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Presentation at
The University of California
Bi-Annual Plastic Surgery Department Symposium

Thank you Dr. Mathes for inviting me to participate in the Alumni Scientific Program. Although I have presented and participated in numerous symposiums, this is a first for me.  I have never given a presentation without slides or visual aids.

Instead, having evolved into a "mature" member of the San Francisco Plastic Surgery community over the past 24 years in private practice, I thought I would speak briefly about some of my experience and opinions with regard to breast augmentation.

When I was in training, almost all cosmetic augmentations performed in the UC. Programs were placed in the submammary plane using smooth gel implants. A peri-areolar or inframammary incision was used.

At one point, I used smooth double lumen saline-gel implants. For a while I used gel-filled polyurethane covered implants. For a while I used textured silicone gel implants Meghan & Mentor products.

Up to this point in time, through Dec. 1991,1 had performed very few, if any, cosmetic saline implant augmentations.

On January 6,1992 a Gel implant moratorium was issued by the FDA for cosmetic breast augmentations. And the trial attorneys went on a pillaging and plundering rampage. We were all obligated to use saline implants for cosmetic breast augmentation.

I will speak briefly concerning my own opinion and experience regarding breast augmentation. As of the gel moratorium, you and I are obligated to use saline implants for pure cosmetic augmentation. I use round smooth saline implants almost always - subpectoral implacement via an inframammary or peri-areolar incision.

In the rare instance of submammary placement I am more inclined to use a textured implant. It is my understanding that both Mentor and Meghan use the RTV shells made by Nusil. As of this presentation, the RTV technology evidently has remained the same since 1990.

The shell thickness of the Mentor implant is reported to be 0.16" thick while those of Meghan is 0.22" in thickness.

I have used both manufacturers' products. I feel they are both excellent products and I have no financial interest in either.

Why do I use the incisions mentioned? I have never performed a transambilical breast augmentation and probably never will. If a patient insists on a transaxillary approach, I will perform it. I very rarely use a teardrop implant. My preference is to use a 3 cm inframammary approach. I release the inferior and medial pectoralis insertions up to 4 o'clock. I will use inflatable saline sizers to assist in identifying the most accurate implant size to use. I will then add at least an additional 100 cc of saline to the sizer in order to additionally expand the subpectoral pocket. I will then do the second side.

I will change gloves, and using minimal touch technique place 50 cc of saline in the implant, evacuate the air, and anoint the implant in a betadine saline solution I will have previously placed betadine ointment on the skin around the incision and on any retractor coming in contact with the implant. Having rolled the implant up, I will slip it into the pocket and fill it up to at least the suggested volume and probably a minimum of 10 cc more. I usually use betadine /saline squeezed lap pads.

I use a multi-layered closure. I use pre-operative Ancef and place the patients in a stretch front closure bra post-operatively. I use general anesthesia. I start gentle message on the 2nd or 3rd post­operative day.

The question I have for Dr. McGrath whom I believe follows the panel, is it possible what goes around comes around? And that gel implants will once again be available in the near future? And that what the past 10 years was all about, bankrupting companies, lining the pockets of class action trial attorneys, and as the editor of the New England Journal of Medicine has stated, creating a whole new area of study called pseudo science? This says nothing of causing the tripling or quadrupling of the cost of gel implants in order to pay for the settlement. If this case is not a basis for the need for tort reform in the U.S., what is?

Fred Suess, M.D., San Francisco, California


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