Breast reconstruction in irradiated patients

Many women following mastectomy will receive adjuvant radiation therapy. 

A recent study by Dr. Steve Kronowitz from MD Anderson in Houston appeared in the October issue of “Plastic and Reconstructive Surgery”.  

Generally, it was found using a patient's own tissue (autologous) for reconstruction gave better results. 

Implants, however, may be the only choice available.  In one study, they found a complication rate of 45% for women receiving implants WITH radiation compared to 24% in women with NO radiation.  Complications were more common when the patient received radiation BEFORE rather than after reconstruction.  

Basically, radiation therapy affects the skin, which ultimately compromises the reconstruction.  It is also important for me to remember, as a cosmetic surgeon, disease control / eradication is ALWAYS my primary goal.

How do YOU see yourself?

A study of how women perceive themselves when they look in the mirror has revealed interesting  changes in perceptions of facial features as women age. The full findings are published in “Mirror on the Wall: A Study of Women’s Perception of Facial Features as They Age,” appearing in the May issue of Aesthetic Surgery Journal.

With Facial aesthetic treatments among the most popular cosmetic procedures around the world, researches asked hte question, "Why do so many women want to change what they see in the mirror?"

In addition, what do they most like or dislike about their faces? 

A group of Turkish researchers found that: 

1. Among women in their 20s, the nose and skin were what women focused on most and most desired to change, 

2. For women in their 30s and 40s the skin and the area around the eyes (periorbital region) were the main areas of concern. 

3. For women in their 50s, the periorbital region and jawline were the primary facial focal points.

“We wanted to better understand why patients desire to alter their facial features. What is it that leads them to seek so-called perfection?” said lead author Billur Sezgin, MD, of Gazi University in Ankara, Turkey. “We found that many women are not at peace with what they see in the mirror. When women look in the mirror, they primarily focus on the parts of their face they most dislike or desire to change. Not surprisingly, this dissatisfaction is the strongest motivator for seeking facial aesthetic treatments.”

As a cosmetic surgeon practicing in Fort Myers and Cape coral, Florida, I find my patients tend to fit the same interest profile.

“This study is very interesting because it clearly shows that most women tend to compare their appearance to that of younger women,” wrote Foad Nahai, MD, Editor-in-Chief of Aesthetic Surgery Journal. 

According to the American Society for Aesthetic Plastic Surgery (ASAPS), women in the U.S. had nearly 8.4 million cosmetic procedures performed in 2011, a large percentage of which involved the face.

BREAST SALVAGE AFTER RECONSTRUCTION

From time to time, as a Fort Myers plastic surgeon, I am exposed to journal articles and reports that may be a little technical for the average reader. But I like to include them here because they may be of interest to some people.

One of the most dreaded complications after breast reconstruction is to develop an infection. A recent study was reported in the Plastic Surgery Journal. It chronicled one surgeons experience.

Once an infection is established, ie: fever, swelling, erythemia or redness, then one must act right away. Usually broad spectrum antibiotics are started. The patient is then taken to the operation room and the infected prosthesis is removed, cultures taken and the pocket is debrided and irrigated with normal saline and antibacterial solution.

If the pocket, in the opinion of the surgeon, was not overly infected, a new prosthesis was placed along with a suction drain. The drain was removed when the output was less than 30 cc’s within 24 hours.

If in the surgeon's opinion, the infection was judged too severe, the prosthesis was NOT replaced.

In the surgeons surveys gathered over several years (2002-2008), 60 patients were identified. Of these, 17 patients (28%) did NOT have the prosthesis replaced. A total of 33 patients had a successful salvage procedure. The success rate was about 77%.

Also of interest was the fact that the average time between the actual reconstruction and the infection / implant exposure was about 14 months.

Buyer-Beware

Another blog message from Fort Myers Cosmetic Surgeon, Dr. Robert J. Brueck MD

BEFORE/AFTER PHOTOS – BUYER BEWARE

The highly competitive market place for cosmetic surgery procedures creates somewhat questionable practices. No other area is as susceptible as so-called "before and after" photos.

With all the newest technologies – new vendors – new software programs such as Photoshop by Adobe systems - "after" photos can be altered to give that “WOW!” effect. These altered "before and after" photo’s can be changed to the point where a prospective patient says, “Wow, I want that."

A case in point of deception is found in a widely-aired television commercial for a trademarked surgical procedure.

The "after" photo’s reveal a result that would be impossible to obtain with this one procedure.

At the bottom of the post-op photo is a disclaimer wherein the producers of the commercial state that other procedures also were done. How many people will see let alone read the disclaimer?

Legal? – yes. Deceptive? – for sure.

I have always told my new patients – "when you become my patient, you get total honesty and I treat you like a member of my family."

Dr. Brueck discusses breast lifts on TV - Syndication Schedule

If you didn't know I have been appearing on American Health Journal's TV broadcasts, you would have missed them. So here is a schedule of markets and times for my breast lift interview. You can read more about breast lifts in Fort Myers at my website, Beauty-by-Brueck.com

Station: My Network 13 – San Diego, CA Station: KHOU / Inde D2 Houston, TX

Day & Time: Sunday @ 11:00 AM Day & Time: M-Th @ 7-8 AM

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Station: CBS 6 – Beaumont, TX Station: WNBW / NBC – Gainesville, FL

Day & Time: Sunday @ 11:05 PM ­­­­­Day & Time: Saturday @ 12:00 PM

Station: 10 News 2 – Knoxville, TN Station: My Network – Gainesville, FL

Day & Time: Saturday @ 4:30 PM Day & Time: Sunday @ 9:00 AM

Station: CBS – Salt Lake City, UT Station: CW 5 – Alexandria, LA

Day & Time: Sunday @ 7:30 AM Day & Time: Sunday, @ 9:00 AM

Station: CBS 2 – Palm Springs, CA Station: ThisTV – Lafayette, LA

Day & Time: Saturday @ 3:30 PM Day & Time: Saturday @ 9:00 AM

Sunday @ 5:30 AM Sunday @ 9:00 AM

AGING - It appears to be in your bones.

Another in a series of blog postings by Fort Myers Board Certified Plastic Surgeon Dr. Robert J. Brueck MD FACS of Fort Myers and Cape Coral, Florida. For more information about cosmetic surgery procedures available in fort Myers, visit Dr. Breuck's web site, Beauty-by-Brueck.com

Aging is something I deal with every day.

Women come in and say my friend Brenda is 10 years older than me, but she looks younger than me. Why is that?

There are so many factors such as sun exposure, genes and the list goes on. For some it's simple, wrinkles and loose skin. But now we can add a new player in the game of facial aging: your facial skeleton.

Researchers at the University of Rochester studied the facial skeleton of 3 age groups. Included were young (20-40's), middle age (41-64) and older (65 and up -I say more mature).

One finding was that the orbit, which contains our eyes, widens and lengthens as we age. The length and height of the mandible decreases with age.

These changes occur sooner in women than in men. That may help to explain in part why men seem to "age better."

It also helps explain why I "volumize" the soft tissue of my patients filler with their own fat and stem cells.

Please visit the website of Dr. Robert J. Brueck MD FACS at Beauty-by-Brueck.com for more information on matters of aging and cosmetic surgery.

NOSE-WORTHY HISTORY REMEMBERED

Another in Dr. Robert j. Brueck MD FACS's series of blogs on subjects of medicine, health, cosmetic surgery and youthful appearance. Dr. Brueck posts more about these subjects on his plastic surgery web site at Beauty-by-Brueck

Plastic surgery is a sub-specialty that has evolved over the centuries.

During the great World War much progress was made in the development of plastic surgery as a recognized surgical sub-specialty. A rare book dealing with plastic surgery was recently purchased at an auction in England.

The book was published in 1597 and was entitled "De Curtorium Chirurgia Per Inritionem." It was written by Gaspare Tagliacozzi, who was a professor of surgery and anatomy at Bologna University.

One of the diagrams in the book shows a patient with a flap from their upper inner arm attached to their nose.

This attachment of the patient's nose to their upper arm had to remain in place for about 3 weeks. Then the flap was separated and inset in the nose to reconstruct it. A true classic!

By the way, if you are looking for something special and unusual for that special person in your life, it was sold at auction for about $17,000.00

This fore-runner to modern rhinoplasty, more commonly known as "nose jobs", has evolved into countless procedures that have made life more enjoyable for individuals with unattractively shaped noses. As one of the most prominent features on a face, a beautiful, aesthetically proportioned nose can be an asset in life.

Happy New Year.

Gynecomastia: Diagnosis and Treatment, by Dr. Robert Brueck MD, Fort Myers

Another in the series of blog postings by Dr. Robert J. Brueck, MD FACS, Board Certified Plastic Surgeon practicing in Fort Myers and Cape Coral, Florida

I recently read an article in a national newspaper talking about the ramifications and the seemingly increasing incidence of gynecomastia or male breast tissue. Gynecomastia can be extremely large, tender and in some cases some men may suffer from breast cancer.

I feel the biggest issue with male breast tissue is the social embarrassment and psychological harm it can do to the individual. It can be truly devastating.

What causes gynecomastia: Usually gynecomastia is triggered by a hormonal imbalance which means less male testosterone compared with the female hormone, estrogen. This imbalance can be due to natural hormonal changes, certain medications and certain health conditions. About 25% of the time it is idiopathic i.e. there is no particular cause.

Male hormones control characteristics we associate with men, such as muscle mass, body hair, etc. Female hormones usually cause female characteristics i.e. breast growth and this hormone is estrogen. It’s important to know and realize that men also produce estrogen, the small quantities produced in men help to regulate bone density, affect their moods and also sperm production.

Gynecomastia in puberty is usually due to hormonal imbalance and usually goes away in a year or two. We often see gynecomastia in obesity and in that situation the abnormal breast tissue or collection of breast tissue, usually is atty tissue. As men age, there is another peak of gynecomastia occurring around the age of 45 to 50. It’s thought that about 25% of men suffer from it.

Certain medications such as AIDS medications or some meds used to treat prostate enlargement or cancer can cause gynecomastia. Some of the more common medications associated with gynecomastia include Digoxin and Furosemide or Lasix which is a very commonly used diuretic. Also the use of anabolic steroids (seen in gym rats) used to enhance athletic performance can cause gynecomastia as well.

On examination the gynecomastia may be fatty tissue and hence we call it psuedogynecomastia or lipomastia. There is very little breast tissue. When one examines this individual the abnormal breast tissue is soft and does not have any firm grittiness to it.

Most of the time the exam reveals a combination of fatty tissue and BREAST TISSUE. The breast tissue itself can be firm and nodular. In some cases the gynecomastia tissue is located underneath the nipple areolar complex. This can cause the nipple areolar complex to increase in size and be puffy. The gynecomastia also can be asymmetrical, that is one side can be larger than the other.

HOW TO TREAT IT: Treatment varies depending on what one finds on examination. Assuming there are no offending medicines, anabolic steroids, etc then one can either accept the condition or consider getting it surgically removed. Obviously, if there is a medication that may be the underlying culprit then stopping that medication may cause the gynecomastia to go away on its own.

If the underlying breast tissue is fatty tissue only then liposuction alone may be adequate. If it is a combination of breast tissue and underlying fatty tissue then I utilize suctioning and actually direct excision.

Usually, the incision I use is centered around the nipple areolar complex. Obviously we want to create as little scarring as possible. The biggest decision is, do we need to remove excess skin? We try to do the excess skin excision, if necessary with incisions around the nipple. This way the incision can be camouflaged and be limited to the area around the nipple areolar complex. There are some examples of this on my website.

The operation usually takes one to two hours and is done as an outpatient under sedation. What this basically means is there is no pain associated with it. There is minimal discomfort post-op as well and we certainly provide the patient with pain medication to control any discomfort they may have.

I think the most important thing to do post-op is to wear a compressive vest overlying the chest area night and day to minimize swelling and keep the skin from folding. I usually recommend that an individual wears his vest for a minimum of two weeks, sometimes up to four weeks depending on the degrees of skin laxity, swelling and edema.

Sometimes, but rarely, insurance will help pay for the procedure. I have to say that the results can be amazing and, oh so gratifying, when you can give an individual his life back as a result of suffering from gynecomastia.

If you would like to learn more about plastic surgery and how it may help you with facial or body concerns, visit Dr. Brueck's website at http://www.Beauty-by-Brueck.com

This could save your life - Advice from Dr. Robert Brueck, Fort Myers Plastic Surgeon

This blog message is brought to you by Dr. Robert J. Brueck, Board Certified plastic surgeon in Fort Myers, Florida, who also has a web site at http://www.BeautybyBrueck.com .

THIS COULD SAVE YOUR LIFE!

Now that I have your attention let me give all of you, my wonderful friends and patients, a few words of warning that conceivably could save your life.

Realize that supplements are not as closely scrutinized as drugs in America. A senate judiciary committee recently sat down to plan a hearing this month focusing on dietary supplements and their safety.

There are countless stories of individuals taking dietary supplements and developing liver problems, bleeding problems, mood changes or alterations and the like.

I remember a short time ago I did a face lift on a lady who was taking Omega-3 fish oils. She bled profusely and developed a hematoma which is a collection of blood under the skin. This had to be drained. In the end she was fine. What was surprising to me was that nearly 67% of adults take dietary supplements. That’s a lot of people. It’s important to understand the concerns that may exist concerning certain supplements.

In a 2007 survey of weight loss and athletic supplements the British labs analyzing these substances found trace amounts of steroids in 25% of the samples that they tested.

Since December, 2008 the FDA has issued warnings about more than 70 weight loss supplements. Now we all know why so many athletes are banned for steroid use or is this really the case? I know I have all of my surgical patients get off ALL dietary supplements two weeks before surgery.

Some helpful websites include the National Libraries of Medicines Medlineplus.gov under the heading drugs and supplements.

Also try NCCAM.NIH.gov and dietarysupplements.info.nih.gov.

You can also go to www.FDA.gov to see if supplements that you are currently taking are included under the warnings label. I guess it’s true that sometimes simple is better.

All the very best and I hope this proves beneficial to you.

A New Filler - Fort Myers plastic surgeon Dr. Brueck comments

NEW FILLER - OBSERVATIONS FROM

DR. BRUECK

It seems every time I get up from bed there is a new filler/a new toy to tempt us to answer the needs of our patients.

The newest kid on the block is Hydrell/recently approved by the FDA.

It’s the newest Hyaluronic acid filler with anesthesia already in it.

The drug is manufactured by Anika Therapeutics and will be distributed in the U.S. by Coapt Systems. It is designed to fill in mid to deep dermis facial wrinkles and folds. It requires about 50% of the typical injection volume, meaning fewer injections to fill in those ugly, nasty facial wrinkles.

So far no word about when it will be released but I am sure there will soon be a new “knock on my door”.

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