I like to say that unlike most blogs by plastic surgeons, Plastic Surgery 101 really isn't about me, but today's post is actually about me.

I was asked by the editor of Plastic Surgery Products (PSP) magazine, an industry trade journal, to come up with something interesting to write about for his magazine. One of the questions that I'm always thinking about is "What are the things we do that really cause long term problems and how can I avoid that?".

Spending time as a fellow working with the world's best re-operative breast surgeon (for my money), Nashville's Dr. Pat Maxwell, really gave me a different kind of respect for some of the long term sequalla we can produce with cosmetic and reconstructive breast surgeries. There's a famous quote (attributed to former Houston Oilers coach Bum Phillips) about Alabama football coach Paul "Bear" Bryant, that he could "Take his'n and beat your'n, and then take your'n and beat his'n.". Well Pat could do the same with some of the most unfavorable or difficult to treat scenarios in breast surgery that you can imagine.

Anyway, I've kind of gotten an interest in this kind of patient and put some of my understanding and thinking on these issues down for PSP in an article entitled "Solid Strategies in Revisional Breast Surgery" which you can read here.

Thanks to editor Jeff Frentzen for the opportunity to contribute, however Jeff, I'm going to demand the cover story next time :)

Ok now back to posts definately "not about me".

Rob

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There's a great primer (for those interested) that can be read here at Plastic Surgery Products Magazine on how surgeons approach and analyze all the processes and steps that go into getting the best results and least complications with breast augmentation procedures.

It's written by my friend and mentor, Dr. Pat Maxwell, who knows as much on this subject as anyone on the planet. I think it's worth paying particular attention to his description of "biodimensional" principles, a now wide taught concept he pioneered. Another interesting thing Dr. Maxwell outlines is to look back at the sequential stages in implant development to see what went wrong (thin shell/thin gel designs in the 1970's) all the way to the sophisticated manufacturing of current and future devices. The engineering and computer modeling of implant designs is indeed impressive.

First Generation (1962-1970)
Thick, two-piece shell
Smooth surface with Dacron fixation patches
Anatomically shaped(teardrop)
Viscous silicone gel
Second Generation (1970-1982)
Thin, slightly permeable shell
Smooth surface (no Dacron patches)
Less viscous silicone gel
Third Generation (1982-1992)
Thick, strong, low-bleed shell
Smooth surface
Round shape
More viscous silicone gel
Fourth Generation (1993-present)
Thick, strong, low-bleed shell
Smooth and textured surfaces
Round and anatomically shaped
More viscous (cohesive) silicone gel
Fifth Generation (1993-present)
Thick, strong, low-bleed shell
Smooth and textured surfaces
Round and diverse anatomical shapes
Enhanced cohesive and form-stable silicone gel
* In accordance with technical parameters established by the ASTM.

Fifth generation devices will hopefully be available late this year or early 2008. While not useful in all scenarios, they offer significant advantages in breast reconstruction and in primary (initial) breast augmentation procedures.

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