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Dual-plane breast augmentation refers to the placement of a breast implant in a specific anatomic position — partly behind the pectoralis muscle, and partly behind breast tissue. The layers of the breast, from external to internal, are skin, breast tissue, pectoralis muscle and ribs. Plastic surgeons have debated the best plane for implant placement over many decades — some preferring placement between the breast tissue and the muscle (the “subglandular plane”), and others preferring placement between the muscle and the chest wall (the “submuscular plane”). There are advantages and disadvantages to each. The “dual plane” was first described by Dr. John Tebbets in 2001 as a way to combine the advantages of both.
In the dual plane approach, the lower origin of the pectoralis muscle is detached from the chest wall and separated from the lower part of the breast tissue. This allows the muscle to slide upward slightly. When the implant is placed, the upper portion is covered by muscle and breast tissue, while the lower portion is covered by breast tissue alone. The upper muscle coverage of the implant reduces the risk of rippling and implant visibility in the upper part of the breast, capsular contracture, and disruption of cleavage (synmastia), while improving mammography accuracy. At the same time, the lower part of the breast implant that is covered by breast tissue benefits from a smoother implant-breast transition, enhanced shape, and a more natural look and feel.
The dual plane technique comes in very handy in cases of breast deflation with ptosis (sagging), which occurs after having children, breastfeeding, losing weight, or naturally with time. In these cases, a dual plane allows the implant to be placed slightly lower to fill the lower pole of the breast and give a lifted appearance during breast augmentation. This does not replace the need for breast lifting (mastopexy) in moderate to severe cases, but it does occasionally prevent the need for lifting in more mild cases.
Drs. Donaldson and Sieffert prefer dual plane breast augmentation for all of the benefits mentioned here. At Donaldson Plastic Surgery, our patients consistently comment on how proportionate and natural their results look, and how quickly they recover with minimal pain. We’ve used the dual plane approach to help over a thousand patients achieve their goals — safely, predictably and beautifully!
For many women, the decision to get a breast augmentation is a process that requires several different factors before reaching the final decision. One such factor that is often quite difficult is choosing the right size — not too large, not too small — for the implants. We know that breast size affects many aspects of a woman’s life, including her relationships, social interactions and overall physical well-being. We want to make sure that patients have the resources and guidance to choose the perfect implant size!
Here are some of the most important factors to consider and discuss with your surgeon before settling on what implant size to choose for your breast augmentation.
We all know that bra cups are typically sized in A, B, C and up, but implants are measured in cubic centimeters — cc for short. For approximately every 150 to 200 ccs, the breasts will usually increase about one or one and a half cup sizes. That can vary a bit depending on your specific measurements and even the bra manufacturer, but it gives you an idea! You can always try on different sizes with specialized bras during your consultation to see how the implants look and feel on your body.
With such a large range of sizes, it’s important to realize that not every woman’s body type and breasts will be able to handle implants higher up on the scale. Your body type, including the width of your natural breasts and shape and size of the chest wall, will factor into the ideal size of implant to create the desired fullness, shape, and profile.
It should come as no surprise that larger breasts, whether natural or augmented, are heavy. This can take a toll on a woman’s entire body. Women with larger frames and/or stronger muscles are best equipped to handle large breast implants, but even they can be susceptible to issues. Choosing a too-large breast implant size can lead to fatigue, back and shoulder pain, and potentially even the need for a breast reduction.
Depending on your frame, a high, moderate, or low profile may work best. For those with a small frame, a high profile may be ideal because this option has a narrower width. While a low volume option may work for those with broad shoulders and a larger frame to create an even proportion.
Now that we have covered several body-related factors to consider, it’s time to talk about lifestyle. For active women, athletes, or women with more physically demanding jobs, larger breast implants may not be ideal. It’s simple: the larger the breasts, the more tiresome and potentially painful it will be to carry the extra weight while working, running, lifting weights or playing a sport.
It’s also important for you to think about what kinds of clothing you normally like to wear, and if those items will be compatible with larger breast implant sizes. Augmentation will certainly affect how shirts, bras, swimsuit tops, and dresses fit, and additional procedures like lifts or reconstructions will affect things even further.
There’s a lot to think about when deciding on breast implant sizes! If you’re considering breast augmentation surgery and wondering if it’s right for you, we would love to see you at Donaldson Plastic Surgery. Dr. Donaldson will perform a personalized consultation that takes into account your specific anatomy and the results you’re looking for. He and his surgical assistant, Bobbie, will work with you to determine the best option according to your body shape. Call today to schedule a consultation and we can help make sure that you get the best results from your breast augmentation surgery.
The chest can cause a significant amount of discomfort and distress for transgender individuals. The breasts, in particular, are one of the most gender-identifying features and should strongly reflect a person’s identity.
Top surgery (breast augmentation) can provide a transgender woman with the shapely, feminine breasts she desires to better match her gender identity. Dr. Donaldson understands that the journey to self-discovery for a transgender patient can be complex and arduous. We treat all of our patients with sensitivity and care, and our goal is to help make inner confidence more apparent externally.
Here are 3 things to consider when selecting a doctor to perform your Male to Female Top Surgery.
A board-certified plastic surgeon has completed a thorough residency, masters program, and medical school, and must demonstrate proficiency in all areas of plastic surgery before taking the board exams. A board-certified plastic surgeon has the training necessary to ensure safe, beautiful results. It is also critical that your surgeon has experience with the intricacies required to ensure a natural result.
Dr. Donaldson and his surgical team are extremely proud of their work and our patients are beyond happy with their results. A quick look at our reviews and testimonials will tell you as much. When selecting a surgeon we always suggest reading patient reviews to hear first-hand about former patient experiences. Look for a doctor who is proud of their patient reviews.
Choosing to undergo top surgery is a major decision and it’s completely normal for patients to be nervous, scared, or anxious about it. One of the most important factors during this process is to feel understood by the surgeon performing the procedure. Test the staff as well – they will also be a huge part of your experience, and they should provide experience and care.
On Thursday, February 8th, 2019, the Food and Drug Administration (FDA) issued a report about Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) to health care providers inside and outside of the field of plastic surgery to raise general awareness, promote accurate diagnosis, and hopefully ensure more timely treatments. Dr. Donaldson and the staff at Donaldson Plastic Surgery support and advocate the FDA’s efforts to gather and disseminate accurate information. BIA-ALCL is a rare form of cancer that has been studied extensively by the plastic surgery community for the past several years. As a practice, we strive to be a trusted resource for all of our past, current, and future patients. Dr. Donaldson has attended national presentations, stayed up-to-date with clinical reports, followed best-practice recommendations, and communicated closely with his colleagues, staff, and patients regarding this topic. Fortunately, out of nearly ten million patients worldwide who have had breast augmentation surgery, only 457 have had a confirmed diagnosis of BIA-ALCL. All of these cases have been associated with the use of textured breast implants. Dr. Donaldson has NEVER used this type of implant. We have compiled the following information to present what is currently known about BIA-ALCL, including the risks, frequency, diagnosis, and treatment of this condition.
First, we will provide a description of our typical breast augmentation surgical technique. After a small skin incision, Dr. Donaldson separates tissue to create a pocket for the breast implant. Before implantation, the pocket is irrigated with an antibacterial solution to ensure a clean environment. The implant is then opened from its sterile packaging and, using a separate pair of sterile surgical gloves, Dr. Donaldson is the only person who directly handles the implant. It is rinsed with the antibacterial solution and compressed through the incision into the surgically-created pocket. The correct positioning is confirmed, and the pocket is closed with a series of dissolvable sutures. The operation typically takes less than an hour. The healing process begins almost immediately as the body’s immune system triggers a normal “foreign body” reaction that causes scar tissue to develop around the implant. Over time, the tissue completely encloses the implant, creating a capsule that separates the implant from the breast tissue.
One of the primary goals throughout the surgery is to ensure that the skin, pocket, and implant are kept completely sterile to minimize exposure to bacteria or other contaminants. Dr. Donaldson and the entire operating room staff go to great lengths to maintain sterility through the use of “minimal-touch” and “no-touch” techniques; antibacterial solutions; nipple guards; IV antibiotics; and, in some cases, implant delivery devices that reduce implant-skin contact. It is nearly impossible to prevent every bacterium from the skin and/or bloodstream from adhering to the implant. This normal process creates a biofilm between the implant and the newly-forming capsule. The body’s immune system can comfortably handle this minimal bacterial load unless a critical point is reached where the bacterial levels are high enough to trigger a chronic inflammatory response.
If the immune system develops a chronic inflammatory response, it is usually delayed a year or more after surgery and is affected by individual genetics and immune status. A chronic inflammatory response to the implant and biofilm has been linked to capsular contracture, additional scar tissue that can be seen and felt through swelling, tightening, or firming of the breast and a change in breast shape or position. Capsular contracture is graded on a scale of I-IV, and Dr. Donaldson prefers to treat the more severe grades III and IV through re-operation with capsule release and/or implant removal and/or replacement. The risk of capsular contracture occurring is less than 5 percent.
The biofilm that develops after an implant is inserted into the breast is commonly suspected as the cause for BIA-ALCL. When a chronic inflammatory response is not severe enough or fast enough to create a capsular contracture, it may lie dormant as a mild, long-term, low-grade infection inside of the capsule. Over a 7-10 year period, this underlying condition is believed to cause an immune T-cell abnormality that then progresses to BIA-ALCL. The first symptom is usually a late-onset seroma, or fluid collection, which causes swelling of the breast, asymmetry, and/or pain. In these early stages, the lymphoma resides inside of the protective capsule and is not connected to the breast tissue.
Biofilm seems to be more problematic with textured implants. In the late 1960s, textured-surface implants were designed in an attempt to reduce the rate of capsular contracture. Early results showed promise, but ten-year follow-up studies demonstrated that the texture of the implant does not affect the rate of capsular contracture. Since then, smooth, round implants have been preferred by most plastic surgeons in the United States, while textured implants have been more popular in Europe and South America. The recent introduction of shaped, highly-cohesive anatomical implants has increased the use of textured-surfaces because these implants cannot be permitted to flip or spin.
In contrast to a round implant that can flip or spin in the breast pocket with no visible difference, movement of an anatomically-shaped implant creates an unattractive breast shape that may cause the breast to appear sideways or upside-down. The texturized surface of an anatomically-shaped implant causes the capsule to grip the implant and prevent movement within the pocket. Dr. Donaldson does not use textured implants, and he does not use anatomical implants. He exclusively uses smooth, round implants.
Of the FDA-confirmed 457 cases of BIA-ALCL, no cases with purely smooth breast implants have been reported in any series, registry, or case with a detailed history. The texture on the outside shell of an implant may hinder the elimination of biofilm-creating bacteria due to the irregularity of the surface, multiple crevices, and increased surface area. Studies show significantly more bacterial adherence to textured versus smooth implant surfaces, as well as an increased number of lymphocytes–the cells that can become abnormal in cases of lymphoma.
If symptoms arise, it is imperative to consult with a board-certified plastic surgeon. If a patient’s history and exam seem suspicious, the surgeon will order tests that look for fluid around the implant. If a seroma or mass is detected, the fluid will be sampled and/or the tissue will be biopsied. Tests will then reveal whether known markers of BIA-ALCL are present. If confirmed, the surgeon will collaborate with an oncological team to create a plan for treatment. In early-stage disease, the implant and capsule are completely removed with no need for chemotherapy or radiation. Current three-year follow-ups show that 93 percent of patients are disease-free when following this protocol. If reports of symptoms, diagnosis, or treatment are delayed, then the lymphoma may spread and become systemic. The FDA has reported 9 known deaths in the US from BIA-ALCL. None of these patients received complete surgical excision or the targeted therapy that is now recommended.
Although our understanding of BIA-ALCL has improved dramatically over the past decade, further studies are underway, which should provide additional information. The FDA’s recent announcement was intended to increase awareness and encourage more health care providers to take part in the identification of BIA-ALCL. As a practice, Donaldson Plastic Surgery records all implant information in case future evaluation becomes necessary. To date, we have diagnosed ZERO patients with BIA-ALCL. Nonetheless, Dr. Donaldson is prepared to follow the most current diagnostic and treatment protocols, including radiographic imaging, fluid sampling, and immediate removal of the implant and capsule.
Our patients can confirm that their safety and wellbeing is our top priority. We believe that all of the risks associated with plastic surgery should be discussed and properly understood. There are approximately 300,000 breast augmentations in the United States every year. Given the extremely low overall incidence of BIA-ALCL, its exclusive association with textured implants, and its excellent prognosis with timely diagnosis and treatment, we continue to believe in the safety of smooth, round breast implants and the positive impact that breast augmentation has had on our patients’ lives.
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In 2011, I came to Dr. Donaldson and got a breast augmentation and a mini tummy tuck; and eight years later, I decided to come right back to Dr. Donaldson again because I trusted him and because he did such amazing work before, I trusted him to do it again. You’re probably wondering, “why’d you have to come back in eight years?”. Well, I mean, your body fluctuates within eight years – gaining weight, losing weight, gaining weight, losing weight– and I just wasn’t happy with what I had up here anymore. I thought “you know what? it’s time for a little pick-me-up”, so that’s exactly what Dr. Donaldson gave me again. I couldn’t be happier with the results that I have. I recommend everyone to come to Dr. Donaldson. I even live in Cleveland, just FYI. I used to live in Columbus, which is why I went to him, and I moved to Cleveland to be with my husband; and he drove me down to get my surgery done because that’s how much I trust and believe in Dr. Donaldson. So, come to him! I trust him and you should too!
*Note: Patient results will vary. All video testimonials were voluntarily submitted by actual patients with permission to publish on our website. Testimonials or statements made by any person(s) within this site are not intended to guarantee outcomes.
Just this past weekend, an online advertisement encouraged patients from the United States to have elective breast surgery in India — see link. The ad suggests that these operations are offered “at a fraction of world costs with comparable success rates and service levels.” This type of medical tourism has begun to flourish in Asia and South America as well.
Dr. Donaldson has helped to teach plastic surgeons from India, Turkey, Japan, Columbia, Mexico and New Zealand, and he has a great amount of respect for international plastic surgery; however, he does not recommend traveling to a foreign country to save money on breast augmentation. Columbus, Ohio residents are fortunate to have a
world-class option right at home with Jeffrey Donaldson, MD.
There are many reasons to avoid medical tourism: any savings from surgery are spent on travel; surgeon reputation and patient outcomes may be difficult to determine; language barriers can hinder communication between doctors and patients about goals and expectations; pre-operative testing and post-operative care is abbreviated or eliminated in order to get patients home more quickly.
Dr. Donaldson’s patients enjoy personalized consultations, medical examinations and pre-operative clearance in Columbus, Ohio. Breast augmentation surgery is then followed post-operatively with careful observation and encouragement by Dr. Donaldson and his staff. Any concern that may arise is handled with compassion, immediacy, and great expertise —
without the need for boarding a plane!
The first decision in breast augmentation is where to place the incision. How long will it be? Will it show?
One option is to hide the incision in the fold beneath the breast. This location tends to blend in well over time, but the position must be precise so that it does not rise up onto the lower part of the breast or sink down to the upper part of the abdomen. It is easy to make this incision longer if necessary to accomodate a larger implant.
Another option is to place the incision along the curve of the nipple/areola, in a half-circle that hides between the lighter skin of the breast and the darker skin of the areola. This approach makes sense if changes in the shape of the areola are desired, a small “lift” is planned or the fold under the breast is too exposed. The length of incision is limited by the size of the areola.
Finally, for many women in Columbus, Ohio, breast augmentation is only desirable when there are no incisions on the breast at all. These patients opt to have their implants placed through the axilla or armpit. The small scar fades fast, and it is best for saline implants that are placed under the pectoralis muscle. It requires specialized endoscopic equipment and training to achieve optimal results.
Many surgeons learned one way to perform breast augmentation, and they still use the same incision every time. For breast augmentation, Columbus, Ohio surgeon Dr. Jeffrey Donaldson trained with leaders in the field nationwide, and he is comfortable offering each patient a personalized, customized approach. He will help you choose an incision that suits your individual needs and preferences.
There has been a great amount of study, speculation and debate about breast implants over the past decade. The most important questions: are they safe? What material is best? What size? What shape?
Safety: First and foremost, breast implants are safe. The FDA has approved both saline-filled implants and silicone implants for breast augmentation after considering a vast amount of scientific data, patient experiences and doctors’ statements. There is no increased risk for certain illnesses or cancer, although the surgery itself carries some risk of bleeding, infection and other complications.
Materials: Most breast implants in the United States have a very thin silicone shell — the difference is what’s inside. Some are filled with saline (salt water), and others are filled with silicone gel. Some surgeons feel strongly about using one style of implant every time; Dr. Donaldson offers both types of implants, as he believes there are specific reasons to choose one or the other to match each patient’s body type and goals during breast augmentation.
Columbus, Ohio patients recognize in a side-by-side comparison that silicone feels more natural than saline — one is like a water balloon, and the other is like a breast. But in certain circumstances — such as when the implant is placed behind the chest muscle or beneath a large amount of natural breast tissue — it is often quite difficult to tell the difference.
Size: The most frequent reason for re-operation after breast augmentation is to change the size. To avoid this dilemma, Dr. Donaldson works hard with his patients to determine their goals and expectations in advance. Each person is different: some want a discreet enhancement that is only obvious when naked or in a bathing suit, others want a maximum impact that is obvious even in winter clothes!
Implants are sized according to their volume, which is usually measured in cubic centimeters, or cc’s. The typical range from small to large is 150 to 500cc’s, although they are made even smaller and bigger when necessary for women in Columbus, Ohio. Breast augmentation measurements to consider also include projection (distance projecting outward from chest) and width (distance from side of chest to middle of chest). The shape and size of a person’s chest and torso help determine which implant measurements will ultimately provide the best fit.
Shape: “Teardrop” or “anatomical” shapes are available, but Dr. Donaldson generally prefers smooth, round implants because they have a pleasant appearance from every angle. Also, if they turn in place, they will still look the same!
The breast implant may be positioned beneath the pectoralis major muscle in the chest (subpectoral, or submuscular position), between the breast tissue and the muscle (subglandular, or pre-pectoral position), or in a “bi-planar” position which is a combination of the two. Also, the implant may be placed high in the chest, low, toward the sides or toward the middle.
It is important for a woman who is considering breast augmentation in Columbus, Ohio to carefully examine herself, and to think about where she desires more fullness, what amount of cleavage, possible improvements in symmetry from side to side. Dr. Donaldson considers this information essential to his discussions with patients about their goals and expectations, and he uses it to customize his decisions about implant position for each patient.
A decision to go above or below the muscle is often determined by several factors: the incision, the implant type, and the shape and quantity of natural breast tissue. If the incision is made in the armpit, the submuscular position is generally preferred because it is a simpler surgical plane. If the implant is filled with saline, the submuscular position may also be preferred to improve the natural feel and to disguise the edges. A large amount of natural breast tissue often makes a subglandular position desirable; whereas a breast that has dropped some from breastfeeding may respond well to a bi-planar position to encourage fullness toward the neckline. When augmentation is combined with a significant breast lifting procedure, it may be advantageous to protect the implant under an extra layer of muscle.
While some surgeons are only trained to place implants in one position, and others tend to fall into a rut using the same technique for every patient, Dr. Donaldson approaches each patient uniquely in Columbus, Ohio; breast augmentation results can vary remarkably depending upon the implant position.
Most breast augmentations are straightforward procedures with beautiful results, but on occasion, a bothersome process known as capsular contracture develops. This occurs when the body tries to wall off an implant as a foreign object (like a splinter) with an abnormal amount of scar tissue. The scarring can be firm, and even painful when severe.
Experts are not convinced about what causes capsular contractures: some think it is bacteria or “biofilm,” while others believe it is trauma from surgery. Regardless, the reported incidence is anywhere from two to thirty percent depending upon the surgeon.
Dr. Donaldson takes many precautions to prevent capsular contractures in his own practice. First, he uses meticulous sterile technique and antibiotics to avoid bacteria and infection. He insists on “no touch” handling of implants so they go directly into position without delay. He operates with a soft touch — “gentle with tissue” — to minimize trauma. These simple principles have helped Dr. Donaldson achieve an extremely low rate of capsular contracture.
Columbus, Ohio patients also visit Dr. Donaldson for second opinions regarding capsular contracture treatment. For these individuals, he performs an operation including capsulotomy (scoring and release of capsules) or capsulectomy (removal of capsules), with removal of the old breast implants and placement of new breast implants.
*Earned by Dr. Donaldson