Natural Breast Enlargement
Studies of phytoestrogens, naturally occurring substances found in most plants, have yielded conflicting results. Phytoestrogens are classified as phenolic estrogens, contrasted with steroidal estrogens, such as estradiol, which are manufactured by human ovaries. They are weaker than steroidal estrogens, with a potency of 1 20 000 to 1 50 that of estradiol. They mimic many estrogen effects in the body. Isoflavones are the most estrogenically potent of the five most common types of phytoestrogens found in the human diet. They are contained primarily in legumes (chickpeas (garbanzo beans), soy, clover, lentils, and beans.) There are over 1000 isoflavones, but the most strongly estrogenic are formononetin, daidzein, biochanin, and genistein. Each acts somewhat differently. Biochanin is the most effective in blocking the effects of estradiol. If levels of steroidal estrogen are high, then isoflavones display anti-estrogenic activity, binding to estrogen receptors in place of more potent...
Phytoestrogens In another open trial, Baird et al.85 compared the responses of women at least 2 years postmenopause to a control (usual) diet (n 25), and to a soy diet in which approximately 33 of energy was provided as soy products (n 66). Urinary phytoestrogens were monitored, and the vaginal maturation index was assessed as an index of estrogenicity. After 4 weeks A number of trials that may provide more definitive results are currently under way in this area. Presently, however, it appears that there is a substantial placebo response to interventions. Although modest differential effects of soy phytoestrogens may exist for hot flushes, other menopausal symptoms do not appear to be affected. In addition to phytoestrogens, various herbal preparations have been used by women to relieve menopausal symptoms.89 Although little systematic
The most serious complication of breast reduction surgery is nipple-areola complex (NAC) or breast necrosis. Very large breasts and or significant breast ptosis are the main reasons for such a disastrous complication, particularly in inexperienced hands. However, partial or total necrosis of the NAC can still occur in patients with high risk factors such as smoking, diabetes, or chronic corticosteroid therapy. Free nipple techniques in breast reduction are a viable alternative option for patients with large or ptotic breasts and should be considered and discussed early. Viability of the NAC depends more on adequate venous return than arterial input, with most cases of NAC necrosis being secondary to venous congestion. Methods to avoid later venous congestion include choosing
The inferior pedicle is widely used in North America, the U.K., and Australia 5,6 . The pedicle has a robust blood supply and a relatively reproducible outcome, which is why it has been used for so long. Sagging of the pedicle is unavoidable at long-term follow-up and likely to occur more frequently than with other pedicles thus favorable aesthetic results that are long lasting are more difficult to achieve with the inferior-pedicle-based mammaplasty. Modifications in the design of the inferior pedicle such as using anchoring to the thorax or tightening the closure of the vertical pillar can provide more reliable results 19 . The inferior pedicle can be ideally used for very large breasts with considerable ptosis in which the nipple actually points to the ground. The length of the inferior pedicle may be shorter than that of any other pedicle. Nipple-areola sensitivity is better preserved if the pedicle is shifted more laterally to include the deep branch of the fourth intercostal...
There is no true contraindication for the vertical mammaplasty. However, as in any breast reduction technique, care must be taken in special occasions. The superior pedicle technique has proved reliable in large breasts. However, in elderly obese patients needing a large reduction, the Thorek amputation is probably more advisable. In large reductions, care must be taken to widen the areolar pedicle in accordance with Breast sensation after reduction is a major concern. The superior pedicle technique has often been criticized because of the potential damage to the nerve supply of the nipple-areola complex. In a prospective study 7 , we showed that recovery of breast sensation was observed in moderate breast hypertrophy. In large breasts, pressure sensibility recovered after lyear, but temperature and vibration sensitivity decreased on the nipple-areola complex.
In my practice the vertical technique is applied to all reductions and mastopexies regardless of size. I personally do not believe that breast size is a limiting factor rather I believe that the amount of excess skin, the quality of the skin, the relationship of the skin envelope to the breast tissue, and the distance the nipple has to be moved are far more important factors than breast size alone. The best candidates are those with normal skin elasticity and a skin envelope that adheres to the underlying breast tissue and those with moderately large breasts. Less ideal candidates are those with poor-quality skin, a loose envelope where the skin adheres poorly to the underlying breast tissue, and extreme ptosis or breast hypertrophy.
It is important to note that, in cases of asymmetry, the new nipple position needs to be lowered in the larger breast. The closure of the vertical ellipse and the coning of the pillars not only pushes the vertical scar lower inferiorly, it also pushes the vertical scar higher superiorly. This results in a higher nipple position at the end of the procedure. It is important to keep the new nipple design lower in all large breasts, but especially in the larger side in cases of significant asymmetry.
Available data on the impact of dietary components such as phytoestrogens, fiber, and fat, intakes of which may differ between vegetarians and non-vegetarians, are not consistent. 4. Soy phytoestrogens may reduce the frequency of menopausal hot flushes slightly in comparison to placebo, but do not appear to affect the severity of other menopausal symptoms.
Also, how do we explain major changes in the rate of complications when the technique is used in the same department during various periods It may be that supervision of the residents was reduced if the team lacked trained surgeons for a period or that other, more impalpable factors intervened. Another example is the attention paid to certain data like obesity or preoperative volume of the breasts in the appreciation of complications. I was able to observe from my own experience that obesity per se increases the rate of complications and that the major factor of risk is a combination of obesity and very large breasts. All these major or minor factors explain why it is so difficult to obtain comparable evaluations. For a long time, evaluations were not even done. The rate of complications presented in publications was too vague to be taken into account. I am really very pleased to see that recent articles tend to better analyze and discuss complications. This is the best...
Patients with large breasts,where the amount of tissue resection exceeds 1000 g per breast, and older patients, where skin has lost its elasticity and the breast has been replaced by adipose tissue, are not good candidates for this technique. In these cases, the amount of skin that has to be resected is too great, resulting in the classical inverted T-shaped scar. Another point of concern in those patients is the loose and flaccid tissue that can lead to early ptosis and lack of projection of the breast.
My personal algorithm in scar selection is summarized in Fig. 15.1. I choose vertical scar mammaplasty in all patients under 30 years old. These patients usually have good skin quality, and skin retraction is expected. In very large breasts (more than 1000 g), secondary revision of the vertical scar is more likely to be necessary (see Chap. 14).
Recently, in 2003,Berthe et al. 21 published an interesting study in which 170 consecutive patients (330 breasts) underwent the classic Lejour mammaplasty technique from 1991 to 1994. Minor complications, which included seroma, hematoma, partial areola necrosis, and superficial wound dehiscence, were observed in 30 of patients. Major complications, comprising glandular necrosis, total areola necrosis, and glandular infection, were seen in 15 of patients. A surgical revision rate of 28 was necessary in this series. Noting these unacceptably high complication rates, Berthe et al. modified their technique by limiting breast liposuction to the axillary area in large breasts and minimizing skin undermining. Similar modifications have been described by Hall-Findlay 19 . Berthe et al. also performed primary skin excision in the inframammary fold if the excess could not be gathered adequately. The second part of this study, between 1996 and 1999, consisted of 138 consecutive patients (227...
Which are inhibitors of HMG-CoA reductase in the biosynthesis of cholesterol. Hence, tocotrienols are effective hypocholesterolemic agents, as well as potent cancer-preventive substances.68-70 Peanuts contain substantial levels of trans-resveratrol, the protective compound in red wine and grape juice shown to inhibit the formation of blood clots. As far as phytoestrogens are concerned, nuts and sunflower seeds have a substantial lignan content, while peanuts contain small amounts of isoflavones.65,85
A 30-year-old woman experiences bilateral breast enlargement and tenderness, which fluctuates with her menstrual cycle. On physical examination the breast feels lumpy, and the patient indicates a sensitive area with a discrete 1.5-cm nodule, which she says is consistently painful. A fine-needle aspiration is performed, and clear fluid is withdrawn. Clinically the cysts resolved.
Evidence from animal studies suggests a beneficial effect of phytoestrogens on bone, but long-term human studies are lacking.45 Epidemiologic evidence reporting that Asian women have a lower fracture rate than white women, even though the bone density of Asian women is less than that of African-American women, promotes consideration of the impact of nutrition. It is possible that high soy intake contributes to improved bone quality in Asian women. A study of a soy-protein diet high in isoflavones as compared with a milk-protein diet or medium-isoflavone and soy-protein diet demonstrated that those receiving the high-isoflavone preparation had improvement in trabecular (vertebral) bone rather than cortical (femoral) bone.46
A role for female sex hormones in breast cancer has long been suspected because women are far more susceptible than men. Early menarche and late menopause, which lengthen the period of exposure to sex hormones, increase the risk for breast cancer. The age at which a woman has her first child, the number of pregnancies, and whether she breast feeds may also be risk factors and are related to hormonal status. The amount of breast tissue available may be a factor, but small-breasted women are at similar risk to those with large breasts.
Many physicians take a guarded view of the benefits of dietary supplements. Since the FDA does not regulate the industry adequately, there are concerns as to the purity of these products, the true concentrations of active ingredients (if they are active), their side effects, and potentially dangerous contaminants. There are also concerns that their actions, if any, may be due to a placebo effect. Specific effects cannot legally be put on labels. Some of these products have potentially dangerous interactions with conventional medicines. Some, however, may be beneficial. For example, most physicians recommend dietary supplements of calcium for peri-menopausal and post-menopausal women to help prevent osteoporosis. Soy byproducts known as isoflavones act as phytoestrogens (phyto plant) and may eliminate some of the discomforts of menopause while not stimulating proliferation of breast tissue.
Wide or malpositioned scars more frequently occur at the base of the vertical scar. Using a purse-string suture at this level during initial surgery is a good option for shortening the vertical wound and for keeping the scar above the IMF however, it may still result in a wide scar with persistent wrinkles. Such scars are usually easily corrected by reexcision and meticulous closure (Fig. 14.1). The vertical scar is more difficult to correct when it crosses the IMF. In this case, the scar can be elevated by a crescentic excision that incorporates the bottom of the wound into the IMF this is in conjunction with liposuction on either side of the scar to avoid new dog ears. These simple corrections are amenable to local anesthesia. The wise surgeon should make the patient aware of the need for occasional tidy-up procedures at the initial consultation, especially in the case of large breasts. Taping of the scar postoperatively may reduce problems significantly. Correction is ideally...
The active phytochemicals are located principally in the bran and the germ, which compose less than 20 of the kernel. Hence, the refining of wheat causes very substantial losses of phytochemicals.114 The protective substances include those that affect the gut environment, such as dietary fiber, resistant starch, and oligosaccharides compounds that function as antioxidants, such as selenium, tocopherols, tocotrienols, flavonoids, ellagic acid and phenolic acids, such as ferulic, caffeic, vanillic and p-coumaric acids (these phenolic acids occur in high levels in whole grains) and lignans (phytoestrogens).107,108 Rye and barley contain the highest level of lignans among the grains, while wheat and corn have the least.65 Other important health-promoting phytochemicals in whole grains include phytosterols, phytates, and saponins.107
The isoflavones are well known for their estrogenic activity, which varies substantially from one compound to another. These nonsteroidal phytoestrogens have an array of potent biological activities, of both a hormonal and non-hormonal nature, which influence the development of chronic diseases. The isoflavones can undergo enterohepatic recycling and reach circulating levels that exceed, by several orders of magnitude, the amounts of natural endogenous estrogens.82 The major tissues targeted by the phytoestrogens are the reproductive tissues (uterus, breast, and prostate), the cardiovascular tissues (arteries and blood lipids) and the skeletal tissues.83 About 30-60 mg of isoflavones, per day appear to be the required threshold level needed to lower the risk of heart disease and cancer in humans. Higher levels are apparently needed for improving bone health.82,84 These levels can be achieved from a modest intake of a variety of soy products in the diet (see Table 14.3). The growth of...
Diagnostic imaging techniques are intended to identify tumors at the earliest possible stages. Ultimately, the goal is to distinguish between dense tissue, benign lumps, and cancer. To date, mammo-grams still offer the best imaging available for early diagnosis of breast cancer. However, they are not foolproof, and miss perhaps 10 percent of cancers. In younger women with dense breast tissue, mammograms may not distinguish a small tumor from surrounding tissue, although digital enhancing may enhance the sensitivity. They often cannot detect lobular carcinoma in situ in early stages. They are not reliable in women who have breast implants, nor do they distinguish fluid-filled cysts from solid fibroadenomas as well as does ultrasound. Current research is focused on better imaging with the least possible radiation.
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