There are so many conditions of the breast that go poorly understood because of the emphasis on detecting breast cancer early. While finding breast cancer early is indeed of utmost importance, this column is devoted to the other conditions that are significantly encountered in the breast.
Breast size: There is often some difference in the size of a woman’s breast. This is often magnified because of a woman’s concern that this means something is wrong or that she looks “funny”. Even though there are rare cases of women with only one breast developing, most commonly there is only a slight variation in the size, usually only noticed by the woman herself. This is benign when it has “always been that way” and unless it gets to be a psychological barrier for the woman, does not need to be addressed. Plastic surgery is the answer when the difference is significant for the woman.
Breasts that are too large is another problem that sometimes is significant. Some women are just genetically programmed to have breasts that are painfully large. This tendency is not dependent on being “fat” but carrying extra weight can aggravate the condition. Women can be miserable. It can affect a woman’s choice of activities, causing women to avoid playing tennis, jogging, or other vigorous activities. Some women develop deep tender grooves over their shoulders from bra straps digging in and/or they suffer from chronic neck and upper back pain that can cause daily misery. It is a woman’s judgement call to decide when this condition needs to be addressed surgically. Many of my patients are grateful to have had the surgery and never look back. However, scarring can be a problem especially in keloid-formers and successful breast feeding can be made impossible. It is a big decision.
Breast lumps: Benign lumps can be divided into solid or cystic lesions. Many breast cysts that I see in my practice are discovered by the patient. They appear all of a sudden resulting in a visually obvious, tender lump. We usually go ahead with draining the cyst in the office. If it goes away completely with draining, the fluid is clear to milky, and the cyst does not recur, nothing further needs to be done. Some women are prone to this problem and are very familiar with this plan. Other cysts are not noted until a mammogram is done. Often, an area of density on the mammogram will turn out to be a cyst or simple fluid collection when examined by ultrasound. As long as all the cyst criteria are benign, i.e. thin-wall, single cavity, clear, etc., nothing further needs to be done. Anytime the cyst is complicated in appearance, recurrent, or filled with bloody fluid, biopsy should be considered.
The most common solid lump in the breast is something called the fibroadenoma. These can be seen even in the teenage years. They have specific criteria associated with them and sometimes are just observed over time. I lean towards recommending removal for lesions of any size for several reasons. First, patients worry if we are wrong and there is something in their body that will “get them”. Second, these lesions can grow and the bigger it is when removed, the larger the scar or breast defect may be. Third, follow-up can be difficult because of distortion from the lesion.
After a blow to the breast, especially after something like a shelf or table corner hit, or a car accident with seat belt bruising, the breast can undergo fat necrosis in that area, forming a firm nodule that eventually softens but may lead to some long-term distortion.
Nipple discharge: This is very common. When it comes from both nipples, is milky, and is not associated with pregnancy, it can represent an abnormal increase in Prolactin hormone and should be evaluated. Bizarre nipple discharge that is green or black is associated with fibrocystic change in the breast and usually only comes from one nipple at the time. Despite the strange appearance, this is a non-worrisome process. Bloody nipple discharge can be associated with a benign growth in a milk duct called a papilloma. Still, any bloody drainage should be further evaluated to exclude a cancer as the cause.
Commonly, many of the above symptoms are seen in women with fibrocystic change. Up to 40% of women have this condition that can promote the development of cysts, densities that can make the breast feel like beanbags, and colorful nipple discharge. Forty percent, that is a lot of women. All of the conditions mentioned here are very common. Benign changes including swelling before a period or any of the changes mentioned above will often be encountered by a woman. The above descriptions are provided to let women know that most changes don’t represent cancer. One should not be afraid! It is certainly prudent however to see your doctor about any change you notice that is different for you. Particularly, bloody drainage, lumps, or thickened areas should prompt a visit. Let your physician help to determine what evaluation should be done to help you rest assured.
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The process of choosing a breast implant size that will look right for you takes careful planning and collaboration with your surgeon to produce results you will be very satisfied with. You want to make the right choice, the first time. You want to achieve an improved breast line and a balanced, pleasing, natural-looking body form without the risk or expense of a secondary surgery. I am fortunate to say that, due to my 25 years of experience, the vast majority of my patients are very happy with their results after surgery. But, nationwide, it is reported that a full third of patients nationwide choose to have a second operation to change the implant size. Here’s how that can be avoided.
Two common questions women who are seeking breast augmentation ask are: “What will I look like?” and “How will different sizes will look on me?” Many are concerned that the size they choose will be too large and will look unnatural and that they will feel awkward in front of people they know. Pre-planning with your surgeon will go a long way toward ensuring that when your breast augmentation experience is complete, you'll be happy with the results and feel very comfortable with your appearance.
First, it is important to choose an experienced, board-certified plastic surgeon specializing in breast augmentation to help you decide how much larger you want to be than your current breast size. A boarded certified plastic surgeon can evaluate your anatomy and take accurate measurements of your chest and breasts to determine the proper proportions for your frame as well as take into consideration how loose your skin is. You must have enough tissue to cover the breast implants for an aesthetically pleasing augmentation.
Most women want to make sure they will look natural, but improved. My staff and I take the patient through the size selection process carefully so she will end up being satisfied how she will look after surgery. I have found the Axis 3D breast augmentation simulator to be an enormously helpful tool for assisting a patient in selecting the best implant size for her body. You will be able to see your own body with varying implant sizes. We can show you an actual visual image of yourself in 3 dimensional form, simulating the “before and after”. We work with you to explore just the right implant in size and shape that compliments your own body.
The breast augmentation simulator allows greater guidance and direction for more accurate customization, placement and shaping of the implants. It is especially helpful if a woman has asymmetrical breasts. The visualization also helps you see the desired outcome from all angles- side and front- before the procedure is performed and to make any necessary adjustments, which is a very important aid. The simulation is also helpful for a woman to understand if breast implants alone would correct sagging skin or if she may need a breast lift. I perform augmentation using both saline and silicone implants. Fitting the right size implants to a woman is the same process for both saline and silicone. The imager helps with both types of implants.
Is bigger better? Not necessarily. Patients have often been advised by other surgeons to “go larger”, because it is a common statement made: “I wish I had gone larger”. It is my opinion that the larger you go, the more you risk an unnatural look. Also, larger implants are often too wide for a smaller body. I feel that it is better to have as accurate a prediction process ahead of time as possible. With the Axis 3D simulator, you are much more likely to choose the size that is right for your body the first time around- not too small, not too large. Implants that are too large not only will upset the aesthetic balance of your figure, they also may be more prone to sagging and ultimately give you a “matronly” look. Many patients mistakenly think that larger implants will correct sagging. The imager helps to visually demonstrate that if a patient needs a lift, no implant alone will substitute for a lift.
The American Society for Aesthetic Plastic Surgery (ASAPS) offers helpful tips to women trying to make this decision with which I heartily agree with and pass along to my patients: Communication is key! Be frank and open in discussing size. Select several photographs from magazines illustrating your ideal proportions, and bring these to your consultation. Be as specific as possible about what you like about them, but realize that your own "after" pictures will reflect your desires and who you are. Bring examples of individuals with a similar body type to yours. Don’t define your desired size only in terms of bra-cup size. Cup size can vary significantly among bra styles and manufacturers. Maintain realistic objectives. The best approach is to select implants that will look like a natural part of your body. Ask to see before & after pictures, not only to judge your surgeon’s work, but, to get an idea of what size implant you will need. Obviously, the breast size you start with will influence the implant size you choose. If you start as an A cup, you'll need more volume to take you to a C cup than a woman who starts as a B cup. I have actual breast implants that you can try on during your visit, in addition to using the 3D imager, if you so choose. It's important to note that volume refers to size, not breast shape. Breasts that have sagged over time may need a breast lift in addition to augmentation to achieve the look you want.
After you've presented your goals, listen to what your surgeon has to say. If my professional and experienced opinion is that your selection is too big for your frame, I hope you will listen to why I may feel that way. Or I may be able to offer the opinion that you could go larger and still get excellent results. The Axis 3D can demonstrate the “why” in either case. Your consultation should be a give-and-take arrangement that's open and honest so that can agree on the best outcome available.
The process of deciding the right breast implant size for you is layered with important choices and considerations. The right breast size depends on your individual taste, your body frame and type, and the "look" you're going for. Choose a size that makes you happy, not your spouse, significant other or friend. You're the one who will be living with this decision. The professional opinion of a board-certified plastic surgeon who's experienced in breast augmentation, coupled with realistic expectations on your part, can help ensure that you'll end up with the bust line you've always wanted.
Breast Augmentation Using Implants
More volume is added to the breasts by inserting implants. The two commonly used breast implant options are saline and silicone gel implants. The new silicone gel implants or Memory Gel implants are softer than saline implants. Silicone gel implants area popular choice for patients with very little breast tissue and subcutaneous fat.
Breast Augmentation – the Procedure
Depending on a number of factors specific to each patient, implants can be placed either under the breast tissue or under the chest muscle. For more natural, softer breasts and to provide more coverage over the implant, the implants are placed underneath the muscle (submuscular) rather than underneath the breast tissue (subglandular). These factors can also determine where the necessary incisions will be made. Breast implants can be placed through one of four incisions: in the crease under the breast, through the areola (at the border of the colored part around the nipple), through the belly button, or through the armpit.
Breast augmentation surgery takes approximately 1-2 hours and can be performed in the doctor’s office as an outpatient procedure. Usually, general anesthesia is administered for this procedure.
Benefit from a More Appealing Breast Contour
Breast augmentation is beneficial in that it provides a more attractive breast contour. Whatever your preference is, plastic surgeons will work closely with you to create the desired size and shape, taking into account your goals and expectations.
Several methods may be used to remove tissue for the pathologist to examine. The choice of which biopsy method is used depends on the size and location of your abnormality, and whether is can be felt or not.
- • Fine Needle Aspiration: A type of biopsy that is performed with a small needle and syringe. Cells are removed that can be examined under the microscope.
- • Core Needle Biopsy: A type of biopsy that is performed using a larger, hollow needle and a spring loaded instrument. Several cores of tissue are removed for examination under the microscope. Additional information can be obtained with these slightly larger pieces of tissue.
- Excisional Biopsy: A type of biopsy that is performed in an operating room. A small incision is made on the skin above the lump. The area of concern is then removed for examination under the microscope. The incision is closed with stitches.
- Ultrasound Guided Core Needle Biopsy: A type of biopsy that is performed using a larger, hollow needle and a spring loaded instrument. Using ultrasound guidance, the area of concern is found. Several “cores” or samples of tissue are removed and then examined under the microscope.
- Mammotome Biopsy: A type of biopsy is done by using a larger, hollow needle. The area of concern is found by using ultrasound as a guide. Several samples or cores of tissue are removed to be examined under the microscope.
- Stereotactic Biopsy: A type of biopsy that utilizes a special computerized mammogram and instrument. Lying face down, the breast hangs through an opening in this special table. A needle apparatus is inserted into the breast; an additional needle withdraws tissue from the area of concern. This tissue is then examined under the microscope.
- Needle Localization Biopsy: A type of biopsy that uses radiology guidance to insert a needle close to the area of concern. A small incision is made on the skin near this needle. The area of concern is then removed for examination under the microscope. The incision is closed with stitches.
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Breast Tissue
The breast is made up of various types of tissues. These tissues change over a woman's lifetime as her hormones change. Before menopause, a woman's breasts are mostly made of dense, fibrous tissue and fat. As a woman passes through menopause, this fibrous tissue often turns to fat. This causes the breasts to feel much softer and less lumpy. If a woman takes estrogen after menopause, her breasts may often remain fibrous.
Fibrous tissue can sometimes hide a small cancer making it more difficult to feel or find on a mammogram. It is still important to obtain annual mammograms and examine your breast regularly. As you become older with less hormonal influence on your breast tissue, visibility on a mammogram should improve.
There are several types of breast cancers.
- Infiltrating Ductal Carcinoma (most common type) is a breast cancer that starts in the milk duct and spreads through the ductal wall into surrounding tissue. Once that invasion has occurred, the cells can enter lymph vessels and blood vessels. These vessels are pathways that can carry cancer cells to other parts of the body. For this reason, breast cancer is often described as a system wide disease.
- Ductal Carcinoma in Situ (DCIS) is a non-invasive type of breast cancer. It cannot spread. It is important to surgically remove all traces of the DCIS to improve local control of the cancer.
- Infiltrating Lobular Carcinoma is a cancer that starts in the lobule of the breast. It has microscopic projections that can break through the lobule wall and start moving into the surrounding tissue, often making this a more difficult cancer to diagnose at an early stage. It is treated the same as infiltrating ductal carcinoma, although sometimes clear lumpectomy margins are more difficult to obtain. It is also considered a system wide disease.
- Inflammatory Breast Cancer is characterized by redness and swelling of the breast with skin changes. This breast cancer can grow very rapidly. It has a higher chance of spreading elsewhere in the body and must be treated more quickly. It is treated first with chemotherapy, followed by surgery and radiation therapy.
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- 1. Maintain your ideal body weight.
- 2. Participate in regular (3-4 times per week) aerobic exercise.
- 3. Avoid exposure to tobacco products. Do not smoke. If you do smoke, seek assistance in quitting.
- 4. Be moderate in the use of alcohol. For women, one drink per day is considered within acceptable alcohol consumption limits.
- 5. Adopt a healthy diet which emphasizes fresh fruits and vegetables, and reduces the consumption of animal fat and beef.
- 6. Prevent exposure to sexually transmitted diseases by practicing safe sexual behavior.
- 7. Avoid excessive sun exposure. Do not get sunburned.
- 8. Follow general health guidelines related to screening for other diseases such as cervical cancer and colon cancer.
Cardiovascular Health Maintenance
- Monitor your blood pressure regularly (it should be less than 120/80), and treat high blood pressure if it is found.
- Maintain your ideal body weight (your body mass index* should be less than 25).
- Monitor your blood lipid levels (LDL cholesterol should be less than 100; HDL cholesterol target: 50-60), and treat unacceptable cholesterol levels.
- Monitor your blood sugar periodically, and treat diabetes if it is found.
- Keep your waist circumference less than 32 inches.
- Participate in regular (3-4 times per week) aerobic exercise.
- Do not smoke! If you do smoke, seek assistance in quitting.
Bone Health Maintenance
- Participate in regular (3-4 times per week) weight-bearing aerobic exercise.
- Monitor your bone density: Ask you doctor for a baseline bone density test, Repeat the scan periodically. Treat bone loss aggressively: Take calcium and vitamin D after undergoing RRSO.
Consider other medications, such as pamidronate, risedronate, tamoxifen or raloxifene, if your bone density continues to decline. Estrogen is also effective in the treatment of osteoporosis, but its safety for women who are at increased genetic risk of breast cancer is uncertain. - Do not smoke! Smoking can also increase the risk of osteoporosis. If you do smoke, seek assistance in quitting.
Breast Health Maintenance
- Consult your physician regarding breast self-examination, since all the women who participate in this study are at increased risk of breast cancer.
- Seek medical attention promptly if you detect an abnormality in your breast.
- Have a clinical breast exam by your health care provider twice a year.
- Undergo screening mammograms at least once per year.
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When people talk about increasing penis exercise they usually mean exercising the corpora cavernosa. The corpora cavernosa consists of 2 chambers that run the length of your penis. It is filled with soft, spongy tissue. These chambers are responsible for your erection. When you are aroused, penile muscles respond, allowing blood to rush in and fill these 2 chambers, creating an erection. It then goes without saying that the total length and thickness of your penis when it is erect is dependent on the maximum size of your corpora cavernosa when it fills with blood.
Working with the corpora cavernosa to increase penis size is not just done through exercises. You might be interested to note that there is a surgical procedure where the corpora cavernosa is removed and replaced with balloon implants that mimic the function of the corpora cavernosa. Instead of balloons that match the size of your corpora cavernosa, larger ones can be implanted into your penis, making it longer and bigger. This surgery however, is not recommended for cosmetic purposes and is primarily intended for men who suffer from impotence. When increasing penis size, doing exercises are still the safest option I know of.
What makes the corpora cavernosa so special is that it is possible to encourage new cell growth in this area of your body. When you encourage new cells to grow, then you can make it bigger and longer. To encourage new cells to grow, you can do exercises that stimulate increased blood flow to the area.
One such exercise that you can do is called jelqing. This exercise makes use of your hands and is completely natural and safe. Here are the steps to this exercise:
- Get yourself into a 40% to 50% erection.
- Make a circle with your thumb and forefinger, and stretch out the middle finger, ring finger and the pinky. This should look like an OK sign.
- Use mild lubrication if you wish. Place the OK sign at the base of your penis. Then, with a firm grip, gently move your hand towards the head of the penis. You should do this without sliding your hand over the skin of your penis.
- Once you reach the maximum distance that your hand can move along the shaft without removing your grip, release it.
- Initially do about 20 to 30 repetitions per session, gradually working up to 50 repetitions per session. You may alternate hands if you like.
Men who have tried this exercise have reported seeing results within a couple of weeks of doing this exercise. Real results – in as little as 2 weeks! Anyone can do it, but those who have severe health problems or have Peyronie’s disease should avoid doing this exercise without consulting with their physicians first.
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