Celebs and their plastic surgery

Articles about Breast Augmentation

FDA Approves New Natrelle 410 “Gummy Bear” Breast Implant

Thursday, February 21st, 2013

This is a very big deal in the field of plastic surgery.  Today the FDA approved the Natrelle (Allergan) Style 410 “Gummy Bear” silicone breast implant.  This is a true “form-stable” implant, with silicone that literally feels like a gummy bear, hence the name.  Plastic surgeons have been predicting the FDA approval of these devices for over ten years, so it’s a long-awaited announcement.  From the FDA webpage:

The U.S. Food and Drug Administration today approved the Natrelle 410 Highly
Cohesive Anatomically Shaped Silicone-Gel Filled Breast Implant to increase
breast size (augmentation) in women at least 22 years old and to rebuild breast
tissue (reconstruction) in women of any age. Natrelle 410 implants are
manufactured by Allergan, Inc.

The FDA based its approval on seven years of data from 941 women. Most
complications and outcomes reflect those found in previous breast implant
studies including tightening of the area around the implant (capsular
contracture), re-operation, implant removal, an uneven appearance (asymmetry),
and infection.  In addition, investigators observed fissures (cracks) in the gel
of some Natrelle 410 implants.  This is a characteristic called gel fracture and
is unique to this implant.

“It’s important to remember that breast implants are not lifetime devices.
Women should fully understand the risks associated with breast implants before
considering augmentation or reconstruction surgery, and they should recognize
that long-term monitoring is essential,” said Jeffrey Shuren, M.D., director of
the FDA’s Center for Devices and Radiological Health.

“The data we reviewed showed a reasonable assurance of safety and
effectiveness,” said Shuren. “We will be looking at the results from
post-approval studies that will focus on their long-term safety and

The silicone gel in the Natrelle 410 implant contains more cross-linking
compared to the silicone gel used in Allergan’s previously approved Natrelle
implant. This increased cross-linking results in a silicone gel that’s firmer.
Cross-linking refers to the bonds that link one silicone chain to another. The
clinical significance of this type of silicone gel is not known.

These implants are completely different from the silicone gel implants otherwise on the market.  They are much firmer and hold their shape, unlike the current silicone implants in use.  Time will tell just how popular these implants will get.  Some things to consider with the Natrelle Style 410 silicone gel implant:

1. The textured surface and teardrop shape mean that these implants are made to stay in place.  Unlike the smooth-walled silicone implants currently used by most plastic surgeons, these implants are not made to move.  For some, the fact that these implants stay in their position might be construed as looking and feeling less natural.

2. They are FIRM.

3. The incision necessary to insert these implants is much longer than a traditional incision, since these implants can not be squeezed into a smaller opening.

4. The plastic surgeon who inserts these implants must be very accurate in the creation of the breast pocket.  You DO NOT want some careless doctor ripping open a breast pocket and trying to stuff one of these in you.   Make sure to see a reputable plastic surgeon who’s a member of the American Society of Plastic Surgeons and/or the American Society for Aesthetic Plastic Surgery.

5. The gummy bear implants can’t be inserted through the belly button or the armpit.  They are too stiff.

6. These implants can be useful in reconstruction, revision breast surgery, and in people with really thin tissues and a risk of bottoming out.

To read the FDA announcement about the Natrelle Style 410 “Gummy Bear” Implant approval, click HERE.


Breast Implants 101 – Everything You Wanted To Know About Them!

Saturday, December 8th, 2012

This a recent segment I did with Fox News. We discuss the current types of breast implants, including silicone, saline, and the new, FDA approved ‘gummy bear’ breast implants. I also compare two vastly different sizes, and discuss who has what!


Breast Implants 101: My Segment on Fox News

Thursday, November 1st, 2012

Fox 2 News Headlines


An Ideal Implant?

Wednesday, September 19th, 2012

A new study on an investigational breast implant shows that it could have some considerable benefits compared to the currently utilized breast implants.  According to a study published in the Aesthetic Surgery Journal, the Ideal Implant (a double-lumen, saline-filled breast implant) has a high rate of patient and surgeon satisfaction, low rate of wrinkling, and a surprisingly low rate of capsular contracture when compared to the single lumen saline implants used today.  Here are the results:

Two-year follow-up  visits were completed by 472 of the 502 women (94.0%) enrolled at 35  private practices, 378 of whom had undergone primary breast augmentation and 94 of whom had received replacement augmentation. Patient-reported  satisfaction with the outcome was 94.3% for primary augmentations and  92.3% for replacement augmentations; surgeon-reported satisfaction was  also high (96.5% and 93.4%, respectively). The incidence of  moderate-to-severe wrinkling was 3.8% (primary) and 12.0% (replacement).  Baker Grade III and IV capsular contracture rates were 3.8% (primary)  and 8.2% (replacement). These two-year rates are lower than those  reported for current single-lumen saline implants at one year.  Deflations, none of which were caused by a shell fold flaw, occurred in  4.8% of primary augmentations and 3.3% of replacement augmentations.

I’ve had the privilege of examining the Ideal Implant and talking with its developer, and so far I’m impressed.  The implant feels more natural than traditional saline implants, but without the controversy of silicone implants.  Unfortunately, it’s not FDA approved yet.  When it does achieve FDA approval, however, I will announce it on this site!

For more information on the Ideal Implant, click HERE to visit their website.


Selecting Your A.S.S.E.T.S.: RealSelf.com’s Guide To Breast Implant Options

Wednesday, March 28th, 2012

Real Self.com is one of the foremost plastic surgery sites on the internet.  Here is their new guide to selecting breast implants.  It’s a great place to start if you’re thinking about getting your breasts enhanced.  Click the picture to make it larger.

If you’re considering a breast augmentation, make sure to choose a plastic surgeon certified by the American Board of Plastic Surgery and a member of the American Society of Plastic Surgeons.


FDA Approves New Silicone Gel Breast Implant

Saturday, March 10th, 2012

The FDA has approved the silicone breast implant from the manufacturer Sientra.  From the FDA website:

FDA approves new silicone gel-filled breast
Approval conditioned on post-approval safety studies

Today, the U.S. Food and Drug Administration approved a silicone gel-filled
breast implant manufactured by Sientra Inc. to increase breast size
(augmentation) in women at least 22 years old and to rebuild breast tissue
(reconstruction) in women of any age.

As a condition of approval, Sientra is required to conduct post-approval
studies that will assess long-term safety and effectiveness outcomes as well as
the risks of rare disease outcomes.

Silicone gel-filled breast implants are medical devices implanted under the
breast tissue or under the chest muscle for breast augmentation or
reconstruction. These implants have a silicone outer shell that is filled with
silicone gel. They come in different sizes and have either smooth or textured

With today’s approval, there are now three FDA-approved silicone gel-filled
breast implants in the U.S. manufactured by Allergan, Mentor and Sientra.

“Data on these and other approved silicone gel-filled breast implants
continue to demonstrate a reasonable assurance of safety and effectiveness,”
said William Maisel, M.D., M.P.H., deputy director for science in the FDA’s
Center for Devices and Radiological Health.

“It’s important to remember that breast implants are not lifetime devices.
Women should fully understand risks associated with breast implants before
considering augmentation or reconstruction surgery, and recognize that long-term
monitoring is essential.” said Maisel.

The FDA based its Sientra approval on three years of clinical data from 1,788
participants. Complications and outcomes reflected those found in previous
studies of other breast implants and included tightening of the area around the
implant (capsular contracture), re-operation, implant removal, an uneven
appearance (asymmetry), and infection.

In June 2011, the FDA released a report that included preliminary safety data
from post-approval studies from earlier breast implant approvals. The experience
collecting and analyzing data from these studies informed the design and
structure of post-approval studies for Sientra breast implants.

In addition to other post-approval conditions, Sientra will:

  • continue to follow the 1,788 clinical trial participants in their pre-market
    study for an additional 7 years;
  • conduct a 10-year study of 4,782 women receiving Sientra silicone gel-filled
    breast implants to collect information on long-term local complications such as
    capsular contracture, as well as less common disease outcomes, such as
    rheumatoid arthritis and breast and lung cancer; and
  • conduct five case-control studies that will evaluate the association between
    Sientra’s silicone gel-filled breast implants and five rare diseases: rare
    connective tissue disease, neurological disease, brain cancer, cervical/vulvar
    cancer, and lymphoma.

“The design of these post-approval studies will require Sientra to collect
valuable safety information with adequate enrollment and follow-up,” said
Maisel. “The FDA is committed to working with breast implant manufacturers to
collect useful post-market data on long-term safety and effectiveness.”

My comment: This is a big deal in the plastic surgery field.  Mentor and Allergan (aka McGhan) have been the only real players in the breast implant market for 20 years.  Although Sientra’s implants are now approved for use, their products remain unknown to the vast majority of plastic surgeons.  Study results have not been publicly released (to my knowledge), and therefore how Sientra’s implants stack up to Mentor and Allergan’s is still in question.

Breast augmentation is the number one cosmetic plastic surgery in the country, with over 300,000 women undergoing the surgery each year according to the American Society of Plastic Surgeons.  If Sientra’s implants test as well as the other two companies AND have a lower price, then we may see more and more women being able to afford breast augmentation.  I’ll report on the new Sientra silicone breast implant as information is released.


Thank The FDA For Your Breast Implants

Thursday, March 1st, 2012

Last month 30,000 French women were urged by their government to have their PIP breast implants removed. The French Ministry of Health fears that the implants’ industrial-strength silicone filler, originally made for mattresses, could leak and cause serious health problems.

So what should American women with breast implants do?

Thank the Food and Drug Administration.

Breast implants are big business. According to the American Society of Plastic Surgeons, last year nearly 300,000 women underwent breast augmentation in the United States. I currently perform over 150 breast implant surgeries per year, by far my most popular procedure.

So what went wrong in France that hasn’t gone wrong here?

The implants under scrutiny were manufactured by the now-defunct Poly Implant Prosthese (PIP), at one time the world’s third largest supplier of breast implants. The company, which went bankrupt and liquidated in 2010, fitted approximately 300,000 women around the world with these devices.

The advice given to women regarding their PIP implants has varied from country to country. France and Venezuela have urged their affected citizens to have the implants removed as soon as possible, while Britain has stated there is no evidence to recommend routine removal in all patients. Women with PIP implants around the world are furious that their government’s health ministries have allowed these unsafe implants to be used in so many people.

Here in the U.S., two companies manufacture the bulk of breast implants, Allergan and Mentor. The saline and silicone implants from both companies have stood up to the rigorous testing standards of the FDA.

Interestingly, PIP submitted their saline breast implants for FDA approval, but was rejected in March 2000. Specific reasons behind the FDA denial are unclear, but a study published in Plastic and Reconstructive Surgery by Stevens, et al., may provide a big clue. They discovered PIP saline implants had 3.5 times the rupture rate of Mentor saline implants. When an unacceptably high rupture rate is combined with contaminated silicone many complications can occur, including infection, inflammation, scar tissue, and possibly even cancer.

PIP silicone breast implants were never really used in the United States. If you had your breast augmentation in the U.S., it’s highly unlikely that you have these defective devices.

However, if you had your surgery overseas, then it’s a good idea to obtain your breast implant information from your surgeon. If your implants were manufactured by PIP, it may be a wise decision to switch them out for Mentor or Allergan implants.

If you’re thinking about undergoing a breast augmentation, don’t be afraid of silicone. Silicone breast implants are quite possibly the most studied medical device in the history of the world, and the FDA has deemed them safe for use.

Make sure you consult with a surgeon certified by the American Board of Plastic Surgery and a member of the American Society of Plastic Surgeons. Discuss the pros and cons of saline versus silicone. Recent surveys have found that, while silicone breast implants account for 60% of sales, a significant number of patients are still undergoing augmentation with saline. Silicone implants look and feel more natural than saline, but a broken silicone implant is harder to detect than a broken saline implant.

Studies show that over 90% of women with breast implants are satisfied with their outcomes. Still, I turn down one out of every five women who consult for breast augmentation, usually because I believe it’s not right for them.

Breast implants aren’t for everyone.

But the implants used in the United States are safe.


Study Shows Breast Augmentation Can Improve Your Sex Life… Duh!

Thursday, February 16th, 2012

RealSelf.com is a plastic surgery site that’s great at creating dialogue between real plastic surgeons and the public.  This is the site that allows patients to vote on whether certain procedures are “worth it.”  For example, Breast augmentation has a 91% worth it rating, whereas the Lifestyle Lift has a 52% worth it rating.

RealSelf.com also has a popular blog which posts fascinating stories and graphics, like the one below.  Can breast implants improve your sex life?  Of course!  Read more about it HERE.


FDA Issues Communication Regarding a Possible Link Between Breast Implants and Anaplastic Large Cell Lymphoma (ALCL)

Wednesday, January 26th, 2011

The FDA has issued a statement alerting physicians and patients to a possible link between breast implants and a rare type of cancer.   Although ALCL is extremely rare, the FDA believes that women with breast implants may have a very small but increased risk of developing the condition.  

ALCL in the presence of breast implants has been noted in sporadic case reports over the past 25 years.  To date, ALCL has only been identified in 34 cases out of an estimated 5 to 10 million women with implants worldwide.  As opposed to systemic ALCL which can occur anywhere in the body, this condition appears in the scar tissue that forms around the implant.  It is encouraging that when this condition occurs in the presence of breast implants the patients have responded to a variety of treatments, including simple removal of the implant and surrounding scar capsule.

ASAPS (American Society for Aesthetic Plastic Surgery) recommends that all women including those with breast implants should follow their normal routine in medical care and follow-up, specifically regular self examination and mammography when appropriate. Any woman should watch for changes in her breasts such as pain and swelling and contact her physician if she has any questions.

For my patients with breast implants, I don’t recommend that they lose any sleep over this.  The disease is very rare and a connection between ALCL and breast implants has not been conclusively proven.  There is some thought that the salt-texturing of the shell of a textured breast implant may be the connection between breast implants and ALCL.  Joan Kron’s excellent article in Allure (which can be found here) touches on this hypothesis.  

Here are the recommendations from the American Society of Plastic Surgeons (ASPS):

What You Should Know

  • ALCL is extremely rare - of the estimated 10 million breast implants worldwide, only 34 cases of ALCL have been reported since 1989.
  • The FDA believes that any potential risk that women with breast implants will develop ALCL is extremely low.
  • A woman is more likely to be struck by lightning than get this condition.
  • Both the FDA and ASPS are confident that breast implants remain safe and effective.

What You Should Do

  • If you have implants, continue your normal routine in medical care.
  • Watch for changes – if you notice unusual pain or swelling, contact an ASPS Member Surgeon.
  • As always, those considering breast implant surgery should discuss any potential benefits or risks with an ASPS Member Surgeon.

For the FDA press release, click here.

For the ASPS website, click here.


Saline or Silicone Gel? The Results May Surprise You…

Wednesday, April 29th, 2009

A recent survey published in the Aesthetic Surgery Journal shows what the current preferences are for breast augmentation surgery. According to a survey of 1746 board-certified plastic surgeons and members of the ASAPS:

- Sixty percent of surgeons are still using saline implants, and the vast majority of them are using them 75-100% of the time.
- The majority of surgeons (64%) preferred an incision near the breast crease, while 25% preferred an incision around the bottom half of the areola.
- The average implant size reported by 81% of surgeons was 300 to 400 cc (which is approximately a small to a full “C” cup bra).
- Smooth implants, rather than implants with a textured surface, were most often preferred by 92% of respondents because it was the surgeon’s preference, less wrinkling, or overall better results for the patient.
- Ninety-six percent of surgeons used round, rather than anatomically-shaped, implants.
- The most common position for implant placement was under the muscle (62% of surgeons).

With the exception of the majority use of saline implants, these statistics reflect what I see in my practice. I estimate that I use saline implants only 25% of the time, since most patients seem to prefer gel. I utilize three incisions (underneath the breast, around the areola, and the armpit), with the most common being underneath the breast. My average size implant is probably 350-375cc, and I usually use smooth round implants placed under the muscle. I find that these choices usually minimize any complications and revisions.
To view a breast augmentation I performed on Fox News, click here.

Statistics source

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.


National Breast Cancer Awareness Month

Saturday, September 27th, 2008

October is National Breast Cancer Awareness Month. Each year over 175,000 women (and 2000 men!) are diagnosed with breast cancer. Approximately 1 in 9 women will be diagnosed with breast cancer in their lifetime. Aside from skin cancer, it is the most common cancer in women. So how does this affect you if you have breast implants?

It’s estimated that over 5 million women have breast implants today. If you have breast implants, how do you screen yourself for breast cancer, and how is this different from someone without implants?

The major rule is that you should follow the American Cancer Society guidelines for the early detection of breast cancer. Here they are:

Women ages 20-39: Monthly breast self-exam, clinical exam by your physician every three years.

Women ages 40 and up: Monthly breast self-exam, clinical exam by your physician every year, mammogram yearly.

Women at high risk (close family history of breast cancer, etc.) should discuss with their physician whether a yearly MRI may be indicated. – When the FDA lifted the ban on silicone gel breast implants in November 2006, they recommended that anyone who undergoes silicone gel breast augmentation undergo an MRI three years after surgery, and every other year thereafter.

If you have breast implants, here are some other things to consider:

  1. Breast implants can limit the amount of breast tissue that can be seen on a mammogram. If you have implants, then make sure your mammogram center takes extra pictures (called the Ecklund technique) to allow the radiologist to see as much of your breast tissue as possible.
  2. Some physicians believe breast implants can actually facilitate (or improve) the ability to detect a breast mass on examination.
  3. Studies show that breast implants do not increase your risk of breast cancer, delay your diagnosis of breast cancer, or worsen your prognosis once breast cancer is diagnosed.
  4. If you are unsure how to perform a breast self-exam on implanted breasts, be sure to ask your plastic surgeon.

For more information on breast cancer and screening, visit http://www.cancer.org/.

Thanks for reading!

Michigan-based Plastic Surgeon

Anthony Youn, M.D.


Breast Augmentation Using Stem Cells? Not Yet…

Saturday, August 30th, 2008

An interesting article claims that plastic surgeons in Europe and Japan are using stem cells for breast augmentation. It also states that some surgeons in the United States are also performing stem cell breast augmentation.

The closest thing to stem cell breast augmentation that I have experience with is fat grafting to the breast. Fat actually does contain a large amount of stem cells, and the procedure does work. However, due to significant controversy regarding its possible effects on mammography and breast cancer detection, I don’t recommend it except in those situations where breast implants are not able to be used. The standard of care for breast augmentation is still the breast implant, and I expect that this will not change for a long time.

I know of no plastic surgeons in the U.S. who actually experiment with stem cells for breast augmentation.

Story credit: upi.com

Photo credit: The Soap Box

Thanks for reading.

Michigan-based Plastic Surgeon

Anthony Youn, M.D.


Breast Augmentation News Story on Fox 2 Detroit

Thursday, September 20th, 2007

I was recently featured on a the local Fox affiliate here in Detroit in a segment about the rising popularity of silicone gel implants. They follow one of my patients through her breast augmentation surgery with Memory Gel implants. Check it out here if you have a minute and are interested.

Thanks to Lila Lazarus and Sean Lee of Fox 2 Detroit for the nice story!

Thanks for reading.
Michigan-based Plastic Surgeon

Anthony Youn, M.D.


Breast Augmentation is #1

Wednesday, June 27th, 2007

The American Society of Plastic Surgeons recently released their plastic surgery statistics for the year 2006. For the first time ever, breast augmentation was the top cosmetic plastic surgery performed. Last year 329,000 people underwent breast augmentation surgery, up from 291,000 the year before. Liposuction, last year’s number one, drops to #3, with rhinoplasty at #2.

Why is breast augmentation #1? Could it be:

Ivanka Trump having a breast augmentation? No, that appeared to happen in December or January.

Maybe it’s because of people inspired by the woman who had a breast implant save her from the shrapnel of a Hizbollah rocket? Cool story, but I doubt it.

Could it be because of Jodie Marsh? God, no.

It’s likely that the increasing number of women having breast augmentation is partially due to the strong economy (in everywhere but here in Michigan) and the fact that silicone gel implants were approved by the FDA in November. These implants are so superior to the saline implants in appearance and feel that I am now finding more women opting for these implants over saline implants, which are considerably less expensive and have been the standard in North America for 14 years (although outside North America are somewhat rarely used).

Back in 1992, when the silicone gel implants were banned by the FDA for widespread use, the ASPS reported only 32,600 breast augmentations performed for the year. This has now increased over 10-fold. Why is this? I believe one major factor is the vast improvement in quality of breast augmentation surgeries today. In the past, plastic surgeons often placed smaller, older style silicone gel implants on top of the muscle, using larger scars. This often created breasts which were hard, scarred, and unrealistic-appearing (sometimes as common as 70% of the time). The newer techniques utilize shorter scars and somewhat larger implants whch are often placed below the chest muscle. This usually creates a softer, more realistic breast.

With more and more silicone gel implants being used this year, I expect the numbers of breast augmentation surgeries to increase significantly from 2006 to 2007. We may see more and more celebrities having breast augmentation surgery as well, as the surgery continues to become more and more common.

For the ASPS statistics, visit plasticsurgery.org.

To view a video of breast augmentation I performed for Fox News, click here.

Thanks for reading.
Michigan-based Plastic Surgeon
Anthony Youn, M.D.


Celebrities with Breast Augmentation on Wikipedia

Tuesday, January 23rd, 2007

Wikipedia has a list of celebrities who’ve supposedly had breast augmentation. It’s not a really complete list, but does appear to be pretty accurate to my eyes. For those of you not familiar with Wikipedia, it is an online encyclopedia which is written by the readers. The readers are the ones who alter the information by adding, subtracting, and correcting it. It can be a very valuable resource for certain subjects, although can be influenced by the opinions of the people writing it. Any comments on Wikipedia are appreciated, as I am not really familiar with it. They also have a list of celebrities who’ve had breast reduction. I didn’t know that Whoopi Goldberg had a breast reduction

Michigan-based Plastic Surgeon
Anthony Youn, M.D.


Gel Implants Are Back

Friday, November 17th, 2006

The FDA has just lifted the 14 year ban on silicone gel breast implants. The moratorium was placed on these implants after numerous women came forward with what were believed to be arthritis and other diseases from gel implants. Subsequent large scale studies have not proven any connection between silicone gel implants and these “connective tissue diseases.”

What’s the difference between gel implants and saline implants? A lot. Prior to today, the U.S. was the only major industrialized country to ban the use of these implants. Gel implants feel and look much more realistic than saline implants. There is no comparison between the two cosmetically.

MEDIA: If you would like to speak with me about the subject of silicone gel breast implants, feel free to email me at miplasticsurgeon@yahoo.com or call my office at 248-650-1900 and have me paged if it is after hours.

Thanks for reading.
Michigan-based Plastic Surgeon

Anthony Youn, M.D.


The most common celebrity plastic surgeries

Thursday, April 13th, 2006

What is the most common plastic surgery for celebrities? The following comments are my opinion only, deduced after working as a Hollywood plastic surgeon for a time and becoming a pop culture and celebrity plastic surgery “expert.” By far the most common cosmetic procedure is Botox. Botox has gotten so widespread in Hollywood nowadays that I notice when people do not have Botox more than when people do. This was most evident when I watched Tea Leoni act all flustered in that Adam Sandler clunker, “Spanglish.” She had so many forehead wrinkles and crow’s feet in that movie that I found it almost distracting to watch her. That many forehead wrinkles are rarely seen in beautiful Hollywood actresses today, so I applaud her for going au natural.

As far as surgery goes, the top three in my opinion are liposuction, breast augmentation, and rhinoplasty. All three of these occur much more often in celebrities than in the normal population. Breast augmentations are often obvious (hello Mariah Carey!), whereas liposuction can be difficult to determine (I’ve had people tell me that J. Lo has had it done numerous times), and rhinoplasties are either good (Halle Berry?) or bad (Jennifer Grey?). There are many more celebrities who’ve had these surgeries done than most people may realize. (I even believe that the great Julia Roberts has had her nose done!) At some point, the normal population may catch up with Hollywood celebrities in the amount of plastic surgery performed, but by then the celebrities may have gone onto bigger and more drastic ways to keep themselves young and relevant. Maybe they will have started cloning themselves by then. Just what we need, another Carrottop!

Have a great Easter! My son Daniel (3 months old) is getting baptized on Easter Sunday, so we are very excited…