Submitted by Twin City Plastic Surgery

There is nothing easy or simple about a cancer diagnosis. From the moment a patient hears the words “you have breast cancer,” she begins an exhausting schedule of medical appointments, treatments, and procedures. While much attention is given to treating the patient’s medical condition, she also needs support in thinking through her options impacting her health and appearance.

The vast majority of breast cancer diagnoses involve some type of surgical treatment with lumpectomies being more common in early-stage cancer situations. According to the American Cancer Society (ACS), 57 percent of women with early stage (Stage I or II) breast cancer have a lumpectomy or partial mastectomy and 36 percent have a full mastectomy, with others electing non-surgical options. Thirteen percent of women with late stage breast cancer (Stage III or IV) have a lumpectomy or partial mastectomy and 60 percent have a mastectomy.

The ACS also tells us 20 to 40 percent of women who undergo mastectomy have breast reconstruction which typically includes an implant, tissue from another part of the body, or a combination of the two.  Some types of reconstruction can begin during the mastecomy surgery itself, so having a reconstruction plan from the beginning of treatment is critical. Of course, some women are not candidates for lumpectomies due to the size or location of the tumor. But for a woman who has options, how does she make the decision to remove part or all of her breast?

Current data shows the type of surgery – lumpectomy or mastectomy – does not appear to impact a patient’s survival rate or possibility of cancer recurrence. Also, these surgical options do not impact the need and/or type of chemotherapy and/or hormone therapy a doctor recommends.

A lumpectomy almost always:

• Allows the patient to preserve more of their breast, which can give the patient comfort and an obvious feeling of normalcy.
• Involves a less extensive surgery in which the patient can go home the same day.
• Requires radiation as part of the therapy to treat the breast cancer.
• Does not involve placement of an implant.

Lumpectomy with radiation therapy (XRT) is becoming much more common versus a full mastectomy; from a breast conservation perspective and oncologic perspective, this is good. But there are some downsides to choosing lumpectomy/XRT that are rarely mentioned to the patient.

• Lumpectomies can result in uneven breasts which may not give the patient the look they hoped for.
• The defect may still leave a significant cosmetic concern, but any surgery to correct this may be considered cosmetic and be more difficult to get covered by insurance.
• Radiation treatments can cause adverse cosmetic changes such as darkening of the skin at the treatment site.
• Any surgery that is ever done on the radiated breast for the rest of that patient’s life is at a much higher risk for complications due to the radiation, and, therefore, limits the patient’s options for reconstructive surgery in the future.

The decision to have a lumpectomy or mastectomy is as individual and personal as a surgery can be. Each patient should talk with their plastic surgeon prior to making their final decision so they can be fully informed of the advantages and challenges of each option. As board-certified plastic surgeons, they have the education and experience to provide effective breast reconstruction consultations and provide patients peace of mind during a stressful time as they reclaim their life and body from this disease.

Submitted by Twin City Plastic Surgery

Most people have seen advertisements that promise to “melt fat away without diet or exercise!”  And most people would dismiss such claims as too good to be true.  However, there really is an FDA approved treatment called Kybella that gets rid of fat in the area below the chin.  Many people feel that their “double chin” makes them look older or heavier than they really are.  Weight gain, aging, and genetics are causes for this problem area in both men and women, and it is often an area that cannot be improved by diet and exercise, especially if genetics is the cause. For those people that are bothered by excess chin fat, Kybella may be an excellent solution.

So how does this fat-melting process work? Deoxycholic acid is naturally produced in the body to break down dietary fat.  Kybella is synthetic deoxycholic acid. When it is injected directly into the fat tissue, it physically destroys the fat cells.  The cells die and are then eliminated naturally from the body.   And once these fat cells are destroyed, they don’t ever come back, so the results are permanent.

Kybella is a quick, in-office treatment that takes about 20 minutes.  You can resume your normal activities right away, although there will likely be some swelling and bruising. Most people need more than one treatment to achieve the best results, and subsequent treatments are usually spaced 1-1/2 to 2 months apart.  Results aren’t noticeable right away.  Since the fat cells are being destroyed, it is more of a gradual process where you will see improvement over the course of several months. Many people have reported that they notice a significant difference after the second treatment.  Even though the results aren’t immediate, the treatment is effective and the improvement is permanent.

It’s important to note that Kybella will not tighten saggy skin – it only gets rid of the fat. And currently, it is only approved for use in the chin area. It cannot be used to eliminate fat in the abdominal area, such as a “muffin top” or “love handles” as these areas are too large and would require too many injections.  It is also not approved for use around the eye area due to safety concerns.

Kybella is very safe. Not only is it made from something that is naturally found in the body, it has been extensively tested.  About the only serious side effect is the small possibility of injuring a nerve, which could cause some weakness of the facial muscles.  But even if this should happen, it would not be permanent.  The most common side effects of Kybella include swelling, bruising, pain, numbness, redness and areas of hardness around the treatment area.

Like most cosmetic procedures, Kybella is not covered by insurance.  But unlike many other non-surgical cosmetic procedures, the results are permanent, so you do not need to worry about any maintenance or future costs. Kybella is not for everyone, so it’s important to consult a plastic surgeon like Dr. Paige Holt who can answer all your questions and determine the best procedure for you.

Ears: Those wonderful features on the sides of head that allow you to hear the world around you.

For most of us, we probably hear few comments about our ears. But for others, their ears may be the subject of unnecessary conversation.  No one wants to be teased about their appearance, but unfortunately big ears are a regular target. It’s estimated that five percent of the population has ears that stick out beyond a normal range.

Many kids are born with cute little ears that stick out. And, when kids are little, those pronounced ears just add to their overall cuteness. As children grow, the vast majority find their ears slowly become less prominent as their head and features settle into their adult position. However, sometimes ears don’t shift into position or an injury may cause the ears to stick out even more.

Around 20,000 people a year in the US undergo otoplasty, a surgical procedure to adjust or reform the ears. The procedure itself can address a variety of issues either coming from the natural position or size of the person’s ears, medical conditions creating ear deformities, or injuries resulting in disfiguration. Before considering surgery for these types of conditions, it’s best to wait until the patient’s ears are fully grown or, if issues are due to an injury, fully healed. Most surgeons recommend waiting until a child is at least 6 years old, if not older, prior to considering surgery.

If surgery is the right option, the surgeon will meet with the patient ahead of time and plan their surgical procedure. The surgeon will provide the patient (and his/her parents, if the patient is a child) with an overview of what incisions will be needed and what to expect for recovery.

Most times, otoplasty can be performed as an outpatient surgery. The patient is given anesthesia and incisions are made by the surgeon based on the exact needs of the patient’s condition. For many surgeries, the incisions are made behind the ears where the ears can be adjusted but the scars can be easily hid. If incisions are needed in the front of the ears, many surgeons will try to place the incisions inside the folds of the ears to keep the visible scars as limited as possible. Permanent internal sutures are typically used to hold the cartilage in place after the necessary adjustments are made. The surgeon then uses stitches to close the incisions, again focusing on making the stitches as discrete as possible.

Recovery from otoplasty is fairly consistent with other facial plastic surgeries. The patient can expect itching as the stitches heal, and will need to keep the incisions clean and untouched as much as possible. Two things that can be especially challenging after otoplasty are sleeping – if the patient tends to sleep on his/her sides – or washing his/her hair the first few days. In both situations, a patient can discuss the location of the specific incisions for their surgery and ask for recommendations for how best to handle the days that follow surgery.

“Should I or shouldn’t I?” many women ponder before going under the knife. Prior to considering any type of cosmetic surgery, it’s important to weigh the pros and cons associated with the procedure. Deciding whether to go through with a surgery can be difficult enough without having to wade through the laundry list of myths commonly associated with the operation.

Breast augmentation, which was the No. 1 surgery performed during 2012, according to the American Society for Aesthetic Plastic Surgery, can help improve a woman’s self-confidence, but can it lead to breast cancer? Will they leak? Won’t they feel unnatural? The answer to most of the common myths associated with this procedure is no, but there’s no harm in asking your physician anyway.

They will look fake: FALSE
 A properly performed breast augmentation surgery will not lead to unnatural looking breasts. Healingwell.com emphasizes that the most important selection to be made prior to your surgery is choosing the proper doctor, one who is board certified and experienced in performing cosmetic procedures. Tissue is constructed to match the patient’s age, weight, height and existing cup size, then implants are placed with care and precision for the most natural look.

I won’t be able to breastfeed: FALSE
 One of the most common myths associated with breast surgery is that the patient will no longer be able to breastfeed due to inability or fear of transferring harmful chemicals to an infant. These are both, however, false claims. Mother Inc. explains that there currently exists no medical evidence that states breast implants interfere with breastfeeding capabilities. With or without implants, some women are unable to successfully breastfeed, but implants should not impede a woman’s ability to do so.
They will have to be replaced regularly: FALSE – but there are caveats
While implants do not have to be regularly replaced, ASAPS does remind interested individuals that they may eventually need to be. However, this solely relies upon the patient’s age when receiving the procedure, the type of implant she receives and how she treats her physical health.

Like many others, I’ve been under the assumption that breast implants impeded the ability to breastfeed. My mother took this into account when she got her implants in the 1980s, after my little brother had moved on to solid food.
Thanks to a lot of scientific improvements since then, and with informative guidance in a recent article by What to Expect(R), I learned that yes, it’s still possible to nourish a newborn with your own breasts, even after augmentation.

The ability to do so will rest on a couple of considerations.

First, location, location, location. As in real estate, so it goes with surgical incisions. Periareolar incisions are made near the areolae. If your incision cut is across the nipple, there is the likelihood that the milk ducts were cut and scarred, which can impede the flow of milk.  But if the implant was inserted through an in the armpit or in the inframammary fold, not only should the nerves to the nipple likely still be intact, milk should flow as well.

The location of the incision is not the only important aspect of breast feeding after an augmentation, but also the placement of the implants themselves is a factor in the ability to feed. Surgeons recommend this based on your anatomy. If the implants are placed underneath the pectoral muscle, they are less likely to interfere with breastfeeding.

Another consideration is the overall reason for getting implants in the first place. If the procedure was used simply to increase a small bust line, then there will likely not be an issue that concerns breastfeeding. But if the augmentation was designed to enhance breasts that developed too far apart, asymmetrically, or the tissue never developed at all, then breastfeeding may not be an option due to some more substantive issues of glandular development.

Perhaps the easiest way to self-evaluate your ability to breastfeed: do you have feeling in your nipples? If the nerves were cut during the surgery, the chances of lactation are diminished.

We know that expectant mothers are HIGHLY cautioned against ANY toxic exposure during pregnancy (from mercury from fish, nitrates in sandwich meat, scary stuff from hair dye), but if you’re worried about the silicone that could be in your implant, rest assured. According to What to Expect: “In the unlikely event that your breast implants contain silicon, there’s no risk to your baby if you breastfeed. In fact, cow’s milk and formula actually contain more of the element silicon than breast milk from moms with implants.” Now we know!

As stressful as this time can be, remember, many women have issues in this area, regardless of breast augmentation. If you have implants and hope to nurse your newborn, give these four considerations thought and reach out to Dr. Paige Holt and a good lactation consultant to discuss.