Gynecomastia is breast growth in males. It is present in approximately 1 in 3 men and it affects 2 in 3 adolescent boys. Only 3 of every 4 cases are bilateral. The cause is a relative or absolute excess of circulating estrogens (female hormones) versus a decrease of androgens (male hormones). Most cases are idiopathic (doctor word for “we don’t know”), but some are due to liver disease, endocrine tumors, testicular masses, marijuana, anabolic steroids, and various other prescription medications. There is no risk of cancer unless associated with a rare genetic syndrome. The condition is graded I to IV.
Most gynecomastia associated with puberty resolves, but if it is present for more than one year, it is likely to be permanent. The condition is emotionally distressing to both adolescents as well as adults. A complex endocrine blood test work up is not indicated, but abdominal and testicular exams are necessary. Ceasing any drugs asscociated with gynecomastia is manadtory and weight loss to a healthy level is encouraged.
Surgery may be performed on adolescents who have had the condition for greater than one year and on adults who have met the above conditions is appropriate. Liposuction is used for lower grades of gynecomastia while additional skin and fibrous breast tissue excision is required for higher grades. Excisions may be avoided in boderline cases if liposuction is done first and the skin allowed to retract, but most patients are not interested in 2 stages of surgery. Removing tissue is not the hardest part; making a smooth contour to blend into the rest of the chest is.
For plastic surgeons, insurers do not cover the procedure as the consider it cosmetic. Patients go home the same day of surgery and wear a compression garment to minimize bleeding and help form a smooth contour. Recovery is several weeks. Most patients with realistic expectations are happy with their results and accept any scarring as they understand that this is a scar versus contour trade off operation.
Mark D. Wigod, MD, FACS
Plastic Surgery for Boise, Meridian, and the greater Southeastern Idaho Region
Injectable fillers for facial rejuvenation has become a frequently performed treatment. This month, I will discuss the types of fillers and the advantages and disadvantages of using them.
Have you ever thought about exactly why we look older as we age? As it turns out, Plastic Surgeons and other related specialties think about this quite a bit. One of the most noticeable changes is in the skin surface - pigment and texture irregularities. That is why it is best to avoid sun exposure, use sun screen, and visit your friendly esthetician for skin products, microdermabrasion, and laser photofacials. The skin also loses elasticity and sages. Tightening procedures like facelifts improve this problem. Finally, there are changes in fat distribution. It is controversial exactly how this occurs, but suffice to say that older faces seem to have fat in all the wrong places. That is where fillers come in to play. They can supply volume where it is missing.
The gold standard in volume replacement is fat. This my favored filler, but it is best performed in an operating room and often requires several sessions for the best effect. The desired effect, once achieved, is durable and the fat seems to improve the condition of the overlying skin. Another filler is Sculptra. It was originally used to replace volume in patients with HIV associated atrophy of the facial fat. The substance is relatively expensive, has a delayed effect, and lasts a couple of years.
The most commonly injected fillers, however, are hyaluronic acid based. Hyaluronic acid is a “ground substance” molecule that is found in our tissues where it provides bulk and holds fluid. It is relatively inexpensive and can be injected under a local anesthetic in an office setting. There is usually little bruising and the effect is immediate. The effect however, is far from permanent. It seems to last 6 months to greater than a year in the face, except in the lips where it is usually gone by 6 months. While that time frame does not sound very appealing, it does make sense if one puts it into proper perspective. Women frequently spend significant sums of money to color their hair or paint their nails and accept that these improvements are temporary. If the price is right ( and that is an individual judgement ), then temporary filler injection is really no different. In addition to limited time effect, fillers may also cause contour irregularities (bumps) which are normally short lived, but under rare circumstances may cause more serious problems.
My preferred hyaluronic acid filler is Juvederm because I like how it injects. Restalyne is another similar product which is excellent as well and preferred by many. Radiesse is hyaluronic acid with small spheres of calcium hydroxyapatite ( the salt found in bone ) which lasts longer, but has been associated with greater granuloma ( serious bump ) formation. It is not for use in lips for this reason. Juvederm is most commonly injected into the lips, nasolabial folds ( crease from the nose to the corners of the mouth ), and marionette lines ( creases from the corners of the mouth to the lower border of the mandible ). Juvederm can be injected into the hollows below the eyes, but there can be problems with seeing and feeling the material. Juvederm can be dissolved with an injection of hyaluronidase.
Another big reason why fillers are often injected is that you do not have to be a Plastic Surgeon to do it. A Plastic Surgeon, however, is experienced in aesthetic judgment and can perform all the appropriate options for rejuvenation with the proper perspective. In addition, filler injection by a Plastic Surgeon typically costs no more than by another provider; prices are fairly standard because patients will go elsewhere for a better price. So, if you look in the mirror and are considering a filler, schedule a consult for a full evaluation.
Mark D. Wigod, MD, FACS
Plastic Surgery for Boise, Meridian, and the greater Southeastern Idaho Region
Finally, a photo of Wigod Plastic Surgery's Komen Race for the Cure Team.
Despite a rain filled Spring, we have nearly made it to Summer and the Sun is out.Sure the Sun feels great beating down on us and many love the tanned look, but the results of Sun damage are no longer a secret.Minimize your risk of skin cancer (including potentially deadly melanoma) and maximize your chances of youthful skin later in life by applying Sun Screen before you go outside.Ask our staff about PCA products, or use your favorite brand. The following is a primer by PCA on sunscreens
Two types of Sun Protection:
There are two types of sun protection available: chemical and physical sunscreens. A chemical sunscreen works by absorbing, reflecting or scattering the sun’s rays (UV radiation) before they affect the skin. A physical sunscreen sits on the skin’s surface and reflects or scatters UV radiation before it is able to damage the skin, buy does not have the capacity to absorb. These two forms of protection have different methods of achieving a similar goal.
The FDA requires that all sun protection products display a Sun Protection Factor or SPF label, although many consumers are unaware of the fact that this label only indicates the relative amount of protection from UVB rays a product can provide when used correctly. Certain ingredients must be included in a product to receive adequate UVA protection. In order for a sun protection product to provide broad-spectrum UVA/UVB protection zinc oxide, titanium dioxide, avobenzone or ecampsule (MexorylTM) must be included. Sunscreens with an SPF of at least 30 are recommended. High SPF numbers can be misleading, as an SPF of 30 is not twice as protective as an SPF of 15. When used properly, an SPF of 15 protects the skin from 93% of UVB radiation, an SPF 30 97% and an SPF 65 98% protection.
Two types of UV Radiation:
The two types of UV radiation that can affect the skin, UVA and UVB, have both been linked to skin cancer and a weakening of the immune system. They also both cause skin color changes and contribute to premature aging. UVA rays are not absorbed by the ozone layer and penetrate deep into the skin. UVB rays mostly impact the surface of the skin and are the primary cause of sunburn. Up to 90% of the visible skin changes commonly attributed to aging are caused by sun exposure.
About PCA SKIN Sun Protection Products:
SPF products from PCA SKIN are formulated with a sophisticated blend of zinc oxide and several proven chemical sunscreen ingredients that protect the skin from UVA and UVB rays. The suite of highly effective and cosmetically elegant sun protection products from PCA SKIN provide:
Protection for every skin type, condition and tone. This ensures that most people can wear our products comfortably on a daily basis. Daily broad-spectrum UVA and UVB protection is important for everyone of every color.
PCA SKIN sun protection products also provide important antioxidant protection with silybin (milk thistle) and caffeine to prevent and correct free radical damage. Topically applied caffeine has also been shown to cause damaged skin cells into apoptosis (cell death) minimizing the chances of skin cancer.
The May 7, 2011 Komen for the Cure Race Day was a great effort in the fight against breast cancer. Our team was 52 members strong and we won for the largest team in our category for the second year in a row. More importantly, several of our breast cancer reconstruction patients were outstanding fund raisers. Their hard work contributed to a total of $2,645 raised by the team thus far. That places us at 8th amongst all teams and 2nd in our category.
We were happy to see staff, patients, family, and friends get together for a good time and a great cause. We had walkers, runners, and even a few kids. We are grateful to all of those who joined or contributed to our team effort to raise money to fight breast cancer. We look forward to a great effort next year. Be sure to look for our team photo in an upcoming blog (it was, unfortunately, unavailable at this time).
The Susan G. Komen for the Cure annual 5k (3 mile) walk / run is coming up soon on Saturday, May 7th. The office has formed a team again this year and we already have 24 members. We made it to 50 members last year. We hope that you will join our team and walk or run the race with us. Most team members are office staff or patient friends and family, but all are welcome. This year, we will be giving out pink bandannas instead of ball caps. We will also offer esthetician services such as facials and microdermabrasion to our top fundraisers. Follow the link to see who is on the team and to sign up. As May 7th draws closer, we will send an e-mail to the team with details on shirt pick up and our race day meeting point.
I went to Wikipedia and found some information to share with you on the Komen phenomenon. The foundation was formed in 1982, is the largest and best funded breast cancer organization in the U.S., and has invested approximately $2 billion for the campaign against breast cancer. Susan G. Komen was diagnosed with breast cancer at the age of 33 and died in 1980 at the age of 36. Her younger sister, Nancy Goodman Brinker, founded the Komen organization 2 years later. The rest, as they say, is history.
After graduating medical school, Dr. Wigod completed eight years of formal General Surgery Residency and Plastic Surgery Fellowship training. His 16 years of higher education allows him to perform both Cosmetic and Reconstructive Plastic Surgery and to treat the whole patient without being limited to one body part or technique. Broad surgical training, large volume practice experience, and continuing education assist Dr. Wigod in his efforts to provide optimal care for his patients. Dr. Wigod has experience in all aspects of Plastic Surgery, but now specializes in Cosmetic Surgery of the Breast, Body and Face, as well as Breast Cancer Reconstruction.
After graduating medical school, Dr. Wigod completed eight years of formal General Surgery Residency and Plastic Surgery Fellowship training. His 16 years of higher education allows him to perform both Cosmetic and Reconstructive Plastic Surgery and to treat the whole patient without being limited to one body part or technique. Broad surgical training, large volume practice experience, and continuing education assist Dr. Wigod in his efforts to provide optimal care for his patients. Dr. Wigod has experience in all aspects of Plastic Surgery, but now specializes in Cosmetic Surgery of the Breast, Body and Face, as well as Breast Cancer Reconstruction.
