August 23rd, 2014 Dr. Mele
Eyes play a central role in defining facial beauty. Unfortunately, the eyelids are one of the first facial features to show the signs of aging.
Eyelid Surgery Before and After Photos
The Eyelid Lift or Blepharoplasty removes the skin that hangs over the eyes and the bags that hang under the eyes.
What Does Blepharoplasty (Eyelid Surgery) Do?
Blepharoplasty is performed to removed excess skin and bagginess from the eyelids. The Blepharoplasty Before and After Pictures above show the difference an Eyelid Lift can make. The excess skin on the upper eyelid presses on her eyelashes causing a heavy sensation, a tired look and it makes wearing eye makeup next to impossible. The lower eyelid is overstuffed and baggy. The after photo shows an alert appearance with a clean upper eyelid fold and smoothed lower eyelid bags.
Blepharoplasty Before and After Pictures
This Blepharoplasty Before and After Photo set shows how eyelid surgery can remove excess upper eyelid skin and lighten baggy lower eyelids.
Keloids and Eyelid Surgery
My patients of African descent, who are considering cosmetic surgery, usually ask about keloid formation. The techniques used in African Eyelid Surgery are essentially the same as those for Caucasian Eyelid Surgery. While keloid formation is common on the chest, shoulders and ears, the eyelids are a privileged area, and keloid formation is extremely rare. Hypertrophic (thick) scars are also very rare on the eyelids, because the eyelid skin is very thin, and usually heals very quickly. As with any surgery, close follow-up is important to assure the best possible results.
Asian Eyelid Surgery
Asian Eyelid Surgery has many of the same goals as caucasian eyelid lifts, but may also include defining the upper eyelid crease. The Asian eyelid has a poorly defined upper eyelid crease. This allows the upper eyelid fat pad to fall forward and hang lower in the lid. The fold itself may be absent, or may consist of multiple folds. Eyelid surgery can be used to form a single clean fold in the lid and elevate the fat within the upper eyelid restoring a more youthful appearance.
Asian Eyelid Surgery can include defining an irregular upper eyelid crease in addition to removing upper eyelid skin redundancy and lower eyelid bags.
If you are considering Eyelid Rejuvenation call (925) 943-6353 today and schedule a personalized consultation appointment. More information about Blepharoplasty is available on the San Francisco Plastic Surgery Blog and on my main website, DrMele.com, but nothing can substitute for an in-person consultation with a Board Certified Plastic Surgeon.
August 16th, 2014 Dr. Mele
The popularity of Botched was confirmed this week when the E! Network announced the Plastic Surgery reality show has been renewed for a second season.
Botched will be Unbotching again next year.
If you haven’t watched Botched, the show features two Plastic Surgeons on a quest to revise bad plastic surgery results with a liberal sprinkling of interesting personalities.
Life is What Happens to You While You’re Busy Making Other Plans
Perhaps you’ve heard the quote above. It is often attributed to John Lennon, but it seems Allen Saunders said it first. Life also happens to Plastic Surgery, sometimes literally, in the form of pregnancy. The Mommy Makeover is named after the procedures, Breast Augmentation and Tummy Tuck, combined to repair the breast and belly damage that pregnancy can cause.
The Mommy Makeover – When you’re unhappy with what life does to your body, there is something that can be done.
Breast Augmentation Revision After Pregnancy
Many patients who become pregnant after Breast Augmentation have no problems, especially if they were small before getting Breast Implants. For others, life happens to their beautiful results. The Breast Augmentation Revision Before and After Photos below show what can happen, and how it can be unbotched.
Breast Augmentation Revision can lift the breasts back onto their Breast Implant after postpartum sagging causes them to fall down.
The photo on the left shows the result that pregnancy can have on otherwise perfectly fine Breast Augmentation. The breast tissue, in front of the implant, responds naturally by enlarging for lactation. Once breast feeding stops, the breast tissue atrophies, leaving loose saggy skin. This would happen with or without a Breast Implant, but in this case with Breast Implants, the breasts have fallen off their implants. After a Breast Lift and Breast Implant Replacement, a much perkier result is obtained.
Capsular Contracture Can Happen Too
Most Breast Implants remain soft and mobile; however, when the pocket around the implant shrinks, the result can be a firm breast, that often rides up. The good news is the tightness can be released.
Capsular Contracture release can improve the feel and location of the Breast Implant.
The Capsular Contracture Release Before and After Pictures above show how elevated breast implant malposition can be corrected by removing or expanding the tight Breast Implant Capsule.
Sometimes Enough is Too Much
Sometimes Breast Implant Malposition is the result of too big an implant and too little support. The woman below had Breast Augmentation with a Breast Lift. Unfortunately, her Breast Implant was too heavy for her skin. The result was bottomed out breasts and an angry scar.
Heavy Breast Implants can stretch out the breasts and cause bottoming out. Downsizing and a Breast Lift with Scar Revision can often help.
In the Breast Augmentation Revision Before and After Photos above, the angry scar was revised, the breast was lifted again and a smaller Breast Implant was selected. The result is a superior shape, contour and feel. While there can be no guarantees in life, the chances of bottoming-out again are reduced by the reduced weight of the new implants.
Botched Breast Implants Can Be Unbotched
If you are unhappy with your Breast Augmentation, you don’t have to go to Beverly Hills and visit the Botched doctors for help. The San Francisco Bay Area is not only the site of the first Plastic Surgery training program west of the Mississippi, it remains home to two of the most competitive plastic surgery programs in the United States. You have many Board Certified Plastic Surgeons to choose from.
About The Author
With 20 years of experience with Breast Augmentation and Breast Augmentation Revision, Dr. Joseph Mele is a Board Certified Plastic Surgeon with the ability to get results. If you would like to schedule a personal consultation, give his Walnut Creek Plastic Surgery office a call at (925) 943-6353.
August 9th, 2014 Dr. Mele
Gynecomastia, or enlarged male breasts, is a common problem that appears at puberty. Often, Gynecomastia occurs rapidly and can resolve as the body adjusts to adult hormones levels. However, if the hormonally Enlarged Male Breasts remain for more than a year or two, it is unlikely to resolve without Gynecomastia Reduction.
Gynecomastia Breast Reduction Before and After Pictures with Liposuction and Excision
Often termed “Man Boobs” or “Moobs“, enlarged male breasts can be a source of concern for adolescents and adults alike. Here is an example of before and after Male Breast Reduction.
Gynecomastia Before and After Pictures – Firm breast tissue fills the areola and pushes the nipple out causing embarrassment in and out of clothing. Reduction with a combination of Liposuction and precise excision of the tough glandular tissue provides a smooth, masculine and attractive result.
Breast Reduction for Men Video
Recently, I was able to discuss Gynecomastia, and the techniques I use every week for Male Breast Reduction, on KRON 4′s Body Beautiful. This television segment provides Gynecomastia Before and After Pictures, which illustrate the results of Liposuction, Gland Excision and Skin Excision. Which procedure to use depends on your unique situation. The best way to learn about your options is with an in-person consultation. To schedule your personal, confidential appointment call (925) 943-6353.
Gynecomastia (Male Breast) Reduction Video
Gynecomastia Breast Reduction Before and After Pictures with Excision Only
For Body Builders, chest contour problems are not usually due to fat. Most often, Gynecomastia presents as a solitary nodule of over-developed breast tissue centered beneath the nipple. A small, curved incision is made from 4 to 8 o’clock, hidden along the edge of the areola, and the excess gland is removed. The goal is a smooth contour that hugs the muscle and does not overproject or hang.
Gynecomastia Reduction provided smaller areolae, improved symmetry, elevation of the nipple and removal of the stigma of possible steroid use. The improved contour, before and after gynecomastia surgery, is obvious on this lateral view.
Gynecomastia Reduction After Weight Loss
Male Breast Reduction is not as simple as losing weight. The body builder above has no excess body fat, and still has Gynecomastia. In these cases, direct excision of the disproportionate glandular tissue drastically improves the chest’s proportions.
The male breast will enlarge with weight gain; however, weight loss alone does not always turn back the hands of time. Disproportionately large breasts may require severe weight loss to improve their contour at the cost of one looking anorexic. Disproportionate enlargement of the chest due to fat can be reduced with selective Liposuction, which removes the excess fat directly from the breasts.
When weight loss is successful, the disproportionate fat may be corrected; however, the breast gland and the skin need to cooperate to get the best results. When the gland remains enlarged, the situation illustrated by the body builder above occurs. When excess skin remains, or begins to sag, some skin may also need to be removed.
Gynecomastia and Skin Reduction – The before picture shows enlarged breasts with disproportionate fat, excess glandular tissue and skin folding onto itself at the base of the breasts. After, the excess fat, gland and skin have been removed through an incision that runs along the base of the breasts. After breast reduction, as his tan shows, this patient is happier both in and out of clothing.
The Male Breast Reduction Before and After Pictures above show how Gynecomastia reduction can incorporate several different techniques. Liposuction, gland reduction and skin excision are used to completely recontour the chest. If Liposuction alone were performed, fullness would remain beneath the nipples. If skin excision was neglected, the breast would appear deflated and saggy.
While the San Francisco Plastic Surgery Blog and other Internet information can introduce you to the methods used for Gynecomastia Reduction, only a consultation with an experienced Board Certified Plastic Surgeon can help you make an informed decision. If you are considering Male Breast Reduction, give me a call at (925) 943-6353, or use the contact form to the left and schedule your private consultation.
August 2nd, 2014 Dr. Mele
The San Francisco Bay Area is a very competitive place. We support the headquarters for Silicon Valley start-ups and Multinationals alike. The East Bay is home to the third largest corporation in the the US (San Ramon’s Chevron), and the world’s hottest electric auto assembly plant (Fremont’s Tesla). Though technically, Tesla is headquartered in the South Bay’s Palo Alto, not far from the fifth largest US company, (Apple Computers in Cupertino).
The Competitive World of Cosmetic Plastic Surgery
The Mini Tummy Tuck can clean up loose skin, lax muscle and disproportionate fat on the lower abdomen without the downtime of a full Abdominoplasty.
This spirit of successful innovation extends to Cosmetic Plastic Surgery also. The first facial filler was investigated and developed at Stanford University. Palo Alto remains the home of Collagen Corporation. For the home of the first Plastic Surgery Training Program West of the Mississippi, you might think Beverly Hills, or at least Southern California, but in fact it was my alma mater in San Francisco. The Plastic Surgery fellowships at Stanford and UC San Francisco remain as two of the best in the world.
With Plastic Surgery Competition Comes Innovation
Competition breeds innovation. New products like Neodyne’s Embrace Scar Therapy, and new techniques are constantly developing, making my job safer and more predictable. The quest to get better results with less intervention and downtime is ongoing.
Mini Tummy Tucks and other “Mini” procedures
For this bulge at the bottom of the belly, a Mini Tummy Tuck is just what the doctor ordered.
An area of innovation is the development of “Mini” procedures. From Mini Facelifts to Mini Tummy Tucks, for the right patient, less is more. Mini Abdominoplasty provides abdominal rejuvenation for anyone who does not require a full Tummy Tuck, in half the time and with half the recovery. A Mini Abdominoplasty cannot do everything its big sister can do; however, if your tummy problems are exclusively below your belly button, the Mini Tummy Tuck may be your answer.
Mini Abdominoplasty Television
The Mini Tummy Tuck is featured in this week’s KRON 4 Body Beautiful Segment. A review of the procedure and before and after pictures are shown. This provides a good overview of what a Mini Abdominoplasty can do. For specific information be certain to see an experienced and Board Certified Plastic Surgeon.
Mini Abdominoplasty (Mini Tummy Tuck) Video
Mini Tummy Tuck Frequently Asked Questions
The Mini Abdominoplasty Video above answers many of the most Frequently Asked Questions. Topics covered include:
- What is a Mini Tummy Tuck?
- What can a Mini Abdominoplasty fix?
- What can’t a Mini Tummy Tuck fix?
- When is a Tummy Tuck better?
- When will Liposuction alone help?
- Do Plastic Surgeons cut the muscle for a Tummy Tuck?
- Is the Mini Tummy Tuck scar smaller?
- What is the recovery time for a Mini vs a Full Tummy Tuck?
- Can Liposuction be combined with Tummy Tucks?
- Where is the scar for Tummy Tucks?
- And of course, Mini Tummy Tuck Before and After Pictures
What Was I Trying to Say about Mini Tummy Tucks at the End of the Video?
From flabby to fit. A Mini Abdominoplasty was all that was needed to restore this belly.
We did not get to the last thing I was going to mention on the show. It has to do with improving your Mini or Full Abdominoplasty scar. I was a primary investigator for Neodyne’s Embrace Scar Therapy. It is a patch placed over the Abdominoplasty scar to help it heal better. The patch is used for several weeks after surgery, and helps reduce redness and improves scar formation. A randomized control trial comparing Abdominoplasty scars with and without Embrace therapy showed clinical improvement in the scars treated with Embrace. Embrace is another example of the cutting edge innovation coming out of the San Francisco Bay Area.
Mini Tummy Tuck Consultations
Are you a candidate for a Mini Tummy Tuck? If you have questions about Mini Abdominoplasty, Liposuction or Tummy Tucks, give me a call at (925) 943-6353, or use the contact form to the left, and schedule your individualized plastic surgery consultation today. The details for your exact situation will be discerned and a plan tailored just for your belly will be created.
July 26th, 2014 Dr. Mele
Breast Augmentation and Breast Lifts are complementary procedures. The Breast Augmentation Lift can restore perky, youthful contours to the deflated, sagging breast. With the large number of Breast Lifts and Breast Implants available, there has never been a better time to have the procedure. On the other hand, with so many choices, how do you decide what will work for you? As a Board Certified Plastic Surgeon, I help women navigate their plastic surgery options every day.
Breast Augmentation Lift Video Presentation
One way I can offer advice is via KRON 4′s Body Beautiful. This live television show covers current plastic surgery and allows viewers to call in with their questions. This Breast Augmentation Mastopexy Video segment details how the combination provides the best breast enhancing aspects of Breast Enlargement and the Breast Lift. In other words, it’s a breast lift that can add volume, especially for the empty upper breast. Augmentation Mastopexy can change sad and saggy breasts into proud and perky breasts.
Breast Augmentation Lift (Mastopexy) Video
What Breast Augmentation Mastopexy Does
Breast Augmentation and Breast Lifts are complementary procedures. Breast Augmentation adds volume to the breast. The Breast Implant can be used to enlarge the entire breast, or more selectively enhance upper pole fullness. This selective enhancement can correct the situation when you are happy with your cup size, but the breast does not fill the upper half of your bra’s cups.
Breast Lifts reshape the breasts. Not all Breast Lifts are created equal. There are many types of Breast Lifts that are used for correcting sagginess ranging from slight to massive. It is important to choose the correct lift to get the best results. A Mastopexy alone does not change the breasts’ volume. When less volume is desired, a Breast Reduction is performed. When more volume is needed, an Augmentation Mastopexy is best.
Breast Augmentation Lift Before and After Pictures
Breast Augmentation Mastopexy can lift the breast and add volume for a perky, and full, breast.
How to Choose Your Breast Aug Mastopexy
The combination of Breast Augmentation and Breast Lift is one of the most complicated plastic surgery combinations, but it can also be one of the most rewarding. It requires a thorough, in-person examination and discussion with an experienced, Board Certified Plastic Surgeon to formulate the best plan for you.
For more information about Breast Augmentation Mastopexy or any Cosmetic Plastic Surgery, give me a call at (925) 943-6353, or use the contact form in the column. A personalized consultation appointment is the best way to get the specific information you need.
July 19th, 2014 Dr. Mele
Facial Augmentation encompasses everything from Dermal Fillers like Restylane, Juvederm, Perlane and Radiesse, to chin, cheek and nasal implants. Facial Fillers and Facial Implants are used to replace lost volume, restore facial support and to create more pleasing facial proportions. Facial Fillers are a great way to try out your new Facial Enhancement; however, fillers require periodic maintenance, while Facial Implants can provide long lasting correction.
Facial Augmentation: Chin, Cheek and Nasal Implants
Facial Augmentation is used to provide harmony between the different features of the face. The size of any single facial feature is not as important as its proportion to the rest of the face. For example, a small chin will make the nose look larger, while a large chin will make the nose look smaller. Facial Plastic Surgeons use this to our advantage when we evaluate a face. It helps guide us to the safest, most predictable and thus best methods for enhancing your face.
There are many types of Facial Implants. The most common facial implants are chin implants, cheek implants and nasal implants. Like us, they come in many shapes and sizes. This allows Board Certified Plastic Surgeons to select the implant that is most harmonious with your face.
Facial Enhancement with Chin, Cheek and Nasal Implants
I had the opportunity to discuss Facial Augmentation on KRON 4′s Body Beautiful recently. The video from this television show focuses on Facial enhancement with chin implants, cheek implants and nasal implants. The procedures, recovery and outcomes are discussed, and before and after pictures are revealed.
Facial Augmentation Video Featuring Facial Implants
Facial Augmentation Frequently Asked Questions
Many of the most frequently asked questions about Facial Implants are answered in the Facial Augmentation Video above. Some of the topics discussed include:
- The most common Facial Implants
- Dorsal Nasal Implants
- Chin Implants
- Cheek Implants (Malar Implants)
- The differences between Dermal Fillers and Facial Implants
- Can you choose a shape for your new Chin Implant?
- Who is a candidate for Facial Augmentation?
- The importance of Facial Proportions – Math helps!
- How are Facial Implants placed?
- How do Cheek Implants help the eyelids?
- How do Chin Implants effect the nose?
- What is the recovery period associated with Facial Augmentation?
Facial Implants Before and After Pictures
Before and After Pictures of the most frequently used implants for Facial Enhancement are also included:
- Before and After Nasal Implants Pictures
- (Nose Implants for enhancing a nose that is flat between the eyes)
- Before and After Malar Implant Pictures
- (Cheek Implants to enhance the cheeks and support the lower eyelids)
- Before and After Chin Implant Pictures
- (Chin Implants enhance the chin and shrink the appearance of the nose)
Chin, Cheek and Nasal Implants
If you are seeking more information about Chin, Cheek and Nasal Enhancement, call (925) 943-6353, or contact me through the form in the side column. While the Internet can provide good general information, only an in-person consultation with a well trained and experienced Cosmetic Plastic Surgeon can get you the details required to make an informed decision. I frequently use Computer Imaging to help me understand what you are looking for, and to explain what can be expected. This makes Plastic Surgery, personal surgery.
July 12th, 2014 Dr. Mele
This weekend the San Francisco Bay Area is focused on protecting your breasts. The Avon Walk for Breast Cancer: San Francisco and Breastfest are both happening today at Fort Mason.
Avon Walk for Breast Cancer: San Francisco
2014 Avon Walk for Breast Cancer: San Francisco Map
The Avon Walk for Breast Cancer: San Francisco kicks off this morning. It is one of the most scenic breast cancer walks available, incorporating North Beach, my home during my Plastic Surgery residency, as well as Pacific Heights, Fisherman’s Wharf, the Ferry Building, the Presidio, the Golden Gate Bridge, Sausalito and the Marin countryside. Saturday’s route is 23.8 miles and the walk continues on Sunday with another 15.5 miles. An optional 2.5 mile additional loop is available for those who want to walk a full marathon before recuperating at the Wellness Village, located at the base of Mount Tamalpais.
More than 192,000 Avon Walk participants have raised donations of over $500 million to breast cancer programs since 2003. The dollars are used both nationally and locally to help in the research, diagnosis and treatment of breast cancer. Today’s event promotes healthy activities and supports patients, centers and treatments alike. The event funds safety net hospitals and provides access for those who may not otherwise be able to afford, or understand, the complexities of breast cancer treatment.
Last year’s Avon Walk for Breast Cancer made a large impact on local efforts to fight breast cancer. Some of the San Francisco Bay Area organizations which benefitted include:
- $700,000 to San Francisco General Hospital for patient care and research
- $300,000 to the University of California, Berkeley to research environmental exposure risks for breast cancer
- $150,000 to Stanford University to research tobacco smoke and Bisphenol-A interactions with breast cancer
- $125,000 to Zero Breast Cancer to research genetic and environmental factors leading to breast cancer
- $110,000 to the Alameda Health System to support the breast cancer patient navigation program
- $110,000 to the Women’s Cancer Resource Center to support breast cancer patient care
- $150,000 to the Charlotte Maxwell Complementary Clinic to support complementary (not alternative) breast cancer patient care
- $200,000 to Project Open Hand to provide nutritional support for patients with breast cancer
Non Walking Breast Cancer Support Also Available
BreastFest 2014 Kicks off in Fort Mason Center at 2 PM – 6 PM today.
If you prefer a cold brew to a long walk, an alternative is available. In fact, this complementary event supports complementary approaches to Breast Cancer Treatment. BreastFest has been supporting the Charlotte Maxwell Complementary Clinic since 2000. The first Brewfest was held in Marin County, CA, hosting 16 local breweries. The 2014 event is expected to have more than 80 breweries supporting the cause. The 2013 event raised over $40,000.
July 5th, 2014 Dr. Mele
Dr. Mele’s profile is featured in this month’s Diablo Magazine’s Best of the East Bay edition
Diablo Magazine’s Best of the East Bay
Diablo Magazine‘s Best of the East Bay is out this month. The edition features the best people, places and things to do in the East San Francisco Bay Area. This year’s people include Golden State Warriors point guard, Steph Curry, and Sharknado director Anthony C. Ferrante. New places include dining at the Cooperage American Grille in Lafayette, CA, and Cosplay at East Bay Comic-Con in Concord, CA. One of my favorite Walnut Creek, CA, restaurants, Vanessa’s Bistro 2, also made list for Diablo Readers Pick for their Vietnamese cuisine. While perusing the glossy Diablo Magazine pages, be certain to look for the Joseph A. Mele, MD, FACS, profile. Thanks again this year, Jessamyn and Robert of Jessamyn Photography for making me look good.
Board Certified Plastic Surgery since 1997
I decided to go into Medicine as a Sophomore at Campolindo, and I was fortunate to be able to remain in the greater San Francisco Bay Area for both my training and private practice. It was a long path, which included eight years of training after medical school, with chief residencies in both General Surgery and Plastic Surgery. This allowed me to become Double Board Certified by the American Board of Surgery and the American Board of Plastic Surgery.
World Renowned Professional Societies
The training also allows me to be an active member of some the world’s premier professional societies. Some of these organization are listed below, and more information on each is available by clicking on their names:
Even the best training is meaningless without the ability to apply the knowledge to improving my patients’ lives. Providing High Patient Satisfaction is what keeps me working hard, refining the traditional and learning the latest techniques in Cosmetic Plastic Surgery. Balancing safe and effective with cutting-edge techniques is how I continue to improve my Walnut Creek Plastic Surgery practice.
If you are considering Cosmetic Plastic Surgery, give me a call at (925) 943-6353, or contact me through the contact form on this page. I specialize in cosmetic plastic surgery, both Facial Plastic Surgery and Body Shaping procedures.
June 28th, 2014 Dr. Mele
An ounce of prevention is worth a pound of cure, so every few months I dedicate a post to preventative medicine. Simple actions can have profound effects. Using sunscreen, not smoking and Breast Health Screening are all areas that we hear about so often that the message can get lost. In an effort to catch our attention, the message can also get distorted.
The Crystal Ball of Medicine
Can your doctor predict the future?
It’s hard to predict the future, but doctors are asked to do so every day. Usually we are right, because we can recognize patterns in symptoms or behaviors that are likely to result from a specific disease. Our knowledge of the natural history of the diseases we treat gives us a meaningful basis on which to plan the best treatment. Practicing medicine is made difficult because diseases, and people, do not always behave as predicted. Sometimes, even with the best intensions, in a effort to do good, bad things happen.
If Medicine Were As Simple As Using Google
The Internet is a wealth of information. Not a day goes by without a patient asking me about something they read on-line. When I started my practice in 1997, much of the information about Plastic Surgery was not very helpful. Providing accurate Cosmetic Surgery Information, that is accessible, remains the reason I continuously update my websites and the San Francisco Plastic Surgery Blog. It is still a challenge I enjoy and requires constant investigation into what is new with an open mind and a healthy dose of skepticism.
If it Sounds too Good to be True, It’s Likely False
Rarely does a new technology come along that provides treatments that are safer, more predictable, more effective, cheaper, faster, less painful and with less downtime. Patients, doctors and even insurance plans are constantly searching for these panaceas, and rarely they emerge. When they do, this is called progress. Unfortunately, our desire for progress can sometimes blind us from the truth.
Breast Health Screening
Amy Robach and the Mammography Machine that Saved her Life.
Lately, the information distortion in the area of Breast Health Screening seems to be getting worse. And to be fair, the “facts” can be counter intuitive and are sometimes, frankly contradictory. A study recently publicized out of Canada, the Canadian National Breast Screening Study (CNBSS), showed no difference in breast cancer related mortality in screened women versus a “control group”. For those opposed to mammography, this has added more fuel to their side of the fire. The national news has picked this up story as the headline. It makes good news, but it makes poor medicine, because the rest of the story remains buried.
I posted about Mammograms last year, when Amy Robach was diagnosed at 40 with breast cancer after being coerced into getting one for a feature story on Good Morning America. Her story exemplifies the benefits of breast health screening, and demonstrates how silent tumors can be revealed with the proper test. Another (former) GMA Host, Joan Lunden, has also recently been diagnoses with breast cancer after breast cancer screening that included a normal Mammogram and a positive screening ultrasound. On the other hand, most of the lumps found and biopsied with screening are not cancer, and some will argue that the anxiety and expense of screening and treatment outweighs any benefits.
Fact: Breast Screening Works
Breast Health Screening has been shown to reduce both the morbidity (disfigurement and illness) and the mortality (death) associated with breast cancer. This is clearly and significantly demonstrated in seven large randomized controlled studies. The CNBSS study is the only one that failed to find a reduction in breast cancer mortality with screening mammography. The headline should not be Mammography Fails to Prevent Death from Breast Cancer. The real question should be, Why did the CNBSS fail to demonstrate the benefits of breast cancer screening that other large studies have?
What’s Wrong With CNBSS?
Amy’s story showed what can go right with breast cancer screening. The CNBSS story showed how a poorly designed study can hide the facts, so what’s wrong with the study? Space limits me from expanding the details, but a superficial look at the study reveals several problem areas:
- A Poorly Selected Control Group – The screened group was selected to include more large palpable cancers. In effect, the screened group was a higher risk group when compared to the control group. A better way to think of the study’s results is that with screening, the higher risk group lived just as long as the lower risk group did without screening.
- Poor Mammogram Image Quality – The CNBSS study is a twenty-five year old study with twenty-five year old technology. Older mammogram techniques have since been replaced with digital mammograms and Tomosynthesis, which allows for more accurate readings, especially in younger women or women with more dense breasts.
More Recent Studies
Tomosynthesis promises better pictures with lower radiation and more accurate results for breast cancer screening. Unfortunately, it still requires compressing the breasts.
Between 2001 and 2014, studies using more modern mammography have demonstrated a 25-50% reduction in breast cancer mortality for women between the ages of 40 to 74 years. This leap has been made possible largely by moving from film based mammography to digital mammography. In this month’s Journal of the American Medical Association (JAMA) the next leap forward may be emerging. In the article Breast Cancer Screening Using Tomosynthesis in Combination With Digital Mammography, adding tomosynthesis to screening digital mammography decreases the “recall” rate by 15% while increasing the cancer detection rate by 29%. Sounds too good to be true. Is it? Critics point to the fact that the study was funded by the company providing one version of the tomosynthesis machine. Moreover, more objective readers will note the study is retrospective, i.e., digs through old data to find trends. Only well designed, large, prospective, randomized, multi-center clinical trials, which can evaluate all four currently available tomosynthesis systems can answer if there really is a benefit. These take time and money, and need to be planned better than the CNBSS study.
So many Studies Show Progress. Why Doesn’t This Make the News?
In medical speak, the tomosynthesis data is biased and retrospective, but encouraging. It suggests real progress, but further research is needed. Not exactly a sexy headline, but the truth. Doctors are conservative by nature, because we know lives are at stake. The lives of people we know and care for are at stake. We are taught tried an true methods that we know are not perfect, but are the best available. This takes years of formal training, a lifetime of ongoing education and years of experience treating patients. Moving away from tools that work requires more than a sexy headline. It requires objective evidence. Unlike a Google search, objective evidence takes years to research and tends to be slow, methodical and boring. What makes it harder to explain is that the results are never black and white. The results are always grey, they vary by patient and so we play the odds. Always striving for the path most likely to give the results we and our patients desire. Always striving to influence the future, even if we can’t predict it.
June 21st, 2014 Dr. Mele
I have noticed my San Francisco Bay Area Breast Augmentation patients are some of my happiest patients, and a recent study out of Philadelphia, PA, shows this is a national trend. Over 600,000 women had Cosmetic Breast Surgery last year, with more than half choosing Breast Augmentation. Recent improvements in Breast Implants‘ quality and choices are providing women with safer and more predictable options for Breast Enlargement in the Bay Area.
New research confirms what plastic surgeons have known for years.
Breast Augmentation does more for a woman than just enlarging her breasts.
Breast Implants and Patient Satisfaction
According to an article recently published in Plastic and Reconstructive Surgery, Breast Augmentation is associated with high patient satisfaction and significant improvements in quality of life.
Who Gets Breast Augmentation?
The study entitled Understanding the Effect of Breast Augmentation on Quality of Life: Prospective Analysis Using the BREAST-Q followed 611 women with an average age of 33.5 years and an average BMI of 21.7 for 6 months. The average Breast Implant Size was 360 cc’s and 73% chose silicone gel filled breast implants over saline. These demographics are very similar to my San Francisco Bay Area Breast Implant patient population.
Mommies get Breast Augmentation. The Mommy Makeover above includes a Tummy Tuck and Breast Augmentation.
How Happy are Breast Augmentation Patients?
Significant improvement in patient satisfaction was demonstrated at 6 weeks and 6 months after Breast Augmentation in multiple areas including:
- Satisfaction with Breasts (p<0.001 Kazis effect size of 3.66)
- Psychosocial well-being (p<0.001 Kazis effect size of 2.39)
- Sexual well-being (p<0.001 Kazis effect size of 2.56)
Younger women tended to be more satisfied with their “new” breasts than older women. Not surprising, since younger women tend to have firmer breasts and more elastic breast skin, and both factors contribute to better results. Younger and perkier breasts are also less likely to require a Breast Lift. The study also confirmed that it can take months to adjust physically to Breast Enhancement. Whether this is due to the demands of the Breast Augmentation Surgery or getting used to larger breasts was not studied.
Breast Augmentation Before and Afters
Breasts that have always been small have an advantage when it comes to Breast Augmentation.
Breast Augmentation in the San Francisco Bay Area
Breast Augmentation Surgery in the San Francisco Bay Area, like in the United States in general, remains the most popular cosmetic plastic surgery. It is performed for women who develop small breasts, as well as women who lose breast volume after pregnancy or weight loss. If you are considering Breast Augmentation, more information is available on the San Francisco Plastic Surgery Blog and through the links in this article.
My goal is to provide you with a good foundation of the options for Breast Enhancement, but web sites cannot substitute for an in-person consultation with a Board Certified Plastic Surgeon.
To schedule your personal Breast Augmentation Consultation, call (925) 943-6353 or use the contact form in the margin.