Gynecomastia or male breast development can be a very traumatizing experience for young men. It is common during puberty for boys to experience some breast development and in a few cases it persists beyond puberty. If the gynecomastia persists for a long period of time the young man may be referred to a plastic surgeon for surgery. Often the young man is concerned about the appearance of his chest and may be wearing heavy clothes to camouflage his chest and avoiding situations where he might have to take his shirt off such as swimming . The surgical approach to gynecomastia can be done through an incision around the areola or , as is my preference , through an incision on the lateral chest. I prefer the incision on the lateral chest as it does not draw attention to the breast area and can more quickly allow the boy to resume normal activitie such as taking his shirt off the play basketball without anyone questioning the scar and what procedure he might have had done. If there is a recent scar on both nipple areola complexes I think this is more likely to raise question than if the are two asymmetrically placed scars an the lateral chest which are not both seen at the same time when one is looking straight on at the young man. After surgery the young man does need to wear a compression vest but there are ones out that can easily be worn under a T shirt without being seen. It may take weeks or even several months to see the full effect of the surgery so the winter months are goo d times to do the surgery so that everything is as healed as possible before the next swimming season rolls around.
Breast reduction patients are some of the happiest patients that plastic surgeons see. The relief from neck and shoulder pain is almost immediate. There are some common questions that all reduction patients ask. First - ”Will I need a lift as well?” Answer - a reduction is also a breast lift. The difference between a reduction and a breast lift is that a reduction lifts the breast and at the same time reduces the size of the breast. A breast lift only lifts the breast but does not change the size of the breast. Second- Will my insurance cover this? Answer - In many cases. Insurance companies have set criteria for the amount that breasts need to be reduced in order to qualify as a medically necessary procedure and be covered by insurance . In general a reduction of two or more cup sizes will usually be covered. In addition chronic neck and shoulder pain as well as grooves in the shoulders from the bra straps digging in ( sounds painful!) are evidence that insurance companies look at in order to determine if they will cover the procedure.
There has been a lot of news recently about PIP implants and concerns that not only do they rupture at a rate higher than other implants but the silicone inside may not be medical quality. Fortunately these implants were never sold in the United States. PIP did sell prefilled saline implants in the United States for a while (apparently about 35,000 were sold). However when the FDA asked the three implant companies ( Inamed -now Allergan, Mentor , and PIP) in 2000 to submit a formal application (known as pre-market approval) only two of the companies received approval. The two companies that received approval - Inamed (Allergan) and Mentor- are still the only two companies selling silicone implants in the United States. PIP has stopped selling its prefilled saline implants in the U.S.A.
There were several reports over the holidays about the numbers of cosmetic surgeries and even reconstructive surgeries going up. Is this just a typical cycle or is this an indication that the economy is improving? It is true that all hospital admissions went down during the past few years - a direct result of the recession. When you are worried about the stability of the job market you are unlikely to take time off from work for an elective procedure or want to dig deep to pay those deductibles. There for it is a good sign that elective procedures were up in December. There is also the timing factor though. Although there is no “convenient’ time to schedule an elective procedure - there are less inconvenient times. Timing a surgical procedure around a holiday can allow you to “steal” some more time off work. A lot of offices are closed between Christmas and New Years which can allow you to to recover without sick days. There are other times during the year when you can “steal “ extra time off – long weekends such as Memorial Day, Labor Day or even the 4th of July are examples. Often people expect offices to be closed or at least not fully staffed so your absence is not questioned. Plan ahead though as lots of other patients might have the same idea!
I am excited to announce my participation in an IRB approved study using Seriscaffold for breast reconstruction. Seriscaffold is a FDA approved silk based product which is used to provide soft tissue support and repair during the reconstruction after a mastectomy. For patients who are undergoing breast reconstruction with a tissue expander Seriscaffold is used to support the lower pole of the breast and to help maintain the position of the pectoralis muscle.
I recently returned from a medical mission in Qoya Peru. The organization sponsoring the mission was Women for World Health. Qoya is in the Sacred Valley about 40 kms from Macchu Picchu. We saw a mixture of patients with clefts lips to burn scars. It was exciting to have my sister-in-law Ginger along on the mission . Ginger is a fantastic recovery room nurse who has always wanted to go on missions but was busy raising their four sons. At last she had a chance to go on a mission and hopefully we will be able to go on another one soon together. As always we came home with a renewed sense of how lucky we are and how many opportunities we have . It truly is a privilege to be able to give something back I always get back so much more than I give on a mission.
The American Society of Plastic Surgeons released their statistics for 2010 yesterday. The overall number of cosmetic procedures increased 5 % in 2010. This may represent some pent-up demand as patients return who had put off cosmetic work when the economy was so unstable. Reconstructive procedures also increased 2% in 2010 with breast reconstruction up 8% ! This puts breast reconstruction into the top five reconstructive procedures for the first time . The other top reconstructive procedures were (1) tumor removal (2)laceration repair (3)scar revision and (4) hand surgery. Good news ! Hopefully this means that our work to get the word out to patients undergoing mastectomies about their reconstructive options is working!
A new national registry has been established by the American Society of Plastic Surgeons and the FDA to document reported cases of a rare condition , Anaplastic Large Cell Lyphoma (ALCL) which is possibly associated with breast implants. Thirty four cases of ALCL in patients with breast implants have been reported in the world and that is in the 5-10 million women who have implants world wide. Most of the patients presented with late onset seromas ( swelling) around their breast implants . The condition appears to arise in the capsule surrounding the implants and is not breast cancer. Currently the recommendation for women who are found to have this condition is to remove the capsule ( scar tissue) which surrounds the implant as well as the implant. Safety is always of first concern and I concur with the the American Society of Plastic Surgeons , the Aesthetic Society as well as both implant companies (Mentor and Allergan) in supporting efforts to research this rare condition .
Dr Jorge Palacios just gave me the most wonderful Christmas present. I was with Dr Palacios in Ecuador on a visiting educator trip where we were training young surgeons to do cleft lip and palate surgery. One of the patients was a 45 year old woman with an unrepaired cleft lip. Dr Palacios assigned her care to me. in 45 minutes I was able to repair her lip- a 45 minute operation for which she had waited 45 years !! I am so grateful that I was able to do this for her. She will be able to smile at her children and her husband for the first time . To be given a chance to help another person like this is priceless.