https://find.plasticsurgery.org).

What should you be on the lookout for? Signs and symptoms of BIA-ALCL include swelling, pain, asymmetry, or lumps or masses. Though gradual changes in breast shape do occur over time, any changes that seem abnormal, sudden, or unusual should prompt a call to our office so we can schedule you to come in for a check-up. The vast majority of the time, these findings do not represent anything serious; however, it is always wise to be vigilant and follow-up.

 Your health and safety are and always have been the most important thing to me, as your plastic surgeon. Please feel welcome to call the office any time with questions or concerns. If you currently have silicone breast implants, textured or smooth, please ensure you have a regular follow-up visit scheduled with Dr. Lemaine.

 We look forward to seeing you at your next visit,

 Valerie Lemaine, M.D., M.P.H., FRCS(C), FACS

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Injectables Now Available at Plastic Surgery Consultants

Injectables at Plastic Surgery Consultants are done by our plastic surgeons. We perform a comprehensive array of advanced facial procedures to help you achieve your aesthetic goals and restore your youthful appearance without plastic surgery. Our plastic surgeons will recommend treatments that are tailored to address your concerns. We offer Botox and Fillers.

Botox:

Botox (or other neuromodulators like Xeomin, Dysport or Jeuveau) temporarily smooths out the muscles of the face and neck. This technique is especially powerful for erasing forehead wrinkles, crow’s feet, and furrows between the eyes, all of which can make a person look upset or angry even when he or she is not.  Botox can also be used to treat excess sweating. 

Fillers:

Fillers, including Juvederm, Restylane, Voluma, Vollure, Radiesse, Sculptra, and Belotero, among others, are FDA approved products that add subtle volume to the face. They can be used to augment the fullness of the lips and fill hollow areas under the eyes. Fillers can also be used to fill in deep wrinkles and creases, such as the ones that appear in the nasolabial folds (the lines around the mouth), marionette lines (the lines near jowls), and the glabella (the lines between the eyes).

 Request a consultation using the online form or call us at (952)746-6767 to schedule an appointment.

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Plastic Surgery Consultants to host free melanoma screening

Screen the skin you’re in at this free, family-friendly event in honor of Melanoma Awareness Month! Minnesota Oncology and Plastic Surgery Consultants are hosting a free skin cancer screening and education on skin cancer and prevention! In order to be screened, you must click the sign up tab below and register. Please register each person individually. Please arrive no earlier that 10 minutes prior to your registered time.

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Dr. Valerie Lemaine Joins Plastic Surgery Consultants

Dr. Sam Economou is pleased to welcome board-certified plastic surgeon Dr. Valerie Lemaine to Plastic Surgery Consultants. Dr. Lemaine joins the practice on May 14. 

Dr. Valerie Lemaine is board-certified and a diplomate of both the American Board of Plastic Surgery and the Royal College of Surgeons of Canada. Dr. Lemaine is University of Montreal Medical School-instructed and plastic surgery-trained. Her impeccable credentials also include reconstructive microsurgery and clinical research fellowships at Memorial Sloan-Kettering Cancer Center in New York City, as well as receiving a Master’s Degree in Public Health at Columbia University.

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