Category: Breast health


New Primer for Facing Breast Cancer

Madhulika Sikka’s A Breast Cancer Alphabet 

BreastCancerAlphabetFor years, my mornings have begun listening to National Public Radio’s “Morning Edition” broadcast. Madhulika Sikka, news editor for NPR, is a name I have heard regularly as a producer of newsworthy and provocative stories.  When I heard that she had written a book about her experience with breast cancer, my curiosity was aroused to put humanity to her faceless radio presence. I was very pleased by what I found.

Her new book, “A Breast Cancer Alphabet,” is part memoir of her personal encounter with breast cancer, part social commentary about the “Cancer-Land Culture,” and part intuitive self-help advise for any woman facing dark days.

Memoir

Madhulika describes how each detail of the day she received her cancer diagnosis was stamped on her brain. Sikka was at the White House for an interview with President Obama on the day she was waiting for the fateful call from her doctor.   She talks about the impersonality of having her breasts suddenly become objects of inspection by technicians, residents and doctors.  She calls this both manhandling and “woman-handling” of her private life.  She describes the “I is for Indignities” of mammograms, claustrophobic MRI exams, and special needle localization biopsy where your body has to adapt to the rigid Plexiglas box machine while positioned on your stomach.  

She describes her mastectomy and chemotherapy and how her new diagnosis affected her marriage and her relationships with her children. She describes how losing a breast and losing her hair gave her a different relationship to her body. The rapid change was assault.

“The thing about breast cancer is, it does things to your looks, and not necessarily good things. So, whatever category you fall into–plain or primpedyou find yourself thinking: Why am I so worried about looks right now?”

She recognized that if she needed to look better in order to feel better, “almost like applying a shield.”

Social Commentary

“Cancer-land” was the name she gave to the all-encompassing world of oncology, a land you can never leave once you enter. She was critical of the social pressure to use warrior images of the patient’s treatment endeavor. She disliked the gauzy breast cancer world of pink ribbons and sexy, glamorous warriors fighting back.

“But I am not a woman warrior. I am just a woman, a woman who has been diagnosed with a horrible disease; a woman who has gone through brutal surgery; a woman who has had her body poisoned to “kill” the disease. Can I just be a woman who is going through that? Can I not be a woman warrior? Please?”

Self Help Advice

A Breast Cancer Alphabet is readable, thoughtful and genuine. Her “R is for Reconstruction” chapter  encourages you to think of your reconstructive  plastic surgeon as your very own Michelangelo, who sees each woman’s breast rebuilding as an original artistic creation.Her “T is for Therapy” chapter encourages a variety of ways to heal from the Cancer-Land experience. 

“Therapy is all about healing, and the beauty of healing is that it can apply to your body, your soul, your mind, and your surroundings.

Her writing is beautiful and her word choice speaks to deep reflection on the subject of facing loss in life. Her book is about breast cancer, but is really a healthy reminder of how to respond to many types of dark days, whether they be the result of cancer or not.  

Announcements, Book Review, Breast health, Doctor-Patient Relationship

THE EVOLUTION OF SILICONE BREAST IMPLANTS

silicone-vs-saline-breast-implantwebThe American Society of Plastic Surgeons released its 2013 statistics in February. Breast augmentation was again the most frequently performed surgery and 72% of augmentations were with silicone implants compared to only 28% saline. The preference for silicone over saline is a reversal of trends from a decade ago. In the early 1990’s the US had a brewing controversy over the reliability of silicone, and the Food and Drug Association responded with a ban on their use except when part of a safety study. The implants remained available and widely used in Europe and South America. The FDA pre-approval study gathered data for fourteen years before returning the silicone implant to the list of approved medical devices. 2006 was the time of their return to the market, but the product had been modified to address the concerns that were raised. They have come a long way from where they started.    

Silicone implants are generally considered superior today because of their natural feel and durability.  The evolution of the modern Silicone Implant can be summarized:

  • First Generation: (1962) the original implant had a thick shell (0.25mm on average) filled with a thick viscous silicone gel. A Dacron patch was on the back. Implants were controversial when they first came out, but they rapidly became popular.
    Mark Twain once said, “A man with a new idea is a crank until the idea succeeds.”
  • Second Generation: (1970’s) About 10 years later the wall thinned out to 0.13mm and thinner gel was used on the inside. This change was undertaken to create a softer feel.
  • Third Generation: (1980s) A thick, silica-reinforced shell was developed for the silicone implant, to improve the strength of the outer envelope. This generation had much thinner gel content, compared to the thickness of syrup. The gel was more likely to travel when the shell was compromised. These are the implants that generated the controversy of twenty years ago.
  • Fourth Generation: (1992) The shell was made stronger and the gel was more cohesive in response to the problems that had been identified. The cohesive gel sticks to itself and is not likely to “ooze” out if the shell has a break down. 
  • Fifth Generation: (2012) The most recent modification to be approved by the FDA is the “gummy bear” or form stable implant. It has a much denser gel inside and is shaped with greater fullness at the bottom and texturing on the surface. This latest adaptation is being incorporated into practice in special circumstances. It allows more choices to personalize implant selection for each patient.

Twenty years ago silicone implants were held in suspicion. Careful clinical trials were undertaken to confirm their safety. Ten years ago, while the controversy was still brewing, most women chose saline implants for their augmentation.  Our thinking has evolved in response to the scientific data as well as patients’ experiences. The community of Plastic Surgeons will continue to evolve its thinking as new science and technology becomes available.

If ten years from now we are thinking the same as today, it is likely we are not thinking at all

Beauty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Doctor-Patient Relationship, Mommy Makeover

BRA DAY USA

Jewel-Kilcher---Performing-in-Lancaster--09National Breast Reconstruction Awareness Day

October is Breast Cancer Awareness Month, a  campaign to  educate women  about this all too common disease. Though the disease is common, the treatment can vary widely  and decisions for therapy need to be individualized. For the second year in a row, the American Society of Plastic Surgeons has sponsored Breast Reconstruction Awareness Day, or BRA DAY as part of the October campaign.  

This year’s spoke’s person for BRA Day is singer/songwriter Jewel, who has composed a song The song is entitle “Flower” and can be downloaded on I Tunes to benefit breast reconstruction patients.

Here are a few facts about public awareness of breast reconstructive options:

  1. Only 19% of women understand that the timing of their treatment for breast cancer and the timing of their decision to undergo reconstruction greatly impacts their options and results.
  2. Only 23% of women know that there are a range of options available for breast reconstruction.
  3. Only 22% are familiar with the quality of outcomes that are possible.
  4. 89% of women express the desire to know more about results of breast reconstruction prior to undergoing treatment for breast cancer.

The American Society of Plastic Surgeons urges women to make sure a plastic surgeon is part of their treatment team as they select options for treatment.  Here are a few online resources for breast reconstruction information.

American Society of Plastic Surgery

plasticsurgery.org/choices

BRAdayUSA.org

American Cancer Society

 

Breast health, Doctor-Patient Relationship, Mommy Makeover, Tubular Breasts

After the Weight Loss

scaleOne of the good things about our nation’s obesity epidemic is that there are so many people affected by it learning to reverse the weight gain. I often ask people what made them ready for change.  In my practice about half of the massive weight loss patients I see had bariatric surgery and half used diet and exercise alone. Make no mistake. Both are hard work.

The US population has obesity levels that are sky rocketing compared to our parent’s generation.  Theories abound about the cause of this unprecedented rise, but there is no doubt that it has become a serious public health problem. Health benefits of massive weight loss are large, but people often endure aesthetic and functional impairments that do not go away with weight loss alone.

Studies show that people are pleased with the changes in their appearance after massive weight loss, but their body image satisfaction decreases after 2-3 years.

The change comes from quality of life limitations created by the deflated hanging skin. They experience functional impairments including limited mobility from excess inner thigh skin, postural instability from abdominal skin excess, and increased hygiene demands from areas where the overhanging skin rubs.  16% report sores, rash and skin breakdown. 60% are dissatisfied with the appearance of their thighs.  Many continue to feel uncomfortable about their appearance which can have an impact on sexual and social interactions. The removal of excess skin by body contouring plastic surgery can contribute to better, physical, psychological, and social function. 

Studies have shown that 75-85% of those who have sustained massive weight loss desire body contouring surgery. The desire for plastic surgery after weight loss is twice as frequent in women and inversely related to age.

For more information refer to the December 2012 issue of Annals of Plastic Surgery.

 www.annalsplasticsurgery.com

Beauty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Breast Reduction, Cellulite, Mommy Makeover, Uncategorized, Weight loss

“COVERAGE IS HERE”

Washington-Health-Plan-FinderThere is a lot of change occurring in healthcare currently. One of the best changes is that health insurance will be available to many who were previously ineligible. “Coverage is here” is Washington state’s slogan to educate the public about the new state health benefit exchange. The federal Affordable Care Act has a mandate to increase the number of people covered by health insurance. Enrollment is beginning now for plans that go into effect January 1, 2014. There are 46 health insurance plans participating in the new system. Here are some common questions about the new health benefit exchange:

  1. Who is eligible for these plans?
    Individuals, families and small businesses can purchase insurance through these new plans.
  2. How much will it cost? 
    The cost will vary by how much coverage you choose and whether or not you are eligible for any fee reductions, based on your income.
  3. Will I be able to see my own doctor on the new plan?
    Each insurance plan will have its own panel of doctors.  You may be able to find the plan that your doctor works on before you purchase.
  4. If I have insurance through my employer will I have to go through the state healthcare exchange?
    Most individuals will be able to stay on their company’s plan.

 For more information go to www.wahealthplanfinder.org.

Announcements, Breast health, Doctor-Patient Relationship, Personal Fitness

Easing Recovery After Breast Augmentation

Most women that choose breast implant surgery have been considering it for a long time and are highly motivated. They are happy about their anticipated body change. As the day approaches, it is not uncommon to have concerns about putting up with post-operative discomfort. Here are a few of the ways that postoperative pain can be lessened and use of narcotics can be decreased:

  1. Nerve Blocks Just like the dentist injects the nerves to your teeth to make a procedure comfortable, it is possible to block nerves to the chest wall before breast augmentation. The nerves that bring sensation to the breast area run just below each rib on the chest wall. Injecting these nerves with a long acting local anesthetic, blocks painful impulses. I like to place a lot of local anesthetic in the tissues at the beginning of the procedure. I use “intercostal nerve blocks,” and I put additional local around the incision, beneath the muscle and along the breast fold to get the areas as pain free as possible. If the pain is blocked early in recovery the overall pain response appears to be diminished. These local anesthetic blocks do not eliminate the need for pain pills, but they do reduce the amount of narcotic that is required during recovery. 
  2. on-Q_pump“Pain Pump” Most women find their post augmentation discomfort is manageable, but for those that are particularly worried about dealing with it, I use a device called the On Q Pain Buster. This pain pump technology is an elastic ball filled with local anesthetic that continually delivers the medication to the surgical site through two tiny catheters. It provides good pain relief for three days following the procedure. For more information on the Pain Buster go to iflo.com/prod_onq_classic.php
  3. Exparel Exparel is a new formulation of an old local anesthetic. The medication bupivacaine has long been used for long acting block of pain impulses. It has been created in a slow release form by wrapping the medication in a “liposome.” A liposome is a fat coating that allows a 72 hour sustained release. This medication adds expense comparable to the pain pump, but it can be placed in the surgical area to help numb the discomfort. It provides one more tool to make recovery manageable. Basic information about Exparel can be found on www.everydayhealth.com/drugs/exparel.

I am happy to discuss these options with you when you come in for a consultation about breast enlargement to make your recovery as comfortable as possible.

 

 

Breast Augmentation, Breast health, Breast Implants, Doctor-Patient Relationship, Mommy Makeover

Current Trends Show Fat Grafting the Breast Is Popular

Breast Fat TransferA recent survey of board certified Plastic Surgeons confirms that plastic surgeons are using fat transfer with increasing frequency and success.
80% reported using fat in parts of the body other than breast.
70 % actively perform fat grafting to the breast.
62% used fat transfer as a good choice for improving breast shape and
contour in reconstructive breast surgeries.
28% of the surveyed surgeons employ this technique for cosmetic purposes.

 

 

Here are some of the ways this valuable technique is being used:

  1. Breast implants in thin women can show wrinkling or visible borders. Fat can provide a thicker soft tissue cover to hide implant characteristics.
  2. Fat grafts can cover prominent ribs or an irregular chest wall.
  3. Congenital breast problems, such as tubular breasts or lack of growth of one breast can be reshaped with fat transfer as part of the procedure.
  4. In breast reconstruction after mastectomy, fat can help camouflage the borders of an implant, or fill in a deficit in a flap contour or after a lumpectomy defect. Fat can treat irradiated tissue and seems to improve skin quality. 

There were nearly 72,000 fat grafting procedures reported by US board certified surgeons for 2012, according to the American Society for Aesthetic Surgery. 

For more detail visit the July 2013 issue if Plastic and Reconstructive Surgery, www.PRSJournal.com.

Anti-aging, Blepharoplasty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Breast Reduction, Fat Transfer / Fat Grafting, Mommy Makeover, Tubular Breasts

Studies Confirm Patient Satisfaction with Choosing Breast Augmentation

The purpose of aesthetic plastic surgery is to improve quality of life by enhancing one’s body confidence and comfort. A recent study published in the Aesthetic Surgery Journal looks at the satisfaction and well-being of a group of 155 women that had breast augmentation in 2008 and 2009. The data confirms that women report a significant improvement in their satisfaction with breast appearance, psychosocial well-being, and sense of sexual well-being after surgery. The anonymous survey was administered before and six weeks after their breast implant procedure. The scores were tabulated on a 1-100 point basis.

Here are some of the outcomes reported:

  1. Satisfaction with breast appearance improved from a score of 26 to 82.
  2. 79% were satisfied with the size of their breasts post operatively.
  3. Sense of wellbeing increased from a score of 52 to 85. 
  4. 97% reported they felt attractive, up from 51%.
  5. 96% felt more self-assured, up from 51%.
  6. 94% reported that they felt confident most or all the time, improved from 53% prior to surgery.
  7. 91% answered that they felt confident sexually after their augmentation, up from 46% preoperatively.

The research did not examine those women that did not report improved quality of life after the procedure. This group was small but it would be valuable to gain insight on why they did not achieve the same satisfaction. 

The questionnaire that was used is called the BREAST –Q. It was developed to meet national and international standards of outcomes assessment for evidence based medicine. For a closer look check out the Aesthetic Surgery Journal 33(2)245-251, 2013.

Anti-aging, Beauty, Body Contouring, Breast Augmentation, Breast health, Breast Implants, Personal Fitness

Latest Research on Breast Implant Sizing

WomanwithpinkbraBreast augmentation ranks first in frequently performed plastic surgery procedures. Perhaps the most important factors in assuring satisfaction with the outcome is having the surgeon and patient agree on an implant size that is suitable.  Reoperation for size change of implant happens about 8-9% of the time and can be avoided with careful decision making in advance. The December 2012 edition of the Journal of Plastic and Reconstructive Surgery has a new study published on ways plastic surgeons select implant sizes for their breast augmentation patients. 

“Surgeons that rated breast diameter as the most important variable in size selection had the lowest reoperation rate for size change”

“Choosing a breast implant for a prospective patient is not a straightforward task.”

A survey was sent to 3000 members of the American Society of Plastic Surgeons inviting them to report how they selected implant size prior to surgery and what their reoperation rate was for size change.  Surgeons ranked variables in the following order:

  1. Woman’s desired size
  2. Breast Base Diameter
  3. Amount of skin/breast to cover the implant
  4. Distance from the fold beneath the breast to the nipple, unstretched
  5. Stretched skin distance from fold to nipple
  6. Skin “pinch” thickness
  7. Sterna l notch to nipple distance
  8. Distance between nipples
  9. Diameter of areola
  10. Nipple projection

The variable that could be related to a decrease in reoperation rate for size change was the measurement of base diameter. In the event of a conflict between patient’s desired volume and implant width, surgeons who re-educated their patients about the reasons for  different size choice had a lower repeat surgery rate than those who compromised with their patients in the event of a conflict. 

 

www.PRSJournal.com

 

Body Contouring, Breast Augmentation, Breast health, Breast Implants, Doctor-Patient Relationship, Mommy Makeover

Staying Fit as the Seasons Change

Seattle had a beautiful summer this year that stretched out through most of September. It was easy to stay inspired for outdoor sports. As the leaves are turning and daylight is shorter don’t let weather hold you back from training. Here are a few suggestions:

  1. Train with friends. Having a buddy helps to keep you accountable. It is too easy to let yourself off the hook when you are tired, and besides you can accomplish your social goals at the same time as your fitness goals. Consider it multi-tasking.
  2. Work on your core. The stronger your trunk muscles are, the better your balance and stability.  It enhances any other sporting activity. Yoga and Pilates classes are popular ways to strengthen your abdomen and back.
  3. Increase aerobic endurance. Thirty minutes three times a week is an important baseline for aerobic fitness. Make that 30 minutes increasingly difficult to improve stamina after your routine becomes habit.
  4. Return to the gym. Spinning classes, swimming pools and treadmills are easier to use when there are others around. The energy from other people is contagious. Sports equipment at home is a great idea, but it seems to collect dust before it ends up in garage sales.

What ever you do, be adventurous, creative and open-minded. Staying fit is good for your mood, good for your brain, good for generating energy, and good for your health. Don’t let it lapse when it is unseasonable!

Anti-aging, Beauty, Breast health, Breast Reduction, Doctor-Patient Relationship, Personal Fitness

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