WHAT IS POST-BARIATRIC SURGERY?

BARIATRIC refers to severe weight loss in obese patients.  This can be from dieting or surgery like gastric bypass or stomach banding.   POST-BARIATRIC SURGERY refers to surgery that improves the appearance of patients who successfully lose most or all of their excess weight.  Many patients have lost up to half of their weight but still have all the stretched out skin they had when they were heavy.  POST-BARIATRIC SURGERY focuses on areas that suffer the worst from weight loss after obesity.  These usually involve the abdomen, breasts, thighs, arms, back, and neck.  The surgeries usually involve removing excess skin, reducing any residual fat, lifting areas that have sagged (like the breast).  Patients need to accept incision lines and the fact the skin may never completely recover.  Patients that understand the process are usually very pleased with the results. 

Dr. Graham Kemsley

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WHAT IN THE WORLD IS GYNECOMASTIA?

 The Curse of MOOBS

GYNECOMASTIA is enlargement of the male breast.  We see it in 10% of men.  Men are often very embarrassed by this and will not take their shirts off at the pool or beach.  Gynecomastia can be due to glandular enlargement or fat accumulation.  We see 2 different times this develops.  One is at puberty and this is mostly glandular enlargement from high hormone levels at this age.  The glandular enlargement is similar but not identical to a woman’s breast.  The second time we see gynecomastia is as men mature (sometimes called “man boobs” or “moobs”)and this is mostly fat with possibly some gland.  It can look worse as the skin loosens with age.  If it is mostly glandular we usually need to excise the tissue with a small incision below the nipple.  With mostly fat we can treat it by liposuction which has tiny incisions.  If there is a lot of skin looseness we may tighten the skin which requires more incisions.  Men that have this surgery are usually very grateful and find it changes their life.

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ARE SILICONE IMPLANTS SAFE?

Orange County Silicone Breast Implant Surgery

Today I was asked by a patient if silicone breast implants are really safe.  This, of course, came from restrictions of silicone implants by the FDA  starting in 1990 that lasted for 15 years.  There was concern at that time that silicone might cause autoimmune diseases (like rheumatoid arthritis, scleroderma, and lupus) or increase breast cancer.  At the time I felt fairly comfortable that silicone implants were fine but we had to wait for the FDA to do it’s research.  Silicone implants became the most studied medical device in the history of the FDA.  The best reports came from large studies comparing women without implants and women who had silicone implants for many years.  They found that there was no difference in the two groups.  The only area where there was some difference is  some studies showed breast cancer was actually less in the patients with the implants!!!  The only explanation for this is that women who get implants usually have less breast tissue. 

I do use both silicone and saline implants (saline implants are filled with medical salt water) but I do prefer the silicone.  They have a more natural feel and the chance of breakage (usually from trauma like a car accident) is less(1% a year for saline vs. 0.3% for silicone.  Unfortunately the silicone implants are a little more expensive.

Dr. Kemsley

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