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Dr. Susan Downey: 1301 Twentieth Street | Suite 470 | Santa Monica, CA | Tel: 310.401.2929
Female Plastic Surgeon | Pasadena

Recent Study Supports Breast Reduction Surgery in Teenagers

September 30th, 2019

Breast reduction is one of the most common plastic surgical procedures performed in the United States. Large, heavy breasts can have a considerable impact on a  woman’s quality of life, and surgery can bring considerable physical and mental health improvements .  Teenagers with large breasts can also benefit from reduction surgery and the following review by the American Society of Plastic Surgeons of an article in the Journal of the American Society of Plastic Surgeons supports these surgeries:

“In previous studies, Dr. Labow and his team have shown that young patients with large breasts suffer severely decreased quality of life compared to their unaffected peers, and that theBreast reduction is one of the most common plastic surgical procedures performed in the United States. Large, heavy breasts can have a considerable impact on a  woman’s quality of life, and surgery can bring considerable physical and mental health improvements .  Teenagers with large breasts can also benefit from reduction surgery and the following review by the American Society of Plastic Surgeons of an article in the Journal of the American Society of Plastic Surgeons supports these surgeries: se negative effects can be restored with surgery. In an article published in the September 2019 issue of the Journal of the American Society of Plastic Surgery  Dr Labow and colleagues stated that “Adolescent reduction mammaplasty remains controversial due to concerns of and lack of data regarding postoperative breast growth, complications, and the effect on well-being.”

Dr Labow and his researchers analyzed complications and their impact on quality of life in 512 adolescent girls and young women, aged 12 to 21, who underwent breast reduction surgery between 2008 and 2017. Outcomes showed that the benefits of breast reduction surgery were similar to those reported in previous studies: pain and other breast-related symptoms decreased, while physical well-being, psychosocial functioning, and self-esteem improved.

About one-third of patients developed some kind of complication – however, the “vast majority” of complications were minor. “Patients had significant postoperative improvements in their physical and psychosocial well-being regardless if they experienced a complication,” Dr. Labow and coauthors write.

The most common complication was thickened or raised scars (hypertrophic scarring), occurring in 20 percent of patients. Those concerned about scarring were offered treatment, either surgery or steroid injection.

One concern about reduction mammaplasty in adolescents is the risk of breast growth after surgery. This occurred in about five percent of patients in the study, leading to the return of breast-related symptoms in about half of cases. Noting that postoperative breast growth was unrelated to age, the researchers highlight the need to individually assess maturation in each patient.

While the benefits and risks of breast reduction surgery in adults are well-documented, few studies have focused on the risks and benefits of this procedure in adolescents and young women. Despite the fact that 80 percent of affected women first experience symptoms during adolescence, most women who undergo breast reduction surgery are around 50 years old.

The new study supports the good outcomes of breast reduction surgery in patients aged 12 to 21, despite a substantial risk of mostly minor complications. Dr. Labow and colleagues conclude: “Fear of potential complications should not preclude otherwise healthy patients from the benefits that reduction mammaplasty can provide adolescents.” “

From the American Society of Plastic Surgeons : Frequently asked questions about BIA-ALCL.

September 25th, 2019

1. Do I need to have my implants removed?

No, the FDA has specifically stated that implant removal is not necessary at this point unless you are diagnosed with BIA-ALCL. Having symptoms such as breast swelling, a lump in your breast or armpit, persistent breast pain, a rash or any change in your implants should be investigated by your physician. If you have any of these symptoms you should make an appointment to see your board-certified plastic surgeon and member of the American Society of Plastic Surgeons.

2. I have Allergan BIOCELL implants. What should I do?

Unless you are having the symptoms noted below, there is nothing to do at the present time other than routine continual breast examinations. Any changes in your breast should be examined and discussed with a board-certified plastic surgeon. The current recommendation from the FDA is that women with Allergan BIOCELL implants that do not have symptoms do not require removal. If you have Allergan BIOCELL implants, you should understand that textured surface implants are associated with a low but real risk of BIA-ALCL, a cancer of the lymphatic system. You should know the signs and symptoms of the disease. As long as you have your breast implant(s), you should monitor your breast area for any changes.

It is important to note that on September 12, 2019 the FDA released an update identifying Allergan BIOCELL Textured Breast Implant(s) as a Class I recall, the most serious type of recall. If changes to your breast(s) arise, you should seek evaluation promptly. More information about BIA-ALCL can be found at:

3. I have a textured implant(s) but my implant(s) have not been recalled. What is my risk for developing BIA-ALCL?

At the present time, your exact risk is not known. However, it appears to be significantly less than the risk noted below in question 4. The FDA and a 2017 study of US epidemiology of BIA-ALCL noted that Allergan BIOCELL implants appeared to be 6x more likely to be associated with the development of BIA-ALCL than other textured implants currently on the market.

4. What is my risk of BIA-ALCL? Is my risk of BIA-ALCL lower if I remove my implants and do not have them replaced?

The risk and incidence of BIA-ALCL in patients with Allergan BIOCELL textured implants ranges from 1:443 (median of 7 years) to 1:3345. The overall risk of BIA-ALCL in the US is 1:30,000 which is an average of several high and lower risk textured implants. There is no known procedure that can reduce risk for the development of the disease in the future. Patients have developed BIA-ALCL with a history of a retained scar capsule and a history of only simple implant exchange. However, patients should note that the current risks associated with any surgery are higher than the risk of developing BIA-ALCL. Discuss all benefits and risks with your board-certified plastic surgeon. Understanding all potential risk factors will help with better decision-making that is best for you and your health.

5. I had (or currently have) textured tissue expanders. Should I be worried? What is my risk of BIA-ALCL?

Risk of disease with tissue expanders has not been determined at this time. It is important to stay vigilant and upon noticing any changes in your breasts, consult a board-certified plastic surgeon.

6. Is there a screening test for BIA-ALCL?

At present there is no screening test or tool for BIA-ALCL. The best course of action is careful routine breast examination. If you have symptoms such as breast swelling, a mass in your breast or armpit, a new rash on your breast or persistent breast pain, or any change whatsoever in your breasts, you should see your plastic surgeon for evaluation.

7. I have symptoms of BIA-ALCL. What should I do?

The most common sign of BIA-ALCL is fluid or swelling around a breast implant. This usually happens many years after the implant was originally placed. BIA-ALCL can also cause tumors that arise from the scar capsule around the implant. Less commonly, BIA-ALCL can cause a breast to become lumpy or misshapen with the development of thick scar capsule around an implant.

If you have any of these symptoms of BIA-ALCL or other changes in your breast(s), your health care provider should evaluate you promptly. It is important to note that these signs and symptoms do not necessarily mean a diagnosis of BIA-ALCL. These changes, for example, can also result from a leaking implant or trauma to the breast area. To evaluate for BIA-ALCL, your health care provider will take your history, perform a physical exam and may order imaging or an assessment of any fluid or tissue around your implant.

8. If I choose to have my implants removed and/or replaced, do I need to have the capsule (scar around my implant) removed? What is an En-Bloc resection?

If you choose to have your breast implant(s) removed out of concern for BIA-ALCL, you should have a discussion with your surgeon about implant removal, implant exchange, and partial or total scar capsule removal. The surgical removal of the scar capsule around your implant is called a “capsulectomy” in an otherwise healthy patient. Having a total capsulectomy at the time of implant removal is not known to change the risk of developing BIA-ALCL. The risk of performing a capsulectomy includes, but is not limited to, bleeding and other wound complications. For reconstruction patients, a capsulectomy could result in a change of shape to your breast or loss of the reconstruction.

En-Bloc resection is often a misused term that means a cancer removal in a BIA-ALCL diagnosed patient with removal of the implant, complete capsule in conjunction with any associated mass and a rim or margin of surrounding healthy tissue.

9. I didn’t receive an implant card. How do I find out what kind of implant I have?

The best and easiest way is to contact the surgeon who performed your surgery or the hospital where you had your surgery performed and ask for your medical records. If your surgeon is no longer in practice or a significant time has elapsed since your surgery, the implant manufacturers may have this information through their device tracking mechanisms. Call the medical information division at one of the companies to find out about your implants.

10. Am I in the NBIR/PROFILE registries?

The aggregate NBIR and PROFILE registry datasets do not contain any personal identifying information. Contact your plastic surgeon and/or treating physician to determine whether or not your information was entered in either registry.

Allergan announces Biocell textured implant withdrawal

September 25th, 2019

Allergan announced on July 24, 2019 that it was launching a voluntary, global withdrawal of its Biocell textured breast implants and tissue expanders. The withdrawal follows increased scrutiny of textured breast implants and their connection to BIA-ALCL -  a rare lymphoma which can develop around breast implants. The FDA has said that women who have Allergan textured implants and are symptom free do not need to undergo explantation (removal) .  If a woman with Allergan textured implants wished to have them removed and replaced with smooth Implants Allergan will provide at no charge smooth Allergan implants.

Athena Implants- Breast reconstruction with larger implants

August 10th, 2016

A Study of the Safety and Effectiveness of the Mentor Larger Size MemoryGel Ultra High Profile breast Implants in Subjects Who are Undergoing primary breast Reconstruction or revision reconstruction ( Athena)

I am proud to be a principle investigator in this study.  For many years the FDA has limited the size of breast implants to 800 cc.  Unfortunately even the 800 cc were not adequate for many women.  This meant that they were required to have a reduction on the opposite breast or were left with a reconstruction which did not fill out their chest wall.   Finally we have access to larger implants ( up to 1445 cc)  for both primary and revision breast reconstruction patients.  The implants have to be fully evaluated before the FDA approves them for use by any plastic surgeon and so patients are being enrolled in a study.  The patients who are enrolled will be followed for ten years and will periodically undergo MRI’s to evaluate the status of the implants.  This is an exciting advance for women and breast reconstruction and I am pleased to be a part of it!

The Dangers of Plastic Surgery Tourism

July 24th, 2014

Treatment of Gynecomastia ( Male Breast Reduction) in Los Angeles

August 24th, 2012

Gynecomastia or male breast development can be a very traumatizing experience for young men.  It is common during puberty for boys to experience some breast development and in a few cases it persists beyond puberty.  If the gynecomastia persists for a long period of time the young man may be referred to a plastic surgeon for surgery.  Often the young man is concerned about the appearance of his chest and may  be wearing heavy clothes to camouflage his chest and avoiding situations where he might have to take his shirt off such as swimming .    The surgical approach to gynecomastia can be done through  an incision around the areola or , as is my preference , through an incision on the lateral chest.  I prefer the incision on the lateral chest as it does not draw attention to the breast area and can more quickly allow the boy to resume normal activitie  such as taking his shirt off the play basketball without anyone questioning the scar and what procedure he might have had done.  If there is a recent scar on both nipple areola complexes  I think this is more likely to raise question than if the are two asymmetrically placed scars an the lateral chest which are not both seen at the same time when one is looking straight on at the young man.  After surgery the young man does need to wear a compression vest but there are ones out that can easily be worn under a T shirt without being seen.  It may take weeks or even several months to see the full effect of the surgery so the winter months are goo d times to do the surgery so that everything is as healed as possible before the next swimming season rolls around.

Breast reduction in Los Angeles : common questions answered

August 24th, 2012

Breast reduction patients are some of the happiest patients that plastic surgeons see.  The relief from neck and shoulder pain is almost immediate.   There are some common questions that all reduction patients ask.  First - ”Will I need a lift as well?”  Answer -  a reduction is also a breast lift.   The difference between a reduction and a breast lift is that a reduction lifts the breast and at the same time reduces the size of the breast.  A breast lift only lifts the breast but does not change the size of the breast.   Second- Will my insurance cover this?   Answer -  In many cases.   Insurance companies have set criteria for the amount that breasts need to be reduced in order to qualify as a medically necessary procedure and be covered by insurance .  In general a reduction of two or more cup sizes will usually be covered.  In addition  chronic neck and shoulder pain as well as grooves in the shoulders from the bra straps digging in ( sounds painful!) are evidence that insurance companies look at in order to determine if they will cover the procedure.

PIP Breast Implants in the United States

January 13th, 2012

There has been a lot of news recently about PIP implants   and concerns that not only do they rupture at a rate higher than other implants but the silicone inside may not be medical quality.  Fortunately these implants  were never sold in the United States.  PIP did sell prefilled saline implants in the United States for a while (apparently about 35,000 were sold). However when  the FDA asked the three implant companies ( Inamed -now Allergan, Mentor , and PIP) in 2000 to submit a formal application (known as pre-market approval) only two of the companies received approval.  The two companies that received approval -  Inamed (Allergan) and Mentor-  are still the only two companies selling silicone implants in the United States.  PIP has stopped selling its prefilled saline implants in the U.S.A.

Timing of Surgery

January 13th, 2012

There were several reports over the holidays about the numbers of cosmetic surgeries and even reconstructive surgeries going up.  Is this just a typical cycle or is this an indication that the economy is improving?   It is true that all hospital admissions went down during the past few years -  a direct result of the recession.    When you are worried about the stability of the job market you are unlikely to take time off from work for an elective procedure or want to dig deep to pay those deductibles.    There for it is a good sign that elective procedures were up in December.  There is also the timing factor though.  Although there is no “convenient’ time to schedule an elective procedure -  there are less inconvenient times.    Timing a surgical procedure around a holiday can allow you to “steal” some more time off work.  A lot of offices are closed between Christmas and New Years which can allow you to to recover without sick days.  There are other times during the year when you can “steal “  extra time off –  long weekends such as Memorial Day, Labor Day or even the 4th of July are examples.   Often people expect offices to be closed or  at least not fully staffed so your absence is not questioned.  Plan ahead though as lots of other patients might have the same idea!

Visitng Educator in Ecuador

December 16th, 2011
I just returned from a trip to Porto Viejo Ecuador.  This was a Visiting Educator ( VE ) trip sponsored by Resurge( Interplast).   The purpose of this trip was to work alongside residents in Plastic Surgery from the University of Guayaquil and to help teach them techniques in cleft  lip and palate repairs.  Visiting educator programs also exist in the united States.  Professors from one university travel to others and lecture as well as sometimes operate alongside the residents to expose the residents to different techniques and skills.  It is a privilege to be invited to participate in such a program.  I was very impressed with the caliber of the residents and I must admit the exposure to different types of cases and the compexities of the cases they see is beyond what most residents in the United States see in their training.  As alwyas I get so much more from these trips than I give.  I am lucky to be able to participate in programs such as these.