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

Stay on Top of Your Breast Health:

  1. Do a breast self-exam (learn how at
  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

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.

Quick Tips

There are a many different approaches for achieving a refreshed look, without surgery.  Here are just two of them:

Botox Eyebrow Lift.

There are several ways Botox can improve one’s overall appearance.  Everyone knows it works great for frown lines. But there are tricks that most people don’t know (or won’t tell you!) that can have a fabulous effect and can do much, much more.

Small injections next to the end of the brow release the muscles that bring your brow down. A single injection of 10 units in the tail of the brow raises it as much as 5mm, depending on how strong the muscle is. This can save your upper lid from looking saggy as well as give you a beautifully arched brow.

Accent  for Lower Face, Jowls and Neck Maintenance

The Accent laser is a relatively new device that is great for tightening loose skin. It uses a radio-frequency energy that is transmitted through a handheld device. It feels like a hot rock massage, as the warming energy is transmitted to the deeper, collagen-containing layers of the skin.  This heat tightens the collagen layer, causing the skin to lift – and more importantly, it prevents sagging and horizontal neck lines from ever getting a hold of you. The Accent takes about 30 minutes for each neck treatment. I recommend a treatment every 6 months from the time you are 40 for neck maintenance, and for already sagging necks it may take 4 or more treatments to catch up.

For more Quick Tips, stay tuned…

(C) 2011 Dr. Lisa Cassileth