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
Though the overriding goals in breast reduction surgery are to adequately decrease the sizes of the breasts and to obtain reasonable contours after doing so, the final appearances of the nipple-areola complexes also rate high. With everything else being equal, the nipples have a much better likelihood of retaining their aesthetic characteristics if they are not detached from their blood supply, ducts and underlying tissue.
However, in women with extremely massive breasts, this may not be possible if a free nipple graft breast reduction procedure is selected. This technique does provide for the most predictable and aesthetic outcome including size but does necessitate the removal and then replacement of the nipple-areola complexes as skin grafts. Consequently, there will be some deterioration of its structure and appearance.
What are the most common sequelae that are seen? The projection of the nipple usually is minimal and there may only be an outline of its location. The areola itself is thinner and not domal shaped. In darker complected women, there can be partial loss of pigmentation yielding a variegated pattern that may be either temporary or permanent.
One such example of the appearance of a nipple-areola complex following a free nipple graft reduction mammoplasty can be seen below. Pigmentation has been maintained as has some of the projection of the nipple. This result should not be considered to be representative of all outcomes with this procedure.
Example of the appearance of the nipple-areola complexes following a free nipple graft breast reduction.
For more information on breast reduction surgery or on any other plastic surgery procedure that I perform or to schedule a complimentary cosmetic consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Women with naturally large breasts frequently experience several common and uncomfortable symptoms and physical findings. These may include pains in the shoulder, neck and back, fatigue, indentation and irritation of the shoulders, headaches, rashes, skin irritation and infections, numbness of the hands, arthritis of the neck and/or lower back, postural changes and even discomfort sleeping on their back. Fortunately, breast reduction surgery is virtually always quite successful in alleviating the symptoms associated with enlarged breasts though some physical changes may be permanent.
A vast majority of the patients that see me in consultation for breast reduction surgery exhibit indentations of their shoulders as a consequence of the weight of their breasts causing their bra straps to dig into their shoulders. The more massive the breasts and the longer a woman waits to undergo a breast reduction, the deeper these grooves may be.
In the photos below of a patient who saw me in consultation for breast reduction surgery, you can see the prominent indentations of the shoulders. Interestingly enough, the deeper groove is situated on the right, the same side as the much larger breast. These invariably persist even long term after successful surgery.
Woman with shoulder indentations seeking breast reduction surgery. The deeper groove on the right is also associated with the larger right breast.
Right shoulder. Deeper indentation here associated with the larger right breast.
Left shoulder. Indentation here is not as deep due to a smaller breast on this side.
If you would like to obtain more information on breast reduction surgery or on any other 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 armpit incision for a breast enlargement, also known as the axillary approach, is fairly popular for a variety of reasons including the desire for some women not to have a scar situated directly on their breast. This preference can work as a double edged sword, though. If the ultimate scar that remains is not aesthetically ideal – inconspicuous – then its presence can be quite problematic and exposed for the world to see. This could then limit a woman’s options regarding certain clothing styles, for example, sleeveless tops.
My preference most of the time for the incision in breast augmentation is the inframammary one which lies along the crease at the bottom of the breast. It has numerous advantages over both the transaxillary and periareolar locations which can be discussed at the time of your consultation.
The patient whose underarm scar is shown in the photo, had her breast augmentation surgery performed elsewhere using the transaxillary incision. She developed thick hypertophric scars postoperatively which her plastic surgeon excised but they recurred. The problems that she faces now are scars which are prominent and visible when she wears sleeveless tops, gowns and bathing suits and which are occasionally associated with discomfort particularly when reaching.
Exposed keloid that resulted from a transaxillary incision in a breast augmentation. This already had been revised once by her original plastic surgeon.
If these same scars had been situated on her breasts, they would at least be covered by her clothes and not be so visible to others. As a result, she has to be very selective with the clothes that she wears including avoiding sleeveless tops which can make enduring Arizona summers with temperatures far in excess of 100 degrees Fahrenheit less tolerable.
For more information on breast augmentations, breast revision surgery or on 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 mastopexy is the surgical procedure that addresses droopy breasts by tightening the skin, recontouring the shape, and lifting the tissues to create a more youthful appearance. Without the insertion of breast implants, the results may be breasts that are more normal in shape than before but often smaller than expected by the individual which can lead to some disappointment.
When, then, should you consider implants be for your mastopexy? The answer to this is not very difficult most of the time. If you feel that your drooping breasts now are smaller than you would like them to ultimately be, then undergoing a breast augmentation along with the breast lift should allow you to achieve the desired enlarged size. Conversely, if your breasts presently are much larger than you want them to be, there would be no need for implants. Instead, a reduction in size by removing breast tissue would be appropriate.
It is somewhere in between these two “extremes” that determining whether or not to insert breast implants may not be entirely obvious. This decision is also based on the facts that a mastopexy involves the removal of at minimum a small amount of breast tissue and compacts the volume of what remains, most women desire more volume at the upper part of their breasts (a push-up look) and most women would prefer to be a little bigger than a little smaller.
I have found that a vast majority of my patients who undergo a mastopexy also have a concurrent breast augmentation. Even a relatively small breast implant may create a firmer, fuller, rejuvenated appearance with improved cleavage that can be quite alluring.
Breast augmentation has been one of the top two cosmetic procedures for years that women have chosen for themselves. Furthermore, around 94% of them were so satisfied with the procedure and its effects that they would make the same decision again. This is an incredibly high level of satisfaction for anything so there must be some significant underlying reasons for it. Clearly, this plastic surgery procedure should not be considered to be frivolous.
What are some of these reasons for its popularity? Having larger and more attractive breasts does provide women with a greater sense of confidence and assuredness, self-worth and an improved self image. In many ways they can further validate and enhance their femininity, attractiveness and allure all of which are important. Thus, the positive effects are a combination of physical, mental and emotional influences.
Most people nowadays seem to recognize the importance of the beneficial effects that breast enlargement has on women – and not from a self-serving perspective. I generally see husbands, boyfriends, family and friends being quite supportive for women considering this procedure – which is how it should be.
The following video is the heart felt testimony of a patient of mine that clearly expresses the positive impact that a breast augmentation has on a woman’s psyche, emotions and attitude and outlook:
If you want more information on breast augmentation or other procedures such as a breast lift or tummy tuck or to schedule a free consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Over more than twenty two years of practicing plastic surgery in the Scottsdale, Glendale and Phoenix metropolitan area, I have seen countless patients in consultation who have shared with me their extremely unpleasant and very painful experiences of having had their breast enlargement performed elsewhere with “twilight” anesthesia (awake but sedated). Many of them stated that they felt totally awake and were quite apprehensive throughout the procedure. Their final result might have been good but their negative experiences left an indelible mark.
My unequivocal recommendation for anesthesia for a breast enlargement and what I use for all of my patients is general anesthesia administered by an anesthesiologist, a doctor specializing in this area. You simply go to sleep, wake up and remember nothing until after you have been in the recovery room for a while. No anxiety and no unpleasant experiences. Period!
An overwhelming majority of board certified Plastic Surgeons use general anesthesia when performing breast augmentations as well as breast lifts and breast revision surgery and do so in fully accredited facilities such as outpatient centers and hospitals. Your safety and the pleasantness of the experience are of utmost importance.
You also should be aware that many of the physicians either marketing or using a “twilight” anesthetic for their patients’ breast augmentations are not board certified plastic surgeons. More often than not, they may be an obstetrician-gynecologist, general surgeon, an internist or even a family practitioner. Compounding this quality and safety issue even further, they may have the anesthesia delivered either by a nurse anesthetist or by a standard nurse or
other office personnel under their direction.
Do you really want to risk your health, safety, well-being and results to maybe save some money – at least in the very short term?
I didn’t think so!
If you would like additional information on anesthesia and breast augmentations, breast lifts or breast revisions or on any other plastic surgery procedure that I perform or to schedule a free consultation with me, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
You are now ready to have that breast augmentation or breast lift that you have always wanted but there is just one problem: how to pay for it? After all, the economy is pretty bad right now and you don’t have a whole lot of cash just lying around. Do you just consign yourself to either giving up your dream or having to wait a whole lot longer? Maybe not!
My staff and I here at the Arizona Center for Aesthetic Breast Surgery have found and worked with several financing companies that do offer loans to qualified individuals for cosmetic surgery and procedures which could make your wish come true. Our patients have had the most success with CareCredit, myMedicalLoan.com and SurgeryLoans – and in that order. It has also been our experience that a rejection for a loan from one company doesn’t mean that you won’t be able to obtain one from another one. Some of our patients even obtain loans from more than one source.
How can you obtain information or apply for a loan? You can call my office to have your questions answered and even have us submit your application. Another option would be to go to the Financing page on my website, www.arizonabreast.com, and either click on the desired icon or call the listed toll free telephone number.
Women who have had breast augmentations are overwhelming satisfied with their decision with 94% stating that they would definitely make the same choice again. Their breast enhancement has had positive effects not only their appearance but also on their mental and emotional well being. An interesting question that is not often asked is how well these physical results hold up over time.
In the years that follow their breast augmentations, many women will have significant weight fluctuations or even permanent weight gains. Surely, there must be an effect on the breast size, appearance, etc. and there is. Even with sizable weight gains, persistence of good results can be possible. Pregnancy and breast feeding, on the other hand, can be quite detrimental to the elasticity of the skin as well as to the inherent density and volume of breast tissue resulting in drooping that may need to be addressed with a breast lift. However, with the presence of breast implants, significant volume and shape can still be maintained.
I have been fortunate enough to have seen many of my breast enlargement patients who had their surgery ten to twenty or more years previously. From this follow up, it is clear that a majority still have aesthetically pleasing improvements even despite marked weight gains. It should be pointed out that virtually all of the breast enlargements that I performed had the breast implants inserted in a submuscular pocket where there is better long term support against gravity. Implants that have been placed in a submammary pocket generally don’t do nearly as well over time because of the far greater drooping that will occur.
Before breast augmentation - front view
Before breast augmentation - side view
4 months after breast augmentation - frontal view
4 months after breast augmentation - side view
8 years after breast augmentation and 40 pound weight gain - frontal view
8 years after breast augmentation and 40 pound weight gain - side view
If you have additional questions regarding breast augmentation, breast implants or any other cosmetic surgery procedure that I perform or to schedule a complimentary consultation, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Women who have very large breasts often have to contend with persistent neck, back and shoulder pains, rashes, headaches and fatigue on a daily basis just doing routine activities. Even more frustrating are the extent of the symptoms and the limitations that they have when trying to engage in vigorous sports such as softball, volleyball, tennis, swimming and even jogging. In order to attempt to be more comfortable, many will wear two or three sports bras which can be another challenge. Many find the hassles and symptoms so problematic that they just give up on playing sports that they would otherwise enjoy.
Fortunately, the solution to this problem is straightforward and long lasting: pursuing a breast reduction. With a significant decrease in the size and weight of the breasts along with their elevation and removal of excess skin, most if not all of the annoying symptoms can be alleviated. Then, all one would need when participating in vigorous activities is just one well fitting sports bra.
Many of my breast reduction patients over the years have told me that following their surgery, they were able to engage in sports symptom free which they could not do previously. This made them extremely thrilled. In addition, they also confided that it was much easier to lose their excess weight now because they could exercise more vigorously and comfortably.
For more information on breast reductions or any other plastic surgery procedure that I perform or to schedule a consultation with me, please contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Men who happen to have male breast enlargement are quite often distressed mentally and emotionally and often do whatever they can to hide their deformity. Feelings of insecurity, excessive self consciousness, poor self image and even depression are quite common. Having gynecomastia can adversely affect interactions and relationships with others, particularly women, and even involvement in activities such as sports and working out. The good news about gynecomastia is that the surgical treatment is usually quite effective and not associated with a lot of discomfort.
Most of the men that I operate on for male breast enlargement can be treated quite effectively using ultrasonic assisted liposuction alone or combined with a small direct excision of breast tissue. This liposuction technique involves the direct injection into the tissues of a fluid containing a local anesthetic that can be clinically effective for many hours after surgery. As a result, recovery can be quite tolerable … even for a man!
A majority of my patients have indicated that the level of postoperative discomfort was quite tolerable and well controlled with oral pain medications. Many, in fact, returned to sedentary jobs within four to five days. I do recommend that they not engage in sports and working out for around 2 ½ weeks.
Replacing of a woman’s own implants for newer ones is referred to as breast implant exchange surgery which also is a category of breast revision surgery. The implants could have been originally placed for a breast augmentation, during a breast lift or in breast reconstruction.
There are several reasons why a woman would select this course of action with some of the most common ones being to:
change the size of the implant
alter the shape with regard to projection and width
change from saline to silicone implants or vice versa
replace an implant which has ruptured
change the implants as an incidental part of another breast issue such as drooping or capsular contracture
Usually the number one reason for a breast implant exchange is to obtain larger implants in order to have breasts that are significantly larger. Very uncommonly does a patient request going to a smaller size. In most of these situations, it is either because they were made excessively large initially by their surgeon or they gained a considerable amount of weight in the intervening period of time resulting in concomitant natural breast enlargement.
It is quite rare for my personal patients to desire different implant sizes and when they do, it is usually years later and often precipitated by another event such as an implant rupture. How is it that my implant exchange rate is very low? During my patient’s consultation, I listen carefully to their desires and concerns, take measurements, have them “try on” different implants as well as show them photographs of other patients that may be relevant for their situation. Finally, during surgery I will first use temporary “sizers” so as to precisely determine the perfect implant for them.
The relative proportions (profile) of the implant which affect the ultimate breast configuration, are also important. By explaining and offering different profile implants such moderate, high and super-high, my patients can realize the customized appearance they desire. For example, a patient who has a very narrow chest and wants a lot of projection but without excessive width, would benefit from a higher profile implant. A woman who is relatively broad, has a moderate amount of breast tissue and doesn’t want to be extremely large, would be better off with a moderate profile implant.
Finally, most of the patients that I see who have saline implants and are undergoing an exchange for whatever reason, switch to silicone implants. The reason is fairly obvious – they look and feel far more natural. Only in rare circumstances do they go from silicone to saline and it is never for aesthetic reasons.
For more information on breast implants, breast enlargement or any other plastic surgery procedure that I perform or to schedule a complimentary consultation, please contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Dr. Turkeltaub has been selected once again by the Consumers’ Research Council of America as one of America’s Top Plastic Surgeons for 2009. To be selected for this honor, a plastic surgeon is evaluated on strict and objective criteria and rated using a point system versus some “honors” which base their results on advertising dollars spent with the particular organization or other very subjective factors.
We are very appreciative of the honor and the recognition that it bestows. Our philosophy and goals have been and always will be to provide our patients the absolute best possible care and to do so in a comfortable, caring and professional environment. This includes full informing our patients of options as well as all the information that they need to reach prudent decisions. We are satisfied when our patients are very happy with their results.
If you would like to schedule a consultation with Dr. Turkeltaub, please feel free to call our office at 480-451-3000.
Arizona Center for Aesthetic Plastic Surgery
Scottsdale and Phoenix, Arizona
Women who undergo bilateral breast reconstruction have the best possible chance of obtaining relatively symmetrical results. This would be independent of the technique employed, whether it is immediate insertion of implants, utilization of tissue expanders or flap procedures such as a TRAM flap.
A significant exception to this would be unilateral radiation treatments as adjunct therapy for breast cancer. As I described in a previous post (Tissue Expansion for Breast Reconstruction Can Be Challenging In Women With Previous Radiation Therapy), radiation treatment causes permanent damage to the skin and underlying tissues resulting in scarring, thickening and rigidity often with some associated change of skin color and texture. It does impede the ability to stretch the skin as is required for breast reconstruction using tissue expanders and will substantially affect the final outcome.
The following patient of mine exemplifies this effect. She underwent a bilateral mastectomy and unilateral radiation treatments on the left side. This converted a situation that could have provided her with relatively symmetrical results to one in which this was an impossibility. The method of breast reconstruction that she chose was to use tissue expanders.
a.) Bilateral mastectomy and left breast irradiation. Preoperative
b.) Postoperative insertion and inflation of tissue expanders
c.) Preoperative
d.) Postoperative
e.) Preoperative
f.) Postoperative
Identical tissue expanders were inserted on both sides with the radiated side requiring a greater amount of inflation to reach what appears to be a less substantial sized mound. This is a clear manifestation of the effects of radiation on the tissues.
If you have some questions with regards to breast reconstruction, breast implants or any other plastic surgery procedure that I perform or if you would like to schedule a consultation with me, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Though the results from a breast augmentation are generally excellent with a satisfaction rate well over 90 percent, complications and less than desirable results do occur. One of the less common problems that can occur is where the breasts are so close together that they seem to coalesce into one breast unit. This is called symmastia (or synmastia) or in pseudo lay terms, a uniboob.
Symmastia of breasts
What are the causes of this deformity known as symmastia? Usually this is the result of attempting to move the breasts closer together in order to obtain improved cleavage. The pockets for the implants are dissected too far toward the midline which detaches the skin and underlying tissue from adhering to the sternum. The skin then drapes over the breast implants without having a discrete attachment to the sternum creating this amorphous “uniboob”. The situation is further exacerbated with implants that are inappropriately sized for the woman’s dimensions. Symmastia can occur both with breast implants placed in front of and behind the pectoralis major (chest wall) muscle.
Women who are very thin do have a slightly greater risk of this deformity occurring as do those who have a chest wall deformity known as pectus excavatum (where the sternum has a caved in appearance). Very conservative dissection in these situations and avoiding disproportionately large breast implants can help to minimize the development of symmastia.
There are several approaches which have been employed to address this challenging deformity. A relatively new technique involving the placement of specially processed tissue (Alloderm® and Strattice®) offer the potential of more predictable, satisfactory and permanent results.
For more information on symmastia, breast implants, breast augmentation or any other cosmetic surgery procedure 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
Most patients undergoing a breast reduction should have a fairly recent mammogram prior to surgery if they are past a certain age. The reason for this is that if any abnormal findings are detected that need further delineation, they should be pursued before proceeding with the planned breast reduction. A finding of breast cancer would preclude the need and indication for a breast reduction as this would be an inadequate treatment for breast cancer.
It would be ideal if mammograms could detect all occurrences of breast cancer but they do not. A fairly small percentage of breast cancers as well as pre-malignant lesions do escape detection but can be identified pathologically – from the specimen. This is why all breast tissue that is removed by the procedure is assessed by a pathologist.
A few studies have been performed over the years to determine the exact incidence of these “occult” breast cancers that can only be identified pathologically. The results indicate that the percentage is around 0.16% to 0.40% or up to 4 cases per thousand women. Nevertheless, these women are very fortunate because the early identification of their tumors translates into extremely high cure rates. If not for their initial desire for a breast reduction, they might not have had these cancers detected until a much later date at which point the prognosis would not be nearly as favorable.
The following patient exemplifies this scenario. She was a 39 year old woman wearing a 34G bra seeking a breast reduction. There were no abnormal detected masses on breast examination, her mammogram was unremarkable and there was no family history of breast cancer. Despite this, the breast tissue sent for pathological evaluation revealed the presence of early breast cancer.
Her treatment then consisted of bilateral mastectomies with immediate breast reconstruction. The photos below included her preoperative appearance, immediately following her breast reduction and then the final results after reconstruction.
Before breast reduction - Frontal view
Before breast reduction - Side view
Immediately following breast reduction - frontal view
Immediately following breast reduction - Side view
After breast reconstruction - in bra
After breast reconstruction - Frontal view
After breast reconstruction - Oblique view
After breast reconstruction - in bra
Following breast reconstruction - Side view
Following breast reconstruction - in bra
If you would like more information on breast reduction, breast reconstruction, information on any other cosmetic surgery procedure 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
Medications and Drugs That Can Lead to Enlarged Male Breasts (Gynecomastia)
Gynecomastia, which is the enlargement of breasts in a male is relatively common and is a frequent cause of embarrassment and insecurity. I have indicated elsewhere that the underlying cause of gynecomastia is related to the absolute and relative levels of the sex hormones testosterone and estrogen. Their levels are significantly affected by puberty, aging, alcohol, and a variety of medications, illicit and street drugs, and diseases.
Listed below are several broad categories of medications with some specific examples that are associated with male breast enlargement:
Anti-androgens used to treat prostate enlargement or cancer: finasteride (Proscar, Propecia), dutasteride (Avodart), flutamide (Eulexin); cyproterone (Androcur)
Anti-anxiety medications: diazepam (Valium)
Tricyclic antidepressants: amitriptyline (Elavil), doxepin (Sinequan) and imipramine (Tofranil)
Antibiotics such as ketoconazole (Nizoral) and isoniazid
Ulcer medications such as cimetidine (Tagamet)
Certain chemotherapy agents used in the treatment of cancer.
Cardiac medications such as digitalis (Digoxin) and calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem) and nifedipine (Procardia)
Certain AIDS medications especially Efavirenz
Products that contain tea tree oil or lavender oil
Miscellaneous medications such as estrogen, spironolactone (Aldactone), and HCG (human chorionic gonadotropin)
The following includes street and illicit drugs that have been found to cause gynecomastia:
Marijuana
Cocaine
Anabolic steroids
Methadone
Heroin
Amphetamines
If you have developed gynecomastia that is not related to puberty, alcohol or certain diseases and may be on one of the agents listed above or a similar medication or drug, it would be wise to investigate the situation further. You may want to discuss the situation with your primary care doctor or the appropriate prescribing physician if relevant.
To later cosmetically address the enlargement of the breasts (if appropriate), male breast reduction surgery can be considered. This procedure may involve ultrasonic assisted liposuction of the breasts with or without directly removing the enlarged glandular tissue.
If you would like more information on male breast reduction surgery for the treatment of gynecomastia such as with ultrasonic assisted liposuction or information on any other cosmetic surgery procedure, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Though radiation therapy is important in many situations for the treatment of breast cancer, it does present a challenge for breast reconstruction. Its permanent effects on the tissues of the chest can be significant and will have some impact on the reconstructive results.
The ionizing radiation injures and destroys healthy cells leading to scarring, thickening and rigidity of the tissues often with some associated change of color and texture. The outcome is skin and underlying tissues that feel firm, somewhat rigid and more resistant to stretching which is required for breast reconstruction using tissue expansion. In addition, nutritional blood flow to the area exposed to the radiation is significantly decreased due to permanently injured blood vessels. The consequences of this are an increased risk of infection, prolonged healing times from surgery and injury and greater susceptibility to trauma.
Because of these manifestations of radiation, it is not uncommon to be unable to stretch the tissue out to the predetermined volume and it definitely requires more time and patience. Infections are more common as is the incidence of capsular contracture, the formation of additional restricting scar tissue that further limits expansion. Incisions take much longer to heal and may reopen during the expansion. The tissue expanders not infrequently erode through the skin requiring an immediate surgical response.
Breast reconstruction employing tissue expanders in previously irradiated tissue can be successful but the risks and challenges should be understood as well as other options that may be available.
If you would like additional information on breast reconstruction or any other surgical procedure or to schedule a consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Hematomas, which are undesirable accumulations of blood, are an inherent risk of most surgical procedures. They are relatively uncommon following a breast augmentation, occurring in about 1 to 4 percent of patients. Simple precautions can be taken to help minimize the incidence.
Medications and other substances that interfere with the ability of blood to clot normally will increase the risk for the development of a hematoma following surgery. Commonly used medications that are known to have this side-effect include aspirin, ibuprofen, Motrin and Aleve. There are also ones specifically used as blood thinning agents to prevent clots such as Coumadin, Warfarin and Plavix. Many herbal supplement as well as Vitamin E and fish oils also have blood thinning effects.
My patients are provided with a thorough list of medicines, supplements and herbs that should be avoided for a specific period of time. Most of these medications, Vitamin E and herbal supplements should not be taken starting two weeks preoperatively and continuing until two weeks postoperatively. Therapeutic blood thinners like Coumadin and Warfarin are typically stopped two to three days before surgery and restarted again around two to three days postoperatively. Clearance from your physician to temporarily discontinue these medications is mandatory.
Vigorous activities that involve considerable exertion, heavy lifting or repetitive upper extremity movements can increase the risk of hematomas. My patients are instructed to avoid sports, aerobics, jogging, and similar activities for around three weeks after surgery. For those women who have a fairly physical or strenuous job such as hairdressers, nurses and waitresses, some restrictions are recommended during this period of time.
A few simple steps taken can keep your risk low for developing a hematoma following a breast enlargement and therefore avoid the undesirable consequences.
If you would like additional information on breast augmentation, breast implants or other cosmetic procedures, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Breast reductions are most commonly performed for functional reasons, that is, to alleviate symptoms such as neck, back and shoulder pains, headaches and rashes. Even in these situations, there is an aesthetic effect as the smaller breasts will also be lifted and rejuvenated in appearance.
What are some of the reasons to undergo a breast reduction for cosmetic reasons? These can involve situations where the breasts are large but not so gigantic that they would be associated with discomfort but they are bigger than the woman desires or attract unwanted attention or comments. By reducing their size they will be more to the woman’s sought after body image and would be less conspicuous.
Another reason to pursue a breast reduction for aesthetic reasons is where the breasts are both droopy (ptotic) and larger than desired. In this scenario, they are not large enough to cause symptoms or to qualify for insurance coverage. By decreasing their size, tightening the skin envelope and lifting the tissue, smaller, perkier and more youthful appearing breasts can result.
This last scenario can possibly be considered also to be a breast lift (mastopexy) with a small reduction. There can be confusion at times as to what constitutes a breast reduction of which a lift is usually an intrinsic component versus a breast lift with a small reduction. Both procedures usually involve the same incisions. The difference lies in the amount of breast tissue that is removed. Though there is no specific amount that distinguishes between the two, some consider removal of less than 300 grams per side to warrant being called a lift with a small reduction.
Either way, the results are smaller, lifted and perkier breasts.
For additional information on breast reduction surgery, breast lifts or other breast procedure or to schedule a 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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