Male Breast Reduction Treatment for Dwayne ‘the Rock’ Johnson Shows the Widespread Appeal of Plastic Surgery, says Dr. J Plastic Surgery

 

Dr. Payam Jarrah-Nejad_n

A July 30 article on ShowBiz CheatSheet explores the fascinating career of football-player turned pro-wrestler turned superstar actor Dwayne Johnson, aka the Rock. Contrary to what most of us would assume about a bulked up icon of a certain type of male perfection, the famously down-to-earth Mr. Johnson is surprisingly open about admitting to having had male breast reduction to deal with gynecomastia, a common condition that causes enlarged male breasts.

Unlike the vast majority of men dealing with the issue, however, by that point, Mr. Johnson had already been making his living shirtless as a superstar wrestler. He was, however, not too thrilled with his torso’s appearance in efforts such as 2001’s ‘The Mummy Returns’ and found that no amount of exercise was going to reduce the size of his widely seen pectorals.

While Mr. Johnson’s situation is not so typical, the embarrassment he may have felt being seen by millions is probably not all that different from the feelings of a young man at the beach or swimming pool.

Dr. Payam Jarrah-Nejad

Beverly Hills plastic surgeon Dr. Payam Jarrah-Nejad, M.D., F.I.C.S., F.A.C.S., known affectionately to his patients and colleagues as Dr. J, says that, while Mr. Johnson’s situation is not so typical, the embarrassment he may have felt being seen by millions is probably not all that different from the feelings of a young man at the beach or swimming pool terrified that even one person might notice his unusually large breasts.

Dr. J points out that his gynecomastia patients are typically extremely happy with their outcomes. He notes that the surgery, like female breast reduction, ear pinning (aka otoplasty), and many other procedures, fundamentally differ from such widely discussed plastic surgeries as breast augmentations and Brazilian butt lifts. Some plastic surgery patients are already extremely attractive people who want to stand out by looking that much more fabulous, says Dr. J. Other patients are, on the other hand, seeking to attract less of what they find to be the wrong kind of attention, he adds.

Plastic surgery, says Dr. J, is often thought of as a glamorous specialty but it is one of the most challenging of all medical disciplines requiring years of instruction, study, and practice to fully master. He says that, while facelifts and rhinoplasty have very long histories, plastic surgery hit the medical mainstream during the latter days of World War I as injured servicemen often felt forced to wear elaborate masks; new skin grafting procedures were developed to allow former soldiers to live more normal lives. Dr. J concludes by noting that, while the circumstances of plastic surgeries vary drastically, they are all connected by helping patients live the best lives possible.

 

About Dr. Payam Jarrah-Nejad, Dr. J

Payam Jarrah-Nejad, MD, FICS, FACS is a double board certified Beverly Hills Plastic Surgeon. Nicknamed Dr. J by his patients and staff, he holds certifications from both the American Board of Plastic Surgery and the American Board of Surgery. Dr. J is also an active member of the American Society of Plastic Surgeons and a Fellow of The American College of Surgeons.

Dr. J first started his medical career during an internship he held in NYU. It was during this time that he also began working with hospitals around the New York area. It was in New Jersey that he completed his training and served as Chief Resident at Morristown Memorial Hospital.

Newly certified by the American Board of Surgery and the American Board of Plastic Surgery, Dr. Jarrah-Nejad received a fellowship at Beth Israel Medical Center in New York City to specialize in hand surgery. The fellowship was under the guidance of Dr. Charles P. Melone which was a big influence on the young doctor. It was during his training at Wayne State University, Detroit Medical Center in Michigan that Dr. J found his true calling working with many well-known plastic surgeons.

Years later, practicing as a board-certified plastic surgeon, Dr. J still uses the same techniques he learned in his training in his frequent operation on the face and body. He is greatly admired by his staff and patients who happily contribute positive testimonials to his website.

Dr. J is known throughout the Los Angeles Area medical community as well as beyond it, for his record of outstanding outcomes and his engaging, patient-friendly personality. He has published a wide range of papers in many prestigious scientific and medical journals and has presented his research to local, regional and national symposia.

Finally, Dr. J has performed pro-bono surgery in several countries as part of humanitarian efforts helping children with congenital anomalies. He works side by side with charitable organizations devoted to providing needy children around the world with free plastic surgeries to repair such issues as cleft lips and palates.

Come into the beautiful world of Dr. J.

 

 

 

 

Advances in Post Mastectomy Breast Reconstruction: Nipple Preservation

Dr.-Constance-M-Chen

Mastectomy has changed a great deal over the years. Long gone are the radical mastectomies of your grandmother’s day which removed not only breast tissue but also extensive breast skin, lymph nodes, and underlying chest muscles. By the 1980s, the most common approach was the modified radical mastectomy, which left the chest muscles intact.

Since then, the standard mastectomy is the simple mastectomy in which all of the chest muscles, most if not all of the lymph nodes, and most recently, the nipple and areola complex are all preserved. When combined with an immediate breast reconstruction at the time of the mastectomy, these techniques produce a superior cosmetic result while eliminating diseased tissue.

Nipple-sparing mastectomy has become more widespread as more breast surgeons realize the importance of the nipple-areola complex to patients after surgery. Looking and feeling normal and whole improves self-esteem both for women who are losing a breast to cancer and for those who are considering prophylactic (or preventive) mastectomy because they are at high risk for breast cancer due to family history or because they carry a genetic mutation.

Dr. Constance M. Chen

Women who are considering skin and nipple-sparing surgery must be evaluated for factors such as the size, location, and nature of the cancer to ensure that they are good candidates for the procedure. Imaging and examination are performed to look for tumor in the nipple and to rule out symptoms such as nipple discharge that might indicate the presence of disease in the nipple.

During surgery, all breast tissue is removed and the breast specimen is submitted to pathology to ensure that there are no cancer cells in or near the skin and nipple complex. Nipple preservation is possible with both small and large breasts and can be used when reconstruction is to be either with implants or with a woman’s own tissue (‘autologous reconstruction’).

Many women are candidates for nipple-sparing mastectomy, in which the nipple is preserved during the mastectomy. For women whose nipple has been resected a more traditional type of mastectomy, however, it is possible to surgically reconstruct the nipple to recreate a complete breast.

Dr. Constance M. Chen

The primary benefits of skin and nipple preservation are the superior aesthetic outcome and the resulting psychological boost. The combination of skin and nipple preservation with autologous reconstruction produces a soft, warm, natural breast that may be difficult to distinguish from the woman’s original breast.

The risk of breast cancer is considerably greater for women who inherit a genetic mutation, such as the BRCA1 or BRCA2 gene, that makes a woman more likely to develop breast cancer. As more women become aware of their risk, those who test positive for the harmful mutations face the difficult decision of whether to reduce their risk by undergoing bilateral prophylactic mastectomy – preventive removal of both breasts.

These women may wonder if surgery that conserves the nipple will leave in place breast tissue that might be subject to cancer. The experience of thousands of women and their healthcare providers has been that nipple-sparing mastectomy is safe for women with genetic mutations and a major study in 2017 confirmed that prophylactic surgery essentially eliminates the risk of cancer with or without breast reconstruction.

(‘Oncologic Safety of Prophylactic Nipple-Sparing Mastectomy in a Population With BRCA Mutations’ by Jakub et al, was published in the Journal of the American Medical Association in September 2017.) The report concludes that nipple-sparing mastectomies are ‘highly preventive’ against breast cancer in a BRCA population.

For women with no indication of disease in or near the nipple, including those with BRCA mutations, a nipple-sparing mastectomy essentially eliminates the risk of breast cancer and offers the opportunity for state-of-the-art breast reconstruction that maintains both the woman’s health and her sense of self.

 

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

 

 

 

 

 

Managing Expectations for Breast Reconstruction; It’s a Process

Dr.-Constance-M-Chen

Breast reconstruction has come a long way. Advances in surgical technique have made it possible to use a woman’s own tissue to construct a breast that is soft and warm and often very similar to the breast she has lost to mastectomy. This ‘autologous reconstruction’ has become the gold standard in breast reconstruction and can even offer women the possibility of reconnecting nerves to restore sensation to the breast.

Autologous reconstruction can be performed with excellent results at any time, but the best aesthetic outcome is achieved when we do reconstruction in a single surgery at the time of the mastectomy. When the woman awakes after surgery, she already has a new breast, which reduces the emotional impact of having lost a breast. However, it is important for women to know from her first surgical consultation that the breast she wakes up with after surgery – whether performed at the time of her mastectomy or later – may not represent the end of breast reconstruction but a giant first step. For most women, breast reconstruction is not a single procedure but requires a process of adjustments until the best possible result is achieved.

Dr. Constance M. Chen

The goal of reconstruction is to restore symmetry to a woman’s body – symmetry to her other breast and proper proportion to the rest of her body. Symmetry is easier to achieve when both breasts have been removed and are being reconstructed at the same time (bilateral reconstruction). When reconstructing one breast (unilateral reconstruction), it can be more difficult to match the size, shape, and position of the ‘sister’ breast and adjustments may be needed to one or both breasts to achieve the desired symmetry.

We have a wide range of techniques we can use to make the necessary adjustments. Each woman will have an individualized plan that may include one or more of these procedures.

Dr. Constance M. Chen

A mastoplexy or breast lift may be performed on the unaffected breast if its natural droop cannot be replicated in the reconstructed breast. A breast lift will remove excess skin and may elevate only the nipple and areola so they are placed higher on the breast or elevate the breast tissue itself so it sits higher on the chest wall. A breast lift will not significantly alter the size of the breast.

A breast reduction on the unaffected breast may be needed to match the size of the reconstructed breast. The procedure will remove excess skin and tissue and position the breast tissue and nipple-areola complex higher on the chest wall. Breast augmentation to increase the size of the unaffected breast will typically involve placing a silicone gel or saline implant under the pectoral muscle.

Fat grafting, which transfers fat from another part of the body to the breast, is very useful for filling small areas to improve size, shape, and symmetry. Fat is removed from the donor site, frequently the abdomen, using liposuction, which suctions fat out through tiny incisions, and injected into the breast. Fat grafting and liposuction may be used on the unaffected breast or to make small corrections to the reconstructed breast.

Abdominal wall repair may be performed if tissue taken from the abdomen to fashion the new breast leaves the abdomen in need of improvements to its contour.

“Adjustments to autologous breast reconstruction are generally made after the initial surgery has healed and other treatments are complete”. says Dr. Chen. “They represent the final steps in a woman’s journey to restore her health and sense of self”.

 

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

 

 

 

 

Immediate vs Delayed Breast Reconstruction: What is Right for You?

Dr.-Constance-M-Chen

Among the many medical, personal, and financial decisions a woman must make following a diagnosis of breast cancer and the need for a mastectomy are decisions about breast reconstruction. Does she want reconstruction? What kind? When? With so many questions coming at her, some women are relieved to learn that the decision about reconstruction is one that doesn’t have to be made right away.

With proper planning before mastectomy, breast reconstruction can be done with excellent results months or even years later. That said, there are advantages to immediate reconstruction – in a single surgery at the time of mastectomy – and every woman should be made aware of all the factors involved and given the opportunity to decide what is best for her.

Dr. Constance M. Chen

Both immediate and delayed reconstruction are viable options whether the woman opts for implant-based breast reconstruction or natural tissue breast reconstruction (also known as ‘autologous reconstruction’, because it uses a woman’s own tissue to create her new breast). While many women see implants as the quickest, simplest reconstructive option, controversy about the long-term safety of implants has led more and more women to consider natural tissue breast reconstruction, which many consider to be the ‘gold standard’ in breast reconstruction. Dr. Chen explains the advantages:

Along with nipple preservation and techniques that reduce scarring, autologous reconstruction can deliver a soft, warm, natural breast that is similar to a woman’s original breast. In natural tissue breast reconstruction, the reconstructed breast is living so it grows and shrinks as the patient gains and loses weight. Furthermore, new advances also make it possible to reconnect nerves and restore feeling to the reconstructed breast.

Dr. Constance M. Chen

Whichever type of reconstruction is chosen, there are many factors that affect the timing of reconstructive surgery, including a woman’s age, the stage of her disease, her general physical condition, and her treatment plan. For example, women who will need post-mastectomy radiation therapy and want natural tissue breast reconstruction are best served by delaying autologous reconstruction. She can undergo either tissue expander breast reconstruction or no reconstruction at the time of mastectomy, and then undergo autologous reconstruction after radiation therapy is completed to avoid radiating and damaging the healthy new tissue in her reconstructed breast.

This decision should be discussed with her medical team as early as possible,” says Dr. Chen. “If, after weighing all the factors, it is determined that a woman is a good candidate for immediate reconstruction, she can then examine the pros and cons of each approach.

Dr. Constance M. Chen

Immediate reconstruction

Immediate reconstruction is performed in a single surgery at the time of the mastectomy. After the cancerous breast tissue is removed, the reconstructive surgeon fashions the new breast, either with an implant or with tissue from another part of the woman’s body, most frequently the abdomen. When she awakes after surgery, she has a new breast, which for many women can be an important factor in her psychological and emotional recovery. Additional advantages include the fact that she must undergo just one major surgery and hospitalization, which has financial implications and accelerates the sense that she is putting breast cancer behind her.

Another important consideration is that it is sometimes easier to achieve a satisfactory aesthetic result with immediate reconstruction. The combination of skin- and nipple-sparing techniques with immediate reconstruction produce the best possible cosmetic result.

Dr. Constance M. Chen

One disadvantage of immediate reconstruction is that while it entails only a single surgery, it is a more complex surgical procedure with a longer hospital stay and recovery period. Also, because mastectomy is often time sensitive, there is less time for a woman to think through what kind of reconstruction she wants or whether she wants reconstruction at all.

 

Delayed reconstruction

Since delayed reconstruction can be performed months or even years after her mastectomy, a woman can complete all other treatments and give plenty of time to her decisions about whether or how to have reconstruction. She might also consider that her initial mastectomy will be a simpler procedure and she’ll recover more quickly.

We want every woman to understand the options available to her and make the decision that is best for her. Surgical techniques have come a long way and we can assure every woman that whatever choice she makes, we can help her achieve the best possible result and reconfirm her sense of self as she puts breast cancer behind her.

Dr. Constance M. Chen

The primary disadvantage of delayed reconstruction is that she will require a second surgery and hospitalization. The scarring from the mastectomy may also limit options for reconstruction. Also, since the breast skin will shrink after mastectomy, the shape and size of the original breast will be lost and sometimes it is difficult to remove skin creases that have developed.

 

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.

 

 

 

Knowing What to Ask and Planning in Advance Before Breast Reconstruction Surgery

Dr.-Constance-M-Chen

Plastic Surgeon and Breast Specialist Dr. Constance M. Chen offers practical tips for women considering post mastectomy Breast Reconstruction.

A diagnosis of breast cancer upends a woman’s life, and forces her to make many personal, medical, and financial decisions. If a woman must undergo mastectomy, the predicament is further complicated by the decisions she must make about whether, when and how to have breast reconstruction. Many women undergoing breast reconstruction see implants as the quickest and simplest reconstructive option.

Controversy about the long-term safety of implants, however, has driven more and more women to choose ‘autologous reconstruction’, which uses a woman’s own tissue to create a soft, warm breast that looks and feels like her original breast.

“Whichever surgical option a woman chooses, she should have a thorough understanding of what to expect after surgery, when she goes home, and how her new breast will look and feel”, says plastic surgeon and breast reconstruction specialist Dr. Constance M. Chen. “Knowing what to ask and planning in advance with her surgeon before surgery should reduce the risk of surprises later”.

“I’m going home! Yay! But with drains?”

Going home after surgery is an important step emotionally as well as medically. Each woman has a different sense of what is important to her sense of self. She should know in advance that she will probably leave the hospital with surgical drains still in place, and she will need to know how to manage the drains and accommodate them in her clothing as she resumes daily activities. She may be surprised that it is the mundane things, like being able to get in and out of clothes easily, going to the bathroom, and looking normal, that loom large.

“One or more surgical drains are usually required following mastectomy and reconstructive surgery”, says Dr. Chen. “Drains perform the important function of preventing the build-up of fluid in a surgical space”. The drain is a flexible tube that connects from the surgical incision to a small plastic bulb that collects fluid and must be periodically measured and emptied. Drains might be removed in the hospital but are more likely to be removed in the doctor’s office after surgery. Your nurse or doctor will instruct you on how to manage the drains and keep them secure and discreet. “Some patients find a post-surgical camisole with pockets for the drains to be convenient”, says Dr. Chen. “Others prefer an oversized sweater or blouse and loose-fitting pants with roomy pockets to hold the bulb”.

“What if my new breast isn’t what I expected?”

Autologous reconstruction, nipple preservation, and techniques that reduce scarring try to recreate a soft, warm, natural breast that is similar to a woman’s original breast. However, she may find that the natural ‘look and feel’ of her restored breast refers to how the breast will look and feel to someone else. The breast may not feel at all natural to the woman herself, because her reconstructed breast usually lacks feeling and may be completely numb to touch and sexual arousal.

“While results vary, advanced microsurgical techniques now make it possible to reconnect nerves and restore some measure of sensation to the breast”, says Dr. Chen. The importance of breast sensation is different for every woman and should be discussed in the initial surgical consultation so she knows what to expect – especially since not all surgeons are trained in techniques to restore breast sensation.

The goal of breast reconstruction, whether with implants or a woman’s own tissue, is to restore symmetry – to create a breast with the shape of the original that is in proportion with her other breast and with the rest of her body. Matching a reconstructed breast to an existing natural breast may not be possible in a single surgical procedure, however.

Follow-up modifications may be necessary to achieve the desired symmetric result. “For many women, breast reconstruction is a process rather than a single procedure”, says Dr. Chen. “Lack of symmetry in mastectomy patients after reconstruction can be corrected with adjustments to the reconstructed breast or to its unaffected ‘sister.’ This possibility should be discussed in the initial surgical consultation”.

“Our goal is to help every woman make informed decisions so that she can better understand her treatment and recovery”, Dr. Chen concludes. “Comprehensive, accurate information about what to expect is helpful to optimize physical and emotional outcomes”.

 

About Dr. Constance M. Chen

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine.

Dr. Chen is frequently invited to lecture nationally and internationally on new advancements in breast reconstruction and the surgical treatment of lymphedema. She is the author of three books, five book chapters, and fifty journal articles. She has also won numerous awards for her work in plastic and reconstructive surgery at the local, regional, and national levels.

Dr. Chen has developed a reputation in the community for the personalized attention that she devotes to her patients. She is committed to aesthetic restoration of the breast and body, and enjoys helping her patients achieve overall well-being. At the end of the day, there is nothing more important to her than the joy she hopes to bring to her patients’ lives. Come into the beautiful world of Dr. Constance M. Chen.