Posted: December 17, 2012 in Breast Cancer Lymphedema

One of the morbidities of the treatment of breast cancer is lymphedema, swelling of the arm.This problem is associated with obesity, mastectomy, dissection of the axilla [the arm pit], radiation of the axilla, and involvement of axillary lymph nodes with tumor.A recent study from the M.D. Anderson Cancer Center looked at whether reconstruction affected the rate of lymphedema.AThey found that mastectomy and reconstruction was associated with a lower rate of lymphedema than mastectomy alone, as well as a delayed onset of lymphedema


Dense Breasts

Posted: October 4, 2012 in Breast Cancer Breast Procedures Breast Surgery

An article in the Wall Street Journal on August 6th discussed the current controversy regarding mammography for women with dense breast tissue.With dense tissue it may be more difficult to detect breast cancer by mammography.Therefore legislation has been introduced in Missouri, as well as in other states, requiring that women with dense breast tissue be informed of that fact. These women may benefit from screening with ultrasound or some other method.
With breast implants mammography will cover less than 100% of the breast;there is a small percentage of the breast tissuethat is blocked by the implant which is a different density than normal breast tissue.Ultrasound can also be used in that situation to evaluate the breast tissue not visualized by mammography.


The HCG Diet

Posted: August 6, 2012 in Weight Loss

The HCG Diet

I frequently hear advertising for versions of the “HCG Diet.” This typically involves taking homeopathic quantities of the hormone HCG [human chorionic gonadotropin] along with a 500 calorie per day diet. It does make sense that if your intake is only 500 calories per day you will lose weight. Many authorities, however, do not recommend such a low level of intake to avoid creating problems such as loss of muscle mass. That level of intake is not sustainable for the long term so there is often rebound weight gain once it is stopped, rather than a long term maintenance of weight at a more desirable level. In the medical literature there is a lack of published data to support any benefit of HCG for weight loss. has a more detailed analysis of this topic including notice that the FDA and FTC issued warning letters in December, 2011 to manufacturers of these products for making unsubstantiated claims.


Weight Loss in St. Louis

Posted: July 30, 2012 in Weight Loss

Weight Loss in St. Louis

Many of us would benefit from losing our excess weight. This may improve our sense of feeling well along with looking better, making it easier to exercise, reducing stress on our joints, and for some reducing need for medication. The traditional wisdom has been that if you consume fewer calories than you burn up that you will lose weight [or if you eat more than you expend you will gain weight]. However it may be more complex than that. Gary Taubes in “Why We Get Fat” has proposed that insulin released in response to carbohydrate loads makes us store fat. Therefore he suggests that one should avoid carbs for breakfast. This simple change would maintain night time catabolism through the morning.

The South Beach type diets eliminate carbohydrates throughout the entire day which would be the more extreme version of this. Most of us would have trouble sticking with that plan, but may find it easier to get ourself to avoid carbs in the morning. This simple change can make a difference. Avoiding excess throughout the day and increasing regular exercise on top of that can be even more beneficial.


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.


What’s the right treatment for breast cancer patients in St. Louis?

Posted: April 23, 2012 in Board Certified Plastic Surgeon Breast Cancer Breast Surgery

What’s the right treatment for breast cancer?

Today surgical treatment varies from modified radical mastectomy to skin sparing mastectomy, nipple sparing mastectomy and lumpectomy. Adjuvant treatment may include radiation therapy, chemotherapy or hormonal therapy. What is right for any one individual depends upon the tumor: the size, location, type, grade, if receptors are positive, if there evidence of spread locally, to regional lymph nodes, or beyond. Individuals differ in their age, health, medical history, family history of breast cancer, genetics, and their personal desires. Therefore the available options for treatment may be different from one person to another. Is the treatment consistent with the NCI [National Cancer Institute] guidelines? Are there randomized controlled studies to provide data behind the recommendations? How much is risk reduced? New treatments may be described on the internet and show promise, but currently lack the clinical research to determine the true efficacy of those techniques and long term survival. Fortunately in the St. Louis metropolitan area there are multiple well trained surgical oncologists, medical oncologists,and radiation oncologists. It is always reasonable to obtain a second opinion if desired.


St. Louis Breast Procedure Supernumerary Nipples

Posted: April 9, 2012 in Board Certified Plastic Surgeon Breast Procedures Uncategorized

St. Louis Supernumerary Nipples

Supernumerary [extra] nipples are a common, minor congenital anomaly. This type of breast procedure is present in 5 to 6 % of the population. They are most often found along the milk line [the line down the trunk from the midpoint of the clavicle through the nipple]. Less commonly they can be found in other locations. Unlike ectopic breast tissue they can often be identified at birth. But similar to breast tissue the extra nipple can change under the influence of hormones and can be subject to disease processes. The supernumerary nipple is typically smaller than the normal areola in size. Some may resemble the normal nipple-areola complex while others appear to be simply a “mole”. One study has shown them to be more common on the left side and more common in males. Rarely they can be associated with internal conditions, especially urologic. Excision of the extra nipple is commonly done under local anesthesia.


Axillary Breast Tissue

Posted: April 2, 2012 in Breast Procedures Breast Reconstruction

Axillary Breast Tissue

Breast tissue can be found in the axilla [the armpit] more often than people think. It is present in 2 to 6 % of women. It may appear as a soft mass and/or there may be discomfort and tenderness. It may be unilateral or bilateral. It is hormonally responsive like all breast tissue, so there may be tenderness and swelling that varies with the menstrual cycle. This axillary breast tissue may become enlarged with puberty or pregnancy.

Treatment may be done with excision or by liposuction. The procedure may be more comfortable with anesthesia. If the insurer is covering it, then excision is usually required so there will be a specimen for pathology. The same changes which can happen in any breast tissue, even breast cancer, can potentially occur in the axillary breast tissue.

*This information is for educational purposes and should not be relied on as medical advice. Any change in your medical care should be first discussed with your physician.
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