Why breast implants are safer than ever [David Levens, MD, Coral Springs]

Dr. Levens (00:00):
Hi, I'm Dr. David J. Levens. I'm a board certified plastic surgeon in Coral Springs, Florida.

Eva Sheie (00:06):
Let's touch on safety a little more. The safety question itself has changed over the years, and you've been in practice for 40 years. Can you kind of give us the high level, how has the safety question changed throughout your career?

Dr. Levens (00:19):
Absolutely, absolutely. Implants were first used in the 1970s, and the implant was literally a Dacron sponge. There was someone, actually, the first report is using a fat tumor, which is a lipoma, benign fatty tumor and transferring it to someone's breast. So all kinds of crazy things, then liquids, liquids injected, liquid silicone. But basically the modern generation of silicone implants started in the late seventies in Texas, actually. And that was considered the first generation, and right now we're up to the seventh or eighth or even 10th generation, depending on how you want to describe it. So silicone was the implant. In 1992, there was a ban on silicone implants because there was a huge lawsuit, at Dow Corning. It was a big class action suit because there were people that contended that the breast implants were making them sick with rheumatologic diseases, collagen, vascular diseases. So it's considered junk science now because it was never really proven that well scientifically, but they were banned in the United States.

Dr. Levens (01:28):
The rest of the world was still using them. And we had saline implants as our only other option, which is filled with saltwater, which is a perfectly good implant, just not as optimal as a silicone implant. And that was from '92 to 2006. In 2006, implants came out, again, silicone, that was probably the fourth or fifth generation, designed a little stronger, less likely to leak, rupture, et cetera. And when the weight of evidence did not seem to prove that they were really bad for you, a lot of restrictions, you had to be 22 years old, et cetera, et cetera. And then the latest thing, well, not the latest, but then in 2019 something was described called breast implant associated illness, and specifically a very rare non-breast tumor, which is related to the capsule, it's called, it's an A lymphocytic, it's a type of lymphoma that was associated with breast implants.

Dr. Levens (02:34):
And it's still only like one in 30,000, usually silicone, not saline. Implants have been a long time, textured. So that caused the big stir. And then there was a new black box warning from all the implants. And then I think the whole breast implant associated illness list has gone down even longer, brain fog, hair loss, et cetera, et cetera. So that's what I talk about it being not the majority of women that get breast implants, but more of the minority. But they're very vocal, they're online. And I mean, my associates in plastic surgery, very few of us are advocates for that side. There's been a lot of science, a lot of research, trying to figure out is it true, is it not true? We all see a lot more patients nowadays that do want to have their implants removed because they feel they're causing problems. But again, the science does not really back it up.

Dr. Levens (03:25):
They do tend to feel better afterwards. And some of my colleagues, unfortunately, have been promoting what's not really science and growing their practices as I'm an implant removal specialist, and I don't even put them in anymore and charging crazy money and big waiting lists and everything. And it's not considered, at least in my mind, proper. I don't think it's in the patient's best interest. I do take them out of patients that feel like they need them to come out. They do tend to feel better. It's hard to prove that they physiologically are better. But I still use them. And then the latest generation of implants is like, it's called the, so-called gummy bear. They're very thick gel, thick shell, they're still not lifetime devices. So the recommendation is after about three to five years, you should consider a breast MRI. Because examination and imaging like mammogram, ultrasound is not that reliable. So that's about where we are now. Exhausting.

Eva Sheie (04:26):
There's a lot, yeah, there's a lot there.

Dr. Levens (04:28):
Yeah.

Eva Sheie (04:29):
There's no shortage of controversy. So how do you return back to what's best for the patient in front of you?

Dr. Levens (04:37):
Well, I tell them everything. I mean, I have to tell you that 30 plus years ago when I started, we never talked about how long they'd last. So they are not lifetime devices. So it's like a hip prosthesis or a heart valve, or pacemaker, and they can break down and they should be considered not lifetime. And whether it's 10 years or 15 years or 20 years, you should monitor, do the examinations. I certainly don't think you should replace them just because it's been 10 years, because out there too. Oh, you have to replace them every 10 years. Well, that's potentially an unnecessary surgery. So I just present that all to the patients and they're rarely scared away. I do have patients that have had saline because they had saline when they couldn't get silicone and they say they're fine with them, let's put saline in and it's not as optimal. But I say, fine, we can put saline implants in. You could become a plastic surgeon with all the information you're getting.

Eva Sheie (05:36):
I sometimes think I am one already. Where can we find you?

Dr. Levens (05:41):
My office is at 1725 University Drive, suite 300, Coral Springs, Florida 33071. My phone number is (954) 752-1020. And then drlevens@drlevens.com is my email. Website is drLevens.com. I do have three Instagram pages, one with at Dr David J Levens, one is Plastic Surgery Talks, and one is Levens Med Spa.

Eva Sheie (06:15):
On this podcast, we bring you directly to the doctors who are, where before meets after. Links to our guest's website and contact info are in your show notes. Follow us on Instagram @wherebeforemeetsafter. If you're a board certified plastic surgeon and would like to be a guest or a sponsor of the show, go to wherebeforemeetsafter.com for more information. Where Before Meets After is a production of The Axis, the podcast agency for aesthetics, theaxis.io.