1. Capsular Contracture The most common cause for breast implant replacement is capsular contracture or hardening of scar tissue around breast implants. When a breast implant is placed in the breast, the body's first reaction is to form scar tissue around the implant. The scar tissue around the breast implant can become progressively tighter, leading to hardening of the breast implant. As the capsular tightening or contracture advances, the breast implant deforms and becomes painful. The rate of capsular contracture around breast implants is anywhere from 10 to 20% over the first 10 years with over 90% of these occurring in the first year after breast augmentation. Another important trend is the longer the implants are in place, the greater the chance of developing capsular contracture. So after several decades, the rate might increase up to 30%. A number of factors influence the development of capsular contracture. Breast implants used in breast reconstruction have a greater chance for developing capsular contracture than cosmetic breast augmentation. Breast implants placed under the pectoralis muscle have a lower chance for developing capsular contracture than implants placed on top of the muscle. Lastly, implants with a rough sand paper or “textured" shell have a lower chance for developing capsular contracture than smooth shelled implants. Once the capsular contracture progresses, the breast implant hardens leading to breast deformity and pain. After conservative measures have failed, surgery becomes the only option. During capsulectomy surgery, the scar tissue around the breast implant is removed and the breast implant is replaced with another implant. The frequent (10 to 30%) occurrence of capsular contracure makes it the most common cause for breast implant replacement. 2. Dissatisfaction With Breast Size As women age, their breast size can change due to pregnancy, weight change or aging alone. Breasts augmented in the past with implants may no longer be proportional to their figure. Breast implant replacement with a larger or smaller implant can address these concerns. Aging breasts also droop particularly after breastfeeding. Implant replacement with a larger breast implant can produce the extra volume necessary in to lift the breasts to a more youthful position. Another group of women simply wish they had larger breasts after breast augmentation surgery, while very few desire smaller breasts. Breast implant replacement yields more desired sizes in this group of patients. 3. Rupture Breast implant replacement is necessary in cases of breast implant rupture. Ruptured saline implants result in immediate change in breast size over a period of a few days. In such cases, implant replacement as soon as possible is necessary to keep the implant pocket from shrinking around the now deflated saline breast implant. Breast implant replacement is more difficult in cases where the implant pocket has contracted around the ruptured implant as the pocket now has to be expanded surgically before inserting the new implant. Ruptured silicone implants are more difficult to diagnose particularly with the new cohesive or “gummy bear" silicone implants. The first sign of a ruptured silicone implant is likely a change in breast shape or hardening of the implant. As soon as a ruptured silicone implant is suspected, a physical examination by an experienced plastic and reconstructive surgeon is imperative. Diagnostic tests such as ultrasound or MRI can be performed to confirm a suspicion for a ruptured implant. Breast implant replacement is indicated if a ruptured silicone implant is highly suspected or confirmed. 4. Rippling Rippling of a breast implant is visible wrinkling of the implant shell. Rippling typically occurs in women with thin breast tissue covering a breast implant. Rippling most commonly occurs at the bottom of the augmented breasts since there is the least amount of tissue and muscle covering the breast implant at that region. Surgical treatment of rippling is breast implant replacement with possible grafting inside the pocket to thicken the tissue covering the implant. Plastic and reconstructive surgeons typically recommend downsizing the breast implants during a breast implant replacement procedure for treatment of rippling. 5. Infection Breast implant replacement is typically necessary for infections of breast implants. As breast implants do not have circulation, it is difficult to treat infections effectively with antibiotics. Though mild infections can be treated with a trial course of antibiotics, more severe infections require removal of the breast implant. Severity of the infection is determined both by the extent of the infection or the infecting organisms. Implant replacement occurs once the infection has resolved. 6. Extrusion Breast implant extrusion occurs when a breast implant becomes exposed (extruded) through a wound at the breast. Breast implant extrusion is extremely rare and typically occurs in women with thin tissue covering their breast implant. One such circumstance is large implants placed in thin women with very small breasts. Implant replacement with a smaller implant is the treatment of choice in such cases. Implant replacement with a smaller implant places less tension on the wound thereby improving the chances of proper wound healing. 7. Personal Preference For Another Implant Material Personal preference to change breast implant material is another reason for implant replacement. Many women the 1990's chose to replace their silicone breast implants with saline implants due to a scare involving silicone implants. Silicone implants were pulled off the market by the FDA until November 2006 when the FDA re-approved them. During the period when silicone implants were unavailable to the general public, all women received saline breast implants. Since the approval of silicone implants in 2006, many women are returning to plastic and reconstructive surgeons to have saline implant replacement with silicone breast implants. The most common reason to have implant replacement among this group of women is the more natural feel of silicone implants versus saline. Despite this trend, certain women continue to desire silicone implant replacement with saline implants due to concerns for silicone leaking in their breasts. 8. Implant Age Many patients continue to go to their plastic and reconstructive surgeon with concerns of breast implants that are simply too old. Most of these women will have some degree of silicone rupture or bleed when their implants are removed. Implant replacement can be performed with either saline or silicone implants in this group of women. Though there is no age limit to breast implants, it is widely accepted that breast implants do not last forever. Anyone undergoing a breast augmentation surgery should be open to having at least one breast implant replacement surgery in their long lifetime. 9. Dissatisfaction With Implant Shape Not all breast implants are shaped the same. Some implants are tear-drop shaped while others are round. Each type of implant has its strengths and weaknesses, but most surgeons in the United States are currently using round implants. Women with strong preferences for one type of implant versus another can undergo breast implant replacement to receive the implant of their choice. 10. Animation Deformity Deformity of the breast implant with contraction of the pectoralis muscle is called “Animation Deformity." To treat the animation deformity, the breast implant is removed and the pectoralis muscle fibers divided to a greater extent. Implant replacement is next performed to complete the surgery. Some surgeons advocate replacing the breast implant in a different pocket above the pectoralis muscle. In this manner, contraction of the pectoralis will not impact the positioning of the breast implant.

Buprenorphine

Buprenorphine is a partial agonist of opioid receptors that carries a low risk of overdose. Buprenorphine reduces or eliminates withdrawal symptoms associated with opioid dependence but does not produce the euphoria and sedation caused by heroin or other opioids. In 2000, Congress passed the Drug Addiction Treatment Act, allowing qualified physicians to prescribe Schedule III, IV and V medications for the treatment of opioid addiction. This bill created a major paradigm shift that allowed access to opioid treatment in general medical settings, such as primary care offices, rather than limiting it to specialized treatment clinics. Buprenorphine was the first medication approved under the Drug Addiction Treatment Act and is available in two formulations: Subutex®, which is a pure form of buprenorphine and the more commonly prescribed Suboxone®, which is a combination of buprenorphine and the opioid antagonist naloxone. Suboxone is a unique formulation with naloxone that causes severe withdrawal symptoms when addicted individuals inject it to get high. Physicians who provide buprenorphine treatment for detoxification and or maintenance treatment in office must have special accreditation. The government requires these physicians to have the capacity to provide counseling to patients when indicated or to refer patients to those who do. Treatment of opioid addiction in an office can be cost-effective approach that increases the reach of treatment and the options available to patients. Many patients have life circumstances that make treatment in the office of a physician a better option for than specialty clinics. For example, a recovering addict may live far away from a treatment center or have working hours incompatible with the clinic hours. Addiction treatment is available in the office of a primary care physician, psychiatrist and other specialists, such as internists and pediatricians. Patients stabilized on adequate, sustained dosages of methadone or buprenorphine can function normally. Recovering addicts can hold jobs, avoid the crime and violence of the street culture and reduce exposure to HIV by stopping or decreasing injection drug use and other risky sexual behavior. Patients stabilized on medications can also engage more readily in counseling and other behavioral interventions essential to recovery and rehabilitation.

OB/GYN

An obstetrician/gynecologist, commonly abbreviated as OB/GYN, can serve as a primary physician and often serve as a consultant to other physicians. OB/GYNs can have private practices, work in hospital or clinic settings, and maintain teaching positions at university hospitals. OB/GYNs may also work public health and preventive medicine administrations. Obstetrics and gynecology are the two surgical–medical specialties dealing with the female reproductive organs in their pregnant and non-pregnant state, respectively, and as such are often combined to form a single medical specialty and postgraduate training program. This combined training prepares the practicing OB/GYN to be adept at the surgical management of the entire scope of clinical pathology involving female reproductive organs, and to provide care for both pregnant and non-pregnant patients. Obstetrician/gynecologist is a physician specialist who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system. This includes preventative care, prenatal care, detection of sexually transmitted diseases, Pap test screening, and family planning. An obstetrician is a medical doctor who specializes in the management of pregnancy, labor, and birth. They also receive specialized education in the health of the female reproductive system and surgical care. Much of their education focuses on the detection and management of obstetrical and gynecological problems. OB/GYNs have a broad base of knowledge and can vary their professional focus. Many develop unique practices, providing high-quality health care for women. OB/GYNs may choose to specialize in the following areas: An obstetrician closely monitors their patient's health during pregnancy and delivery. They diagnose fetus abnormalities or health issues of their patient and offer healthy living advice and treatment. They see their patients on a regular basis for health consultations, ultrasounds, and any of their patient's prenatal medical needs including forming a birth plan. The frequency of a patients check up often depends on risk factors and resources. Gynecology is a branch of medicine specializing in the disorders of the female reproductive system. Modern gynecology deals with menstrual disorders, menopause, infectious disease and development of the reproductive organs, disturbances of the sex hormones, benign and malignant tumor formation, and the prescription of contraceptive devices. A branch of gynecology, reproductive medicine, deals with infertility and utilizes artificial insemination and in-vitro fertilizations, a human egg fertilized in a test tube, and then implanted into the womb. Some gynecologists also practice obstetrics.

Executive Health

Executive Health Practitioner Associations are coming together to customize health programs for groups of executives and independent businesses with an objective of reducing the lost productivity time. At the core of many Executive Healthcare packages is an Executive Physical. In many instances, the doctor will travel to company facilities in order to perform a basic physical for all executive members. In others, as in the case of Elite IPA (Independent Practitioner Association), the office visit is an option, but executives are given the benefit of in-depth diagnostic treatment, which allows for an even more in-depth analysis of their health than what is typical. This level of the physical exam, given at a time that is convenient for the executive, is to have a positive impact on the bottom line. The average wait to see a physician is 68 minutes. There is no wait with the IPA Health associates for executives. IPA works around the schedule. Nor does IPA rush the visit. The visit is complete only when all of the concerns and questions answered. For those who prefer to communicate in writing, IPA is only an e-mail away. IPA physicians travel with hand-held e-mail devices for quick responses. Furthermore, IPA does not rush the visit. The visit is complete only when all of the concerns and questions are answered. Of course, there are times when one just wants to speak directly with the doctor on the telephone. One of the first things given to a new IPA patient is the doctor’s personal cell phone number. Wherever business or pleasure takes you, IPA is just a phone call away. Turn to IPA’s Executive Health for a complete executive physical that looks at health from all angles. True health and wellness is only achieved when there is a good understanding of the family history and personal medical history. IPA offers the latest in both non-invasive and blood-based cardiovascular screening testing. For early cancer detection, there may be reason to consider modern scanning approaches, including the PET technology. The integration of state-of-the-art cancer detection approach is a major feature of the program, as is ready access to leading specialists for preventive consultations.