Federal Health Care Reform - Concerns of the California Medical Association

November 21, 2009

Special Alert: Federal Health Reform

Today the United States Senate will vote on “cloture” to begin debate on health reform. CMA is opposed to the proposal currently before the Senate and has communicated our position and concerns to both California Senators. I and Immediate Past-President Dr. Dev GnanaDev will speak directly to Senators Feinstein and Boxer on Monday to make clear our concerns with the current proposal. In CMA’s view the current version does not improve patient care and could in fact, substantially harm the doctor-patient relationship. CMA is committed to working with our Congressional Delegation to substantially improve this legislation.

It is our hope that we will be able to support a final product that protects what currently works well for patients and fixes what is broken. The CMA Executive Committee and Board of Trustees will review any final legislative agreement and, with input from CMA member physicians, make a decision as to our final position.

Please stay tuned for more updates; CMA will provide a more detailed summary of our concerns shortly.

J. Brennan Cassidy, M.D.
CMA President

Research, Stem Cells and Microsurgery - Working toward growing breast tissue in the lab

The following describes exciting new research on "growing" breast tissue in the lab, using stem cells, tissue engineering and technology!

Breast 'regrowth' trial planned

Researchers in Australia plan to test a medical "scaffold" designed to stimulate natural breast tissue to regrow following surgery.

Doctors from the Bernard O'Brien Institute of Microsurgery in Melbourne, will test the technique next year in a trial involving six patients.

The team say that the permanent fat found in breasts can be grown inside this contoured scaffold. They claim to have successfully tested the device in pigs.

The results of that experiment were presented at a plastic surgery conference in Sydney. The researchers recently announced on the institute's website that they had received funding from the Australian government to carry out the human trial.

If this is successful, they hope to develop it into a breast reconstruction technique that avoids using silicone.

Breast scaffold

The teams says that when the "empty chamber" is implanted, fat tissue will naturally fill it to form a new breast.

It's at such an early stage, it is not yet clear whether it will work in people - Dr. Lesley Walker, Cancer Research UK.

This chamber will also contain a gel made using the patients' muscle cells to "induce fat tissue production".

Professor Anthony Hollander, an expert in tissue engineering from the University of Bristol in the UK, said the attractions of this approach were its simplicity and the fact that the tissue growth occurred inside the body.

"At the time of implanting the cells the surgeon redirects the vasculature of the body which keeps a good blood supply to the implant. That is in itself nothing new, but combining it with a cell implant is an interesting step," he said.

He said that the technological advance was the use of a biomaterial cage used to trap the cells in the right place.

In future, the team plan to make this cage biodegradable so it does not have to be removed.
"If it's tried and it works that will be a really nice approach," Professor Hollander said.
But he cautioned that there was "still some way to go".

"This procedure is first likely to be used on cancer patients," he said. "[The team will] have to be able to demonstrate a technique that guarantees that all the cancerous cells are removed and none are grown up in the process, so there is still some way to go."

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: "We know that having a mastectomy can be a very difficult experience for many women and so research to try to improve breast reconstruction after surgery is important.

"[But] it's at such an early stage, it is not yet clear whether it will work in people. Even if this surgery proves to be effective, it will be a number of years before it can be used in the clinic."

The Jakarta Post Article - The Brave New World of Plastic Surgery

I was recently interviewed by San Francisco freelance writer, May-lee Chai, for an article in the Jakarta Post, Indonesia.

Click on the images for a full-size version of this article on Plastic Surgery.

Local Heroes in Medicine: Women Pioneers that Shaped Medicine in San Francisco

The following is an article from the September 2009 San Francisco Medicine publication:

www.sfms.org

Local Heroes in Medicine


Pioneers that Shaped Medicine in San Francisco
by Nancy Thomson, MD

“Women should not be expected to write or fight or build or compose scores. She does all by inspiring men to do all.” —Ralph Waldo Emerson (1802–1882)

In 1948, when I started college at Stanford University, my physician father discouraged me from preparing for medical school, saying that I would take a man’s place, then marry and never practice. Lois Scully, MD, a San Francisco internist, Stanford graduate, and 1979 president of the American Women’s Medical Association, ran into the same bias at about the same time when the
Stanford physician who interviewed her told her to go home, marry, and have five children.

In the early 19th century, Lucy Stone (1818–1893) wanted a good education, but the only college in the world that accepted women at that time was in Brazil. Luckily, Oberlin University was founded in 1835 in Ohio, the first U.S. college to accept both women and African-American students. Stone enrolled and graduated in 1847. However, when it came time to seek a profession, the only field open to women was teaching. In 1849 (the year Elizabeth Blackwell graduated from Geneva Medical College in New York), Lucy Stone wrote, “We believe that if the system of educating females for physicians be generally adopted, a great amount of suffering and death will be saved.”

In fact, the number of female medical school graduates rose steadily from 1849 to 1900. By 1900 in Boston, women represented 18 percent of practicing physicians. However, by 1903 women’s participation in medicine began to decline, as most of the women’s medical schools established in the previous 50 years were closed or merged with male dominated schools, which continued to reject women applicants. This situation generally prevailed until the 1970s, when the feminist movement and antibias legislation brought about an increase in women attending medical schools.

In 1970, female admissions to medical schools were at 9.2 percent; in 1980 they had risen to 27.9 percent, and they are at almost 50 percent today. The decline in economic potential for physicians (which was historically one of the foremost motivations for male medical students) is given comparatively little importance by female students, who cite longtime interest in medicine and science, the desire to help others, and dissatisfaction with other types of work among
their reasons for choosing medicine.

The following time line highlights women’s place in the medical history of San Francisco.

Historical Time Line

From the time of landing at Plymouth Rock, women as well as men practice medicine in New England, often after an apprenticeship with a practicing physician. However, when American medical schools are established, they follow the European pattern of barring women from
seeking medical degrees.

1863
Elizabeth Pfeifer Stone, the first woman to practice medicine in California, settles in San Francisco. Probably German-born and -trained, she previously practiced in New York.

1873
University of California acquires Toland Medical School in San Francisco, and since U.C. is already coeducational, Lucy Maria Field Wanzer, a thirty-three year-old teacher, is accepted as its first female medical student. However, the dean suggests to her fellow students that they “make it so uncomfortable for her that she cannot stay.”

1874
Charlotte Blake Brown applies to the San Francisco Medical Society for admission. Some members of the membership committee feel strongly that females are mentally, physically, and morally unfit to study medicine, let alone practice the profession. On advice of mentors, Brown
withdraws her application.

1875
Following the model of Elizabeth Blackwell’s New York Infirmary for Indigent Women, Pacific Dispensary for Women and Children is founded by three women, all educated on the East Coast: Charlotte Blake Brown, Martha Bucknall, and Sarah E. Browne. This outpatient clinic, initially located at 510 Taylor Street, is intended to provide opportunities for women physicians to obtain internship experience.

1876
San Francisco Medical College of the Pacific accepts its first female student, Alice Boyle Higgins, who graduates in 1877.

1877
Having been admitted to the California Medical Society along with four other women in 1876, Lucy Wanzer becomes the first female member of the San Francisco Medical Society.

1880
Founders of Pacific Dispensary create the first nursing school west of the Rockies. Its one-year course becomes a two-year curriculum in 1882.

1887
The Pacific Dispensary moves to a new two-story building at California and Maple Streets and becomes Children’s Hospital. Interns and residents can be either male or female, but there are no men allowed on the medical staff.

1895
Citizens of San Francisco raise money to build the Little Jim Building for pediatrics at Children’s Hospital.

1896
One year after X-rays are discovered, Elizabeth Fleischman-Aschheim, an engineer, opens the first X-ray laboratory in California, at 611 Sutter Street.

1896
William Randolph Hearst leads the campaign for the Eye and Ear Pavilion at Children’s Hospital.

1904
Dr. Charlotte Blake Brown dies at age fifty-eight. Her daughter, Adelaide Brown, MD (1868–1933), carries on her mother’s work at Children’s Hospital but also serves on the Stanford faculty at Lane Hospital. She fights locally and nationally for clean milk, sanitary garbage disposal, maternal and child welfare, visiting nurse services, and clinics offering cardiac care and birth control.

1906
The San Francisco earthquake forces the demolition of the 1887 Children’s Hospital building.

1911
A new, four-story brick Children’s Hospital building opens at California and Cherry Streets.

1912
The Contagious Disease Pavilion opens at Children’s Hospital, with money donated by William Randolph Hearst, to care for diphtheria, scarlet fever, measles, TB, and, later, polio.

1915
Children’s Hospital affiliates with the University of California for the teaching of medical students.

1915
The American Medical Association admits its first female member.

1916
Henries Hagar Duggan, MD, becomes a pioneering medical anesthesiologist. She works at various hospitals but settles at Children’s for twenty-five years, retiring after the end of World War II.

1938
UCSF pediatricians Mary Olney and Ellen Simpson found summer camps for children with diabetes.

1946
Marian Yueh Mei Li arrives in San Francisco, having completed medical school in Shanghai. She eventually opens a private practice and becomes the first Chinese female ophthalmologist to practice in Chinatown.

1952
Pediatrician Hulda Thelander establishes the Child Development Center at Children’s Hospital for children with cerebral palsy, developmental delays, and congenital defects.

1960
Internist Roberta Fenlon, MD, becomes the first female president of the San Francisco Medical Society.

1971
Dr. Roberta Fenlon becomes the first female president of the California Medical Association.

1977
Linda Hawes Clever, MD, MPH, founds (and chairs) the Department of Occupational Health at California Pacific Medical Center. She is also the first female editor of the Western Journal of
Medicine and is the founder of RENEW, an organization to help fight professional exhaustion and dissatisfaction.

1980
Children’s Hospital acquires St. Joseph’s Hospital.

1988
Marshall Hale Hospital, formerly Hahnemann Homeopathic Hospital, merges with Children’s Hospital.

1991
Children’s Hospital and Pacific-Presbyterian Medical Center merge to create California Pacific Medical Center (CPMC). CPMC joins the Sutter Health chain.

1995
Judith M. Mates, MD (ob-gyn), becomes the second female president of the San Francisco Medical Society.

1996
Toni J. Brayer, MD (internist), becomes third female president of SFMS and, in 1990, the first female chief of staff at California Pacific Medical Center.

2003
Rita Melkonian, MD, FACOG (obgyn), becomes the fourth female president of the San Francisco Medical Society, with E. Ann Myers, MD (endocrinology), as the president-elect.

In closing, it’s interesting to note that in 1868, while debating the admission of women, the American Medical Association recorded this statement by Dr. Alfred Stille, prominent teacher of pathology:

“Another disease has become epidemic. The woman question in relation to medicine is only one of the forms in which the pestis mulieribus vexes the world. In other shapes it attacks the bar, wriggles in the jury box, and clearly means to mount upon the bench; it strives thus far in vain to serve at the altar and thunder from the pulpit; it raves at political meetings, harangues in the lecture room, infects the masses with its poison, and even pierces the triple brass that surrounds the politician.”

If only Dr. Stille could see us today. We’ve sure come a long way.

Nancy Thomson, MD, was a practicing anesthesiologist at Children’s Hospital from 1963 to 1985. In 1988 she received her master’s in public health from the University of California at Berkeley. From 1991 to 2000 she worked as the infectious disease officer and staff physician at San Quentin State Prison. Dr. Thomson currently serves on the editorial board for San Francisco Medicine and is the magazine’s obituarist.

All About Labiaplasty - Labia Minora Reduction

WHAT IS LABIAPLASTY?

Labiaplasty is a surgical procedure which corrects excessively long, enlarged or redundant labia minora. Women who seek this surgical procedure may be self-conscious about hanging labial tissue, they may have asymmetric labias, or they may have pain or discomfort during sex, with exercise or sometimes just walking!

The purpose of labiaplasty is to surgically reduce excessive large labia minorae, to create symmetry when it is lacking, and to make the labia appear more cosmetically appealing. Occasionally excess tissue around the clitoral hood is also carefully trimmed, without any injury to the nerves that provide sexual stimulation.

Labiaplasty only addresses the labia minora (inner lips of the external genitalia of women). It does not generally affect the labia majora (outer lips), nor does it alter the vagina.

HOW IS LABIAPLASTY PERFORMED?

In order to ensure complete comfort and relaxation, we perform labiaplasty in the operating room, under a short and safe general anesthesia. Surgical loupes (microscope glasses) are always used to ensure the most meticulous possible repair.

The area to be trimmed is marked, and local anesthetic containing epinephrine (adrenaline) is injected to prevent bleeding and bruising during surgery, and to keep the area numb for many hours after surgery. Next, excess tissue is trimmed. A multiple-layer closure is then done (usually 2-3 layers of stitches) using all dissolving (absorbable) sutures. Antibiotic ointment is applied, and mesh panties with an absorbable pad are placed.

On average, surgery takes around an hour and a half to two hours. It is outpatient surgery - women can go home in a couple of hours, when they are awake and alert, without nausea and when they are eating and drinking well.

WHAT IS THE RECOVERY FOLLOWING LABIAPLASTY?

You can expect some mild discomfort requiring oral pain medication such as Tylenol or occasionally something stronger (Vicodin or Percocet) for a few days. Aspirin or Ibuprofen (Advil, Motrin) should be avoided as these can increase bruising or bleeding.

There will be some swelling and possibly bruising of the genital region. You can shower the next day, and will be advised to apply antibiotic ointment daily and wear a thin pad in your underwear in case of any spotting or bleeding.

If you have your period, use a pad instead of a tampon for your first 1-2 menstrual cycles to avoid irritation of the incisions while they are healing.

Most women take at least a few days off of work, or work from home during the first few days after surgery, when they are swollen and tender.

Sexual intercourse should be avoided for 3-6 weeks, or until the area is no longer swollen and tender. Aggressive physical activity should also be avoided for at least a week, as increasing your heart rate and blood pressure will bring more blood flow to the area and create more discomfort or swelling.

Some women describe intense itching (due to histamine release during healing), while others have very little discomfort at all after surgery. Keeping a small pillow in your purse can cushion the area if you are sitting on a hard surface during healing.

Like any incision, it takes at least 3-4 weeks for initial healing, and 6 months up to a year for the results to be absolutely final. Incisions are hidden in the natural crease. The area of surgery will eventually be very difficult to see, and there is usually very little scarring, as it involves a mucosal membrane (think about cuts to the inside of your mouth or gums, and how they have healed).

You will be seen back at your surgeon's office within a few days of surgery for an initial checkup, and then usually at 2-3 weeks, 6 weeks, 6 months and one year. All follow-up visits are covered by your surgery fees.

Most women find this operation liberating and are very satisfied with the results.

POTENTIAL RISKS AND COMPLICATIONS OF LABIAPLASTY:

Any surgical procedure carries with it potential risks of anesthesia (nausea, headache, etc), the potential for bleeding, infection and wound healing problems. There will be temporary pain or tenderness, swelling, bruising, and numbness of the area.

Bleeding is controlled during surgery by a cautery pen that coagulates any blood vessels that are encountered. You likely be given a few days of prophylactic (preventative) antibiotics to help prevent infection. You should shower daily and ensure the area is kept clean after surgery.

Your labia may not be completely symmetric - this is the norm for most women. You can have temporary change in pigmentation (lighter or darker) while you are healing.

WHO SEEKS LABIAPLASTY SURGERY?

Women of all backgrounds, shapes and sizes, professions (including stay-at-home moms) and cultures seek labiaplasty! Many women are born with asymmetric or redundant labial tissue, which is normal for them! Sometimes after childbearing, labial tissue can become stretched, and following menopause, the area can droop more.

Labiaplasty is a private procedure that should not be viewed with embarrassment or shame! It is often an empowering experience that can improve a woman's body image and self-esteem.

WHAT IS THE COST OF LABIAPLASTY?

Any surgical procedure includes a surgical fee, operating room or facility fee, and anesthesia-related fees. On average, the total cost can range between $4000 and $8000, depending on the complexity of the surgery, time needed for surgery, and other details specific to your unique anatomy.

Insurance does not usually cover labiaplasty. You can inquire with your insurance carrier about this benefit, but labiaplasty is usually viewed as cosmetic.

HOW SHOULD I PREPARE FOR MY LABIAPLASTY PROCEDURE?

Smoking should be stopped for at least 6 weeks before any operation. Other health problems such as diabetes, heart disease, high blood pressure, or autoimmune disorders should be well-controlled before considering any surgery.

You should be cleared by your primary care physician for surgery, and have had routine preoperative tests (bloodwork, EKG), as appropriate based on your age and medical history. You should not be pregnant, and should not undergo surgery immediately before a major life event (give yourself at least 4-6 weeks to heal before a vacation, etc).

Avoid medications and herbs or nutritional supplements that can increase the risk of bleeding or bruising with surgery (aspirin, anti-inflammatories, vitamin E, fish oil, etc) - your surgeon will give you a comprehensive list of what types of things to avoid and for how long before and after surgery.

Research pays off when choosing a breast implant surgeon

When you are considering breast augmentation, be sure to research both the procedure and your surgeon extensively.

Learn as much as you can about the procedure using online sources (visit reputable websites such as the American Society of Plastic Surgeons (ASPS) or the ASAPS website) that do not feature only one surgeon, and that provide data on national statistics and safety issues.

Visit a surgeon who is experienced with breast augmentation, and is Board-Certified by either the American Board of Medical Specialties or the Royal College of Physicians and Surgeons of Canada (these are the only two Boards recognized by the American Societies for Plastic Surgery and Aesthetic Plastic Surgery).

Write your questions down for your surgeon, and ask to see before-and-after photographs of typical (not just the best) patient results. Ask to speak to patients who have had the procedure before.

Do your homework! Ensure you have found a good fit with the surgeon in terms of personality, office environment, and aesthetic goals for the procedure.

Why Postoperative Breast Implant Massage is Important!

QUESTION:

about massage for breast implant
October 27, 2009 9:46 AM | Breast Augmentation

I am 5 weeks postop and I had a lift with silcone gel implants and was told I did not need to massage them . Is there a reason I was told this?

ANSWER:

Doctor/Professional Answers (1)

There was an error posting your comment. Please try again.

Your answer was posted successfully.

drkarenhorton Plastic surgeon San Francisco, CA United States

Why Postoperative Breast Implant Massage is Important! October 27, 2009 10:16 AM

After a breast augmentation, we teach our patients to massage their implants each day in order to ensure that they stay soft and mobile, with the most natural results.

Implants can be placed under the pectoralis major muscle ("submuscular" or "subpectoral"), or on top of the muscle and under the breast tissue alone ("subglandular").

Sometimes, surgeons feel that having the implant under the muscle will do some of the massaging motion just by normal muscle movement and that massage of the implants by hand is not necessary.

In Plastic Surgery, there are few absolutely right or wrong answers. What I teach my patients is that implant massage helps to create a "pocket" that is larger than the implant itself. This will facilitate the implant to move around naturally inside its pocket and have a natural shape and motion, like a normal breast.

Implant massage also functions to some extent as a breast self-exam. Two studies of women with breast implants found that in those women who developed a breast lump, it was found earlier if they regularly massaged and felt their implants - which could be life-saving!

I recommend women massage their implants for a few minutes each day, for the rest of their life! After the scar tissue has completely healed and softened (by one year), massage could simply consist of lying on your tummy or rolling with your breasts against an exercise ball.

The purpose is to ensure the implants move around within their space and that the scar tissue does not contract around the implant ("capsular contacture").

There are videos on implant massage on my website you could refer to for reference: CLICK HERE TO VIEW THE VIDEO.

Ask your Plastic Surgeon what their normal postoperative routine is and to demonstrate what you should be doing.

Karen M. Horton, MD, MSc, FRCSC

What to expect after routine liposuction: What is normal?

Question:

i had lipo to my hips and back area 4 days ago. i was really surprised that i had no drainage from the lipo. i went home an hour after surgery.

Details:

i was expecting drainage from the lipo. i had nothing! not one drop. is that normal? i do have severe bruising. i also weighed myself, i now weigh more than before my surgery. is all this normal?

ANSWER:

After routine liposuction, it is normal to expect the following signs and symptoms:

1. Bruising - despite the use of "tumescent" solution, some bruising is normal. This will take 2-3 weeks to resolve.

2. Swelling - most MDs recommend the use of compression garments that help keep the swelling under control and feel protective while you are swollen. You can expect to wear your garment for up to 6 weeks.

3. Water retention - seen as weight gain. Stop weighing yourself! Give yourself at least 6 weeks for the majority of the initial surgical swelling and water retention to be processed by your kidneys, and to be eliminated.

4. Fatigue - you will not feel like yourself for at least a few weeks after liposuction. Your body is busy recovering from surgery; you will not have the usual energy to perform all your usual activities during the daytime. Ensure you have some helpers to assist with your activities of daily living, child care, house work, tasks around the home, etc. Be sure to take as much time as you realistically need off work!

In addition, as long as the amount of tumescent solution injected was approximately at a 1:1 ratio to the fat removed (known as the "superwet" technique), you will not likely drain from the incisions. Most Plastic Surgeons perform this technique, as it enables accurate evaluation of how much was is being removed during surgery, enables a smooth contour, and avoids blood loss during the procedure.

Get some rest and remember that any surgery is an "injury". You need to allow your body to heal, and to deliver the building blocks needed for healing in the form of healthy nutrition, lots of restful sleep, and a positive attitude.

Happy healing!
Karen M. Horton, MD, MSc, FRCSC
womensplasticsurgery.com

Karen M. Horton, MD answers: Sacramento Tummy Tuck doctor recommendations

Q:

I live in Oregon but I am spending 3 months with a friend in Sacramento. I have been searching the internet for a quality doctor in Sacramento, CA to perform a tummy tuck. This will be the biggest surgery of my life and I want quality work. Any success stories out there?

A:

2 seconds ago

By Karen M. Horton, MD - San Francisco Plastic Surgeon

A tummy tuck is a wonderful procedure and one of my very favorite operations to do!

For women who have completed childbearing, an abdominoplasty makes up the abdominal portion of a "mommy makeover".

For anyone considering surgery, my advice is always this:

Do your research and homework before deciding on a Plastic Surgeon!

The internet is often a good start, but word of mouth and referrals from other doctors is also a good source of information. Think about how you found your dentist, a realtor, your childcare giver, a plumber... You will be trusting your body to this person! Do your 'due diligence'.

Following your online research, visit a number of surgeons in person - bring a list of questions with you, and bring a friend to act as another listener and objective observer. Ask to see before and after photos - both of the best results, but average results. Ask to speak to former patients about their experience with the doctor.

There should be a "good fit" between you and the physician - in terms of personality, aesthetic goals for the procedure, office staff atmosphere, etc.

Often, making the trip outside your immediate area is worth it. If you don't find someone directly in your town, consider going to a larger cosmopolitan area for treatment. You will probably stay overnight in the hospital or surgery center after a tummy tuck, and you are usually seen 3-5 days after surgery in the surgeon's office for your first follow up visit.

I see many out of state patients for surgery. I recommend my out-of-town patients stay in the near vicinity (within a 3 hour drive) for at least 2 weeks before traveling home.

Best of luck to you!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

Wait to have breast augmentation surgery until your health is stable

http://www.realself.com/question/Breast-augmentation-safety-thyroid-ablation

Breast implants safe after thyroid ablation?

I'm 31 years old and a mother of 3 children. After the birth of my last child, I got Graves Disease. I tried for remission on an anti-thyroid drug, but I did not obtain it.

I'm scheduled to have my thyroid ablation on Nov. 6th. I'm also scheduled for breast augmentation on Nov. 23rd. I'm very excited about both procedures. Is it safe for me to have surgery after the ablation? And, I will be using the IV sedation with the augmentation which is only about 45mins. Will my hormones react to anesthesia?

Enough3 in North Myrtle Beach

A: Wait to have breast augmentation surgery until your health is stable

By Karen M. Horton, MD - San Francisco Plastic Surgeon

Congratulations on your decision to have breast augmentation! As long as it is done for the right reasons, in an appropriate candidate, and by a Board-Certified Plastic Surgeon, and at the appropriate time, breast augmentation is a wonderful procedure with fabulous results!

However, when you are actively treating any complex medical condition such as Graves Disease (overactive thyroid), you should postpone elective surgery until your medical situation has stabilized.

Radioactive ablation of the thyroid can have a short-term surge of thyroid hormone release, followed by a longer period of hypothyroidism (low thyroid) when your natural thyroid hormone decreases.

I speak from personal experience: it can take up to a year or longer for the full effect of the thyroid ablation to be complete. During this time, you will need to take increasing doses of thyroid replacement until your own thyroid has completely stopped working or its production of hormone is stable. Your mood, energy level, metabolism and other body systems can undergo major swings.

The thyroid gland controls your metabolism and nearly all your organ systems. I would strongly advise against having a surgical procedure while you are being treated for this condition.

Ask your Endocrinologist about how long you should wait before undergoing elective surgery.

Best of luck to you, and take care of your health first!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

Breast Cancer In Young Women May Be Hereditary

Many women presenting to my office for breast reconstruction do not actually have breast cancer.

Many of them have a strongly positive family history for breast and/or ovarian cancer, and upon testing, they may learn they carry the BRCA gene. They may wish to have prophylactic (preventative) mastectomy and reconstruction to lower their risk of developing breast cancer.

Read the article below on hereditary breast cancer from the latest FORCE publication:


WHAT is hereditary cancer?

Breast cancer can result from changes in genes called "hereditary mutations." These gene changes can be passed down from the mother or the father to daughters or sons and cause cancer to run in some families.

The genes most often associated with hereditary breast cancer are called BRCA1 and BRCA2.
Changes in these genes can increase the risk for breast, ovarian, and other types of cancer.

If you have had breast cancer at age 50 or younger, you are more likely to have a BRCA mutation if you have:

• had ovarian cancer
• breast cancer in both breasts
• a relative with ovarian cancer at any age
• a relative with breast cancer at any age
• a relative with male breast cancer
• a relative with pancreatic cancer
• a relative with prostate cancer
• Eastern European Jewish (Ashkenazi Jewish) heritage

Women with “triple negative” breast cancer (one that is negative for estrogen receptors, progesterone receptors, and Her-2/neu status) may be more likely to have a BRCA1 mutation.

WHAT is gene testing and how would it affect me?

If you are a young woman who has been diagnosed with breast cancer, you can take a blood test (or a genetic test using cells swabbed from the inside of your cheek) to find out if you carry a BRCA gene mutation.

Cancer genetics experts include genetic counselors, risk assessment counselors, geneticists and other physicians with advanced training in genetics and hereditary disease. Before gene testing, you should talk with a genetics expert to learn if your cancer may have been caused by a BRCA mutation, and to help you and your family members decide if gene testing is right for you.

(I usually refer my patients to their breast surgeon or an oncologist to determine whether genetic testing is appropriate for them).

Learning that your breast cancer is hereditary may change treatment or follow-up recommendations. If you test positive for a mutation, each of your children and siblings has a 50% chance of carrying the mutation. Aunts, uncles, nieces, nephews, and cousins may carry the mutation, too.

If you test positive for a mutation, your risk for a second breast cancer and other cancers may be
increased. If you test negative for these mutations, your risk for additional cancers depends on other factors. A genetics expert can help you better understand your risks for additional cancers.

The cost for gene testing can vary depending on which test is ordered. The cost is usually covered for young women diagnosed with breast cancer, either in part or in full, by insurance carriers.

WHERE can I learn more about hereditary cancer?

Experts in cancer genetics can help you understand hereditary cancer and provide you and your family with information about your cancer risk. They will:

• review your family medical history to assess and explain your risk for cancer
• describe the benefits and drawbacks of gene testing and discuss whether you are a candidate for testing
• order the appropriate test if you choose to proceed with gene testing
• assist with insurance coverage of testing
• interpret gene test results and explain what they mean for you and your family
• discuss how to manage your cancer risk and refer you to experts for follow-up care

If you are a young woman with breast cancer, please talk with a genetics expert and your doctor about gene testing for a hereditary mutation!

To find an expert in your area, or to receive support and information visit www.facingourrisk.org or call the helpline at (866) 288-RISK (7475)

Women who develop breast cancer before age 50 are more likely to have one of these gene changes than women who develop breast cancer after age 50. There are options available for you and your family members to lower cancer risk and to detect cancer at an earlier, more curable stage.

Busted! Fifteen Bodacious Facts About Boobs - DivineCaroline

Busted! Fifteen Bodacious Facts About Boobs - DivineCaroline

Although breast cancer is a serious health threat to women, boobs shouldn’t only conjure up thoughts of mammograms, mastectomies, and medical issues. Breasts as we know them are unique to the human female body, and there are many things that most people don’t even know about them. In honor of National Breast Cancer Awareness Month, check out these crazy, fascinating, and downright weird things you may not have realized about boobs.

1. Human females are the only mammals whose breasts are visible at all times throughout maturity. Most animals, such as dogs, cats, and lesser primates, display swollen or enlarged mammaries only when they are pregnant or nursing their young; their breasts recede when the offspring are weaned. Evolutionary biologists think that humans’ permanently displayed breasts are intended to confuse potential mates about women’s reproductive status.

2. In Greek mythology, the universe was created when the god Zeus tricked his wife, Hera, into breastfeeding his half-human son Heracles. According to the legend, when Hera realized that the suckling infant was not her own, she pushed him away and the drops of spilled milk became the Milky Way galaxy.

3. There’s no such thing as a perfectly symmetrical set of breasts. All breasts have differences, but most discrepancies are simply too tiny to be noticed. For reasons unknown, the left breast tends to be larger than the right.

4. Two million women in the United States have breast implants. The average age at which a woman gets implants is thirty-four.

5. In early 2009, Sheyla Hershey of Brazil was awarded the Guinness World Record for having the largest set of breasts. After nine surgeries and more than a gallon of silicone, her breasts are a size 38KKK.

6. Women who get breast implants are at least three times more likely to commit suicide, a risk that increases with time. As the August 2007 Annals of Plastic Surgery reported, it’s unlikely that silicone toxicity causes the correlation. It’s more probable that women who undergo breast augmentation are more apt to have an underlying psychiatric problem that predisposes them to suicide. (Most women seeking breast augmentation are good candidates. The best candidate for surgery is a woman who is mature, with realistic expectations, a supportive support network and who has done all of her homework! See a Board-Certified Plastic Surgeon for more information).
   

7. Contrary to popular legend, the brassiere was not invented by a man named Otto Titzling. Although women have worn chest-binding garments for exercise at least since the time of the ancient Greeks, the modern bra was invented by a French woman named Herminie Cadolle in 1889. The word brassiere—denoting an upper-body harness with straps—has been in use since at least the seventeenth century. It wasn’t until the 1920s that the term referred to a garment that supports the breasts.

8. At Hong Kong’s Polytechnic University, students can major and get a degree in bra studies.

9. Sleeping on one’s chest can change the shape of breasts over time, stretching the skin and leading to sagging. Experts recommend that women sleep on their side with their breasts supported by a pillow. (This is debatable)
   

10. Wearing a bra to sleep does not lead to breast cancer. (The main risk factor for any woman is family history.)
    

11. Breasts contain no muscle tissue, so there’s no exercise that can change their shape. The only way to make breasts look firmer or perkier is to exercise the pectoral muscles underneath the breast tissue.

12. Men can lactate, too. It’s exceptionally rare, but since men possess mammary glands just like women do, they have the capacity to produce milk. When male lactation happens, it’s usually because of hormonal treatments for diseases like cancer.

13. According to the American Surgeon, up to 6 percent of the population has extra breast tissue, a condition called polymastia. The excess tissue usually exists in the armpit, although in rare cases, extra breasts may also appear on the neck, face, back, buttocks, vulva, thigh, or even foot and may be fully functional for nursing. The development of extra nipples without breasts is a condition called polythelia.

14. “Breast ironing” is a practice in Cameroon in which young girls’ developing breasts are beaten and flattened with heavy objects to prevent their emergence. Usually performed by mothers and older female relatives, the procedure is intended to ward off men’s unwanted sexual advances, as well as to prevent early marriage.

15. According to lingerie manufacturers, the average American woman’s bra size has increased in the past ten years, from a 34B to a 36C.

A woman’s lifetime risk of developing breast cancer is about one in eight, and the likelihood is higher for women who smoke, are obese or inactive, or have a family history of the disease.

It’s no secret that people—both men and women—are obsessed with breasts. But far from being simple lust objects, they’re actually surprising, versatile, and highly individual parts of a woman’s body. This October, do yours a favor and do a breast self-exam to make sure they stay healthy and beautiful for years to come.

First published October 2009

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http://www.divinecaroline.com/22180/85367-busted--fifteen-bodacious-facts-boobs

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Breast Cancer Picture Book - A Year of Treatment

See the video link in this blog post for for a very special photo album created by one of my patients.

She shares with each of us her personal journey through bilateral (double) nipple-sparing mastectomies, implant reconstruction, with later chemotherapy and radiation.

She shows the transition through the various stages of her treatment, to the final few shots of her being active on vacation and living with lymphedema.

Thank you for sharing these intimate and very special memories with us!

DIEP flaps give breast cancer survivor a second chance at her prom!

Tori is a tragically young breast cancer survivor who traveled from South Dakota to California for her bilateral DIEP flap breast reconstructions.

After recovering from mastectomies, chemotherapy, radiation, and finally delayed reconstruction, she is loving life with her handsome husband and enjoying her new figure!

I am so proud of her.

Congratulations, Tori!

Women's Plastic Surgery featured in the CRAVE San Francisco publication!

See the CRAVE SF website for additional information!

Stretch marks - Unlikely to be caused by surgery, but expected after pregnancy

Karen M. Horton, MD answers:

Will Breast Implants and Liposculpture cause stretch marks after pregnancy?

I am 32 and I am planning to have a breast augmentation (something discreet) and a liposculpture within the next two weeks, but also I would like to get pregnant of my second baby in about 10 months. I did not get any stretch marks at all from my first pregnancy, but I am really concerned that the breast implants or the Lipo will cause them when I get pregnant again. Any opinions?

Brenda, Chicago

By Karen M. Horton, MD - San Francisco Plastic Surgeon

Stretch marks ("striae") are a common occurrence after rapid weight gain or stretching of the skin, as in puberty or pregnancy.

Striae are caused by a small tear in the dermis (lower layer of the skin) th

at heals by filling itself in with scar tissue. The epidermis (top layer of the skin) remains intact, but is often stretched out, enabling the scar tissue below to be visible as a shiny, irregular and sometimes depressed area of skin.

One study estimated that between 75% and 90% of women develop some degree of stretch marks after pregnancy, usually in the lower belly region.

Unfortunately, stretch marks are permanent. Although they tend to fade with time, like all scars, they are permanent, like scars.

Despite many claims, topical creams and other therapies to the skin cannot eliminate or remove stretch marks. The only way to permanently remove stretch marks is to surgically excise them, for instance, in a tummy tuck. Many moms are proud of their stretch marks, as they remind them of their pregnancies and their beloved little ones!

A breast augmentation and liposuction would be very unlikely to create stretch marks, so long as the breast implants were not so large that they caused massive stretching and tearing of the dermis of the breast skin. By a "discrete" breast augmentation, I assume you are aiming for a natural, subtle result. This would be highly unlikely to create any striae.

You are lucky that you did not have stretch marks following your first pregnancy. This may be because of your age and genetics. Hopefully, you will continue to enjoy a body free of stretch marks. However, changes occur with each and every pregnancy, and you may discover some new striae after your next pregnancy.

Best of luck, and congratulations on your family!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

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Enter post below (See 8 tips to get noticed): * <p><strong>Stretch marks ("striae") </strong>are a common occurrence after rapid weight gain or stretching of the skin, as in puberty or pregnancy. </p><p>Striae are caused by a small tear in the <strong>dermis </strong>(lower layer of the skin) that heals by filling itself in with scar tissue. The epidermis (top layer of the skin) remains intact, but is often stretched out, enabling the scar tissue below to be visible as a shiny, irregular and sometimes depressed area of skin. </p><p>One study estimated that between 75% and 90% of women develop some degree of stretch marks after pregnancy, usually in the lower belly region. </p><p>Unfortunately, stretch marks are <strong>permanent</strong>. Although they tend to fade with time, like all scars, they are permanent, like scars. </p><p>Despite many claims, topical creams and other therapies to the skin cannot eliminate or remove stretch marks. The only way to <em>permanently remove stretch marks</em> is to surgically excise them, for instance, in a tummy tuck. Many moms are proud of their stretch marks, as they remind them of their pregnancies and their beloved little ones!</p><p>A breast augmentation and liposuction would be very <em>unlikely </em>to create stretch marks, so long as the breast implants were not so large that they caused massive stretching and tearing of the dermis of the breast skin. By a "discrete" breast augmentation, I assume you are aiming for a natural, subtle result. This would be highly unlikely to create any striae.</p><p>You are lucky that you did not have stretch marks following your first pregnancy. This may be because of your age and genetics. Hopefully, you will continue to enjoy a body free of stretch marks. However, changes occur with each and every pregnancy, and you may discover some new striae after your next pregnancy. </p><p>Best of luck, and congratulations on your family!</p><p>Karen M. Horton, M.D., M.Sc., F.R.C.S.C.</p>

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Designing scars for tummy tucks - You have input!

Karen M. Horton, MD answers: Different location and direction of Tummy Tuck incisions?

Why are some Tummy Tuck incisions straight across and some in a dramatic "u"? Is there an advantage to the "u"?

Aromagal Vancouver BC

By Karen M. Horton, MD - San Francisco Plastic Surgeon

A tummy tuck ("abdominoplasty") requires creation of a longish scar across the lower abdomen, and usually also around the belly button.

During a tummy tuck, excess skin and fat is removed from the lower belly, and the muscles of the abdominal wall are brought together by a technique called "rectus fascial plication".

Adbominoplasty is really a three-dimensional operation, serving to corset your midline from the inside, and tuck excess skin and fat on the outside! It is an incredible procedure for some women who are good candidates.

The location of the incision can be designed to fit within your normal swimsuit or undergarment lines.

Some women wear very low-cut bathing suits or jeans, and wish their scar to be as low and horizontal as possible.

However, other women may wear a more high-cut undergarment or bikini bottom, and may wish the scar to lie slightly higher. Most women know which cut or style of bottom flatters their figure most, and tend to stick to that style.

You can bring your undergarment with you to a consultation with a Board-Certified Plastic Surgeon and show your Plastic Surgeon where the ideal location for the scar to lie, if possible.

Remember, however, that styles and fashions can change. Scars are permanent, but fade dramatically with time.

If you are seriously considering a tummy tuck, stay involved with the planning process and don't be shy about asking your Plastic Surgeon to tailor the procedure so that it suits your body, fashions and lifestyle the very best!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

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Provided by professional:

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Enter post below (See 8 tips to get noticed): * <p>A tummy tuck ("abdominoplasty") requires creation of a longish scar across the lower abdomen, and usually also around the belly button.</p><p>During a tummy tuck, excess skin and fat is removed from the lower belly, and the muscles of the abdominal wall are brought together by a technique called "rectus fascial plication". </p><p>Adbominoplasty is really a three-dimensional operation, serving to corset your midline from the inside, and tuck excess skin and fat on the outside! It is an incredible procedure for some women who are good candidates. </p><p>The location of the incision can be designed to fit within your normal swimsuit or undergarment lines. </p><p>Some women wear very low-cut bathing suits or jeans, and wish their scar to be as low and horizontal as possible.</p><p>However, other women may wear a more high-cut undergarment or bikini bottom, and may wish the scar to lie slightly higher. Most women know which cut or style of bottom flatters their figure most, and tend to stick to that style.</p><p>You can bring your undergarment with you to a consultation with a Board-Certified Plastic Surgeon and show your Plastic Surgeon where the ideal location for the scar to lie, if possible.</p><p>Remember, however, that styles and fashions can change. Scars are permanent, but fade dramatically with time. </p><p>If you are seriously considering a tummy tuck, stay involved with the planning process and don't be shy about asking your Plastic Surgeon to tailor the procedure so that it suits your body, fashions and lifestyle the very best!</p><p>Karen M. Horton, M.D., M.Sc., F.R.C.S.C.</p>

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