Prior to undergoing a breast reduction, it is the standard of care to have an up to date mammogram for women of at least a certain age (which can vary). The purpose of this is to screen for any abnormalities that may need to be addressed prior to surgery. If a suspicious mass or area is noted that raises concerns for possibly being of malignant potential, a biopsy can be performed prior to the planned procedure. If the results are benign, then one can proceed with the breast reduction. Conversely, if the biopsy results reveal breast cancer, then treatment of this would be to be undertaken rather than the originally proposed breast reduction.

Mammograms do not identify every single case of breast cancer. A small percentage of breast cancers that are early or very small can evade detection with this method of screening but can be identified pathologically. These “occult” cancers are the reason why the breast tissue removed in the performance of a breast reduction is always sent for pathological evaluation.

Scientific studies have been done to investigate the incidence of these occult cancers in women who have undergone a breast reduction. The percentage is very low, somewhere in the range of 0.16% to 0.40%. Despite having been diagnosed with breast cancer, these women are lucky in that their tumors were identified early on, offering them a very high cure rate with appropriate treatment. If they hadn’t been seeking a breast reduction, it is likely that many of these cancers might not have been identified until they were larger and with a less favorable prognosis.

The following patient of mine exemplifies this scenario. She presented for a breast reduction at age 39, wearing a size 34G bra, no family history of breast cancer and with a normal mammogram. A reduction mammoplasty was successfully performed and she had an otherwise unremarkable postoperative course. However, the pathology report of her removed breast tissue revealed early cancer.

After consulting with a general surgeon, she underwent bilateral mastectomies with immediate reconstruction. The following photos illustrate her preoperative appearance, immediately following her breast reduction and appearance after reconstruction.

Before Breast Reduction - Frontal view

Before Breast Reduction - Side view

Immediately following Breast Reduction - Frontal view

Immediately following Breast Reduction - Side view

After Breast Reconstruction - Frontal view in bra

After Breast Reconstruction - Frontal view

After Breast Reconstruction - Oblique view

After Breast Reconstruction - Oblique view in bra

Following Breast Reconstruction - Side view

Following Breast Reconstruction - Side view in bra

If you would like to obtain additional information on breast reduction, breast reconstruction or any other cosmetic surgery 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

A tummy tuck, also known as an abdominoplasty, is the procedure that improves the appearance of the abdomen by addressing the excess skin with or without tightening of the underlying muscles. There are variations of the procedure including in extent which would depend on your particular situation.

A full or standard abdominoplasty is selected when there is an excess of skin both above and below the umbilicus that is also usually associated with laxity of the abdominal wall muscles. The mini-tummy tuck is essentially an abridged version that is chosen when the skin and muscle issues are localized to the lower abdomen. It is a more limited procedure with less postoperative discomfort and a shorter incision.

The full abdominoplasty typically involves a bikini line incision extending from hip to hip and a second one around the belly button. Skin of the abdomen is elevated up to the rib cage and the excess is precisely removed. The underlying muscle layer is tightened and contoured to yield a flatter, slimmer, more sculptured and complimentary appearance. The umbilicus remains where it was situated originally, being brought through a new opening in the skin.

A mini-tummy tuck incision is much shorter, often extending just past the Mons pubis (hair bearing area) and does not entail a second one placed around the umbilicus. The skin is elevated just to the level of the umbilicus with a more limited amount needed to be removed. Tightening of the muscles is frequently but not always performed and would depend on whether or not there is separation between the muscles or laxity present.

Which procedure is most appropriate for you would be determined at the time of your consultation. If you would like to obtain additional information on tummy tucks, liposuction or any other cosmetic 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

Have you noticed that in pictures of you taken in profile, your chin seems to be somewhat missing in action? Does your nose appear to be very prominent when it really isn’t? Does your jaw appear to be hidden by a fatty neck? If you answered yes to any of these questions, then maybe a chin augmentation (also known as an augmentation mentoplasty, mentoplasty, or genioplasty) should be considered.

When you examine people, you can sense either facial harmony or disharmony. There is an accepted relationship among the upper, mid and lower face that when disrupted, creates a sense of imbalance. This is most vividly evidenced by those who have an extremely underdeveloped chin which over accentuates the projection of an otherwise normal sized nose.

The simplest solution to providing greater projection of the chin involves the insertion of a chin implant that is most often constructed of a rubberized solid silicone that feels like the underlying bone that it is placed on. These chin implants can be inserted either through an incision placed in the natural crease below the chin or through one made intraorally.

A chin augmentation can be performed as an isolated procedure or combined with others, most commonly a rhinoplasty, neck liposuction or contouring, or facelift. The surgery is fairly minor but the results can be quite impressive.

Before chin augmentation

After chin augmentation

If you would like to obtain additional information on a chin augmentation or any other cosmetic surgery 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

Enlargement of the male breast (Gynecomastia) is a fairly common condition which frequently is a source of embarrassment and insecurity. As I have noted previous, its development is related to the absolute and relative levels of the sex hormones testosterone and estrogen. These levels are significantly affected by puberty, aging, alcohol, and certain drugs, medications and diseases.

So what are some of the medications and drugs that are associated with male breast enlargement? The following enumerates several categories of medications and identifies some specific examples:

• Anti-androgens that are used to treat enlargement or cancer of the prostate. These act to decrease the biological effect of male sex hormones. Some examples include finasteride (Proscar, Propecia), dutasteride (Avodart), flutamide (Eulexin); cyproterone (Androcur, Climen)
• Anti-anxiety medications: diazepam (Valium)
• Tricyclic antidepressants such as amitriptyline (Elavil), doxepin (Sinequan) and imipramine (Tofranil)
• Antibiotics such as ketoconazole (Nizoral), isoniazid
• Ulcer medications such as cimetidine (Tagamet)
• Certain chemotherapy agents used in the treatment of cancer.
• Cardiac medications such as digitalis (Digoxin) and calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem) and nifedipine (Procardia)
• AIDS medications, most notably Efavirenz
• Products containing tea tree oil or lavender oil
• Miscellaneous medications including estrogen, spironolactone (Aldactone), and HCG (human chorionic gonadotropin)

The following are some of the street and illicit drugs associated with Gynecomastia:

• Marijuana
• Cocaine
• Anabolic steroids
• Methadone
• Amphetamines
• Heroin

The above listing is not meant to be comprehensive but instead as a guide. If you are experiencing increasing gynecomastia unrelated to puberty and may be on one of the agents listed above or a similar medication or drug, you may want to investigate this further and discuss it with your appropriate physician. In order to surgically address the enlargement induced by the medication or drugs (if appropriate), male breast reduction surgery can be considered. This may involve ultrasonic assisted liposuction of the breasts and/or direct excision of the enlarged glandular tissue.

If you would like additional information on male breast reduction surgery in the treatment of enlarged male breasts (gynecomastia) such as with ultrasonic assisted liposuction or on 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