Nippin’ Out
July 9th, 2009
I just do not know how else to describe the recent article in Allure Magazine. Quoting a London Daily Mail article about Victoria Beckham, they show a photo of her is a fitted top. The photo prominently displays the shape of her nipples and areola. The article claims surgical enhancement to create this appearance is becoming more popular.
The breast can be separated into three profile components. First is the breast mound, which accounts for the majority of the breast size. Traditional breast enlargement surgery enhances this through placement of an implant beneath the breast and/or muscle. The center portion of the breast is highlighted by the nipple and areola. This is the eye point or where a person looks when they look at another person’s (man or woman) chest. The nipple is the central portion of this area. It projects out from the breast normally. The nipple represents the termination of the breast milk ducts allowing breast feeding. The darker skin around the nipple is known as the areola. Its color varies widely with genetic background and past pregnancy history. The areola is usually flat in relation to the surrounding breast mound. Sometimes this projects above the breast mound to add another contour to the breast. This is apparent in the Allure photo.
There are a variety of cosmetic nipple surgeries. The most common procedure in the past has been correction of inverted nipples. In this condition, the normal milk ducts are too short and cause the central part of the nipple to be drawn inward thus reducing the nipple projection. Correction of inverted nipples eliminates the ability to breast feed and can interfere with nipple sensation. It is important to understand nipple inversion can be a sign of breast cancer. The internal mass can cause scarring of the milk ducts which draw in the nipple. If a patient experiences this inward movement after having normally projecting nipples, they must be evaluated for a possible breast tumor.
Some women are self conscious of nipple prominence. It embarrasses them when they wear clothing. For those women I suggest the use of clear plastic adhesive dressings which flatten the nipples. The dressings are imperceptible beneath clothing.
Other women are requesting increased nipple and sometimes areola projection. There are implants available but these are generally reserved for nipple reconstruction after breast cancer surgery. In addition, there are many reconstructive nipple procedures which use the remaining skin and fat after the cancer surgery to make a new nipple. The potential scarring resulting from these procedures require that they generally keep those surgeries in the realm of reconstruction surgery.
Women considering increased nipple and areola projection might consider temporary fillers like Restylane ® or Juvederm ®. These will be reabsorbed after six to nine months. If there are any reservations regarding the appearance, nothing need be done. A more permanent solution is fat graft injections. Fat taken from another area of the body is transferred with injections to the areola and/or nipple. The result can be permanent but some of the initial improvement will be lost as the body absorbs some of the transferred fat.
Just like clothing and hair styles, this fashionable trend may only be popular only for a season or two. I think temporary solutions to increase nipple and areola projection are the best choices. Any surgery is serious business and it should not be considered frivolously.
Recreational Diprovan
July 6th, 2009
General anesthesia is used in my operating room to complete cosmetic surgeries like breast enlargement, tummy tucks, and liposuction. There are many drugs used in during these cases. They can be categorized by how they work. Muscle relaxants paralyze muscle tissue. Narcotics help reduce pain. Vasopressors restore low blood pressure. General anesthetic agents induce sleep and maintain the sleep state during anesthesia.
There are two main general anesthetic agents that I use. One is a gas called Ultane (sevoflurane). It is administered by trained professional medical staff through a breathing tube through the lungs. The other is Diprivan or propofol.
Diprovan is administered through the vein. It is frequently used to induce sleep in the operating room, intensive care unit, and emergency room. Patients may stop breathing when Diprovan is given. In all of the settings where Diprovan is used appropriately, the medical staff has the training and capacity to care for this cessation of breathing when it occurs. Accredited surgical facilities must have this capacity.
Prior to this past week, I was unaware of ANY use of Diprovan outside the clinical settings that include access to immediate breathing support. We procure this drug through our medication provider. It is certainly not part of any formulary outside hospitals or surgery clinics. You simply cannot go to your local pharmacy to fill a prescription for Diprovan. They do not have it! So, how Jackson supposedly gained access to it remains for law enforcement to figure out.
Recreational use of Diprovan obviously is extremely dangerous. Yet I can understand its appeal. Many patients who awaken after surgery where Diprovan was the only general anesthetic agent used, report extreme euphoria and pleasure. Still, I am shocked at the reports of the possible use of Diprovan by Michael Jackson. I will be truly dismayed if his personal medical staff were complicit in accessing the drug and facilitated its use by Jackson. It is my opinion that this would be a devastating embarrassment for most American physicians who take an oath when becoming doctors, “to do no harm.” Jackson’s untimely death is a tragedy that most likely could have been prevented.
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