The actress and director revealed that she recently chose to have a double mastectomy after doctors told her she had the breast cancer gene BRCA1, meaning Jolie has an (estimated) 87 percent risk of getting the disease.

She decided to be “proactive” and undergo a preventive double mastectomy, followed by breast reconstruction with implants. The procedures were completed just last month.

About her reconstruction, she writes:

“Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.”

Photo by the Foreign and Commonwealth Office

A Food and Drug Administration (FDA) panel recently recommended that the agency approve Juvéderm Voluma XC for cheek augmentation.

If approval takes place – and the FDA generally follows advisory committee recommendations — Juvederm would be the first filler with this indication, which could happen later this year.

A gel composed of hyaluronic acid suspended in phosphate buffered saline with 0.3 percent Lidocaine, Juvéderm Voluma helps restore deep volume loss and smooths the mid-face, rejuvenating sunken areas around the cheeks, re-creating youthful contour and fullness in the chin. The results are instant, natural looking and can last up to 18 months. There’s little if any downtime – most people resume normal activities immediately.

Based on the clinical trial data presented, the FDA’s General and Plastic Surgery Devices Panel agreed that the product is effective and safe and the benefits outweigh the risks. The most frequent common treatment site responses (CTRs) reported in the trial were tenderness, swelling, and firmness.

FDA reviewers noted that the incidence of CTRs decreased for subjects receiving touch-up and repeat treatments. More than half (52.8 percent) of subjects received the optional retreatment at the end of the extended follow-up period “suggesting these subjects perceived an acceptable benefit/risk profile for [its] continued use,” the reviewers said.

An additional consensus was that Juvéderm Voluma XC fills more than cheeks, meeting the needs of what people want in plastic surgery. According to the American Society for Dermatologic Surgery (ASDS), in 2012 nearly 2 million people had soft tissue filler augmentation, representing a 205 percent increase since 2000.

Photo by Alaskan Dude on Flickr

After mastectomy, you may feel overwhelmed by the physical and emotional ramifications of diagnosis, surgery and breast reconstruction. With hospital stays averaging three days or less, it’s important to know what to expect. Here are some brief checklists that may help guide your expectations through the process.

Before leaving the hospital, you’ll receive instructions on:

• Taking pain medication
• Caring for the bandage over your incision and, if still inserted, a surgical drain
• Managing stitches and staples (most stitches dissolve, while staples are removed later during an office visit)
• Recognizing signs of infection and lymphedema, the swelling of the soft tissues caused by fluid buildup
• Wearing a prosthesis or a bra (often depends on type of surgery and time needed to heal).

When you get home:

• Recovery times vary, depending upon the type of surgery.
• Get plenty of rest. It’s normal to experience fatigue for several weeks after mastectomy.
• Take pain medication only as needed
• Take sponge baths until your doctor removes drains and/or sutures
• Ask for help — have friends and family pitch in around the house

In the months following mastectomy:

• As nerves regrow, you may experience phantom sensations or pain in the area around the mastectomy. Analgesics such as such as acetaminophen and ibuprofen can usually take care of this.
• Expect some fatigue, although if it persists and remains constant, consult your physician.
• Throughout your recovery, it’s important to start exercising soon after surgery. Along with preventing arm and shoulder stiffness, exercise will keep the area limber and help initiate healing.

Your healthcare team should provide written, illustrated instructions for a routine tailored to your needs. Follow all post-operative instructions from your provider. The above checklist is for discussion only and should not replace your provider’s specific instructions for recovery after mastectomy.

Over a five-year period, researchers reviewed data on 2,089 office-based injections, including:

• 1,047 injections of hyaluronic acid (Juvederm, Restylane, Prevelle)
• 811 with poly-L-lactic acid (Sculptra)
• 231 with calcium hydroxylapatite (Radiesse)

Complications were found in only 14 cases, with the lowest number (0.2 percent) occurring in patients treated with hyaluronic acid. The complication rate was intermediate with poly-L-lactic acid (0.7 percent), and highest with calcium hydroxylapatite (2.6 percent).

Before and After Juvederm®. Photo Courtesy of Allergan Inc.

Silicone was excluded because of its potentially devastating consequences in these types of treatments, according to the authors.

They also cautioned that, when complications such as infection, fibrotic nodules, granular formations and others do occur, physicians must be thorough in recognizing and managing them.

Additionally the authors expressed some concern that patients might not have understood the symptoms of complications, failed to follow up with their physicians or even perhaps sought care with another doctor.

Nevertheless, “injectable fillers are a versatile solution for patients seeking facial rejuvenation without the downtime of surgery,” observed co-author Steven M. Daines MD of Daines Plastic Surgery in Newport Beach, California. “When administered by a trained practitioner, filler treatments are extremely safe and most complications are minor and can be managed without long-term side effects.”

While text messaging started out as a fad among teenagers, today its widespread use has extended to breast reconstruction after mastectomy.

A recent study in Plastic and Reconstructive Surgery found that text messaging between the patient and surgeon led to faster recovery times. Women who exchanged texts with their surgeon made significantly fewer clinic visits and phone calls; texting also reduced the amount of time the postsurgical drain was needed.

The study, the first to show potential benefits of text messaging between surgeons and patients undergoing a specific procedure, included 102 women with similar characteristics who used comparable surgeons and techniques. One group participated in routine postoperative text messaging while the other did not.

“Consistent with the benefits of text messaging (ease of use, speed, simplicity), patients’ adherence to medical advice (monitoring and recording…drain output) improved in this study,” stated Dr. Roshni Rao of University of Texas Southwestern Medical Center, Dallas. Some patients mentioned that being able to communicate with their surgeon via text helped them feel “empowered and an advocate for their own care.”

Yet despite its potential advantages, texting between doctors and patients has yet to catch on. Concerns include patient confidentiality as well as protecting the privacy of physicians and the amount of time involved in texting. Reimbursement is another potential area of question. In the study, patients used text messaging to send only the requested information during specified hours and messages only appeared on a password-protected cell phone.

Yet if routine postoperative text messages can help reduce unnecessary visits and quicken recovery, everyone wins. “The results of this exploratory study are intriguing and may provide a strategy for innovative communication between physicians and patients,” writes Dr. Rao and coauthors.

Photo: Texting at Comic-Con by kevin dooley on Flickr

The tummy tuck (abdominoplasty), a procedure that’s available to a wider range of patients, has shown promise in permanent weight loss, especially for those who were overweight or obese before surgery.

A recent study found that not only was weight loss maintained a year after the tummy tuck but that the procedure also resulted in increased satiety, the sense of feeling full after eating. Removing fat cells from the abdomen may lead to reduced levels of hormones affecting appetite, according to the study. And as anyone who’s ever tried it knows, portion control is key to losing weight.

The study evaluated short- and long-term weight loss in 20 women undergoing tummy tucks; they had an initial average weight loss of five pounds due to the surgery. Fourteen of the women, who had BMIs of 24.5 or more at the time of surgery and were generally considered overweight, not only maintained the initial loss but shed some additional pounds as well. The study also found that sustained weight loss was more likely for women who had a greater amount of excess tissue removed at abdominoplasty.

Further research is needed to confirm these results. “Whether or not long-term weight reduction is associated with abdominoplasty has been little investigated and remained controversial,” observes Dr. Rex Edward Moulton-Barrett of Alameda Hospital in Alameda, California, who co-authored the study. So while a tummy tuck may help you obtain a flatter stomach, there’s no guarantee that the rest of the body will follow suit.

Until recently, tissue expansion, a procedure that enables the body to grow extra skin in breast reconstruction, was limited to injections, which involved time-consuming office visits. A silicone balloon expander was inserted under the skin near the area to be repaired, then gradually filled with salt water over a period of 4-6 months, causing the skin to stretch and preparing the breast for permanent implant.

The new AeroForm patient-controlled tissue expander (PCE) allows for wireless control of tissue expansion through carbon dioxide inflation. “[It] has a needle-free design and anatomical shape, is lightweight, is expanded at home by the patient, is dosed according to comfort….and is easy to use,” observes Tony Connell, MD, principal investigator of the Patient Activated Controlled Expansion (PACE) II trial.

After being implanted, the small and anatomically shaped expander device is activated the first few times by the surgeon during the early healing phase. Then the patient takes over the job, using a remote-control device to send signals to the expander to release small amounts of compressed carbon-dioxide.

Manufactured by AirXpanders, Inc. of Palo Alto, California, the AeroForm has been through successful clinical trials in Australia, with results confirmed in a larger trial in the United States. Not only were expansion and reconstruction achieved nearly every patient, but both the women and their physicians expressed 100 percent satisfaction with the device.

In the US trial, the average expansion time was 17 days with the PCE vs. 52 days with the saline expander, while time to final implant was 106 days vs. 150 days with the saline device.

Last October, AirXpanders received the European CE mark of approval, which enables the company to commercialize the system in Europe and other select markets around the world. Additional confirming trials are still underway in the US.

Photo: Releasing balloons by joebeone on Flickr

When undergoing breast reconstruction, women have many options: Saline or silicone? Implants or autologous (using one’a own tissue)? Immediate or delayed reconstruction?

If you’re overwhelmed by these choices, this recent study of women who chose round vs. anatomical “shaped” silicone implants may ease your decision-making process a bit.

Patients in the study completed the BREAST-Q questionnaire, which evaluated changes in several areas including satisfaction with breasts as well as psychosocial, sexual, and physical well-being and satisfaction with care. The BREAST-Q data showed good overall outcomes with both types of implants.

The study included 65 women who received round implants with a smooth surface and 63 who obtained shaped implants with a textured surface. Data was collected one to four years after breast reconstruction and about 80 percent of women had reconstruction immediately after mastectomy.

As a side note, there was no difference in implant “rippling” between groups. Rippling, or wrinkling, had been a drawback of the first generation of shaped implants. Newer shaped silicone implants with less or no rippling are not yet approved in the United States; clinical trials are underway.

While the two types of implants were equivalent in terms of satisfaction, the women with shaped implants rated their breasts as “firmer.” Such findings help inform women about the expected outcomes of reconstruction, along with introducing shaped implants for widespread use.

Photo: Building blocks by Holger Zscheyge on Flickr

Recent Food and Drug Administration (FDA) approval of the Natrelle 410 breast implant offers yet another option for women undergoing breast augmentation or breast reconstruction. Unlike the “round” look usually found in implants, the anatomically shaped silhouette closely mirrors the natural curves of a woman’s breast while remaining soft to the touch.

Previously only available in Europe and Canada, it was the most selected gel implant in markets there. And because the implant contains a highly cohesive gel, it is designed to hold its shape for a long period of time. The latter is especially good news for patients who have “minimal breast tissue remaining after the removal of a tumor or have lost breast volume over the years,” adds Scott L. Spear, M.D., FACS, chairman, Department of Plastic Surgery, Georgetown University School of Medicine.

Approval was based on several years of data with nearly 1,000 women. Most complications were similar to those found in previous breast implant studies — tightening of the area around the implant (capsular contracture), re-operation, implant removal, rupture and infection. In addition, some implants had cracks in the gel.

Overall, however, the FDA has deemed it to be safe and effective. And, as a condition of continued approval, Allergan must conduct additional studies of 3500 women receiving the Natrelle 410 over the next five years as well as studies of potential long-term complications and occurrence of certain diseases, as well as evaluating women’s perceptions of patient labeling and analyzing manufacturer returns.

Adds Dr. Spear: “The option of a breast implant designed with an anatomical shape that lasts over time is important as it may help [women] obtain the aesthetic look they are seeking.”

As the economy experienced gains in 2012, so did cosmetic plastic surgery, with an overall increase of 5 percent since 2011. According to statistics released by the American Society of Plastic Surgeons (ASPS), some 14.6 million cosmetic plastic surgery procedures, including both minimally-invasive and surgical, were performed in the United States last year. And that’s in addition to another 5.6 million reconstructive plastic surgery procedures, an increase of 1 percent in that area.

However, certain types of cosmetic breast surgeries decreased, with female breast augmentation and breast lifts dropping by 2 percent. But those were the only types of breast surgeries that saw a decline — male breast reduction (gynecomastia) experienced a 5 percent rise to 21,000 procedures, an amazing jump considering it was relatively unheard-of only a few years ago. And, at 8 percent, reconstructive breast surgery rose even higher, with over 68,000 breast reductions alone performed last year.

And insurance continues to be an obstacle for some types of reconstructive breast surgeries, although the Affordable Care Act due to come into effect in 2014 may change this. “Although breast reduction has many physical and psychological benefits, obstacles remain in acquiring insurance coverage,” observed ASPS President Gregory Evans, MD. “It’s promising to see gains in this and other beneficial, medically necessary surgeries.”

Information is reported through an online national database for plastic surgery procedures and combined with an annual survey of the American Board of Medical Specialties (ABMS) certified physicians. The comprehensive census has been available online since 2005.

Photo: Arrows showing up by FutUndBeidl on Flickr