Does Breast Augmentation Increase Risk of Dying from Breast Cancer?

This month the British Medical Journal (BMJ) published an article entitled “Breast Cancer Detection and Survival Among Women With Cosmetic Breast Implants.”  It’s a pretty benign title and one I could have easily skimmed over were it not for the email that hit my inbox:

Cosmetic Implants Adversely Affect Breast Cancer Survival

 

This frightening declaration was the subject line of an email from Medscape, a news service that summarizes the latest scientific journal publications and delivers them to your email.  It obviously caught my attention- breast implants are a big part of the plastic surgery business.  According to the American Society of Plastic Surgery 2010 statistics, nearly 300,000 women a year undergo augmentation mammaplasty.

So this shocking headline should be all over major news networks, right?  I’ve googled   But this is an excellent demonstration of why it’s important to read the article itself.  And if you don’t have access to the article, let me summarize a few key points for you.

  • The BMJ study is a meta-analysis, which a way to lump several previous studies together and analyze them as a group.  The very best type of study would be to randomize women to different two different groups- one that receives breast implants, and one that does not- then follow them for several years and see which group has a higher risk of dying from breast cancer.  This clearly isn’t possible, so the next best thing is to look back (retrospectively) at women who had breast augmentation compared to women who didn’t and compare those two groups.  The BMJ meta-analysis looked at several studies that essentially did just that.
  • 12 studies were included in the initial analysis, which did not conclude that breast implants increase the risk of dying from breast cancer.  Then the authors did some complicated statistical analyses, which I will fully admit are beyond my rudimentary grasp of statistics.  But the end result was that they excluded 7 of the studies and analyzed only the remaining 5, which is a very small number.
  • Looking at those 5 studies, only one of the five actually concluded that breast implants increase the risk of dying from cancer.  The other four studies were not statistically significant (i.e. not able to conclude that breast augmentation decreases breast cancer survival.)
  • The total number of patients looked at in the meta-analysis was not given, so we have no idea if there were enough patients to accurately represent the overall population.
  • The authors of the study themselves are very cautious in drawing their conclusions, stating only that “This systematic review suggests that women with cosmetic breast implants have later stage tumors at diagnosis of breast cancer.” (emphasis is mine).

Now I must warn you that I am not a statistician.  And if someone who is has any input into the way the stats were done in this study, I would love to hear their opinion.  But it is clear that the conclusions of this study were much more tentative than the way it is being advertised by Medscape, and on some of the websites I’ve seen discussing the article (click here and here to see how others interpreted this article).  The best conclusion to draw from this is that more research needs to be done in this area.  And keep in mind that there are several studies which suggest no difference in breast cancer survivability for patients who have had breast augmentation.  For now the jury is still out, and I would not recommend basing your decision to have breast augmentation on reading a single scientific study.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

The Best Treatment for Wrinkles and Fine Lines?

I am often asked by patients: What is the best way to treat fine lines and wrinkles?  This is an excellent question, and one without a simple answer.  The best treatment for you depends on:

Courtesy of office.com

Courtesy of office.com

  1. Your goals.  Do you have one specific area that bothers you?  For example, the creases along the sides of your mouth, aka nasolabial folds, are a common problem area.  But treatment of a single area may differ than if you want full-face improvement.
  2.  Can you afford down-time? A minimally invasive treatment such as a filler will result in mild bruising or swelling.  But a more invasive treatment such as a laser peel will result in 2-3 days of redness (think bright tomato-red, not just mildly flushed) followed by a few more days of flaking and peeling.  I’ve had some patients go to work the day after a peel, while others prefer to hunker down at home until they can wear make-up again.
  3. Cost.  The price-point for treatments can vary from a few hundred dollars with fillers, to over a thousand dollars for a laser peel and profractional peel combination.  Don’t be afraid to give your physician a budget, and ask what will give you the best results within that price range.

In past posts I’ve discussed fillers, laser peels and skin care.  Now I’m going to give you a framework in which to place specific treatments.  There are three fundamentals to good skin care: prevention, improvement, and maintenance.

  • Prevention- taking good care of your skin helps prevent future damage.  Sunscreen is the number one preventative treatment that I recommend to all patients.  Wear a daily moisturizer with SPF 15 or higher to prevent the accumulative damage of the short bursts of sun exposure your face sustains throughout the day.  Adding an antioxidant such as Vitamin C will also help prevent damage from other environmental factors (think smog, cigarette smoke etc.).  I also consider Botox in the preventative category, as it keeps wrinkles from getting worse.
  • Improvement- Anything that sets back the clock will fall into this category.  Laser peels obviously improve skin.  But even non-invasive treatments such as Retin-A will improve fine lines and increase collagen production.  Hydroquinone cream or BBL treatments, on the other hand, reduce the brown spots and discolorations that occur with age and sun damage.
  • Maintenance-  If you’ve spent money on improving the appearance of your skin, maintaining this improvement is key.  A good skin care regimen is important, and will not only sustain the improvements you’ve made, but also continue to improve the look of your skin while preventing future damage.  I’ve written a post previously that details some of the products I recommend, and you can read that here.  But to sum up, a good skin care regimen should include cleanser, moisturize, hydroquinone,  Retin-A, and an antioxidant such as vitamin C.

I hope this gave you a better idea of what to look for in skin treatments.  Do you have a skin care question?

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Advertising in Plastic Surgery

I was on a cruise recently, and I was astonished to see that in addition to the regular spa services offered, passengers could also get Botox, Dysport and several fillers while onboard.  The physician on the ship was advertised as both licensed and board certified, but none of the advertising literature I came across actually mentioned what particular field he was board certified in.  My hope is that he was board certified in Plastic Surgery, Facial Cosmetic Surgery, or something similar, but without an extensive online search of the particular physician by name, I had no way of knowing.

Courtesy of Office.com

Courtesy of Office.com

Now I have no particular issue with offering Botox or fillers on a cruise ship (and if you’re imaging a doctor’s hand holding a syringe coming at your face while you both stand on a moving deck, cruise ships are really very stable).  What I did find interesting was the content of the advertising itself.  Please don’t quote me verbatim, as I’m working from memory, but many of the advertisement made claims such as:

“Look 10 years younger instantly with no down time and no side effects!”

Sound great, right?  Of course it does.  And there is no treatment available today that can offer that, be it laser, injectables, or surgery.  In the United States, the American Board of Plastic Surgery takes a very clear view of advertising by Plastic Surgeons:

“…it does not approve of advertising which leads to unrealistic expectations, which is false or misleading, which minimizes the magnitude and possible risks of surgery, or which solicits patients for operations that they might not otherwise consider.” (Italics are mine)

Thus it was unusual for me to see such… shall we say sensational? advertising.  For this reason, I’m speculating that the physician on board the ship was not a board-certified plastic surgeon.  Or maybe it had something to do with the fact that the ship was based in the Bahamas, not the United States.  But it did serve as a reminder to me that no treatment is without risk, even the routine ones I do daily.  And it’s important for prospective patients to understand both the risks, and the potential benefit before engaging in any cosmetic procedure.  Remember, if something seems too good to be true, it probably is.

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Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.