Findings from a study in the September/October 2008 issue of the Aesthetic Surgery Journal show that breastfeeding is not a likely cause of post-pregnancy drooping of the breasts.  We often see women in our practice that complain about postpartum sagging which many people believed to be linked to breastfeeding.  However, as this new study demonstrates it appears that other factors such as age, higher body mass index and a history of smoking are responsible for the sagging that some women experience after pregnancy.

“It is widely assumed that breastfeeding will adversely affect the appearance of the breast and this has been a major reason cited by women who choose not to breastfeed.  However, there has been very little objective data to support or deny this fact.  With this study we hope to shed some light on the subject, ” said Brian Rinker, MD.

The current study set out to identify risk factors associated with the development of breast ptosis (sagging breasts) and to determine if there is a correlation between breastfeeding and breast appearance.  The information showed that greater age, higher body mass index, greater number of pregnancies, larger pre-pregnancy bra cup size and a history of smoking were all significant  risk factors in the development of sagging breasts.  Breastfeeding was not, even as the duration of breastfeeding increased.

While furhter studies are needed to asses each of the factor’s effects on breast sagging this is a good start in providing information for those who are concerned about the potential effects of breastfeeding.

This post is a compressed form of an article recently published in The Plastic Surgery News.

Lipo alternatives make impressive claims but lack long-term data
By Lynn Yoffee

Advertising campaigns for nonsurgical or less-invasive alternatives to traditional liposuction – purportedly with no down time, no surgery and no worries – dangle tantalizing claims to an eager public while plastic surgeons are often left waiting for proof of safety and efficacy “Patients are fascinated with these non-invasive ways of having fat removed,” says ASPS Member Surgeon Robert Centeno, MD. “Their appetite for non-invasive treatment is insatiable. But the marketing by the manufacturers is far ahead of the clinical trial data.”
More than 300,000 liposuction procedures were performed in 2007, according to ASPS statistics garnered from the National Clearinghouse of Plastic Surgery Statistics. In addition, 9.9 million minimally invasive cosmetic procedures were performed during the same period, up 81 percent since 2000. These statistics are illustrative of the growing demand for non- and minimally invasive procedures for all areas of the face and body.
The range of alternative tools and procedures for fat removal including Mesotherapy – which, according to proponents, uses micro-injections of conventional or homeopathic drugs, vitamins, minerals and amino acids to dissolve fat – seems to send up the brightest warning flares among the plastic surgical community.
“Injection lipolysis is not approved by the FDA and should be avoided,” says ASPS President Richard D’Amico, MD. “There is a dire lack of clinical research demonstrating its safety and efficacy, and neither the mixtures of chemicals nor the methods used for injecting it are standardized. It’s a procedure plastic surgeons – and the public – would simply do well to avoid.”
For ultrasound, radio frequency and laser-assisted liposuction techniques, which work by literally melting fat cells through a variety of means for less-invasive methods of removal, Dr. D’Amico advises waiting for more research – even when a technique has FDA approval.
“If a plastic surgeon chooses to use an external method or an internal method using a tiny laser, he or she is doing so despite a lack of good scientific data for efficacy,” he says. “We simply don’t yet have enough data to support using these techniques.”
“We tend to give a lot of these technologies credibility that they don’t warrant,” adds ASAPS President-elect Alan Gold, MD, Great Neck, N.Y. “Plastic surgeons who invest in these techniques too quickly may ultimately find that their patients will be extremely disappointed.”
Mesotherapy: Science or sham?
Though some states have taken action against mesotherapy to limit its use to investigative trials, it is still widely offered throughout much of the country as a nonsurgical alternative to reduce fat deposits. However, mesotherapy’s lack of double-blinded studies demonstrating its effectiveness (and safety) for cosmetic conditions gives many plastic surgeons serious reservations about its use.
In addition, the lack of a uniform formula for compounding agents used in mesotherapy has limited the potential for scientific research efforts. Mesotherapy compounds may include any combination of phosphatidyl choline, silicium, CRP 1000, hyaluronic acid, glutathione, ascorbic acid, glycolic acid, pyruvate, vitamins, minerals and more.
“We don’t even know what’s in these various potions,” says Susan Kaweski, MD, chair of the ASPS Technology Assessment Committee. “I don’t understand how patients can even consent to this procedure when they could be receiving an injection of any combination of plant extract, antibiotics, hormones, nutrients or vasodilators. What really concerns me are substances like isoproterinol, which is basically used for treating asthma and could be deleterious to a normal person who gets to much of it.”
“None of the substances that are being put together in these cocktails and injected have individually been approved by FDA for injection,” adds Dr. Centeno. “They may be approved for other modes of use, but they have never been used for subcutaneous injection. The studies done so far are typically small trials, poorly controlled and not rigorous enough to substantiate these treatments.”
Despite these concerns, public interest in mesotherapy seems to remain strong.
“You would think we’re in some Third World country where people wouldn’t know any better, but mesotherapy is around every corner and being touted as a way to avoid surgery,” says Dr. Kaweski. “The FDA hasn’t approved this for injection and people are still going to these places and having it injected. I’m flabbergasted by it.”
“Mesotherapy academies and associations are springing up in the United States,” Dr. Centeno adds. “Most of these organizations are being put together to promote training courses and the adoption of this technique to legitimize a process that doesn’t have a great deal of well-designed scientific studies proving its efficacy.”
One of the biggest questions surrounding mesotherapy (and other fat-melting techniques): Following the procedure, where does the dissolved fat go if it’s not suctioned out?
“The commonly explained mechanism is that the fat is excreted,” says Dr. Centeno. “Some people say it’s excreted in the GI tract or urine, but that doesn’t make sense from a biochemical standpoint. It’s possible that it’s not excreted, but rather redistributed.”
A grave concern is that the fat rushes into the bloodstream and collects in the circulatory system.
“Do the end products ultimately go to the heart and cause cardiovascular disease?” she says. “Beyond that, how do we control for fat destruction so that you’re only going to get the middle layer of fat cells and not the superficial layer? What are the short-term effects vs. the long-term effects? None of these questions have been answered.”
As an experiment, Dr. Centeno says he purchased the fat dissolving substances from a compounding pharmacy and tried it on a partner and a nurse to see if there were any clinical effects.
“The early result was that it caused a very intense inflammatory reaction and an intense amount of edema and third-space fluid shifting, but no significant abdominal circumferential reduction,” he says. “It’s supposed to be a no-down-time procedure – but it turned into a couple of weeks of pain. It’s not a benign therapy. It’s probably doing something, but is it really reducing fat?”
More research needed
LipoDissolve®, was manufactured by Fig before the company closed its doors in December 2007 and filed for bankruptcy.
LipoDissolve involves micro-injection of phosphatidylcholine deoxycholate to permanently dissolve fat. According to Fig, the hardened fat cells break down within a few weeks and are flushed out via excretions, and over the course of the treatment period, the fat cells in the targeted area are permanently eliminated from the body.
Upon first learning of the procedure, Dr. Koenig decided to attend a LipoDissolve training conference in 2004. “I went to figure out if it was worth doing,” Dr. Koenig says. “I had it done on myself and explored it with some other people in the practice. It definitely did give modest results, so I incorporated it into my practice.”
Going to that first meeting was also an “eye opener” for Dr. Koenig. “They truly look at the world differently from us surgeons,” he says. “There is such ignorance about what surgery can do and how to approach problems – people at the meeting were volunteering to have it put in their eyelids, and that really freaked me out. They were willing to try anything. As plastic surgeons, we need evidence that it works and is safe.”
In February 2005, ASPS issued a policy statement saying it does not endorse the use of mesotherapy because further research on safety and efficacy is needed. “The seemingly painless approach to body contouring will always be appealing to many, but without scientific evidence to verify mesotherapy’s usefulness, practitioners and patients must be aware of the risks of the treatments and the lack of FDA approval of medications used in the injections,” the statement reads.

There has been a lot in the media concerning  the economy and how it may effect cosmetic plastic surgery.  Fortunately over the years my practice has been quite resistant to changes in the economy and I have remained busy.  Members of our community are seeing decreases in stock value as well as possibly decreases in their income.  I think that it is important at this time that people to not panic and make poor decisions regarding their health care based upon finances.  I think it is inappropriate for patients to consider having discount or bargain basement procedures as a replacement for quality plastic surgery.  Should you be considering having a facelift, it may seem attractive to have a less effective “quick” procedure performed by a poorly trained or inexperienced surgeon based on their mass marketed questionable results.  Not only will you pay a considerable sum for a lesser quality procedure which is likely not to meet your desires, you may end up with a problem that could end up costing more to have fixed than a well done procedure in the first place.  Keep in mind that Plastic Surgeons certified by the American Board of Plastic Surgery and who are members of The American Society of Plastic Surgeons and The American Society of Aesthetic Surgery are committed to bringing you the best quality results at a reasonable price.  Typically surgeons like myself are committed to offering patients procedures which are peer reviewed at Plastic Surgery Meetings  and have survived the scrutiny of established Plastic Surgeons and perhaps more importantly “The test of time”.  Over the last year or so I have seen a number of patients who are unhappy with results performed by the “weekend ” trained surgeons and also patients who have had surgery in foreign countries with poor results.  They have no recourse with their surgeons and are looking at expensive procedures to fix their problems.  I saw one patient who had a breast augmentation in Mexico and 6 months after the surgery the phones were disconnected and the web site was gone!  She was given no information on her breast implants such as size, manufacturer, filler.  Qualified surgeons are reluctant to take on such a patient because the information on the previous procedure is so lacking.  She is in a pickle with a poor result.

Poor results are not limited to surgical procedures.  Beware the discount Botox.  When your only tool is a hammer everything in the world looks like a nail.  More to come on injectables next week.

If a surgical procedure seems out of reach financially at this time slow down and look at the big picture.  Consider putting it off until things improve (and they will).  Fillers and Botox can help to take care of some issues until you are more ready to go ahead with surgery.  Don’t make a decision you may regret.

I read a very interesting article in the Aesthetic Surgery Journal last night regarding the use of injectables to nonsurgically improve the facial appearance.  Over the years I have developed significant amount of knowledge on the safety and efficacy of injectables.  It is however always encouraging when our thoughts are reinforced by articles published by members of the surgical community outlining their use of similar technology.

Injectable products which are comprised of hyaluronic acid continue to be the number one used injectable across the country.  Their safety and efficacy has been widely proven with millions of procedures performed with these products.  They have proven very useful in lip enhancement and recontouring of the lower and upper face to establish a more youthful appearance.  We currently use a product called Juvederm.  In Juvederm the hyaluronic acid molecule is somewhat larger than some of the other products available and therefore lasts longer.  We have recently incorporated a new product called Prevelle Silk which although it doesn’t last as long has proven useful in finer lines and is less expensive.

Another product which we frequently use is called Radiesse.  The active ingredient is a calcium product which naturally occurs in the skin.  Over time the body replace the calcium with collagen to rejuvenate the skin. Although not recommended for lip augmentation Radiesse has proven very useful in improving deep lines of the mid and lower face.

I currently have two nurse injecters in the office, both of which are highly trained and experienced in the use of these injectables.  I have been very careful to only select products which have a proven safety record as well as a high degree of efficacy and patient satisfaction.  There are other more permanent injectables on the market but I am concerned about possibility of scarring and deformity with some of these products, which can be difficult to treat.  Should you be interested in these forms of facial rejuvenation which do not require surgery please contact the office for a free consultation.

September is always a busy month here and this year is no exception.  I have been busy with the media this month arranging for some articles about The Colorado Center for Breast Augmentation.  Recently I appeared on the local Fox affiliate Fox 31 Denver to discuss the safety of breast implants, in particular silicone implants for breast augmentation.  There is a link to the video on our website.  I tried to emphasize the safety of the implants, in particular, the newest generation of silicone gel implants with thicker implant shells and thicker silicone gel which decreases the risk to the patient if the implant leaks.  No implant is perfect but the newest silicone gel implants have withstood the highest research scrutiny ever given to a medical device on its way to FDA approval.  We also discussed how the current availability of breast implants brings to each woman a huge matrix of implant choices which will help to give them the most satisfactory result.  Today I am having an interview with the Villager Newspaper to discuss The Colorado Center for Breast Augmentation with an emphasis on the same issues.  Breast augmentation continues to be the number one cosmetic procedure performed on women and I will continue to strive to bring as much education to the public as possible regarding this high satisfaction procedure.

I have recently met with the consultant who has been assessing the status of my practice.  It is a service offered by the breast implant manufacturer with which I am closely associated.

Her conclusion is that my practice is busier than average.  Across all procedure lines I tend to do more procedures than the average plastic surgeon, however this was particularly true with breast augmentations where I typically perform approximately 3 times as many breast augmentations per year as the average plastic surgeon.  Despite the fact that I  do more breast augmentations than the average surgeon, this remains an area which I promote strongly in the practice.  I feel that it is to  the benefit of patient that her surgery is performed by a physician who focuses on a particular procedure.

This concept of a Center of Excellence has become commonplace in medicine and offers the patient reassurance that the surgeon is able to offer the patient the highest likelihood of a great result with minimal complications and easier recovery.  My devoted surgical team and experienced office staff aid in bringing to each patient the best surgical experienced possible.

Below are some of the latest nationwide statistics for Botox Cosmetic.  These results are compiled by Allergan, the makers of Botox products.

· 3,181,592: Number of BOTOX^® Cosmetic treatments administered in the United States in 2006 alone^[i]

· 1,000,000s: People who received treatment with BOTOX^® for medical and aesthetic purposes around the world^[ii]

· 300,000: Number of men who received treatment with BOTOX^® Cosmetic in 2006^[iii

· 10,000: People in clinical trials^[iv]

· 3,000: Publications on Botulinum Toxin Type A in scientific and medical journals^[v]

· 100: Years of study into botulinum neurotoxins^[vi]

· 97: Percentage of people satisfied with their BOTOX^® Cosmetic treatment based on a survey of approximately 1,000 patients^[vii]

· 75: Countries around the world who have approved use of BOTOX^®

· 20: BOTOX^® indications approved by regulatory authorities around the world, including the aesthetic indication

· 18: Years since U.S. Food and Drug Administration (FDA) approved BOTOX^® to treat excessive eye blinking and crossed eyes.

· 6: Years since FDA approval of BOTOX^® Cosmetic for the treatment of the moderate to severe glabellar (vertical) lines between the brows in adults 18 to 65

· 4: Years since FDA approval of BOTOX^® for the treatment of severe primary hyperhidrosis (excessive underarm sweating) inadequately managed with topical agents

· 1: Rank of BOTOX^® Cosmetic on list of “Top 5 Surgical & Nonsurgical Physician Administered Cosmetic Procedures,”^[viii according to American Society for Aesthetic Plastic Surgery^]

Our very own plastic surgeon, Dr. Terrence Murphy, was on Denver’s 106.7 KBPI radio station earlier this week.  The radio station’s morning crew, Willy B and Missy, interviewed Dr. Murphy on his expertise on breast implants.  The interview on the station that “Rocks the Rockies” was lots of fun.  Look for the link to the interview on our websites www.murphyplsticsurgery.com and www.breastaugmentation-denver.com soon.

The staff here at Murphy Plastic Surgery are all excited for our seminar at the Ritz Carlton in downtown Denver next Tuesday, April 8th!  The goody bags with free gifts and coupons for Botox® and Juvederm® have been wrapped.  And the menu items including a curry lobster salad, goat cheese bites and antipasto table, have all been decided on.

We are eagerly anticipating Dr. Murphy’s presentation on the new Colorado Center for Breast Augmentation and all the latest options for breast enhancement surgery.  I guess all that’s left to do is pick out an outfit for our fabulous downtown event.

Nicole Worsham – Office Manager