Smiley boobs

Clever text "smiley boobs" from the Every Man For Himself blog.

My favorite is the vampire bite :)

(o)(o) perfect breasts
( + )( + ) fake silicone breasts
(*)(*) high nipple breasts
(@)(@) big nipple breasts (you know who you are)
o o a cups
{ O }{ O } d cups
(oYo) wonder bra breasts
( ^)( ^) cold breasts
(o)(O) lopsided breasts
(Q)(Q) pierced breasts
(p)(p) breasts w/hanging tassels
(:o)(o) bitten by a vampire breasts
\o/\o/ Grandma's breasts
( - )( - ) flat against the shower door breasts
(o) _ Breast cancer survivor breast

If you’ve followed our blog, you already know some movies have used plastic surgery as a plot gimmick. (See
the posts on the films Time and 200 Pounds of Beauty.)

But do the movies influence the plastic surgeries that people want?

300 Pounds of Pecs?

One of 2006’s favorite movies was “300,” about the last stand of 300 Spartan soldiers in 480 B.C. when those few Greeks held off an invading army of invading Persians, got killed in the process but saved all of Greece.

Virtually all the actors playing Greeks had massively developed chest muscles (pectoralis major). Hey, just call them “pecs” like serious weight lifters do. But to the Persians, it must have looked like they had to fight through a wall of buff chests.

In a case where life may be imitating art, the American Society of Plastic Surgeons reported the number of pec implants increased 99 percent, jumping from a mere 209 in 2005. (There were no reports at all of pec implants in 2004.) Read more about the Pectoral Augmentation surgery.

A pec implant is something you really, really must want. According to a San Francisco Chronicle article, pec implants alone cost $1600 a pair. The surgery to implant them runs from $7000 to $9000. Read more.

(Pec implant before and after photos, courtesy of Sam Gershaum, M.D.)

So -- movies not withstanding -- why would a guy pony up that much for a buff, square chest? Tired of having sand kicked in his face? Always the last guy picked for touch football pickup games? Need to hold off a Persian army, maybe?

Actually, a personal trainer says the appeal is projecting power, strength, health and virility. Others in the know say some other psychological benefits are providing a really nice place for the weary heads of significant others to rest upon.

And isn’t that a sweet gesture with Valentine’s Day approaching?

Any readers out there ever had a pec implant? What’s it like?

Read more about the costs of plastic surgery.

Top Ten Things You Should Never Say to a Plastic Surgeon

1. I’m 45; Make me Look I did at 20.

A plastic surgeon can turn the clock back a little but
can’t reset your appearance to two decades ago. Read more.

2. Write me a ‘Script for Some Extra Pain Killers

Basically, don’t ask a plastic surgeon to break the law. Sure, you can have a prescription for a few pain killers, sleep aids or tranquilizers in connection with a surgery, but don’t try to cop a major score. More.

3. Make me Look like Angelina Jolie (Brad Pitt, etc. etc.)

One of the ways a plastic surgeon has of knowing you know the meaning of “realistic expectations” in plastic surgery is to exclude those who want to look like celebrities. The whole idea is to make the best possible version of you.

4. I want a Face Lift because (my wife divorced me; my husband is seeing his secretary; my dog died) and want to feel better.

Plastic surgeons are trained to screen out people who want the surgery for the wrong reasons. So having surgery when you are going through a divorce or some other deeply troubling event is usually out. More.

5. Why Do You Charge So Much for only Two incisions?

If you are in the office of a plastic surgeon who is board certified in plastic surgery, otolaryngology (head and neck surgery) or facial plastic surgery, it requires anywhere from four to seven years of extra training after he or she receives the M.D. degree. Not everybody has the smarts, coordination and determination to get there. More.

6. I Want Liposuction because I don’t like Working Out.

Actually, you’ll have the best results if you can get off the coach, watch what you eat and work out. Your surgeon may even tell you to go home and lose weight before he’ll give you liposuction, which is not a method of weight control. More.

7. I Want to Get off the Table Immediately Afterwards

If you want an invasive procedure, you must show the surgeon you have time to take care of yourself and let your body heal after surgery. More.

8. I Sued My Last Plastic Surgeon!

Among people for whom rejuvenation surgery is probably not right are some with an odd condition (body dysmorphic disorder) in which no amount of plastic surgery is enough. And no results are ever good enough. So they file ungrounded lawsuits. More.

9. Help Me Fudge a Health Insurance Report, Doc

See #2. Besides, almost all plastic surgery is paid up front.
Very few procedures are covered by insurance. More.

10. Don’t Bother checking my Blood Pressure (Glucose level; EKG reading, etc.etc.)

No way around it: you gotta be healthy enough for plastic surgery. Want to wind up like Donda West? If you have a chronic health condition like high blood pressure, diabetes or heart woes, the only way your plastic surgeon can go forward is to check your medical tests. Read more about why your plastic surgeon does not do the health checks him-or-herself.

Botox Has a Competitor!

Pretty bold, considering there are about 4 million Botox injections given yearly! The stuff is used to treat everything from wrinkles to damp palms to writer’s cramp to urgent bladders. Read more about Botox.

Zap “The 11s”

The new kid on the block is not another drug, but a machine that zaps the nerve allowing you to scrunch up the area between your eyes. (Plastic surgeons call that area “The 11s” because it looks like, well, a big number 11 on your forehead.) The treatment is known as GFX, or glabellar furrow relaxation. Read more.

Approved by the FDA, here’s how GFX works: the doc asks you to frown real hard so he can locate your frown muscles. (I don’t know about you, but I automatically go into a massive frown at the mere mention of doctor bills!)

No More Frowning

Then, the doctor numbs up your forehead and uses a small needle to find the nerve that triggers a frown. Next, a little RF (radio frequency) energy is aimed at the nerve to zap its activity. Presto! No more frowning, even if you wanted to. Even over doctor bills! The nerve isn’t destroyed; it’s just in total shock for a while.

Showing “The 11s”.

The upside: while it requires Botox a couple of days to show results that only last for three to five months, GFX is said to last anywhere from eight to 18 months.

Downside: Botox costs anywhere from $250 to $450 per treatment depending on where you live. But because only two U.S. physicians are currently delivering GFX, a treatment is running anywhere from $1800 to $3000.

Read more about plastic surgery costs.
It’s not drooping flesh. Or wrinkles. Not baggy eyelids, either.

It’s that curse of aging, the square jaw.

So declares the America Society of Plastic Surgeons in a special report studying images of 16 people taken when they were mere babes -- about 16 -- in the woods and again at “maturity,” meaning 56 or older. Read more.

So we wondered what famous people would have looked like with those jaws.

(Images courtesy of

Einstein would not look
much older with a square jaw.
It looks like maybe boxing promoter
Don King copied the hairstyle, though.
(I’ve read both guys comb their hair
with jumper cables.)

The Golden State “Governator”
only looks tougher and more determined
to “bee bach” with a square jaw.

With a square jaw, Bonnie Prince
looks like he’s ready to take
over the Royal Reins from
the Queen Mum and be a proper

More mailbag questions!

Tom Fiala, a fellow plastic surgeon, asks "Do you think American women will make the switch to the Allergan Style 410 implants? Or does the required larger incision size, and un-naturally firm texture overwhelm the advantages of the non-collapsing shape? I read about lower capsule rates in the literature - but is that because they're so darned hard to start with? "

My prediction - there will be tremendous promotion of the form stable devices (the Allergan 410 & the Mentor CPG)upon approval with a signifigant backlash after people attempt to use them in the wrong patients. These devices demand a "virgin" pocket of tissue for tissue adherence and will not be a great choice for reoperative patients with the large pockets that smooth,round implants require. You will see a lot of rotational problems present as people experiment with these implants. These anatomic shaped implants are also a poor choice for patients with significant ptosis (droop).

If Allergan & Mentor are smart, they should be manufacturing a line of round, form-stable devices for the American market which will be what we gravitate towards I bet. The stiffness of these devices is also going to take getting used to. There exists a slightly less stiff cohesive 410-style device in Europe which might be a better fit for American tastes.

Underdog implant manufacturer, Sientra (aka Silimed) has had one of the softer cohesive gel "tweeners" in their lineup (which is still in FDA trials) that feels like it hits the sweet spot just right. They've also got some really sharp management in former Inamed execs Hani Zeini and Dan Carlisle. I haven't seen any of their implant performance data, but it will be interesting to see if the outstanding Allergan 410/Mentor CPG numbers in re. to rupture and capsular contracture are maintained when you soften the implant slightly like Sientra.

Snafu Suz also asked for news about the form stable (gummy bear) devices.

The million dollar question now is, "When will Allergan's & Mentor's devices be available?". You could go broke betting on how the FDA moves on anything. However, the data is so overwhelming that these type of implants dramatically reduce complications that it seems approval is likely this spring. I've heard thru the grapevine that major inservice meetings for the device reps. have been scheduled within the next few months which I take to mean that the FDA has communicated to these companies their endorsement of their PMA applications. Rupture rates of almost 0% and capsular contracture rates 60-80% less then current devices in recent studies seemed to have been persuasive.

Dancing Bev left this comment on a post re. to fat-grafting lumpectomy defects using a proprietary system by Cytori (see here) of which I was pessimistic on it's practicality. She writes "I recently heard a presentation of them stating that the costs for the whole reconstruction procedure (doctor fee, equipment, medical personal, energy...) would not surpass 8000$ of which the stem cell product itself costs roughly $2000. "

$8000? I'd counter that on planet earth it unfortunately costs more then $8000 to take somebody to the hospital O.R. to put a cast on for 10 minutes, much less perform a procedure taking several hours with several thousand dollars worth of disposable goods as is outlined in the description of that type of fat grafting. I sat through 5 lectures on fat grafting and 2 live surgeries this past weekend and the costs for those procedures was apparently between $30,000-50,000.

Don't take that to mean I'm not interested in this, I just don't understand the economics of complex fat grafting setups. A number of Europeans are presenting fairly simple ways of fat harvest and grafting irradiated breast wounds that can be performed in less then 30 minutes under local in your office. I was so impressed that I just bought some simple equipment to start doing fat grafts on radiation induced breast wounds in my procedure room.

1. Belly Button Surgery

Some people with “innies” want “outies” and vice-versa. Technically, the operation is known as an umbilicoplasty. Read more.

2. Toe-Besity Surgery

Got tubbie toes? Stubby toes? Slim them! More.

3. Eyebrow Transplants

There’s no woe like skimpy or no eyebrow woe! More.

4. Foot Facelift

A toe may be too long or short; maybe it’s the dreaded “high heel foot” condition or corns, bunions or hammertoes. Solution? Anything but sensible shoes. Puh-lease! Better: a toe tuck and foot facelift to look good in sandals.

5. Ear on the Forearm

You don’t see a lot of this but one “performance” artist
implanted a more-or-less real human ear on his forearm. Something to do
with seeing what he is hearing? I don’t get it either but, hey,
today’s avant garde is tomorrow’s ho-hum. More.

This is not Photoshopped. The ear
was grown from human cells in a
Petri dish in a university lab.

6. Rib Removal

I always thought this was taken care of in the Garden of Eden. Anyhow, some women who want an hourglass shaped figure have two or three ribs removed. But the patient also must have a tummy tuck (abdominoplasty) for the whole concept to come together. More.

A patient shows her new waist just after her surgery, left,
and after things have healed better.

7. The Human Barbie

Sarah Burge, 46, an English woman, has had 26 plastic surgeries over the last 20 years, trying to make herself look like Barbie. It’s actually quite a lonely life because there is no Ken in sight. Any volunteers, guys? It has only cost Sarah $351,775 to get a certain Barbie look. So far, that is. More.

8. Plastic Surgery for Kangaroos.

Feznick, a popular Hollywood movie star, (well, in roles that call for a kangaroo,
anyhow,) was bit by one of his neighbors where a lot of acting animals live. Hey,
this is California, you know! Because his close-ups would be ruined, he had
plastic surgery on his snout. More

9. Michael Jackson

Need we say more? Some plastic surgeons figure 10 to 15 surgeries on that nose. More

10.Jocelyn Wildenstein

Ha! You didn’t think we could top Michael Jackson, huh? Jocelyn’s bill for plastic surgery -- no wait, make that bad plastic surgery -- is said to be over 3 million dollars, thanks to a multi-million dollar inheritance. More.

Jocelyn, aka “The Cat Woman”

Questions from the mail bag

Today is the innagural session of attempting to answer questions from the audience. I'd like to make this a regular feature.

Gorgeous black woman (what a great ID!) asks me to discuss "relatively new procedures (SmartLipo, Liposelection, surgery-free nose job, transumbilical breast augmentation)"

Everyone's always looking for "something for nothing" which describes most of those things you're asking about. My thoughts in order.

1. "Smartlipo" - this is a kind of liposuction machine which has a weak laser at the tip of the liposuction instrument which ostensibly breaks up fat at the end. It's promoted as having less edema, pain, etc... which is a claim that Plastic Surgeons have learned to be skeptical about. I'm withholding judgement on this particular device, but the track record of this kind of "laser assisted" liposuction is poor there are very experienced liposuction surgeons panning this. The fact that you will still need to extract the emulsified fat with traditional liposuction instruments makes some skeptical that it makes sense to buy a $100K+ machine to pretreat an area prior to suction.

Another thing to note is who is promoting these devices. By and large it's dermatologists, gynecologists, and the nebulous "cosmetic surgeon" types rather then Plastic Surgeons who actually have a great deal of body contouring training and experience. If you go to the manufacturers website the 3 physicians spotlighted are a family practice doctor and 2 gynecologists, one of whom claims "board-certification" by the American Academy for Cosmetic Gynecology of all things (color me impressed!). The 3 doctors in my state promoting this are a dermatologist and two ENT doctors BTW.

That's a big red flag to me that this is more sizzle then steak, but I am interested in seeing this hands on. I reserve the right to reevaluate this technology as it's techniques matures.

2. Liposelection (aka. VASER) this is a refined version of ultrasonic liposuction (UAL) technology. Despite initial enthusiasm, UAL has stiffed as it has been associated with higher complication rates with no clear advantage in results. VASER is a "kinder, gentler" UAL which has actually gotten fairly good reviews. The cost of the device ($50K+ I think) has killed wider usage, as it's really not clear that it offers any advantage over traditional techniques. Much like SmartLipo, the economics of it make no sense for most surgeons. If the price comes down it's use may increase somewhat. Think of it as an alternative to Smartlipo with a little better track record at this point.

3. "surgery free" rhinoplasty is not something I think you want to jump on board with. A number of referral rhinoplasty experts report that they are seeing serious complication from injectables in the nose with dramatic amounts of scarring/inflammation which make surgery very difficult. The picture at right is from Dr. Dean Toriumi, a rhinoplasty super(duper)star from November's "Cosmetic Surgery Times" feature on this practice.

Nasal skin is fairly specialized and can be pretty finicky in how it reacts to either defatting (to thin it out) or to augmentation with soft tissue fillers. Some defects can be camouflaged by fillers or more traditionally cartilage grafts (which have their own set of complications long-term). If I was going to be attempting correction with a filler it would probably be with something like the small-particle size Juvederm which should cause the least problems and wear off at some point.

The article by Dr. Toriumi clearly shows why if you are considering doing this, you need to have someone who actually knows nasal anatomy and surgery discuss this with you. This is not something your dermatologist or other cosmetic medicine provider she be dabbling with.

Anon, a breast cancer survivor, asks "I take tamoxifen. I exercise an hour a day - tough things like spinning and hiking. I keep gaining weight. Yes, I eat. But do I really need to starve myself? Is it the meds? The surgery? The menopause?"

Tamoxifen and other related drugs (Arimadex, Femora) literally induces a "chemical menopause" as they block estrogen receptors. It can play havoc with some people's metabolisms. At the end of the day though, all weight gain comes from taking in more calories then you're expending. If you're having problems with your diet, consider sitting down with a dietitian and they may have some relatively painless ways to cut back on high-cal/high-carb intake.

Anon #2 asks me to comment on the rumor that various insurance companies are cancelling or refusing to grant medical policies to women with breast implants.

I've yet to see this in writing anywhere, but I've heard it anecdotally from a surgeon in California. This should become less of an issue as we continue to produce better data on outcomes after breast augmentation. The longitudinal data that keeps churning out from the U.S. FDA data and from Europe looks better and better, particularly with the devices we're about to get wider access to in the United States.

Keep your questions & comments coming. I love this stuff!



Koreans Put Plastic Surgery into their Movies

While American, British and Australians are fascinated with T.V. plastic surgery programs, Koreans like to go to the movies for their plastic surgery entertainment.

If you’ve followed our blog, you already know about 200 Pounds of Love, a Korean rock ‘n’ roll movie that used plastic surgery as a plot device.

Three Hankies

Now, for a three-hanky review! Star-crossed lovers deal with, not demanding families and feuding gangs, but plastic surgery and appearance.

The latest is Time, now playing on the Sundance Channel. The flick has a Korean sound track with English subtitles. Read more about the film.

While it’s a touching love story, it shows something American, British and Australian plastic surgeons (and probably many others, worldwide) would, and should, not do: provide plastic surgery to a person who wants it for all the wrong reasons. In this case, a patient is afraid her boyfriend will tire of her looks.

Take a knife to this face? Are you kidding?

Here’s what happens:

She-hee, the already gorgeous young woman above, becomes insecure about her appearance two years into a serious love affair. Her solution? Plastic surgery.

While a surgeon tells Seh-hee he can not make her any more pretty, she insists on having a surgical makeover. Afterwards, she splits on her lover, Ji-woo, while her face heals. The poor guy is heartbroken and searches everywhere for her. After six months, Seh-hee returns to him with a new name and is unrecognized. They start seeing each other again.

Another Plastic Surgery

Eventually, the boyfriend catches on and goes in for a total surgical facial makeover, too. Now it’s Seh-hee’s turn to go searching. Because she knows Ji-woo has a new face, she stops many handsome guys but the only way she can tell if a guy is really Ji-woo is by how the guy’s hand fits into hers.

I won’t give away the ending but it involves one more plastic surgery by one of the main characters, again for all the wrong reasons.

Seh-hee and Ji-woo before plastic

The 98-minute movie is also worth seeing because South Korea looks modern, clean, uncrowded and with delicate Asian touches everywhere. As you might have guessed, the nation is also becoming a plastic surgery hot spot.

To read more about the right reasons for having plastic surgery, try the following article about choosing a plastic surgeon -- and why a plastic surgeon just might send you on your merry way.

Atlanta Breast Symposium 2008 - lots to digest!

Sorry for no posts since last week, but I've just returned back from the 2008 Atlanta Breast Symposium. Like I mentioned last year, Atlanta is kind of the "spiritual home" for plastic surgery of the breast in America, and this meeting is kind of the premier forum for discussing issues re. to breast surgery.

Lots of things buzzing around my head which I'll be writing about soon!

Expect forthcoming writings on:
  • fat grafting of the breast
  • controversies in breast reconstruction
  • technical and safety advances
  • the pending approval of form-stable "gummy bear" implants



Top Ten Myths about Breast Augmentation

Breast Augmentation is the number one plastic surgery for 2006, the most recent year for which statistics exist. According to the American Society of Plastic Surgeons, 329,000 breast augmentation procedures were done in’06.

Myth #1: Breast Implants Cause Cancer
Studies and experimental data have not been able to link breast implants with cancer.

Myth #2: Breast Implants Must be Removed Every 10 Years
No specific data exists on the duration for implant replacement. Implants may last a lifetime or only a few years depending on various medical factors.

Myth #3: An Underwire Bra Should Never Be Worn with Implants
Underwire bras can be worn after healing. Over time, without proper support, the weight of the implants can create significant sagginess and stretch the breast tissue and skin. An underwire bra can prevent that.

A silicone breast implant

Myth #4: Shaped Implants are more Natural than Round Implants
Imaging studies have shown that both shaped, or anatomical, and round implants appear to have a similar natural slope when properly placed under the chest muscle. One complication of the shaped version: the implant bag can rotate and lead to disfigurement.

Myth #5: Loss of Nipple Sensitivity is Associated Only with the Periareolar Surgical Approach (through the nipple area).
Numbness can occur from any surgical approach if the nerves are stretched or traumatized during surgery.

Myth#6: Mammograms are Not Possible with Implants
Placing silicone or saline implants under the chest muscle helps with Displacement Technique Mammography and allows excellent results.

Myth#7: Over 50 Women Should not have Breast Augmentation
Patients of any age may undergo implant surgery as long as they are healthy, in good medical condition and free of breast cancer. Lab work is required for all surgical candidates while a routine mammogram is required for anyone over the age of 35 or with a family history of breast cancer.

A patient selects a breast implant

Myth#8: The Most Common Reason for Reopening the Incision is the Patient’s Desire to Remove the Implant Entirely
Actually, deflation (18 percent) and capsular contracture (also 18 percent) are the top reasons for reopening or undergoing a second procedure.

Myth#9: More Women Want to Go Larger on the Next Surgery, Believing They Went Too Small at First
That is not a myth but a true statement! Women get used to the swelling that generally occurs during the first two to three months after surgery. When the swelling subsides, they miss the fuller feeling and ask to have slightly larger implants put in.

Myth#10: It’s Easy to Detect a Rupture or Tear in a Silicone Gel Implant
Silicone ruptures are often silent because the implant holds its shape and may go undetected for years. An MRI is the most definitive method for determining a rupture or tear.

Source: Stuart A. Linder, M.D. F.A.C.S.
from his book, The Beverly Hills Shape: The Truth about Plastic Surgery.

*At right is a computer model of the BRCA-1 gene protein

The American Journal of Medical Genetics published a provocative paper this month titled, "Should genetic testing for BRCA1/2 be permitted for minors?" and reflected the surveyed opinions of adult carriers of the most defined "breast cancer gene" mutations, BRCA-1 & BRCA-2, about their feelings on having their children screened in adolescence.

What was the result?
A strong majority felt they'd support more aggressive screening. No surprise there.

What's the controversy?
Is it right to burden teenagers with genetic information that they may not be able to properly understand or cope with. This topic of "genetic destiny" also predictably brings with it discussion of practical issues (Will I be discriminated against for getting a job or health insurance?) as well as discussion of ridiculous parallels (ie. Nazi eugenics).

I personally find the logic of not screening to be flawed. Carriers of the gene are predisposed to not only breast cancer, but also to ovarian, colon, prostate, and uterine malignancy among others. More aggressive screening tests and liberal use of prophylactic mastectomy would actually make a dramatic difference in cancer-specific mortality in this subset of the population.

Something to think about!


Plastic Surgery Prices Explained

If you’ve ever wondered why the costs of plastic surgery vary so much from place to place in the United States, read more about it in a special report explaining at least some of it!
British reporter Clover Stroud, below left as she normally looks and while having the equivalent of a 36DD breast implant applied.

Stroud, a reporter for the Daily Mail in London, England, wondered about all the fuss over breast enhancements.

So a movie makeup artist applied the bosom of a woman who has 36 DD implants. Stroud then wore the getup for 24 hours and walked around London while noting the different ways men -- and other women -- responded to her.

Wrote Stroud about a range of odd reactions: “But what had inspired this frankly odd behavior from complete strangers? Quite simply, it was my pair of perfectly perky 36DD breasts.” Read more.

NEXT: Toe-besity: There’s a surgery for that!

If any surgical procedure, including cosmetic plastic surgery, has left you hurting, skip the anti-pain drugs and try a video game instead.

Researchers at the University of Barcelona in Spain are using computer games and virtual reality helmets to measure how much high tech gizmos can reduce pain. So far, researchers have found the technique reduces the need for sedatives. Video games seem to work because you can only pay so much attention to any one thing; the games or virtual reality helmets distract your brain from your pain by more fully involving your other senses. More.

The Spanish are not alone in trying e-cures.

Researchers at Simon Fraser University in Vancouver, Canada, have done experiments that show patients who are distracted in a virtual reality world like a 3-D skiing adventure, report less pain than others using drug-based pain therapy. More.

But it’s not so bad when you consider that surgical pain is just weakness leaving the body.

Physicians can read about it here: Article: Wismeijer, AAJ; Vingerhoets, AJJM, "The use of virtual reality and audiovisual eyeglass systems as adjunct analgesic techniques: A review of the literature", Annals of Behavioral Medicine, 30 (3): 268-278 DEC 2005

The most excellent blog, Truth in Cosmetic Surgery, written by John Di Saia, M.D, a board certified plastic surgeon in San Clemente, California,
found a hilarious commercial for a type of chewing gum known as “Boobie Chew.”

Take a look:

The video seems to date from the 1980s; nobody is sure if it ever actually aired because its medical claims never got assigned to the precise category in science known as “believable.”

Nonetheless, you can still find chewing gum that purports to increase breast size. For instance, in Japan B2UP (short for “Bust Up Gum”) is a big seller.

The magic B2UP ingredient? Extracts from the Kwao Krua plant which is said to make breasts grow, improve shape and tone. Hey, what’s this? Breasts now have tone? Well, maybe a G would be all right with most people but I imagine a B flat would be a big fizzle. Read more.

Also available for the chewing gum and bosom-challenged public are Zoft Breast Gum (Contains Phytoestrogens! Chew less! Grow More!) and Breast Success, among others.

Here’s an odd but related item about chewing gum:

While chewing gum really can make surgical incisions heal faster, the one thing it does not do is make breasts grow larger, says Dr. Si Saia.

Florida, you deserve better then this from your state medical board

Today I feel like throwing some rhetorical grenades!

I'm reading today's New York Time health section when I came across another article about cosmetic medicine encroaching on retail environments, "Having a Little Work Done (at the Mall" when the photo below caught my eye.

The photo's caption reads "At the Sleek MedSpa in Aventura, Fla., Martha Mena undergoes a procedure to dissolve cellulite. Lorianne English, a nurse practitioner, gives the shots as Ms. Mena’s friend Erika Galan looks on."


Let me get this straight: You have an unsupervised allied health provider (a nurse practitioner in this case) in the mall delivering off-label medications in an injectable form they're not approved for, which also have a track record of potentially serious complications.

Is the Florida State Medical Board asleep at the wheel? While Florida is liberal with scope of practice issues with their nurse practitioners and physician assistants, I'm taken aback that this is not being scrutinized closer. I got interested enough that I sent an email to the office of Quality Assurance in the state medical board asking for a position on this. I'm sure they'll get back to me el pronto. (snark!)

Awhile back I'd written about (see here) the Democratic Governor of Wisconsin, Jim Doyle, raiding a trust fund set up (and paid for) by Doctors to stabilize medical-malpractice insurance costs in that state. Why? In order to avoid unpopular budget and spending cuts to balance his budget. That case is still being litigated.

Taking inspiration from his Democratic cohort, Pennsylvania's governor, Ed Rendell (D-Pa) has targeted their state's Medical Care Availability and Reduction of Error Fund to the tune of $400 million USD to cover deficits in their state's budget. A summary of this can be viewed in the AMA News, here.

This program known as "Mcare" has been successful in partially turning around Pennsylvania's climate for being a horrible state for doctor's to work in re. to med-mal conditions. MCare provides doctors with catastrophic coverage for medical malpractice. Doctors in Pennsylvania purchase $500,000 worth of insurance from a primary carrier and then another $500,000 worth of coverage from MCare. It was also a key component of limited tort reform in that state. On its Web site, the Pennsylvania medical society has posted the question, "Would you continue to practice in Pennsylvania if you no longer received relief (abatement) from MCare?" Nearly two-thirds of respondents said they would not.

FREE ADVICE: Ed, in a state struggling with access problems, I'm not sure that driving away health care providers is the way to go.

Governor Rendell has been progressive in trying to expand health care coverage in Pennsylvania (which is a good thing), but he has been unwilling to make hard spending cuts and unsuccessful in persuading his state legislature to fund his ideas thru taxes on tobacco and business not offering health insurance. He now is trying to play political hardball and quite willing to disrespect the health care providers in his state to do it. An article in today's Pittsburgh Post Gazette quotes the Governor as saying
"If I have to choose between taking care of doctors and taking care of someone who has cancer and doesn't have health insurance, it's an easy choice"
This is an unbelievably cynical "straw man" tactic (ie. setting up false alternatives to make a rhetorical point).

There's no plausible or logical link between Mcare and his political failures, but merely he sees a pot of "easy money" sitting around funding a successful program whose constituents (ie. doctors) don't have the resources to hurt him politically if he steamrolls them.

To Governor Rendell, I ask you:



The autopsy report on Ms. Donde West, mother of hip-hop star, Kayne West has been released. You can read it here. On November 9th, 2007 Ms. West underwent breast augmentation/mastopexy, belt-lipectomy ("around the world" tummy tuck), and liposuction of her trunk.

Her autopsy report noted that West had moderate coronary artery disease (CAD), with blockage between 50 to 70 percent in her right coronary and left circumflex arteries. The 5-foot-2-inch, 188-pound woman also was moderately overweight and had developed several complications after surgery, including fluid in her lung. The investigation found nothing unusually high in the level of her narcotics and no signs of internal bleeding, infection, or pulmonary emboli.

According to West's autopsy report, she underwent cosmetic surgery on Nov. 9 and went home that day, "even though she was advised that she receive postoperative care at another facility." (That advice in her record may become very important for Dr. Adams defense when this is investigated)

Her first day home she was walking around and appeared fine according to the interviews with some of her care takers . She did complain of pain as you'd expect from such a huge series of procedures. The next day she developed mild trouble breathing and was found in full arrest when left alone for a short period of time.

A separate report by a coroner's investigator said it couldn't be determined whether West underwent any type of pre-surgical screening before her plastic surgery. She apparently had a stress test in January 2007 after experiencing vague chest and shoulder pain, but those symptoms apparently never returned and she seemed to be on only modest medications.

I'm 100% convinced after reading her full autopsy report that the explanation is pretty simple. It is very likely that she vomited and aspirated and then went into respiratory arrest. You see this frequently in hospitals and nursing homes in older and younger patients. I'm not sure why her pathologist was obtuse in his language about this. I take that back.... I know exactly why he is so guarded! He knew this case was going to be scrutinized and probably later litigated. This is defensive medical language 101 to me in all honesty.

To me, Dr. Jan Adams comes off a little better with this information in hand. This wasn't a surgical complication at all per se, and she apparently did not have any evidence of a heart attack (read the autopsy description of the heart itself - it was normal). Even if he'd kept her overnight in the hospital (which I think most people might do for this), it still would not have prevented this as it happened well after 24 hours post op. You can argue the wisdom of such a complex set of procedures as an outpatient surgery on a nearly 60 year old overweight woman with borderline hypertension, but I'm not sure that she would have been medically excluded from surgery all together by her internist. (Remember, she apparently had a fairly unremarkable cardiac stress test earlier in the year that did not trigger further work-up with a cardiac cath study.)

It will be interesting how this plays out. I will be surprised if the logic I'm outlining is not exactly how this plays out in front of the California Medial Board review of this episode.

Rarely do you see such an, ah, uplifting story.

Here’s the heart of it: Cut down fewer trees while creating more cleavage for all those who want it. It might even replace breast augmentation procedures.

As a nation, Japan throws away some 25 billion chopsticks yearly, causing large swaths of forest to be cut down.

And what’s the best way to stop that waste?

Why, silly, wearing a chopstick bra!

If you want to see the chopstick bra in action, check out this video:

Lingerie maker Triumph Internal Japan developed the support garment so the wearer could insert several pair of reusable chopsticks into the bra’s underarm panels. See where this is headed?

Triumph didn’t explain it fully but additional chopsticks can be used against the bosom to create a more flattering décolletage.

But don’t be mislead by the woman posing for the above picture. One cup resembles a rice bowl and the other a soup bowl (Chopsticks for soup? I don’t get it either!) but it’s all a grab for media attention.

The production model bra will most likely be just ordinary cloth cups with plenty of chopstick pockets. So far, nothing special is in the works for guys who want to carry collapsible eating utensils. Maybe a longer shirt pocket?

By the way, Triumph is a fashion designer with an odd sense of style. Read more about their take on the top eight most bizarre bras.

And if you’re interested in new bustlines, here’s a more-or-less normal story about adjustable breast implants.

Suggestion Box - What would you like to hear about?

If there are any topics that the audience would like to hear me wax poetic on, please feel free to throw ideas in the suggestion box I'll keep in the comments section of this post.


Top 8 Far-Out Uses for Breast Implants

The world is filled with the results of unintended consequences. Sure, you can use cat litter to provide traction on an icy sidewalk, but whoever thought so many unintended uses for breast implants would crop up? We present the top eight:

1. Book Title

To win a $100,000 bet, Brian Zembic stepped up when another gambler put up the cash against Brian keeping 38C breast implants in his chest for one year. (Tip for guys: Women were fascinated and not the least bit put off by the enhancement. Maybe having a beefy chest is not such a bad thing, after all? Maybe forget the gynecomastia surgery?) The outcome? Brian became $100,000 richer and then was featured in the book, Man with the $100,000 Breasts. More. Casting for the movie continues but, so far, every leading actor has turned the role down because none wants to be seen with a bustline.

2. Airbags

Perhaps inspired by a Bulgarian woman whose 40 DD breast implants served as airbags and saved her life in a car crash, Japanese technology company Takata, the world’s leading supplier of auto safety belts, used a giant double implant template and came up with an improved air bag for cars. More

3. Man Pacifier

A San Francisco blogger known only as donnauwanna noted her life partner seemed to consider her breasts a source of comfort. So the clever donnauwanna decided to take matters into her own hands and created a squishy breast shaped stress reliever, modeled after one of her own. (We are NOT making this up. Read more.) Her fondest hope? “Maybe now he’ll leave me alone so I can get important things done!” Anyhow, here’s how to make one. But you really must want to do this because you start with a plaster cast of one breast. However, if the lady love is (understandably!) unwilling to slather her torso with cold, clammy plaster mix and sit still, waiting four hours for it to dry, some wives just toss their mates a silicone breast implant. Why? Silicone is like the real deal.

Of course, all this could easily be nipped in the bud because a new scholarly study found breast feeding can make kids more resilient to stress. More.

4. Ebay Sale

Mary Carey, an adult film start who ran for governor of California in 2003, put her 36 D implants (removed only because she wanted 36 DDD implant replacements ) up for sale on Ebay. As of January 8th, bidding was at U.S. $316.00. More.

5. Solve Crimes

A British murder victim was missing her hands and head when police found the body. But the woman had breast and buttocks implants, both of which carry serial numbers. The numbers cracked the case. More. Similar I.D.-by-breast-implant cases have taken place in New York and in Georgia.

6. Get-out-of-Army pass.

“ACHTUNG!! Today, D Cups! Tomorrow, Triple D Cups!”

(Actually, the headline reads: “The German Army will not allow my bustline.”

A German female soldier, 24-year-old Alessija Dorfmann, must leave the Army because she has D-cup size silicone breast implants. A German Army spokesman, Harald Kammerbauer, explained there is an increased risk of injury. More.

“I chust vanted to be all I can be,” lamented Alessija.

The case is under review so Fraulein/PFC Dorfman may be able to become the army medic, she signed up for after all.

7. A Curvy Tattoo

Above, Lane’s right leg. He is editor of
a body art and tattoo magazine in Edmonton, Alberta.

Thinking that a 2-D tat was too tame, Canadian Lane Jensen
asked a tattoo artist and wannabe surgeon to open his leg and surgically
implant tiny breast implants in the anatomically correct position of a
buxom woman tattoo. (Note: Do not try this at home. While these people were
totally untrained professionals working in a dangerous environment, they were lucky!
Lane still has his leg which is a miracle in itself!) More (without the
breast-or-leg man quips!)

8. Body Armor

(Photo by mzacha)

A woman’s silicone breast implants stopped a piece of shrapnel “inches from her heart” after a rocket attack in Israel. “The implants saved her life,” said an attending physician.

If you’re still interested in breast implants and how they are used by more-or-less “normal” people, read more about inserting breast implants through the belly button.

Next: Implants? Who needs ‘em anyhow? Chewing gum claims it can enhance breasts!

Catch of the day - things that make me go hmmm

Couple of things on my radar:

- Yet another study convincingly demonstrates the lack of relationship between thimerosol (a mercury-based preservative) in vaccines and links to autism. Read my blog entry, "Mad Science" to get up to speed if you're unfamiliar.

- One of the nation's leading Plastic Surgery groups that focuses on hand surgery in Houston,TX has published data suggesting nearly 4% suffer irreversible nerve damage from carpal tunnel symptoms that persist longer then 8 weeks, and that less then 2% of patients respond with traditional non-operative treatment demanded by insurance companies. This finding adds to the body of literature now suggesting we treat median nerve compression at the wrist (aka. carpal tunnel syndrome) much more aggressively.

- CNN news anchor, Glenn Beck, describes his experience after hemorrhoid surgery. Why is this a news story exactly? He's offended that he wasn't treated the empathy he feels he deserved after coming to the emergency room with post-operative pain (which is an emergency not an EMERGENCY!). He comes off looking a little crazy in his interviews and the infamous you tube video .

- A Catholic hospital in California is being sued as it is refusing to allow a transgender man to get breast augmentation surgery on it's campus. This kind of political grandstanding against traditional Catholic teachings (which is what this case is) by the gay/lesbian/transgender activists is noxious. There are many places nearby where this surgery could be performed without issue, and this is just another kind of "lawsuit abuse" that's substituted for the political process in America.

- Many hospital systems are formally adopting policies of not charging patients or insurers for costs associated with treating "never event" complications like wrong site surgeries or cases where surgical instruments or sponges are left in patients. This is a good thing! Still to be determined however are complication costs more related to patient age or preexisting medical conditions like urinary tract infections, pressure sores, or falls. This is an unworkable policy penalizing hospitals for these last 3 things, and definitely falls into the V.A. LOGIC (see here & here) realm of bureaucratic insanity.


Human Fat-Powered Speedboat?

The vast majority of plastic surgeons don’t have a use for the fat they suck or melt from your body during liposuction.

Of course, a few noble souls are searching. Some even freeze patients’ fat in case some future discovery is made. A few surgeons move fat from one unwanted location of your body to another while research labs constantly look for medical uses.

Suddenly, a really practical thing comes along. Now, human fat can be used to power your speedboat! Why didn’t somebody think of this before? Will bass fishing ever be the same?

The Earthrace -- World’s
First Blubber Boat

In New Zealand, Pete Bethune, a former oil industry worker, created the Earthrace, a US$3 million dollar ship that will try to break the world’s speed record for zipping around the globe. The boat is powered by natural biofuels which usually combines recycled restaurant grease with some diesel fuel. Actually, Pete wants to promote biofuels more than snaring the world record.

To attract attention, Bethune and others underwent liposuction, collecting two gallons of fat that can drive the boat about nine miles.

Is that to say human blubber only gets four and one half miles per gallon? Well, it depends on what you’re driving and how fast you are going. At 23 tons, the Earthrace is a really big boat that goes really fat, er, that is, fast at a blazing 23 to 29 mph.

If all goes according to plan, the boat should take 75 days to race 32,000 miles around the world, thereby breaking the record by 10 days.

Unless they have to stop to take on more fat.

"VA Logic" in re. to plastic surgery - German style

It's always amusing to hear the United States Veteran's Administration (VA) hospital system celebrated by advocates of universal health care as a model system. If you've ever worked in one, you quickly learn it's a quagmire of competing impenetrable bureaucracies with insane regulations relating to everything. These regulations combined with a unionized workforce can make simple things (like taking care of patients for instance) not so simple. Illogical rules and regulations, and the irrational thinking behind them is what we used to call "VA logic".

VA logic has metastasized to private hospitals in the form of rules like the Federal Emergency Medical Treatment and Active Labor Act EMTALA, the Health Insurance Portability and Accountability Act HIPAA , and the growth industry of "nurses with clipboards" (NWC), nurses who aspire to have no patient contact, but serve vague administrative roles in hospitals harassing everyone. Each of these things started off with the best of intentions, but have spiraled out of control and now serve non-contributory bureaucratic roles.

A recent case from the German military comes to mind, where enforcement of an outdated and illogical regulation on cosmetic surgery led to the dismissal of a female soldier from her position after she'd had a breast augmentation surgery. From the report

A 23-year old female recruit who underwent breast implant is appealing to military authorities for reinstatement after she was booted out of army training in Germany for have boob job. Alessija Dorfmann, who has cup D after the operation, claims she was devastated after being kicked out of the army training as it has it been always her dream to be a soldier with a great figure. "And now my fake boobs have cost me my job," said Dorfmann adding she earned the money for the boob job by working as in an OAP's home before joining the army. "I could not stop crying when they told me. I wanted to work as an army medic and help save lives."However, military chiefs have vowed to review the Dorfmann's plight. "The rule that was brought in because of the increased risk of an injury is under review," said Army spokesman Harald Kammerbauer. "It was introduced more than a decade ago and it may be that it is no longer relevant in the modern army. In future we may be prepared to make exceptions."

Dorfmann will, however, apparently be allowed to join the Navy (go figure). With great pain, I will refrain from any jokes about floaties.

The rationale for this old policy doesn't make much sense, particularly if she had her surgery done when she wasn't on active duty or while on vacation. When done well, the down time after breast augmentation can be fairly modest. One of these days, I'll write down some thoughts on my take the evolution of surgical techniques for breast augmentation which I think we'll be interesting for the lay audience here.

Nurses get breast implants fairly frequently and are usually able to return to work within a week with only mild restrictions. Most breast augmentations in Europe are now done using textured form-stable silicone ("gummy bear") anatomic implants placed over the muscle, which has much less recovery time then the submuscular (partially under the pec muscle) placement that we do more here in the United States (another good topic for another day). Those kind of implants are so solid that they literally cannot physically rupture, although they can "fracture". If this woman was not in a front line position, it's fairly ridiculous to assert she's endangered herself or increased her risk of injury by her surgery.

As an interesting aside, while looking for some information on German nursing, I came across this old World War II propaganda poster from Great Britain which was trying to stir passion among the Brits over the German nurses' reputation for not treating captured wound allied soldiers.

P.S. Warning - Don't do an image search on Google using the term "German nurse" with children or your spouse around, as apparently there is a thriving porn-fetish industry around the theme :)

P.S.S. "French nurse" image searches are even more risque as you end up with both nurses and French maids ;)


Top 10 Cosmetic Plastic Surgery Stories for 2007

1. Botox Injections at Home and Work
Beauty is now being delivered to your doorstep or office. Read more.

2. Birthmarks: Getting the Blemishes Removed
Millions of people are afflicted with marks they want removed. More.

3. NBC’s Biggest Loser
Losing 311 pounds is the way to grab this prize! More.

4. Plastic Surgeons Recall Volunteering on 9-11-2001
A 110-story building fell on one plastic surgeon volunteer . More.

5. Can Plastic Surgery Cure the Blues?
Everybody feels better when they look better. But some patients lose their depression after plastic surgery. More

6. Breast Enhancement -- via Fat Grafting
It’s big in Europe -- using your own fat to enhance breasts.
A New York City surgeon shows the way. More.

7. Eyelash Transplants
Skimpy eye winkers? Hate gloppy mascara?
Transplants might brighten your eyes. More

8. Botox & Restylane for 20-somethings
Cosmetic plastic surgery is no longer just for old-timers. More.

9. Repairing Tubular Breasts
Many small breasted women don’t know they have a deformity. For tubular breasts, the surgeon must do a breast enlargement, lift and reduction -- all at once. More.

10. SmartLipo
The new liposuction kid on the block melts fat with a needle-sized, laser-tipped wand. More.

Doctor's who are part of the tort problem

Many of the major product liability cases of the last 30 years involving occupational exposure and medical devices have served as the poster-children for what's wrong about the way the United States legal system sorts these issues out. Class-action plaintiff's attorneys have repeatedly exhibited some of the most jaw-dropping acts of dishonorable behavior in the pursuit of settlements that pay themselves ten's or even hundreds of millions of dollars in legal fees and compensation.

Law professor, Lester Brickman recently estimated in the New York Times that “mass tort fraud” has cost at least $30 billion just in the last 15 years and cited "compelling evidence” that "many if not most of the medical reports supporting more than 700,000 damage claims filed in asbestos, silica, diet drug and silicone breast implant litigation are frauds

Many of these cases would have gone nowhere without the complicity of physicians from a number of disciplines who have either inaccurately or fraudulently testified in court, or those that have set up lucrative "diagnosis mills" based on referrals from trial lawyers to establish their claim.

From the Wall Street Journal:

Over one million potential litigants have been screened by agents for tort lawyers in asbestos, silica, silicone breast implant and diet drug (fen-phen) litigation. The lawyers sponsoring these screenings have paid over $100 million for medical reports to support the 700,000 or more claims generated by these screenings. There is compelling evidence, much of it reviewed in my published writings, that the vast majority of these medical reports, including chest X-ray readings, echocardiograms, pulmonary function tests and diagnoses are bogus.

The dimensions of this fraud are stunning. An asbestos screening of 1,000 potential litigants generates about 500-600 diagnoses of asbestosis. If these same occupationally exposed workers were examined in clinical settings, approximately 30-50 would be diagnosed with asbestosis. The total take for "excess" asbestos diagnoses is more than $25 billion, of which $10 billion has gone to the lawyers. More billions for bogus claims in the diet drug (fen-phen) and silicone breast implant litigations can be added to this bill.

A comparative handful of doctors and technicians are responsible for the vast majority of bogus medical tests and diagnoses. To indict and prosecute those responsible would require testimony from other doctors that the mass-produced diagnoses cannot have been rendered in good faith.

To be sure, doctors can differ in reading X-rays or making a diagnosis. But when a doctor has been paid millions of dollars to produce 5,000 or even 50,000 diagnoses in the course of mass-tort screenings -- and when panels of experts have found the vast majority of these to be in error -- the most compelling conclusion is that the diagnoses were "manufactured for money."

There's been a long overdue movement in medicine about better regulating the way Doctor's serve as expert witnesses. A number of specialty societies' have started to put forth registries for their members to enlist in for tracking and also allow peer review of expert testimony. Along with this are calls to put reasonable caps on how much a doctor should charge for their case review and testimony fees so as to remove the financial incentive to become a "professional expert witness". Predictably, the trial bar gets incendiary over this claiming doctor's want to intimidate their peers into not ever cooperating with tort or med-mal cases (a la the "blue line" about cops testifying on other cops).

Missiouri doctor, John Hagan M.D., wrote a blurb about the serial expert witness industry "testimony tart" in his blog saying:

For the right price these mendacious individuals will find malpractice in almost all of the cases they are asked to review. They serve exclusively the plaintiff’s bar. Known variously as “hired guns” or (my favorite) “testimony tarts”, they not infrequently earn millions of dollars per year.
Most are driven by base greed and avarice; a few are motivated by delusional standards of excellence and perfection that they think they alone practice and can determine. Their names and credentials are shilled in legal publications, over the web or through procuring agencies. Hometown physician colleagues are frequently unaware of the hired gun’s sordid and sub rosa activities.
What’s the going rate for a top testimony tart? Try $1000-1500/hour to review records, for trials or depositions $10,000-15,000/day, first class airline or private jet travel, limousine service, suite of rooms at the best hotel, expensive gifts at Christmas and, for the most egregiously corrupt, a contingency fee based on a favorable verdict and large judgment. Some allegedly guarantee their testimony will result in a big settlement or guilty verdict.

In doing some research on this, I found reference to this going back to a New York Times article in 1897 (!), which reported that The Committee for Remedial Legislation in Regard to Expert Testimony called for all physician witnesses to be paid by the county rather then lawyers or prosecutors so as to remove potential bias. It seems we're still trying to get our hands around this issue 110 years later.