Gynecomastia Reduction – Male Breast Reduction | San Francisco Bay Area

Posted November 11, 2019 in Breast Reduction, Breast Reduction (Men), Home, Liposuction

Between men and women, the breasts are an area with significant aesthetic differences. For both sexes, shape trumps size. However, size is particularly important for the masculine chest. Male breast enlargement is a source of embarrassment and a common reason that men both young and old seek plastic surgery.

Gynecomastia Reduction - before and after pictures

Gynecomastia Reduction Before and After Pictures – The before picture on the left is of an adolescent male who experienced sudden and severe gynecomastia development while still attending high school. He was more comfortable and happy in the after photo on the right.

Gynecomastia Reduction Surgery is a relatively short outpatient surgical procedure. Also known as Male Breast Reduction, it is often performed for men whose breast tissue has grown too large, making them unhappy with the appearance of their chest.

The Ideal Male Chest

Gynecomastia Reduction before and after photos - Male Bodybuilder

Gynecomastia Reduction before and after photos – The above Male Bodybuilder has spent a lot of time developing and contouring his chest. Unfortunately, he had a small amount of gynecomastia causing puffiness behind his nipples, left greater than right. Gynecomastia reduction improved his symmetry and put the icing on this beefcake.

While a man’s chest is generally flatter than a woman’s, it is not flat. A certain amount of projection and curvature is masculine. On the other hand, too much projection is feminizing. This applies to both the chest mound and the nipples. The lateral aspect of the ideal masculine chest ends at the edge of the pectoralis major muscle. Unlike a woman’s breasts, the masculine chest does not have “side-boob”, and male nipples are smaller and flatter.

Gynecomastia Reduction before and after photos - body builder side view

Gynecomastia Reduction before and after photos – This is the same body builder seen above. On the side view, his puffy nipples due to gynecomastia are more easily seen. The after photos shows his improved appearance.

What Is Gynecomastia?

Gynecomastia is overdeveloped breast tissue in men. It can be a source of embarrassment both in and out of clothing. Even in clothing, an overdeveloped male chest can be hard to disguise. The majority of the breast tissue in a man is behind the nipple. Excess fullness in this area causes the areolae (the circles of colored skin around the nipple) to over project, making the nipples stick out. The more prominent the tissue, the harder it may be to participate in normal activities such as going to the beach or swimming. This is often referred to as “puffy nipples”.

What Is Gynecomastia Reduction?

Gynecomastia Reduction is an outpatient surgical procedure which removes disproportionate breast tissue and fat from the male chest. It is the most effective way to remove gynecomastia and masculinize the chest. Male Breast Reduction, whether for body builders and regular Joes, is one of the most satisfying services I provide every week as a Cosmetic Plastic SurgeonWalnut Creek Plastic Surgery practice.

Gynecomastia reduction with liposuction and direct excision - before and after photos

Gynecomastia reduction before and after photos: Even this hairy chest looked feminine in a shirt. A combination of Liposuction and direct excision was used to remove the excess breast tissue and masculinize this patient’s chest.

Gynecomastia Reduction is usually performed with a combination of Liposuction and direct excision of the excess breast tissue. This two-pronged approach allows for the removal of excess fat via small incisions in the armpits and removal of the firm, rubbery breast tissue from beneath the nipples via periareolar incisions. The incisions are usually discreet, but the results are clearly evident and very satisfying.

Gynecomastia Consultations

Gynecomastia Reduction Consultations should be sought from an experienced, Board Certified Plastic Surgeon. In the San Francisco Bay Area, call (925) 943-6353 for your private and personal consultation appointment. More details about the procedure are available here, on the San Francisco Plastic Surgery Blog, but for the best information, there is no substitute for an in-person evaluation.

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Breast Revision Surgery Video

Posted November 04, 2019 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Home, Videos

Breast Augmentation remains one of the most frequently performed cosmetic plastic surgery operations. While the procedure remains the safest and most reliable means of Breast Enlargement, from time to time, patients may require Breast Augmentation Revision Surgery.

Saline Breast Implant Deflation Replacement Before and After Pictures

Saline Breast Implant Deflation Replacement Before and After Pictures

Saline Breast Implant Deflation Replacement Before and After Pictures – On the left, this patient’s saline breast implant has clearly deflated. On the right, after breast augmentation revision surgery, both breast implants were replaced and the breasts are now rejuvenated. A great time to consider changing the size, style or type of breast implant is when you need to replace a deflated device.

Breast Implant Revision Video Presentation

Today’s Plastic Surgery Video outlines several of the most common Breast Implant Revision Surgeries, and illustrates what is possible with numerous Breast Augmentation Revision Before and After Pictures. My segment segment first aired on, the San Francisco Bay Area’s news station KRON 4’s Body Beautiful. I have made numerous appearances during the show’s 12-years run, I have had the opportunity to inform millions of viewers about the pros and cons of Cosmetic Plastic Surgery.

Breast Revision Surgery Video Presentation as seen on KRON 4’s Body Beautiful

Breast Augmentation Revision Surgery

Breast Augmentation Revision Surgery for Capsular Contracture - Before and After Pictures

Breast Augmentation Revision Surgery for Capsular Contracture – Before and After Pictures show treatment of capsular contracture of this patient’s right breast implant. The results are improved symmetry, softness and patient satisfaction.

The majority of patients do not require revision surgery; however, Breast Implants are not considered lifetime devices. As such, they may require maintenance. The care of Breast Augmentation patients has become a specialty unto itself. Breast Augmentation Revision encompasses a variety of procedures including surgeries to adjust breast implant size, soften capsular contracture, reposition implants that have shifted and replace implants that have ruptured.

Breast Implant Revision Surgery for Symmastia - Before and After Pictures

Breast Implant Revision Surgery for Symmastia – Before and After Pictures. This patient developed symmastia, uni-boob or breast-loafing of her breast implants. Before correction, she had breast implant malposition with both symmastia and bottoming-out. After breast revision surgery, her breasts are separated and elevated to a more aesthetic position.

Breast Augmentation Revision Surgery Consultations

Breast Implant Revision is an important aspect of maintaining Breast Augmentation aesthetics. Like primary Breast Augmentation, careful attention to detail is necessary. If you are considering Breast Implant Revision surgery, be certain to consult with an experienced and Board Certified Plastic Surgeon. In the San Francisco Bay Area, call (925) 943-6353 to schedule your private consultation appointment.

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Liposuction Before and After Video

Posted October 28, 2019 in Home, Liposuction, Videos

Liposuction of the Abdomen Before And After Pictures

Liposuction removes disproportionate fat from the abdomen and other areas of the body.

Today’s Liposuction Video

Today’s video presentation is all about Liposuction. Liposuction is a cosmetic plastic surgery procedure used to vacuum away unwanted fat via small, discrete incisions. In the example above, Liposuction contoured the abdominal wall and an Abdominoplasty was unnecessary. The Liposuction Video below is from the San Francisco Bay Area’s News Station, and first aired on KRON 4’s, Body Beautiful. The video provides details about the procedure and illustrates actual results with before and after pictures narrated by San Francisco Bay Area, Board Certified Plastic Surgeon, Dr. Joseph Mele.

Liposuction Video Presentation as seen on TV

The History Of Liposuction

Liposuction has been around for almost 100 years. French surgeon Charles Dujarier first introduced the concept of body contouring with fat removal in the 1920’s. Often a curette, a small sharp edged spoon, was used to scrape, shift or remove fat. The results were often unpredictable and irregular.

Blunt Cannulas and Tumescent Liposuction

Liposuction became more practical and reliable in the mid 1970’s after Italian surgeons, Arpad and Giorgio Fischer, father and son, developed liposuction in Rome utilizing the blunt style of cannula which we still use today. In 1982, French surgeons Yves-Gerard Illouz and Pierre Fournier improved the technique. Illouz was one of the first to popularize the injection of tumescent fluid prior to liposuction, and Fournier developed the criss-cross technique using multiple access points to smooth the results. The combination of blunt cannulas, “wet” techniques and multiple crisscrossing incisions made Liposuction safer, allowed for more extensive fat removal and provided superior results.

Liposuction of the Abdomen and Chest before and after pictures

Liposuction of the Abdomen and Chest contours these areas, reduces fat and improves body proportions.

In the mid 90’s, Dr. Klein revolutionized liposuction with the introduction of the tumescent technique. The introduction of Tumescent Liposuction introduces local anesthetic (like Lidocaine) and a drug that shrinks capillaries (epinephrine) into the wetting solution. This provides pain control and less bleeding allowing for the safe aspiration of larger volumes of fat. It is what allowed liposuction to become a mainstream cosmetic plastic surgery procedure. Despite attempts to improve liposuction outcomes with lasers and ultrasound, Tumescent Liposuction remains the gold standard for Liposuction today.

Liposuction before and after pictures of the neck and under the chin

Liposuction can remove stubborn fat from the neck and under the chin.

Ultrasound, Lasers and Power, Oh My

During the 1990’s various forms of energy were added to Liposuction in an attempt to further increase its effectiveness. The main goal of these devices was to provide additional skin shrinkage. While demonstrable, in their current form, the amount of skin shrinkage provided with these techniques remains minimal. Sadly, corporations have become invested in these “name brand” procedures. They advertise positive, discounting the small magnitude of these advantages and do not discuss the downsides, which can be significant. The use of high energy liposuction devices has lead to an increase in burns and other complications with debatable improvement at best.

Liposuction Consultations

If you are considering Liposuction, be certain to select an experienced and Board Certified Plastic Surgeon like Dr. Joseph Mele. In the San Francisco Bay Area call (925) 943-6353 and schedule a private consultation appointment tailored specifically to your needs.

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Dr. Mele Voted Top 10 Plastic Surgeon by the National Academy of Plastic Surgeons

Posted October 25, 2019 in Home, Plastic Surgery Societies

Top 10 Plastic Surgeon Award 2019

Dr. Joseph Mele was awarded the Top 10 Plastic Surgeon Award by the National Academy of Plastic Surgeons for 2019.

The National Academy of Plastic Surgeons recognizes dynamic Plastic Surgeons who have achieved and continue to maintain the highest standards of excellence. Their mission statement is:

  • The mission of the National Academy of Plastic Surgeons is to recognize annually the most qualified and accomplished Plastic Surgeons. Membership in each specific category is by invitation-only after a selection process that examines the Plastic Surgeon’s career achievements, professional experience, peer reputation, patient satisfaction, other notable honors, media notoriety, and community impact.

    Membership selection is intended to help prospective new Patients identify the absolute best Plastic Surgeon in their State or area. ​

Elite Plastic Surgeon

Dr. Joseph Mele, award winning San Francisco Bay Area Plastic Surgeon

Dr. Joseph Mele, award winning San Francisco Bay Area Plastic Surgeon

Because of the NAOPS’s stringent standards, less than 1% of Plastic Surgeons nationwide will receive this award. I am humbled to receive this honor, which is based not only on career achievements, peer reputation and most important to me, patient satisfaction. Thank you to my peers, my patients and the National Academy of Plastic Surgeons for this unique and elite distinction.

Cosmetic Plastic Surgery Consultations

Individual care is what my Walnut Creek Plastic Surgery office is known for. If you are considering Cosmetic Plastic Surgery in the San Francisco Bay Area, call (925) 943-6353 and schedule a private consultation appointment tailored to your specific needs.

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Skin Tightening After Massive Weight Loss Video

Posted October 15, 2019 in Arm Lift (Brachioplasty), Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Breast Reduction, Breast Reduction (Men), Breast Reduction (Women), Butt Lifts, Home, Lower Body Lift (Belt Lipectomy), Mommy Makeover, Post-Bariatric Surgery (After Weight Loss), Thigh Lifts (Thighplasty), Tummy Tuck (Abdominoplasty), Videos

Bariatric Surgery has made massive weight loss commonplace. If you have ever watched My 600-lb Life you know what I am talking about. The show also airs in Colombia under a more appropriate title: Kilos Mortales. The title translates to Deadly Kilos, putting the emphasis on the fact that excess weight is deadly.

Massive Weight

Tummy Tuck after weight loss before and after pictures

Tummy Tuck after weight loss before and after pictures – The pounds and inches are gone, but the skin that used to cover them persists. A Tummy Tuck (Abdominoplasty) tightens the abdominal muscles and removes the excess skin and fat that remain after massive weight loss.

Morbid Obesity is no joke. It is associated with multiple health problems including heart disease, high blood pressure, strokes, high cholesterol and diabetes. Moreover, it makes taking care of oneself challenging. An individual is considered morbidly obese if he or she is 100 pounds over their ideal body weight, has a BMI of 40 or more, or 35 or more and experiencing obesity-related health conditions, such as high blood pressure or diabetes.

Achieving Massive Weight Loss

Chest Reduction (Male Breast Reduction) before and after pictures

Chest Reduction (Male Breast Reduction) before and after pictures – the chest can be left with excess skin too. In this case, gynecomastia reduction was combined with a skin reduction procedure to reveal a more masculine chest. The scar is in the inframammary folds under the breasts.

Before Weight Loss Surgery, losing weight depended solely on lifestyle modifications including diet and exercise. While effective, the process is slow and requires daily compliance. Today, weight loss surgery, also known as Bariatric Surgery, is an option that can significantly augment weight loss efforts. The availability of Bariatric Surgery has made massive weight loss attainable for more people.

Individuals meeting the criteria for surgical intervention have an option to help them meet their weight loss goals. Bariatric Surgery helps with weight loss in two ways. The first is mechanical and the second effects absorption. The mechanical aspect of weight loss surgery reduces intake. By making one feel full more quickly, negative feedback is provided for overindulgence. The result is that less food is consumed.

The second mechanism is decreasing the absorption of the food that is eaten. Internal bypasses are created surgically to shorten the gut and route the food past areas where it is better absorbed. By allowing food to pass through incompletely digested, the number of calories absorbed is reduced. Overall, less food is consumed and fewer calories are absorbed after Bariatric Surgery.

The Health Benefits Of Weight Loss

There are many Health Benefits associated with weight loss. Blood pressure can return to normal allowing the dose of antihypertensive medications to be decreased and sometimes even stopped. Elevated glucose levels can also decrease, which may mean stopping supplemental insulin and oral diabetes medications. As high blood pressure and diabetes come under control, the complications and mortality associated with them also decrease.

Where Did All This Skin Come From?

For many, the weight loss journey doesn’t end when the pounds disappear. When we gain weight our skin expands. The tension placed on the skin causes it to grow to cover the additional girth. Unfortunately, when we lose weight, the excess skin is not absorbed and often it does not recoil.

Mommy Makeover before and after photos

Mommy Makeover before and after photos – weight loss, like pregnancy, can lead to deflated breasts and loose bellies. The Mommy Makeover, originally designed to repair the damages of pregnancy, is modified for weight loss to provide enhancement of the breast and abdomen and create a more feminine physique.

The Excess Skin that remains after weight loss can be problematic and bothersome for Bariatric Surgery patients. Often, the residual skin becomes lax and folds upon itself causing pain, rashes and infections. Additionally, excess skin makes it challenging to find comfortable clothing and difficult to perform many activities of daily living.

Massive Tummy Tuck before and after pictures

Massive Tummy Tuck before and after pictures – This tummy tuck has been “super-sized” to address over stretching of the abdominal muscles and generous amounts of excess, redundant skin.

Excess skin of the arms, neck, chest, abdomen, back and thighs is common after massive weight loss and the reason many Bariatric Patients seek Post Bariatric Plastic Surgery to complete their transformation.

Post Bariatric Plastic Surgery

Arm lift before and after pictures

Arm lift before and after pictures – The weight is gone, but the arms still don’t fit in a sleeve. An Arm Lift (Brachioplasty) removes the excess skin and slims the arms allowing them to better fit into a sleeve.

Post Bariatric Plastic Surgery is a specialized branch of Plastic Surgery that deals with the extra skin left after weight loss. It is often referred to as skin removal surgery. Many of the procedures are similar to those used for normal amounts of weight loss or after pregnancy, but often they are modified (super-sized) to treat the enormous skin excesses seen after massive weight loss.

Post Bariatric Plastic Surgery Video

Today’s video is from KRON 4’s Body Beautiful and includes many of the commonly performed Post Bariatric Plastic Surgery Procedures. I perform many including: Tummy Tucks, Body Lifts, Arm Lifts, Breast Reduction, Chest Reduction, Breast Augmentation, Breast Lifts, Thigh Lifts, Buttock Lifts, Neck Lifts and Face Lifts. These procedures are highlighted on my web site’s Post Bariatric Plastic Surgery Page and on each procedure’s specific page.

Post Bariatric Plastic Surgery Consultations

The American Society of Bariatric Plastic Surgeons

Dr. Mele is an active member of the American Society of Bariatric Plastic Surgeons, a professional society of board certified plastic surgeons specializing in skin removal surgery after massive weight loss.

If you have lost a massive amount of weight and are unhappy with excess skin, call (925) 943-6353 today to schedule a personalized consultation appointment. As a member of the American Society of Bariatric Plastic Surgeons, I am and experienced specialist in these types of plastic surgery procedures, and would be happy to guide you through the process.

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Breast Cancer Awareness Means Men Too

Posted October 07, 2019 in Breast Cancer Awareness, Breast Reduction (Men), Home, Patient Safety

October is Breast Cancer Awareness Month.

October is Breast Cancer Awareness month, so check your breasts and follow-up with your healthcare provider for any abnormalities. Men get breast cancer too, so everyone needs to check. Getting started is simple and painless.

Breast Cancer Awareness

October is Breast Cancer Awareness Month. We all, women and men alike, need to take a few minutes to take care of ourselves. We have all heard the sound bites. One in eight women get breast cancer, and only 20% have a family history of breast cancer.

Breast Cancer in Men is rare. One in 1000 men will develop breast cancer, and less than 1% of all breast cancer cases develop in men. This may be because men have fewer breast cells and lower estrogen levels. On the other hand, early detection in men, while somewhat easier, is even more important than for women. Smaller breasts mean that the cancer cells can escape the breast faster and invade locally more quickly, especially when treatment is delayed by assuming men don’t get breast cancer.

According to the American Cancer Society, there will be about 3000 new cases of invasive breast cancer in men in the U.S. this year and about 500 men will die from the disease, and black men tend to have a worse prognosis.

Breast Cancer Detection

The most common presentation of Breast Cancer in men is a hard, painless lump underneath the nipple and areola. The lump can be fixed and it may be hard to determine the edges as the cancer invades the surrounding normal tissues. For 67-year-old Mathew Knowles, perhaps know better as Solange and Beyonce’s father, the first indication that something was wrong was when he and his wife noticed small dots of blood on his shirts and bedsheets.

Matthew Knowles, seen here with his daughter Beyonce, was recently diagnosed with breast cancer.

Matthew Knowles, seen here with his daughter Beyonce, was recently diagnosed with breast cancer.

Mister Knowles was on Good Morning America last Wednesday with host Michael Strahan, sharing his experiences and encouraging men and women to do their breast self-exams and get tested promptly. He had surgery at the end of July, and in his words is doing “really good.”

“I’m hoping by me coming here today, speaking out, letting folks know that you can survive this. But it has to be early detection. And I can’t overemphasize the word early,” he said. Well done Beyonce’s dad. Well done.

Breast Cancer Genetics

Although treatment outcomes are very similar to women at the same stage of detection, a man diagnosed with breast cancer should also consider seeing a genetics counselor for a consultation. If a man tests positive for a defective gene like BRCA1 or BRCA2, it can lead to a future diagnosis of breast cancer and his children have a 50% chance of carrying the gene. These statistics come from the National Breast Cancer Foundation.

KISS drummer Peter Criss is an outspoken advocate for male breast cancer awareness.

KISS drummer Peter Criss is an outspoken advocate for male breast cancer awareness. In his words, “You don’t need boobs to get breast cancer.”

Peter Criss found a lump in his left breast after a workout in 2007. The legendary KISS drummer survives after successful treatment, and he remains an outspoken advocate for male breast cancer awareness.

A male child of a man with breast cancer who inherits the defective BRCA2 gene has an approximately 6% chance of eventually developing breast cancer and just over 1% chance with BRCA1. A female child of a man with breast cancer who inherits the defective gene has a risk between 40% and 80% of eventually developing breast cancer. Men with a genetic predisposition to breast cancer are also at a higher risk of getting prostate cancer at a younger age.

Macho Men Get Breast Cancer Too

Richard Roundtree, the actor and model, exploded onto the big screen in 1971 as John Shaft, an action hero who took no guff. As an actor, Richard Roundtree’s Shaft is as macho as a man can be. He was diagnosed with breast cancer in 1993 and underwent a double mastectomy and chemotherapy. I am happy to report that he is alive and well at age 77. Early detection and treatment are key. I can dig it!.

Richard Roundtree was diagnosed with breast cancer in 1993 and underwent a double mastectomy and chemotherapy, and is alive and well at 77

Richard Roundtree was diagnosed with breast cancer in 1993 and underwent a double mastectomy and chemotherapy, and is alive and well at 77. According to the theme song, “Who’s the cat that won’t cop out when there’s danger all about?” Can ya dig it?

Rod Roddy, Come On Down

You may not recognize the name, but if you are old enough to remember Bob Barker on the Price is Right, you will remember Rod’s voice. As the hyper-energetic off-stage announcer he would call out an audience member’s name followed by one of the most iconic catchphrases to grace daytime game shows, “Come on down! You’re the next contestant on the Price is Right!” Even though the “Come on down,” was first uttered by Johnny Olson, Rod Roddy belted it out for 17 years, longer than any other announcer.

The Price is Right announcer Rod Roddy had both breast and colon cancer during his lifetime.

The Price is Right announcer Rod Roddy had both breast and colon cancer during his lifetime.

Breast cancer and colon cancer can travel together. On September 11, 2001, Mr. Roddy was diagnosed with colon cancer, and in 2002 had a recurrence. In March of 2003, he was diagnosed with Breast Cancer. In the last few years of his life, he became a spokesperson for early detection of cancer. In an interview with CBS, he said, “I could have prevented all this with a colonoscopy, and of course, that’s the campaign I’ve been on since I had the first surgery. To everybody out there, get a mammogram! It can happen to men, too.”

Breast Cancer and Politics

Edward William Brooke III was an American Republican politician. In 1966, he became the first African American popularly elected to the United States Senate, and he represented Massachusetts in the Senate for 12 years, from 1967 to 1979. In September 2002, he was diagnosed with breast cancer and assumed a national role in raising awareness of the disease among men.

In 1966, Edward Brooke became the first African-American elected to the US Senate. He is seen here with his mother after receiving the 1978 Man of the Year Award. In September of 2002, Senator Brooke was diagnosed with breast cancer. (AP)

In 1966, Edward Brooke became the first African-American elected to the US Senate. He is seen here with his mother after receiving the 1978 Man of the Year Award. In September of 2002, Senator Brooke was diagnosed with breast cancer. (AP)

Brooke experienced pain under his right nipple. Most breast cancer is painless, but pain harder to ignore than a lump. His first thought was that he had pulled a muscle from gardening, but it was more serious. It was breast cancer. He underwent a double mastectomy, and remained cancer free until his death in January 2015 at age 95.

You Better Check Yourself…

There are expected to be about 3000 new cases of male breast cancer diagnosed this year. For women it is closer to 300,000 cases, and, an estimated 42,000 women will die from breast cancer in the U.S.. The good news is that 62% of breast cancer cases are diagnosed early when they are still localized. In localized cases, the 5-year survival rate is 99%.

I tell all my patients, “If something doesn’t seem right; it might be wrong. Call me.” Early detection and intervention is key for all medical issues. It allows more options for treatment and better outcomes. There is little downside. If there’s nothing wrong, you wasted a little time to find out that you are alright, plus you get peace of mind. On the other hand, if you have a problem, treatment can begin. All breast lumps and bumps need to be evaluated by your physician in a timely fashion, so if you have a lump in your breast, contact your physician today.

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Vaping, Plastic Surgery and Life

Posted September 16, 2019 in Home, Patient Safety, Smoking and Plastic Surgery

I’ve written about smoking and plastic surgery and even vaping and plastic surgery previously. However, as the use of electronic cigarettes becomes more widespread, we are learning more about the negative consequences associated with vaping.

Vaping Done Properly is Toxic

We are only just beginning to learn the problems that vaping causes.

Last night’s news links six deaths to vaping. Hundreds of people have been sickened, and sadly, most have been previously healthy teens and young adults. Public health officials are trying to pinpoint the chemistry and mechanisms causing vaping-associated pulmonary illness.

Cheaper Is Not Better

Just like Plastic Surgery, when is comes to vaping, cheaper is not better. This applies to cheaper vapes whose batteries explode and bootleg vape cartridges containing toxic pesticides. Counterfeit THC oil is especially toxic as it has been demonstrated to release deadly hydrogen cyanide.

Vaping And Surgery

Since smoking has been around longer than vaping, much more is known about the health problems associated with smoking. When it comes to smoking and surgery, the combination is not good. Higher risks of infection and wound healing problems are associated with smoking. For example, smokers are six times more likely to have wound problems after a facelift.

Benefits of smoking cessation

How long does it take for your body to recover from smoking? The above timeline gives just a few examples and includes the average time it takes for each health benefits to be seen.

At first, it was hoped that vaping would have fewer detrimental effects than smoking. We know that smoking causes contraction and injury of the blood vessels in the skin which decreases the perfusion and oxygen delivery needed for wound healing. New evidence shows that vaping also has undesirable consequences. We won’t know what vaping is doing to our bodies for another 40 years, but the chart above may be a good indicator of the future findings.

Vaping and Nicotine

Nicotine, derived from tobacco, is the main addictive ingredient in vaping cartridges. Previous studies have shown that nicotinized electronic cigarettes cause cell damage and inflammation. A recent paper from the University of Pennsylvania School of Medicine explored the effect of the aerosol alone on endothelial function, and the results are frightening.

E-cigarettes Damage Your Blood Vessels

The article showed that a single e-cigarette can be harmful to your blood vessels. The article’s title is a mouthful: Acute Effects of Electronic Cigarette Aerosol Inhalation on Vascular Function Detected at Quantitative MRI. The results were published in the August 20, 2019, issue of the journal Radiology.

Long Term Effects of Vaping

The investigators at Penn concluded that, “Inhaling nicotine-free electronic cigarette aerosol transiently impacted endothelial function in healthy nonsmokers. Further studies are needed to address the potentially adverse long-term effects on vascular health.” Unfortunately, long term effects take a long time to discover. It has taken decades to demonstrate the enormous number of ill effects of smoking tobacco, and yet there are still deniers.

Both smoking and vaping are highly addictive, and both industries target youth to maximize the person-hours of smoking they can capture. Why else would a company offer sour gummy flavored vape juice? Since young people tend to be healthier and have more reserve, the ill effects are harder to detect in this population.

Ironically, the recent industry pivot to offer vaping as a method to stop smoking may attract an older, weaker population, so the problems associated with vaping may become apparent more quickly. However, the fact that so many young people have had dramatic, life-threatening health problems should be a clue that the use of e-cigarettes is hazardous.

Protecting Children From Candy-Coated Vaping

Last year, San Francisco voters upheld a ban on flavored vaping products. Michigan, not California, is the first state to ban flavored e-cigarettes. Last week, Governor Andrew Cuomo banned the sale of flavored electronic cigarettes in New York through an emergency executive action. Even President Trump is proposing a ban on vape flavors. While good intentioned, it will likely have little effect on teen vaping as they can already flavor their own cartridges with readily available dessert tastes.

Banning Vaping Altogether

This summer, San Francisco took the battle a step further when Mayor London Breed signed an ordinance effectively banning e-cigarette sales within the city, despite the fact that Juul is headquartered in SF. Unfortunately, since last year, the number of vapers has more than doubled. Again, the intentions are good; however, people have to want to quit. If we remember prohibition, many people died from unregulated bootleg liquor, and we have already seen deaths from bootleg vape cartridges despite both vaping and marijuana being legal currently.

Plastic Surgery And Vaping

Smoking and Aging - Twin Study

Can you tell which twin smokes? If you guessed the twin on the right, you are correct. Compared to her non-smoking sister in blue, the twin in red has advanced signs of aging including: marked loss of mid and lower face fullness, deeper nasolabial folds and smoker’s lines around the lips.

Like most plastic surgeons, I recommend halting all smoking and vaping for four weeks prior to any surgery involving skin flaps like Facelifts, Tummy Tucks and Breast Reductions. Multiple studies have demonstrated that stopping prior to surgery significantly decreases the preoperative risks; moreover, stopping also eliminates a bad habit that accelerates aging. For this reason, many patients remain non-smokers after surgery. Kicking the habit is not easy, but it is definitely worth it.

Whether you are a current smoker, former smoker or non-smoker and are considering plastic surgery, be sure to consult with a Board Certified Plastic Surgeon near you. In the San Francisco Bay Area, call (925) 943-6353 to schedule your private appointment in our Walnut Creek Plastic Surgery Center.

UPDATE 09/17/19 – Seventh vaping related death happened in California today.

UPDATE 09/18/19 – Michigan bans all flavored vaping products.

UPDATE 09/19/19 – Eighth vaping related death happened in Missouri today.

UPDATE 9/24/19 – Ninth vaping related death, the second in Kansas.

UPDATE 9/25/19 – Since this article was published a week ago, hundreds more vaping related injuries have been reported. Where is the FDA action? Cities and states have responded with restrictions designed to protect minors, and more recently adults, from this elective and sometimes deadly habit, but this is the FDA’s primary role. In the name of public safety and disease prevention, the FDA requested that Allergan® stop selling textured breast implants linked to fewer and more treatable injuries which occurred over decades. There have been a greater number of more serious injuries from vaping in the last 6 weeks, where is the recall order?

UPDATE 9/30/19 – 12 to 13 confirmed vaping deaths and 805 cases of lung injury. 77% used both tobacco and THC with 36% vaping only TNC and 16% vaping only tobacco. According to the CDC approximately 70% of lung injured patients said they used “Dank Vapes.” “Dank Vapes” appears to be the leader in a large class of counterfeit brands of vape cartridges with THC. Others labels include TKO, Off White, Moon Rocks, Cookies, Chronic Carts, Mario Carts, Kingpen, California Confidential, Cereal Carts and Supreme G.

UPDATE 10/03/19 – 18 deaths and 1080 hospitalizations.

UPDATE 10/17/19 – 31 deaths and 1300 hospitalizations.

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Plastic Surgery After Massive Weight Loss

Posted September 09, 2019 in Arm Lift (Brachioplasty), Breast Lift (Mastopexy), Butt Lifts, Facelift (Rhytidectomy), Home, Lower Body Lift (Belt Lipectomy), Neck Lift (Rhytidectomy), Post-Bariatric Surgery (After Weight Loss), Thigh Lifts (Thighplasty), Tummy Tuck (Abdominoplasty)

Excessive weight can cause diabetes, high blood pressure, increased serum cholesterol and other health problems. For mild cases, diet and exercise are often effective treatment. For more severe cases weight loss surgery, Bariatric Surgery, may be recommended.

Bariatric Surgery has been proven successful for weight reduction, although proper diet and exercise are still required. Patients can lose tens to hundreds of pounds. Despite the fat is loss, excess skin often remains. Since it is uncommon for the skin to shrink sufficiently to the new body contours, patients often still feel uncomfortable with their appearance. Often, Post-Bariatric Plastic Surgery is requested to remove the excess skin.

Post-Bariatric Plastic Surgery Before And Afters

Extended Tummy Tuck Before and After Pictures Post-Bariatric Plastic Surgery

Post-Bariatric Plastic Surgery specializes in skin reduction after massive weight loss. Above, Extended Tummy Tuck Before and After Pictures show tightening of the abdominal wall and removal of the excess skin and fat from the abdominal wall and flanks.

Tummy Tuck Before and Afters

This post has several examples of Post-Bariatric Plastic Surgery. The Post-Bariatric Plastic Surgery Before And After Pictures above show what an extended Tummy Tuck can do. Tummy Tucks after massive weight loss are similar to abdominoplasty after pregnancy, but often need to be extended. The ultimate extended tummy tuck goes all the way around the trunk and is called a lower body lift

Arm Lift Before and Afters

Arm Lift Before and After Pictures - Post-Bariatric Plastic Surgery

An Arm Lift, also called a Brachioplasty, removes the excess skin that remains after weight loss.

Arm Lifts are another common Post-Bariatric Plastic Surgery. It is especially helpful in cases with redundant upper arm skin that makes it uncomfortable or impossible to wear normal sleeves.

Breast Augmentation with Breast Lift Before and Afters

Breast Augmentation with Breast Lift Before and After Pictures

After massive weight loss, the breasts often sag and appear deflated. Breast Augmentation with a Breast Lift can help restore the breasts to a more youthful and attractive state.

Breast Augmentation and Breast Lift (Mastopexy) surgery can help restore the breasts after childbirth and weight loss. The combination is particularly helpful after massive weight loss. A Breast Implant can restore volume, while a breast lift corrects sagging. When combined, the procedure is called Mastopexy Augmentation.

Breast Reduction for Men

Breast reduction for Men, also known as Gynecomastia Reduction usually involves removing fat and glandular tissue from behind the nipple. After massive weight loss, however, excess chest skin is very common and leads to sagging of the breasts. In the Breast Reduction Before and After Pictures below, simply removing the excess tissue from the breasts would leave the chest skin empty and saggy.

Gynecomastia Reduction Before and After Pictures

Male Breast Reduction after massive weight loss - post-bariatric plastic surgery  before and after pictures

The Post-Bariatric Plastic Surgery before and after pictures above show male breast reduction with removal of excess skin via an incision along the bottom of the breasts.

Skin removal for Breast Reduction is almost always needed for women, but rarely required for men. When it is necessary, it is almost always in association with massive weight loss like that seen after Bariatric Surgery. In the case above, the excess skin was removed via incisions placed in the fold under the breasts. If the nipples are below the fold, repositioning the nipples higher onto the chest is recommended for optimal results.

Post-Bariatric Plastic Surgery Consultations

If you have had Bariatric Surgery or have lost a lot of weight and are bothered by the excess skin that remains, consider a consultation for Post-Bariatric Plastic Surgery. In the San Francisco Bay Area call (925) 943-6353 to schedule a private consultation appointment. As a member of the American Society of Post Bariatric Plastic Surgeons, it is an area of Plastic Surgery in which I have experience and interest.

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Breast Augmentation Revision Surgery – SF Bay Area

Posted September 02, 2019 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Removal, Breast Implant Revision Surgery, Breast Lift (Mastopexy), Capsular Contracture, Home

Breast Implant Revision Surgery is performed when there is a problem with the breast implants. Some problems are subjective, for example when the implants are judged to be too small or too large. Other problems are objective, such as issues with the breasts’ shape, firmness, symmetry or position. These are commonly associated with Capsular Contracture and breast implant malposition. A third group of breast implant problems require urgent attention, like infections or exposure of the breast implants.

Today’s post reviews Breast Revision Surgery and the treatment for some of the more common Breast Augmentation Problems.

Capsular Contracture Correction

Capsular Contracture occurs when the normal pocket that holds the breast implant in place becomes tight. It can be tight all around the implant causing firmness and a reduction in the apparent size of the implant(s), or it can be along one side, pushing the implant out of position, usually upward.

Breast Implant Revision for Capsular Contracture Before and After Pictures - Front View

These breast augmentation revision before and after pictures show grade III/IV capsular contracture of the right breast preoperatively, and the result of removing the tight capsule (capsulectomy) thus lowering the breast mound to match the left side. (Click image for uncensored view.)

In the Breast Implant Revision Before and After Pictures above, the right breast mound is significantly higher, and harder, than the normal appearing left breast mound (Grade III Capsular Contracture). This is a problem for the patient both in and out of clothing, and with time, the right breast has become tender (Grade IV Capsular Contracture).

This Breast Implant Malposition was treated with a complete capsulectomy, removal of the tight scar. The result is a softer breast, that is lowered back to its normal and symmetrical position. The areolae are also more symmetrical postoperatively. To see the nipple position, click or touch the picture above and the censoring will be removed. Tap again to replace it.

Symmastia Correction for Uniboob

Symmastia is a specific type of Breast Implant Malposition where the implant(s) move toward the midline. It is more common in women with tighter skin and larger, high profile breast implants. Just like raising the towers on the Golden Gate Bridge would raise the bridge’s cables across the mouth of the San Francisco Bay, the high profile breast implants have raised the skin across the sternum causing a Uniboob Deformity or “Bread Loafing”. In addition, this patient has “bottoming-out” of her breast implants, greater on her right side.

Breast Implant Revision for Symastia or Uniboob Before and After Pictures - Front View

These breast augmentation revision before and after pictures show symmastia of the breasts and bottoming out (right greater than left) preoperatively. The after photo shows the result of symmastia repair and breast implant replacement with smaller breast implants and raising of the inframammary folds (IMFs) thus getting rid of the uniboob bread-loafing of the implants in the midline. (Click image for uncensored view.)

The Symmastia Deformity was corrected by both repairing the damage and addressing the original problem to prevent recurrence. The damage was repaired by closing the original capsule medially, forming a pseudoneopocket in the correct anatomical position and reinforcing the repair. Since the original cause was breast implants too large for the chest, they were replaced with smaller implants. The after picture shows that the breasts have been elevated and separated into two separate breast mounds. Breast symmetry is improved and the reduction in breast implant size should help to maintain the superior cosmetic result.

Stage 1 – Breast Implant Removal for Impending Exposure

Breast Implant Exposure and Breast Implant Infections are emergencies, and require prompt surgical intervention. In the picture below, the square area at the base of her left breast is the lower edge of the breast implant which is about to erode through the breast skin. Once exposed, infection is inevitable, so the implant was removed promptly to prevent this eventuality.

Breast Implant Removal for impending breast implant exposure Before and After Pictures - Front View

These breast augmentation revision before and after pictures show stage one of treatment for breast implant exposure. Once an implant is exposed, it requires removal to prevent infection and sepsis. The after photo reveals that the left breast was smaller before breast augmentation, confirmed by the removal of a larger breast implant during surgery. (Click image for uncensored view.)

An inframammary incision was used to remove the breast implant, and the damaged skin at the base of the breast was also removed to allow for a secure closure. Her left breast implant was larger than the right, because her left breast was smaller than her right breast before Breast Augmentation. The size discrepancy is apparent in the after picture

Stage 2 – Breast Implant Replacement after Exposure

After breast implant infection or exposure, a minimum of three months is allowed to pass before replacing the breast implant. This is to reduce the risk of another infection. After three months, the patient returned to the operating room for delayed Breast Implant Replacement.

Breast Implant Replacement after breast implant exposure Before and After Pictures - Front View

These breast augmentation revision before and after pictures show stage two of treatment for breast implant exposure. After the breast implant is removed, and the site heals for several months, the breast implant can be replaced. The after photo shows the restoration of symmetrical breast mounds after Asymmetrical Breast Augmentation. (Click image for uncensored view.)

The before and after pictures above show the results of the second stage of reconstruction. The breast implants were replaced without complications, and the patient was happy to have her figure back.

Breast Augmentation Revision Consultations

If you are considering Breast Augmentation Revision be certain to consult with an experienced and Board Certified Plastic Surgeon in your area.

If you are in the San Francisco Bay Area, call (925) 943-6353, to schedule a private consultation appointment in my Walnut Creek, CA, plastic surgery office.

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Breast Implant Removal in the San Francisco Bay Area

Posted August 26, 2019 in Breast Implant Removal, Breast Implant Revision Surgery, Home

Breast Implant Removal is performed for about 1% of all Breast Augmentation patients. It is not a common procedure. Often it is elective, but sometimes it is as necessary as it is unwanted.

Breast Implant Removal Before and After Pictures - Side View

These breast implant removal before and after pictures show the result of removing moderate sized breast implants from a woman with young, elastic skin. No lift was needed. (Click image for uncensored view.)

Why Breast Implants Are Removed

Breast Implant Removal is chosen for many reasons ranging from completely elective to emergency situations. Elective reasons include the desire to have smaller breast, anticipating pregnancy and breast feeding and even a desire to exchange the current breast implants for larger ones. Urgent situations include exposure and infection of the implants.

How Are Breast Implants Removed?

Breast Implant Removal With Breast Lift Before and After Pictures - Side View

These breast implant removal before and after pictures show the result of removing ptotic, “bottomed-out” breast implants with a Breast Lift performed at the same time. (Click image for uncensored view.)

Breast Implants are often removed during a relatively short outpatient procedure through the same incisions originally used to place them.

For Saline Breast Implants, after a small incision is made the implants are deflated and then removed. The empty shell allows removal through a smaller incision.

Silicone Breast Implants are not deflated prior to removal to avoid leaving silicone inside the breasts. If silicone breast implants are already ruptured, the capsule is often removed to contain the extravasated silicone and to prevent gel migration.

Breast Implant Removal Recovery

Breast Implant Removal Before and After Pictures - Side View

These breast implant removal before and after pictures show the result of removing large breast implants from breasts with less elastic skin. No lift was performed, so the skin sags after the loss of support previously provided by the breast implants. (Click image for uncensored view.)

Recovery after Elective Breast Implant Removal is normally just a few days. If a capsulectomy is performed, a drain is often placed, and it may take longer for the swelling to subside. Aesthetically, the appearance of the breasts continues to improve for several months as the skin recoils postoperatively.

BioCell® Textured Breast Implants

Since the recall of BioCell® Textured Breast Implants a few weeks ago, I have received several phone inquiries regarding breast implant removal. This textured surface is associated with a small risk of developing BIA-ALCL; however, the FDA’s current recommendation is to leave the implants in place and follow them clinically for signs and symptoms including enlargement due to fluid collections around the implants and swelling.

Despite the FDA’s current recommendations, some patients feel more comfortable having their BioCell® textured breast implants removed or replaced. Allergan® will provide smooth replacement implants at not charge (until July 24, 2021). Since the FDA does not recommend removal, there is no financial support available for the elective surgical removal of BioCell® textured breast implants.

Breast Implant Removal Consultations

If you are considering elective Breast Implant Removal, be certain to consult with an experienced and Board Certified Plastic Surgeon. In cases with larger implants and skin laxity, a Breast Lift may be recommended, either at the time of breast implant removal or staged after recovery.

An experienced plastic surgeon can discuss these and other options with you and offer personalized guidance during an in-person consultation appointment. To schedule a private consultation in our Walnut Creek plastic surgery office call (925) 943-6353.

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