March 6th, 2010 admin
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.
Gynecomastia - before surgery
After surgery
If you would like additional information on male breast reduction surgery for gynecomastia or to schedule a complimentary consultation with me, please contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Posted in Male breast reduction (treatment of gynecomastia), liposuction | No Comments »
February 10th, 2010 admin
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
Posted in Breast augmentation, Breast implants, saline implants, silicone implants | Comments Off
January 25th, 2010 admin
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
Posted in News / Press | Comments Off
December 27th, 2009 admin
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
Posted in Breast cancer, Breast reconstruction, Tissue expanders, radiation treatments | Comments Off
December 1st, 2009 admin
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
Posted in Breast augmentation, Breast implants, symmastia | Comments Off
October 30th, 2009 admin
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
Posted in Breast cancer, Breast reconstruction, Breast reduction | Comments Off
August 30th, 2009 Dr. Turkeltaub
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
Posted in Male breast reduction (treatment of gynecomastia) | Comments Off
August 23rd, 2009 Dr. Turkeltaub
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
Posted in Breast cancer, Breast reconstruction, Tissue expanders | Comments Off
August 16th, 2009 Dr. Turkeltaub
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
Posted in Breast augmentation | Comments Off
August 9th, 2009 Dr. Turkeltaub
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
Posted in Breast reduction, Mastopexy | Comments Off
