The use of mammography before breast reduction varies.  Some plastic surgeons may recommend it and some may not.  According to Dr. M.J. Campbell and the authors of this study, between 31% and 72% of patients do not undergo mammograms before breast reduction surgery.   They suggest that the role of mammography in breast reduction is “ill defined” and there are “no formal guidelines for surgeons.”

Of the 207 breast reconstruction patients studied, 32 of them presented abnormal mammographic results, and all were false positives.  While the authors say the reason for this unexpectedly high number is unknown, they do offer a theory:

“The high incidence of false-positive results may be the result of poor image clarity, as obese women, typically with larger breasts, might have a thicker volume of breast tissue compressed between the mammography plates, which can lead to more scattered radiation and decreased image contrast and quality.”

You can read the entire study, “The role of preoperative mammography in women considering reduction mammoplasty: a single institution review of 207 patients” in the May 2010 issue of The American Journal of Surgery.

To dispel the first and most common misunderstanding, the nipple/areola is not removed.  Although the incision scars give this impression.  The fact is that the nipple areolar complex remains attached to the “pedicle” or the breast tissue remaining after everything else has been removed.  The most common method of breast reduction has been the “inferior pedicle” technique.  This means that the breast tissue is removed from the lateral, superior and medial aspects of the breast.  Or if one thinks about it as a clock, from about 7:00 to 5:00.  The remaining pedicle is the tissue between 5:00 and 7:00 up to the center of the clock.  This center is where the nipple areolar complex is.

There are a few issues I take with this technique.  First, the blood supply is limited so large reductions cannot be done.  Second, it removes the breast tissue in the upper part, or superior pole, of the breast which can lead to a flattened area between the collar bone and the nipple.  And finally a breast reduction also lifts the breast but this technique tries to push the breast up.  Since breast tissue is like gelatin that doesn’t work that well.  Don’t get me wrong.  Most surgeons use this technique and get good outcomes but I think there is a better technique.

I prefer a “superomedial” pedicle technique.  Although this was first introduced in the 1950’s it never caught on for unknown reasons.  However, around 10 years ago Dr. Elizabeth Hall-Findlay, of Canada, reintroduced the technique.  In this technique the breast tissue that is removed is the breast tissue that bothers women.  The tissue is removed from about the 4:00 position, around the bottom of the breast to the 11:00 position.

I think this is a better technique for several reasons.  First, as I said the tissue that bothers women with large breasts the most is removed.  Second, the pedicle or remaining breast tissue has fantastic blood supply so even the largest reduction is possible.  And finally the breast is supported from above like a suspension bridge-which works well for breast tissue.

So if you’re looking for a better breast reduction in the Washington DC area, call my assistant Katie to schedule your consultation.

In a November 1st interview with STV, Jeremy Piven commented briefly that he stopped drinking soy milk because he was afraid it might cause breast growth.  While talk show hosts and celebrity bloggers seem to think this is funny, they probably don’t know that 1) Piven might be right about soy milk and 2) for many men out there, male breasts are a major source of anxiety.

The purpose of this post is to direct readers to one article in an academic journal that may just validate his concern about soy milk.  Note that the article documents a single case – not a widespread scientific study. It should not be interpreted as conclusive.

This article in the May-June 2008 issue of Endocrine Practice documented an “unusual case of gynecomastia related to the consumption of soy products.”  According to the authors, a 60 year old male came in with 6 months duration of bilateral gynecomastia (male breasts) and no underlying conditions.  Because physical evaluations didn’t reveal a cause, they interviewed the man more thoroughly.

The patient “described a daily intake of 3 quarts of soy milk. After he discontinued drinking soy milk, his breast tenderness resolved.”

Gynecomastia is a hormonal and physical problem that may be caused by several different lifestyle factors.  Men who experience the condition should see a doctor to help resolve the underlying causes when possible.  If breast tissue persists after the cause is resolved, male breast reduction surgery is an option.

1. Better Breasts
Clearly the main goal of cosmetic breast surgery – participants of the study commented about improvements in breast shape and the clothing options that were now available to them as a result.  One patient with breast implants comments, “Some things are much more fun to put on, and the stuff that I used to wear looks way better–I am sure they looked good before, too–but I just fill in a bit more, look a bit more busty in them.”

2. Better Physical Well-Being
Breast reduction patients can get relief from back and neck pain, which often allows increased activity and better health.

3. Improved Psychosocial Well-Being
Patients in the study shared the positive changes in self perception and experiences in social settings. Increased confidence and feeling as if you fit the perceived “norm” of the female body are said to be a common benefits of breast surgery.

4. Improved Sexual Well Being
When people feel more attractive, they generally experience more sexual pleasure.  If breast implants or another surgery improve a woman’s perception of her self and her body, sexual well being can consequently improve.

5.  Great Surgeon-Patient Relationship
Women who experienced a good surgeon-patient relationship – with open, honest communication – expressed more satisfaction with breast surgery.  Patients who had an adverse relationship with the surgeon or staff reported being fearful, uncomfortable, and less satisfied.

6. Overall Satisfaction
Researchers also included the simple category of general satisfaction.  Would you undergo the surgery again?  One breast augmentation patient responds, “there is not one day that goes by that I am not so pleased that I did it.”

The article referenced is called “Satisfaction and quality of life in women who undergo breast surgery: A qualitative study” and you can find it here on BMC Women’s Health.

Here are two questions for our readers:

• Are there goals you have considered for breast surgery that aren’t listed above?
  
• If you have undergone a breast lift, breast reduction, reconstruction, or augmentation, were there additional benefits (or influencing factors) that these researchers haven’t identified?

Top of the Ticket, a Los Angeles Times blog, claims the tax would be a 10% charge tacked onto elective procedures like a tummy tuck, breast augmentation, rhinoplasty, and other popular cosmetic enhancements. Blog writers at the Speaker’s Lobby say the idea came from a treasury department official, and that the proposal is supposedly “off the table” for now.  Apparently, most finance committee members are not even aware of the tax proposal.

The so-called ‘Botax’ is being contested in many different ways, but here are two arguments that are being reiterated most.

First and foremost, such a tax would be paid almost entirely by women.  Despite the growing popularity of cosmetic surgery for men, women still make up over 90 percent of the patient demographic in the United States.  Obviously, imposing a tax such as the one in question would unfairly discriminate against women.  Think about it this way: would a tax be imposed on men who purchase expensive tattoos, fashionable clothing, or bodybuilding equipment?  It doesn’t seem likely.

Second, a common misconception that’s probably at work here (which may have been true in the past) is that only the rich and famous pursue cosmetic surgery.  Let’s not forget the 2004 survey conducted by the American Society of Plastic Surgeons; it revealed that nearly “a third of people considering plastic surgery reported average household incomes below $30,000.” Also, perhaps you remember the New York Times story by Natasha Singer titled “Who Is the Real Face of Plastic Surgery?” in which Ms. Singer discussed the fact that many patients choose to finance their cosmetic procedures like they would a new car.

According to news sources in the UK, Ms. Halep complained that her large (34 DD) breasts have slowed her reaction time on the court and caused discomfort. “It’s the weight that troubles me – my ability to react quickly”, she told The Sun.

In 2008, Halep won the junior French Open. She is now ranked 317th in the world.

Women pursue breast reduction surgery for a several reasons, increased mobility being just one of them. One breast reduction patient stated, “Before I didn’t want to run anywhere, [not] even across the street. If something happened, I would not run.  It was painful and embarrassing” (Klassen 2009).

Beside issues with physical activity, many women hope to alleviate irritation around their bra strap and underneath the breast, pain in the back and neck, and discomfort during sleeping.

The procedure can be described as a ‘normalizing’ experience for women. Once the surgery is complete, patients often say they are less self-conscious, they fit into more ‘regular’ sized clothes, and that they typify what is perceived as ‘the norm’ of the female body.

For more information on breast reduction surgery in Virginia, see this part of our homepage.

The breast reduction procedure involves designing a skin incision, removing breast tissue from around the pedicle, or remaining breast tissue that contains the nipple/areolar complex, then closing the reduced skin and breast.  The more modern technique that I use, a pedicle from the top rather than the bottom of the breast, gives outstanding long lasting results. (See breast reduction photos.)

So when I saw a young woman recently in consultation with large sagging breasts who told me that other plastic surgeons had suggested liposuctioning the breasts instead of a formal reduction I had to discuss it.

First, usually one of the significant problems with large breasts is that the nipple is too low or rather the breast is ptotic (sagging).  This is an unappealing appearance for the patients.  Formal breast reduction surgery not only reduces the breast size but also returns the nipple to its proper position, on a level just above the breast fold or crease.

Liposuction can reduce fatty tissue in the breast but does nothing to elevate the nipple.  Second, liposuction will remove fat and little else.  So in young patients who tend to have fibrous glandular tissue mixed with fat the fat will be removed leaving the fibrous tissue.  Unfortunately, these tissues aren’t evenly distributed and the breast will end up with a lumpy bumpy empty sack appearance.  Not my idea of artistic surgery.

So for the most part liposuction breast reduction doesn’t work with young sagging breasts.  However, in patients where there is significantly less fibrous or glandular tissue, the nipple is in the correct location and the skin has great tone liposuction may have a role.  But these patients are few and far between.  My advice to this patient was get the correct surgery that will give the best, aesthetically pleasing and predictable results.

If you’d like to discuss breast reduction, liposuction or any cosmetic issue contact our office at 703.752.6608 or click here to arrange a complementary consultation.

Journalist Finlo Rohrer of the BBC suggests that media – especially the tabloid scrutinization of celebrities – has popularized the concept of ‘man boobs.’ During the summer of 06, Tony Blair and UK conservative party leader, David Cameron, were pictured shirtless, which led several media outlets to “comment on their moobs.”

The weblog www.manboobs.uk, which according to one reader, has “plumbed the depths of poor taste,” pokes fun at the concept, but further popularizes it.  American television sitcoms like Seinfeld and Friends have done the same.  According to Rorher, this popularity could lead to “more men making their way through the surgeon’s doors.”

So what is the deal with male breasts?  Here are a few things you might not know:

• Gynecomastia that forms breast tissue in males, is a relatively common condition, often mistaken for simple excess fat. It can affect newborns, pubescent boys, and adults.  While it isn’t serious (unless it is a sign of something else), it can be painful and embarrassing.

• While obesity will often cause a condition of excess breast tissue, real gynecomastia is caused by a hormone imbalance.  In either case, surgery can alleviate the symptoms.

• Illegal drugs like marijuana and anabolic steroids can cause gynecomastia. Medications that are used during treatment for prostate cancer are also to blame.

• Gynecomastia may also be caused by genetic conditions like Klinefelter’s Syndrome.

• Surgery isn’t the only option: in cases of pubertal gynecomastia, the condition will often disappear over time or when puberty is over.  Other cases have shown improvement without any interventions; one case published in the June 2008 issue of Endocrine Practices documents a rare case of bilateral gynecomastia in a 60 year old man. The patient’s examination results were normal, but he reported a daily intake of 3 qts soy milk.  Once the patient ceased his intake of soy milk, his condition improved and his hormone imbalance was resolved.

While underlying issues like hormone imbalance and obesity should always be addressed,  many patients find that surgery is the right choice to correct excess breast tissue.  Surgery can restore a natural masculine appearance. If you are interested in learning more about male breast reduction, contact us for a consultation.

Cigarette smoke contains who knows, maybe 100 plus different chemicals that penetrate the body raking havoc with different systems.  First the nicotine attacks the blood vessels leading to the growth of new blood vessels withing the existing ones.  In addition fat released by nicotine’s effect on the brain becomes plaque in the blood vessels.  Combined, over time, this leads to a significant reduction in blood flow by constricting the vessels.  In addition the second major ingredient of cigarette smoke, carbon monoxide binds to the molecule that transports oxygen in red cells and displaces the oxygen.  This reduces the amount of oxygen that gets to healing tissue (ischemia).  In addition the third major ingredient in cigarette smoke, hydrogen cyanide, decreases the number of collagen producing cells and other inflammatory cells.

To put it in a little better perspective, smoking one cigarette significantly reduces blood flow to the skin for 30-50 minutes.  This means that for most of the day a smoker is ischemic or has significantly decreased blood flow to the skin.  The plastic surgery literature is filled with studies that have demonstrated the detrimental effects of cigarette smoking on wound healing.  But what does it mean to each patient.  For example if a patient smokes and desires a breast reduction, augmentation, mastopexy, abdominoplasty or any other surgery the risk of tissue loss, such as the nipple/areola, abdominal skin or belly button is incredibly high.

So, first stop smoking.  If you desire cosmetic surgery see your surgeon and your internist so you can get the help you need to quite.  I am a conservative surgeon and will request that patients quit at least 1 month prior to surgery.  In addition I will check a nicotine level at the time of surgery and if elevated will cancel the surgery.  A bad outcome from cosmetic surgery, because of smoking, isn’t worth the pain and aggravation to both the patient and the physician.

To start with some companies insist on removal of at least 500g (grams) of tissue on each side.  Other companies require more; I had one company insist on 900g per side!  This means that should less be removed they won’t pay.  And unfortunately 500g is significantly different between patients.   In addition instead of a breast reduction being a cosmetic/aesthetic procedure it’s an accounting equation.  Next prior to “preapproval”, whatever that means, most insurance companies require that the patient see their primary care physician, on at least 3 separate occasions, specifically for neck and back pain, intertrigo, shoulder grooving, headaches and any other symptom related to large breast size.   Next the patient must have the physician document that she has been properly fitted for a bra, wears that bra and possibly a second.  Next, the patient must have documentation that she has undergone intense physical therapy to strengthen neck and back muscles, has used multiple medications for pain/symptom relief and has achieved weight loss.

Finally, to add insult to injury if the insurance company does pay the physician it is usually only 15-20% of their fee.  Therefore, I am a strong believer in breast surgery as an artistic endeavor and not just to “fill the quota” for tissue.  So if you would like to have pretty breasts that are proportionate to your body after breast reduction please click here or contact our office at 703.752.6608 for a complementary consultation with Dr. Christopher Hess.