Q. I am 31 years old with one child. My mother developed breast cancer at age 41 and my older sister was diagnosed with breast cancer at age 37. My mother and my sister were treated with a mastectomy. My ob/gyn doctor recommended I have the BRCA gene mutation test to see if I am at higher risk for breast cancer. I had the blood test and it came back positive for the mutation. After consulting with a genetic counselor, talking to my family doctor and an oncologist, I have decided to have a prophylactic double mastectomy and I would like to have the surgery where the nipple is spared. Here is the problem, I went to see a surgeon who told me that my breasts are too big to have a nipple sparing mastectomy. I wear a DD bra. He said the complication rate is higher in women who have large breasts when preforming a nipple sparing mastectomy. He has suggested a standard mastectomy on both sides. I have seen the results for a nipple sparing mastectomy and a standard mastectomy and I like the results of the nipple sparing mastectomy much better. Is the advice that I have been given correct?
A. First, let me say that I think you were so smart to have the BRCA gene mutation test. I am sorry that the results were positive, but now you can decide what you want to do about your breasts without waiting and wondering what might happen in the future. I am certain that you have been told that with the BRCA mutation you have a higher risk of developing breast cancer than the general female population. You have also likely been told that you can markedly reduce that risk if you electively decide to remove your breasts. In patients who chose to remove the breasts before the diagnosis of cancer, there are options for surgery, including the nipple sparing surgery, and you have the luxury of doing the surgery on your schedule. To answer your question, your surgeon is 100% correct that a nipple sparing mastectomy in large breasted women has a higher complication rate, specifically issues with wound healing and nipple viability after the surgery. The nipple can lose a critical amount of its circulation during the mastectomy and it can die, then you end up with no nipple or areolar. For this reason, some surgeons prefer to do a standard mastectomy. There is, however, an alternative that has been studied and found to dramatically reduce the complication rates in large breasted women undergoing nipple sparing mastectomy. A staged mastectomy, meaning two different surgeries are performed. The first surgery is a breast reduction performed by a plastic surgeon to get the breast down to a smaller size, say a C cup. Then, 4-6 months later the breast cancer surgeon performs a nipple sparing mastectomy with reconstruction. Studies have documented that the complication rate in staged mastectomy is similar to the rate in women who do not have large breasts and have a nipple sparing mastectomy as the only procedure. This is an important discovery and opens the door for women in your shoes. The staged mastectomy is an option for you, and you should consult with a plastic surgeon who works closely with a breast cancer surgeon who can tell you whether you are a candidate. Good luck on your journey.
Q. I would like to do something to my face to make me look younger. I am 60 years old, recently retired and feel great but I see wrinkles and jowls on my cheeks, and loose skin under my chin. What are my options regarding facial rejuvenation, and is there anything other than surgery to tighten my face and reduce my wrinkles?
A. Sorry, but the short answer to your question is that only surgery will lift the loose skin on your cheeks and under your chin. Wrinkles (fine lines) can be treated with laser skin resurfacing, which technically is not surgery since there are no incisions, however, laser is still a procedure with a week or so recovery and can have a short period of being uncomfortable. (Read More)
Q. I recently saw my primary care doctor who did a yearly physical including examining my breasts. He noticed that my breasts were kind of hard and a bit misshapen and he asked me how old my breast implants were. I told him they were more than 30 years old and he looked surprised. He suggested that I see a plastic surgeon to find out about how safe it is to have such old implants. I have had a mammogram every year since I turned 40 and have never been told there is any issue with my implants. Do you agree that I should be evaluated for my implants? I am 63 and had my augmentation in my early 30’s.
A. Let me ask you a question. Are you happy with the look and feel of your breasts? Normal breasts, with or without implants, should be relatively soft and should have a normal breast shape. (Read More)
Q. I have the implant that was recently recalled by the FDA. Do I need to do anything about this or is it safe to keep my implant?
A. If you know that you have the textured Allergan or McGhan silicone gel or saline implant, then yes, you should see the plastic surgeon who placed the implant. The FDA is not recommending the implants be removed; however, you should talk to your doctor and get the latest information on the reason why the implant has been recalled. (Read More)
Q. My son is a college student and is very bothered by his prominent ears. I never knew that he was sensitive about his ears, but he has recently opened up about it. He wears his hair long, so it is not very noticeable. Is my son too old to have ear surgery? I have always been told that this surgery should be performed as a baby.
A. Your son is not too old to have his prominent ears corrected. Although it is more common to perform ear surgery for prominent ears during the preschool years, I have done this surgery on adults as well as teenagers. (Read More)
Q. I have a lot of lines on my face from too much sun when I was younger. I recently went to an aesthetician at a local spa who did 4 chemical peels on my face over a four-month period. I really do not see much improvement in the wrinkles. I do not want surgery but is there anything other than surgery that will help smooth my skin? I am almost 50 years old but my skin wrinkles make me look much older.
A. Sun can have a profoundly negative effect on the skin of the face if you do not protect it with a good sunscreen, consistently applied while outdoors. Genetics also plays an important role in how one ages. Since you cannot affect your genetics, at least for now, the only control you have is protection from the sun’s harmful rays. (Read More)
Q. I have been contemplating having a face lift for several years. I have even had a couple of consultations with a plastic surgeon. I want to have the surgery, but I am afraid that I will not look like myself. I have seen people both locally and on television that truly do not look like the same person. This possibility scares me as I want to look like me, just a little more refreshed. How do I know that I won’t look too different after surgery? What do I need to say to the surgeon to convey what I am looking for?
A. Thank you for your question and it is good that you are thinking about this before surgery and not after surgery. I know the look that you are talking about, and it can be frightening. The people who have undergone overly aggressive facial rejuvenation do not look any younger, they just look different, and sometimes they look strange. (Read More)
Q. I recently completed breast reconstruction on both breasts after bilateral mastectomies for breast cancer. I have breast implants on both sides. I am, for the most part satisfied, however I have a significant dent in the upper part of one of my breasts which is noticeable if I wear a bathing suit. I don’t want to have more surgery if I can help it, so is there anything that can be done for this indentation?
A. Contour irregularities of the breast after breast reconstruction is not uncommon, regardless of the technique used to reconstruct the breast. These deformities can be either an area of hollowness leaving a dent in the breast or an area of excess tissue creating a bulge. (Learn More)
Q. I am 28 years old and had twins about 1 year ago. After delivery, my stomach was a mess, loose skin and stretched muscles. I have been working my buns off for the last 6 months trying to return my tummy to the way it was before pregnancy and it is just not happening. I still have skin that sags around my belly button and I still look like I am 3 months pregnant. My weight is back to what it was before getting pregnant, but I hate my tummy. How can I tighten my skin?
A. Twin pregnancy can be very tough on your tummy because of the stretching that occurs carrying 2 babies. Often the skin stretches beyond its capability of re-tightening, and what is left is loose skin. (Read More)
Q. I have read some recent reports that the FDA is beginning to investigate the safety of breast implants. I have had implants for 7 years and have been happy, but I do not want something in my body that can harm me. Now I am worried and do not know what to do about the implants. Should I have them removed?
A. First, let me say that unless you are having some problem with your breast implants the short answer is NO. The reports that you refer to are correct that the FDA is seeking information from a variety of sources to see if there is any pattern of concern relative to safety of breast implants. (Read More)
Q. I recently had an evaluation for Coolsculpting at a spa in the Triad area. I was told that I am a perfect candidate and I could expect great results after one or two treatments. The area that is bothering me is my hip roll. I have not had the treatment yet because I felt a little like I was being given a sales pitch and I am also somewhat skeptical as to whether Coolsculpting really works. Does Coolsculpting work as good as what I am being led to believe?
A. Coolsculpting works, but not for everyone. It is so important that you be evaluated by an experienced Coolsculpting practice. When the procedure is done on the appropriate patient, that is, one who is dealing with a localized pocket of fat, then a good result can be expected. (Read More)
Q. Can you tell me what the latest options are on non-surgical wrinkle reduction? I have fine lines around my mouth, my cheeks and under my eyes. I am only 50 and definitely do not want to have a face lift. I have tried pretty much every cream in the department stores and on the infomercials and my wrinkles are still in the mirror. Please tell me there are some good options.
A. You have posed one of the most common questions I get in my practice; how do I get rid of the fine lines on my face? These wrinkles often first appear in your 40’s and continue from that point on. Just to set your mind at ease, a face lift is almost never the answer for fine lines on the face. (Read More)
Q. I get injections of Restylane® in my cheek fold about once or twice a year. I have never had any issues other than temporary bruising and swelling, however I read an article recently that talked about blindness that can occur as a result of filler injections to the face. I am now too scared to get injections again. The office where I have received the injections has never mentioned that blindness can occur. Are fillers safe, or do I need to stop doing them?
A. Fillers such as Restylane® and Juvederm® are compounds containing hyaluronic acid that is injected into wrinkles, such as where you get yours, the nasolabial fold, and also where there is a hollow area, such as on the cheek for example. Basically, fillers do as their name suggests, fills up a wrinkle or a hollow. (Read More)
Q. I am totally confused about what kind of skin care would be good for my face. I am a middle-aged woman who has some sun damage from my younger days, but otherwise fairly decent skin quality. My goal is to minimize wrinkle formation and help fade some of the brown spots on my cheeks. Nothing that I have purchased from the cosmetics counter has helped very much and I have spent a small fortune. Is there a skin care program that you recommend for most women?
A. There is no single answer for every person regarding what will repair damaged skin, or what will help maintain good skin quality. The skin care business in the United States is a multi-billion-dollar business, and unfortunately much of what is purchased by the consumer does not do what it advertises. (Read More)
Q. I read about a new saline implant in your Q&A article in this magazine a few years ago called the Ideal Implant. I am interested in a breast augmentation and it sounds like a good alternative to silicone implants. However, at the time I read the article they were very new to the market and I was worried that they had not been in use long enough to know for sure that they are safe. Are you still using these new saline implants and if so, do you think they are good implants? (Read More)
Q. I am almost fifty and have been using both Botox and fillers for my facial wrinkles for almost 8 years. I love the effect as it smooths my forehead lines and the fillers fill in the lines around my mouth. I am just a little concerned that I have been using these injectables for so long and I cannot find any information as to whether it is dangerous to be on these products for a long time. What is your opinion? (Read More)
Q. I desperately want a breast reduction and have even been approved by my insurance company for coverage of the procedure, however, I am so hung up on the potential risks of being put to sleep that I just cannot convince myself to proceed with the surgery. I would like to know your opinion regarding the safety of anesthesia for breast reduction surgery. (Read More)
Q. I have dark circles under my eyes that make me look tired. Is there anything that can be done to lighten my eyelid skin? (Read More)
Q. I had a facelift about two months ago and I can still see my scars in front of my ears. I am worried that they will be permanent. What should I do? (Read More)
Q. I grew up on the coast of North Carolina spending way too much time in the sun. I now have numerous scaly spots on my face and recently had a skin cancer removed. I have read about a cream that can be applied to the face to remove some skin cancers and the scaly spots on the face. Do you know anything about this? The cream is called Efudex. (Read More)
Q. When I was 39 years old (12 years ago), I had breast cancer and had a mastectomy with immediate reconstruction using tissue from my tummy. My reconstructed breast is doing just fine but my problem is that over the last 12 years I have gained some weight and my natural breast is now larger and droopier than it used to be. So unfortunately, my breasts do not match anymore. Is there a way to make them more symmetrical? I am very self-conscious when I put a bathing suit on because the difference is very noticeable. (Read More)
Q. I had a breast augmentation 9 years ago. I have silicone gel implants. One of my breasts is literally as hard as a rock and looks misshapen. I have not been back to a plastic surgeon because I had the surgery in another state. What is going on with this breast, and can it be fixed? (Read More)
Q. I had a breast augmentation last December. My right nipple area is completely numb. My left side is fairly normal. My surgeon said that the numbness will get better, but it has been four months and no change. What is your experience with loss of sensation in that area? (Read More)
Q. I have been keeping up with some of the reports on the association between textured surface silicone implants and the occurrence of breast lymphoma. I have discovered that the implant type that is most associated with this disease is the implant that I have. I am so worried now and wonder if I should have my implants removed? (Read More)
Q. I was recently diagnosed with a malignant melanoma on my shoulder. My husband found it and I unfortunately just watched it for a few months before going to the dermatologist. She biopsied it and ultimately removed it. I was lucky because it was called a superficial melanoma and the only treatment recommended was close follow up for the next five years. I was advised to use sun screen regularly, but I am wondering if there is anything else that I can do and how do I protect my children from this terrible skin cancer? (Read More)
Q. I am a 46-year-old healthy woman who has inherited from my father a neck that has no definition and seems to be full of fat. On a picture of my profile it is hard to tell where my face ends and my neck begins. I have had this neck for about 15 years, but it has gotten worse since I had children and gained some weight. Is there anything that can be done to restore some definition to my neck? (Read More)
Q. About a year ago, I had an upper eyelid lift by a plastic surgeon outside of Greensboro. Everything seemed to have gone well after surgery except that I am still not able to completely close my eyelids together. There is a gap between each upper and lower eyelid when they are supposedly closed. I really cannot see the gap myself, but my husband says it is very noticeable when I am asleep. In addition, my eyes are always dry, and I am constantly having to use drops to moisten them. My plastic surgeon says that it will eventually get better and that there is nothing that needs to be done about the issue. Is there anything that I can do to help this problem? (Read More)
Q. I am contemplating a breast augmentation in the next year or so. I am researching implant options and I remember reading in Kernersville Magazine a year or so ago about a new implant called the Ideal Implant. Can you tell me if you have experience with this implant and if you think it is a good alternative to the silicone gel implant? (Read More)
Q. I had a breast augmentation about 10 years ago. I am older now and having large breasts is not that important to me. I am a long distance runner and the implants just seem to get in the way when I run. I would like to have them removed but I have read online that removing without putting another implant back in will cause distortion of the breasts. Is it true and is it possible to take my implants out? (Read More)
Q. I am in my mid-twenties and I was born with a cleft lip. My lip was repaired when I was a baby and it looks fine to me. However my nose does not look normal and I was wondering if there is anything that can be done to improve its appearance? I have never had any surgery on my nose as far as I know, unless something was done when I was a baby. (Read More)
Q. I am the mother of 4 children and nursed all of them for nearly a year each. I have small breasts but my nipples are too big and honestly just look like they are stretched out. They were not like that before I had children so I think it is related to four years of nursing. Can this be fixed? (Read More)
Q. I had a face lift about 15 years ago and have been very happy. However, my cheeks are again beginning to sag, especially in the jowl area. I am 68 years old and do not think I want to go through another face lift. Is there an alternative to a full face lift to re-tighten my relaxed cheek skin? (Read More)
Q. I have heard that there are some technologies that will tighten the skin of the neck and face so that a face lift can be avoided. Is this true and does it work well? (Read More)
Q. I have heavy upper eyelids with too much skin hanging down. How can I find out if my insurance will pay for an upper eyelid lift? (Read More)
Q. I am contemplating having fat injections in my buttock area. I have seen a surgeon who has scheduled my surgery. However, I recently read some reports about problems with butt lift procedures using fat. Before proceeding, I just want to make sure the procedure is safe. What is your opinion regarding a Brazilian butt lift with fat? (Read More)
Q. I would like to know when I should replace my breast implants. I had an augmentation about 10 years ago in another state. I know that I have saline implants but do not know anything else about them. When should I plan to replace these implants?(Read More)
Q: I had a breast augmentation with silicone implants about 2 years ago. My right side is perfect, but my left side is very hard and does not look natural. My surgery was done in another state and I have moved to the Triad area and do not have a plastic surgeon. What can be done to improve the appearance of my “bad side”? (Read More)
Q: I am 42 years old and have fine lines on my cheeks and around my mouth. I do not have any saggy skin on my face but I do hate the fine wrinkles. I grew up on the coast and abused my skin when I was a teenager. Now it seems that I am paying for this mistake. Is there anything that works to smooth fine lines on the cheeks and around the mouth? (Read More)
Q. Is there any way to get rid of the signs of aging on my upper chest? I have brown spots, red spots, and wrinkles. I confess I do go into the sun a fair amount. (Read More)
Q. I would like to have some filler like Juvederm® injected into my cheek folds that run from my nose to my mouth. These folds have progressively gotten more noticeable as I have aged. I read online that one of the complications of filler to the face is blindness, so I have held off doing the injection. Is this true and if so, is it very common? (Read More)
Q. I recently had the breast cancer gene test and was found to be BRCA2 positive. My mother died of breast cancer at 40 and I am now 36. My mammograms are clear so far but I have been advised to consider removing both of my breasts to protect myself from the disease. What is the best form of reconstruction for double mastectomy if I chose to go this route? (Read More)
Q. I recently moved to the Triad area after living in the Northeast for most of my life. I am interested in having some plastic surgery on my eyes but I do not know how to find the right plastic surgeon since I am relatively new here. Can you give any advice on making sure I pick a good doctor?. (Read More)
Q. A few years ago I had a facelift. Most everything went well except where the facelift scar went into my hair in the temple area. I now have a bald spot about the size of a nickel, but only on one side. It is not that noticeable except when my hair is wet. Is there anything that can be done to get hair to grow back? My plastic surgeon basically told me that it is not noticeable and not to worry about it.. (Read More)