Enlarge your breasts two cup sizes in 90 days with our new, amazing breast growth tablets. There is no pain. No greasy lotions to stain your clothes. You don’t have to suffer the embarrassment of getting caught while rubbing some cream on your breasts that must be applied six times a day. No dangerous chemicals to mix. And best of all – there are absolutely no side effects.
Just larger, fuller, firm, voluptuous, and sexy breasts. Like you always dreamed about.
Your friends in Scottsdale, Phoenix, Glendale, Mesa and even Chandler and Gilbert will be astonished at the new, improved shapely You but no one will know your secret but You! And it’s permanent (provided you continue with my inexpensive maintenance pack).
No! No! No! No! You don’t want those fake, manufactured things in YOUR body!
Plastic surgeons will be outraged … but you can laugh, look great and not have to pay those exorbitant surgical fees. And best of all: avoid surgery!
How is this possible?
It can’t be true, can it?
I, myself, never thought it possible that some rare and exotic herb could have such beneficial effects. Being highly skeptical, I hiked deep into a remote region of the Amazon to visit a primitive tribe I heard about where all the women were at least a “D” cup. Even more amazing, as I subsequently learned, was that their breasts remained firm and youthful well into their 50’s – even after several pregnancies and breast feeding.
What is their “secret”?
The answer is a diet rich in a leafy plant that only the women eat. It’s an herb that is found nowhere else on the planet.
Until now.
So if you want your breasts to grow bigger the natural way, without the risks and pain of breast augmentation surgery, you don’t have to go to the Amazon rainforest to obtain this amazing herb. I’ve brought it back for you in my safe, all natural proprietary formulation.
So hurry now and take advantage of this introductory, discounted limited time offer! You can get 100 of these amazing, patented breast pills for the easy low price of $89.99 plus S & H. And for the first 1000 callers, I will throw in a second bottle at no charge. You just pay the additional S & H.
To place your order now, just call 800-TIT-PILLS (or 800-848-7455). Operators are standing by 24 hours a day.
If you call in the next 60 minutes, we will include for free in your order, 25 tablets for your man that contain another tropical herb that will help to further extend his interest in you …
Do you really believe advertisements like this touting incredible pills, tablet, or lotions guaranteed to enlarge your breasts or your man’s manhood?
Hopefully not, as they don’t exist!
These scams only serve to enlarge the bank accounts of the con artists promoting their quack medications and formulations. As the old adage goes: “If it sounds too good to be true, it probably is.”
If you would like some information on the real thing, breast augmentation surgery, or for any other plastic surgery procedure that I perform or to schedule a consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Over the years, many thousands of women have seen me in consultation for their breast augmentation. When sharing their goals to me, a majority of them invariably requested that they wanted their breasts to look “natural”. Then they proceeded to describe these desired outcomes that were in reality not so very “natural”. What might be “natural” to one woman would not be very satisfactory to another who was also looking for that “natural” result. Furthermore, many women just use the term but haven’t really thought about what it means to them except that it doesn’t include obscenely big.
What are natural looking breasts?
Are they a so called “C” cup or a “D” cup? Or even a “B” cup for the very petite? And which company’s bra will be the standard to make that determination?
Are they somewhat round, broad and with moderate projection? Or are they more projecting and less wide?
Is a tear drop shaped breast more natural or more desirable than a smooth and round one?
I could go on but you get the gist. Though it may give some people the warm and fuzzies, the use of “natural” together with breast implants and breast augmentation is not a very useful, descriptive or precise term. The one thing that it does convey is that the woman does not want to be grotesquely large (whatever size that may be!).
“Natural”, like beauty, is in the eyes of the beholder. When you are seeking to have a breast augmentation, know exactly what it is that you want and if you still insist on using the term “natural”, explain to your plastic surgeon exactly what that means to you. This includes such considerations as relative cup size, proportionality, cleavage, roundness, fullness, etc. Providing some photos showing women both in more revealing clothes and naked can be helpful to convey your thoughts.
If you don’t express exactly what it is that you want from your breast augmentation, there is a greater chance that you might not be entirely satisfied with the outcome.
For more information on breast augmentation surgery, breast implants or for any plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
A French manufacturer of breast implants, Poly Implant Prosthese (PIP), has been in the news worldwide and for all the wrong reasons.
Inferior quality breast implants that break easily.
Usage of unauthorized, non-medical grade silicone in their silicone implants.
Poor quality control and manufacturing techniques.
Concern that their implants may be associated with an increased incidence of cancer.
And now there are allegations that a fuel additive, untested in any human trials, was used in these implants.
These issues show an egregious violation of standards, ethics and integrity. On top of this, European medical regulatory agencies and other government agencies failed to protect the consumer.
Women in numerous countries around the world who had these implants used for their breast enlargement are quite understandably in a panic. There may be hundreds of thousands of them.
What about American women? Do they have anything to worry about here? How many of these implants were used in the United States?
Fortunately, the answers to these questions are both easy and positive.
PIP sold only saline implants in the United States for a short period of time – between the end of 1996 and 2000. In their investigation of the company and its saline implants, the FDA (Federal Drug Administration) in 2000 cited numerous issues and concerns including quality control problems and the unacceptably high deflation rate. This led to PIP immediately withdrawing these implants from the United States market.
And now for even better news: No PIP silicone implants were ever legally sold or used in the United States. Therefore, despite the worldwide uproar and concerns about these disastrous PIP silicone breast implants, American women don’t have to worry about this issue because they were never available for implantation here.
If you would like to obtain information on silicone breast implants, breast augmentation surgery or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
A few days ago, there were countless headlines and stories in the media about a woman whose breast implant was “swallowed” by her body while doing Pilates. These were in response to a medical report documenting an unusual case that was just published in the Dec. 15th issue of the New England Journal of Medicine.
These reports garnished quite a lot of attention and also provoked some anxiety, concern and questions particularly in some women who already have breast implants. They want to know: “Is there a risk that the body can really “swallow” a breast implant?”
This case report involved a 59 year old woman who had previously undergone a bilateral mastectomy for breast cancer and had reconstruction with breast implants. During a Pilates stretching exercise, her right breast implant … disappeared. Gone in a flash! No external trace. She experienced no symptoms such as pain or shortness of breath.
A medical evaluation was performed including obtaining an ultrasound, chest X-ray and CT scan. What was discovered was that her intact breast implant was in her right chest cavity. It had been sucked into it during her stretching exercise.
She was taken to surgery during which the implant was extracted from the chest cavity and repositioned on the chest wall again where it belonged. A defect between the ribs which had allowed the implant to be displaced, was repaired. And she lived happily ever after. (Well, I don’t exactly know about that!)
So how did this bizarre situation occur?
This was the result of a confluence of issues and factors that together created the “perfect storm” for this rarity. The patient already had weak, flexible ribs. Her implants were not very large. And most importantly and what wasn’t clearly disclosed: she recently had undergone a mitral valve (a heart valve) replacement for a leaky heart valve and the approach used to access the heart was between the same two ribs that the implant slid between. The normal anatomy was disrupted by the surgery and a significant defect remained between these two ribs. Now, add to all of this a stretching maneuver that separated the ribs and created a negative force and, voilà, her breast implant was sucked into the chest cavity.
As you can see, the odds of this happening are less than being struck by lightning or winning the lottery. It is about on par with the probability of Obama suddenly becoming an adherent of conservative policies and slightly higher that the likelihood of taking a snapshot of the Loch Ness monster frolicking with its family or eating lunch with the Abominable snowman.
There are more important things to worry about in life.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
The incision that I have always preferred for a breast augmentation is the inframammary one (with rare exceptions). The reasons have been many including the relatively inconspicuous location and healing of the incision, better surgical exposure that facilitates precise technique and control, a reduced risk of developing capsular contracture (tight scar formation around the implant causing the breasts to feel hard), and what intuitively seemed to have a lower risk of affecting the sensation of the nipple-areola complex (NAC). No large scale study had been conducted to prove or refute my sentiment on the effect of the incision location on sensation until now.
A large scientific study was conducted in Italy that evaluated the possible effect of the incision location for breast augmentation surgery on the postoperative sensation of the nipple-areola complex. This assessed data from over 1200 women who had the same plastic surgeon perform their surgery over a slightly greater than six year period. Among the variables investigated were patient age, the breast implant size and whether the implants were placed above or below the muscle.
What the study found was that the implant size had no significant impact on the sensation of the nipple-areola complex postoperatively, an outcome that may surprise many. In addition, neither the patient’s age nor whether the implant was in a submuscular or submammary pocket, had any influence on sensation. The only variable that had a statistically significant association with reduced NAC sensation after surgery was the incision location, with the periareolar affecting 9.5% of women compared to 3.5% with the inframammary one which translates into a 2.7 times greater risk of sensory loss. It also had a 3.5 times greater risk of causing areolar pain.
Now there is even more convincing evidence supporting the superiority of the inframammary incision over the periareolar one for breast augmentation surgery.
If you would like to obtain more information on breast augmentation surgery or for any other plastic surgery procedure that I perform, or to schedule a consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
A question that many women have who are either considering a breast reduction or have already undergone one is “When can I start wearing an underwire bra?” Some are under the impression that they are not suppose to wear one any more following surgery; others have heard recommendations that involve widely differing periods of time. This can be decidedly confusing.
What is the right answer?
Well, there really is not one absolute, definitive answer. (Even this sounds vague!) One of the reasons for this is that there are no evidence based studies in the medical literature which identify one specific period of time following breast reduction surgery that is better than any other to start wearing an underwire bra again. Consequently, each plastic surgeon determines his or her own protocol based on a variety of factors including experiences with their patients. Some may recommend waiting at least 3 or 4 weeks whereas others may suggest 2 to 3 months or more.
What is my protocol for wearing an underwire bra following a breast reduction?
Upon removal of their operative dressing a few days after surgery, my patients are placed in a sports bra which they will wear for a couple of weeks. After this, they can wear any comfortable but supportive bra which they like and which includes an underwire bra. The purpose is to help to maintain the improved shape of their breasts for a longer period of time by counteracting, to some extent, the relentless forces of gravity.
With normal postoperative healing, the incision along the crease at the bottom of the breast will be inflamed and even tender for several months. During this period of time, an underwire bra may be somewhat uncomfortable to wear. As a result, most patients will wait at least 2 to 3 months before being wearing one on a regular basis.
For more information on breast reduction surgery or for any other plastic surgery procedure that I perform or to schedule your free consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Plastic Surgeon in Arizona Discusses Choosing the Right Practice for Breast Augmentation Procedure
Breast augmentation is the most popular form of surgical cosmetic enhancement according to the latest study from the American Society for Aesthetic Plastic Surgery (ASAPS). At his Arizona plastic surgery practice, Dr. Steven Turkeltaub discusses the essential traits of a plastic surgeon, and the need for an individualized treatment plan for each patient.
More than 9.3 million cosmetic procedures, including 318,123 breast augmentation procedures, were performed in 2010 according to the latest data from the American Society for Aesthetic Plastic Surgery (ASAPS). As the popularity of cosmetic enhancement continues to grow, Dr. Steven Turkeltaub states that patients must address several important elements when considering plastic surgery in Arizona and around the U. S., including a surgeon’s experience, an individualized surgical treatment plan, and their own level of comfort with the surgeon and his team.
When patients are considering breast augmentation in Arizona, Dr. Turkeltaub says he emphatically recommends that they seek consultations with experienced and reputable plastic surgeons who are certified by the American Board of Plastic Surgery. “Unfortunately, there are thousands of physicians across the country who are not plastic surgeons yet are performing breast augmentation surgery despite significant deficiencies in their qualifications, skills and training. Often using slick marketing including the non-specific term “board certified”, they directly and indirectly portray themselves as equivalents or actual plastic surgeons when they are not. Patients can pay a heavy price monetarily and health wise if they do not do adequate research.”
In addition to board certification, Dr. Turkeltaub states that identifying and exploring individual aesthetic enhancement goals and reviewing expectations are extremely important. He recommends a full discussion of the surgical treatment plan including all the relevant options. He adds that photographs of the surgeon’s before-and-after gallery can be helpful to better ensure that the patient and surgeon are on the same page. Dr. Turkeltaub says doing so is especially important when patients are considering breast augmentation because of the impact such a procedure can have on a woman’s overall sense of femininity and self-confidence.
Dr. Turkeltaub also had this to say: “It should go without saying that patients should have a good feeling about the plastic surgeon that they are considering to perform their surgery. A good bedside manner and a warm, caring office staff go a long way in making the overall experience more comfortable, more pleasant and less stressful.”
About Steven Turkeltaub, MD, PC
Dr. Steven Turkeltaub earned his medical degree from the Boston University School of Medicine. He then completed his general surgery training at the University of Miami Jackson Memorial Hospital, and the Northwestern Medical Center in Chicago, followed by a plastic surgery residency at the University of Massachusetts Medical Center. Dr. Turkeltaub is certified by the American Board of Plastic Surgery, and is a member of the American Society of Plastic Surgeons and the Arizona Society of Plastic and Reconstructive Surgeons, among others.
Arizona Plastic Surgery Practice Reflects ASAPS Statistics
Of the more than 9.3 million cosmetic enhancement procedures performed in 2010, breast augmentation was the most common form of surgical enhancement according to the latest study from the American Society for Aesthetic Plastic Surgery (ASAPS). As a board-certified plastic surgeon in Phoenix, AZ, Dr. Steven Turkeltaub says the same is true at the Arizona Center for Breast Surgery.
According to the latest study from the American Society for Aesthetic Plastic Surgery (ASAPS), breast augmentation was the most common cosmetic plastic surgery procedure in 2010, followed by liposuction, eyelid surgery, abdominoplasty, and breast reduction. Dr. Steven Turkeltaub says that this is consistent with the breast surgery procedures that he performed for his patients in 2010 as well as the first half of 2011 at his Arizona plastic surgery practice.
Nearly 580,000 breast surgery procedures were performed in 2010. This total represents a 9% increase over the 2009 totals, which were adversely affected by the recession. However, Dr. Turkeltaub says this increase is due to more than the improved financial conditions: “As highlighted by the latest ASAPS study, an ever greater percentage of Americans approve of cosmetic enhancements, which are increasingly considered as mainstream procedures. In addition to wanting to look better—and feel better about themselves—as they have in the past, for some patients seeking employment or trying to hold on to their jobs, they believe a more youthful, attractive, and even alluring appearance may just provide them with a noticeable and competitive advantage.”
Regardless of the slight decrease in 2009, a 14-year comparison of breast augmentation reveals the number of procedures performed more than tripled from 101,176 in 1997, to 318,123 in 2010. Dr. Turkeltaub says the constant drive for innovation in the field of aesthetic enhancement is likely the cause of such a increase. “During this same period, there have been technological advancements as well as refinements in technique that should provide patients with more predictable and durable results along with even greater safety and comfort.”
About Steven H. Turkeltaub, MD, PC
Dr. Steven Turkeltaub earned his medical degree from Boston University School of Medicine. He completed his general and plastic surgery residencies at the University of Massachusetts Medical Center, where he also held an appointment as a Clinical Instructor. Dr. Turkeltaub has authored several papers and chapters for plastic surgery textbooks, as well as several magazines and newspapers. He is a member of the American Society of Plastic Surgeons, the Arizona Society of Plastic and Reconstructive Surgeons, and the Arizona Medical Society.
The Arizona Center for Breast Surgery has two locations: the Scottsdale office is located at 10290 N. 92nd St. Ste. 207 in Scottsdale, AZ 85258; and the Glendale office located at 18275 N. 59th Ave. Bldg. E Ste. 126 in Glendale, AZ 85308. Both locations can be reached at (480) 451-3000, or found online at arizonabreast.com or the Plastic Surgery Arizona Facebook page.
Breast reduction surgery effectively reduces or eliminates symptoms that many women with very large breasts experience such as neck, back and shoulder pain, rashes, skin breakdown, fatigue and discomfort associated with physical activities. I have had numerous patients of mine over the years tell me how absolutely happy they were following their breast reduction surgery in that they were once again able to be involved in sports and other vigorous activities that they previously had to avoid or limit their involvement in due to either discomfort or embarrassment.
It doesn’t take a rocket scientist to realize the detrimental effects that large, heavy breasts (macromastia) have on a multitude of levels. When it comes to sports, particularly competitive ones, the impact can be enormous (coincidentally metaphorical). For example, when was the last time that you saw an elite female runner competing in the 100 yard dash?
What about the high jump?
Thought so!
Most of these superior athletes from the neck down are seemingly androgynous. It is very rare to see the likes of an Anna Kournikova (tennis) particularly in certain sports.
There is a somewhat publicized case (at least by her “adoring” male fans) of an elite female athlete who underwent a breast reduction in order to improve her ability to compete as well as to alleviate severe neck and back pains. This involves the Romanian tennis star Simona Halep who also was the junior champion at the 2009 French Open at the age of 18. Though her 34DD breasts significantly enlarged her appeal and following, they were fatiguing, painful and physically limiting.
Tennis star Simona Halep before breast reduction surgery
Halep underwent a breast reduction in 2009, reducing her breast size from a 34DD cup down to a 34C. It is no coincidence that following surgery, her world ranking has improved by 450 spots – now at 57th in the world. She states that she is faster and much more agile than she was prior to her breast reduction and no longer experiences any neck or back pains.
After breast reduction surgery
Simona Halpe runs faster, has greater agility and is a more competitive tennis player following her breast reduction surgery
On the down side, with her reduced breast size she cost her some of her male fan base …!
If you have any questions regarding breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a consultation with me, please feel free to call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
As a result of research and technological advancements, there have been fundamental improvements in the design and construction of silicone breast implants over the years. These have translated into breast implants filled with a cohesive gel (like taffy) that are stronger, far more durable and resistant to a multitude of forces and factors and which will last considerably longer compared to previous generations of implants. They will not, however, necessarily last forever.
In 2006, the FDA issued recommendations (not a mandate) that women who have silicone breast implants as a results of breast augmentation or breast reconstruction should have an MRI starting three years after their surgery and then every other year subsequently. However, there was no scientific data to support this approach. Given the considerable expenses (and inconvenience) incurred by having these MRI’s which may not even be covered by insurance, we need to consider whether the FDA’s recommendations are really a prudent and necessary.
Research conducted at the University of Michigan and published in the March 2011 issue of the Plastic and Reconstructive Surgery® journal provides some compelling answers to this issue. This research combined and analyzed 21 previous studies that assessed the ability of MRI’s to detect silicone breast implant rupture in order to arrive at their conclusions.
What they discovered was that the MRI’s overall were fairly accurate in detecting ruptured silicone breast implants. However, in certain situations their accuracy rate was extremely high. In fact, they discovered that in women who presented with symptoms related to their breast implants, the MRI’s were 14 times more likely to discern a rupture than in those women who had no symptoms. Thus, in women who were asymptomatic, they were far less helpful.
How can we use this information to formulate reasonable recommendations?
Given that silicone gel breast implants will last on average well in excess of 10 years, MRI’s are not a cost effective tool to screen for ruptured breast implants in otherwise asymptomatic women during this first decade. Instead, mammograms and/or ultrasounds should be performed. If evidence arises or there is a significant index of suspicion for rupture, an MRI can then be considered.
The term “gummy bear” breast implants has been used in the public realm for several years now yet most people know little about them. What they have heard is that they are the latest type of silicone breast implant and something that they may just want to have for their breast augmentation or breast reconstruction.
You might have wondered: “Exactly what are these breast implants and why are they named after a candy?”
You may even be thinking: “Can I have them for my surgery?”
“Gummy bear” implants are a new generation of silicone breast implants that have some of the characteristics of the candy that they were nicknamed after – though they are not also edible! These implants differ from all earlier versions in that they are composed of a very highly cohesive and form-stable (maintains their shape) gel that resembles the candy though softer.
These 5th generation breast implants have been used elsewhere around the world for breast augmentations and reconstructions since the early 1990’s. They have been extensively researched for years including in large clinical trials but have not yet been cleared by the FDA (Federal Drug Administration) for usage here in the United States although approval may be imminent. (Note: Plastic surgeons here in the United States have been hearing this for several years now – and we are still waiting!)
These new silicone breast implants do offer at least a few advantages over the current cohesive silicone gel ones (as well as some disadvantages). They have been noted to be more durable and last longer and the potential of the silicone gel migrating elsewhere is close to zero. The risk of developing hardness around the implants known as capsular contracture has been found to be lower, around an incidence of 3% as compared to 5 – 10% or more with previous generations of silicone implants.
A definite disadvantage of these “gummy bear” implants is the cost which is expected to be significantly more expensive than those that are used now. Whether this difference is an additional several hundred dollars or much more is not known as of yet. Their increased cost will definitely have some effect on their popularity and selection. Ultimately, however, several factors will play a role in influencing each woman’s decision regarding which type of silicone breast implant is right for her.
We are very proud to announce that Dr. Steven Turkeltaub has been chosen as a recipient of the prestigious Patients’ Choice Award for 2010. This honor recognizes those physicians across the country that have gone above and beyond to make a clear-cut difference in the lives of their patients. The criteria for the Patient’s Choice Award is based on a series of rigorous standards, which include: doctor-patient interaction time, bedside manner, follow-up care, professionalism of office support staff & overall patient experience and care . There are a myriad of physician reviews submitted by patients online everyday, but very few of these physicians being reviewed actually receive enthusiastic patient testimonials on a consistent basis. In fact, Dr. Turkeltaub is only amongst 6% of physicians across the country to receive the Patients’ Choice Award.
A very common question that many women have who are considering a breast augmentation is what their exercise restrictions will be following surgery. They might have heard or read different and sometimes conflicting information and just want to know the proper routine. This is a subject that I discuss at length during your consultation.
There is no one correct answer for activity limitations and resumption but I will tell you what I have found over the years that works and does minimize your risks for significant problems such as bleeding that can result in the formation of a hematoma (collection of blood around the implant). The rare individual who develops this usually precipitated it by engaging in prohibited vigorous activities or consuming blood thinning agents such as aspirin or anti-inflammatory medication like ibuprofen, naprosyn, Motrin® or Aleve® within 10 days of surgery or immediately afterwards.
It is important that you avoid any heavy lifting, straining, aerobics and sports for three weeks after your breast augmentation. This also pertains to any activity that would substantially increase your heart rate and/or blood pressure such as jogging or swimming. If as part of your work-out you do pectoralis muscle (chest wall muscle) strengthening, this should be avoided for at least 8 weeks after surgery.
You may initially find that you experience increased swelling, tightness or tenderness in one or both breasts following certain activities. Don’t worry. This is normal and will ultimately not be an issue after several months.
For more information on breast enlargement, breast implants or for any other plastic surgery procedure that I perform or to schedule a consultation with me, feel free to call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
The Federal Drug Administration (FDA) just issued a press release regarding the appearance of a very rare type of cancer that has been found in some women who have either saline or silicone breast implants. In these women, anaplastic large-cell lymphoma (ALCL) has been identified in the capsule (scar tissue) that forms around breast implants along with the accumulation of fluid known as a seroma. Despite these few cases, there is no evidence that there is any direct cause and effect and so more studies will need to be conducted to determine whether or not there is any relationship.
ALCL is extremely rare in general with an annual incidence in this country of 1 out of every 500,000 women. The rate of occurrence with the primary location in the breast is an infinitesimally microscopic 3 in 100,000,000 women per year. Worldwide, there have been somewhere between 34 and 60 cases of this disease out of an estimated total of 10 million or more women who have had breast implants.
How insignificant is this? The average annual risk of developing primary breast cancer in American women is 123 per 100,000 which is equivalent to 123,000 cases per 100 million women. This translates to a risk that is 41,000 times more common than ALCL.
The form of ALCL that has been identified in women who also have breast implants is a relatively “benign” disease that presents with a consistent constellation of symptoms that can facilitate the diagnosis once a level of suspicion is raised. These findings include the onset of pain in the affected breast associated with a mass and a rapid increase in size as a consequence of the accumulation of fluid. The median time of occurrence of ALCL following the placement of breast implants is 8 years.
Once the diagnosis is made, treatment is straightforward and curative with no need for chemotherapy or radiation therapy. The cure is simply the removal of the scar tissue (capsule) that surrounds the implant which is the location of the disease. Some of the affected women actually had new implants reinserted without untoward consequence though studies will need to be performed to determine the advisability of this. Importantly, there have never been any report of death associated with ALCL.
To sum up the findings of anaplastic large-cell lymphoma (ALCL) with regards to breast implants:
no association has been firmly established between the disease and either saline or silicone breast implants
the constellation of presenting symptoms can make the diagnosis of this relatively easy with a level of suspicion
the disease is quite benign and completely cured with surgical removal of the capsule surrounding the breast implant
there is no need for chemotherapy or radiation therapy
If you have any questions regarding this issue or on any cosmetic or reconstructive breast surgery or other plastic surgery procedure that I perform, please feel free to call my office at 480-451-3000. You can also schedule a complimentary consultation at that time.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Do you find searching for an attractive bra a frustrating or boring experience? The lingerie company La Senza, a subsidiary of the Limited Brands which also owns Victoria’s Secret, might have found a great solution. It has created a video showcasing some of its bras that is quite entertaining for both women and men and even has a holiday theme.
Now this isn’t just any video. It is a “musical” video featuring an assemblage of seven scantily clad voluptuous models each wearing a different sized cup ranging from an “A” to a “G”. Called “The Cup Size Choir”, these models are filmed provocatively lying in beds singing the Christmas song “Deck the Halls” with each one singing a musical note based on her bra cup size. Simply put, the model wearing the “A” cup sings all the “A” notes, the “B” cup one sings all the “B” notes, etc.
Not surprisingly, this video has become an internet sensation (for good reasons). You may want to watch it again and again together with your significant other. They probably won’t mind!
If after viewing this video (and with some previous consideration) you could just imagine yourself filling up and alluringly wearing one of these attractive bras but don’t have what it takes yet – feel free to give us a call. We would be happy to provide you with information on breast enlargement surgery, breast lifts or on any other plastic surgery that you may be considering. You can also schedule a complimentary consultation with me.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
For any breast procedure requiring the placement of breast implants, my patients are offered the option of using either silicone or saline implants. This would include women who are considering breast augmentation, breast lift with implants, breast implant exchange and breast reconstruction. I thoroughly discuss with them all the important and relevant information about these two types of implants such as appearance, feel, durability, aesthetics, rupture, risks and possible areas of concern. They also are able to touch and closely examine both the silicone and saline implants.
What have I found is the overwhelming majority of my patients select the silicone implants for both cosmetic and reconstructive procedures and they definitely don’t regret the choice. The aesthetic results and much higher level of satisfaction irrefutably support the substantially greater superiority of silicone implants as compared to the saline ones. This is true for both cosmetic and reconstructive procedures. In my practice it is quite rare now for a woman to opt for saline implants and when they do it is virtually always because they cost $1,000 less a pair which then makes the cosmetic surgery affordable.
This finding is consistent with the medical literature including research just published in the November issue of “Cancer”. This multicenter study examined and analyzed the responses obtained from 672 women who had post-mastectomy (for breast cancer) breast reconstruction utilizing either silicone or saline implants. The results revealed a statistically significant greater level of satisfaction in women who chose the silicone breast implants for their reconstruction as opposed to the saline ones.
So, if you are interesting in pursuing either a cosmetic or reconstructive breast procedure that involves the usage of breast implants and were initially leaning toward saline implants you may want to strongly reconsider.
Taking into consideration all major cosmetic and reconstructive plastic surgery procedures, women who have had breast reduction surgery are the happiest and most satisfied patients. To put this into perspective, it even exceeds breast augmentation surgery where 94% of women would make the same decision if they had to do it all over again. A major reason for this is that breast reduction surgery is so effective in improving or totally alleviating pain, discomfort and even activity restrictions related to very large breast size.
An example of the substantial results than can be obtained with breast reduction surgery is illustrated with the following patient of mine. This is a 29 year old woman who was experiencing severe neck, back and shoulder pains directly related to the enormous size of her breasts for which she wore 36G bras (photos A, C and E). They also prevented her from engaging in anything more than mild physical activities such as sports and aerobics.
A.) before - frontal view
B.) after breast reduction
C.) before - side view
D.) after breast reduction
E.) before - oblique view
F.) after breast reduction
Even at her relatively young age, she already had deep grooves of her shoulders from the bra straps digging into her skin (photo G).
G.) groove of right shoulder
Her decision to pursue breast reduction surgery was an easy one. The technique employed involved an anchor shaped incision where the nipple-areola complex was kept attached to the tissues but reduced in size and elevated to the appropriate position. Five pounds of breast tissue were removed during the procedure.
The results from her reduction mammoplasty are seen in photos B, D, and F and are quite dramatic. There has been total resolution or her neck, back and shoulder pains and is now able to participate in sports and engage in other very physical activities which she was unable to do for years. She is now wearing “C” or “D” bras rather than tent sized “G” bras and is no longer feels self conscious about her breasts. (In fact, she is quite proud of them right now.) As an added bonus, despite the substantial size of the reduction, she has retained some sensation of her nipples.
If you would like additional information regarding breast reduction surgery or any for any other other plastic surgery procedure that I perform or to schedule a consultation, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
It is universally accepted that smoking is bad for you and your health. Not only is it unequivocally associated with premature aging, both physiologically and in appearance, but also with an increased incidence of numerous diseases and cancers as well as a reduced quality of life. Smoking also significantly elevates the rate of complications and other untoward issues in several cosmetic and reconstructive breast surgical procedures.
For the more than 23 years that I have been practicing in the Scottsdale and Phoenix areas, I have been routinely informing and warning my smoking patients of the substantially elevated risks that smoking has on many surgical procedures and their outcomes. The chemicals in cigarettes cause a constriction (narrowing of the diameter) of the blood vessels in the tissues which results in a decreased blood supply to the tissues and therefore less of the vital oxygen and other nutrients important for cell survival and healing. For areas that have undergone surgery, this can directly translate into delayed or improper healing or worse – lack of survival of some tissues which may then require the need for corrective reconstructive procedures such as skin grafting.
Though I do make my patients aware of the risks that smoking has on their health and surgery, for certain procedures I do request and many times demand that they at least stop smoking for a specific period of time prior to their scheduled date because the impact from such smoking can be far more severe. The breast procedures at substantially higher risks for healing problems such as skin necrosis (where the skin turns black and dies) include primary (immediate) breast reconstruction, secondary breast reconstruction in those who have had radiation treatments, breast reductions and breast lifts.
Patients having these procedures are instructed to stop smoking starting one month prior to their surgery until at least two to four week postoperatively. It takes but a few cigarettes just prior to or after surgery to jeopardize the healing process. Chronic smokers who are able to stop smoking during this period of time do better than those who continue even at reduced levels.
To put this in even clearer perspective and provide additional motivation, I ask my patients whether it worth the prolonged healing time, expenses, inconveniences, compromised aesthetic results and the possible need for additional surgery just to continue smoking. Stated this way, most will make a serious effort to quit.
For more information on any plastic surgery procedure that I perform or to schedule a complimentary consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
The following patient of mine illustrates an example of revisional breast surgery in a woman who underwent a subcutaneous mastectomy with immediate reconstruction 25 years ago in order to reduce an elevated risk and strong family history of breast cancer. Seeking to further improve the results, she had several subsequent procedures in attempts to improve the results. I was consulted because she was very dissatisfied with the appearance of her breasts and also was experiencing significant chronic pain in both sides.
Subcutaneous mastectomy before breast revision
After surgery
Before - side view
After surgery
Before surgery - oblique view
After surgery
The photos of her breasts clearly delineate the substantial deformities, asymmetries and implant malposition with the right side being situated too high. You can appreciate the extensive irregularities of contour and skin folds as well as the relatively low positioning of her nipple-areola complexes in relation to the breast mounds.
To achieve a more desirable result, her breast revision entailed the precise release and removal of the deforming scar tissue along with reshaping of her breasts and replacing her implants with much more appropriately configured and sized implants. In addition, I employed AlloDerm® dermal grafting material for both breasts which served to provide greater support of the implants, contouring, durability and increased soft tissue thickness.
As you can judge from the photos, the transformation from the breast revision surgery resulted in breasts that were much more acceptable and desirable in appearance which made her quite happy and thankful and boosted her self-confidence.
If you have any questions regarding breast revision surgery whether for cosmetic or reconstructive issues or for any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
A periareolar mastopexy, which is also called a purse string, doughnut (donut) or circumareolar mastopexy, is a technique used for breast lifts that employs just one incision which is situated around the areola. It is inherently attractive to many women who are seeking to rejuvenate and lift their breasts with few tell-tale signs. I feel strongly that a periareolar mastopexy is a rarely indicated approach except for very rare situations involving very minor drooping. The tradeoffs are too high a price to pay in comparison to the far superior results that can be obtained with more and longer incisions.
Unfortunately, many people including physicians have a tendency to equate shorter scars with better, more advanced or state of the art results as well as a more talented surgeon. In situations where the results are exactly the same irrelevant of incision length, such as in gall bladder surgery, this belief can be well founded. However, this isn’t valid in breast lift surgery where I have always believed that if more or longer incisions would allow for an unequivocally superior contour and appearance, then the trade off would be worth it.
The goal of a mastopexy is to recreate a natural, conical shaped breast that has the areola situated at the most projecting part. An inverted-T (or anchor shaped) incision allows for the most precise reshaping of the breast and skin envelope in a three dimensional fashion. It also facilitates the accurate repositioning of the nipple-areola complex on the ideally recontoured and rejuvenated breast.
The limited incision periareolar mastopexy technique eliminates the vertical scar extending down from the areola as well as the horizontal scar in the breast fold. Therefore, essentially a two dimensional approach is expected to solve a three dimensional problem involving lifting and reshaping the breasts, resizing and repositioning the areolas and attempting to obtain improved symmetry. This all has to be performed with the asymmetric removal of a doughnut of excess skin from around the areola and then and purse stringing the larger circle to the smaller circle (areola) which tightens the skin.
This technique creates maximum tension around the areola which then translates into significant untoward and predictable consequences including:
1.) flattening of the shape of the breast yielding more of a pancake contour rather than a conical one
2.) a stretched and often flattened areola causing that can be irregular in shape
3.) widened and thickened scars around the areola
4.) the appearance of skin pleats and lines emanating radially outward from the areola
5.) limited flexibility in the precise placement of the areola on the breast mound
6.) difficulty obtaining better symmetry of the breasts particularly when they were significantly different in size and or shape prior to surgery
A quite convincing illustration of these issues can be seen in the photos below. This 36 year old woman had a periareolar mastopexy performed by another plastic surgeon and was very unhappy with the outcome on several accounts. She saw me in consultation in order seek correction of her suboptimal results.
This is the outcome of a periareolar mastopexy that was performed by another plastic surgeon. The scars around the areolas are very noticeable, wide and unacceptable. A pleating effect - lines in the skin radiating outwards from the areola - can also be seen.
The scars resulting from the donut mastopexy are prominently visible. The flattening of the areolas as a consequence of the purse string technique is well illustrated in the right breast. Instead of the breasts being perky and somewhat conically shaped, they are flattened and underprojecting.
Very wide and unacceptable scar on the left breast from the periareolar mastopexy
For additional information on breast lift surgery with or without a concomitant breast augmentation or on any other plastic surgery procedure that I perform or to schedule a complimentary consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
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