Friday, December 29, 2006

A triplet of features on breast cancer

A few interesting things on breast cancer caught my eye the last week or so.

For starters, the Tuesday (Dec 26) New York Times had an outstanding interview with Dr. V. Craig Jordan, one of the directors at the Fox Chase Cancer Center in Philadelphia. The topic of discussion was how to make sense of the recent story on the dramatic decrease in breast cancer rates we've observe since hormone replacement therapy (HRT) after menopause became less common.

Adjacent to that was a story revisiting the effectiveness of women performing self breast exams. Promoting self-exams to detect breast cancer has been dogma for years, but does it work? The research seems to indicate that it is not very effective and leads to a significant number of unnecessary procedures. A number of epidemiologists have advocated dropping self-exams as a recommendation, but have run into a buzz-saw of controversy from breast cancer activists and some physicians.

I personally think there is little utility (at least on a systems-wide analysis), especially when women have fibrous breast tissue. It is impossible for me in fibrous breasts to sort out anything. I've been very impressed with the ability of ultrasound to quickly characterize masses accurately and proceed to needle biopsies as needed. On the other hand I have had patients find lumps themselves that do in fact turn out to be cancer. For most women, annual mammograms and a physician breast exam are going to be effective.

There is a classic TV ad about self-exams from the Canadian Breast Cancer Society from a few years ago that still cracks me up where a geeky teen offers up his services for breast exams to the smooth sounds of Barry White. America is too uptight to ever use humor this effectively.

Thru the magic of you can click on the screen below to see it:

The most odd-ball feature is this one from the BBC titles "Housework cuts breast cancer risk.".

The research on more than 200,000 women from nine European countries found doing household chores was far more cancer protective than playing sport.... Housework cut breast cancer risk by 30% among the pre-menopausal women and 20% among the post-menopausal women

I'll be sure to get a reprint of this for my wife :)

Friday, December 22, 2006

Phony plastic surgeon is ordered to pay $5 million

Another tragic example in the Latino community of a poseur performing cosmetic surgery came to it's conclusion recently. If you remember last summer, this well-documented episode near Boston where someone died after complications from liposuction performed in the basement of an apartment complex.

Cuban national, Reinaldo Silvestre, operated in an unliscened medical clinic in the late 1990s in Miami Beach. He offered very low rates and dealt primarily with immigrants who wanted plastic surgery. Silvestre, "the Butcher of South Beach", abruptly abandoned the United States in Miami Beach in 1999 when investigations into his practices began after a number of complaints. He was collared five years later in Belize, where he was performing surgeries and aparently a faculty member at a local medical school. One of his students saw an America's Most Wanted episode profiling him and alerted authorities.

A victim of a botched breast surgery necessitating nearly $100,000 USD in reconstructive surgery was awarded nearly $5 million USD for pain and suffering. As a foreign national with no assests here, it would seem likely that little if any of this award will be realized (and remember 30-50% of the award often goes to the attorney).

Apparently Silvestre also had occasion to videotape surgery (a screen capture pic is shown below) on a male patient, former Mexican national champion bodybuilder, Alex Baez. Baez had gone in seeking pectoral implants, but awoke to find he had been given female breast implants. Baez's attorney says his client was anesthetized with horse tranquilizers, and actually woke up several times during the surgeries. El doctor Silvestre was also demonstrated using kitchen utensils for parts of the surgery.

Spencer Aronfeld, a lawyer for several alleged victims of Silvestre, said Mr. Baez wanted pumped-up pectorals but came out of surgery performed by Silvestre with what looked like women's breasts
"So this big bodybuilder from Mexico wakes up from this surgery expecting to look like Tarzan and instead he looks like Pamela (Anderson Lee), Dolly Parton,"
A detailed narrative from Maxim magazine about this can be read here.

That is not what male pectoral implants should look like (if you couldn't figure that out already)! They tend to be low-profile flat devices traditionally molded from semi-solid silicone rubber rather then silicone rubber shells filled with gel as implants for breast augmentation or reconstruction are.

Sunday, December 17, 2006

What to make of suicide rates and breast augmentation patients?

A trend has been identified in several studies of patients with implants which briefly merited some attention last summer, namely that increased suicide rates has been observed among implant patients in some of the large European databases.

Does this suggest that implants actually cause suicide? Absolutely not.

Rather, it likely reflects selection bias (a phenomena where accurate conclusions from statistical analysis is undermined) in the studied patient groups.

What's that in this instance?
An increased incidence of mental illness and depression among prospective patients.

One of the Danish studies reported that the women with breast implants had almost double the rate of psychiatric morbidity as those in the control groups. This data is easier studied in countries with centralized health care as exists in Canada & Western Europe, and is where most of this information comes from.

It has been suggested that a psychiatric condition, body dysmorphic disorder may explain the elevated suicide risk among breast implant recipients. Earlier research from the University of Pennsylvania Center for Human Appearances (Yes, there actually is such a thing!)suggested that as many as 15% of cosmetic surgery patients have the condition, characterized by preoccupation with small or imagined defects in appearance.

About 80 percent of breast implants in the United States are for cosmetic reasons and 20 percent for breast reconstruction after breast cancer surgery. Dr. Leroy Young, a Plastic Surgeon from St. Louis,one of the world's experts on silicone implants and a respected basic scientist speculated a few years ago that the data trickling in may in fact no longer be applicable to today's breast augmentation patient

In the 1960s and '70s, women in the U.S. who had breast augmentation tended to smoke, drink alcohol, and report other risk-taking behaviors more often than the general population, but our findings suggest that this is no longer the case,”.

A recent survey of 5,000 women in the U.S. who had either received breast implants or were considering them found that the women were less likely to drink alcohol and smoke than the general population. Young says these women had a lower frequency of signs of depression than did the earlier generation of American implant recipients and the women in the European studies

Is there a plausible explanation for breast implants causing suicide?
Not really. Some anti-implant activists are suggesting something along the lines that implants cause so much psychic or physical pain that it must be driving these women to killing themselves.

Jacques Brisson, M.D., D.Sc., of Laval University in Quebec City and lead author of the largest study which has noted this phenomena had this to say:
"Recently, it was suggested that complications experienced by women who received breast implants could contribute to increased despair, which may increase the chance of suicide," the authors said.

However, our findings to not support this hypothesis because we found no increase in the standardized mortality ratio for suicide with increasing length of follow-up," they said. "Additionally, there were no differences in suicide rates between implant patients and other plastic surgery patients

The most recent such study, presented by Dr. Brisson, was performed in a population much larger then the others in a group of Canadian women. (see here for a blog entry I did on this last summer) Like the other work, there was an elevated suicide rate. However, the suicide rate was similar to that of women who had other cosmetic plastic surgery procedures which further strengthens the belief that breast augmentation (and indeed all cosmetic surgery) has a correlative relationship to depression/mental illness rather then a causative one to suicide.

Will today's patients have similar such rates or will observations like Dr. Young's ultimately prove correct. Check back in 10-15 years.

Saturday, December 16, 2006

Plastic Surgery Stocks

I saw a really interesting analysis of the stock prospects of several of the major cosmetic medicine & Plastic Surgery industry companies on The, specifically the heavy hitters Allergan-Inamed, Mentor, & Medicis are all spotlighted, each incidentally is up ~10% for this year.

There are a lot of competing products hitting the market as Allergan's new injectable filler, Juvederm tries to unseat the popular Restalyne (from Medicis). Likewise, Medacis' Reloxin (a drug similar to Botox) should hit the market in the US next year. Hopefully that will lower the price of some of these injectables.

Things are set to heat up in the US implant market with the recent silicone implant reintroduction. The article writes,

"Allergan and Mentor are the dominant players in this $500 million to $600 million global market segment. Most analysts expect 30% to 40% first-year conversion rates of the saline-implant market, but early gains may be greater, as a result of pent-up market demand. The anticipated switch to more profitable implants supports a strong revenue outlook and further margin upside for these two players in '07."

I personally think an estimate of 30-40% market share for silicone is on the low end talking to other surgeons. Meanwhile, my savvy Plastic Surgery stock-pick of Ivivi is now sitting a full 10% below it's IPO price. I guess my kids will be going to state instead of Princeton :)

Sunday, December 10, 2006

Breast reconstruction using own twin

In this weeks' PEOPLE magazine, there's a feature on twin sisters from Pennsylvania who underwent an unusual type of organ transplantation. After radiation treatments and a failed implant-based breast reconstruction, Naomi DeSalvo Whinnie turned to micro-surgeon extraordinaire Dr. Bob Allen in Charleston, SC for help.

Dr. Allen is the father of the "DIEP" flap for breast reconstruction, an operation that uses microsurgical techniques to transfer tissue from the abdomen to the chest and performs more then 100 hundred such reconstructions annually. The catch here is that the tissue in this case was provided from the abdomen of Mrs. Whinnie's identical twin sister, Nina DeSalvo Hildebrand. This operation can be performed on twins without intense immunosuppression because their immune systems do not recognize the tissue as foreign and reject it. This is the third such twin-twin DIEP flap Dr. Allen has performed in what is likely the largest personal experience in the world.

Seen below are the sisters shown recovering in a shared hospital room.

Friday, December 08, 2006

The trial bar searching for new targets.

Two articles in today's Wall Street Journal provide an interesting lesson in the way the trial lawyers treat medical device issues.

The first article,"Panel Supports Drug-Coated Stents " describing the conclusions of an FDA advisory panel on drug-eluding stents (small metal tubes which prop open clogged arteries) which have the potential for keeping arteries open longer then the traditional bare metal stents. An issue at those hearings is whether the drug-coated stents are tied to a small but significant danger of potentially deadly blood clots. This is still being sorted out, but most feel these types of stents have saved a significant number of lives and it is likely there will be more refined indications on who benefits more or less from using these.

Adjacent to this is an article titled "Stents are Galvanizing the Plaintiff's' Bar"
Some patients and lawyers aren't waiting (for studies)to file lawsuits, claiming manufacturers of the devices failed to warn them of the possible clotting risks, and of a severe itching problem caused by a hypersensitive reaction they allege can develop after stent implantation

The case comes amid a surge of lawsuits against pharmaceutical and medical device companies. The shift has taken place as massive lawsuits against tobacco and asbestos companies have dried up....

So as the perpetual feeding trough of the asbestos issue is disappearing, you can see each & every drug and device being eyed as the next cash cow for extorting settlements from industry. If the silicone breast implant debacle of the early 1990's taught us nothing, it's that science should not be established by lawyers in a court but by researchers in clinical trials. Does the plaintiff bar actually care about the truth in these cases as they're furious registering sites like to recruit clients?

Thursday, December 07, 2006

Safer surfing on the cheap

As an aside from Plastic Surgery I'd like to highlight a few FREE resources that will make your Internet experience safer. As computer viruses, mal-ware (programs that cause problems with your computer), email SPAM, tracking "cookies" (bits of code that can trace your activity), key-stroke logging (programs that record all keyboard activity), and Phishing (obtaining secure information using false pretenses) are increasingly common, you should not be using the Internet "naked".

There are many excellent commercial software programs (ie. Norton's, McAfee, etc..) and built-in Windows features which help with this, but you can get many of these types of programs for free which are superior to the included Windows programs. (follow the highlighted text for direct links)

AVG Anti-virus has an outstanding free anti-virus with updates for non-commercial users

Spybot S&D is the atomic bomb for destroying malicious software, tracking cookies, & key-stroke logging programs

Zone Alarm is an award-wining firewall which has a great bare-bones free version

Tuesday, December 05, 2006

Two new breast cancer devlopments worth watching

A few intersting things in the press about breast cancer.

First, a new technique of ultrasound imaging of breast masses called "Elasticity Imaging" is being described. It attempts to characterize mass as benign or malignant based on the degree to which it can be manually compressed and the speed with which it resumes it's original shape. The potential benefit of this is that it avoids requiring obtaining a tissue biopsy (by a surgeon or radiologist)and evaluation by a pathologist. The risk is that ultrasound is very dependent upon the skill and subjective judgement of the user. The accuracy of this is still being evaluated in larger clinical trials which will compare the ultrasound interpretation to the actual biopsy reports.

Second, RU-486 ("the abortion pill") has shown the potential to signifigantly reduce the development of breast cancers in mice who are bred with the BRCA-1 gene, which is one that causes breast cancer in women by causing the hormone progesterone to more actively stimulate breast tissue proliferation. More than half of women with this gene will develop breast or ovarian cancer by age 70.

Thursday, November 30, 2006

Recovering from the breast implant panic

Editorials continue to trickle in....

The editorial from today's Chicago Tribune , reflecting on the treatment of breast implants here in the USA.

The whole episode was a case study in the folly of policymaking by anecdote..... So why did it take a decade and a half for the FDA to let these implants back on the market? One reason is government regulators don't like admitting they were wrong. Another is that they prefer to err on the side of excessive caution. No one will get sick from an operation she is not allowed to have, which means no bureaucrat will be blamed for the illness.

Another comment from the NewsBusters blog titled "Deflating Hysteria: Implant Scare of Early '90s Had No Merit"

From the Saginaw (MI) News "Greed, implants and iffy science"
The FDA's approval this month still doesn't address the shortcomings of a legal system that steamrolled over science and caused manufacturers to suspend or quit marketing of silicone based medical devices. Its anyone's guess how many lives and health hardship that cost....It's a travesty of our product liability system that it took so long and cost so much to give women the choice. The only big winners in this legal-medical saga were the lawyers. (emphasis mine)

From the Business & Media Institute " article "Unhealthy Bias in Implant Stories, Then and Now" which focuses on the media treatment from the early 1990's culminated in the infamous Connie Chung hit piece on "48 Hours"

From AEI comes "Two Cheers for the FDA - The recent decision to allow silicone breast implants was a sadly unusual victory of evidence over fear for the agency."

Wednesday, November 29, 2006

Apology long overdue to Dow Corning over silicone implants

One of the true victims perpetrated by the American Silicone Breast Implant crisis of the early 1990's was Dow Corning and it's shareholders. Based on nothing but innuendo, a group strong-armed trial lawyers suited the company out of existence. In fact, Dow is still paying settlement money based on claims we have since demonstrated were largely fiction (to the best of our medical evidence).

You don't suppose the law firms who pocketed tens to hundreds of millions of dollars are offering to refund this now that the FDA has officially come around on this (long after science and the rest of the world did)?

An editorial I found asks this same question.

From the editorial page of Midland Daily News:

Something was missing in Friday's announcement by the Food and Drug Administration that it was lifting a 14-year ban on silicone-gel breast implants: an apology to Midland's Dow Corning Corp. That's the least the agency could do, since it was the FDA's ban on the implants in 1992 that sparked an onslaught of lawsuits -- 19,000 of them -- and forced Dow Corning into Chapter 11 bankruptcy to keep the company afloat.

Billions of dollars later, Dow Corning emerged from bankruptcy. Perhaps along with an apology, the FDA should have offered some help in paying those billions the company had to shell out to settle its legal claims. Isn't that the least the FDA could do, since it played such a huge role in casting doubt about the silicone-gel implants the agency now is saying are safe?

Dow Corning officials, in their response to the FDA announcement, took the high road, simply pointing out that this case shows "the critical need for science literacy and its importance in making informed decisions, as individuals, as government agencies and as a society."

We'll take it one step further. This case shows the problems that occur when a government agency becomes a pawn for a class-action-eager civil lawsuit system willing to take down an innocent company for the sake of the almighty buck.

The FDA's announcement Friday was welcome, but it was more than a decade overdue.

Friday, November 17, 2006

Silicone breast implants approved today!!!!!

Wow! I didn't see this coming so soon. The FDA unexpectedly came in on the silicone breast implant approval. Sometimes it is amazing when science trumps politics as it did with this long overdue approval.


From the FDA press release:
“FDA has reviewed an extensive amount of data from clinical trials of women studied for up to four years, as well as a wealth of other information to determine the benefits and risks of these products,” said Daniel Schultz, M.D., Director, Center for Devices and Radiological Health, FDA. “The extensive body of scientific evidence provides reasonable assurance of the benefits and risks of these devices. This information is available in the product labeling and will enable women and their physicians to make informed decisions.”

"FDA’s decision to approve these implants was based on a thorough review of each company’s clinical (core) and preclinical studies, a review of studies by independent scientific bodies and deliberations of advisory panels of outside experts that heard public comment from hundreds of stakeholders.

In the past decade, a number of independent studies have examined whether silicone gel-filled breast implants are associated with connective tissue disease or cancer. The studies, including a report by the Institute of Medicine, have concluded there is no convincing evidence that breast implants are associated with either of these diseases. However, these issues will be addressed further in the postapproval studies conducted by the companies.

“The silicone breast implant is one of the most extensively studied medical devices,” said Schultz. “We now have a good understanding of what complications can occur and at what rates. We also know that women who get these devices will probably need to have additional breast implant surgery at least once. This is valuable information for women who may be considering these products. ”

Thursday, November 16, 2006

12 year old liposuction fallout

A story about a 12 year old undergoing high-volume liposuction continues to draw fire. ABC's Diane Sawyer profiles this in a televised segment you can see here.

I first read about this on Tony Youn's delightful Celebrity Plastic Surgery Blog a few weeks ago. It's been touched on as well in John Disaia's popular "Truth in Cosmetic Surgery Blog", and Plasticized which are the only Plastic Surgery themed blogs I've found worth reading (most blog searches pull up trash which are essentially marketing vehicles with no content)

In a syndicated piece on the ASAPS has commented, including a quote from Peter Rubin, one of the real thoughtful Plastic Surgeons doing both clinical & basic science research on treating obesity after massive weight loss.

The American Society for Aesthetic Plastic Surgery (ASAPS) announced today that there is no scientific evidence to support the safety or efficacy of large-volume lipoplasty (liposuction) for weight loss in obese children. Further, the Society noted that liposuction is not an effective treatment for obesity in any patient - adult or child. The statement was issued in response to recent media reports of an obese 12-year old American female who underwent large-volume lipoplasty.

Clinical studies have demonstrated that (lipoplasty) does not have the same health benefits (e.g., reduced risk of heart disease, diabetes or benefits to metabolism) as diet and exercise. It does not address the important lifestyle and diet issues necessary for long term weight loss success. The best liposuction candidates are close to their ideal body weight and have discrete fat deposits that, when treated, will result in a positive change in contour, not obese patients looking for weight loss.

“This treatment plan sends a dangerous message to our young people, that plastic surgery is a cure for being overweight. That is simply not the case,” said J. Peter Rubin, MD, of the Aesthetic Society’s Body Contouring Committee and Assistant Professor of Plastic Surgery at University of Pittsburgh. “I would question the ability of a 12 year old girl to fully appreciate the scope of possible complications and make a reasonable decision about an elective cosmetic procedure

The treatment offered to this 12 year old seems wrong on so many levels.

Tuesday, November 14, 2006

Extreme Makeover has now officially jumped the shark

The return of Plastic Surgery reality show "Extreme Makeover" lasted one week after ABC has pulled the plastic surgery series after one low-rated airing.

Thank you God!

Monday, November 13, 2006

Slow news day: Ivivi - Allerghan deal & the election's effect on silicone breast implants

It's been a little slow on things interesting me to write about.

Two things off the wire:

1) Good news: Ivivi Technologies has announced a world-wide distribution agreement with Allergan for its devices which should really allow this pulsed magnetic field device company to establish a presence in post-op management of pain & swelling. Allergan is the parent company which owns Inamed (the breast implant & Lap-band manufacturer), BOTOX, some of the new injectable fillers.

2) Bad News: My small Ivivi stock purchase is now slightly underwater from it's purchase price of $6/share! So much for my savvy investing skills. I do have faith that this will rebound as Ivivi becomes wider distributed. How the market valuates things like this escape me.

My prediction that the election results last week will be seized upon to affect the debate on silicone implants seems to be showing signs of coming true. A PR release from N.O.W. issued today specifically mentions this in the context of the new agenda N.O.W. expects to be advanced:
"Rep. Rosa DeLauro (D-Conn.) has introduced the FDA Scientific Fairness Act for Women, which would halt the Food and Drug Administration's approval process on silicone breast implants until the agency can actually establish the life of silicone breast implants and until implant makers can prove the safety of the product"

As has been elaborated here on Plastic Surgery 101 before, this is complete rubbish and reflects a rope-a-dope strategy by the anti-implant crusaders to stall this indefinately. We have a fair number of well-followed patients at a decade+ to estimate failure rates of 4th generation silicone implants (~5-8% rupture rate at a decade) and the forthcoming 5th generation implants (the Inamed 410 "gummy bear") has a recently reported rupture rate of nearly zero (0.3% at 6 years). Safety has also been established for years to everyone's satisfaction (both here and abroad) except the fringe cadre of activists who refuses to accept the published work on the subject.


Monday, November 06, 2006

Breast Implant article quoting Pat Maxwell in Wired Magazine

I saw an interesting article on Wired magazine's website about the pending silicone breast implant reintroduction. It caught my attention as it quoted my friend & mentor, Dr. Pat Maxwell from Nashville,TN in the article.

There's a great quote from him putting into context some of the demands being asked of manufacturers by the anti-implant lobbying groups:

"It's like telling Nokia or Motorola they haven't proved cell phones don't cause brain cancer," said Pat Maxwell, a Nashville, Tennessee-based plastic surgeon and a clinical professor of surgery at Vanderbilt University.

Maxwell helped invent the silicone breast implant marketed by Inamed, which was bought by Allergan for $3.21 billion in March.Maxwell noted that penis implants that have been used for decades are made of the same type of silicone as their breast counterparts. "American surgeons are 15 years behind the times. In Tasmania, of all places, they're shocked that American women don't have access to silicone gel implants," said Maxwell, who was on the Australian island to speak at a plastic surgery conference.

No word yet from the FDA though. I'm watching tomorrow's congressional election closely as I mentioned previously, as this could have an effect on the status of these devices.


Saturday, November 04, 2006

Inictments announced in Massachusetts underground liposuction death

Quick follow up from this post about the death of a Worcester, Mass. women by an unliscenced Brazilian physician performing liposuction in an apartment basement.

From the Worcester (MA) Telgram:
A Middlesex Grand Jury on Tuesday indicted Dr. Luiz Carlos Ribeiro, 49, on charges of manslaughter, two counts of practicing medicine without a license and drug counts. Ribeiro's wife, Ana Maria Miranda Ribeiro, 49, is charged with manslaughter and two counts of drug distribution. The owner of the home where the surgery occurred, Ana Celia Pena Sielemann, 41, is charged with being an accessory before and after the fact of manslaughter and two drug counts.

Tuesday, October 31, 2006

Silicone sisters run for the border

German police are hunting a quartet of surgically-enhanced women who legged it without paying for their treatment, the German newspaper Bild reports.

To help them in their search, Cologne-based plastic surgeon Michael Koenig has provided law enforcement officials with post-operative pics of the four - including 26-year-old "Tanya's" splendid new €8,000 implants taken before their proud owners "went out for fresh air" and never came back.

Koenig explained: "The women registered under fake names. After the operations, which lasted about an hour, they just ran away."

The other perps are listed as "Sabine" (boob job, €9,500); "Silke" (nose job, €7,000); and "Beate" (nose job, €7,000).

Koening says he now intends to ask for payment in advance

This story is so ridiculous that I've not decided whether this was a joke article or not. I have this surreal image in my head of a scene a la Fox's Prison Break with these women on the lam trying to run being tracked by dogs like in classic prison escapes.

As an aside, along this storyline and related to my previous expose on the history of bras, a kind of strange flash simulation from a British sports-bra maker exists, the "Bounce-o-meter" (I'm sure a guy thought that tacky name up) where you can visually simulate the effect of different exercise/activity on different breast sizes using some interesting flash animation.

I presume the names these women gave are the German equivalents of Stripper aliases (Sierra, Chastity, etc...) :)


Sunday, October 29, 2006

Leave it to Cleavage: Candidate for Alabama Governor Campaigns on Boobs

Meet Loretta Nall, a Libertarian write-in candidate for governor from down her in Alabama. Ms. Nall is rapidly gaining minor celebrity status for her "unorthodox" political platform and wonderful anecdotes like the one where she and her mother were denied visitation rights to her bother in prision because they weren't weraing panties (click to read).

Her campaign is offering T-shirts and marijuana stash boxes adorned with a photo (see right) of her with a plunging neckline and the words: “More of these boobs.” Below that are pictures of other candidates for governor — including Republican incumbent Bob Riley and Democratic Lt. Gov. Lucy Baxley _ and the words: “And less of these boobs.”

Here's some funny stuff on this from the Men's News Daily blog on this:
Here’s Nall’s official campaign website, where you can learn other tidbits such as her stand on border security, why she doesn’t wear panties, why “not being in jail is cool,” and how much dope you have to smoke before Pauly Shore is funny (it’s a trick question: there isn’t enough on the planet).

The possibilities for additional campaign slogans are endless…

“Alabama’s cups runneth over”

“For a hands-on governor, not just another titular head”

“Tippecanoe and titties too”

“Are you better off than you were two boobs ago?”

“Trick or teat”

“Thanks for the mammaries”

“Give me a trampoline and a push-up bra, or give me death”

“Turn the udder cheek"

Friday, October 27, 2006

A story sure to be seen on a future CSI or "Nip/Tuck"

You really can't make up stories up like this.

A nurse anesthetist, Sally Jordan Hill, in Charlotte,NC is accused of killing a patient (one Sandra Joyner)after a cosmetic surgery procedure in 2001 with a deliberate overdose of narcotics. That's bad enough, but the hook here is that apparently the motive police are investigating has to do with the fact Mrs. Joyner stole Mrs. Hill's boyfriend some 30 years prior to this.

You can bet some variation of this is furiously being written into a 'CSI' or 'Nip/Tuck' episode.

Wednesday, October 25, 2006

Could the fate of silicone breast implants in America depend upon the midterm elections?

Besides philosophic differences between Republicans & Democrats on Iraq, Social Security, the Economy, abortion rights, and other issues, there is a chance that breast implants (of all things) could be caught up in partisanship.

There's a real interesting drama playing out about the expected FDA approval of silicone breast implants for unrestricted cosmetic surgery indications. By all indications we have expected approval with some strings attached re. long-term surveillance. The approval last week by Health Canada has made this seem even yet more imminent and has the Siliconistas firing up their PR machine.

Sens. Dianne Feinstein (D-Calif.) and Olympia Snowe (Republican in name only-Maine) have now joined the fray in trying to intimidate the FDA into delaying action on their own advisory committee's report from 2005 which recommended approval for major manufacturers, Inamed & Mentor Corp.

Earlier this month Rep. Rosa DeLauro (D-Conn)took an aggressive posture on this issue, siding with activists intent on stopping silicone implants by any means necessary. Mrs. DeLauro is the ranking Democratic member of the House Appropriations Agriculture Subcommittee, a committee which controls in large part the purse strings of the FDA.

Which brings us to this $64,000 question:

With the midterm congressional elections in 2 weeks, does the fate of silicone implants hang on whether Democrats recapture the house and turn Rosa DeLauro overnight into Chairwoman of the House Appropriations Agriculture Subcommittee? It is conceivable that she could an end run around international scientific & medical consensus and tie this up indefinitely if she assumes the leadership position.


Sunday, October 22, 2006

Canada removes all restrictions on silicone breast implants

On Friday, Health Canada (the Canadian FDA equivalent) finally weighed in on silicone Breast Implants, removing all restrictions on their use in Canada. Prior to this, the implants were available (and widely used) but required a case by case paperwork application.

"I think it's safe to say that these medical devices are the most intensively studied medical devices in medical history," said Supriya Sharma, associate director-general of the therapeutic products directorate for Health Canada. "Health Canada's licensing of a medical device does not mean the device is risk-free. Rather, it means the device has the potential to provide benefits, and the risks have been reduced as much as possible."

Hopefully, this foreshadows what should be a straight forward adoption of the 2005 FDA advisory panel recommendation that the US adopt a similar position. The US now stands alone in countries restricting access to the devices.

Canada's acknowledgment that there is general consensus of no causal relationship to auto-immune disease or cancer has predictably driven the American anti-implant activists beserk & stimulated a flurry of hysterical press releases on what they believe to be a pending "silicone holocaust". Funny thing though, you certainly see nothing on the ground in Asia, Europe, S. America, & Canada (and the US as well for that matter) to support their concerns.


Thursday, October 19, 2006

Ivivi technologies IPO today

Ivivi Technologies had their IPO today.

Wayyyyyyyy back in December 2005 I wrote a little blurb on Ivivi. The "widget" this company sells is related to pulsing magnetic fields used for wound care, pain, and stimulating blood vessel growth. Apparently (and the physics and math behind this are formidable) pulsing magnetic fields at specific frequencies can have profound effects on the signals cells give to each other. This manipulation clinically results in rapid proliferation of healing tissues and down-regulating inflammation.

I've been impressed with the pain-control qualities of the technology for some of my post breast cancer reconstruction patients. Any effect there may be on blood-flow to the skin is just a bonus in that respect for me. However, this potential for non-invasive stimulation of blood vessel generation/healing + reducing inflammation addresses part of the exact scenario induce by heart attacks and blunt spinal cord injuries. If research pans out in those areas this kind of technology could really become widely used which would bode well for a company like Ivivi or others making similar devices.

While I'm somewhat ignorant of the market forces & accounting that would make a companies stock like Ivivi worth owning, it seems that could be a lot of upside. I've decided to put my money where my mouth is and buy a small position today. wish me luck!


Wednesday, October 18, 2006

New human-sourced medical products spawns modern day grave robbers

There has been a rapidly growing scandal in biomedical products which are sourced from human donor elements. There are dozens of products used in a variety of procedures (including Plastic & Reconstructive, Orthopedics, Urology, and Neurosurgery) and the "competition" for bits of skin, cartilage, bone, & other biomaterials has made this a lucrative market.

Reported here is the indictments against a number of funeral home directors for harvesting (without consent) human tissue from "clients" for reselling to brokers who go on to deliver these to manufacturers for processing.

In Plastic Surgery, Alloderm, a product made from the back skin of organ donors, has literally exploded in indications both reconstructive and cosmetic. In fact, I'm going Friday to a Washington D.C. meeting devoted to the utility of Alloderm for use with breast reconstruction procedures. It is also found a niche in rhinoplasty procedures and abdominal wall hernia repairs.


Thursday, October 12, 2006

Free cancer journal subscription

Never let it be said I never gave my loyal audience nothing. The excellent quarterly cancer journal Cure is available for free to US residents. Follow this link to a form to fill out and fax back to start your subscription. Cure has excellent overview articles both for laypeople and Physicians. Particularly provocative is the article in the month's issue discussing the evolving treatment of ductal carcinoma in situ of the breast.


Wednesday, October 11, 2006

Breast cancer Barbie

Along the lines of "Boobiethon 2006", (where there comes a point where the commercialization of breast cancer goes above & beyond what's appropriate) I give you

Breast Cancer Barbie
"Wearing a pink gown with a signature pink ribbon pinned to her shoulder, Pink Ribbon Barbie® doll can help open a dialogue with those affected by breast cancer, while supporting this worthy cause!"

The dolls cost about $24.95 in retail stores like Target and Wal-Mart, and Mattel plans to donate $100,000 to the Susan G. Komen Breast Cancer Foundation.

There was an excellent article in Harper's Magazine "Welcome to Cancer Land." written by a breast cancer survivor's reaction on the "Cult of Pink Kitsch" that has cropped up around the business of breast cancer.

Thursday, October 05, 2006

Boobie-Thon 2006

From October 1-7, bloggers from across the globe can submit pictures of their bare and covered breasts to raise money for breast cancer causes at Boobie-Thon .

The "sampler" menu can be seen here. Full access to the "pay-per-boobie" content can be purchased for $50, whose proceeds are to be donated to a number of breast cancer related charities.

I'm not a prude, but this fund-raising campaign bothers me because I think it trivializes breast cancer and I'm not sure whether sexualizing this really empowers either women or breast cancer survivors.

I saw reference to this on the delightful Feministing blog, a blog about as far politically from me as you can get, but whose author is both clever and witty enough to keep me coming back.

I don't like the implication that certain parts of women's bodies are "worth saving" because they're sexy. Boobiethon is sending a message that breast cancer should be stopped because it claims beautiful breasts as its victims-- not because it's a horrible disease that's killing women. I'd almost prefer a website that featured women naked from the belly button up, and showed their faces. Because at least then you can see that this disease affects real women, not just disembodied breasts.

From the comments section on Feministing for her blog post which hits the absurdity of this on the head(despite the campaigns good intentions):

"On, come on. If they were raising money to fight testicular cancer, would they be approaching male bloggers for ball-shots?"

Tuesday, October 03, 2006

Implants save another life!

Another woman's life saved by her implants in Bulgaria. Kind of the companion piece to the Israeli woman who survived the mortar blast in August (see here)

I can see the marketing now touting the health benefits: "Breast Implants- the new red wine" :)

From today's newswire:

Forget airbags, silicone breasts will do. A Bulgarian newspaper reports a woman in the town of Ruse survived a car crash thanks to her silicone breasts, which acted as an airbag.

The 24-year-old ran through a red light and crashed her car into another vehicle at a busy crossroad in the middle of town Saturday over the weekend.

"The two cars were crumpled past recognition in the crash but the woman's silicone breasts acted as airbags and saved her life", the report said, citing eyewitnesses.

But survival came at a price as the woman burst her silicone implants in the crash. A police expert explained that the 40DD silicone implants "absorbed the impact of the crash".
He added: "They worked just like airbags - protecting the victim's ribs and vital organs from damage.However they are not as safe as the real thing because they exploded, which airbags are not supposed to do."


Saturday, September 30, 2006

Iran - nose job capital of the world?

Who would believe it, but according to the BBC one thing we share we apparently share with Iran is a growing appetite for cosmetic surgery. In Tehran alone, there are a reported 3000 Physicians practicing plastic surgery procedures.

An interesting cultural angle on this is the large #'s of women undergoing rhinoplasty. As the nose and the eyes are the only facial features displayed in traditional women's Islamic garb, these women are determined to make sure what show looks good. The traditional Iranian ethnic nose has fallen out of favor it seems as the influence of Western pop culture has invaded Iran via satellite TV.

Here a link to a CBS news story on this rhinoplasty phenomena

Sunday, September 24, 2006

Desperate measures by anti-implant lobby

Predictably as we prepare for the long overdue reintroducing of silicone breast implants, there's a final desperate attempt to do an end run around overwhelming scientific and medical evidence.

In the irony of ironies, a bill was introduced by Connecticut Democrat, Rosa DeLauro which ties claims of political interference delaying release OTC emergency contraception pills with a call for political interference to delay the reclassification of silicone implants from investigational status. For a summary of the major studies on silicone breast implants read this.

First the widely discredited issue re. platinum in implants was dug up from the grave (see here) in their press release:
"FDA decisions surrounding silicone breast implants have also been subject to industry pressures, according to the National Organization for Women (NOW). Women with breast implants have higher rates of hazardous levels of an oxidized form of platinum in hair, urine, blood, and breast milk samples. Some women were unaware of these risks, and made their children sick after breast feeding."

Even more ridiculous and echoing the bizarre testimony at several FDA hearings was the presence of someone at the press conference who claimed silicone implants both caused his wife to commit suicide & blamed breast-feeding for his daughters health problems(!).
"My wife, P.J., breast-fed two of our daughters after getting implants. Both are seriously ill," said Ed Brent during the press briefing. "My daughter Catherine is now in a wheelchair. In addition, five major studies, including one by National Cancer Institute, found that women with implants are more likely to commit suicide than other women. After my wife killed herself, the autopsy showed that she had platinum in her brain tissue, which a CDC scientist said could have influenced her decision. That's why the FDA needs to make sure that the implants being sold now are safe for long-term use, meaning ten years or more."

The findings that breast augmentation patients in some European studies have had slightly higher suicide rates is long been known (This has not been reproduced in North American series which have compared implant patients to all cosmetic surgery patients BTW). No one plausibly argues that implants cause suicidal ideations, but rather it correlates to a higher incidence of psychiatric disorders and depression among the self-selected group seeking cosmetic surgery. The issue re. to breast feeding has also long been settled to the medical community at large.


Wednesday, September 20, 2006

World's 1st penis transplant - "On again, off again!"

I missed the announcement of this tabloid-esq Plastic Surgery first, but some Plastic Surgeons performed the world's first penis transplant in China recently. The man had the surgery in Guangzhou, China after his own penis was damaged beyond repair in an accident this year, leaving him with a 1cm stump with which he was unable to urinate or have sexual intercourse. Surgeons at Guangzhou General Hospital said it took 15 hours of microsurgery on the unidentified 44-year-old man to attach the 4-inch organ donated by the family of a younger brain-dead patient.

The surgery itself went without problems which is not surprising. The techniques of microsurgical & urologic surgery used are well-established & have been used to reattach a number of traumatic amputations (eg. John Wayne Bobbit from a few years back). After 10 days, tests revealed the organ had a rich blood supply and the man could urinate normally. This is a truly remarkable achievement to get such brisk return of function IMO.

Much like the face and hand transplants done prior, the real problems with these procedures are

1. How can the morbidity of the immunosuppressive be reduced to justify more widespread use? Our current immunosuppresive therapy has advanced tremendously, but we still require patients to take expensive drugs indefinitely which predispose them to opportunistic infections and cancers.

2. Are we as a society prepared to pay for these VERY expensive transplant scenarios when the healthcare system is going bankrupt?

3. How well are these transplanted organs going to function & what are we going to consider a success?

4. Who is a qualified candiate psychologically to receive part of another human?

It's this last point that has reared it's head again with this patient. Surgeons had to remove the penis after just two weeks. "Because of a severe psychological problem of the recipient and his wife, the transplanted penis regretfully had to be cut off," Dr Hu (the surgeon who performed the procedure) said.


This once again show a breakdown in patient screening that plagued the first hand & partial face transplant patients performed by Dr. Jean-Michel Dubernard in France. The desire for publicity runs ahead of measures to allow true "informed consent" to patients.


Sunday, September 17, 2006

Tracking outbreaks of unusual breast augmentation infections

An interesting study of microbial forensics was published about surgical wound infections caused by an unusual and rapidly growing mycobacterium (seen at right) developed in 15 women after breast augmentation. Using sophisticated DNA sequencing, the outbreak was traced back to a single surgeon operating at an outpatient surgery center.

Identical strains of mycobacterium were grown from the infected wounds of the patients; from the eyebrows, hair, face, nose, ears, and groin of this particular surgeon. What's also interesting was the infection was also thriving in the surgeon's outdoor whirlpool. As this strain of mycobacterium was somewhat distinct from common strains, the authors have proposed "Mycobacterium jacuzzii", which I think that's some kind of inside nerd joke :)

When "Typhoid Hairy" discontinued his use of the whirlpool and began cleaning the hairy areas of his body with a shampoo containing triclosan, the outbreak ended.

Clinical infections with breast implant surgery are very low, usually cited as <1%. Routine procedure would include an antimicrobial skin prep as well as a dose of antibiotics prior to surgery. Subclinical bacterial contamination has been suspected (though not proved) to be the cause of many cases of capsular contracture (hardening of the breast)as it seems that irrigation of the pocket around the implant with triple antibiotic solutions seem to be effective in reducing (but not eliminating) capsular contracture.

Physician to patient infections can occur in many scenarios. Hand washing and gowns in particular have received a lot of attention in recent years. A number of outbreaks have been traced to one person. Often this has been MRSA which can asymptomatically colonize people, most commonly harboring quietly in their nasal passage. Just this week I diagnosed and started treatment on a nurse who was having outbreaks of MRSA boils break out on her frequently. One of the most heart-breaking stories has been the outbreak of infections in neonatal ICU's & nurseries attributed to infections harbored under nurses fingernails.

From an article on Sign on San Diego discussing this:
Studies offer mounting evidence that long nails or those that are bonded with cosmetic acrylic or plastic material can shelter bacteria, viruses or fungi such as yeast and pose a special danger to those with weakened immune systems. According to a growing number of studies, nails longer than a quarter of an inch offer a good environment for infections to grow. Newborns, patients with cancer and other diseases, and those in high-risk settings such as intensive-care units or operating rooms are especially vulnerable.


Thursday, September 14, 2006

The utility of Botox cosmetic for improving scar quality

I saw this blurb somewhere else but it's somewhat interesting.

There's a study showing some short term (6 month) follow-up of using
as an aid to improving facial scar quality. This may sound strange, but it actually makes a lot of sense. Botox is a product sourced from the toxin produced by the bacteria that causes botulism. It has the effect of muscle paralysis. The first indications for it's use were in opthamology for problems with eyelid muscles, when one of the physicians noticed an improvement in brow/forehead wrinkles which are produced or exagerated by the muscles of facial expression. This observation birthed a multi-billion dollar industry.

Since it's original indications, we've seen series of patients being treated for migraine headaches, incontinence, prostate enlargement, hidradenitis (infected sweat glands in the armpits & groin), excess sweating of the palms/armpit, etc....

How does this improve scar quality? Well in areas of facial expression the movement of the underlying muscles causes shear & tension on the wound. Selectively paralyzing these mimetic muscles presumably would decrease that & improve scar quality.

Is BOTOX practical for this use? Not currently. The true cost (sans mark-up) is nearly $500 USD per vial of 100 units of the product. It would take ~15-20 units in many areas to paralyze selective areas for this & he patient would likely be charged several hundred dollars for this out of pocket. This makes it cost-prohibitive for most patients & would make this a real niche market. It is also not clear whether this suggested effect of BOTOX is going to be real & reproducible or superior to many other product used topically for improving scar quality (eg. Scar-Gard, Mederma, etc.)


Saturday, September 09, 2006

Woman awarded $8.25M after breast augmentation & mastopexy complication

In a full display of "jackpot justice" American-style, a Florida jury awarded a women over $ 8 million (USD) to compensate for pain and suffering for complications resulting from an augmentation mastopexy surgery. This episode highlights both a tort system out of control as well as the risk associated many breast operations (reductions, lifts, augmentations).

Simultaneous augmentation-mastopexy are tricky operations with known higher complication rates. If you think about it conceptually, you're doing a procedure with two competing forces - tightening the skin + "stuffing" the inside. When these the tension from the surgery exceeds the remaining blood supply to the breast tissue & nipple complex, you get tissue loss. Sometimes this is confined to just "fat necrosis" where some small areas of the fatty breast tissue harden & cause little problem other then being able to be felt. Large areas of fat necrosis can require surgery to remove as it can be both painful and hard.

Despite risks much higher then either procedure alone, we do these fairly frequently. Why? Patient demand and convenience. Staging these procedures requires 2 facility, anesthesia, and surgeons' fees which raise the cost a great deal. Also factor in recovery time from an additional procedure and it's easy to see why patients demand theses & surgeons' offer them.

What can be done to minimize the risks?
Don't operate on smokers or diabetics
Don't stuff oversized implants in
Don't go to "the edge of the ledge" while tucking the skin
Consider an adjustable device like the Mentor Spectrum implant (see here)


Tuesday, September 05, 2006

Get well cards for Plastic Surgery

Tapping into the pop culture emergence (and acceptance of cosmetic surgery), a company has now designed a line of get well cards for Plastic Surgery patients. Lift Me Up Cards, whose a privately held company based out of Dallas, TX who says they developed these cards "because as they say...everything is bigger in Texas".

A feature in the Florida Sun-Sentinal writes:

"The idea came in 2005 when four of creator Camie Dunbar's family and friends had work done. Dunbar couldn't find suitable cards, so she jotted messages and sketched stick figures. One card for her breast-enhanced friends said, "Congratulations on the Twins!" A liposuction card read, "I thought we could just sit around and chew the fat …"

Enlisting the help of South Florida graphic designer Matt Santamarina, the cards tread where major card companies fear is taboo, Dunbar said."

The line of cards (seen here) includes ones for breast augmentation, breast lifts, liposuction, vein removal, and BOTOX cosmetic.

Saturday, September 02, 2006

Ick! Breast discovered buried at Pa. church

In Meadville,PA workers renovating a church unearthed a package of m ,(edical waste that contained a woman's , and police believe it was buried there by someone who had . Officials at the Unitarian Universalist Church of Meadville told police it may have been put there by a woman 10 to 15 years ago who had requested prayers for healing of breast cancer.

story link here

Thursday, August 31, 2006

Tattoos have officially jumped the shark & the "tramp stamp" video

New York Times columnist, David Brooks, published a column this weekend commenting on how have "jumped the shark" in pop culture. There's already some grumbling in the blogosphere here & here (among other places) painting Brooks as both 1) an old fuddy-dutty & 2) a little late to the party with his column.

Tattoo removal is a small part of a lot of
and practices that do a lot of laser surgery. Different color inks are best treated with different types of (eg. CO2, Erbium, Argon, etc..) which react with characteristics of the different pigments. By and large, a lot of the treatments are unsatisfactory to me. They're both painful & often incomplete. In addition, many of the colors being added to modern tattoos are poorly treated with current laser & intense pulsed light technologies.

The popularity of tattoos in recent years has bothered me a little as most people who've ever worked in a Veteran's Administration (VA) hospital can tell you the fate of many of these after several decades from treating WWII & Korean war vets, peer groups in whom tattoos seem to have been popular.

What exactly are people expecting to look like with barbed-wire or large tribal designs 20-30 years from now? They're going to look ridiculous. An amusing associated issue are a large number of Asian alphabet tattoos with gibberish or mistranslations coming in for removal. Story on this here.

Perhaps the one I think most will regret are the lower back tattoos on many young ladies. Alternately known as the "tramp stamp", ass antlers, California/Santa Cruz/Tijuana license tags, the "Hag Tag", or the "Panama City bumper sticker" this kind of 'ink has already been the butt (I could not resist that one) of a lot of jokes.

New Rule from Real Time with Bill Maher:
Just because your tattoo has Chinese characters in it doesn't make you spiritual. It's right above the crack of your ass. And it translates to "beef with broccoli." The last time you did anything spiritual, you were praying to God you weren't pregnant. You're not spiritual. You're just high.
In the film, Wedding Crashers, the character Jeremy Grey (Vince Vaughn), upon seeing a lower back tattoo, exclaims, "Tattoo on the lower back... might as well be a bullseye."

There's a hilarious commercial skit from a few years ago about a home treatment product, Turlington's Lower Back Tattoo Remover, for suburban moms with racy tattoos back tatoos. A product that promised "when applied once, every hour, for 72 straight hours," slowly burns away unwanted lower back tattoos. "That tingling means it's working!Turlington's Lower Back Tattoo Remover - Because it won't be cool forever..."

Here's a link for your viewing pleasure


Monday, August 28, 2006

Christopher Hitchens - American Hero (via the U.K.)

Now for something completely removed from Plastic Surgery........

An amazing ten minutes of television was on Real Time with Bill Maher on HBO over the weekend. Vanity Fair columnist, Christopher Hitchens, was a panelist on the show in an incendiary and brilliant segment. For those of you not familiar with the 'Hitch, he is a witty & sardonic British ex-pat who is the ultimate contrarian. He's also my hero and someone you never want to miss when he's on TV.

In the span of ten minutes he silences both Bill Maher & the left-leaning audience with a searing dismissal of pavlovian responses to our President and the fight against the rise of Islamic fascism. He was truly a shark among minnows in the intellectual firepower department as well as also managing to give them the finger (see picture above) in a devastatingly effective way.

The video can be downloaded here.

I'd like to thank The Malcontent blog for the video capture.

Now back to our regularly scheduled programming!



Sunday, August 27, 2006

Heavy handed comments by Aussie politician on teen Plastic Surgery procedures

New South Wales, state Premier Morris Iemma is quoted in today's Sunday Telegraph newspaper that he feels the number of people under 18 seeking enhancements has gotten out of hand.

What set this off? One, ,(pictured above). The article reports that Premier Iemma became "disturbed" when he learned that the teenaged Forscutt, a contestant on the program Big Brother, had had breast implants. Now Iemama has been inspired to introduce new laws requiring teenagers to get a referral from their doctor, have a "cooling off" period prior to surgery, and undergo counseling before receiving . Iemma's full editorial can be read here..
"It used to be the case that the biggest question parents faced was whether to give their children permission to have their ears pierced," Iemma told the paper.

"Then it was tattoos. But, increasingly, parents are being asked to fund breast implants or a nose job as birthday or graduation gifts," he added.

Ms Forscutt, who was 19 when she appeared on Big Brother, said she supported Mr Iemma's proposal for counseling under-18s. "It is a minute part of who I am. I'm more than just a pair of fake tits,'' the now 20-year-old said.

This is a pretty reactionary step without much data behind it that there indeed exists a problem to address in the first place. While some reasonable parental requirements for surgery consent in minors (much like American laws) exist, mandating a primary care doctor's "referral" for psychiatric counseling strikes me as both paternalistic and offensive.

Former Australian Society of Plastic Surgeons president Norm Olbourne said teen surgery is rare (at least in re. to breast augmentation) and that "there are the groups of girls wanting breast enlargements, although I've never seen a girl under 18 wanting one who didn't come in holding her mother's hand". Blanket responses like Iemma's give short shrift to many of the psychological consequences adolescents face when they possess particularly large, small, or deformed breasts, noses, and ears.

Saturday, August 26, 2006

UK feature misses the point re. breast implant sizes

This article in the London Daily Mail describes a scenario that is a failure of both doctor & patient education.

In a breezy feauture on sisters with "identical boob jobs" a 39 year old, 'Louise' is described as gleefully going from a 36B to a 36DD after augmentation. Louise describes her sensitivity over years of teasing by her friends and after deciding on surgery says "I decided to go for a 36DD - perfect for my frame - with silicone implants. I'm 5ft 6in and a size 12". It sounds like Louise has internalized an image common among breast augmentation candidates that the "average" womens breasts are larger then they are.

Bad idea. You can not achieve that increase from a B cup to a DD cup without aggresively violating her native breast boundry and placing 500-600cc implants. There is NO way that her tissue is going to support that for long. She's going to end up with knockers to her to her knees in 3-5 years with a difficult reoperative surgery required if she wishes something to resemble an aesthetic breast shape.


Wednesday, August 23, 2006

Bariatric surgery in the adolescent population

Very poignant article at Slate Magazine about one of the new frontiers in bariatric (weight loss) surgeries which pose the question, how young is too young to consider or for treating obesity?

This comes on the heels of the studies in the Annals of Medicine & the Journal of the American Medical Association which showed significantly shortened lifespan related to complications of obesity when it develops in teenagers. This difference appears to be far more significant the the already formidable problems we see in obesity with later onset.

The exploration of indications for operating on teens is one we've had publicly in for many years. Most often this has to do with the question of when is an appropriate age to consider , but increasingly there has been reports on a trend where teens are receiving rhinoplasties or as "graduation gifts".

I won't dwell on the specific of the story but some of the risk/benefit analysis is a very good read. As someone who did a lot of bariatric surgery during my general surgery training & has an active practice in post massive weight loss Plastic Surgery, I feel the benefits strongly exceed the risks. There is a real opportunity to nip life-threatening obesity in the bud in selected children who statistically have little real hope of controlling their weight on their own once they reach that age.

Also, I'd like to point people with an interest in weight loss surgery to a neat little community, Renewed Reflections, which is a forum for information & support for those considering or those who've had bariatric surgery.

Tuesday, August 22, 2006

ENT (ear,nose, & thighlifts?) nailed by California for playing Plastic Surgeon

As if some people really doubted my earlier blog entry on ENT doctors and others who were performing procedures arguably well outside the scope of their training.

An Irvin,California ENT (head & neck trained)surgeon was sanctioned by the California Medical Board in July for not telling a patient before performing a thigh-lift procedure that he was trained in ear, nose and throat surgery. The doctor was also cited for allegedly failing to appropriately treat the post-surgical wound complications and for not keeping accurate medical records. This episode is noted in the July report by the California Medical Association.

Performing complex body contouring procedures without the proper training documented is going to be hard to defend in court, even if the Physician in question has performed them before. Plastic Surgeons do not delight in these kind of public displays of bad judgement by other providers, as it's clear that the the public unfortunately does not largely understand the distinction between us and other medical specialties when it comes cosmetic surgery.


Thursday, August 17, 2006

Some bad news about cellulite and weight loss

A study published in August's Plastic & Reconstructive Surgery seems to put to bed one of the myths about cellulite and it's relationship to your weight. In summary, as you gain weight the appearance of cellulite will worsen but losing weight will not necessarily improve the appearance.

John Kitzmiller, a plastic surgeon and co-author on the study, said: "Cellulite is not specific to overweight people but excess weight may worsen the condition. Although the appearance of cellulite diminished for the majority of patients, weight loss did not totally eradicate the condition. The dimples appear to be permanent features that lessen in depth as the pounds come off."

This is really old news to some extent and highlights the two mechanisms we usually have to explain cellulite.

1. Cellulite is produced as cells of fat get bigger & stretch against and distort some of the connective tissue boundaries if adjacent tissue. This is why we think you get cellulite from weight gain (ie. the distortion causes the surface irregularities).

2. Cellulite is produced from relaxation and descent with resulting traction of connective tissue fibers that normally run perpendicular to the skin. This is the cellulite that you see on some very thin women and those who've lost large amounts of weight. You can witness this phenomena by watching the cellulite disappear or exaggerate depending upon one's position. In the massive weight loss group after gastric bypass or banding, the connective tissue is severely attenuated and ripples despite the fat collections often being deflated.


Wednesday, August 16, 2006

Breast Implant deflects Hizbollah rocket shrapnel

Quick hitter for today:

From the Reuters news wire today: An Israeli woman's breast implants saved her life when she was wounded in a Hizbollah rocket attack during Israel's war with the Lebanese group, a hospital spokesman said Tuesday.

Doctors found shrapnel embedded in the silicone implants, just inches from the 24-year-old's heart.

"She was saved from death," said a spokesman for Nahariya Hospital in northern Israel. The woman has been released from hospital.

Tuesday, August 15, 2006

Asian Plastic Surgey patients adopting western tastes for breast implants

There are international stereotypes relating to breast augmentation.
Americans like the breast big and the butt small.

Brazilians like the breast small and the butt big

Europeans like somewhere in between.

What about Asia? Well traditionally they weren't even part of the discussion as breast augmenatation was fairly limited outside of Japan. As the economies of Asia & Southeast Asia have grown, the #'s of elective cosmetic surgery procedures has been growing at a staggering rate.

For decades, the Chinese government forbade cosmetic surgery, seeing it as a reflection of despised western values. Only 20 years ago, plastic surgery expertise was restricted to a small number of doctors specializing in traumatic and cancer reconstructive surgeries. According to figures from the PRC government, at present the Chinese now spend 2.4 billion USD a year(!) on cosmetic surgery, with an estimated 1 million operations performed a year. The Japanese spend over 2 trillion yen (18.7 billion USD) on cosmetic surgery each year. South Korea's Seoul is now home to over 2,000 private clinics, with surveys suggesting that at least 50 percent of Korean women in their twenties have experienced some form of plastic surgery -- an estimate some call conservative. (The bulk of the proceding paragraph came from this article in Zee News)

As the average Asian woman is smaller in frame then those of western Euorpean, African, or Latin descent the sizes of implants were naturally somewhat smaller. However, as the tastes & expectations of the west are permeating the east via media and pop culture, trends in cosmetic surgery are also reflecting the American ideal.

At the plastic surgery clinic BARAM in South Korea surgeons say the size of breast implants has doubled from 135 cc on average in 1994 to 265 cc in 2003. BARAM clinic chief Sim Hyung-bo points out the obvious that “One way to tell augmented breasts with the naked eye is that it is safe to say that skinny women with very large breasts probably had them enlarged. It is true that Koreans’ physique has changed remarkably over the years, but their breasts are still smaller than those of Westerners.”

135 cc implants! Those aren't even commercially available in the United States & Europe except by special order. A survey a few years back in one of the Plastic Surgery trades had the average size of implant somewhere around 350cc. Discussions between Plastic Surgeons would seem to indicate that the "average" augmentation in some peoples practices has crept up over the 400-425cc range.

For a related post on implant sizes & the consequences thereof see"How big is too big?"