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Sun Protection

Posted: May 31, 2012 in Uncategorized

Sun Protection

An article in the New York Times on 5/29/12 highlights the limitations for sun protection from clothing. Regular clothing must be dark or tightly woven to provide much protection from the sun, so they are not the most comfortable in the summer. Garments with specific sun protection have been available for some time from outlets like REI and manufacturers like Solumbra. They work by adding chemicals to the fabric so lighter materials can be effective for sun protection. Today more manufacturers are producing these products. A rating system for sun protection provided by these garments called ultraviolet protection factor [UPF] rates them on a scale of 1 to 50 [with the higher number indicating better protection]. There are also laundry treatments that add chemicals which provide sun protection to clothing, such as Sun Guard.

While these special garments can help provide protection, they only work if you wear them. And they only help for those areas that they actually cover. Traditional methods to reduce sun exposure such as sun screens, wearing a hat, and doing outdoor activity early or late in the day should not be forgotten and may be more cost effective.

St. Louis Plastic Surgeon on Accolate for Capsular Contracture

Posted: May 21, 2012 in Board Certified Plastic Surgeon Breast Procedures Breast Surgery Capsular Contracture

Accolate for Capsular Contracture

The drug Accolate has been proposed as a treatment for capsular contracture since 2002. At that time there was a report of a series of patients with contractures treated with that drug and it appeared to soften early contractures. Accolate (zafirlukast), along with Singular (montelukast), is a type of drug called leukotriene receptor antagonists. It is used to treat asthma by blocking the action of smooth muscle cells that tighten the airways. Myofibroblasts, the cells which cause contraction of the scar surrounding breast implants, are anatomically similar to smooth muscle cells and have these same receptors.

Since then there has been few scientific studies attempting to validate the effectiveness of this treatment. A series of thirty seven patients from Northwestern with smooth surfaced, saline-filled implants placed submuscularly with mild contracture showed a statistically significant response. A series of 60 patients in Italy showed softening of their capsular contracture compared to a similar number treated with vitamin E. A series of 19 patients from UCLA were treated with Singular and the majority showed improvement, better in those with mild contracture. Studies with silicone implants in rats treated with Accolate demonstrated thinner capsules in one study and less internal pressure within the capsule in another study.

In short there is a logical basis for the use of Accolate to treat capsular contracture, and promising reports. But after ten years there has not yet been published any prospective, randomized, controlled study with large numbers of patients in this country which demonstrates the effectiveness of Accolate for either the prevention of formation of tight capsules, or for the treatment of established capsular contracture.

The package insert notes that Accolate should not be taken by women who are pregnant, breast feeding, or have a history of liver disease. There are multiple possible drug interactions with Accolate including Coumadin, calcium channel blockers, and erythromycin.

If you have any questions, please feel free to contact my office.

Bariatric Surgery

Posted: May 10, 2012 in Bariatric Surgery

Bariatric Surgery

The American Medical Association reports that the number of bariatric surgical procedures performed per year has leveled off after increasing rapidly for a decade. The number performed is still greater than 200,00 per year in the United States. There are still many candidates with morbid obesity who could benefit from the procedure. The slowing of growth is likely due to the decreased numbers covered by insurance secondary to the slowdown in the economy starting in 2008.

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