Breast Reductions

January 15, 2010

Tissue Glue Rather Than Drains (?!)

There is an old surgical adage:

If a surgeon thinks that the patient might benefit from a drain, he should put it in.  A surgeon never regrets placing a drain.

Patients, however, hate drains.  They are a post-operative nuisance.  Most patients grudgingly accept drains because they minimize fluid collections (called seromata) and infections.

Since drains are so uncomfortable, there have been a number of products and techniques developed to obviate the need for drains....

  • Quilting sutures beneath tissue flaps to minimize "dead space"
  • Tissue glues

Biological tissues glues are particularly exciting because they are quick, effective, and precise.  Unfortunately, there have been no specific research studies which have rigorously documented the safety and efficacy of biological glues for plastic surgery.  A study published in Plastic and Reconstructive Surgery in 2008 proved the success of tissue glues in a canine abdominoplasty ("tummy tuck") model; however, dog and human tissues do respond differently, and the results of an animal model can not necessarily be generalized to human beings.

To investigate human plastic surgery patients' response to biological glues, Cohera Medical, Inc., has just enrolled its first few patients in a study of its TissuGlu.  The clinical investigation is a prospective, open-label, randomized study to investigate the safety of TissuGlu, its effect on wound drainage, and its relationship to complications.  The study will compare 40 abdominoplasty patients in Bonn, Frankfurt, and Freiburg, Germany, who will undergo...

standard wound closure techniques versus

standard wound closure techniques plus the application of TissuGlu

Currently, patients who undergo abdominoplasties require the insertion of one or more drains to remove fluids that accumulate under the skin at the surgical site.  (The old surgical adage remains true in tummy tucks!)  However, TissuGlu will hopefully adhere the flaps created during the procedure to reduce fluid accumulation, and, ultimately, the duration of use of surgical drains.  With the use of TissuGlu, patients may experience a reduction in fluid accumulation, a more comfortable recovery, and a quicker return to normal activity.

If the European trial goes favorably, Cohera will apply for a larger U.S.-based trial later this year.  Let's say our prayers that TissuGlu works!...


November 07, 2009

Breast Reductions Reduce Pain...In 16 Year Olds

I'm almost 16 and I have a 36DD breast size.  Do I need to wait to have a breast reduction?

- Carla

No!  But there are caveats....

Breast reductions are fantastic operations.  Of all the surgeries and procedures that I routinely perform, breast reductions have the highest rate of satisfaction.  Not only are breasts reconstructed to be higher and cuter, but also the patient receives significant symptom relief.

Carla, what are your goals?  Are you interested in...?

  • decreasing pain in your neck, upper back, and shoulders
  • minimizing sweating and rashes in the folds beneath your breasts
  • feeling more confident around your peers, especially in a bathing suit

If yes, then breast reductions are a great option--regardless of age.

The big issue with breast surgery at 16 years old, Carla, is that your breasts will continue to change.  (Of course, breasts are going to change from any age.  Ask any 45-year-old woman who has had kids!  She probably wished that her breasts had not changed!)  Nevertheless, 16-year-old women will probably experience more change than 25 year olds.

I have performed breast reductions on 16 year olds, and they have been thrilled.  But, in a few cases, the breasts continued to grow.  Then, I had to perform a second breast reduction on those patients (even though the patients and their mothers thought that the breasts had been fully developed before the first surgery).

Also, you must realize that your smaller breasts will have scars and that you will be having a major surgery.  I am not trying to dissuade you, but just want you to be fully informed.

Check out these before and after pics of a recent patient--in her early 20s--who underwent breast reductions.  She couldn't be happier:  less neck and back pain, less shoulder grooving and discomfort, less sweating and rashes, and more self-confidence.

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February 18, 2008

Breast Reductions on Smokers: Proceed with Caution

Recently, I refused to perform breast reductions because the patient was a heavy smoker.  My concern was for her well-being.  Smoking is the single greatest contributor to complications after all types of plastic surgery.

However, one of my colleagues did reduce this patient's breasts, and the patient healed uneventfully.  She sent me the following note:

I have heard all of the issues related to smoking and breast reduction.  In fact, you told me personally you would not perform a reduction on me unless I stopped smoking.

I had a reduction in October.  I had cut down to two cigs a day, and I have had NO problems at all.

My question is...

  • Do you think everyone is different in healing?
  • Or did I just get lucky?

My plastic surgeon has 34 years of experience, and he didn't seem too worried that I smoked!

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