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| Sunday, 7 March 2004 |
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Features |  |
| News Business Features Editorial
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Breast reduction through cosmetic surgery Having large and heavy breasts can cause embarrassment and lead to psycho-social problems in women. Dr Purnimar Aiyer, a Plastic and Cosmetic surgeon at the Apollo Hospitals, Colombo discusses with Carol Aloysius how this problem can be overcome. Q: How does having too large or heavy breasts affect a woman? A: Some of them feel that their breasts interfere with their exercises especially those who are overweight and have started on an exercise routine. They are also subject to constant ridicule which causes psychological problems. Still others complain of physical problems such as the tight bra strap producing a deep grooving in the shoulder region. There can also be neck, shoulder and back pain when the body is unable to support the breasts. Most patients with large breasts also feel physically and socially unattractive. In rare cases there can be a numbness in the little finger due to pressure of the breasts. Large heavy breasts can also result in a rash or irritation under the breasts. Q: Why do only some women develop large breasts? A: The factors for this physical condition are not well defined as yet. In some however family tendencies have been noted. There is also a rare condition called benign Giant Virginal Hypertrophy (enlargement) which is seen in pre-pubertal and pubertal girls between the ages of 10 - 15 years. This condition leads to massive breasts out of proportion to the normal chest and body size, which can have a devastating impact on a young girl's self confidence. Q: Some new born children have enlarged breasts. How does this happen? A: There is an entity called neo-natal gynaecomastia which is not a disease, but a physiological and temporary condition sometimes seen in new born males who are subject to the influence of maternal hormones i.e. excess of oestrogen. But this is very different from the previous condition I referred to. It also usually subsides on its own and needs no treatment or surgery. Q: How does cosmetic surgery reduce the size of a breast? A: Surgery helps to decrease the size of the breast to the desired size as for example from a 'C' cup size to an 'A' cup size. Q: Does such a drastic reduction have any adverse effects on the patient? A: On the contrary,the psychological benefits are dramatic. In addition to relief of the physical symptoms described earlier, the patient receives a tremendous boost to her self confidence and is able to take part in social activities and physical exercises which she avoided previously. Q: Can breasts get enlarged again after surgery? A; Only in the case of Benign virginal hypertrophy patients. In these patients recurrence is common and the patient is warned about this before surgery. However in the case of patients with normal breast enlargement, most patients are able to maintain a long lasting breast size- except for a few exceptions. Q: Such as? A: When there is a severe weight loss or a big weight gain after surgery. Then the breast can droop or get enlarged . Q: What would be the ideal age for a woman to have her breast size reduced? A: I would say when her breasts are fully formed i.e. several years after the onset of menarche that is around the age of 19 or 20. However if the breasts are very large and interfere with the activities or self esteem of the patient, the procedure can be done earlier. Q: Tell us about the procedure. A: It involves the removal of the excess skin, fatty, glandular tissue and re-positioning of the nipple to a higher and a more cosmetically suitable location. It is basically a tailoring of the breast to make it more attractive in terms of size and shape. The critical procedure involves careful preservation of the blood circulation to the nipple . Q: What are the complications involved? A: Very rarely , there may be necrosis or loss of the nipple and areola after surgery due to the damage to the blood circulation to the nipple. But this is very rare. The important thing as I said earlier is to maintain blood circulation to the nipple. Q: Any other side effects? A: Like any other operations, infections can develop. Collection of blood in the breast ( Haematoma) can also occur after surgery. But proper attention to sterile procedures used in the operating theatre, use of antibiotics and draining the collected blood within the breast by use of drainage tubes removed after 48 hours, can minimise these risks. Q: Is the operation done under local or general anaesthesia. Is hospitalisation necessary ? A: It is done under general anaesthesia. Hospitalisation is required for between 2-3 days. Q: Does it leave scars on the region of the breasts? A: There is a scar around the aureola following surgery. But this is not permanent. There will also be another vertical scar going from the areola to the fold under the breast and a scar in the infra-mammary crease depending on the surgical technique used. Q: Tell us about the techniques you use. A: We use the inferior pedicle, superior Pedicle, Central pedicle techniques. The newest breakthrough is the Verticle mammoplasty technique which can completely avoid the scar in the infra mammary crease. Q: Can suction of the fat also reduce scarring? A: Lipo suction technique or suction of the fat has been successful in patients with minimum to moderate breast enlargement-provided the patient has a good skin tone, where the shape of the breast is satisfactory, and the breasts are not sagging. Q: What does this technique involve? A: It involves a tiny cut, inserting a metal cannula, and suctioning the fat. Q: Is there any relation between cancer and large breasts? A: Some studies have shown an increase of cancer in patients with large breasts and have suggested that breast reduction may decrease this risk. However other studies have shown no increase in the cancer risk unless the patient has other risk factors like positive family history. Q: So do you screen patients for cancer risks before surgery? A: All patients above 35 years are subjected to mammogram before surgery and after surgery and the breast tissue is submitted for pathological examination. Q: Can overweight patients undergo this operation? A: It is best that an overweight patient loses weight before the operation to ensure that her breasts will be of the size requested. If she plans on losing weight after the breast reduction, there will be some loss of breast volume to an unpredictable degree. Furthermore, if the abdomen is protuberant, uplifting the breast may make the bulging more obvious. So a patient should either lose weight before the operation or can undergo lipto suction of the abdomen. Or else have a tummy tuck before the operation. Q: Is there any restriction of activities after surgery? Does the patient have pain? A: Pain can be adequately addressed by pain killers given after surgery? In my practice I have found that the local application of ice is useful in reducing pain. I also advise my patients not to do any weight training or swim for three weeks following surgery and to wear a sports bra day and night for 2 months. This gives good support for the breast and reduces discomfort. Q. Can this operation affect breast feeding? A: Breast feeding may not be successful after the operation although there are techniques which preserve the attachment of the gland to the nipple which are likely to preserve the ability to breastfeed. Q: Finally, is surgery the first line of treatment to reduce one's breasts? A: If a woman is overweight she should first try to reduce her breasts with exercise. But where the breast is out of proportion to the rest of the body and distorts the body image and affects self esteem, surgery should be considered an option. Does consumption of broiler chicken cause precocious puberty in girls? Menarche (first menstrual bleeding in the female) occurs in majority of girls at the age of 10-15 years depending on the nutritional and emotional status and signifies the approach of reproductive maturity. I have never seen a single case of precocious puberty (menache) in girls before the age of 10 years during my medical student days and during my house officer days when I worked in gynaecology and paediatric wards. I came across a girl 7 years 2 month old, who has attained menarche and I was told by her parents that their family doctor has told them that the precocious puberty may be due to excessive consumption of broiler chicken. This girl had external features of puberty and was in year 2 in school and the premature puberty was a big headache to the parents. I am sure that there must be some psychological abnormalities in this little girl who misses her normal childhood life and who may have awareness of her femininity and sexuality. Precocious puberty in children can rarely be due to certain tumours involving the hypothalamus and the pituitary. The parents of this girl (who are my heart patients) told me that this case has been fully investigate by their paediatrician. A veterinarian has recently mentioned in one of his articles to the newspapers that there are no hormones such as growth hormone or oestrogen in the broiler chicken sold in U.S.A. I would be very grateful if any reader including veterinarians who could inform the reading public whether Sri Lankan broiler chicken contains any hormones such as growth hormone or oestrogen. Has any Sri Lankan done a chemical analysis of the Sri Lankan broiler chicken with a view to exclude hormones such as growth hormone and oestrogens? by Dr. D.P. Atukorale How much is a mother worth? Maternal conditions represent the leading disease burden for women of reproductive age, comprising at least 18 per cent of the burden of disease for this age group. It is likely, however, that the disease burden is even greater than estimated.
Disabilities due to other direct causes of maternal deaths such as antepartum haemorrhage, ectopic pregnancy, embolisms, and anaesthesia complications are not included in the calculations. 'Nor do the calculations include deaths or disabilities due to indirect maternal complications such as malaria, hepatitis, anaemia, and cardiovascular conditions. For example, it is estimated that almost 60 percent of all pregnant women in developing countries suffer from nutritional anaemia (a rate which has remained virtually unchanged over the past 35 years). Psychological morbidities associated with childbirth (including postpartum depression) are also excluded. Moreover, the 4.3 million stillbirths which occur each year may cause mental depression and immediate repeated pregnancy, contributing to maternal depletion. Lastly, the psychological stress burden from conditions such as obstetric fistulae and infertility are not quantified as part of the burden from maternal conditions. Survival of children To a significant extent, the survival and well-being of children depends on the health of their mothers. When mothers are sufficiently nourished and adequate care is provided during pregnancy, delivery and postpartum, newborns will have the greatest likelihood of survival and optimal capacity for physical, emotional, and mental growth. In developing countries, a mother's death in childbirth means almost certain death for the newborn and severe consequences for her older children. Those who survive their mother's death face an uncertain future, and maternal deaths leave two million children orphaned annually. Children whose mothers die are there to ten times more likely to die within two years than those with living parents. When mothers survive but are malnourished, sickly, or received inadequate maternity care, their children face a high risk of disease and death. Stillbirths and newborn deaths are more common than maternal deaths. There are seven times more newborns who die, as well as seven times more stillbirths, for each maternal death. This mainly reflects the lack of adequate maternal and neonatal health care and the vulnerability of the fetus and newborn. Strengthening maternal health services can thus bring significant benefits to society as a whole as well as the health system. WHO - When becoming pregnant is a problem Infertility is not really a problem of either partner. It is a problem of the couple.
Notably, this "prevention first" approach to preserving fertility involves achieving the still difficult goal of integrating sexual and reproductive health services to address both unintended pregnancy and STIs. Chlamydial infection and gonorrhoea first attack the inner lining of the cervix, then - if untreated - can ascend to the upper genital tract. They do so by moving through the uterus to the fallopian tubes, and in some women, to the ovaries and abdominal cavity. Infection of the uterus, fallopian tubes, or ovaries - called pelvic inflammatory disease (PID) - can cause infertility by either blocking or damaging the fallopian tubes. Preventing tubal infertility Preventing STI-related tubal infertility can occur at two levels. Men and women can achieve primary prevention to block acquisition of infection by delaying initiation of sexual intercourse, choosing an uninfected sexual partner, and - if neither of these conditions is met - using condoms to reduce the risks of chlamydial infection and gonorrhoea. Secondary prevention intended to block progression of lower genital tract infection to the upper genital tract emphasizes STI screening, partner notification, and treatment. Treating "endstage" tubal infertility is very costly;' thus, preventing the condition is imperative. The secondary prevention approach of screening for STIs can be problematic in many developing-world settings where diagnostic laboratory tests are unavailable Factors Contributing to Infertility . Anatomical problems . Endocrinological problems . Genetic problems . Immunological problems . Increasing age . Infectious and parasitic diseases . Genital tuberculosis . Malaria . Schistosomiasis . Malnutrition . Potentially harmful substances . Aflatoxins . Arsenic . Pesticides . Tobacco, alcohol, or caffeine . Reproductive tract infections . Postabortion infections . Postpartum infections . Sexually transmitted infections Chlamydial Infection, Gonorrhoea main cause for infertility Chlamydial infection and gonorrhoea - primary causes of infertility - are easily transmitted. About one in every five unprotected sexual acts by someone with chlamydial infection will result in transmission to an uninfected partner. For gonorrhoea, the risks of transmission are even higher: about one of every two exposed individuals will be infected. Consistent and correct condom use can reduce the risk of transmitting these infections. However, because condoms can slip or break, they do not provide absolute protection. The only way to absolutely prevent transmission of these infections, and thus preserve fertility, is to delay or abstain from sexual intercourse or be sexually active only in a monogamous relationship with an uninfected individual. From Family Health International The pill and women with HPV Use of oral contraceptives for five years or more appears to raise the risk of cervical cancer among women infected with human papillomavirus (HPV). the odds of developing cervical cancer are nearly tripled among women who use pill for 5-9 years and quadrupled among those who rely on the pill for 10 years or more, compared with the odds among never users. An HPV-positive woman's likelihood of developing cervical cancer is also associated with the number of times she has given birth. Compared with those who have never borne a child, HPV-infected women who have had 1-2 births have twice the odds of developing cervical cancer, and those who have given birth seven or more times have four times the odds. Oral contraceptive use and high parity long have been thought to be tied to the development of cervical cancer. Yet past research into these associations has been hindered by a lack of information about whether women were infected with HPV one of the main immediate causes of cervical cancer. A series of studies by the International Agency for Research on Cancer (IARC) included assessments of women's HPV status and thus provide an opportunity to investigate the independent role of reproductive factors in the development of cervical cancer. From International Family Planning Perspectives Vitamin C prevents heart attacks in women Vitamin C or Ascorbic Acid is perhaps one of the most important vitamins known to science. Scurvy, the deficiency disease caused by lack of vitamin C has been known since the time of Crusades. There is now scientific evidence that in take of vitamin C can prevent a large number of diseases. Vitamin C is the main water-soluble antioxidant in human plasma and as hypothesized to have a protective role in coronary artery disease, by inhibiting low density lipoprotein (LDL) or bad cholesterol from getting oxidized and has been identified in atherosclerotic lesions. High dietary in take of vitamin C has thus been associated with a moderately low risk of C.A.D. A prospective study Osgarian etal from Harvard University followed up 85118 nurses who took vitamin C supplements (Nurses Health Study) and found that those who took vitamin C supplements had a significant lower risk of C.A.D. than women who did not take vitamin C supplements. They thus concluded that users of vitamin C supplements appear to be at a lower risk of heart attacks, than women who did not take vitamin C supplements. Low or deficient intake of vitamin C is associated with an increased risk of C.A.D. and an intake of about 100 mg of vitamin C. C per cent is sufficient for maximum reduction of C.A.D. risk by vitamin C among non-smoking men and women. The vitamin C in take from diet alone is not associated with a reduction of C.A.D. risk. The cardio-protective effect of vitamin C may manifest only when plasma and cells and presumably tissues are completely saturated with vitamin C. Vitamin C is a very cheap vitamin and daily dose for heart patients or those with coronary risk factors is 100 mg and this costs only 30 cents. All patients with coronary artery disease or those having coronary risk factors such as hypercholesterolaemia, smoking, hypertension, obesity, homocysteinaemia and diabetes mellitus should take 100 mg. of vitamin C daily in addition to the vitamin C available in the diet. |
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The disease burden calculations include deaths and disabilities from
direct causes of death, postpartum haemorrhage, sepsis, complications
related to unsafe abortion, hypertensive disorders in pregnancy and
obstructed labour.
The main preventable causes of infertility are sexually transmitted
infections (STIs), primarily chlamydial infection and gonorrhoea. Because
these widespread and easily transmitted infections are often
"silent" or asymptomatic, active screening of sexually active
persons for these particular STIs is crucial. Otherwise, few women will
realize that they have a fertility-threatening infection until they try to
become pregnant and are unable to do so.
