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Monthly Archives: April 2014

BLUNT TRAUMA SEROMA – SURGICAL APPROACH

The patient to the right is status post augmentation mammoplasty procedure with high profile saline implants, who was involved in a blunt trauma where her right chest hit the steering column.  Notice that there is significant swelling of the right breast.  It is also engorged, enlarged and quite painful and she has developed scar tissue contracture.  Patients like this should undergo surgery as soon as possible for evacuation of seroma, capsular release and implant replacement as necessary in order to recreate symmetry.

This patient’s preop photo shows significant 45% enlargement of the right breast with swelling and lowering of the inframammary fold.  Notice her reconstructive photo shows complete resolution after evacuation of the seroma, evening of the breast and elevation of the right inframammary fold.  The patient is now pain-free, has healed well and will continue with follow-up over the next six weeks.

Patients who have blunt trauma to the chest often develop capsular tears with seromas.  These should be immediately explored, evacuated and scar tissue released.

The Aesthetic Meeting 2014

The Aesthetic Meeting in San Francisco is the highlight of our year as Plastic Surgeon‘s, as it delivers the education needed to ensure that we stay at the top of our craft, improve patient safety, and enhance our practices.  With over over 130 teaching courses available to choose from.

I look forward to attend this years meeting.

Gynecomastia: Does Marijuana Use Promote It?

Given the establishment of a booming marijuana trade, plastic surgeons in Colorado are beginning to wonder if mile high guys may see more patients asking about gynecomastia to see if they can rid themselves of the hated “man boobs.”

Having gynecomastia surgery is not just ego. A guy’s fleshy chest can interfere with normal development because the typical patient does not want to take off his shirt or even wear a tee shirt. During the teen years, guys with man boobs are teased and ridiculed without mercy. Many have come to the their gym lockers and found a bra hanging on it.

(Look at some gynecomastia before and after pictures.)

Most men are as, or more, sensitive to the flatness of their chests as they are to the shape of their nose. As you may know, rhinoplasty was the leading facial procedure among men during 2013, according to the ASPS.

But where does the marijuana use enter the picture? The substance has been shown to lower the male hormone, testosterone, at least in animals.

(Learn more about the gynecomastia procedure and recovery.)

Doctors note that gynecomastia develops during the teen years when an imbalance takes place between the male and main female hormone, estrogen. But lowering an already low level of testosterone with marijuana is not the wisest move.

Other studies have shown high estrogen levels in many drinking water supplies. Other scientists have found some prescription drugs also linked to gynecomastia.

(Read more about the gynecomastia-pharmaceutical link.)

Still other scientists have found common products – like some hair shampoo – and too many female hormones in drinking water supplies responsible for the rise in “man boobs.”

(Read more about Man boobs and estrogen in drinking water.)

Moreover, the numbers of gynecomastia procedures are up, says the latest plastic surgery statistics. According to the American Society of Plastic Surgeons, (ASPS), 21,000 male breast reduction procedures were performed in 2013, a five percent increase over the previous years.

The American Society for Aesthetic Plastic Surgery (ASAPS) counted 22,638 gynecomastia procedures for 2013 and noted it was the 4th leading procedure for men among the members of their organization.

BEVERLY HILLS ABDOMINOPLASTY

Interestingly, not a lot has changed over the last 30 years on tummy tuck surgery.  The gold standard is still a lower abdominal C-section-like scar which is extended all the way to the hips bilaterally.

Notice this patient preoperatively has significant abdominal wall laxity, skin laxity and her muscles have been pulled apart, called rectus diastasis.  Her six-week postop shows beautiful tightening of the lower abdominal musculature, tightening of the skin along the lower abdominal flap and notice the scar is well-hidden under the bikini line.  Liposculpturing of the hips has allowed smoothing out and contouring as well.  Conventional standard abdominoplasty surgery should be performed under general anesthesia by only Board Certified Plastic and Reconstructive Surgeons using Board Certified Anesthesiologists.  Our patients are given muscle relaxants in order to relax the abdominal wall and allow tightening with the O-Ethibond sutures along the midline rectus sheath, both above and below the belly button.  Our patients are instructed not to do heavy lifting for six weeks postoperative.  Notice her after-result.  Both frontal and oblique views show beautiful flattening of the abdominal stomach.  She is now continuing her exercise regimen, including training and muscle fitness.

LONG-TERM SEROMA

 

STATUS POST MAMMOGRAM TRAUMA – LEFT BREAST

This patient presents with a very swollen and painful left breast that has endured a 10-month history of having had a mammogram and pulling on the breast with severe tearing of the left medial pectoralis muscle tendon and the inframammary fold.

On examination, the patient has a severely painful and swollen left breast.  There is venous dilatation and dilation of the veins around the left areola and great asymmetry compared to the right.   She went to surgery and underwent exploration of the left breast with evacuation of 300 cc yellow seroma with identification of two large tears with small blood clots in the medial upper muscle tendon of the pectoralis major muscle as well as two separate small blood clots along the left inframammary fold.  These areas were cleaned, irrigated with antibiotic solution and coagulated as necessary.  As you can see in the video, there is a significant amount of yellow chronic serous fluid with breakdown in protein associated with this traumatic double tear of her left breast.  Seromas like this should not wait a year to be drained.  They should be drained as soon as possible to prevent further tissue damage as has occurred in this patient with complete tearing of the upper medial muscle as well as the inframammary fold.  There were blood clots that had to be cleansed and resolved.  These patients are at an increased risk for recurrent scar tissue and capsular contracture.

 

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