In the 1970s, women’s health advocates were highly suspicious of mastectomies. They argued that surgeons — in those days, pretty much an all-male club — were far too quick to remove a breast after a diagnosis of cancer, with disfiguring results.But today, the pendulum has swung the other way. A new generation of women want doctors to take a more aggressive approach, and more and more are asking that even healthy breasts be removed to ward off cancer before it can strike.Researchers estimate that as many as 15 percent of women with breast cancer — 30,000 a year — opt to have both breasts removed, up from less than 3 percent in the late 1990s. Notably, it appears that the vast majority of these women have never received genetic testing or counseling and are basing the decision on exaggerated fears about their risk of recurrence.
In addition, doctors say an increasing number of women who have never had a cancer diagnosis are demanding mastectomies based on genetic risk. (Cancer databases don’t track these women, so their numbers are unknown.)“We are confronting almost an epidemic of prophylactic mastectomy,” said Dr. Isabelle Bedrosian, a surgical oncologist at M. D. Anderson Cancer Center in Houston. “I think the medical community has taken notice. We don’t have data that say oncologically this is a necessity, so why are women making this choice?”One reason may be the never-ending awareness campaigns that have left many women in perpetual fear of the disease. Improvements in breast reconstruction may also be driving the trend, along with celebrities who go public with their decision to undergo preventive mastectomy.
This month Allyn Rose, a 24-year-old Miss America contestant from Washington, D.C., made headlines when she announced plans to have both her healthy breasts removed after the pageant; both her mother and her grandmother died from breast cancer. The television personality Giuliana Rancic, 37, and the actress Christina Applegate, 41, also talked publicly about having double mastectomies after diagnoses of early-stage breast cancer.“You’re not going to find other organs that people cut out of their bodies because they’re worried about disease,” said the medical historian Dr. Barron H. Lerner, author of “The Breast Cancer Wars” (2001). “Because breast cancer is a disease that is so emotionally charged and gets so much attention, I think at times women feel almost obligated to be as proactive as possible — that’s the culture of breast cancer.”Most of the data on prophylactic mastectomy come from the University of Minnesota, where researchers tracked contralateral mastectomy trends (removing a healthy breast alongside one with cancer) from 1998 to 2006. Dr. Todd M. Tuttle, chief of surgical oncology, said double mastectomy rates more than doubled during that period and the rise showed no signs of slowing. From those trends as well as anecdotal reports, Dr. Tuttle estimates that at least 15 percent of women who receive a breast cancer diagnosis will have the second, healthy breast removed. “It’s younger women who are doing it,” he said.
The risk that a woman with breast cancer will develop cancer in the other breast is about 5 percent over 10 years, Dr. Tuttle said. Yet a University of Minnesota study found that women estimated their risk to be more than 30 percent. “I think there are women who markedly overestimate their risk of getting cancer,” he said.
Most experts agree that double mastectomy is a reasonable option for women who have a strong genetic risk and have tested positive for a breast cancer gene. That was the case with Allison Gilbert, 42, a writer in Westchester County who discovered her genetic risk after her grandmother died of breast cancer and her mother died of ovarian cancer. Even so, she delayed the decision to get prophylactic mastectomy until her aunt died from an aggressive breast cancer. In August, she had a double mastectomy. (She had her ovaries removed earlier.) “I feel the women in my family didn’t have a way to avoid their fate,” said Ms. Gilbert, author of the 2011 book “Parentless Parents,” about how losing a parent influences one’s own style of parenting. “Here I was given an incredible opportunity to know what I have and to do something about it and, God willing, be around for my kids longer.” Even so, she said her decisions were not made lightly. The double mastectomy and reconstruction required an initial 11 1/2-hour surgery and an “intense” recovery. She got genetic counseling, joined support groups and researched her options. But doctors say many women are not making such informed decisions. Last month, University of Michigan researchers reported on a study of more than 1,446 women who had breast cancer. Four years after their diagnosis, 35 percent were considering removing their healthy breast and 7 percent had already done so. Notably, most of the women who had a double mastectomy were not at high risk for a cancer recurrence. In fact, studies suggest that most women who have double mastectomies never seek genetic testing or counseling. “Breast cancer becomes very emotional for people, and they view a breast differently than an arm or a required body part that you use every day,” said Sarah T. Hawley, an associate professor of internal medicine at the University of Michigan. “Women feel like it’s a body part over which they totally have a choice, and they say, ‘I want to put this behind me — I don’t want to worry about it anymore.’ ”
Wednesday, January 30, 2013
Tuesday, January 15, 2013
RESISTANT WOUND INFECTIONS
Research Seeks to Get a Handle on Resistant Wound Infections
The focus of the study will be the interaction of the immune system and biofilms, from which a chronic wound model of infection that mimics human disease will be developed. Researchers will test their hypothesis that biofilm-related infections delay healing in human wound infections. The findings will be integral to the development of novel therapeutics to combat biofilm infections.
Ohio State researchers have received a 5-year, $2.1 million award from the National Institute of Nursing Research of the National Institutes of Health to study resistant wound infections.
Faculty from Ohio State College of Medicine's Department of Microbial Infection and Immunity and The Ohio State University Wexner Medical Center's Department of Surgery, Comprehensive Wound Center and Comprehensive Burn Center will use molecular and genomic approaches to define how biofilm-growing bacteria resist treatment and host immune cells.The focus of the study will be the interaction of the immune system and biofilms, from which a chronic wound model of infection that mimics human disease will be developed. Researchers will test their hypothesis that biofilm-related infections delay healing in human wound infections. The findings will be integral to the development of novel therapeutics to combat biofilm infections.
BREAST LIFTS AND AUGMENTATION
Breast lift surgery and breast augmentation with implants can safely be
performed as a single procedure, according to a new study in the January issue
of Plastic and Reconstructive Surgery.
IMMEDIATE BREAST RECONSTRUCTION
The number of women undergoing immediate breast reconstruction after mastectomy has risen sharply in recent years, and most of this increase is due to implant-based reconstruction, finds a new study in the January issue of Plastic and Reconstructive Surgery.
Wednesday, January 9, 2013
PLASTIC SURGERY MYTHS
People have many misconceptions and oversimplified ideas about plastic surgery. While many associate the field with the material plastic, the word actually comes from the Greek word meaning "to mold". Almost all plastic surgeries have some cosmetic element, but many procedures focus on reconstruction. In 2011, the most common reconstructive surgeries were tumor removal and laceration repair, according to the American Society of Plastic Surgeons. Reconstructive surgery restores the normal and cosmetic surgery improves on the normal," said Dr. Rod Rohrich, professor and chairman of plastic and reconstructive surgery at the University of Texas Southwestern Medical Center in Dallas. But plastic surgery is only part of the equation. Following reconstructive surgery, a patient typically requires rehabilitation. Exercise needs to be done after liposuction. And while cosmetic surgery can tighten skin, a patient may have to apply post-cosmetic surgery creams to minimize lines. Surgical and nonsurgical procedures "can complement and enhance each other, but they don’t replace each other," said Dr. Alan Matarasso, a plastic surgeon practicing in Manhattan, and a spokesman for ASPS. Regardless of the type of surgery someone ultimately has, prospective patients need to understand the risks and benefits of each and have realistic expectations about what it can do. Here, seven common misconceptions are laid to rest:
Liposuction is an effective way to lose weight: False. While liposuction involves removing fat from the body, it's designed to remove fat from trouble spots. For a healthy person with excess fat in a specific area, liposuction may work well. However, it removes 10 to 12 pounds, tops. That’s why, Matarasso said, the procedure may be most helpful in someone who is healthy and prefers a slightly different body shape.
"You can’t go to the gym and say I want to get rid of my love handles," he said. Liposuction allows that targeting."When you lose weight, you lose it overall," Matarasso said. "Weight loss through liposuction is site specific."
Plastic surgery and cosmetic surgery mean the same thing. Because plastic surgery entails a repair or enhancement, almost any procedure has a cosmetic element. But the names are not equivalent. "Cosmetic surgery is a very generic term," Rohrich said. The terms go beyond semantics, however. Board certification in plastic surgery from the American Board of Plastic Surgeons means a physician has completed five years in surgical training at an accredited hospital, with at least two years dedicated to plastic surgery. Physicians in other disciplines may have some training in plastic surgery; for example, an ophthalmologist may be trained to perform cosmetic procedures around the eyes. However, a medical degree and some form of certification in cosmetic surgery does not equal that level of training. That's why prospective patients need to ask about a physician’s training.
Plastic surgery is surgery without scars"Any time you pick up a knife and cut the skin, a scar results," Matarasso said. What plastic surgeons do, however, is minimize the appearance of scars. How visible a scar might be is determined by how the surgical incision is closed; how it is cared for after the operation; and where the incision is made. Typically, a plastic surgeon will make an incision in an area where there are natural creases in the skin, which helps hide the scar. But some physical evidence of the procedure will always be present. "We operate with scalpels, not wands," Rohrich said.
Breast augmentation is a one-time procedure: Breast augmentation is one of three standard plastic surgery procedures that are performed on breasts. The others are breast reduction and breast lift, known as mastopexy. Augmentation and mastopexy may be done at the same time. However, neither is permanent.
Like other procedures, such as facelifts, Rohrich said, maintaining the appearance of the breasts will require another surgery as time passes and environment and genetics take their toll. And breast implants — just like other artificial implants — have a limited shelf life; in the case of breast implants around 10 to 15 years.
But an implant's projected life span is not an expiration date, and how long an implant lasts depends upon the individual. "Patients have to be followed and examined,” Matarasso said. “There’s not a set time when implants have to be taken out."
Fat can reappear in other areas after liposuction. If fat reappears after someone undergoes liposuction, it is not because of the procedure. During liposuction, fat cells are removed from the body — which typically stops producing them during the early teenage years. But the cells that are left behind can still grow. "If you really gain a lot of weight, fat can reappear in other places," Rohrich said. Continuing to exercise and eat healthfully to prevent weight gain are the key to better results. In other cases, the issue of increased fat in other places post-liposuction may be perception, said Matarasso. After undergoing liposuction, people's perceptions of their body are out of proportion. A woman who has had liposuction on her thighs, for example, may feel as though her arms are fatter, he explained.
Cost is the only real barrier to cosmetic surgery. Cosmetic surgery is often elective and therefore is paid for out-of-pocket. In other words, don't expect your health insurer to cover it. But whether or not you can afford the procedure is not the only issue you'll need to consider.While declining prices have helped make middle-income earners the primary consumers for cosmetic surgery, pre-surgical counseling is necessary before someone alters his or her appearance. "I need people to understand it’s not going to be perfect," Rohrich said. "You’re not going to look exactly the same. We’re surgeons, not magicians." In addition to discussing what the surgery can accomplish, the surgeon will often attempt to gauge a patient's expectations; whether she is emotionally stable; and whether she really wants the operation or is being coerced, Matarasso said. For example, is a woman considering a breast augmentation because her husband wants it or is a teenager getting a nose job at the urging of her mother? "You need to be properly screened so that your expectations are met," he said.
Liposuction is an effective way to lose weight: False. While liposuction involves removing fat from the body, it's designed to remove fat from trouble spots. For a healthy person with excess fat in a specific area, liposuction may work well. However, it removes 10 to 12 pounds, tops. That’s why, Matarasso said, the procedure may be most helpful in someone who is healthy and prefers a slightly different body shape.
"You can’t go to the gym and say I want to get rid of my love handles," he said. Liposuction allows that targeting."When you lose weight, you lose it overall," Matarasso said. "Weight loss through liposuction is site specific."
Plastic surgery and cosmetic surgery mean the same thing. Because plastic surgery entails a repair or enhancement, almost any procedure has a cosmetic element. But the names are not equivalent. "Cosmetic surgery is a very generic term," Rohrich said. The terms go beyond semantics, however. Board certification in plastic surgery from the American Board of Plastic Surgeons means a physician has completed five years in surgical training at an accredited hospital, with at least two years dedicated to plastic surgery. Physicians in other disciplines may have some training in plastic surgery; for example, an ophthalmologist may be trained to perform cosmetic procedures around the eyes. However, a medical degree and some form of certification in cosmetic surgery does not equal that level of training. That's why prospective patients need to ask about a physician’s training.
Plastic surgery is surgery without scars"Any time you pick up a knife and cut the skin, a scar results," Matarasso said. What plastic surgeons do, however, is minimize the appearance of scars. How visible a scar might be is determined by how the surgical incision is closed; how it is cared for after the operation; and where the incision is made. Typically, a plastic surgeon will make an incision in an area where there are natural creases in the skin, which helps hide the scar. But some physical evidence of the procedure will always be present. "We operate with scalpels, not wands," Rohrich said.
Breast augmentation is a one-time procedure: Breast augmentation is one of three standard plastic surgery procedures that are performed on breasts. The others are breast reduction and breast lift, known as mastopexy. Augmentation and mastopexy may be done at the same time. However, neither is permanent.
Like other procedures, such as facelifts, Rohrich said, maintaining the appearance of the breasts will require another surgery as time passes and environment and genetics take their toll. And breast implants — just like other artificial implants — have a limited shelf life; in the case of breast implants around 10 to 15 years.
But an implant's projected life span is not an expiration date, and how long an implant lasts depends upon the individual. "Patients have to be followed and examined,” Matarasso said. “There’s not a set time when implants have to be taken out."
Fat can reappear in other areas after liposuction. If fat reappears after someone undergoes liposuction, it is not because of the procedure. During liposuction, fat cells are removed from the body — which typically stops producing them during the early teenage years. But the cells that are left behind can still grow. "If you really gain a lot of weight, fat can reappear in other places," Rohrich said. Continuing to exercise and eat healthfully to prevent weight gain are the key to better results. In other cases, the issue of increased fat in other places post-liposuction may be perception, said Matarasso. After undergoing liposuction, people's perceptions of their body are out of proportion. A woman who has had liposuction on her thighs, for example, may feel as though her arms are fatter, he explained.
Cost is the only real barrier to cosmetic surgery. Cosmetic surgery is often elective and therefore is paid for out-of-pocket. In other words, don't expect your health insurer to cover it. But whether or not you can afford the procedure is not the only issue you'll need to consider.While declining prices have helped make middle-income earners the primary consumers for cosmetic surgery, pre-surgical counseling is necessary before someone alters his or her appearance. "I need people to understand it’s not going to be perfect," Rohrich said. "You’re not going to look exactly the same. We’re surgeons, not magicians." In addition to discussing what the surgery can accomplish, the surgeon will often attempt to gauge a patient's expectations; whether she is emotionally stable; and whether she really wants the operation or is being coerced, Matarasso said. For example, is a woman considering a breast augmentation because her husband wants it or is a teenager getting a nose job at the urging of her mother? "You need to be properly screened so that your expectations are met," he said.
NEW YORK WOMAN "PLAYS DOCTOR"
A Flushing resident who decorated her home like a doctor’s office and performed a buttocks enhancement procedure involving Krazy Glue sent one woman to the hospital and may have caused a lifelong medical problem, Queens’ top prosecutor said last Thursday.And according to a plastic surgeon at a borough hospital, it is a problem he sees all too often. Liliana Coello, 39, of 42-29 157th St., was charged with assault, reckless endangerment and unauthorized practice of medicine in Queens Criminal Court, according to prosecutors, after she injected a 40-year-old woman’s buttocks with multiple substances.
EXCESS SKIN AFTER GASTRIC BY-PASS
Paul Mason, once called the world's fattest man, has lost more than two thirds of his weight and now wants surgery to remove his excess skin.The 51-year-old former postman from Ipswich, England weighed 980 pounds. After having gastric bypass surgery three years ago, he has slimmed down to a comparatively svelte 350 pounds. The dramatic weight loss has left Mason with huge folds of excess skin around his stomach, arms and legs. According to the British newspaper The Sun, Mason must use a wheelchair because the excess skin hampers his ability to walk. "It doesn't matter how much toning up you do, it's only going to get worse," The Sun quotes Mason as saying.
CLEFT LIP AND PALATE
MONDAY, Dec. 31 (HealthDay News) -- When Americans hear "cleft lip" or "cleft palate," they often think of children in developing countries, but U.S. babies are by no means immune to the birth defect.
Each year about 7,000 American children are born with an oral cleft defect, according to the U.S. Centers for Disease Control and Prevention. This means that their lip hasn't formed completely and isn't closed properly in the case of cleft lip or, in the case of cleft palate, that there's a hole in the roof of their mouth.
The good news, though, is that the condition is treatable. "The outcomes for children are excellent," said Dr. Joseph Shin, chief of the division of plastic and reconstructive surgery at Montefiore Medical Center in New York City. "Children do fine with it. It's not the end of the world." Shin has served on humanitarian surgical missions for Operation Smile and other organizations to repair cleft lips and cleft palates in countries in South America, Mexico, Morocco and the Middle East. Cleft lip and cleft palate aren't just cosmetic concerns, however. "There's a lot of function in the palate and the lip," explained Dr. Laura Swibel Rosenthal, an assistant professor in the departments of otolaryngology and pediatrics at Loyola University's Stritch School of Medicine in Chicago. "Babies have to eat and not have food go up through their nose."
Children born with these conditions can also have problems with their ears and sinuses because fluids can travel where they shouldn't. If the defects are not corrected when children are young, they can also interfere with a child's ability to speak properly. And, when the cleft is in the front of the mouth, it interferes with the development of the teeth, said Swibel Rosenthal, who added that sometimes, surgery is needed to move the jaw forward.
It's not clear exactly what causes oral clefts, according to the March of Dimes. Some factors that have been associated with an increased risk for cleft lip and palate include changes in some genes, a deficiency of folic acid before pregnancy, taking certain medications while pregnant, drinking alcohol during pregnancy and having certain infections during pregnancy.
But the biggest risk factor linked to oral clefts is smoking during pregnancy. About one in five babies born with a cleft lip or palate is born to a mother who smoked, according to the March of Dimes.
Shin noted, however, that "sometimes you can do everything right, and you can still have a child with cleft lip or palate." For babies born with a cleft lip or palate, surgery is the main treatment. For cleft lip, he said, surgery is generally scheduled when the child is about 3 months old. For a cleft palate, surgery is usually done at about 1 year old or slightly younger so that there are fewer issues with speech, he said. "The sooner you can do the repair, the better babies heal," Shin said. Besides the procedures to repair the cleft lip or palate, children often also need surgeries for ear tubes to keep their ears clear of fluids while the repair is healing. Depending on the severity of the cleft palate and how the initial surgery has healed, children sometimes need a second surgery on their palates when they're 3 to 7 years old, according to Swibel Rosenthal. Also, cleft lips sometimes require a second surgery to get a better cosmetic outcome, she said. Most kids also will need braces, she added. "Parents shouldn't be nervous about these conditions," Swibel Rosenthal said. "Although they sometimes require multiple surgeries, there are ways to treat cleft lip and cleft palate that are simple, and children do very well." Because cleft lip and palate can be genetic conditions, it's possible that subsequent pregnancies may result in another baby being born with cleft lip or palate, though the odds are relatively low, she said. "If there's only one family member affected, the chances of another child having an oral cleft are about 4 percent," she noted. "If two or more family members are affected, the chances of another child having it are about 9 percent."
Each year about 7,000 American children are born with an oral cleft defect, according to the U.S. Centers for Disease Control and Prevention. This means that their lip hasn't formed completely and isn't closed properly in the case of cleft lip or, in the case of cleft palate, that there's a hole in the roof of their mouth.
The good news, though, is that the condition is treatable. "The outcomes for children are excellent," said Dr. Joseph Shin, chief of the division of plastic and reconstructive surgery at Montefiore Medical Center in New York City. "Children do fine with it. It's not the end of the world." Shin has served on humanitarian surgical missions for Operation Smile and other organizations to repair cleft lips and cleft palates in countries in South America, Mexico, Morocco and the Middle East. Cleft lip and cleft palate aren't just cosmetic concerns, however. "There's a lot of function in the palate and the lip," explained Dr. Laura Swibel Rosenthal, an assistant professor in the departments of otolaryngology and pediatrics at Loyola University's Stritch School of Medicine in Chicago. "Babies have to eat and not have food go up through their nose."
Children born with these conditions can also have problems with their ears and sinuses because fluids can travel where they shouldn't. If the defects are not corrected when children are young, they can also interfere with a child's ability to speak properly. And, when the cleft is in the front of the mouth, it interferes with the development of the teeth, said Swibel Rosenthal, who added that sometimes, surgery is needed to move the jaw forward.
It's not clear exactly what causes oral clefts, according to the March of Dimes. Some factors that have been associated with an increased risk for cleft lip and palate include changes in some genes, a deficiency of folic acid before pregnancy, taking certain medications while pregnant, drinking alcohol during pregnancy and having certain infections during pregnancy.
But the biggest risk factor linked to oral clefts is smoking during pregnancy. About one in five babies born with a cleft lip or palate is born to a mother who smoked, according to the March of Dimes.
Shin noted, however, that "sometimes you can do everything right, and you can still have a child with cleft lip or palate." For babies born with a cleft lip or palate, surgery is the main treatment. For cleft lip, he said, surgery is generally scheduled when the child is about 3 months old. For a cleft palate, surgery is usually done at about 1 year old or slightly younger so that there are fewer issues with speech, he said. "The sooner you can do the repair, the better babies heal," Shin said. Besides the procedures to repair the cleft lip or palate, children often also need surgeries for ear tubes to keep their ears clear of fluids while the repair is healing. Depending on the severity of the cleft palate and how the initial surgery has healed, children sometimes need a second surgery on their palates when they're 3 to 7 years old, according to Swibel Rosenthal. Also, cleft lips sometimes require a second surgery to get a better cosmetic outcome, she said. Most kids also will need braces, she added. "Parents shouldn't be nervous about these conditions," Swibel Rosenthal said. "Although they sometimes require multiple surgeries, there are ways to treat cleft lip and cleft palate that are simple, and children do very well." Because cleft lip and palate can be genetic conditions, it's possible that subsequent pregnancies may result in another baby being born with cleft lip or palate, though the odds are relatively low, she said. "If there's only one family member affected, the chances of another child having an oral cleft are about 4 percent," she noted. "If two or more family members are affected, the chances of another child having it are about 9 percent."
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