News & Features

Plastic Surgery News: World Roundup September 2005

U.K.: Gynecomastia due to Female Hormones in Food & Water?

It's common knowledge that hormones and antibiotics are used in U.S. cattle feed to produce more, well, beefy beef. And because water is scare in some areas of the U.S. and the U.K., waste water is thoroughly cleansed and recycled back into homes. While the water is perfectly safe, some wags have nonetheless named the process, "Toilette-to-tap."

But there's something else silently lurking beneath the surface -- your morning cup of tea or coffee might be swimming with female hormones.

U.K.: Man Boobies due to Female Hormones in Food & Water?

Photos courtesy of
Elliot W. Jacobs, M.D.
New York City.

The first clue was found in scientific journals that reported male fish in rivers and lakes becoming more female due to the glut of feminine hormones and estrogen in their environment. The estrogen gets into the water as many more women take birth control pills, excrete the excess hormones from their bodies in the normal way and then flush them away. But sewage treatment plants do not remove all chemical compounds from water.

Problem is, many men don't want to get entirely in touch with their feminine sides, at least unknowingly. Nonetheless, plastic and cosmetic surgeons in the U.K. are seeing a sharp rise in the number of men requesting breast reduction operations. So one surgeon decided to study the issue more closely. His findings? females hormones in food and water could be creating more cases of male boobs, or gynecomastia, as physicians know the fleshy chest condition that prevents many affected men from going bare chested, even on the hottest days.

Alan Kingdon, M.D., a cosmetic surgeon and medical director of the Cosmetic Surgery Clinic in London, has seen cases of one male breast reduction per month years ago zoom to one per week currently.

"The increased incident of gynecomastia is a personal impression although it does seem to be supported by other practitioners," Dr. Kingdon told News. "I'm sure that estrogen in the food cycle must be a factor."

Moreover, Dr. Kingdon collected samples of gynecomastia tissue taken from mens' buxom chests after operations and discovered mammary gland tissue which is usually found only in women.

The British Association of Aesthetic Plastic Surgeons found in a 2003 survey that its members carried out 22 male breast reductions which, in 2004, rose to 53.

So it may not be too much longer before some college fraternity adopts a new tune as their favorite party song: "Drink and be Mary."

U.S.: Inverted Nipples

Almost two percent of U.S. women have inverted nipples. Sometimes, one breast is affected; sometimes both have the condition.

Nipples in Traction, before and after of a nipple repair

Photos courtesy of
Grant Stevens, M.D.

"If a nipple does not contract when a woman is in very cold water or aroused, I call them 'intensely inverted,'" says Grant Stevens, M.D., F.A.C.S., a plastic surgeon at Marina Plastic Surgery Associates in Marina del Rey, just south of Los Angeles. Dr. Stevens is also an associate clinical professor at the University of Southern California.

"Shy nipples" - which can be drawn out by sexual stimulation or breast feeding -- may cause cosmetic and psychological problems. But densely inverted nipples prevent breast feeding and can become infected or irritated when natural secretions become trapped.

Many techniques to correct inverted nipples sacrifice the milk ducts and prevent breast feeding. Moreover, even when a surgical repair was done, some nipples would slowly revert to the former hidden position.

But Dr. Stevens came up with a better way of doing things. The "Stevens approach" not only pops inverted nipples back out again - usually for good -- but may preserve the milk ducts.

Instead of cutting the milk ducts, Dr. Stevens releases the ducts by making incisions in the breast that run from side to side, parallel to the ducts. The procedure starts when the surgeon makes a small incision at the base of the nipple that goes to - but does not invade - the milk ducts. Once the ducts are exposed, the surgeon can see which ducts or fibers inside the breast are causing the inverted nipple. The restraining tissues are then released, sparring most of the milk ducts. Four stitches right under the
Nipples in Traction

Stent used for 4-6 days postoperatively
Photos courtesy of
Grant Stevens, M.D.

nipple then tighten the supporting tissues to make sure the nipple isn't as likely to become inverted again. A dissolving "purse string" suture is then placed around the nipple. Finally, a suture is placed through the nipple and sutured to a plastic sent. It's known as a "traction" suture because the stitch holds the nipple erect (pictured at right) until everything heals. During the healing period, the patient can wear a bra and clothing; the nipple covering stays on four to six days.

Dr. Stevens and colleagues followed 21 patients for a year, who underwent nipple correction for an article in the professional medical journal Aesthetic Surgery Journal.

"One hundred percent of the subjects retained nipple projection during the study," Dr. Stevens says. "This surgical method should be considered when a corrective procedure for inverted nipple deformity is being thought about," writes Dr. Stevens.

Worldwide: Most Popular Plastic Surgeries

Facelifts in France? Lipoplasty in Lebanaon? Or, Botox in Bulgaria?

Yearly, the International Society of Aesthetic Plastic Surgery (I.S.A.P.S.,) an organization based in Brazil, names the three most popular plastic surgery procedures in 68 nations.

Because increasing popularity of cosmetic and plastic surgery is a huge worldwide trend, the I.S.A.P.S., tracks member reports of how many patients in any particular nation are receiving which procedures or substances.

Because everybody on the planet has heard of Botox and its rejuvenating powers, the substance is number one in popularity in many more places than the U.S. Youth seekers in Argentina, Australia, Columbia, Ecuador, France, Greece, the Philippines and Switzerland have made Botox the top cosmetic treatment.

But in Canada, Lebanon, Portugal and Taiwan, Botox falls to the number two position.

In Middle Eastern nations -- like Turkey, Israel, Jordan and Lebanon - nose reshaping is the most common surgical rejuvenation. (Israeli I.S.A.P.S. member surgeons reported 100 percent of their plastic surgery operations were rhinoplasties.) However, in one other Middle Eastern nation, the United Arab Emirates, hydrogel injections are done most often.

Breast augmentations take the top spot in Bosnia, Great Britain, Italy, Cyprus, Serbia-Montenegro, Spain, the Slovak Republic and Venezuela. But in Finland, the most requested procedure is the breast reduction.

Enhanced breast procedures occupy the number two position in Argentina, Australia, Brazil, Bulgaria, Denmark, Mexico and Sweden.
Taking fat out through liposuction is the most popular surgical rejuvenation in Brazil, Bulgaria, India and Portugal.
However, putting fat back in through fat injections takes the top slot in Chile.
Eyelid operations are number one in Russia, South Korea and Taiwan. The top procedure in Hong Kong is laser skin resurfacing while the outermost layer of facial skin in Malaysia is taken off with that nation's number one treatment, the chemical peel.

The most popular procedure in Canada? Perlane injections.

But apparently, everybody in the nation of F.Y.R.O.M. (that stands for "Former Yugoslav Republic of Macedonia,") has natural beauty and needs no enhancement whatever.

I.S.A.P.S. members there reported doing no cosmetic procedures at all.

Germany: "Bench" Surgery on the Nose

Germany: Bench Surgery on the Nose In most auto shops, you'll find some bench work. A mechanic removes a component like an air conditioning unit or an alternator from the cramped interior where the engine sits and repairs the item on a bench where he has more room to work.

The same concept is now being used in plastic surgery.

German plastic surgeon Wolfgang Gubisch, M.D. at the Clinic for Plastic Surgery, Marienhospital, Stuttgart, Germany, removes severely deviated septums, surgically repairs and then replants them back in patients' noses. He has given the operation the tongue-twisting name, extracorporeal septoplasty.

The nasal septum is a thin partition of cartilage that divides the two main chambers of the nose. When the septum gets banged up, the nose may bend, lean to one side or take some other unusual shape. Even worse, it can cause breathing problems that can block one or both of the owner's airways. The septum is often damaged by injury, malformations of birth like cleft lip and palate deformations, accidents, and -- because nose reshaping is the most demanding of plastic surgeries -- botched rhino-septoplasties.

In the operating room, when the septum is taken from the patient to the bench, the surgeon may sew cracked plates together or straighten or trim excess cartilage. Depending on what the patient needs, the surgeon may also drill holes in the cartilage so that bone and other tissues in the nose will grow into the holes, making the schnoz stronger and straighter.

Until now, most plastic surgeons have done the hard-to-reach, exacting work with the septum still inside the nose. That meant the job was often not done very precisely. Moreover, physicians were reluctant to remove septums because the field (the area where the surgeon works) becomes too bloody, making things hard to see. However, recent advances in new medications, tools and techniques make it easier for surgeons to not only do bench surgery on the septum, but easier to teach to younger physicians.

For a study printed in the July issue of Archives of Facial Plastic Surgery, Dr. Gubisch reviewed the medical charts of patients who had surgery of the septum, either performed by him or under his supervision. The study examined records from 1981 to 2004 of 2,119 patients with severe nasal deviations who had the operation which was developed and refined by Dr. Gubisch.

Based on the surgeon's and patients opinions, plus, the findings of exams done in the clinic, "a good to excellent functional result was obtained in 96 percent of the cases," writes the author.

Avon Calling - With Bras!

Finding the perfect bra is almost as challenging as finding the perfect mate. says the Avon Foundation who is still calling - but with a new line of products: Brassieres. Plus, you can now shop in the comfort of your own space, thanks to Avon, the company for women. Avon reps come to your door with Avon Foundations, a collection of bras which bills itself as "innerwear designed for every woman's personal preference."

The product lineup includes hard-to-find sizes and tons of options to build a bra wardrobe with a style and fit for every figure and look. Best of all, the Avon Foundations collection bypasses the department store dressing room drama by allowing you to shop at home with a Rep who has been specially trained to fit bras.

When it comes to bras, fit means everything. A bra that fits just right is more comfortable, provides better support and makes your clothes look better on you.

To get that fit, here are some tips on selecting a properly sized bra:
Forget your supposed cup size. You may need to go up or down a cup. When you try on the bra, the fabric should not gap, flatten or squeeze you anywhere.

If the cup is not filled out, you may need a smaller size. It's also possible that a larger cup size or a fuller-shaped bra will provide more coverage.

If the back of your bra rides up, the cups could be too small or they might be pulled up too high. Try adjusting the shoulder straps to a more comfortable length and make sure they don't cut into your shoulders.

Each cup should offer complete coverage. If a cup wrinkles, it's too large, while bulges at the top or the sides indicate the cup is too small.

If you find one that fits comfortably, buy as many as you can in case that style is discontinued.

U.S.: Plastic Surgery can Help Mentally Disabled Kids.

Reconstructing severe facial deformities in children with mental disabilities is often a hard decision for parents. But the situation is not helped when insurance companies declare some medically necessary operations to be "only cosmetic" and refuse coverage.

However, craniofacial plastic surgery which corrects abnormalities of the face, skull and neck, can give these children significant psychological, social and emotional edges to help them have a better quality of life, according to a report in the August issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (A.S.P.S.)

"Plastic surgery to correct defects of the face, skull, and neck is reconstructive and functional in nature, not merely cosmetic, as some insurance companies assert," says Steven Buchman, M.D., A.S.P.S. surgeon and author of the report. "Children with severe mental impairments undoubtedly benefit from plastic surgery and ultimately gain functional tools that will help them lead fuller lives."

Plastic Surgery can Help Mentally Disabled Kids According to the report, a child's appearance can positively or negatively influence his or her ability to socialize, make friends and be accepted by others. All that, in turn, can influence the tyke's long-term relationships with his pals, teachers and, someday, his employers. Also affected is one's ability to manage daily tasks and properly function in society. Because social relationships are key predictors of a person's quality of life, says Dr. Buchman, children with facial deformities greatly benefit from craniofacial plastic surgery, allowing them to fit in better with others and gain acceptance from other children.

Moreover, virtually all cultures tend to use a person's facial characteristics to form opinions about character, traits and other personal attributes.

In the case of a child with mental disabilities and facial abnormalities, other children usually react negatively, tease and refuse to play with him or her, often causing the child to withdraw and be alone. Psychologists say consistent rejection at an early age can lead to more serious social impairments and impede the youngster's ability to relate to others later in life.

In addition, the more these children are accepted by their peers, teachers and parents, and the more interactions they have with others, the better they learn in school. Teachers may underestimate the intellectual abilities of children with facial deformities and have correspondingly low expectations which parents may also unknowingly share. By surgically repairing the deformities, the subconscious bias of teachers, parents and other adults may diminish, giving the child a better chance to be exposed to positive feedback and increased learning.

"Calling these surgeries 'cosmetic' demeans the benefits these children gain," says Dr. Buchman. "By surgically fixing their deformities, we positively change the way others interact, react and relate with them, helping shape how well they learn, socialize and adapt to the world around them."

More and increasing insurance company denials, restrictions on covered procedures and a new tactic of excluding specific reconstructive procedures may be forcing some children and adults to live with disfigurement or painful medical conditions. This restrictive access to care contributed to a ten percent decline in reconstructive plastic surgery procedures in 2004, reports the A.S.P.S.

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