Sunday, January 30, 2011


■FDA issues safety signal on ALCL and breast implants

The FDA on Wednesday warned that women with breast implants might be at a "small increased risk" of an immune system cancer called anaplastic large cell lymphoma after data revealed a total of 60 ALCL cases among those with saline and silicone implants. The FDA is seeking more data on ALCL cases and advises women with implants to consult their doctors if they experience implant-related symptoms, including pain, lumps or swelling.

If you have breast implants, there is no need to change your routine medical care and follow-up. ALCL is very rare; it has occurred in only a very small number of the millions of women who have breast implants.
It is estimated that the incidence of ALCL in patients with breast implants is about 1:500,000, whereas, the risk of a woman developing breast cancer over their life-time is about 1 in 9.  To put things in prespective, one is much more likely to be stuck by a lighting bolt or an asteroid than developing ALCL of the breast.  The type of ALCL we are talking about is a rare condition that occurs within the capsule (scar tissue) surrounding the implant.  It is a T-Cell Lymphoma that is ALK negative. It is different than ALCL that starts elsewhere and spreads to the breast.  The ALCL condition that occurs in the capsule around the breast implant seems to be much more indolent than other types of ALCL.  It is usually cured by removing the capsule.  Whether radiation therapy and chemotherapy are necessary is still uncertain, although some physicians studying this condition feel that radiation and chemotherapy are not needed. It is usually a condition that occurs on just one side. There is no blood test available to diagnose this condition.  The most frequent presentation is a late seroma (fluid collecting around the implant) which causes swelling in the breast and pain.  A palpable lump may be another presentation. In other words, the patient knows something has changed within the breast so this is not a condition that occurs without symptoms or signs. This condition usually occurs years after having implants - the mean time is about 8-10 years.

Although not specific to ALCL, you should follow standard medical recommendations including:

· Monitoring your breast implants. If you notice any changes, contact me promptly to schedule an appointment. For more information on self breast exams, visit Medline Plus: Breast Self Exam.
· Getting routine mammography screening.
· If you have silicone gel-filled breast implants, getting periodic magnetic resonance imaging (MRI) to detect ruptures as recommended by me. The FDA-approved product labeling for silicone gel-filled breast implants states that the first MRI should occur three years after implant surgery and every two years thereafter.

If you do not currently have breast implants but are considering breast implant surgery, discuss the risks and benefits with me. You may also visit FDA’s Breast Implants website for additional information.  The FDA has established a registery ( implants) to accumulate more information on this condition, and as more information becomes available, I will share it with you.

Saturday, January 15, 2011


■Drugmaker tests injection to dissolve chin fat
German drugmaker Bayer is starting clinical trials of an injection that dissolves small amounts of fat. The drug, ATX-101, would be given in a series of 40 to 70 mini-injections, with visible results after about 16 weeks, a company spokeswoman said. The Vancouver Sun (British Columbia)/The Daily Telegraph (London) (1/12)


■Facial bone mass decreases with age, study finds
Facial bones lose volume and diminish with age, contributing to wrinkles and sagging skin, researchers found. Women can begin losing significant facial bone mass in their 40s, though the process typically does not start in men until they reach their 60s, according to the study published in Plastic and Reconstructive Surgery. "Aging is multi-factorial," said ASPS President Dr. Phillip Haeck. "The things that affect it are genetics [and] external factors such as sun damage and nicotine use. Then there is plain old loss of volume of the soft tissues and bone." News


A board-certified plastic surgeon who specializes in treating adolescents has written a book to help teens and their parents make responsible decisions about plastic surgery. Dr. Frederick Lukash said he refuses to perform procedures on teens who have unrealistic expectations or who do not seem to understand the risks and limitations of surgery. "Plastic surgery is not the panacea for teen angst," Lukash wrote.

■Bullying can lead teens to consider plastic surgery
About 90,000 teenagers had cosmetic surgery in 2007, with some doing so to improve their self-esteem or avoid bullying. Teens most commonly seek rhinoplasty, breast reduction or augmentation, Botox injections or ear tucks. Plastic surgeons and psychiatrists worry about the potential trend. Plastic surgeon Dr. Michael Fiorillo said he sees "a fair amount" of these cases but that his "preference is, of course, to work out the issues first, the bullying, the teasing. But there are certain situations where people are mature enough. And surgery is a final resort." ABC News (1/12)

Monday, January 10, 2011


At the end of 2010, our federal debt totaled over $13.6 trillion.  This figure does not include the unfunded debt for Medicare, Social Security, and other federal programs.  Some estimate this additional figure to be over $30 Trillion.


The use of honey in wound care dates back to ancient Egypt.  How honey works to promote wound healing is still unknown. Honey has been shown to have an anti-bacterial effect. Medical grade honey has become popular in treating a variety of wounds to include burns.


Plastic surgery has become increasingly popular and accessible in the world today. Still, it’s important that you ask yourself if you’re really a good candidate for cosmetic procedures. A little self-reflection – along with the following criteria – will go a long way when considering plastic surgery.

No. 1: Your Physical Health
There are a number of factors that determine whether or not a patient is a good candidate for plastic surgery. The first consideration is whether or not the patient is healthy enough to undergo the surgery. If you have a shaky medical history, do not respond well to certain types of medication or anesthesia, or have a weak or compromised immune system, plastic surgery might be risky for you. Make sure to discuss your plans for plastic surgery with your primary care physician before proceeding with the surgery. Also, be sure that your plastic surgeon is fully briefed on your medical history before you have your procedure.

No. 2: Being Emotionally Prepared for Plastic Surgery
Being a good candidate for plastic surgery is more complicated that simply being in good physical health. It is important to be emotionally healthy and prepared for the mental effects of the surgery.
Depending on your reasons for undergoing plastic surgery, the procedure and time period afterwards can be an incredibly emotional time. It is important to know that many patients go through a few days of mild depression after plastic surgery. It is also important to be prepared for this and know what to do if the depression does not subside. (If your depression does not subside after three days, contact your physician and plastic surgeon immediately.) Being emotionally prepared for plastic surgery also means being in an emotionally stable place in your life. Sometimes people turn to surgery thinking it will help them through a difficult period in their lives. Getting plastic surgery directly after a traumatic event such as the loss of a loved one or a divorce is often a bad decision.

No. 3 and 4: Being Realistic About Your Goals and Understanding the Risks of Surgery
It is very important that plastic surgery patients to have realistic goals for their bodies. A patient who is 200 pounds overweight will not look like a supermodel the week after bariatric surgery. It can take many years of surgery, physical therapy and proper diet and exercise to completely transform one’s body in such a dramatic way. Furthermore, a complete transformation can require numerous surgeries.
In addition to being realistic about your goals, be sure you understand the risks of your surgery. No matter what kind of surgery you are having, cosmetic or otherwise, there is always risk involved. Be sure to speak frankly with your plastic surgeon about all of the possible outcomes of the surgery, even the negative ones. Being completely informed is the best and healthiest way to enter into this decision.

No. 5: Being Prepared to Follow Your Doctor’s Orders
After plastic surgery, you may be in a very delicate physical state. People who choose to have breast augmentation surgery, for example, must refrain from any rigorous physical activity during their recuperation period. During this period, even light exercise could cause one of the implants to shift or one of the sutures to open. Be sure that you are completely prepared to follow all of your surgeon’s orders during your recuperation period. Be sure that you know how to take care of your body in an ongoing way.

What if I am Not a Good Candidate for Plastic Surgery?
If you are in poor health or, for some reason, your doctor does not feel that you are a good candidate for cosmetic plastic surgery plastic surgery, he or she should tell you so. A doctor who practices with solid medical ethics, and who has your best interests at heart, will not authorize a procedure if it is too risky for you.