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Breast implant-lymphoma connection debated

Although breast implants are without a doubt the most extensively studied medical devices on the market and are widely regarded as safe, a new report is raising questions about a possible connection between implants and a rare form of non-Hodgkin's Lymphoma called ALCL. Dr. Garry Brody, a Professor Emeritus of plastic surgery at USC, has been collecting a database about these rare cases, now totaling 25. Importantly, the tumor occurs in the scar capsule around the implants, not in the breast, and appears to be associated with a specific type of textured implant surface. A more important distinction is that these tumors behave in a very benign fashion and are highly curable by surgical removal of the capsule. This suggests that they are actually something other than ALCL despite the fact that they have all of the features of it under microscopic examination.
Although any report of cancer and breast implants is likely to be sensationalized, a cautious approach would be prudent in interpreting this story. In addition to the unanswered question of whether or not this is really a cancer, the incidence among women with implants appears to be in the range of one in a million, which could only be characterized as extremely rare. There will likely be other reports coming forth as the story is publicized, but given the number of women worldwide with implants, it is likely to remain a rarity. So in the good news column, place the fact that it is highly curable, and if it does have a causative link, it is to a type of implant that is less frequently used now (I have been using exclusively smooth-surface implants for augmentation for 15 years.) To keep this in perspective, it is the drive to the plastic surgeon's office that is the most dangerous part of breast implant surgery, not the implants.

Behind the scenes in a plastic surgery practice

While we hope that we make it look easy, there’s a lot that goes on behind the scenes to make a plastic surgery practice tick. It does simplify matters that I don’t do as much reconstructive surgery as I used to, so my day doesn’t typically start with hospital rounds anymore (I use the time to get to the gym instead.) We do surgery most days here in our accredited facility, which is a great convenience but also a lot of work to keep up to speed and comply with safety standards. Practices that do surgery in an offsite facility often have surgery days and clinic days, so some patients have to wait until the afternoon to start, all the while hungry and thirsty because no oral intake is allowed for anesthesia reasons. But maintaining all of the standards of accreditation for a surgery facility is time consuming work, including such things as regular inspection of all equipment, Advanced Cardiac Life Support certification by all clinical staff, quality assurance reviews, drills for emergency situations, and the like. And every case begins with a “time out” checklist, similar to what an airline pilot does before takeoff. I also serve as an inspector for AAAASF, the accrediting agency for our surgery facility ( http://www.aaaasf.org/consumers.php ), though our own inspections are of course done by an independent examiner.


There’s another aspect to my practice that isn’t typical, in that I use the same nursing staff in surgery as for patient consults, pre-op visits, and post-op care. The advantage of this is that the patient sees the same people before, during, and after surgery, which is a comfort and helps assure consistency. When the surgery is done at a facility separate from the practice, the surgeon has less control over the patient’s experience. The challenge is that my nurses have to possess the technical skills to assist in surgery as well as the people skills to work on the clinic side, and that is a special combination.

Of course before you ever get to the operating room, or the consultation room for that matter, you will have met the front office staff. Their challenge is finding time for all of the administrative chores involved in medical recordkeeping while still devoting 100% of their attention to you.

When it all works as planned, I find time for interesting clinical research projects, blogging, teaching, and learning. There’s not a lot of “down time” around here, and we (or at least I) wouldn’t have it any other way.

innovating the future of plastic surgery

I am off to Hawaii in a couple of days for the annual scientific meeting of the Northwest Society of Plastic Surgeons. I know you feel sorry for me, but you have to give credit to the society for including the state of Hawaii as a member, giving us an excuse to go there from chillier parts of the Northwest in February. As it turns out, I will be working, and I am just now putting the finishing touches on two talks I will be delivering. The first has the high-falutin’ title “Integrating the Future of Plastic Surgery.” If you are a regular reader here you will know that I am interested in trends, new technologies and techniques, and how we can best bring these to our patients for their benefit.


What I am going to talk about is an approach to problem-solving called integrative thinking, defined as the ability to reconcile opposing concepts by creating a solution that has elements of both but is something new and unique. I look at it as involving both sides of the brain, uniting the rational, verbal, linear left with the artistic, holistic, creative right. Einstein described it well: “Invention is not the product of logical thought, even though the final product is tied to a logical structure.”

So what does this have to do with plastic surgery? Plastic surgeons are after all inherently creative people, the word “plastic” implying a flexible approach. No two cases are alike, and so plastic surgery is often more improvisation than cookbook recipe. But as techniques have evolved, certain standard approaches have become the norm, and once this “source code’ is out, any surgeon can learn how to do it. Plastic surgeons now compete with a variety of doctors from other specialties moving into plastic surgery for economic reasons. A related phenomenon is similar to outsourcing; just as your tech support person is likely to be in India, thousands of Americans travel overseas for discount plastic surgery. All of this is based on left-brain thinking and it has been tremendously successful. But because it is based on standards that can be taught and copied, it becomes difficult to contain, and some plastic surgeons feel that we are losing ownership of our own specialty.

I believe the key to continuing success in plastic surgery is innovation. Patients want (and deserve) less invasive procedures delivering more natural results with faster recovery. Creating the innovations that fulfill these goals requires tapping into the artistic right brain, and as Einstein said, tying it to a logical structure. Besides, it’s fun.

Is your avatar having more fun than you?

No, this isn’t about the movie Avatar but it isn’t about the original meaning either (in Hinduism avatars are incarnations of deities.) In modern times, computer games have brought a broader definition to the term, for an assumed identity with whatever characteristics are selected. In other words a sort of alter ego, a double identity.


What does this have to do with plastic surgery? I got to thinking about it reading the book Connected by Nicholas Christakis and James Fowler, about the way social networks impact our lives in unexpected ways. In the book they note that our appearance affects the way people treat us, a topic I have covered here before. Whether we like it or not, attractive people tend to earn more for the same work, attract more friends, and have opportunities presented to them that similarly qualified but less good-looking people do. What’s interesting is the research finding that avatars in online games tend to take on personality characteristics and behaviors matching their appearance, rather than the player’s real-life persona, and other players in the games react to the avatar's appearance in predictable ways too. If like me you don’t play online games, you may still have noticed this sort of thing at Halloween costume parties.

I think there is an element of this phenomenon in plastic surgery. Young people born with a large or crooked nose, for example, who have a rhinoplasty before going off to college often blossom from wallflowers into happy, socially active adults. Women often feel more confident after breast implants, and men after some lipo. Sure, it may be noble to learn to live with one’s genetic inheritance, but keep in mind that appearance affects others’ behavior toward us as much as our own.

What I have observed over the years is that most patients aren’t trying to become a glamour icon and start behaving like celebrities, they are just looking for an improved version of themselves. Plastic surgery for them really does help them fulfill their dreams and improve their lives, and there are scientific studies to prove it. Of course it is possible to have a happy and fulfilling life without either having plastic surgery or winning the genetic lottery for natural good looks, but dismissing the whole notion as vanity doesn’t acknowledge how powerful even a minor transformation can be for some. In the meantime, I will keep working on my techniques to make people 10-feet tall, blue skinned and capable of riding flying dinosaurs. Come to think of it, avatars of Vishnu are often portrayed with blue skin …

Breast implants in athletic women

Women athletes arguably have more obstacles to overcome than their male counterparts, title 9 and lack of career options in professional sports notwithstanding. Lower natural levels of muscle-building hormones such as testosterone means even harder work to develop strength, and the lean build that is beautiful in so many ways becomes less feminine at the same time. There are several versions of attractive female figures, but for many athletes the desire to have at least a few womanly curves is natural. The choice to have breast implants is both personal and justifiable, yet opinions of the many seem to be given credence.
That is probably part of the reason why there has been so much media coverage of the decision of Australian hurdler Jana Rawlingson to have her breast implants removed. Apparently she has decent odds of medaling in the next summer Olympics but felt that the implants might get in the way. Frankly that is a little bit hard to imagine unless they were large to begin with, which is not a typical choice for an athlete in the first place. I wish her luck but if she does well it will be because of her dedication and training, not because she had her implants out.
The question of implants in athletes deserves serious attention from plastic surgeons who breast augmentation, though, because there are unique issues that need to be addressed. Ordinarily, with low body fat and small breasts, submuscular placement of the implants gives a more natural look. However, with a lot of muscle development that just isn’t a good choice for a number of reasons, some obvious and others not. I have been using an in-between option called subfascial implant placement (fascia pronounced like fashion) in cases like these. This provides support for the implants and more natural curves. Combined with small, usually low-profile implants, this results in more real-looking and proportionate breasts. Whether these breasts are truly more aerodynamic is another question.

Plastic surgery addiction: Fact or fiction?

Apparently we are supposed to care that reality TV star Heidi Montag has had a lot of plastic surgery, to the point that she has had to deny accusations of “plastic surgery addiction.” Liposuction, breast implants (maybe she thought that’s what the title of her TV show “The Hills” refers to), chin reduction, fat injections to her cheeks, revision rhinoplasty (updating her previous one), and more, all told some 10 hours worth. Even Nightline is weighing in on the subject, along with a People magazine cover story. And let’s not forget the news about Tiger Woods in treatment for sex addiction. Where does obsession end and true addiction begin?


I don’t know (and don’t particularly care) about Tiger Woods’ sex life, but the question of plastic surgery addiction is worth exploring. In a medical sense, there are strictly defined criteria for addiction; it involves compulsive, persistent dependence on a drug (substance abuse) or behavior (process addiction.) There are known to be genetic factors with drug dependency, and true addictions are associated with actual structural changes in the brain. Another consistent feature is withdrawal symptoms, which can be severe and even life-threatening with some drugs. These physical manifestations are one reason why addictions can be so hard to treat.

But the behavioral addictions – gambling, shopping, sex, maybe even plastic surgery – have more obscure origins. It appears likely that there is a large area of overlap between obsessive but controllable activities and what are commonly considered to be addictions. There is a known diagnosis in the plastic surgery world called Body Dysmorphic Disorder, or BDD, characterized by anxiety stemming from perceived defects in appearance. Plastic surgeons are well-tuned to recognize BDD because many of those with it become serial plastic surgery patients and are never satisfied. What else could explain the bizarre extents to which people like Jocelyn Wildenstein have gone? Counseling rather than surgery is the best treatment for these cases.
So does a marathon makeover surgery on an already attractive 23 year old represent a step on the road to addiction? Despite her announced plans to do more, Heidi Montag’s motives may be a simple case of an attempt to remain in the spotlight as the allotted 15 minutes of fame elapse. I can hardly wait for the next round of updates on the new and even larger implants.

Is Viagra the next cellulite treatment?

Every year or so the next great cure for cellulite appears. First it was creams, then Endermologie, then mesotherapy, then lasers with Endermologie-like roller massage, every permutation that biomedical engineers could think of to beat cottage cheese thighs into submission. Thermage has a cellulite tip, which works well but not for everyone. (http://www.baxterplasticsurgery.com/thermage.html) So a definitive treatment remains elusive.


It’s not for lack of trying. Since estimates of the number of women affected are in the 80-90 percent range, it is an enormous problem and women the world over are clamoring for a solution. But before I introduce the latest idea, we should look at why cellulite is such an intractable problem. To begin with, no one can say definitively what it is. That isn’t to say that we don’t see differences between the skin and fat in women with cellulite and men, or unaffected women; we just don’t know what causes those changes. The skin is thinner, and fat compartments tend to bulge into the skin, causing the characteristic upholstery-like dimples. Poor circulation seems to be an issue, and approaches to cellulite treatments often target this with methods to increase blood flow (back to roller massage.)
So someone (actually four doctors from Croatia) noted that Viagra is also a vasodilator, and proposed a theory in the journal Medical Hypotheses last summer. To be fair, note that the journal is for hypotheses, not proven theories or clinical trials, but it is provocative nonetheless. Sildenafil, the generic name for Viagra, was found to not only increase circulation in the skin (which may or may not be helpful), but it also activated enzymes that help break down fat cells in tissue culture. There’s actually some serious science behind this class of drugs and it may very well turn out to be helpful for cellulite. If so, I can hardly wait to see the marketing campaign.

Post-operative breast implant massage: Does it help?

A frequent question we get about breast augmentation is whether or not post-op massage is recommended or potentially beneficial. One popular website, BreastImplants411.com, has created a checklist including a question about implant massage; patients considering breast augmentation are supposed to ask specifically about it. And plastic surgeons seem to be split on the question, with some strenuously advising it and others cast as non-believers. With such contradictory views, what is an informed person supposed to make of it?
The main idea behind it originated in an era when capsular contracture, a hardening of the scar capsule around the implant, was much more common. Plastic surgeons were trying anything that might make a difference, and cases of contracture were sometimes treated with a fairly brutal procedure called a “closed capsulotomy” which consisted of squeezing the breast hard enough to make the scar capsule rupture. Although patients might run out of the clinic in tears, the breast would be softer (for a while.) So the thinking was that perhaps squeezing the breasts on a regular basis, especially during the healing period, could prevent the scar from contracting in the first place.
In retrospect, it was a fairly naive notion, but there wasn’t much else to offer because the causes of capsular contracture were so poorly understood at that time. So it became entrenched as a routine practice and no one bothered to do a clinical study to see whether it did any good. In fact, to this day no such study has been published. Evidence now points to bacterial biofilms, invisible contaminants caused by miniscule numbers of otherwise harmless germs, that cause a reaction in the scar that encloses the implant. Better surgical techniques and better implants than the ones used 25 years ago appear to be the important variables.

So at this point we still have no objective evidence that post-op implant massage makes any difference in capsular contracture. There are certainly cases where swelling tends to push implants up and massage can be helpful in getting them to settle, but that is only sometimes the case. So the question shouldn’t be “Do you recommend massage?” but if so, “Why?”

the guy's guide to plastic surgery

Plastic surgery is generally considered to be the domain of women, especially with breast implants having become the most popular surgery. All in all, only 15% of patients are men, but that is still quite a lot in terms of absolute numbers. For the record, the most popular procedure for men continues to be liposuction.

One problem I think is that too many of us labor under false notions about plastic surgery. Husbands and boyfriends accompanying their partners for consultation often say something like “I don’t know why she is doing this, I love her just the way she is.” So the first lesson is that she isn’t doing it for you, she has her own personal reasons that don’t really depend on relationships. In fact, having cosmetic surgery in order to improve a relationship is almost always a bad idea.

Another misconception is body contouring surgery vs. diet and exercise. It isn’t an either/or situation, however; there are things that exercise does that cosmetic surgery doesn’t, and vice-versa. Classic examples are doing sit-ups with the expectation that they will tighten abdominal skin, and the idea that specific exercises can affect body fat distribution. Spot-contouring of fat with exercise just doesn’t happen. On the other hand, liposuction isn’t done for weight loss, it is all about reshaping. So thigh exercises may not burn off thigh fat, and crunching the abs won’t result in a 6-pack if the body is genetically programmed to carry extra fat there.

Our typical lipo patient is someone who isn’t overweight but has areas resistant to change. A woman might be a size 4 on the upper half of the body but a different size in the thighs. We see men who are in great shape but have “love handles” or excess abdominal fat. So do continue to hit the gym, and see your plastic surgeon for what you can’t accomplish with exercise and a healthy diet.

A Trendy Topic: The Past Decade of Plastic Surgery

As we inch toward 2010, it seems appropriate to reflect on the past decade in plastic surgery. Ten years ago, we were still in the dot-com economic bubble and plastic surgery was increasing in popularity, after a recession earlier in the 1990’s. Breast implants were becoming more and more accepted, with doubts about their safety having been largely dispelled, though it would be several more years before the FDA would clear silicone implants for general use. Another bubble may have burst, but breast augmentation has now overtaken liposuction as the most popular plastic surgical procedure in America. Plastic surgery in general has become much more accepted and attitudes more positive.

But lost in the big picture is the procedure that has actually increased the most. (This doesn’t count nonsurgical procedures, or Botox would be the clear winner with millions of patients treated.) Although only the 5th most popular procedure, abdominoplasty (tummy tuck) has gone from about 43,000 cases annually a decade ago to nearly 150,000 according to the most recent statistics, a nearly 5-fold increase. We even have a new term for the tummy tuck/breast enhancement combo, the “mommy makeover.”

Why the big run on tummy tucks? There are a number of possible explanations, one of which is the improvements in safety and technique for abdominoplasty. One technique that I have been a fan of is called the Progressive Tension Suture technique. (See my website for details.) Mostly though I think it is just women who are done with childbearing and looking to improve their lives now that the children are grown.

Botax axed

It may seem self-serving to criticize the proposed tax on cosmetic surgery and medical procedures such as Botox injections (hence the too-clever term "Botax"), but there is a long list of reasons why it is unworkable. Fortunately it appears to have been dropped from the health care reform legislation at least for now, replaced by a proposal to tax tanning beds.

So what's the big deal? isn't a "vanity tax" justifiable, just like the "sin taxes" on alcohol and cigarettes? For one thing, it dismisses all cosmetic procedures as being motivated by superficiality and obsession with unrealistic notions of beauty, which anyone in this business can tell you is plain wrong. Cosmetic surgery patients are just moms who want their old bodies back, or those trying to re-enter the workforce and find themselves competing with younger workers. Cosmetic patients are middle income, heart of America folks, and plastic surgeons are employers and small businesspeople trying to do their part to reboot the economy.

Maybe you don't buy that, but there are practical issues too. Here in Washington State there was a proposal two years ago to do the very same thing, and it was dropped as being unworkable. One reason is that it is deceptively difficult to separate what is purely cosmetic, and what is reconstructive or therapeutic. Take the case of breast reconstruction: it is so important to a woman's recovery from cancer after mastectomy that it is a federally mandated insurance benefit. But it isn't a functional breast, just a cosmetic facsimile. Rhinoplasty may be done to correct a breathing problem but a little cosmetic alteration is done at the same time; how much of the expense (including anesthesia and operating room time) is to be allocated to each part?And half of all Botox is used for therapeutic uses. One example of this is patients who have to pay out-of-pocket for it but do it to prevent debilitating migraine headaches. There's an idea for you: tax migraine prevention treatment. Washington State ended up deciding it was just too complicated to sort out, and fortunately the other Washington seems to have done the same thing.

Tanning salons on the other hand, that's an interesting proposal. Earlier this year, the UV lamps used for tanning were officially declared to be a class 1 carcinogen. My guess is that the business is already declining and this will only hasten its demise, with the projected tax revenues evaporating along with it.

Does vitamin C cause cataracts?

Finding solutions to difficult problems sometimes requires tossing aside assumptions and looking at things from a new perspective. Plastic surgery, at is best, consists of this type of creative problem-solving. In fact, the word plastic implies flexibility and changeability. But sometimes our assumptions are so ingrained that challenging them risks being seen as imprudent, if not reckless. The wisdom of taking vitamin supplements is one such sacred cow, though evidence consistently leads us in the other direction.

Albert Szent-Györyi, who won a Nobel prize for his discovery of vitamin C in 1937, said “Discovery consists of seeing what everyone else has seen and thinking what no one else has thought.” He would have been surprised to see how much attention vitamin C would attain as an anti-oxidant supplement, a theory in its infancy during his time. It’s something we take as gospel. I was giving a lecture recently on wine and health, and as I sometimes do I noted that studies have consistently found no anti-aging benefit to use of vitamins. Afterward, one of the attendees said she appreciated the points about wine but disagreed with my statements about vitamins. I gently replied that I am only the reporter on this, is just what the science shows regardless of what we have been told.

What makes it particularly difficult to grasp is that not only do antioxidant vitamins fail to show any benefits in terms of age-related diseases, they actually appear to be harmful. For example, vitamin E users have a higher mortality than those who don’t take supplements. And now vitamin C is implicated in causing cataracts, according to a recently published study from Sweden. But try Googling “vitamin C +cataracts” and all you will find is sites touting the benefits of C in cataract prevention.

Ultimately, it isn’t really complicated. Those who enjoy the best health are those who eat a sensible diet where the vitamins come from natural sources, in their natural context. And wine is a part of this diet; wine drinkers live an average of 5 years longer than teetotalers, and have better health overall.

Lessons from the world's first plastic surgeon

Judging from some of the ads I see, you would have to conclude that plastic surgery was a recent invention, with any number of people taking full credit. But while it may be true that plastic surgery as we know it is less than a century old, its roots go back more than two millennia. While I was in India last week, I noticed that there was an exhibit at the National Science Center Museum highlighting an Indian physician and surgeon from the 5th century B.C. named Susruta, who preceded Hippocrates by hundreds of years. He was a teacher, healer, inventor of many surgical instruments, and developed a cheek flap procedure for nose reconstruction, without a doubt the world’s first plastic surgery. A variation of that is still used today.
So what does this mean for plastic surgeons today? For one, it is humbling to think of the long heritage of innovation and service that we inherit. It reminds us that we should try to create a lasting contribution to the specialty, and treasure the opportunity to make a lasting difference in our patients’ lives. Particularly during the holiday season, we need to remember that our talents are a gift. So while the poverty in India is indeed overwhelming, I am richer for the experience of having gone.

Bollywood Masala: My India Report

Inspired, perspired, impressed, depressed: like India itself, the operative word for my experience there this past week is “contrast.” No question India is worth seeing, not just because with 5 times the U.S. population it is by far the world’s largest democracy, but because despite all of its challenges it is doing a lot of good things. As it turns out, I was there on the one-year anniversary of 26/11 (November 26th), the terrorist attacks on Mumbai and other sites. India has comported itself well in the aftermath of that tragedy, and the commemorative observances were moving.
I was there to give a paper at the IPRAS meeting (International Confederation for Reconstructive, Plastic, and Aesthetic Surgery) in New Delhi. It was interesting to be on a panel with plastic surgeons from Brazil, Columbia, Iran, the U.K., and Portugal. The IPRAS meeting was more than just a meeting of the minds though, it was a source of inspiration in itself. Plastic surgeons around the world have long been able to put aside political differences between governments and work together in the interest of service. Through partnerships with organizations such as Doctors without Borders, and a new effort called Women to Women, IPRAS has fostered efforts to care for burn victims (mostly women) and children with birth defects, where access is limited either by cultural customs, lack of funding, or both. The challenge remains a large one, but encouraging progress is being made.
Of course there was some fun to be had, and seeing the Taj Majal is a worth the effort. We just missed seeing Ben Kingsley (Academy Award-winning actor who played Ghandi) there by a day. He is doing a movie based on the life of Mumtaz Mahal, the wife whose love inspired the Taj.

What's with the attitude? Views on plastic surgery around the world

With Botox annual sales approaching $1 billion, and breast augmentation and liposuction in the hundreds of thousands of cases each year in the U.S., it would seem that people who haven’t had “a little work” done would be the exception. There are still those who don’t “approve” of plastic surgery, but annual surveys by the American Society for Aesthetic Plastic Surgery show attitudes are steadily becoming more positive. It’s not a uniquely American thing though; when I was in Argentina and Brazil a couple of years ago for an international plastic surgery conference, it was hard to escape the impression that the South Americans thought they invented plastic surgery. They did have a head start on the cosmetic surgery side of the specialty, and attitudes have always been more favorable there.
It’s becoming a worldwide phenomenon. Korea, of all places, has the highest number of plastic surgeons per capita of any country, and a survey in Russia found that about half would “consider plastic surgery.” Rhinoplasty specialists are known to do a thriving business in Iran, and Turkey is becoming a destination for cosmetic surgery. I am off to India for a plastic surgery conference this month, and plastic surgery is becoming popular there among those who can afford it. Interestingly, the Dutch and Norwegians remain staunchly against it.
Whatever your view, there is a good side to all this. The more it is out in the open, the more scrutiny will be brought to bear which in turn will foster improved techniques and standards. One downside is that now everyone wants to be a plastic surgeon – often without the years of specialty training.

Enhanced results with lipo plus Thermage

As usual, the Hot Topics session at this week's meeting of the American Society of Plastic Surgeons served up a number of issues. I had the opportunity to present the data from our studies proving that Thermage given immediately after liposuction enhances skin tightening. The reason that this is important to prove in a scientific way is that skin shrinks all by itself after lipo, so additional shrinkage can only be claimed if it is demonstrated to be greater than what occurs normally. Patients who benefit from this are those who have some looseness to the skin, such that lipo alone would not give a good result, but not so much that they need something like a tummy tuck. This latter part is important because some plastic surgeons are pitching laser lipo as an alternative to tummy tucks. It's a risky proposition because I am already seeing patients who should have had a tummy tuck but chose laser lipo instead, and the results are not pretty.
To be fair, there was some data presented showing enhanced skin shrinkage with smart lipo (though not as much as with lipo-Thermage) and another suggesting that VASER ultrasound helps too. But each of these has its own risks and benefits, so for now my money is on the one designed to tighten skin in the first place.

Fat chance: Has the time for breast enlargement with fat injection arrived?

The annual meeting of the American Society of Plastic Surgeons (ASPS) is just about to wrap up here in Seattle. As a member of the Emerging Trends committee, I am involved in putting on the “hot topics” session, which always has a few zingers. I’ll be posting on some of those in the coming days, but the question of whether or not it is safe and effective to use one’s own fat for breast augmentation is front and center.
It’s a simple idea: why can’t we just take some fat out from the bottom, or the love handles, or some other area where it isn’t wanted, and use it to enlarge the breasts? Certainly, there can be no more natural means of breast enhancement. In recent years, techniques for fat grafting have improved a lot and they are being used to improve the results from breast reconstruction and some cases of implant augmentation, by smoothing out contours and irregularities. Why not just do it for the entire breast in the first place?
At the meeting there were a few reports of some success, but also a few cautionary notes. For one, the volumes used are low, with no more than a cup size or so of enlargement possible. Concerns about the grafts leaving lumps that interfere with mammograms seem to have been addressed, so that barrier is coming down. But a French surgeon reported some evidence from animal studies that it is theoretically possible that the grafted fat could stimulate breast cells, resulting in an unknown effect on the risk of breast cancer. There is no evidence of this in humans, but it is a sign that we should proceed cautiously. So stay tuned, but don’t expect every plastic surgeon to be offering the procedure in the immediate future.

Winterize your skin

The Seattle rain festival appears to be in full swing, but forecasters are predicting clearing by June or July. In all seriousness though, it’s time to think about winter skin care. We do love our sunshine, but given that skin cancer is the most common type of cancer, it’s not all bad to have a break. True, most skin cancers are of a non-aggressive type, but deaths from skin cancer are up 50% from the 1970’s, and melanoma-the deadliest type-has risen dramatically too. Even teenagers are now being diagnosed with skin cancer.
So the gray months of the year are a good time for what we might call “corrective” skin care. The basics are moisturizers, because of dry air, but more intense therapies are in order too. Skin peels leave the skin more sun-sensitive for a while so they tend to be less popular during the summer. Products such as tretinoin (Retin-A) are a mainstay of corrective skin care but again the issue of sun sensitivity limits their use for some during sunny times of year.
Just giving your skin a break from UV exposure is a good thing too, but don’t assume that there isn’t any just because the skies are overcast and the days are short. Sunscreen SPF only measures UVB protection from burning, but not UVA which is aging. The deal with UVA is that it penetrates window glass and clouds just as it does skin.
All of this has to be placed in perspective of course. Sun exposure converts cholesterol into vitamin D, and you should probably be taking a D supplement especially during the winter. But there is a growing movement of “sun haters” who take matters to the extreme. So while I do recommend “pleasantly pale” over “terminally tanned,” let’s not get carried away.

Anti-aging: a "Nobel" cause

Mark Twain famously said “Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.” Great advice to be sure, and there is ample evidence to support the notion of a healthy attitude as an anti-aging strategy. But of course how the body ages is important too.
I spend much of my time practicing what is called anti-aging, but the term has lost some of its meaning in recent years. What we call anti-aging these days has more to do with restoring the appearance of youth more than with slowing the aging process itself, or at least steering it in a healthy direction. Recognition of that fact is one of the things that motivated my book Age Gets Better with Wine, out next week. But the science of anti-aging is regaining credibility, as evidenced by last week’s announcement of the Nobel Prize in physiology and medicine. Three Americans-Elizabeth Blackburn, Carol Greider and Jack Szostak-were named winners for their chromosome research that has profound implications for cancer and aging.
Here’s what they found: whenever a cell divides, which it must do in order to heal a wound, refresh the skin, and rebuild organs to maintain their function, it must replicate the chromosomes that hold the DNA programming code. This is accomplished by a sort of unzipping of the DNA strands, but at the end of each one is a sort of cap like on a shoelace called the telomere. These normally limit the number of times the DNA (and therefore the cell) can replicate, but an enzyme called telomerase rebuilds the telomere. In cancer cells, this goes on continuously and out of control, but for anti-aging it may hold the key to extending the cell’s replicative lifespan. This in turn translates to healthier organs, glowing skin, and a sharper mind.
A lot remains to be learned about this process, but the promise is more than enticing. In the meantime, focus on that positive attitude and healthy lifestyle.