Radiation treatment following a mastectomy in the treatment of breast cancer is fairly common. Though refinements have been made in the radiation therapy that have significantly reduced both short and long term sequelae to the skin and underlying tissues, permanent consequences nevertheless exist which will affect the tissue expander breast reconstruction.

What does radiation do to the skin and soft tissues? The ionizing effects damage healthy cells causing scarring and thickening with increased rigidity of the tissues and less suppleness. The result is firmer feeling skin that is more rigid and more resistant to the stretching which is necessary with tissue expansion breast reconstruction. The small blood vessels in the field of treatment are also permanently damaged resulting in a reduction of blood supply to the tissues. Less oxygen and nutrients available to the tissues translates into an increased the risk of infection, greater susceptibility to trauma and prolonged healing times from surgery and injury. .

As a consequence of these changes, it is far more difficult to expand irradiated tissue in facilitating the breast reconstruction as compared to normal tissue. The increase in size obtained may be less than ideally desired and it can take much longer. Qualitatively, it often feels firm and appears darker than the surrounding skin. There is also an increased incidence of infections, formation of scar tissue around the expander, separation of recently closed incisions and even extrusion and exposure of the tissue expander through the skin.

Though tissue expander breast reconstruction can yield satisfactory results in tissue that has been previously irradiated, there are many attendant risks that need to be considered before selecting this option.

If you would like to obtain additional information on breast reconstruction or any other surgical procedure that I perform or to schedule a consultation, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

The development of a hematoma (an undesirable accumulation of blood around the implant) following a breast augmentation is relatively uncommon with an estimated incidence around 1 to 4 percent. A few simple precautions can be taken before and after the surgery to help minimize the risk of it occurring.

Any medication or substance that will interfere with the body’s ability to appropriately form clots (blood thinners) will increase the probability of unwanted bleeding and therefore also increase the likelihood of developing a hematoma. Some of these include analgesics and anti-inflammatories such as aspirin, ibuprofen, Motrin, and Aleve as well as others such as Coumadin, Warfarin, and Plavix. Vitamin E, fish oils and many herbal supplements can also interfere with the clotting mechanism.

My patients are required to avoid taking most of these medications, Vitamin E and herbal supplements beginning from two weeks prior to surgery and continuing until two weeks following surgery. Specific blood thinners such as Coumadin and Warfarin are usually stopped two to three days preoperatively and restarted around two to three days postoperatively. Approval from your primary care doctor to temporarily discontinue this medication is mandatory.  My patients are also provided with a comprehensive list of medications, both generics and proprietary, that should be avoided.

Hematomas are also frequently caused by activities that involve considerable exertion, heavy lifting or repetitive upper extremity movements. This would include sports, aerobics, jogging and similar activities. Though recommendations vary among physicians, I request that my patients avoid these activities for three weeks following surgery. For professions such as a hairdressing, nursing or waitressing, women can return to work sooner but with some restrictions.

A few simple precautionary steps are all that are need to minimize the risk of developing a hematoma and its undesirable consequences.

For further information on breast augmentation, breast implants or any other cosmetic procedure, you can contact my office in Scottsdale or Glendale, Arizona at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Women seek to have the size of their breasts reduced for two reasons that can be interrelated: functional and aesthetic. Most commonly breast reductions are sought out because of the symptoms that are associated with markedly enlarged breasts such as neck, back and shoulder pains, headaches and rashes. Even with reductions where the intent is to alleviate symptoms, there is an aesthetic component as the result will be lifted, smaller and perkier breasts.

Most of the time that women seek a reduction solely for aesthetic reasons, it is where the breasts are a little larger than ideal but not massively enlarged where they would be associated with discomfort. For example a woman may feel self conscious and uncomfortable with all the attention and comments that she may garner with enlarged breasts. Even though she may not be experiencing physical symptoms related to the increased size, by undergoing a breast reduction her breasts will be less conspicuous.

Another example of an aesthetic reason for a breast reduction are breasts that are droopy (ptotic) and larger than she desires. A small reduction and a lift would be the treatment of choice.

There may be some confusion between what constitutes a breast reduction versus a breast lift or mastopexy and some of this relates to insurance company mandates for coverage. An intrinsic component of most breast reductions is a lift. By the same token, a mastopexy or breast lift can be performed with a small reduction in size. Both procedures often employ the exact same incisions. The difference essentially is in the amount of breast tissue removed though there is no exact amount that distinguishes one from the other. In the past, a reduction in size of less than 300 grams per side along with the lift was considered to be a mastopexy with a small reduction.

In essence, this is just semantics as no matter what it is called, the surgical outcome is smaller, lifted and rejuvenated breasts.

If you would like more information on breast reduction or mastopexy surgery or any other cosmetic surgery procedure, you can contact my office at 480-451-3000 or send us an e-mail.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Girls in today’s world are exposed to more body image related issues and information than ever before. This includes from well informed (and endowed) peers, exposure to countless magazines displaying a profusion of voluptuous female bodies, countless sexually overt TV shows, and limitless information and images from the internet. With particular emphasis on breast size, those that are or feel deficient often know what they need to do. Get breast implants!

Dissatisfaction with one’s body image, including breast size, is the norm for the adolescent female. During this period of time, they are growing physically and experiencing myriad psychological and emotional issues and variability. This translates into a period of exceptional instability during which it would not be prudent to consider most cosmetic surgery procedures.

At what age, then, would a girl/woman be an appropriate candidate for a breast enlargement surgery? Though there is not be an exact right or wrong answer given the variability in emotional, physical and intellectual maturation between individuals, my personal recommendation is to wait until 18 years of age except in unusual circumstances. For many reasons, I feel this is best for all parties involved.

There are exceptions, of course. Girls who have breasts of markedly different sizes where the disparities are difficult to camouflage or who have extreme under-development or congenital absence on one side would be candidates for surgery at an earlier age. Technically, these can be considered to be reconstructive procedures.

For further information on breast augmentation, breast implants or any other cosmetic procedure, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

Male breast enlargement, also known as gynecomastia, is a relatively common occurrence. Its development is related to the absolute and relative levels of the sex hormones testosterone and estrogen in men. These hormones can be affected by such factors as puberty, aging, drugs, medication, alcohol and certain diseases.

Just how common is gynecomastia? During puberty, around two thirds of males will develop some degree of breast enlargement which can often be tender. This is related to the fluctuation of hormone levels that occur as a normal part of adolescent development. Typically, seventy five percent of males with gynecomastia will have resolution within two years and around ninety percent by three years. That leaves around ten percent of pubertal breast enlargements that will persist with some claiming an even higher incidence. Therefore, without any additional precipitating causes, the presence of enlarged breasts in men in their late teens, twenties and up just related to pubertal changes is quite common.

As the production of testosterone decreases with aging, the incidence of gynecomastia increases. This may first be noticed around ages 40 to 50 and then become more prominent with time. As many as twenty five to forty percent of males between ages 50 and 80 do have male breast enlargement. This can further be exacerbated by medications taken to treat common medical problems occurring during this stage of life such as for an enlarged prostate.

Obesity also can result in enlarged male breasts. This is often referred as pseudogynecomastia rather than true gynecomastia but the outcome is the same – undesirably enlarged breasts. Weight loss may resolve most if not all of the enlargement.

The treatment for gynecomastia which is surgery is usually quite successful, physically and mentally.

If you would like additional information on the treatment of male breast enlargement or any other cosmetic surgery procedure, you can contact my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona