New Mom’s: Is Exercising Not Working for You?

happy-mom-and-babyWhile there is nothing that changes your life in such a positive way as having a baby, for some new mothers, getting their body back to their pre-pregnancy look, or any desired look, can be a difficult hurdle to overcome.

Extreme dieting isn’t really a viable option for a new mom and having the time to spend hours at the gym is unlikely. Even if a new mom can find the time to do so, it’s no guarantee of results.

Pregnancy and childbirth often create tremendous stresses on a woman’s body that diet, exercise and time are not going to undo. But it is possible to get that body back with a Mommy Makeover.

“Your life really changes after you have kids. You devote your time and energy to taking care of your children, following up on their care and making sure they’re well-fed, clothed, and safe. We really let our physical appearance become something on the back burner. A mommy makeover is such a nice thing to give moms.” – Dr. Kelly Killeen

A Mommy Makeover is a combination of procedures that offer patients different choices and may include the following procedures:

Tummy Tuck (abdominoplasty)
Mastopexy (lift)
Facial Rejuvenation
Liposuction (fat removal)

Moms may choose between surgical and non-surgical options for their makeover experience. Hormonal changes, after a pregnancy, can affect the skin as well as the body.

Dr. Cassileth and Dr. Killeen recommend patients wait at least 6 months after pregnancy, as well as after the child is weened, before a mommy makeover procedure is considered. After 6 months, most women achieve a more stable body weight. (Post-pregnancy weight fluctuations may otherwise obscure the surgical experience).

“Thank you for giving back to me a very positive body image. People always told me it was an achievement to have lost over 110 lbs, but even after the weight loss, I could not stand to see my stomach… Today I have become a stomach exhibitionist, strutting my flat abdominals for all to see. There have been sightings of my bellybutton all over town. Imagine that!!”

To find out more about how a Mommy Makeover would work for you, come see us for a consultation by clicking here or by calling us at 310.819.9340.

Big Talk About Breast Reconstruction

Recently the Cosmetic Surgery Times wrote a wonderful and insightful article about the successful Reddit AUA (ask us anything) hosted by our own Lisa B. Cassileth, M.D., FACS, and Kelly Killeen, M.D.

In this interview following their lively and popular Reddit Q&A (over 2,100 comments), Dr. Cassileth and Dr. Killeen discuss why women should “expect more” with mastectomies and breast reconstruction, including sparing their nipples and avoiding devastating scarring.

Check out the entire article:
Cosmetic Surgery Times Logo

Big Talk About Breast Reconstruction

by Randy Dotinga, Cosmetic Surgery Times

A pair of Beverly Hills plastic surgeons has a simple message for women with breast cancer who seek mastectomies and reconstruction: Expect more.

Beverly Hills Plastic Surgeon Dr. Lisa CassilethLisa B. Cassileth, M.D., FACS, and her partner Kelly Killeen, M.D., tell their breast reconstruction patients that it’s often possible to spare their nipples and avoid devastating scarring. It’s all thanks, they say, to their partnerships with top breast surgeons and a strong focus on aesthetics.

“Women often feel they can’t be naked after a mastectomy, that they feel asexual: ‘I’ve had this happen to me and I’ll move on, but I’ll never be able to be naked again or have anyone see me naked again,’” says Dr. Cassileth, the clinical chief of the Division of Plastic Surgery at Cedars-Sinai Medical Center and an assistant clinical professor at UCLA.

The reality, she believes, is the exact opposite. In fact, women can often even get the breasts they always wanted.

Beverly Hills Plastic Surgeon Dr. Kelly KilleenDr. Cassileth puts it this way when she talks to breast cancer patients: “Sorry to be so superficial, but my job is to make you hot.”

In July, the two surgeons became a hit on the Internet bulletin board Reddit when they took part in an AUA — Ask Us Anything — titled “We are two female Beverly Hills plastic surgeons, sick of seeing crappy breast reconstruction — huge scars, no nipples, ugly results. There are better options!” Their discussion drew more than 2,100 comments.

Cosmetic Surgery Times reached out to the surgeons and asked them to describe their approach to mastectomy and breast reconstruction.

Q: What does the public misunderstand about breast reconstruction after breast cancer?

Dr. Cassileth: The reality is that women have no idea about it. Maybe their mothers or someone they know had a mastectomy, but it’s a taboo subject. You may never be told that you have this big cut across your chest. Then they look online, and the pictures can be really horrific. These women come into my office, and they’re shell-shocked. They just want to get this done.

Q: How have surgeons typically looked at the nipple in mastectomies and reconstructions?

Dr. Killeen: Traditionally, cancer surgeons considered the nipple to be part of the breast tissue, and it was removed. In fact, the nipple can be safely left behind in most patients. This leads to superior cosmetic outcomes, and women feel psychologically better keeping their nipple. Unfortunately, a lot of the country has been slow to adopt this as the standard of care.

Q: Why do you think nipple-sparing surgeries are so uncommon?

Dr. Cassileth: The majority of surgeons I’ve worked with don’t know how to do that. That’s why I’ve reversed the flow so we only work with breast surgeons who are fabulous.

Q: So you choose the breast surgeon instead of a breast surgeon choosing you?

Dr. Cassileth: I’m driving the consult back to the general surgeon, not the other way around. I’m first, and they’re second.

Q: What does your approach mean for the risk of mastectomy flap necrosis, a common complication of breast reconstruction?

Dr. Cassileth: The published complication rate is 15%. I’ve seen an average of 30% among surgeons, and one surgeon reached 55%. They want to do a good job, but they’re not fully aware, it doesn’t hit them like it hits us. All we care about is the aesthetic. When we choose the general surgeon, we keep statistics on every single one of our patients. We’re under 1%. I had one surgeon get up to 2%, and I said this will never happen again.

Q: You perform breast reconstruction at the same time as the mastectomy instead of separating the procedures. What does that accomplish?

Dr. Killeen: Traditionally, a lot of surgeons don’t pay as much attention to creating a perfect pocket. They don’t think they have to get it right the first time, since can be fixed when the patient comes back to get an implant later.

When you get the implant in on the first go, you have to treat that reconstruction with respect. You aren’t coming back another time.

Q: In the Reddit Q&A, you mention something surprising about how many men deal with the breast reconstruction of their loved ones. Can you tell that story?

Dr. Cassileth: When you give a man an implant to hold, they close their eyes and massage it: What does that feel like? I like it when they do that. They’re really committing. They’re fully committed that this will be their wife’s boob.

Q: How can men support the women in their lives when they undergo these procedures?

Dr. Cassileth: The woman’s facing this idea that they’ll somehow be maimed or damaged. They’re inhibited by the idea that their husbands are judging them. If the husband weighs in too heavily, even if he’s trying to be helpful, women will often take that as a criticism of themselves. They’ll feel more nervous and insecure about their reconstruction. Men who say “I love you, I don’t care about what you look like” — even if they’re lying — help women to feel unconditional love.

Skin Cancer Awareness Month: Ways to lower your risk of skin cancer

ways to lower risks of skin cancerSkin cancer is by far the most common cancer in the United States, and it can be deadly. Fortunately there are things you can do to reduce your risk of getting skin cancer. Limiting sun exposure is the best way to protect yourself, here are other top tips to help lower your risk.

Avoid Tanning Beds

If you are a tanning bed devotee, the best way to lower your skin cancer risk is to avoid them! Tanning beds direct UV light to the skin, which causes the skin to produce melanin (brown pigment) and causes damage that may lead to skin cancer. In fact, a law making its way through the Kansas legislature would ban minors from using tanning beds because of their harmful effects on skin. Dr. Kelly Killeen, a Beverly Hills plastic surgeon and an advocate for anti-skin cancer issues, spoke to the legislature on behalf of the bill. As a medical professional and a survivor of melanoma herself, Dr. Killeen has seen firsthand how tanning can harm skin health and elevate cancer risk.

Use Sunscreen

Apply sunscreen with an SPF of 30 or higher on your face and neck every day, even when it is cloudy. As an added bonus, you’ll keep your skin looking younger than those who do not use sunscreen. Over 90 percent of visible signs of skin aging is caused by the sun’s ultraviolet rays. If you anticipate being outside for more than 15 to 20 minutes, apply sunscreen to your whole body. A good rule of thumb is to use a shot glass-sized amount of sunscreen to cover your skin. Reapply every two hours, or after swimming or sweating.

Use Alternative Skin Tanning Products

If you crave that sun-kissed glow, consider using tanning lotion or a spray tan instead of heading out into the hot sun. Unlike the orange streaky looks of the past, today’s tanning alternatives look natural.

Wear a Hat

If you do venture out into the sun, always wear a hat (particularly if you are balding). A hat protects the crown of your head, which can receive considerable amounts of sun exposure.

Comfortable in One’s Skin

Comfortable in ones own skinDoes getting older mean the end of feeling beautiful, or is it just another chapter? When I meet with older patients, all too often they have a defeatist attitude when it comes to their perceived beauty. The truth is, our skin transforms as time makes its inevitable passage forward. But reaching the point of maturity doesn’t mean you have to accept skin that sags and wrinkles. There are so many methods to help correct years of skin damage and the natural effects of aging. I’ve even seen patients look as vibrant and youthful as someone half their age.

So, how can you achieve youthful, glowing skin after forty—or thirty, for that matter?

Getting older doesn’t mean you have to compromise your personal definition of beauty. For most, attractive skin means a smooth, taut, plump surface that is still flexible enough to not look overdone. When executed properly, men and women can enjoy amazing results from injectables like Botox and other fillers. But the thing is, that’s not your only option.

I really encourage my aging patients to reevaluate their lifestyles, as well as explore other corrective skin treatments that are just as effective. First, medical spas offer a number of laser, peel, microneedling, and other results-oriented regimens that yield incredible cosmetic results over just a few sessions. Whether you’re self-conscious about your fine lines, unevenness, general loss of volume, or hyperpigmentation, there are so many rejuvenating methods to complement your injectable routine.

But how can you gain youthful skin at home?

In between MedSpa treatments, I also educate my patients about healthy eating, exercise, and moisturizing habits. It’s important to maintain your skin in between sessions. Dermatologists have specially formulated creams and lotions designed to improve the appearance of damaged or aging skin. These options have given my patients stunning results in smoothing wrinkles and improving texture, tone, and suppleness.

Healthy habits mean healthy skin.

It may seem cliché, but get moving! Regular exercise is scientifically proven to reverse skin aging, especially in individuals who start working out later in life. Forget the aesthetic benefits. Exercising makes you feel healthy and happy, and in turn, you’ll feel beautiful. With all these regimens combined, your gorgeous, glowing appearance won’t be mere smoke and mirrors.

Just remember that getting older doesn’t eliminate beauty—it just means we have to work a little harder at it.

Your Eyes Are The Window To Your Soul

Cosmetic treatments for your eyesEyes convey emotion, sparkle with laughter, and facilitate communication. As we age, the delicate skin around the eyes can become dry, crepey and wrinkled, which detracts from the beauty of your eyes and makes you look older.

The good news is that the skin around the eyes can be improved, depending on the level and depth of the wrinkles or dryness, treatments range from topical products to IPL and laser treatments. The right treatment can transform your look.

Eye-Related Cosmetic Treatments That Take Years Off Your Life

The key to better eye appearance, is to restore moisture and help tighten the skin. Because the skin around the eyes is so delicate, the loss of elasticity and hyaluronic acid (the body’s natural hydrator) associated with getting older, is often first noticed this area. Wearing a daily moisturizer with at least 30 SPF for UV protection is a good way to prevent fine lines and wrinkles. Additionally, use of topical products can provide the intense moisturizing needed to make skin firmer. Choose an eye cream with retinol to decrease the appearance of wrinkles.

Cosmetic fillers are another beneficial, minimally invasive cosmetic procedure. Dermal fillers such as Restylane or Restylane Silk actually restore volume to the under eye area. These fillers improve sagging and create a smooth, youthful skin surface.

Eyelashes also thin as we age. The topical medication Latisse is a wonderful option to improve the length and thickness of eyelashes.

Some people initially worry about investing in cosmetic procedures to restore eye aesthetics. They express concern that this makes them vain or selfish. This couldn’t be farther from the truth. Given our eyes’ enormous role in communication and conveying emotion, they are among our most precious aesthetic assets. Investing in those assets will improve your confidence and restore your youthful appearance.

For more information about non-invasive cosmetic eye treatments including recommendations on home maintenance call 310.819.9340 and schedule an appointment today! Or visit us at Cassileth Cosmetic Medicine.

ACTRESS ARIEL WINTER AND HER BREAST REDUCTION

ariel winter breast reductionThere has been a lot of talk recently around Hollywood actress Ariel Winter (Modern Family) and why she chose to get a breast reduction procedure and I wanted to briefly chime in about it.

First, we should all applaud her on her decision. Making any modifications on your body takes courage, especially when you are a public figure. There is no doubt that she was aware of the potential repercussions of receiving a cosmetic procedure, and to come out as a delegate of breast reduction takes guts.

Like many women looking into a breast reduction, Ariel Winter decided to undergo the procedure after her back and neck pain became too much to bear. Large breasts can create a strain on the neck, back and spine, can make exercise difficult, and feeling good in clothes can be a challenge. Reducing one’s breast size can relieve a lot of this pain and match your proportions.

Having talked to many women considering breast reduction, I can tell you that it’s not uncommon for some women to have concerns about being judged by others for having this procedure. As a society we are trained to believe that larger breasts are better breasts (as reflected by the popularity of breast augmentation). For women with overly large breasts, they have the burden of carrying around all that “beauty” everyday. Beyond the discomfort and pain, breasts that are too large over time can lose their attractive natural shape and are more likely to droop. Bluntly: there is such a thing as too big.

If you are living with pain or discomfort from large breasts, you might want to consider a consultation with an expert. You don’t have to live your life with the discomfort and the burdensome weight. If done properly, a reduction will result in a breast size that compliments your figure and leaves you feeling better and more beautiful than before.

I applaud Ariel and her decision and I hope it inspires more women in her position to follow suite. It’s time for the well endowed woman of the world to stand up straight and be proud of who they are. After all true beauty is about feeling beautiful on your own terms, isn’t it?

Click the link for more information about the breast reduction procedure.

Four Things Every Woman Should Know About Breast Cancer

Melissa Etheridge Jolie Comments Unfounded: Four Things Every Woman Should Know About Breast Cancer

Breast reconstruction expert Dr. Lisa Cassileth knows what breast cancer can mean to a woman and her family. She has called Melissa Etheridge’s comments on the matter “unfounded” and seeks to warn others to make their own choices before cancer makes those choices for them.

“My belief is that cancer comes from inside you and so much of it has to do with the environment of your body. It’s the stress that will turn that gene on or not. Plenty of people have the gene mutation and everything but it never comes to cancer so I would say to anybody faced with that, that choice is way down the line on the spectrum of what you can do and to really consider the advancements we’ve made in things like nutrition and stress levels.” – Melissa Etheridge

Yesterday, I was meeting with one of my patients who had been diagnosed with breast cancer. There she is in front of me. She is so unbelievably healthy—she is someone that when she whips out lunch you go “eeew what is that?” (It is mixed vegetables with vinegar on it, I mean wonderfully healthy food.) She is a stay at home Mom. All she does is take care of her boys, she is not a stressed out person, and she just has a wonderfully healthy approach to life.

Despite the fact that she has lived this way, she reached over and felt a 4cm lump in her breast and was then diagnosed with invasive cancer. Further examination revealed that she had the BRCA2 gene. She had to go on Chemotherapy, all of her hair fell out and she thought she was going to die. Then she underwent a bilateral reconstruction. She had weeks to months of being tearful, thinking, “I won’t be here for my boys.” She made video tapes of herself saying, “If I die, I just want to let you know that I love you.”

Yesterday, she was done with all of her treatments, and after a year of doctor’s appointments, medication, injections and feeling horrible, she has her life back. If I could turn back time and tell her two years ago that she had the BRCA gene, her response would be, “Oh my gosh, how lucky are we that we found this. Get these breasts off so that I don’t have to go through it all.” So that she could avoid the emotional, physical stress, the radiation, chemo, and thinking that she will not be there for her boys.

To say that that her decision would have been cowardly instead of brave is unbelievably disempowering to her, and to any woman that makes that decision. In my opinion, both personally and medically, I think it is an amazing thing to undergo a prophylactic mastectomy because it allows you to make your choice in life instead of cancer making the choice for you.

Four facts that everyone should know about breast cancer:

1. How common it is – About 1 in 8 women in the United States will develop breast cancer over the course of their lifetime. It is the second most commonly diagnosed form of cancer in women.

2. Early Detection – Today one in five women diagnosed with breast cancer will die from this disease. But when breast cancer is detected early enough, the survival rate is 98%. Get regular mammograms and do monthly self-exams. Don’t put it off!

3. Genetic Testing – If a member of your immediate family has had breast or ovarian cancer, you can get tested for the BRCA mutation, which indicates as much as an 80% increased risk for breast cancer.

4. One surgery, a lifetime of possibilities – Today a preventive mastectomy is not only a choice, for many it is a lifesaver. In my practice we offer a one-stage reconstruction procedure that makes it possible to remove the affected tissue, and place an implant during a single surgery. One procedure now makes it possible for a woman to lead a long, healthy cancer-free life.

Dr. Lisa Cassileth is a Board Certified Plastic Surgeon in Beverly Hills, specializing in breast reconstruction for cancer patients. Learn more at http://www.DrCassileth.com.

Angelina Jolie’s Brave Decision

angelina-jolie-breast-cancerGenetic Testing and Breast Cancer

Actress, mother and director Angelina Jolie bravely announced that she opted to have a preventive double mastectomy as a proactive measure to help prevent breast cancer. This is not an easy decision, and we applaud both her courageous decision and her desire to share the details of her journey with the world.

Many of our patients have asked why she would choose to remove her breasts since she wasn’t diagnosed with breast cancer. The truth is, she made the smartest choice she could have made for her situation. Angelina’s own mother fought cancer for almost a decade and sadly lost that battle. After finding out that she herself carried the BRCA1 gene, which indicates a very high risk of future development of breast and ovarian cancer, she decided to take safe, preventive measures and address the problem before it was too late.

Although the thought of undergoing a preventative mastectomy may seem scary; Dr. Cassileth’s advanced one-stage technique results in beautiful, natural looking breasts. In fact, many of our reconstructive patients prefer their new breasts to the ones they were born with! Have a look at before and after photos by going to the One-Stage Breast Reconstruction page on our website.

Know Your Risks:
You should consider testing for hereditary breast and ovarian cancer if any of the following applies to you:

You:

  • Have had breast cancer at age 50 or younger
  • Have had ovarian cancer at any age
  • Are male and have had breast cancer at any age
  • Are of Ashkenazi Jewish descent and have a personal or family history of breast, ovarian or pancreatic cancer

Your Family:

  • Has had two breast cancers in the same person or on the same side of the family
  • Has had somebody diagnosed with triple negative breast cancer at any age
  • Has had pancreatic cancer and an Hereditary Breast and Ovarian Cancer (HBOC) – associated cancer in the same person or on the same side of the family
  • Has three or more family members with breast cancer on the same side of the family
  • Has had a previously identified BRCA1 or BRCA2 mutation in the family

We offer BRCA testing.

Call us to schedule an appointment: 310.819.9340.

Breast Cancer Screening – What Every Woman Needs to Know

Did you know that every woman has a 1 in 8 chance of getting breast cancer? It’s a scary statistic. However, breast cancer prevention and treatment and has come a long way. In my practice we have many young patients in their 20’s and 30’s with breast cancer, so it’s not just an older person’s disease. On the bright side, there are new screening tools that help increase the chance of early detection.pink-ribbon

Stay on Top of Your Breast Health:

  1. Do a breast self-exam (learn how at cancer.org)
  2. Get yearly mammograms, after the age of 40 (covered by insurance!)
  3. Know your family’s health history and share the information with your gynecologist. Having a mother, sister, or daughter with breast cancer almost doubles a woman’s risk. However, most (over 85%) of women who get breast cancer do not have a family history of this disease.

If you have a history of cancer in your family, genetic testing (in addition to mammograms) is recommended, even if you are in your 20’s.

The Genetic Link – New Screening Tests Could Save Your Life!

New advances in gene therapy have led researchers to identify the genetic codes for breast cancer genes. You may have heard or read about these genes, named BRCA1 and BRCA2.

Having one or both of these genes indicates an increased risk (as high as 4 in 5) of getting breast and ovarian cancer.

womanIf You are BRCA-Positive

Women who are BRCA-positive may opt for a mastectomy before they ever get breast cancer rather than face a lifetime of worry. Fortunately there are now new techniques for breast reconstruction that have made prophylactic mastectomy a more attractive option.

Cassileth One-Stage Breast Reconstruction technique was designed with the needs of these women in mind. This unique procedure allows women to wake up from their surgery with new, beautiful breasts.  In fact, many of our patients say they like their new breasts even better than the ones they were born with!

See the amazing before and after photos at drcassileth.com.

We want to know: if you tested positive for the BRCA gene, would you choose to have a preventative mastectomy? Or would you opt to wait and see and decide later? We’d love to hear from you. Post your response in the comments below.

Tori Spelling’s Boob Gap!

Why do we associate specific plastic surgeries with specific people (or celebrities)? I have now fielded my fiftieth request (at least) that goes something like this: “make sure you put my breasts close together – I don’t want to look like Tori Spelling.”

While we’re on the subject, let’s talk about what identifies this particular celebrity with the issue at hand.  Tori has the unfortunate claim to fame of having breasts that are too far apart, producing a Grand Canyon-esque gap in her cleavage. See the photo — no amount of push-up or push-in seems to be able to close that valley!

Generally a gap like this — we’ll call it “gap-osis” — is formed by the implants being too far apart, and with some capsular contracture (explained below), it really shows off the problem.

Tori Spelling

Also, the exact shape of the implant is clearly visible because it is not submuscular (hidden under the muscle).

So, how do you fix this “gap-osis”? 

The fix can vary depending on the problem. The capsule, which is essentially the scar tissue surrounding the implant, can be released near the sternum, allowing the implant to move inward. The capsule over by the outside of the breast can be tightened. These changes together migrate the implant pocket further toward the middle, making it hard for the problem to ever come back.

If the capsule is too tight (capsular contracture), it can be released, with or without using a dermal matrix product (like Alloderm). Finally the whole shebang can be moved under the muscle, but I think the decision to do this really depends on the patient, the width of the sternum, the location of the muscle, and the previous surgery before the final decision is made to do that. Personally I am more willing to switch to a submuscular plane if implant visibility, rippling, and contracture are significant problems.

Get it right the first time! 

Avoiding implant positioning problems from the beginning is always best. Simple best practices like using an appropriate size implant (just narrower than the width of the breast), placing them submuscularly, and keeping them medial and out of the armpits — these alone can make a world of difference. Now I always minimally dissect the area laterally, which keeps it in and looking good. So before you get a breast augmentation, ask your surgeon what technique she (or he) uses in order to position your implants properly.

Copyright (C) 2011, Lisa Cassileth, M.D.