Friday, May 31, 2013

Male breasts are not inconsequential

It seems that gynecomastia is more common than I thought.  

It is, simply put, male breast tissue.  It can affect young adolescents to senior citizens. It’s effects on the younger generation are huge.  

I recently read a study that compared two similar age groups from 12-21.  One group had gynecomastia.  Those individuals with gynecomastia had consistently lower ratings of general health, lower self esteem, social functioning and mental health.  Some young teens had eating disorders and it did not seem to correlate with the degree of gynecomastia.  As a plastic surgeon in Florida, I have witnessed the severe depression that many of these patients feel. It's a shame. But not irreversible.

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Thursday, May 30, 2013

What to do about excess arm skin?

As bariatric surgery becomes more mainstream, more and more patients are requesting arm lifts.  

When there is excess skin there are only 2 choices - accept it or cut it away.

As more and more people shed 50, 70, 100 pounds or more, the big question remains what to do with all the excess skin on one's arms. 

The first brachioplasty or arm lift was described in 1930, however the first written description of a cosmetic brachioplasty was in the 1950’s.  In 2010 surgeons performed 15,183 brachioplasties.  This was about a third more than what was performed in 2000.  

Most brachioplasties are combined with liposuction.  It is an outpatient procedure with minimal discomfort.  Patients in my Fort Myers, FL, plastic surgery practice usually can shower in 24 – 48 hours.  

Potential complications are hypertrophic scarring, fluid collection or seroma,  dehiscence or wound separation, infection or hematoma or a collection of blood.  

In my experience the biggest one is hypertrophic scarring.  No matter where you cut or whoever makes the cut, there will be a scar.  But, when I see potential brachioplasty patients they have such a large excess of skin and fat that surgery is really their only option.  It is done as an outpatient with a little I.V. sedation so there is no pain.  

The incidence of hypertrophic scars is probably less than 10-12%.  When all is said and done they are glad they did it.

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Tuesday, May 28, 2013

Does Board Certification matter?

We hear this question asked over and over.  It has mattered, it still matters and will always matter.  

Logically, a more thorough approach to training and experience is going to make one surgeon more effective than one who has not received that specialized training. 

Moreover, a recent study of panniculectomies was done to see if it mattered in practice. (Panniculectomies are excisions of large amounts of skin/fatty tissue secondary to massive weight loss.)  

The study, which came to my attention as a Fort Myers plastic surgeon, looked at a total of 954 panniculectomies.  Of these, 694 were done by plastic surgeons and 260 were by non-plastic surgeons.  Non-plastic surgeons had a significantly higher overall rate of complications than plastic surgeons.  

The rate was 23.08% complications for non-plastic surgeons versus 8.65% for plastic surgeons.  

Wound infection rate was 12.69% for non-plastic surgeons versus 8.65% for plastic surgeons.  
So, in the real world, Board Certification DOES matter!

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Thursday, May 23, 2013

Is Angelina Jolie's double mastectomy the only route to breast cancer prevention?

The beautiful face of Angelina Jolie was printed across the media recently due to her announcement of “prophylactic” mastectomies.  Ms. Jolie tested positive for a gene BRCA1 which can increase a woman’s chance for breast cancer.  Ms. Jolie lost her mother at age 56 after a 10-year bout with cancer. 

Almost 232,000 new cases of breast cancer are diagnosed every year and 40,000 women die from it annually.  The two genes most commonly associated with breast cancer are BRCA1 and BRCA2.  These represent probably less than 10% of all breast cancers.  There are other genetic markers that can pre-dispose someone to develop breast cancer and some yet to be discovered.  

In short, there are multiple genetic markers for breast cancer but BRCA1 and BRCA2 are the most common ones studied.  They also have a link to ovarian cancer as well.  Having one or both of these genes raises a woman’s risk of breast cancer to about 60% in her lifetime, compared to a normal risk in the range of 8% to 12% for the general population.

Test for these genes costs around $3,400.00 and many insurance plans will cover it.  The route Ms. Jolie took was radical but understandable.  If someone has a strong family history of breast cancer AND tests positive for those genes, careful consideration for bilateral mastectomies should be entertained. 

As a board certified Fort Myers plastic surgeon, I believe the stronger the family history for breast cancer, the more one should consider this route.  Breast reconstruction following mastectomies is in most cases a safe, outpatient procedure.  

But, there are other, more conservative, options such as semi-annual mammograms with ultrasound, MRI or as some physicians believe, thermography.  Some patients may benefit from tomoxifin.  As always, other things a person can do to lower their chances of developing breast cancer is to lead a healthier lifestyle,  ie. no smoking, maintaining a healthy weight, limiting alcohol intake, exercising on a regular basis and a staying on a healthy diet.

In any event, if any signs of breast cancer active or prospective appear, get thee to a physician quickly for diagnosis.

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Saturday, May 18, 2013

Spiritual Steroids - Day 2

Friday began like the day before – up at 4:45 AM and off to the shower.  With only 2 showers available, I figured early is better than later.  

The women on the team were up early as usual fixing us a wonderful breakfast.  We had fruit, sausage, eggs & pancakes – what a joy and blessing.  Like most mornings I had coffee only.  It was STRONG!  WOW!  As we began to filter into the conference room we were getting ready to go to the prison. 

Breakfast was now over and we were loading into the cars and trucks to begin our journey.  It was refreshing to see the rising sun – the morning mist – the quiet calm.  What an awesome site our Lord provided us to begin our journey.  The trip to the prison was around 10 miles or so. 

As we arrived into the parking lot, we had to remember to empty our pockets – only our prison ID’s, drivers license & wedding ring were allowed.  We could take in a comb.  We also had to lock the car and take our key with us.  As we all arrived and congregated in front of the prison entrance, there on a table were 7 or 8 dozen glazed donuts – fresh and waiting to be mated with a cup of coffee.  

We then began the slow entry into the prison – 4 at a time.  The donuts were inspected too.  Once inside we went to the community room where we were greeted by the MIB (men in blue).  They were standing and applauding us.  What a special and memorable moment it was.  After our morning prayers our first speaker spoke on the topic.  “Three Encounters with Christ..”  The first encounter was the Rich man ‘Mark 10:17-22.  The second was Judah –John 12:4-6 and finally Peter – Mark 14:27-31.  We would always pause after each presentation for group table discussions.  Our second talk was about “Choices.”  We were reminded as a child, choices are make for us – some we liked and many we didn’t.  When we’re adolescents we begin choosing based on our expression of independence from our parents.  And as an adult our choices are ours alone.  Those choices are guided by our past experiences.  Making NO choice is also a choice.  With hope, we can amend our ways going forward and make GOOD choices. 

Our next endeavor was to go into the chapel for group photos followed by coffee/snacks.  Around 10:00 or so our next session began entitled “you are not alone.”  We also choose who we go around with or become friends with.  God promises us in the old testament to be with us.  In the new testament He reaffirms this and pronounces to help us.  The church is one way God affirms His help for us.  After this we paused for silent meditation.  While we were waiting for the next talk, team leaders started putting up posters, photo’s and pray chains made by people from all over the country including such distant places as Singapore and Thailand.  There were prayers for MIB from other prisoners across the country, wanting us to know they were in prayer for us. Kairos 60 – DeSoto Correctional!  Wow!  It brought tears to many eyes.

Our next talk was “Friendship with God.”  In essence, God wants to be our friend.  He pursues us.  In spite of our abandonment of God, He continues to cherish, love and pursue us.  God reaches out to us through  the ministry and life of Jesus, His son.  Our MOST important and satisfying life goal is our friendship with God.  We got up and went into the chapel for prayer and song.  One of our ministers than gave a homily based on Isaiah 49.

We then broke for lunch.  Today, were Burger King Whoppers.  For me, mealtime was such an emotional moment watching the faces of the MIB as they began eating a real beef burger, for many their first one in 20 years!  Wow!  Their looks of thanks and appreciation brought tears to my eyes.  I politely passed on my burger.  Greeted with equal zest and zeal were the Burger King ice cream pies!

After lunch, we sang some songs and prepared for the afternoon session.  The first talk was about the Church.  We learned God pursues us and wants us, and He comes to us through others we come to know as the Church.  Sometimes we withdraw and build walls around us.  The Church is the body of Christ – one body with many parts.  Around 3:00, we take a break for more coffee/drinks/snacks.  The next talk is on opening the door.  We learned God wants a relationship with us but we must open the door to let Him in.  It is hoped that this Kairos weekend will help to open the door.  We also spoke to the MIB about spiritual counseling.  Dinner was about 5:00 PM.  Another great meal.  After dinner each table family came forward to introduce themselves.  I was at the table of Matthew.  Each participant was loudly cheered and applauded.  We then had our leader Bob Betancourt do a summary of the day.  We then had evening prayer & songs in the chapel.  We left for home around 8:00 PM.  Once back at church we had snacks, some showered – others visited.  Around 9:00 or so we had round table discussions of the events for the day.  Then around 10-10:30 a quick call to Linda to tell her I loved her – brushed my teeth and collapsed on my air mattress!

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Monday, May 13, 2013

A New Approach to Melanoma

A new research project in mice may hold promise for humans.  Russian scientists injected mice with melanoma cells.  After 10 days, half of the mice received treatment with MMP-9 inhibitor 7!  By inhibiting MMP-9 the growth of the melanoma tumors was suppressed by 43% and blood vessel growth was depressed 53.4%.  Human trials await to commence.

As a Fort Myers Plastic Surgeon, I deal with melanoma frequently. This hopeful news. Or, it may be. 


Thursday, May 9, 2013

It never ceases to amaze me what doctors/scientists will think of  to “study” next.  

A recent article in the European Journal of Pediatrics found that teenage boys living at LOW elevations, within a few hundred feet of sea level, are more prone to develop acne than boys living at higher altitudes.  Also living at high altitudes can delay puberty in girls and boys.  

So I guess when you have kids, and you live in Florida, you may be in for a bout of zits and early anxiety. 

Although, I must say as a plastic surgeon in Fort Myers, I haven't noticed an unusual number of outbreaks of either.

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Saturday, May 4, 2013

My Kairos Weekend

I just returned from my Kairos weekend prison ministry.  It was an unbelievable experience and I just want to share my thoughts and musings about it.  For me, it became a weekend of “spiritual steroids.” 

Kairos is an ancient Greek word that in the New Testament means “the appointed time in the purpose of God.”  It has evolved over the years into a prison ministry.  The first short Kairos was held inside a prison here in Florida named Raiford.  This was conducted in the fall of 1976.  There now are two other programs called Kairos Outside which ministers to female members of the incarcerated men and Kairos Torch, which is for incarcerated men under 25.

My journey began Wednesday night when I drove to Arcadia.  I had to be at the prison early Thursday morning for my training with the chaplain who would go over the ground rules with us.  The chaplain was very dogmatic and matter-of-fact.  These are the rules – these are our measures for security.  He said he always erred on the side of security.  DeSoto has over 2000 inmates who from now on will be called “men in blue” (MIB).  It is a softer identity than criminal prisoner or jail mate.  I came to embrace that term.  Of interest was the fact there were 4 Jehovah witnesses in the training class.

Our day on Thursday was lunch with the MIB.  We had a round-table introduction.  I had to be careful not to tell them I was a doctor.  Chaplain said that was a no-no so I gave as my profession, human resource director.  Each of us was assigned as a sponsor to one of the MIB. – we were there to support them and help them through the weekend even though they sat at a different table.  The room was set up with 6 tables.  At each table there was a clergy, head table leader, assistant table leader (that was my job) and 6 MIB.  Our first lunch was pizza from Domino’s.  We had simple cheese pizza and pepperoni.  Wow – you thought this was a 5 star gourmet meal.  The MIB do not get pizza, beef or fast food at all.  Uniformly, the men were overwhelmed with the prospect of “real” outside food.  The MIB. received 4 pieces to start and team members were given 2.  I ate one and politely handed the other one to one of the MIB.  My eyes filled up with tears when I saw the joy in their faces to eat real pizza – something many have not eaten in 10, 15 or 20 years.

 Our team leader, Mr. Bob Betancourt gave the opening speech after lunch and sort of set the tone of our weekend together and what we hoped to accomplish.  It was against the rules to ask the MIB why they were in prison and how much time they served.  Many would later volunteer the information but it was not required.  As leaders, we were taught the 4 L’s.  Listen, listen, love, love.  Early on we were taught to respect the raised hand.  If a hand is raised the leader will call on that person to speak. Our greetings for the MIB were subdued – if they offered their hand for a shake – we extended ours.  Bob, our leader, encouraged the MIB. not to be too harsh and pre-judge the weekend by one day.  Let the weekend unfold.  We also ask the MIB. to be enthusiastic.  This is your weekend – enjoy – have fun.  We remind the MIB. that what they get out of the weekend will depend on what they GIVE!  Open your heart – be vulnerable to all the possibilities.  Attend with a spirit of charity – ie. love and acceptance.

What was truly REMARKABLE was how total strangers could bond so strongly through God’s blessings in a matter of 4 short days.  Wow!  It was awesome!  A blessing from God.  We were all reminded ALL things said over the weekend were to be held in strictest confidence.  Hear it here…share it here…leave it here.  Before going into the chapel Bob went over the ground rules – simple – like wear your name tag.  Walking into the chapel was done in total silence.  We encourage all participants to have private one on one sessions with the clergy.  After time in chapel, we moved to the conference room.  The first talk was “what is meditation?.”  It was based on John 1:43-51.  The second presentation was on “I chose you.”  The MIB apply to come to Kairos.  There were over 220 applications for 36 openings.  The team captain prays for selecting the member of the team as well as the MIB  These men were chosen by God to be a part of this ministry.  The third talk was by a clergy entitled “Knowing the Father” and it was based on Luke 15:11-16.  The final wrap up was by our team leader Bob Betancourt.  We left abound 8:00 or 8:30 and drove back to the church where we were staying.  We had a team meeting and snacks until about 10:00 or 10:30!  Long day – tired.  Time for lights out.