Juvederm® is a very effective hyaluronic acid dermal filler that I use to treat facial lines and creases, for lip enlargement and to provide volume enhancement and highlighting in strategic areas. It is the only dermal filler of its type that has been approved by the FDA to last up to one year. Most of my patients prefer it over its competitor, Restylane®, and the results seem to be longer lasting.
Juvederm® is the most common injectable that I used for lip enlargement. Because of the discomfort associated with injecting fillers into the lips, I do nerve blocks to anesthetize the lips so that my patients don’t feel anything. The flip side of this is that the nerve blocks can be slightly uncomfortable and the ensuing numbness will persist not just in the lips but in surrounding areas of the face for a few hours. This can make speech, enunciating and eating more difficult until it wears off.
Fortunately, now there is a great solution to this dilemma. Allergan, the manufacturer of Juvederm®, received approval from the U.S. Food and Drug Administration’s (FDA) at the beginning of February to market a new formulation of this product that contains the preservative free local anesthetic lidocaine. It is being marketed as Juvederm® XC and contains a powder form of the anesthetic so that there is no dilution of the concentration of the hyaluronic acid.
I have used this Juvederm® XC on my patients including for lip enlargement without any nerve blocks. My patients unanimously found the injections to be very tolerable and comfortable whereas before without a nerve block, they would have been quite uncomfortable. Not only were they relieved in not needing the initial blocks but they also noted that there were no significant effects on their speech or enunciation.
If you would like more information on Juvederm® XC, Radiesse®, Botox® or any plastic surgery procedure that I perform or to schedule a free consultation with me, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
My experience treating many women over the years with inverted nipples is that the associated adverse psychological effects of having this deformity should never be overestimated. Yes, many girls and women can and do deal with this variant quite well or as a matter of fact. Nevertheless, for girls reaching puberty and womanhood to then discover that one or both or their nipples are abnormal and don’t protrude like their friends, can be devastating. Not only do they become extremely self conscious about this deformity, their self-worth, confidence and sense of femininity plummets.
Many take elaborate precautions so others may not perceive or notice their defect. They wear wearing bulky, loose fitting clothes so the lack of nipple projection won’t be perceived; avoid taking showers in school in front of other women, and change their clothes only in absolute privacy. It can inhibit them from wanting or making themselves available to date. When it comes to intimacy, the impact and stresses can be almost unbearable.
Fortunately, the solution to this often psychological devastating problem of inverted nipples is quite simple and minor. The procedure involves the release of restraining, shortened ligaments and ducts that are preventing the nipple from protruding out. Surgery, which may take only a half an hour to treat both nipples, can be performed in the office under local anesthesia employing tiny incisions that leave essentially imperceptible scars. Pain and down time are minimal with most patients going back to school or work the next day.
size change – usually to increase the implant volume and therefore the breast size; rarely to decrease
to modify the breast configuration such as to make them more projecting or less wide
to switch from saline to silicone implants; rarely, silicone to saline
replace a ruptured breast implant
in the course of treating one of a variety of aesthetic breast issues such as drooping or capsular contracture, replacing older implants with newer ones.
The most common reason for implant exchange is that a woman is unhappy with the selected size and wants to be significantly larger. It is fairly infrequent to desire a smaller size and this is often due either to the surgeon placing a far too large implant initially or the patient gaining a considerable amount of weight resulting in a marked enlargement of breast tissue.
In my practice, it is fairly rare for my patients to desire a change their breast implant size and if they do, it is usually years later. Why can I keep this rate extremely low? When evaluating my patients in consultation, I listen carefully to exactly what they want or think they want. I also measure and size them in the office, have them try on a variety of implants, and show them photos of other patients to provide them with a greater understanding and visualization. During surgery, this is fine tuned, as I will employ temporary implants in order to assess the effects of various sizes and configurations.
By offering many different styles of breast implants, I can customize the appearance that would be most appropriate and desirable for my patients. For example, patients who are very narrow and desire significant projection would be best served with higher profile implants whereas women who are broad with a moderate amount of breast tissue present may benefit more from moderate profile implants. Many of the patients that I perform implant exchanges on were done elsewhere and indicated that they were never offered or explained the options.
It is essentially unanimous that women prefer the silicone implants over the saline ones as they feel similar to breast tissue. When switching between fill materials, virtually all go from saline to silicone whereas the opposite is almost never performed due to aesthetic issues.
A very common question that I am asked from prospective patients who are considering liposuction is if the procedure will also improve their cellulite. Not only do they want to improve their overall body shape with liposuction but they would also like to address the cellulite commonly situated on the thighs, hips and waist in women.
What is cellulite? It is an anatomic structural abnormality involving the fat, tissue between globules of fat and the overlying skin which is affected by hormones and genetics. The skin in these areas has lost its elasticity, presenting with a relative laxity and contour irregularities.
Liposuction will remove the underlying fat but will not address the overall intrinsic anatomy of the area nor will it have any effect on the elasticity of the skin. With less fat stretching out the overlying damaged skin, the cellulite will actually worsen in appearance. Therefore, liposuction is not a treatment for cellulite.
For more information on liposuction, tummy tucks or any other plastic surgery procedure that I perform or if you would like to schedule a complimentary consultation with me, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Stretching of the earlobes has been performed for thousands of years as evidenced by statues of the Pharaohs of ancient Egypt manifesting these changes. There has been a recent resurgence in its popularity for both men and women. This has been facilitated by the relative ease and safety of obtaining the desired outcome as well as the greater acceptance of these body piercings.
Nevertheless, many individuals who have gauged their earlobes decide at some point in time for any of a number of reasons that this appearance is no longer desired or appropriate. Removal of the gauges will result in the shrinkage of the size of the stretched deformity over a period of several months but there will never be closure of the created defect. The ultimate appearance including the size of the persistent defect, quality of the skin, extent of residual stretching and drooping will be affected by a multitude of factors. Many times this residual deformity can attract just as much attention if not more as having large prominent gauges still in place.
Now what? Fortunately, plastic surgery can be performed on the earlobe to reconstitute a more normal appearance. This reconstruction can be performed under local anesthesia in the office. It involves excising the skin along the margins of the opening and configuring a closure that will yield an acceptable earlobe shape. Discomfort from the procedure is usually fairly mild and often requires no pain medication. Sutures are left in for approximately one week.
Liposuction, which is among the most common plastic surgery procedures performed, can provide very satisfying results for the right individuals. The best outcomes are obtained in patients who have localized fat accumulations, good skin tone and who are not far from their ideal body weight. If you elect to have liposuction in situations which significantly deviate from this ideal, your expectations should therefore be tempered.
With this in mind, a question that my office and I are commonly asked is if liposuction can be used as a weight loss procedure. The typical scenario is that the individual is considerably over their ideal body weight, sometimes 40 to 100 pounds or more, and just can’t lose the weight. They are frustrated and state that diets and exercising have not worked. Some indicate that they would use the results from liposuction to motivate them to be more diligent in dieting and exercising.
Delving further into their particular situations reveals that most are not even remotely adhering to their diets, and instead, are consuming far more calories than they think or want to admit to. Their exercise regimens also are highly inadequate, burning off far fewer calories than they think or hoped for. Thus, there is little or no weight loss.
Liposuction, in these situations and in general, is not and should not be employed as a method for weight loss. Removal of large amounts of fat from the body at one time does increase the risk for significant complications or even death when massive and inappropriate suctioning is performed. It is a widely accepted tenet that taking out 5 liters or less of fat in one surgical session is the prudent choice. This translates into only approximately 11 pounds at the time of surgery with the long term amount being notably less.
When you add up the attendant costs for the surgery including possible time off of work, the surgical risks that one is taking, and the considerably compromised aesthetic outcome, it rarely is a wise choice to use liposuction as a means for weight loss. Instead, I strongly recommend being far more diligent in dieting and exercising in order to lose weight.
During the moratorium imposed by the U.S. Food and Drug Administration between 1992 and November 2006 that limited specific uses of silicone breast implants, women who wanted to have a breast augmentation could only be offered saline breast implants. Since the end of 2006, silicone breast implants have once again been available without restriction for all women desiring breast surgery. This includes for breast augmentation as well as breast lifts (mastopexy) with implants, breast reconstruction and those who want or need to exchange their implants for different ones.
Having been in plastic surgery practice for over 22 years in Scottsdale and Phoenix, Arizona, I have long been involved and dealt with and witnessed the multitude of factors and issues regarding silicone and saline breast implants. Prior to 1992, my patients used silicone implants exclusively and were quite happy. During the period of the moratorium in which all my breast augmentation patients and some of my mastopexy and breast reconstruction patients utilized saline implants, I noted that the aesthetic results and level of satisfaction with the naturalness of outcome were decreased and compromised compared to results with silicone implants.
This sentiment came as no surprise. Why? Silicone breast implants feel very natural and “soft”, like breast tissue, so that when they are in place, it often is very difficult to discern their presence particularly for the non-professional. Saline implants, on the other hand, can often be detected, either by sight, feel or both. This is exacerbated in very thin patients who often have “rippling” seen through their skin. These issues and others such as deflations do detract from their popularity. In patients of mine who have had both types of breast implants, every single one of them preferred and were far more satisfied with the silicone ones.
In the more than 3 year period since the lifting of the moratorium on the usage of silicone breast implants, virtually none of my patients select saline implants for their breast surgery which translates to around 99% silicone usage. For the rare few who do, it is only because of the lower cost of the saline implants.
Dr. Turkeltaub has been selected again as one of America’s Top Plastic Surgeons for 2009 by the Consumers’ Research Council of America. Selection for this honor is based on a rigid set of criteria employing an objective point system and not like some that are influenced by advertising dollars or other very subjective factors. We appreciate the great recognition that this award provides. Irrespective of it, however, our philosophy always has always been and will continue to be to fully inform our patients and provide them with the best possible care, offering state of the art procedures in a very comforting, caring and personalized environment. We derive the most satisfaction when our patients are thoroughly happy with their results.
If you are interested in scheduling a consultation with Dr. Steven Turkeltaub, you can contact our office at 480-451-3000.
Arizona Center for Aesthetic Plastic Surgery
Scottsdale and Phoenix, Arizona
Radiesse® is a long lasting injectable dermal filler that is FDA approved for the correction of moderate to severe folds and wrinkles of the face such as naso-labial folds and marionette lines around the mouth and creases of the forehead. It can also be used to augment the chin, cheeks, brows and effect contour changes of the nose and jaw line as well as fill in contour irregularities, deficits and scars. By increasing soft tissue volume in areas, it can serve to rejuvenate one’s appearance. Another area where it has been employed effectively is in the back of the hands which is useful for individuals with thin, atrophic and aged skin.
What is in Radiesse®? It is composed of calcium hydroxylapatite (CaHA) microspheres suspended in a proprietary biocompatible non-allergenic gel that can easily be injected to obtain the desired results. CaHA is the same material found in your teeth and bones. Not only does it provide volume by its presence but it also stimulates the body to produce collagen (protein) resulting in long lasting results.
The injections generally are not associated with much discomfort and can be performed in the office without the need for nerve blocks. The results are seen immediately and can be quite dramatic. Swelling is fairly minimal and typically subsides within 24 to 36 hours.
How long does Radiesse® last for? The duration of the results does vary depending on a variety of factors but somewhere between twelve to eighteen months is fairly typical which significantly exceeds the results of the hyaluronic acids such as Juvederm™, Restylane® and Perlane®. Touchups will often be needed during this period of time to help maintain the results.
If you would like additional information on Radiesse®, Juvederm™, Botox® or on any plastic surgery procedure or service that I perform or to schedule a consultation with me, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Advances in breast reconstruction techniques for the correction of deformities resultant from treatment for breast cancer have shown great potential and results. This specifically relates to the usage of acellular dermis which is specially treated human tissue devoid of cells, infective agents and immunogenic potential (can’t be rejected by one’s body). Used for several years now, it has established a great track record in this usage.
Several biomedical companies offer this tissue though there are clearly differences in the products, results and risks. AlloDerm® by LifeCell Corp. has been the most studied of these with the results being superior.
In the December issue of Plastic and Reconstructive Surgery (Vol. 124 Number 6), a study from the University of Rochester delineated several advantages of acellular dermis in breast reconstruction. For immediate breast reconstruction using tissue expanders, they noted that the expanders could be filled to far greater amounts when AlloDerm® was employed as compared to a different technique. Postoperative inflations were fewer and completed much sooner and allowed for the insertion of the final breast implant at an earlier date. This translated into an accelerated rate of reconstruction, more predictable and satisfactory results and the potential for a better aesthetic appearance. Best of all, there was no significant difference in complication rates with its usage.
I have been using AlloDerm® in my patients undergoing immediate as well as late breast reconstruction procedures and have found it to be an incredibly invaluable addition. It allows for clearly superior and more predictable results in configuration, positioning and softness and reduces the need for subsequent procedures to further refine the results.
If you would like to obtain additional information on breast reconstruction including the usage of tissue expanders or on any other plastic surgery procedure that I perform or if you want to schedule a consultation with me, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
In breast reconstruction, the ultimate goal is to recreate a breast that is as close as possible to the remaining breast. Perfect symmetry is naturally impossible. Even in situations where the reconstructed breast may be somewhat “similar” to the remaining breast in appearance in the immediate postoperative period, the two sides will invariably change or age differently over time, thereby increasing the differences.
Women who have undergone bilateral mastectomies inherently have better odds of obtaining symmetry in their breast reconstruction. Why? The reason is that they are often starting with similar deformities on each side, thereby allowing for the same reconstructive technique to be utilized for both breasts. This is true whether reconstruction is performed with the simple insertion of implants, usage of tissue expanders or with flaps such as a TRAM flap.
One notable caveat to this is if one side had been irradiated as an adjunct treatment of the breast cancer. As I noted in an earlier post (Problems With Tissue Expansion Breast Reconstruction In Previously Irradiated Tissue), the ionizing effects of the radiation treatments damages the skin resulting in scarring, thickening, increased rigidity and less suppleness of the tissues which often also show visual signs of the damage. This translates into tissue that is more resistant to the stretching that is necessary with tissue expansion breast reconstruction as well as breasts that often feel quite rigid or hard.
The following case illustrates this exact scenario. The patient underwent a bilateral mastectomy with radiation subsequently performed on the left side. In the photos, you may be able to appreciate the slightly darker color and firmness of the skin.
a.) Bilateral mastectomies with left breast irradiation. Pre-op
b.) Bilateral mastectomies with left breast irradiation. Post-op insertion and inflation of tissue expanders
c). Pre-op
d.) Post-op insertion and inflation of tissue expanders
e.) Pre-op
f.) Post-op insertion and inflation of tissue expanders
She elected to undergo bilateral breast reconstruction using tissue expanders. Despite using identical tissue expanders, there is a significant difference in appearance between the two sides. Ironically, though the irradiated left side is inflated with more saline than the right, it actually appears less voluminous. That is an effect of the radiation damage.
If you would like to obtain additional information on breast reconstruction, breast implants or any other plastic 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
Unlike with silicone implants used in breast augmentation, the diagnosis of a ruptured saline implant is usually quite easy and apparent. Most of the time there is a rapid and dramatic decrease in volume of the implant and, therefore, in the size of the affected breast. This can occur in a matter of a few hours to a few days though I have had a few patients who have noted a very gradual decrease in size over a period of even several months.
What happens to the saline? Your body will absorb the fluid which is harmless. As it does, your breast will further decrease in size.
Once it is apparent that the implant is ruptured, I recommend that the situation be addressed sooner than later. The reason for this is that the tissue which had been previously stretched out will contract around the deflated breast implant over time and form variable amounts of somewhat constrictive scar tissue. This can make it more difficult to reacquire the level of symmetry that had been present prior to the deflation.
The plastic surgery options available for treatment of a ruptured saline breast implant following a breast augmentation fall into four general categories:
1. Replace just the deflated implant.
2. Elect to undergo a bilateral implant exchange. With this approach, one can also change size, style and switch to silicone implants
3. Remove both breast implants (also known as bilateral explantation).
4. Do nothing at all. This option is almost never selected.
In your consultation, I would discuss each of the above options in detail including the pros and cons in order to allow you to make an informed decision.
Investigators in Australia and Austria have discovered a particular DNA enzyme in the skin of kangaroos that is effective in repairing the genetic damage associated with many skin cancers. This same enzyme is also present in other animals but not in humans. Sunscreens can be helpful in blocking the skin’s absorption of the damaging rays of the sun but it is unpredictably effective and doesn’t treat damage already sustained.
Sunlight with its various wavelengths of ultraviolet light, particularly UVA and UVB, has been associated with aging of the skin including loss of elasticity, pigmentation irregularities and wrinkles as well as skin cancers such as basal and squamous cell carcinomas and the dreaded malignant melanoma. If a topical agent such as a cream or lotion can be manufactured that could repair DNA damaged by ultraviolet light exposure, this would be an incredible breakthrough and an extremely effective way to lower one’s risk of developing skin cancers.
Still, prevention is key. It is important to minimize the exposure of your unprotected skin to strong sunlight as well as avoid tanning booths. This will reduce your future risk of developing skin cancers as well as help keep your skin looking more youthful longer.
If you have any questions about rejuvenative skin care products or procedures such as the CO2 Laser or chemical peels, sunscreens or any cosmetic procedure that I perform or you would like to schedule a complimentary consultation, please contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Botox® has been used clinically since the 1980’s when it was employed by ophthalmologists to treat muscle issues of the eye. Over time, clinical uses of it have expanded considerably. In 2002, the FDA (Federal Drug Administration) approved its use specifically for the temporary cosmetic treatment of moderate to severe frown lines between the eyebrows. Although it is at other sites for the same muscle relaxing effect, these uses are technically considered by the FDA to be off-label.
What are the most common areas in the face that Botox® is requested? These are the areas associated with the most common muscle hyper-animation with expression and include:
1. frown lines situated between the eyebrows and on the bridge of the nose
2. crow’s feet creases at the corners of the eyes
3. creases of the forehead
Far less commonly treated facial areas include the lower eyelid, creases around the mouth and specific neck creases. These are also higher risk areas for significant side effects such as drooping of the lower eyelid or weakness of the muscles of the lip than can affect speech, appearance and ability to purse the lips so you should use considerable caution and prudence before proceeding.
Though the duration of effects do vary from person to person and are even dependent on the specific area, expect around three to four months on average. Some patients can have results that last 6 months or more but this is not very uncommon. In order to maintain the effects, Botox® treatments should be repeated on a regular basis, usually every three to four months.
For more information on Botox®, fillers such as Juvederm™ and Radiesse®, eyelid surgery or any other cosmetic surgery procedure or to schedule a complimentary consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Breast augmentation is among the most common plastic surgery procedures that women chose and is associated with an extremely high satisfaction rate in the vicinity of 94%. Despite such an astounding level of happiness, there are many variables and issues that can lead to less than desirable results. One relatively uncommon problem is where the two breasts seem to coalesce into one larger unit which is scientifically called symmastia (also synmastia) or in lay terms, a uniboob. In this situation, the breast implants can move or be moved so far to the midline that they may actually touch each other.
What are the causes and who is at a greater risk of developing this deformity? In general, women who are fairly thin and those who have a chest wall deformity known as pectus excavatum (where the sternum has a caved in appearance) are at a higher risk. This is risk is further amplified by a desire to have their breasts situated close together and by the selection of disproportionately large implants.
Symmastia is usually the result of overzealous dissection of the implant pocket medially (near the midline). In attempting to decrease the distance between the breasts so as to facilitate more cleavage, a surgeon may over-release tissue that is normally adherent to the underlying sternum. This allows the implants to migrate so far to the midline that they may actually touch. The skin then redrapes over the breast implants rather than discretely attaching to the sternum which results in the amorphous shaped uniboob versus two well defined breasts. Symmastia occurs both with breast implants that have been placed in submammary and submuscular pockets.
A few treatment options are available to correct this deformity including a relatively new approach using specially processed tissue (Alloderm® and Strattice®). Repair of symmastia can be very challenging and the results not always ideal. Selecting smaller and less wide implants will also assist in obtaining a more predictable and permanent correction.
It is not uncommon for patients to perceive a rhinoplasty as a relatively painful procedure. After all, there may be considerable reshaping of the nose required and then … those bones may have to be broken. Ouch! If you have watched any YouTube videos or seen programs explicitly showing the fracturing of the nasal bones, it appears to be pretty brutal. It’s just gotta hurt!
Fortunately, that is usually not the case. A rhinoplasty that just requires cartilaginous work or rasping of an irregularity without the need for breaking of the nasal bones is associated with relatively minor discomfort. If the nasal bones need to be fractured in order to narrow the nose, though there is a significant increase in the extent of swelling, there is often only a minimal increase of pain. For most patients, oxycodone (Percocet®) is more than adequate and is often taken for a very brief period of time.
If you would like additional information on a rhinoplasty, chin enlargement, eyelid surgery or any other aesthetic procedure that I perform or to schedule a complimentary consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
In an earlier post, we noted that women pursue breast reduction surgery for either functional or aesthetic reasons. The vast majority of women that I see as well as those who seek out a breast reduction in general, are doing so in order to alleviate the symptoms associated with their considerably enlarged breasts. These symptoms can include neck, back and shoulder pains, headaches, rashes, and discomfort and limitations engaging in sports and exercising.
However, just because you have one or more of these issues does not mean that your enlarged breasts are a cause or even the only cause of your problems. The best way to ascertain whether a reduction mammoplasty would benefit you is to consult with a Plastic Surgeon certified by the American Board of Plastic Surgery such as myself. If your plastic surgeon determines that a breast reduction could help to alleviate or resolve some or all of your symptoms, then you would be a good candidate for the procedure.
Some women desire their breasts to be reduced in size (and lifted if indicated) solely for aesthetic reasons and not because they are experiencing any related symptoms. They simply want smaller and perkier breasts. A breast reduction can surely accomplish this though a plastic surgeon like myself can assist you in arriving at a prudent decision based on your concerns and goals.
If you have the appropriate functional or aesthetic reasons for pursuing a breast reduction as confirmed by a plastic surgeon and you are a relatively low surgical risk, then you would indeed be a good candidate for breast reduction surgery.
Just what is a “Mommy Makeover”? You probably have been hearing or seeing this expression used in advertisements recently and wondered what it is. Essentially a “Mommy Makeover” is the correction by plastic surgery of the changes that occur as a result of having children in order to regain a more pre-pregnancy figure. Often, related cosmetic procedures can be performed concurrently to improve one’s overall appearance. Pregnancy permanently affects to variable extents women’s breasts, abdomen and body fat deposition and so these are the areas that are addressed.
Following pregnancy, many women lose some firmness, shape and volume of their breasts which may also become droopy and develop stretch marks. These changes can be further exacerbated by breast feeding with the duration and number of children affecting the outcome. A few women actually have a net increase in breast size though the shape and positioning usually suffer. Procedures that can effectively address these changes include a breast augmentation, breast lift with or without a breast enlargement and a breast reduction.
Permanent changes in the appearance of the abdomen following pregnancy are quite variable among women and are affected by a multitude of factors. The often is some residual degree of laxity of the skin and the underlying muscle layer along with changes in the distribution of fat. Cosmetic procedures that could improve the appearance of the abdomen include a mini tummy tuck, a standard tummy tuck (abdominoplasty) and liposuction. Liposuction can also be performed elsewhere including the hips, thighs, knees and even back.
The combination of the appropriate cosmetic procedures of the breast and abdomen with or without liposuction performed at one surgical setting constitutes the “Mommy Makeover”. Of course, other procedures such as eyelid surgery can be done at the same time if warranted and indicated. This rejuvenation of one’s body back to a more desirable shape can do wonders for your psyche, self-confidence and sense of attractiveness.
A rhinoplasty, or cosmetic surgery of the nose, is a very demanding procedure that requires great surgical skill, exacting technique, a keen aesthetic sense and an understanding of the myriad variables and their effects on the ultimate results. Superseding this in importance of affecting the results of surgery are patient based issues such as nasal size, configuration, skin thickness, cartilage and bony structures and previous surgery or trauma. Translation: no matter how phenomenally talented the plastic surgeon is what you start with predetermines the maximal extent of change that is possible. Using a modified adage, if you have a lemon, you can at least make lemonade. You can’t turn it into gold.
Consider what it is that you don’t like about your nose but be realistic with regard to your expectations. It may be helpful to bring in close-up photos of yourself and point out what you do or do not like. Photos of others may help clarify your concerns and tastes but realize that each nose is unique and that someone else’s nose really can’t or shouldn’t be perfectly duplicated on your face.
If you would like additional information on a rhinoplasty, chin augmentation or any other cosmetic surgery procedure that I perform or to schedule a complimentary consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
A patient recently sought my expertise regarding the poor results that she obtained from a mastopexy with implants that was performed elsewhere (by a surgeon who was not board certified). She was very unhappy with the outcome for many reasons but the abnormal shape including the flatness and lack of appropriate projection and the low position of her breast on the chest were the most important issues. To her, the breasts looked bizarre making her feel very self-conscious and frustrated.
She originally presented to the surgeon with drooping (ptosis) and wanting to be larger. The physician recommended a lollipop mastopexy to her without enumerating its pros and cons and did not discuss the much more commonly used inverted-T incision. (A lollipop mastopexy is a breast lift that involves an incision around the nipple-areola complex that then extends down to the breast fold but does not extend along this fold which is employed in the inverted-T technique.)
Her photos can be seen below on the left:
The patient's "lollipop" mastopexy performed by another surgeon. Note the flatness of the breast and droopy appearance with it hanging down well below the breast crease.
This is a mastopexy using a T-shaped (anchor) incision. Note the more pleasing and natural conical shape with greater projection and fullness.
Ignoring factors specifically related to the surgeon, her results also reflect the inherent deficiencies with a lollipop mastopexy. As I noted elsewhere (Periareolar Mastopexy: Sacrificing Shape for Less Incisions), the goal of a breast lift is to recreate a more conically shaped breast with the nipple-areola positioned at the most projecting part. The “standard” inverted-T or anchor shaped approach allows for the precise recontouring of the skin envelope in addition to the underlying breast tissue by utilizing a three dimensional approach. This also facilitates greater accuracy in the placement and size of the nipple-areola so as to create a well shaped aesthetically pleasing breast.
Though the lollipop mastopexy can provide a better shape than what can be obtained with the even more restrictive periareolar mastopexy, its shortcomings are obvious as you can see in these photos. Without being able to adequately remove most of the vertical skin excess that occurs with droopy breasts, the breast remains droopy and abnormally flat including at the nipple-areola complex. Volume that could be used to increase forward projection and yield a more conical shape is instead hanging down, well below the breast crease that is should remain largely above.
Similar to my sentiments regarding a periareolar mastopexy, it is my opinion that a lollipop mastopexy is rarely indicated except for limited situations involving very minor drooping. The tradeoffs in shape and position are too high a price to pay for most women versus the vastly superior results that can be obtained with an additional incision along the breast crease.
If you would like additional information on breast lifts, breast augmentation or any other cosmetic surgery procedure that I perform or you would like to schedule a complimentary consultation, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Gynecomastia, which is enlarged breasts in men, is a quite common occurrence most often related to persistence of hormonally related effects that occurred during puberty. (See Male Breast Enlargement: Is It Common? and Medication and Drug Causes of Enlarged Male Breasts (Gynecomastia) for other causes.) Their presence is often a cause of considerable anxiety, embarrassment, and self-consciousness and may affect the activities one engages in or even the clothes one wears for fear of being seen with this condition.
The degree of breast enlargement in gynecomastia varies from essentially imperceptible to anyone else but the affected person all the way to massive, droopy DD or larger breasts. The surgical treatment including the extent and techniques employed, therefore, would also vary accordingly.
The following photos are some examples of gynecomastia, from mild to quite large:
If you would like to schedule a consultation, obtain additional information on male breast reduction surgery for the treatment of enlarged male breasts (gynecomastia) including ultrasonic assisted liposuction or want to inquire about another cosmetic surgery procedure, please contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Better ability to detect abnormalities on mammograms versus in front of the muscle (submammary)
Lower risk for capsular contracture (hardness of the breast caused by the formation of scar tissue around the implants)
More soft tissue coverage overlying the implant resulting in a lower risk and extent of visible rippling
Provides a better and more natural interface of the implant with the chest wall
Serves to provide better support of the implant long term as compared to above the muscle where the weight of the implant will cause greater stretching and thinning out of the skin over time as well as its descent on the chest wall
Implants above the muscle. Note the rippling, harsher contours, stretched areolas and unnaturalness of the result. (not my patient)
Implants behind the muscle. Note the more natural shape and smoother curves. This approach is recommended for most of my patients.
Except for some rare exceptions, most women are best served with the submuscular placement of their implants. As a result, this is my recommendation for virtually all of my patients.
A periareolar mastopexy, also known as a purse string, doughnut or circumareolar mastopexy, is a breast lift that accomplishes the result with just one incision: around the areola. Many women find the idea attractive because of the idea that there may be fewer scars on the breast. Unfortunately, unless there is minimal drooping to begin with, the trade-off is a poorly shaped flattened breast.
The goal of a breast lift or mastopexy is to recreate a more somewhat conical shaped breast with the nipple-areola situated at the summit of the most projecting part. A “standard” inverted-T or anchor shaped incision allows for precise reshaping of the skin envelope in addition to the underlying breast tissue by utilizing a three dimensional approach. The nipple-areola complex can then be more accurately placed and sized so as to result in an aesthetically pleasing contoured breast.
Inverted "T" Shaped Incision
The periareolar mastopexy approach eliminates the vertical scar as well as the horizontal scar in the fold at the bottom of the breast. Through a two dimensional approach involving just the incision around the areola, it has to both lift and reshape the breast. It accomplishes both by removing excess skin asymmetrically around the areola, taking a larger circle and purse stringing it to make a smaller circle, thereby tightening the skin.
With this approach, the area of maximum tension is centered around the areola. Some of the untoward consequences of this can include but are not limited to:
1.) a flattening of the breast shape creating more of a pancake configuration than a cone
2.) stretching and flattening of the areola causing distortions and irregularities of shape
3.) unsightly pleating of bunched up skin around the areola resulting from the purse string closure
4.) widened and thickened scars around the areola
5.) limitations in the precise positioning of the areola on the breast
6.) difficulty in obtaining closer symmetry is breasts that are significantly different prior to surgery
Periareolar Mastopexy (A). Though mild in this case, flatness and some pleating of the skin of the left breast can be seen centered at the areola (not my patient)
Periareolar mastopexy (B). Greater flattening can be seen including at the lower part of the breast
I strongly feel that a periareolar mastopexy is very rarely indicated except for certain limited situations involving very minor drooping. The trade-offs as noted above are too high a price to pay for most women versus the far superior results that can be obtained with a few more incisions.
In a recent posting, I discussed the need to obtain mammograms for women beyond a certain age prior to undergoing a breast reduction. The reason for is to screen for any abnormalities that may need to be explored further prior to the reduction mammoplasty surgery. It was also noted that even with a “negative” mammogram, there is an incidence of occult breast cancer identified in the removed breast tissue of between 0.16% and 0.40%.
A retrospective study just published in the October 2009 issue of the Plastic and Reconstructive Surgery Journal evaluated the incidence of precancerous lesions present in the tissue removed in breast reductions. What they discovered was very interesting and clinically helpful in potentially identifying women who are at increased risks of developing invasive breast cancer. Atypical ductal or lobular hyperplasia (abnormal but not cancerous) was diagnosed in the specimens in 4.4% of the women and a non-invasive state of breast cancer (ductal and lobular carcinoma in-situ) was seen in an additional 1.8%.
Why is this important? Based on the pathological diagnosis, a woman’s risk for developing breast cancer in the future can be quantified and appropriate preemptive actions taken as warranted. Atypical ductal and lobular hyperplasia have a 4 – 5 time increased risk of developing invasive breast cancer whereas ductal and lobular carcinoma in situ have and 8 – 10 fold greater risk than the average woman. Ordinary fibrocystic disease has no elevated risk for the later development of breast cancer.
Those women with an elevated risk of developing breast cancer can then be referred to either an oncologist or breast cancer surgeon for further evaluation and possible treatment. This could include prophylactic mastectomies, radiation or even estrogen receptor modulator therapy such as taking tamoxifen.
Therefore, women who undergo breast reductions may now receive an additional benefit from a procedure that already has overwhelmingly positive satisfaction – reducing their risk of developing invasive breast cancer.
If you would like to obtain additional information on breast reduction, breast reconstruction or any 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
We are in the midst of an unparalleled epidemic of obesity in this country. This is related to a combination of a general overindulgence in food, excessive consumption of foods high in fat and calories, and a more sedentary life style. Many of these people have realized that, for a variety of reasons, this excess weight needed to be shed. Through arduous dieting, exercise often in conjunction with bariatric surgery such as lap banding or gastric bypass they have lost tremendous amounts of weight, often far exceeding 100 pounds.
Success, finally! Celebration? Maybe not quite yet. Despite the massive weight loss that was so difficult to achieve, what many people didn’t anticipate was the permanent consequences on their bodies of first gaining then losing this sizable poundage. The figure that they envisioned following all this effort is not what they are seeing in the mirror. Instead of being slimmed down, contoured and generally smaller, most are left with unsightly deformities consisting of an excess of lax, irregularly contoured stretched skin that frequently cascades in rolls creating hygienic issues and an aesthetic nightmare.
Which areas are affected? From the face on down, the sequelae from massive weight loss may be seen. There is considerable variability among individuals as to the severity and areas that are most affected. Common areas include the abdomen, buttocks, circumferential trunk, inner and outer thighs, breasts, arms and even face and neck.
If you would like to obtain additional information on body contouring surgery such as for a tummy tuck, belt lipectomy, breast lift (mastopexy), breast augmentation, arm lift and face lift, you can contact my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Dr. Steven H. Turkeltaub is the medical director of the Arizona Center for Aesthetic Plastic Surgery, a cosmetic surgery practice offering a variety of plastic surgery procedures that address aesthetic concerns of the breast, body, skin, and face. Dr. Turkeltaub offers several options for those considering plastic surgery in Phoenix and surrounding areas. In this article, Dr. Turkeltaub discusses how the economy has impacted his Plastic Surgery practice through Phoenix, Scottsdale and the surrounding areas in Arizona.
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
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
Many of my breast reduction consultations ask me the following question before I even discuss the procedure: “Dr. Turkeltaub, will my breasts also be lifted when I have a breast reduction?” After making what I think is a humorous comment about that it would depend on their insurance plan, I let them know that this is an intrinsic part of the procedure.
A breast reduction, also called a reduction mammoplasty, involves a significant reduction in the size of the breast, lifting the tissue up to a more appropriate level, making the breast less wide, reducing the diameter of the nipple-areola complex and elevating it to an ideal vertical height. Most of the time this is accomplished through an anchor shaped/ inverted “T” shaped incision. The result is a smaller, lighter, higher, perkier and more rejuvenated appearance.
Just what the Doctor ordered and what my patients want!
Before Breast Reduction
After Breast Reduction
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Many women request to have the appearance of their abdomens improved but they are not sure what it is that they need. Is it a tummy tuck? Liposuction? Or something else? How does one determine what is best?
A tummy tuck, also known as an abdominoplasty, is designed to address the lax skin and muscles of the abdomen. This can involve minor looseness that is confined to the lower abdomen (a mini tummy tuck), lax skin that is present both above and below the umbilicus (standard or full tummy tuck), and major excess of skin that hangs down in rolls (tummy tuck or a panniculectomy). Liposuction is best reserved for women who have localized fat deposits but relatively good skin and muscle tone. Of course, there are some gray areas where either procedure can result in an improved appearance though addressing slightly different issues depending on the patient’s primary concerns. There are also some situations where both liposuction and a tummy tuck should and can be done concurrently and others where I recommend first performing liposuction followed several months later by a tummy tuck.
In order to precisely determine whether a tummy tuck, liposuction or some sort of combination would be most appropriate for you, I would need to see you in consultation. To schedule an appointment regarding an abdominoplasty, liposuction, panniculectomy or any other cosmetic surgery procedure, you can call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Over time and due to genetics, aging, weight fluctuations, pregnancy, breast feeding, lack of support and even chronic tanning, a very large number of women will experience drooping of their breasts known as ptosis. When they are seen in consultation in order to rejuvenate their breasts, I explain to them that they would benefit from a mastopexy (breast lift) with or without breast implants. For a “standard” mastopexy, the incision required to recontour and lift the breast is anchor shaped and extends from around the areola/ nipple area, then vertically downward to the crease at the bottom of the breast, then along this crease. When performed meticulously, most patients heal their incisions well though there are genetic and other factors that can affect the result.
When recommending and describing the incision entailed in a lift, invariably many patients express apprehension just with the vertical component – not even the one that encircles the areola. Some are so concerned about its presence that they either won’t pursue surgery or will only do so if the scar is limited to just around the areola which will yield an inferior result.
It has been my experience that the vertical component usually heals very well and at times even more inconspicuously than the other areas. By trying to limit the incision length and therefore the scarring by just employing an incision around the areola, the outcome is a flat breast with decreased projection and non-aesthetic contour. The reason for this is that by resecting the excess skin of the breast with the necessary purse-string tightening around the areola, it causes flattening in the exact area that should be the most projecting. Hence, the procedure is also called a donut mastopexy.
To better illustrate the difference between the two approaches using food comparisons, wouldn’t you rather have your breasts look more like a giant Hershey’s Chocolate Kiss, firm and conical in shape, than a flat donut? Unless you hate chocolate, I suspect that you would!
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Asymmetry of the breasts is present in the majority of women. Some might have been aware of the differences whereas some never even noticed the difference until it was pointed out much to their surprise during their consultation. Differences can involve breast shape, size, positioning on the chest wall, drooping, chest wall variations and nipple-areola asymmetries such as size, shape, positioning, contour and projection. Of course, whether or not there is a difference or if it ever was recognized previously, many expect perfect symmetry following surgery.
Breast augmentation surgery will not correct asymmetries. Some differences may be diminished whereas others will persist or may even be accentuated.
A frequent question regards differences in the vertical heights of the areolas and whether they will be situated at the same level following surgery. The answer to this is that they will remain dissimilar most of the time so that one will continue to be higher than the other (see photos). Furthermore, because the breast implants are placed so as to be at the same vertical height on the chest, aesthetically, one nipple-areola complex will always seem to not be in the ideal position. In situations where the areolas are located more to the side of the breast than centrally preoperatively, this malposition may be magnified postoperatively.
Despite these relatively minor issues, a breast augmentation still provides women what they desire from this procedure – fullness, projection, cleavage and a more attractive and alluring appearance.
Different nipple-areola heights preoperatively (frontal view)
Nipple-areola heights following breast augmentation (frontal)
Different nipple-areola heights preoperatively (oblique view)
Nipple-areola heights following breast augmentation (oblique)
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Silicone breast implants have been more thoroughly researched over the years than any other medical device. The purpose of many of these studies was to ascertain whether there existed a causal relationship between them and any disease processes. A quite unexpected discovery which has been well documented in several large patient population evaluations is that there is a lower than expected incidence of breast cancer occurring in women who have undergone a breast augmentation. In other words, women with silicone breast implants have a lower risk of developing breast cancer than the average women.
In the most recent large study, published in the International Journal of Cancer in January 2009, over 6200 Swedish and Danish women were followed post-implantation for a mean duration of over 16.5 years with over thirteen percent having the implants for at least twenty five years. What the researchers determined was that there was a statistically significant 27% reduction in risk of developing breast cancer in women with silicone gel breast implants. This is not a new finding as several studies performed previously reached the same conclusions with some actually showing risk reductions as high as 37 to 53%.
This is great news, of course, for both those women who have had a breast augmentation and those that are contemplating it. Why there is a lowered risk of breast cancer in women who have had silicone breast implants is not entirely clear and there may be several other factors in play. In discussing the procedure with my patients, I do not them that having breast implants will lower their risk of developing breast cancer. What I do indicate is that all evidence points to no increased risk of this type of cancer.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
If you have always dreamed of possessing long, sexy eyelashes your wait is now over. There is finally a legitimate product available that really works and it is the only one that has been approved by the FDA. Latisse™, developed by Allergan, Inc., has been shown to quite effective in stimulating longer, thicker and darker eyelashes.
Latisse™ can be as easy to apply as mascara. It is applied once a day at night to the upper eyelid lashes only. Most women can expect to experience significant growth and thickening of their lashes within six to eight weeks. Full results can take up to sixteen weeks. Study results revealed that eyelashes averaged 25% greater length, 106% more fullness and 18% more darkness. This does not guarantee that your results will be identical. Mascara can further complement the results obtained by the usage of Latisse™.
The most common side effects of Latisse™ are an itching sensation and/or redness of the eyes which occur in 4% of patients. This is usually temporary and does not reflect an allergic reaction. Less commonly, there can be darkening of adjacent eyelid skin which resolves after discontinuation of usage. If you totally stop using Latisse™, your eyelashes will revert back to their previous appearance over a period of several weeks to a few months.
For further information regarding Latisse™ including its purchase or to obtain any other plastic surgery related information, you can contact our office at 480-451-3000.
Before
After
Before
After
Before
After
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Unfortunately, our youthful looks last only so long and at some point they yield to father time. Among the earlier tell tale signs that we are no longer as young as we feel are excess skin particularly of the upper eyelids, downward migration of the outer brows and fat bags of the lower lid. With time, these become progressively worse resulting in an even older and more tired appearance. These changes can be very distressing and even more so in a youth oriented world and competitive work place.
What is the solution? Eyelid surgery, also known as a blepharoplasty, is a very popular and effective procedure that can rejuvenate this area. This involves the precise excision of excess skin of the eyelids and a conservative removal of fat with or without some repositioning of some remaining. As most people have some asymmetry of their eyes including in the manifestations of aging, often there is a need to remove different amounts of skin and fat from each side. There is often a need to tighten the lower eyelid support system which becomes more lax with aging.
Incisions for the upper eyelid are placed in the natural crease that is most often present. The lower lid incision is situated right below the lid margin. Both incisions heal extremely well and are usually quite inconspicuous within a few weeks.
Often, some form of brow lift or forehead lift is also performed in order to more thoroughly rejuvenate the area. This can consist of a local lifting of the eyebrows themselves, an endoscopic forehead lift or the more extensive open approach.
Since opening my plastic surgery practice in Scottsdale and Glendale over 20 years ago, there has been a markedly positive evolution in the postoperative course that my patients have experienced following a breast augmentation. This has resulted in shorter recuperation times, less discomfort, reduced postoperative nausea and shorter times off from work or school.
All my patients have their breast augmentation surgery performed using general anesthesia as it is far more comfortable and humane. Patients who have had their previous breast enlargement done using a twilight anesthetic (not fully asleep) will relate the uncomfortable nature of this approach – physically and emotionally. The anesthetic agents utilized for general anesthesia today are far more refined, effective, predictable and with fewer side-effects. Patients wake up far more rapidly, are lucid and functional in a much shorter period of time without an anesthetic “hangover”. The incidence of nausea has been markedly reduced and the extent is usually fairly mild and well controlled with one of several effective medications.
With an evolution in technique, I have found that the level of surgical discomfort postoperatively has been reduced tremendously. Though pain tolerance varies from person to person, most of my patients take medication to control the pain just for a few days and often not on a regular basis. They may take an occasional analgesic subsequently as they become more active. Some may only require pain medication for the first twenty four hours.
I do recommend light activities for the first few days with certain restrictions. The surgical dressing is typically removed two days after surgery at which point in time you are placed in a supportive but comfortable bra. At that time, you will notice that your breasts will be moderately swollen and firm. This will rapidly subside in the ensuing several weeks so that even at a month, they will appear closer to their long term shape. However, expect that it can take up to six months or longer for a more “stable” long term appearance.
Most patients can resume driving by three to five days. I strongly discourage driving if you are still taking narcotics as they can impair your senses and therefore your ability to drive safely. You are encouraged to resume most of your normal activities when you feel comfortable. I do restrict vigorous activities such as sports, aerobics, and heavy lifting for three weeks following surgery. Pectoralis muscle exercises should be avoided for eight weeks.
Virtually all of my patients return to school or work within five to seven days. If your job requires strenuous activity or long hours, you may need additional time off from work or some sort of temporary assistance or job modification.
If you would like additional information about recovery from a breast augmentation, information about the breast augmentation procedure in general or to schedule a consultation, please call my office at 480-451-3000.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
In April, the FDA approved the usage of another cosmetic wrinkle remover, which like Botox Cosmetic®, is derived from botulinum toxin. To be marketed as Dysport™ by Medicis Pharmaceutical Corp., it will be a direct competitor to Botox Cosmetic® which is sold by Allergan Inc. It has been used with great success since 1991 in Europe where Botox Cosmetic® is also very popular.
Though derived from botulinum toxin, these two products are not identical and do have several differences which will be sorted out in the future with greater experience. Dysport™ has a more rapid onset of action, typically one to two days versus the three to five days seen with Botox Cosmetic®. It also has a greater spread for a more diffuse effect, requires fewer injection points and may last slightly longer than Botox Cosmetic®. However, it does have significantly more adverse side-effects. Botox Cosmetic®, though requiring more injection points, is far more precise, predictable and has a lower risk of adverse problems.
Dysport™ should be available for clinical use here within the next month or two. Pricing is not yet established but will likely undercut the cost of Botox Cosmetic® in order to acquire patients and market share. Its presence will be a win-win situation for patients, allowing for more than one treatment option as well as providing competition which may lead to more favorable pricing and incentives.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
There are many decisions to be made when contemplating breast augmentation surgery such as implant size, shape, projection type, placement behind or in front of the muscle and saline versus silicone. Another factor to consider is the surface characteristics of the implant – smooth or textured. The first generation of breast implants that were used beginning in the 1960’s had a smooth outer surface. Over time, a significant number of these women developed firmness around the implants called capsular contracture. In the 1970’s, it was discovered that placing a thin layer of textured polyurethane foam around the implants resulted in a much lower rate of this contracture developing. The aesthetic results were superior both in feel and appearance to those that did not have this outer layer. These polyurethane implants remained quite popular until they were voluntarily removed from the market in 1992 due to theoretical concerns of long-term safety of the polyurethane itself.
Implant manufacturers sought to simulate these results by incorporating the texturing within the silicone outer shell of the implants without the need for polyurethane. These began appearing around 1986 from a variety of manufacturers and are still being offered today along with the smooth surfaced ones.
So, which is the better choice? The answer is not exactly straightforward. It may depend on several factors as well as on physician preference. Research data on textured versus smooth implants at times has been inconclusive with regard to the development of capsular contracture. For implants placed above the muscle (submammary), there may be a lower rate of firmness developing when the textured surfaced ones are used. However, textured saline implants in this location are associated with a high rate of rippling and irregularities of the skin contour, severely compromising the aesthetic result as compared to the smooth surfaced ones. This can also create discomfort in the breast where the edges of the implant are poking into the skin. The implant may also have a shorter life span.
Research results for the implants placed behind the muscle (submuscular) are less clear. There may be slight differences in the capsular contracture rates and durability between the textured and smooth implants, whether they are silicone or saline.
So, what do I recommend from my years of experience? For several reasons, rarely would I place an implant above the muscle. If I did, it surely would not be a textured saline one! My choice for saline implants behind the muscle is also smooth because they clearly provide a better aesthetic outcome.
Why saline implants placed above the muscle are not recommended - Frontal view (not my patient!)
Why saline implants above the muscle are not recommended - Oblique view (not my patient!)
Both smooth and textured silicone implants placed behind the muscle can yield great results. I base my recommendation largely but not solely on the dimensions of the implant that I am looking for. The textured and smooth implant configurations as designed by the manufacturer of preference, Allergan Corporation, are slightly different throughout the range of sizes with the latter tending to be slightly more projecting and less wide. If someone had a history of capsular contracture, I would more likely consider a textured surfaced implant in that situation.
I find that implant surface type is a non-issue with my patients. They will defer to my recommendations here. After all, they have much more important decisions to make. Like implant size…!
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
Breast reduction surgery is an extremely effective and rewarding procedure that many women undergo for the treatment of large, significantly uncomfortable breasts. It entails the removal of an appropriate amount of breast tissue and skin with recontouring in order to alleviate the symptoms. Research studies have shed light on another benefit: a lowered risk of developing breast cancer for some women. It would seem logical that with less breast tissue available to degenerate into cancer, the risk should be decreased. That is indeed what has been determined. Evidence from several studies performed to examine this possible relationship reveal a risk reduction ranging from 28% to 50%. This effect, however, was only noted to occur in women who were over 40 years old when the surgery was performed. No discernable benefit was seen in those women less than 40 years of age.
This well substantiated finding is just another potential benefit from undergoing a breast reduction. For those women who have an inherently high risk of developing breast cancer, a more appropriate procedure that removes virtually all the breast tissue should be considered such as a subcutaneous or total mastectomy.
Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona
Although breast implants can be very durable, given enough time, they do not last forever. Over time, the cumulative effects of normal intrinsic and extrinsic “wear and tear” will affect the strength and integrity of the implant shell. Silicone implants do last noticeably longer as compared to saline implants.
What are some of the factors that can reduce the lifespan of implants? High impact trauma directly to the breast can significantly stretch and weaken the implant shell or even cause it to disrupt resulting in implant rupture. Common mechanisms for this include car and motorcycle accidents, major falls and even sports injuries. Nevertheless, I have evaluated and treated many women over the years whose implants have survived serious motor vehicle accidents including steering wheel breaking head-on collisions, being thrown from motorcycles, getting hit in the chest with batted softballs or thrown footballs, etc.
Anything that can markedly increase the pressure placed on the implants, sustained or intermittent, may predispose them to premature rupture. This can include extremely aggressive implant manipulations and massage, capsular contracture, and closed capsulotomies whereby the surgeon tries to treat the capsular contracture by intensely squeezing the breasts hoping to tear the scar tissue causing the firmness. (This is no longer an accepted practice because of the now known risks of premature implant rupture.) Rarely, very compressing and aggressive mammograms can precipitate an earlier rupture. This is more likely to occur with much older implants, particularly earlier generation ones that were not nearly as strong as the implants available today.
Penetrating injuries into the breast such as a result of trauma can pierce the implant envelope resulting in loss of integrity. This can even occur during a routine elective breast biopsy where a needle is inserted too deep, penetrating into the implant.
Studies have shown that breast implants subject to considerable forces at the time of insertion, will have weaker envelopes potentially leading to premature failure. This can occur by the plastic surgeon trying to insert a large silicone implant through a very small incision. Damage caused by surgical instruments at the time of surgery can also result in early deflation.
Saline implants that are under filled below the manufacturer’s prescribed amount, have a higher rate of failure. An example of this is a 420cc saline implant with a recommended fill range of 420 – 450cc that is only inflated to 375cc. Under filling will cause implant folds and creases that will ultimately weaken the envelope resulting in tears and, therefore, deflation. Moderately overfilling above the recommended range probably has little or no impact on durability.
Whether used for breast augmentation, mastopexy or breast reconstruction, breast implants are very durable. Their presence should not influence, within reason, “normal” activities of daily living.
Smooth (left) and Textured (right) Silicone Implants
Smooth (left) and Textured (right) Saline Implants
Substantially reducing the size of the breasts with surgery is considered by most plastic surgeons and patients to be reconstructive in nature and not cosmetic. Unfortunately, many insurance companies do not quite see it that way and can make it difficult to obtain authorization for a breast reduction (reduction mammoplasty). The trend by more insurance companies over the last several years has been to exclude this surgery as a potential covered benefit. In order to determine whether you may be eligible for coverage, you will need to contact your insurance company and provide them with your specific policy number.
Even if benefits are available, there is no guarantee that you will be approved for the breast reduction. Most insurance companies require documentation of your symptoms related to your enlarged breasts (mammary hypertrophy or gigantomastia) as well as supportive photos. These issues can include neck, back and shoulder pains, grooving of the shoulders from the bra straps, postural changes, headaches, rashes and skin breakdown, and even numbness of the arms. Some companies have established very stringent criteria that can include height and weight numbers, body mass index (BMI), evidence of a prolonged course of physical therapy that did not alleviate symptoms, and several letters from various medical personnel including your primary care physician. Most also require that the anticipated weight of breast tissue to be removed per side exceeds a specific amount.
In the worse cases scenario, if your policy does not provide benefits for a breast reduction or you have been refused authorization for surgery, the procedure can still be performed though you would be responsible for the attendant costs. The results from the surgery are so effective and rewarding, that many of my patients who cannot get insurance coverage will pay to have the procedure done in order to obtain relief from their symptoms.
At the Arizona Center for Aesthetic Plastic Surgery, we offer several ways for you to keep costs down and make the surgery more affordable. Package pricing is available that can save you thousands of dollars off typical hospital costs. We also accept various credit cards and offer financing from several companies that will allow you to make more affordable payments spread out over time. You can call our office at 480-451-3000 for further information and assistance regarding breast reduction, insurance questions, financing, and scheduling your consultation.
Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona
Wherever you turn nowadays, it seems that big breasts are where it is at. Magazine articles, advertisements in all media including even on billboards, and marketing materials intentionally display alluring, voluptuous women. Television and movie actresses, anchorwoman and even hostesses at many finer restaurants are well endowed in clearly disproportionate numbers. Breast augmentation usually ranks as the number one plastic surgery procedure among women. Why then would a woman choose to reduce the size of her breasts? Could this apparent lack of judgment be caused by drinking too much bottled water or is it the result of a never before recognized side effect of global warming?
The real answer to this is that naturally large breasts can be very big problem. Their sizable weight can be associated with neck, back and shoulder pains, skin irritation and rashes, unpleasant odors, numbness in the extremities, fatigue, and even impairment of breathing. Some women are forced to sleep propped up in bed or in a recliner as their breasts are so massively enlarged (gigantomastia) and heavy that breathing is a chore. With time, many women develop arthritis of the neck, deforming postural changes and deep, painful grooving of the shoulders from the bra straps relentlessly digging into their skin. Exercising can be extremely difficult, painful and even embarrassing so many forego it. I have had patients tell me that they need to wear two or three sports bras just to attempt to feel more comfortable. Many give up on vigorous activities and as a consequence, gain weight. Some of that increased weight goes to their breasts and so it becomes a vicious cycle. An extremely high proportion of women with large breasts, therefore, are well above their ideal body weight which can also lead to other health issues. Finally, many find themselves being gawked at or the target of unwanted comments or ridicule.
Clearly for these women, large breasts are not a blessing but a curse. This is why many seek to have their breasts made smaller through an effective breast reduction procedure (reduction mammoplasty). By reducing the size and weight, recontouring and lifting them, most if not all their symptoms can be alleviated. They can start exercising again, engage in sports that they had to avoid previously, and can address weight issues more effectively. Self-image and confidence improve significantly.
In over 20 years of practice and performing a large number of breast reductions, I find that women who have undergone this procedure are among the happiest and most satisfied of any of my patients along with those who have had a breast augmentation.
Breast Reduction – before
Breast Reduction – after
Breast Reduction – before
Breast Reduction – after
To learn more about breast reduction, breast augmentation or other cosmetic surgery procedures, please contact Dr. Turkeltaub at 480-451-3000.
Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona
Breast implants are not permanent medical devices and should not be expected to last forever. They can be quite durable and long lasting but given enough time, all will eventually need to be replaced or removed. Many of my patients have the misconception that implants have to be replaced every 10 years whether they are silicone or saline. This is absolutely not true. The silicone implants manufactured today can last up to 20 to 30 years or more. Saline implants on average will have to be replaced sooner. Allergan’s (an implant manufacturer) ongoing prospective Core Study of silicone breast implants noted a rupture rate of 2.7% in 4 years for primary enlargements.
Many factors influence the durability of the implants. Some of these include:
Type of implant – Saline versus Silicone. Silicone breast implants generally last longer and are more durable compared to saline implants. There are studies that show a 5 – 10 time greater rupture rates of saline implants as compared to silicone implants at various time periods.
Textured versus smooth implants. In particular, textured saline implants have a noticeably shorter life span when compared to the smooth ones.
Size of implant. Large implants may not last quite as long as small ones.
Manufacturer of the implant. There are technological, manufacturing, and proprietary differences between the implant manufacturers that affect the lifespan of the implants. In over 20 years of practice, I have clearly found that significant “brand” differences.
Surgical technique. A less gentle, more traumatic insertion of the implant can weaken the shell of the implant and predispose it to earlier failure and therefore a shorter lifespan. This can occur in silicone implants by trying to insert a large implant through a very small incision.
Incision location. A trans-umbilical (belly button) incision can affect the durability of the implant due to the trauma of insertion. Insert large silicone implants through limited sized periareola or transaxillary (armpit) incisions can also be detrimental.
Trauma. Very high energy impacts such as car accidents can potentially affect the long term durability. I have seen many women over the years who have been involved in serious car accidents without any injury to their implants. Sharp objects that are stuck in the breast can definitely rupture the implants
Mammograms and frequency. Frequent mammograms, particularly aggressively compressing ones, can weaken the implant envelope.
Breast augmentation is a very rewarding procedure and is associated with an extremely high satisfaction rate. Like many other things in life, (almost) nothing lasts forever and this is true of breast implants as well.
Silicone implants - Smooth (Left) and Textured (Right)
To learn more about breast implants, breast augmentation or other cosmetic surgery, contact Dr. Turkeltaub at 480-451-3000.
Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix Metropolitan Area, Arizona
Should I order that large entrée sized salad or still be hungry after eating the smaller appetizer salad? Will that 42” LCD TV look too small in the room or should I splurge and go for the 60” model. Do I want to live in a small apartment or a nice roomy house with a yard in a quiet neighborhood? Despite what you may have heard, size does matter.
With breast implants this is very true as well. When women come to see me in consultation, their first concern is about size. As is their second… They don’t request “I would like textured implants – in whatever size you have available.” or “Just give me something above the muscle.” No, it is size, size, and size. This is a variation on the mantra for a successful business where it is location, location, and location. Many studies show that the number one reason for reoperations in breast augmentation is unsatisfactory breast implant size. Nearly always it is because the size selected was not big enough.
Complicating this size issue is a misconception of what volume and proportion different cup sizes represent and what is truly proportionate or “fits my body”. One company’s “C” bra may fit exactly like another company’s “D” bra. Furthermore, many women think that a “B” is considered normal and proportionate whereas a “C” is too big. If I had proceeded to give them what they “wanted”, there would have been a lot of unhappy patients. We have had requests for a “small C”, a “regular C”, “large C”, a “small D”, etc. Have you ever gone to buy bras and asked the sales person to show you the selection of 34 large C bras? Or 36 small D bras? She would probably wonder what hole in the desert you crawled out from. There are no such bras! I’ve never seen them. Of course, then again, I have never personally bought a bra either!
Different Breast Implant Sizes
Another issue aside from cup size and proportionality is that often women don’t really know what they want. Women want to be bigger but to what degree? What is too large or not large enough? What may be too big for one woman will be too small for another even though they voiced similar desires. I have found a few constructive ways to help my patients determine what they are really looking for. Trying on implants in the office, although not entirely accurate, gives my patients a 3 dimensional perspective that they can relate to. The photographs of a wide variety of previous breast augmentation patients with specific cup sizes are reviewed. Pictures from magazines or the internet can also be helpful but are limited by several issues including their two dimensional nature, clothing (on some), air brushing, resolution and perspectives. Some people on their own have used bags of rice stuffed into bras to help in sizing. Don’t try doing this with pasta – raw or cooked. It will not usually be a pleasant experience. I find that by carefully listening to my patients, seeing where they are coming from, their overall goals, etc., plus some intuition, I virtually always can determine the general appearance/size that would make them happy.
Based on all this input from my patients and their assessment, I make the final decision on the ideal implant size during surgery. If there is any doubt, it is always better to go a little bigger than a little smaller.
Yes, size does matter!
To learn more about breast implants, breast augmentation or other cosmetic surgery, contact Dr. Turkeltaub at 480-451-3000
Silicone gel breast implants have been around since 1962. Over the ensuing years and with many design and technological changes, it has evolved into the safe, refined, durable and aesthetically pleasing implant that we have today. In the early days, there was a very high rate of capsular contracture, a situation where the body forms firm scar tissue around the implant causing palpable hardness and a deformed appearance of the breast. Changes were made in the 1970’s which helped lower this rate. However, with thinner implant shells and a less viscous form of silicone, there was a higher rate of implant rupture as well as silicone leaching through this outer envelope.
In the 1980’s and 1990’s, the implant shells were thickened, strengthened and made largely impermeable to the silicone. This has increased their durability and life span quite substantially. In addition, the silicone gel was altered to be far more viscous, into a cohesive form much like taffy or cream cheese. If one takes a knife and cuts a silicone implant in half (you can try this at home if you have an extra implant!), the halves maintain their fullness and shape. There is no oozing of any silicone because it is very sticky and cohesive.
In the early 1990’s, the news media began relentlessly generating unwarranted hysteria regarding the safety of these implants. Their misinformation created such a “feeding frenzy” that tens of thousands of anxious women across the country were calling their plastic surgeons concerned that they had a ticking time bomb inside them. Unfortunately, many went so far as to have their implants removed just on this fear alone despite no scientific evidence to justify their decision. Even today, I still get asked by many of patients considering silicone implants for breast augmentation: “Are they safe?”
Silicone implants are probably the most investigated, scrutinized of any medical device ever. Countless basic science and clinical studies to assess risks and other issues have been done over the years by a broad array of researchers including physicians, scientists, and manufacturers. In fact, the FDA restricted the usage of silicone implants between 1992 and 2006, until additional studies were performed to substantiate the safety of these implants. This data overwhelming supports the safety of silicone breast implants. It also shows that there is no causal relationship with significant diseases such as autoimmune diseases as had been contended by non-scientists. Quite importantly, there also is no increased incidence of breast cancer in women who have silicone implants.
When you are contemplating your breast augmentation, remember:”Yes, silicone implants are safe!”
To learn more about breast implants, breast augmentation or other cosmetic surgery, contact Dr. Turkeltaub at 480-451-3000
Hello and welcome to the blog for Dr. Steven Turkeltaub! We’ve created this resource to assist our patients who are considering plastic surgery. Our goal is to make your experience as pleasant, informative and stress-free as possible. Our blog will also serve as a forum for patients to learn about their surgical options from our Scottsdale plastic surgeon, Dr. Steven Turkeltaub. We welcome any questions that you may have!
