It seems that there are still misconceptions regarding the presence and magnitude of pain and discomfort following breast augmentation surgery. Many women believe that considerable pain is inherent to the procedure – unavoidable, natural and expected. This belief has actually caused some women to delay or abandon their dreams of acquiring larger, more voluptuous breasts.

The reality is that breast augmentation surgery does not have to be a very painful procedure. It is the surgical skills and techniques employed by the plastic surgeon which are of primary importance in affecting the presence and extent of pain postoperatively. When performed proficiently, expect the level of discomfort initially to be of a mild to moderate nature which then usually subsides fairly quickly.

Of course, there are always the outliers. These are the patients who, for example, must take a week off from work due to the “debilitating” pain of an ingrown fingernail or need the following day off due to a brain freeze caused by gluttonously devouring chocolate ice cream earlier in the day.

Immediately following their breast augmentation, a majority of my patients experience only a mild to moderate amount of discomfort which is usually well controlled with their prescribed medication. In fact, many take little or no narcotic pain medication after 24 hours and are already engaging in some more normal but non-strenuous activities. I believe that the relatively atraumatic techniques that I use in surgery along with an effective postoperative regimen are paramount in helping to minimize my patients’ discomfort.

In the video below, a recent patient of mine who just had a breast augmentation 24 hours earlier, candidly shares her experiences and thoughts including her level of comfort.

If you are strongly considering pursuing breast enlargement surgery and are very apprehensive about the associated pain, hopefully this information will help to ease your mind.

For more information on a breast augmentation or on any other plastic surgery procedure or to schedule your complimentary consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Silicone breast implants are used in the majority of breast augmentations that are now being performed. In fact, in 2012 they constituted 72% of the total number of breast implants used for breast enlargement with the remaining 28% being saline. In my practice, due to my firm evidence based convictions on the superiority of silicone implants over the saline ones, nearly 99% of my patients choose the silicone ones.

This preponderance of silicone implants being placed in breast enlargements was “artificially” eliminated between 1992 and 2006 due to the federal government’s (FDA) restriction on their usage. As a result, during this period, women electing to have this surgery either had to accept the usage of saline implants for their breast augmentations or forgo the surgery. (There were some exceptions to this edict.) In the last year of the moratorium which was 2006, 81% of the implants used were saline ones.

As you might expect, virtually all women decided that a breast enlargement with saline breast implants was better than having no surgery at all. Clearly, the benefits from undergoing this surgery – such as more aesthetically pleasing and alluring breasts and appearance, improvements in self-esteem, confidence, in relationships with others and in one’s sex life – far outweighed the downsides associated with saline implants.

Why are silicone breast implants so popular and chosen by the majority of women?

The reason is that they simulate quite well the feel and consistency of the female breast. They are the gold standard of breast implants. Cosmetically, they are light years superior to the saline ones which many people characterize as feeling like water balloons. Additionally, you can actually feel the envelope of the saline implant which often presents firm, discrete edges – not a natural occurrence in the female breast and a not so subtle reminder of their presence. Particularly in thin skinned individuals and those with their implants placed above the muscle, these edges can often be felt and seen as ripples of the overlying skin.

Despite all of this, many women who have saline implants are extremely happy with their results which they consider to be very good. The following patient of mine with a 10 year follow-up is but one example:

At the age of 37, this patient decided to pursue a breast enlargement which she had been thinking about for a long period of time (Fig A, C and E). Because of the restriction on the usage of silicone breast implants for primary breast augmentations, she underwent the procedure with saline implants that were placed behind the muscle. That was 10 years ago. She has been very happy with her results and has had no problems including rippling, hardness (capsular contracture) or contour irregularities (Fig B, D and F).

A). Before breast augmentation

B). 10 years after breast augmentation

C). Before surgery – side view

D). After surgery – side view

E). Before surgery – side view

F). After surgery – side view

My examination revealed that her breasts were soft, the implants naturally mobile and that there was no rippling present. She did develop some laxity of the skin over time from gravity and age. The implants themselves could barely be felt.

This patient, like many others who have had breast augmentation with saline implants, demonstrates that despite the superiority of silicone breast implants, saline ones can still provide excellent aesthetic results.

If you would like additional information on breast augmentation surgery, on silicone or saline breast implants or on any other plastic surgery procedure that I perform, please feel free to contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

In my blog, Gummy Bear” Silicone Breast Implants Just Approved by the FDA for Usage, I shared with you the news that the FDA finally allowed widespread usage of these next generation silicone breast implants after over a 12 year wait. Also, rather than being referred to as “gummy bear” implants, they have now been given an official name, the Natrelle® 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants – or Natrelle® 410, for short.

Is this an earth shattering event?

Has there been a recent increase in seismic activity or an unusual number of earthquakes subsequent to this announcement?

No, and of course not!

However, if you are considering having a breast augmentation or a mastopexy (breast lift) with implants, now you have one more option available to you. These Natrelle® 410 implants do have several advantages over the round highly cohesive silicone gel breast implant (as I noted in that post). There are also a few drawbacks.

These are anatomic shaped implants (tear drop in configuration) so if you are looking for a “push-up” look with a lot of roundness and fullness at the top of your breast, this style implant will not be for you. If you are also desiring to be disproportionately large, the same holds true – so go with the round silicone breast implants.

These Natrelle® 410 implants require far more precision in their selection and insertion than the round silicone implants (although I already am very precise and meticulous as regards the round silicone gel implants). In fact, this is such a crucial issue that that any plastic surgeon desiring to offer these implants must obtain certification for their usage.

And guess what?

I have completed the certification program and am fully certified to offer and use these Natrelle® 410 implants.

Finally, these new implants are substantially more expensive than the round silicone gel breast implants. Consequently, this will translate into a significant premium to the cost of undergoing a breast augmentation if you opt for using them. This additional expense to the procedure will vary among plastic surgeons, but it could be in the range of $2000 – $3000 more.

If you would like additional information on the new Natrelle® 410 silicone breast implants or on breast augmentation surgery in general or if you would like to schedule your complimentary consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Natrelle® 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants

After waiting years for approval of the widespread usage in the United States of the so called “gummy bear” silicone breast implants, the U.S. Food and Drug Administration (FDA) yesterday finally announced their formal approval to the manufacturer of this implant, Allergan, Inc. This implant will be officially known by the marketing name Natrelle® 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants or Natrelle® 410 for short.

Or “gummy bear” implant if all this is too technical!

This breast implant has undergone the most rigorous scientific research for years and that has also included numerous clinical studies. Additionally, it has already been used worldwide for 20 years including in Canada and Europe. What has been learned is that women love them overwhelmingly (and so do men!). In fact, the satisfaction rate in those who have them is 96.5%, which even exceeds the already extremely high rate of satisfaction associated with the silicone breast implants that we have been using.

There are a few characteristics that make this silicone breast implant unique – and its formal name says it all. It is an anatomically shaped implant in the form of a tear drop or wedge compared to the round implants which have been used for decades. It also consist of a silicone gel that is highly cohesive – it sticks together to a very high degree, far greater than any other previous breast implant. Consequently, it maintains its intended anatomic tear drop shape for a more natural look but still has somewhat of a soft feel. Additionally and importantly, there has not been noted to be any silicone gel migration from the implant at 7 years.

This gummy bear implant also has the advantage of staying in place versus what can happen at times with the round breast implants. This is a double-edged sword in some ways, though. A well trained experienced plastic surgeon can place it precisely where it is desired allowing for even greater control of shape and other factors. There isn’t the so called “dropping” effect that many people have heard about with the round implants (though this doesn’t really occur either). Conversely, if the insertion is not performed skillfully, the results may reflect this.

Because of how this implant is constituted, the associated risks of rippling or wrinkling are virtually non-existent – at less than 1% at 7 years in primary breast augmentations. This is less than that of the “present” day round silicone breast implants and light years better than that associated with the saline breast implants.

This style 410 silicone breast implant is intended for usage in breast augmentation, breast reconstruction and breast revision surgery with the additional FDA stipulation that a woman must be at least 22 years of age. It will also not be for everyone who wants silicone breast implants. In fact, it may end up be a niche type choice partially because the results will be more “natural” in appearance which is not what many women are looking for (though many are as well!). The round implants that we are presently using provide that more popular appearance of considerable fullness – that round, push-up bra look.

And then there is the cost… It will be priced higher than the round silicone breast implants.

Once these Natrelle® 410 implants become physically available within the next week or so, I will be offering them as another silicone breast implant option.

For more information on the newly introduced Natrelle® 410 silicone breast implants, on breast augmentation surgery in general or on any other plastic surgery procedure that I perform, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

For a woman who has undergone breast augmentation surgery or even a breast lift with an enlargement, it is not necessarily one and done with regard to the implants. That is, there is a substantial likelihood that those aren’t the last pair of implants that she is going to have in her lifetime.

Why?

First of all, breast implants are not permanent medical devices and will not last forever if given long enough. At some point in time, they will either need to be replaced (implant exchange) or removed due to rupture or loss of integrity. It has been my experience that most women, even those in their 70’s, elect to have new implants put back in again rather than have them removed permanently. They just don’t want to be walking around without “breasts”.

This is not the only reason for changing out breast implants, a type of breast revision surgery. Some of the other reasons that women choose or need to obtain new implants include:

1) a desire to change their breast size – usually going bigger; rarely do they elect to go smaller
2) switching their type of implant from saline to silicone; the reverse, going from silicone to saline is extremely rare
3) a desire to alter the shape and projection of their breasts such as going to a higher profile implant to obtain more projection
4) to replace very old implants with newer but similar ones
5) to treat hardness or irregularities that have developed around the implants such as significant capsular contracture
6) development of infection (exceedingly rare)

This breast revision surgery is typically associated with minimal initial postoperative discomfort and is a far easier and more pleasant experience than the initial breast augmentation or breast lift with implants. I have found this to be almost universally true in my practice over more than 25 years.

The following patient of mine exemplifies a few of the reasons why women electively decide to pursue breast implant exchange surgery. At age 18 she underwent a breast augmentation that involved the submuscular placement of smooth surfaced moderate profile saline breast implants with 240cc on the left and 265cc on the right (Fig A, C and E). This gave her the shape and “C” cup that she had wanted so that she was very happy with the results.

A) Breast augmentation with saline implants – prior to implant exchange

B) After breast implant exchange, going from saline to silicone

C) Before implant exchange – side view

D) After implant exchange – oblique view

E) Before implant exchange – side view

F) After implant exchange – side view

After several years and experiencing no problems whatsoever, she decided that she wanted her breasts to be even larger and to also switch to the much more natural feeling silicone breast implants. For her breast revision, she had placement of smooth surfaced ultra high profile silicone breast implants with 360cc on the left and 400cc on the right (Fig B, D and F). There was virtually no discomfort following surgery and she went back to work within a few days. The results were just what she had desired and she was extremely happy.

For more information regarding breast revision surgery, breast augmentation or on any other plastic surgery procedure that I perform, please contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

If you are considering having a breast augmentation or a breast lift along with a breast enlargement, figuring out the size that you want to be and how that will look on you can be VERY confusing. Compounding this dilemma is the lack of standardization of cup size. After all, two different bra cup sizes produced by different bra manufacturers may fit you exactly the same presently.

How do you better express the appearance that you desire?

Many women state that what they want is to be proportional or somewhat natural looking.

What is that?

Proportional or natural looking means different things to different women. What is proportional for one may be far too small for another.

A woman may indicate that she wants to be a moderate “C” or a large “C”. Or maybe even a small to moderate “D” but not too big.

What exactly is a moderate “C” or a large “C”? Or a moderate “D”?

Exactly!

There is no such specific thing.

For more than 25 years, I have been highly successful in using an approach for my patients wanting a breast enlargement which can accurately determine the look that they desire and then translates that into the appropriate breast implant sizes. This system uses extensive and crucial information that I obtain from my patients during their thorough consultations and examinations as well as during surgery. Still, there are some women who really need to see what they will look like before undergoing their breast augmentation.

Fortunately, I can now provide a good solution for this: computer imaging of their breasts that algorithmically projects their results based both on implant size in cc’s and profile (moderate, high and ultra-high). In this fashion, my patients can visualize the effects of various implant sizes as well as their configurations on the appearance of their breasts, their chest and overall proportionality.

Though I find the results from this high tech imaging still not highly accurate and predictive, the patients of mine that have requested it have found the simulation to be quite helpful for them in many ways.

If you would like more information on breast augmentation surgery or on any other plastic surgery procedure that I perform or to schedule your complimentary consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Do you want to know some of the secrets of making your breasts look as youthful and attractive as possible?

Of course you do!

We’re not talking here about surgical procedures that enlarge, lift or reduce the size of your breasts like breast augmentation, breast lift or breast reduction surgery. These are very effective procedures that can definitely have a great impact on their size, shape and allure but involve surgery and are performed on what is already there. Instead, based on your genetic code for breast size, quality, shape, etc., there are actually actions that you can take and other ones that you should avoid in order to keep your breasts looking as youthful and attractive as possible.

And there is no charge!

Or scars!

What are these breast beauty “secrets” and how were they discovered? (Surely not by reading the latest issue of Cosmopolitan magazine!)

The appearance of one’s breasts are affected both by genetic as well as environmental factors, the latter which includes actions or habits on your part. By controlling the genetic factor in a study, the effects of other factors can be better assessed.

How can this be precisely done?

By using identical twins and then evaluating other variables.

A study was performed through the Dept. of Plastic Surgery at Case Western Reserve University School of Medicine in Cleveland that consisted of 161 pairs of identical female twins with an average age of 47 years. It analyzed numerous independent external factors such as pregnancy, breast feeding, smoking and alcohol consumption and assessed their impact on breast quality and beauty based on several precise parameters. The data was then rigorously and statistically analyzed in order to determine the scientific significance of the findings.

So what were their findings (translated to beauty secrets for the breasts)?

Factors that had an adverse impact on the appearance of the breasts included multiple pregnancies, higher weight (BMI), cigarette smoking, alcohol consumption, sun exposure and larger cup and bra size. Skin quality was universally affected by all of these factors. It was interesting that of the 16 parameters used to assess the breast quality, cigarette smoking negatively impacted 8 of them.

One more factor that I can add to this list which wasn’t mentioned in the study is exposure of the breasts in tanning beds. Over the years, I have seen numerous women, including many still in their twenties, who have sustained significant damage and premature aging of their breast skin through multiple exposures to tanning beds.

On the positive side, it was found that daily moisturizing of the skin of the breasts resulted in less wrinkled, more youthful appearing skin. Hormone replacement therapy after menopause was associated with more attractive breast shape, size, projection and areola size and shape. Surprisingly, it was also discovered that breast feeding resulted in better appearing breast skin than those who were pregnant but did not breast feed.

So, if you want your breasts to remain youthful and as attractive looking as possible, avoid becoming overweight, don’t smoke, keep alcohol consumption to a minimum and don’t sunbathe or tan in tanning booths topless.
And find that hunk or significant other who would surely enjoy applying moisturizers to your breasts on a daily basis. (This may just be the easiest one to do!)

If you would like some information on cosmetic plastic surgery procedures of the breast such as breast augmentation, breast lifts or breast reduction, you can call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Scottsdale Plastic Surgery Practice Stands Behind U.S. Breast Implant Safety

Scottsdale, AZ — Breast augmentation remains the most popular surgical cosmetic enhancement in the U.S., which is mirrored in the Scottsdale plastic surgery practice of Dr. Steven Turkeltaub. He believes the extensive, exhaustive studies and research conducted over the years supports the general safety of both silicone and saline breast implants and refutes the nebulous charges of self interest groups. Furthermore, he states that the strict requirements and thorough oversight by the FDA in their approval adds additional credence to their safety.

The recently publicized breast implant safety issue concerned the French breast implant manufacturer Poly Implant Prothese (PIP), which was caught substituting industrial grade silicone for some of their implants instead of using the far more expensive medical grade silicone. Fortunately, none of their silicone breast implants were used in the United States because the company failed to meet the numerous and strict regulations and guidelines established by the FDA. As a board-certified Scottsdale plastic surgeon, Dr. Turkeltaub says that a patient who has had a breast augmentation in the U.S. from a reputable board-certified plastic surgeon need not be concerned about this issue.

Dr. Turkeltaub says he strongly believes in the safety of silicone gel implants for patients looking for breast augmentation in Scottsdale, Phoenix, and Glendale. “Silicone gel breast implants, which are FDA approved, are probably the most studied medical device ever. I feel extremely comfortable reassuring my patients of their safety and effectiveness and recommending them.” In fact, Dr. Turkeltaub says silicone breast implants in Scottsdale are the most popular choice of implant for patients at his practice, noting that more than 95% of his patients select the gel option for its natural look, feel and durability. “My patients find that silicone feels more like natural breast tissue, whereas saline implants can feel more like a water balloon. When considering a procedure that can have such a significant impact on the way a woman looks and feels about her body, I’m not surprised a majority of women choose the silicone gel implants.” The American Society for Aesthetic Plastic Surgery (ASAPS) confirms his observations, reporting that 62% of breast augmentation procedures used silicone implants, whereas only 38% of cases used saline.

Whether patients are looking for silicone or saline implants for a breast enlargement in Scottsdale, Dr. Turkeltaub says consulting with an experienced and reputable board certified plastic surgery practice is essential for having a much greater likelihood for achieving an aesthetically-pleasing outcome. He also stresses the importance of seeking a board-certified plastic surgeon who is caring, easily relates with patients, and spends an appropriate amount of time discussing all aspects of the procedure and answering their questions.

“Board certification with the American Board of Plastic Surgery is critically important when considering a procedure such as breast augmentation. Many of my patients have told me that word-of-mouth from friends and acquaintances who are or have been patients of the plastic surgeon can be quite helpful.”

About Steven H. Turkeltaub, MD, PC

A graduate of the Six-Year Medical Program at Boston University and Boston University School of Medicine, Dr. Steven Turkeltaub completed his general surgery residency at the University of Miami/Jackson Memorial Hospital and Northwestern Medical Center in Chicago, as well as a plastic surgery residency at the University of Massachusetts Medical Center. He is a member of the American Society of Plastic Surgeons, the Arizona Society of Plastic and Reconstructive Surgeons, the Arizona Medical Association, and several other professional societies. Board-certified in Plastic Surgery, Dr. Turkeltaub has also been published in several scholarly articles and textbooks on plastic surgery, in addition to a number of magazines and newspapers.

With two locations at 10290 N. 92nd Street Suite 207 in Scottsdale, AZ and 18275 N. 59th Avenue Bldg. E Suite 126 in Glendale, AZ, Dr. Turkeltaub’s practice, the Arizona Center for Aesthetic Plastic Surgery, can be reached at (480) 451-3000. He can also be contacted online via the website turkeltaub.com, arizonabreast.com, or the Arizona Center for Breast Surgery Facebook page.

Contact:
Rosemont Media
Aaron Hurst
aaron@rosemontmedia.com
(858) 200-0044

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Breast augmentation continues to be the most popular cosmetic plastic surgery procedure being performed today and for very good reasons (which I won’t delve into here). Related to this is the finding that an astounding 94% of women who have undergone this procedure would make the same decision to pursue breast enlargement surgery if they had to do it all over again. Looking at this from another perspective, there are few things in life that 94% of women can agree on (well, maybe unless it has to do with some complaints regarding men in general!).

There is considerable disagreement, however, on the amount of discomfort that is experienced immediately following a breast augmentation where the breast implants are placed behind the muscle. Many women are under the impression that there is necessarily a considerable amount of pain for several days following the surgery. They might have heard this from some of their friends or even read about it online. This can create anxiety prior to surgery or even cause some women to abandon their pursuit of a breast enlargement.

How true is this?

Should you expect to be in a considerable amount of pain for days after your surgery?

For most women, when the breast augmentation surgery is performed by a plastic surgeon employing the most advanced and meticulous plastic surgery techniques, the immediate postoperative course can be surprisingly tolerable with mild, fairly easily manageable discomfort. Of course and unfortunately, this is not true in every situation.

In the pursuit of seeking the ideal ways to minimize immediate postoperative discomfort following a breast augmentation, my techniques and approaches have evolved considerably over my 25 years in practice here in Scottsdale and the Phoenix metropolitan area. The result is that it is not very common for my patients to complain about greater than mild to moderate pain that can’t be controlled with analgesics and muscle relaxants. Unfortunately, there are many plastic surgeons and other physicians performing breast augmentations who are not very mindful of the ways to make the postoperative course far more pleasant and tolerable.

The following is a video of a recent patient of mine who wanted to share with others her experiences and perspectives following her breast augmentation surgery.

If you would like more information on breast augmentation surgery or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Enlarge your breasts two cup sizes in 90 days with our new, amazing breast growth tablets. There is no pain. No greasy lotions to stain your clothes. You don’t have to suffer the embarrassment of getting caught while rubbing some cream on your breasts that must be applied six times a day. No dangerous chemicals to mix. And best of all – there are absolutely no side effects.

Just larger, fuller, firm, voluptuous, and sexy breasts. Like you always dreamed about.

Your friends in Scottsdale, Phoenix, Glendale, Mesa and even Chandler and Gilbert will be astonished at the new, improved shapely You but no one will know your secret but You! And it’s permanent (provided you continue with my inexpensive maintenance pack).

There is no need for risky breast enlargement surgery. Say “no thanks” to those dangerous breast implants.

No! No! No! No! You don’t want those fake, manufactured things in YOUR body!

Plastic surgeons will be outraged … but you can laugh, look great and not have to pay those exorbitant surgical fees. And best of all: avoid surgery!

How is this possible?

It can’t be true, can it?

I, myself, never thought it possible that some rare and exotic herb could have such beneficial effects. Being highly skeptical, I hiked deep into a remote region of the Amazon to visit a primitive tribe I heard about where all the women were at least a “D” cup. Even more amazing, as I subsequently learned, was that their breasts remained firm and youthful well into their 50’s – even after several pregnancies and breast feeding.

What is their “secret”?

The answer is a diet rich in a leafy plant that only the women eat. It’s an herb that is found nowhere else on the planet.

Until now.

So if you want your breasts to grow bigger the natural way, without the risks and pain of breast augmentation surgery, you don’t have to go to the Amazon rainforest to obtain this amazing herb. I’ve brought it back for you in my safe, all natural proprietary formulation.

So hurry now and take advantage of this introductory, discounted limited time offer! You can get 100 of these amazing, patented breast pills for the easy low price of $89.99 plus S & H. And for the first 1000 callers, I will throw in a second bottle at no charge.  You just pay the additional S & H.

To place your order now, just call 800-TIT-PILLS (or 800-848-7455). Operators are standing by 24 hours a day.

If you call in the next 60 minutes, we will include for free in your order, 25 tablets for your man that contain another tropical herb that will help to further extend his interest in you …

Do you really believe advertisements like this touting incredible pills, tablet, or lotions guaranteed to enlarge your breasts or your man’s manhood?

Hopefully not, as they don’t exist!

These scams only serve to enlarge the bank accounts of the con artists promoting their quack medications and formulations. As the old adage goes: “If it sounds too good to be true, it probably is.”

If you would like some information on the real thing, breast augmentation surgery, or for any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

“Natural” looking breasts.

Over the years, many thousands of women have seen me in consultation for their breast augmentation. When sharing their goals to me, a majority of them invariably requested that they wanted their breasts to look “natural”. Then they proceeded to describe these desired outcomes that were in reality not so very “natural”. What might be “natural” to one woman would not be very satisfactory to another who was also looking for that “natural” result. Furthermore, many women just use the term but haven’t really thought about what it means to them except that it doesn’t include obscenely big.

What are natural looking breasts?

Are they a so called “C” cup or a “D” cup? Or even a “B” cup for the very petite? And which company’s bra will be the standard to make that determination?

Are they somewhat round, broad and with moderate projection? Or are they more projecting and less wide?

Is a tear drop shaped breast more natural or more desirable than a smooth and round one?

I could go on but you get the gist. Though it may give some people the warm and fuzzies, the use of “natural” together with breast implants and breast augmentation is not a very useful, descriptive or precise term. The one thing that it does convey is that the woman does not want to be grotesquely large (whatever size that may be!).

“Natural”, like beauty, is in the eyes of the beholder. When you are seeking to have a breast augmentation, know exactly what it is that you want and if you still insist on using the term “natural”, explain to your plastic surgeon exactly what that means to you. This includes such considerations as relative cup size, proportionality, cleavage, roundness, fullness, etc. Providing some photos showing women both in more revealing clothes and naked can be helpful to convey your thoughts.

If you don’t express exactly what it is that you want from your breast augmentation, there is a greater chance that you might not be entirely satisfied with the outcome.

For more information on breast augmentation surgery, breast implants or for any plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A French manufacturer of breast implants, Poly Implant Prosthese (PIP), has been in the news worldwide and for all the wrong reasons.

Inferior quality breast implants that break easily.
Usage of unauthorized, non-medical grade silicone in their silicone implants.
Poor quality control and manufacturing techniques.
Concern that their implants may be associated with an increased incidence of cancer.
And now there are allegations that a fuel additive, untested in any human trials, was used in these implants.

These issues show an egregious violation of standards, ethics and integrity. On top of this, European medical regulatory agencies and other government agencies failed to protect the consumer.

Women in numerous countries around the world who had these implants used for their breast enlargement are quite understandably in a panic. There may be hundreds of thousands of them.

What about American women? Do they have anything to worry about here? How many of these implants were used in the United States?

Fortunately, the answers to these questions are both easy and positive.

PIP sold only saline implants in the United States for a short period of time – between the end of 1996 and 2000. In their investigation of the company and its saline implants, the FDA (Federal Drug Administration) in 2000 cited numerous issues and concerns including quality control problems and the unacceptably high deflation rate. This led to PIP immediately withdrawing these implants from the United States market.

And now for even better news: No PIP silicone implants were ever legally sold or used in the United States. Therefore, despite the worldwide uproar and concerns about these disastrous PIP silicone breast implants, American women don’t have to worry about this issue because they were never available for implantation here.

If you would like to obtain information on silicone breast implants, breast augmentation surgery or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The incision that I have always preferred for a breast augmentation is the inframammary one (with rare exceptions). The reasons have been many including the relatively inconspicuous location and healing of the incision, better surgical exposure that facilitates precise technique and control, a reduced risk of developing capsular contracture (tight scar formation around the implant causing the breasts to feel hard), and what intuitively seemed to have a lower risk of affecting the sensation of the nipple-areola complex (NAC). No large scale study had been conducted to prove or refute my sentiment on the effect of the incision location on sensation until now.

A large scientific study was conducted in Italy that evaluated the possible effect of the incision location for breast augmentation surgery on the postoperative sensation of the nipple-areola complex. This assessed data from over 1200 women who had the same plastic surgeon perform their surgery over a slightly greater than six year period. Among the variables investigated were patient age, the breast implant size and whether the implants were placed above or below the muscle.

What the study found was that the implant size had no significant impact on the sensation of the nipple-areola complex postoperatively, an outcome that may surprise many. In addition, neither the patient’s age nor whether the implant was in a submuscular or submammary pocket, had any influence on sensation. The only variable that had a statistically significant association with reduced NAC sensation after surgery was the incision location, with the periareolar affecting 9.5% of women compared to 3.5% with the inframammary one which translates into a 2.7 times greater risk of sensory loss. It also had a 3.5 times greater risk of causing areolar pain.

Now there is even more convincing evidence supporting the superiority of the inframammary incision over the periareolar one for breast augmentation surgery.

If you would like to obtain more information on breast augmentation surgery or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Arizona Plastic Surgery Practice Reflects ASAPS Statistics

Of the more than 9.3 million cosmetic enhancement procedures performed in 2010, breast augmentation was the most common form of surgical enhancement according to the latest study from the American Society for Aesthetic Plastic Surgery (ASAPS). As a board-certified plastic surgeon in Phoenix, AZ, Dr. Steven Turkeltaub says the same is true at the Arizona Center for Breast Surgery.

According to the latest study from the American Society for Aesthetic Plastic Surgery (ASAPS), breast augmentation was the most common cosmetic plastic surgery procedure in 2010, followed by liposuction, eyelid surgery, abdominoplasty, and breast reduction. Dr. Steven Turkeltaub says that this is consistent with the breast surgery procedures that he performed for his patients in 2010 as well as the first half of 2011 at his Arizona plastic surgery practice.

Nearly 580,000 breast surgery procedures were performed in 2010. This total represents a 9% increase over the 2009 totals, which were adversely affected by the recession. However, Dr. Turkeltaub says this increase is due to more than the improved financial conditions: “As highlighted by the latest ASAPS study, an ever greater percentage of Americans approve of cosmetic enhancements, which are increasingly considered as mainstream procedures. In addition to wanting to look better—and feel better about themselves—as they have in the past, for some patients seeking employment or trying to hold on to their jobs, they believe a more youthful, attractive, and even alluring appearance may just provide them with a noticeable and competitive advantage.”

Regardless of the slight decrease in 2009, a 14-year comparison of breast augmentation reveals the number of procedures performed more than tripled from 101,176 in 1997, to 318,123 in 2010. Dr. Turkeltaub says the constant drive for innovation in the field of aesthetic enhancement is likely the cause of such a increase. “During this same period, there have been technological advancements as well as refinements in technique that should provide patients with more predictable and durable results along with even greater safety and comfort.”

About Steven H. Turkeltaub, MD, PC

Dr. Steven Turkeltaub earned his medical degree from Boston University School of Medicine. He completed his general and plastic surgery residencies at the University of Massachusetts Medical Center, where he also held an appointment as a Clinical Instructor. Dr. Turkeltaub has authored several papers and chapters for plastic surgery textbooks, as well as several magazines and newspapers. He is a member of the American Society of Plastic Surgeons, the Arizona Society of Plastic and Reconstructive Surgeons, and the Arizona Medical Society.

The Arizona Center for Breast Surgery has two locations: the Scottsdale office is located at 10290 N. 92nd St. Ste. 207 in Scottsdale, AZ 85258; and the Glendale office located at 18275 N. 59th Ave. Bldg. E Ste. 126 in Glendale, AZ 85308. Both locations can be reached at (480) 451-3000, or found online at arizonabreast.com or the Plastic Surgery Arizona Facebook page.

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As a result of research and technological advancements, there have been fundamental improvements in the design and construction of silicone breast implants over the years. These have translated into breast implants filled with a cohesive gel (like taffy) that are stronger, far more durable and resistant to a multitude of forces and factors and which will last considerably longer compared to previous generations of implants. They will not, however, necessarily last forever.

In 2006, the FDA issued recommendations (not a mandate) that women who have silicone breast implants as a results of breast augmentation or breast reconstruction should have an MRI starting three years after their surgery and then every other year subsequently. However, there was no scientific data to support this approach. Given the considerable expenses (and inconvenience) incurred by having these MRI’s which may not even be covered by insurance, we need to consider whether the FDA’s recommendations are really a prudent and necessary.

Research conducted at the University of Michigan and published in the March 2011 issue of the Plastic and Reconstructive Surgery® journal provides some compelling answers to this issue. This research combined and analyzed 21 previous studies that assessed the ability of MRI’s to detect silicone breast implant rupture in order to arrive at their conclusions.

What they discovered was that the MRI’s overall were fairly accurate in detecting ruptured silicone breast implants. However, in certain situations their accuracy rate was extremely high. In fact, they discovered that in women who presented with symptoms related to their breast implants, the MRI’s were 14 times more likely to discern a rupture than in those women who had no symptoms. Thus, in women who were asymptomatic, they were far less helpful.

How can we use this information to formulate reasonable recommendations?

Given that silicone gel breast implants will last on average well in excess of 10 years, MRI’s are not a cost effective tool to screen for ruptured breast implants in otherwise asymptomatic women during this first decade. Instead, mammograms and/or ultrasounds should be performed. If evidence arises or there is a significant index of suspicion for rupture, an MRI can then be considered.

If you would like more information on silicone gel breast implants, breast augmentation, breast reconstruction or for any other plastic surgery procedure that I perform or to schedule a complimentary consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The term “gummy bear” breast implants has been used in the public realm for several years now yet most people know little about them. What they have heard is that they are the latest type of silicone breast implant and something that they may just want to have for their breast augmentation or breast reconstruction.

You might have wondered: “Exactly what are these breast implants and why are they named after a candy?”

You may even be thinking: “Can I have them for my surgery?”

“Gummy bear” implants are a new generation of silicone breast implants that have some of the characteristics of the candy that they were nicknamed after – though they are not also edible! These implants differ from all earlier versions in that they are composed of a very highly cohesive and form-stable (maintains their shape) gel that resembles the candy though softer.

These 5th generation breast implants have been used elsewhere around the world for breast augmentations and reconstructions since the early 1990’s. They have been extensively researched for years including in large clinical trials but have not yet been cleared by the FDA (Federal Drug Administration) for usage here in the United States although approval may be imminent. (Note: Plastic surgeons here in the United States have been hearing this for several years now – and we are still waiting!)

These new silicone breast implants do offer at least a few advantages over the current cohesive silicone gel ones (as well as some disadvantages). They have been noted to be more durable and last longer and the potential of the silicone gel migrating elsewhere is close to zero. The risk of developing hardness around the implants known as capsular contracture has been found to be lower, around an incidence of 3% as compared to 5 – 10% or more with previous generations of silicone implants.

A definite disadvantage of these “gummy bear” implants is the cost which is expected to be significantly more expensive than those that are used now. Whether this difference is an additional several hundred dollars or much more is not known as of yet. Their increased cost will definitely have some effect on their popularity and selection. Ultimately, however, several factors will play a role in influencing each woman’s decision regarding which type of silicone breast implant is right for her.

For more information on silicone gel breast implants, breast augmentation surgery or for any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

A very common question that many women have who are considering a breast augmentation is what their exercise restrictions will be following surgery. They might have heard or read different and sometimes conflicting information and just want to know the proper routine. This is a subject that I discuss at length during your consultation.

There is no one correct answer for activity limitations and resumption but I will tell you what I have found over the years that works and does minimize your risks for significant problems such as bleeding that can result in the formation of a hematoma (collection of blood around the implant). The rare individual who develops this usually precipitated it by engaging in prohibited vigorous activities or consuming blood thinning agents such as aspirin or anti-inflammatory medication like ibuprofen, naprosyn, Motrin® or Aleve® within 10 days of surgery or immediately afterwards.

It is important that you avoid any heavy lifting, straining, aerobics and sports for three weeks after your breast augmentation. This also pertains to any activity that would substantially increase your heart rate and/or blood pressure such as jogging or swimming. If as part of your work-out you do pectoralis muscle (chest wall muscle) strengthening, this should be avoided for at least 8 weeks after surgery.

You may initially find that you experience increased swelling, tightness or tenderness in one or both breasts following certain activities. Don’t worry. This is normal and will ultimately not be an issue after several months.

For more information on breast enlargement, breast implants or for any other plastic surgery procedure that I perform or to schedule a consultation with me, feel free to call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Do you find searching for an attractive bra a frustrating or boring experience? The lingerie company La Senza, a subsidiary of the Limited Brands which also owns Victoria’s Secret, might have found a great solution. It has created a video showcasing some of its bras that is quite entertaining for both women and men and even has a holiday theme.

Now this isn’t just any video. It is a “musical” video featuring an assemblage of seven scantily clad voluptuous models each wearing a different sized cup ranging from an “A” to a “G”. Called “The Cup Size Choir”, these models are filmed provocatively lying in beds singing the Christmas song “Deck the Halls” with each one singing a musical note based on her bra cup size. Simply put, the model wearing the “A” cup sings all the “A” notes, the “B” cup one sings all the “B” notes, etc.

Not surprisingly, this video has become an internet sensation (for good reasons). You may want to watch it again and again together  with your significant other. They probably won’t mind!

If after viewing this video (and with some previous consideration) you could just imagine yourself filling up and alluringly wearing one of these attractive bras but don’t have what it takes yet – feel free to give us a call. We would be happy to provide you with information on breast enlargement surgery, breast lifts or on any other plastic surgery that you may be considering. You can also schedule a complimentary consultation with me.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

For any breast procedure requiring the placement of breast implants, my patients are offered the option of using either silicone or saline implants. This would include women who are considering breast augmentation, breast lift with implants, breast implant exchange and breast reconstruction. I thoroughly discuss with them all the important and relevant information about these two types of implants such as appearance, feel, durability, aesthetics, rupture, risks and possible areas of concern. They also are able to touch and closely examine both the silicone and saline implants.

What have I found is the overwhelming majority of my patients select the silicone implants for both cosmetic and reconstructive procedures and they definitely don’t regret the choice. The aesthetic results and much higher level of satisfaction irrefutably support the substantially greater superiority of silicone implants as compared to the saline ones. This is true for both cosmetic and reconstructive procedures. In my practice it is quite rare now for a woman to opt for saline implants and when they do it is virtually always because they cost $1,000 less a pair which then makes the cosmetic surgery affordable.

This finding is consistent with the medical literature including research just published in the November issue of “Cancer”. This multicenter study examined and analyzed the responses obtained from 672 women who had post-mastectomy (for breast cancer) breast reconstruction utilizing either silicone or saline implants. The results revealed a statistically significant greater level of satisfaction in women who chose the silicone breast implants for their reconstruction as opposed to the saline ones.

So, if you are interesting in pursuing either a cosmetic or reconstructive breast procedure that involves the usage of breast implants and were initially leaning toward saline implants you may want to strongly reconsider.

For additional information on silicone or saline breast implants, breast augmentation, breast reconstruction or for any other plastic surgery procedure that I perform or to schedule a consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The armpit incision for a breast enlargement, also known as the axillary approach, is fairly popular for a variety of reasons including the desire for some women not to have a scar situated directly on their breast. This preference can work as a double edged sword, though. If the ultimate scar that remains is not aesthetically ideal – inconspicuous – then its presence can be quite problematic and exposed for the world to see. This could then limit a woman’s options regarding certain clothing styles, for example, sleeveless tops.

My preference most of the time for the incision in breast augmentation is the inframammary one which lies along the crease at the bottom of the breast. It has numerous advantages over both the transaxillary and periareolar locations which can be discussed at the time of your consultation.

The patient whose underarm scar is shown in the photo, had her breast augmentation surgery performed elsewhere using the transaxillary incision. She developed thick hypertophric scars postoperatively which her plastic surgeon excised but they recurred. The problems that she faces now are scars which are prominent and visible when she wears sleeveless tops, gowns and bathing suits and which are occasionally associated with discomfort particularly when reaching.

Exposed keloid that resulted from a transaxillary incision in a breast augmentation. This already had been revised once by her original plastic surgeon.

If these same scars had been situated on her breasts, they would at least be covered by her clothes and not be so visible to others. As a result, she has to be very selective with the clothes that she wears including avoiding sleeveless tops which can make enduring Arizona summers with temperatures far in excess of 100 degrees Fahrenheit less tolerable.

For more information on breast augmentations, breast revision surgery or on any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona