Today, Angelina Jolie’s decision to go public with her choice to undergo bilateral prophylactic mastectomy and immediate implant-based reconstruction is shedding new light on patient’s healthcare choices in breast cancer therapy. For most women who will unfortunately develop breast cancer during their lifetime (a staggering 1 in 8 women), only a small portion of them will be BRCA 1 or BRCA 2 positive on genetic testing. In fact, only about 7% of breast cancers that occur nowadays, occur in patients who test positive for the BRCA 1 and BRCA 2 genes. For women who do carry these genetic mutations, they have a significantly increased lifetime risk of developing both breast cancer and ovarian cancer.Patients who test positive for these mutations  have risks up to 87% for breast cancer and 44% for ovarian cancer by the age of 70.

In order to determine your individual risk, the surgical oncologists at ROX Cancer Center have implemented a hereditary cancer quiz. Should you find that you are at high risk (positive family history, etc.), just remember that genetic Testing for BRCA1 and BRCA 2 mutations  is easy. Women who are considered at risk simply rinse their mouths with scope and spit the contents into a test tube. This test tube is sent to the lab where it is tested for the mutations causing breast cancer. Results are available in about two weeks.  Insurance covers the cost of genetic testing in women who are considered at risk. Genetic testing is offered at the Rox Cancer Center.

For women who choose to undergo prophylactic mastectomy, it is important to remember that there are excellent breast reconstruction options available. Reconstruction with either a patient’s own tissues, or with immediate breast implant based reconstruction both provide great long term results.

Aesthetic TV

Hosted by Dr. Andrew Ordon (Co-host of CBS’ The Doctors), The Aesthetic Show will run from May 16th through May 19th, 2013. The program that has been assembled combines leaders in the fields of plastic surgery and dermatology for an intensive, three day seminar. Important topics to be covered include surgical and non-surgical breast and body shaping technologies, anti-aging skincare products as well as use of laser technology for the skin.

Other seminar and lecture topics include: treating melasma, omega three in skin health, treating acne and rosecea, use of radio-frequency technologies, thermal imaging, hair removal systems, use of cellular therapy, use of platelet rish plasma in facial aesthetics, oral supplementation for women with thinning hair, treating injectable complications, optimal use of dermal fillers, as well as updates on female genital surgery. To learn more, visit aestheticshow.com.

Facelift Recovery: 5 things to Expect.

After a facelift, recovery is very straightforward. Here are five things you need to know during your facelift recovery:

1) Where do I recover after my facelift?

Since a facelift is a fairly involved procedure, all of Dr. Brenner’s patients spend the first night after surgery in a nurse-supervised surgical recovery facility. Our patients find this to be very comforting, as they are being looked after very closely.

2) What medications will I need during my facelift recovery?

Patients note that facelift surgery results in quite minimal discomfort. However, patients will be supplied with a narcotic pain reliever (i.e Percocet, or Vicodan) as well as a sleep aid medication (i.e. Ambien or Valium)>

3) When will my sutures be removed after my facelift?

Suture Removal Tray

The types of sutures that will be placed during surgery will ultimately depend on the type of facelift or necklift that you may have. Most patients will have small sutures placed around the edges of the ear, and/or underneath the chin. These sutures are usually removed between four and seven days after surgery. For patients that undergo a browlift procedure, they may have staples in the hair-bearing scalp that will be removed about seven to ten days following surgery. For patients who wear make-up, they may resume using it once all sutures have been removed and the incisions are healing normally.

4) Will I have drains after surgery?

It is standard to have two small drains placed following a lower face and necklift. These are invariably removed in the office on the day after your procedure.

Small Surgical Drain

5) Will I need to wear a face compression garment after my facelift?

In general, most facelift patients will be placed into a headwrap for the first night after surgery. This is removed in the office on the first day after surgery. For patients that undergo extensive liposuction of the area under the chin or along the jawline, they will be placed into a compression garment for several weeks after surgery.

6) Will I have bruising or swelling after my facelift?

A little bruising and swelling is normal following a facelift procedure. The bulk of the swelling usually subsides between one to two weeks following the procedure. However, patients may have a small amount of swelling that persists beyond that.

Botox injections work great for Excessive Sweating

Do you suffer from Excessive Sweating?

Botox is not just useful for reducing fine lines and wrinkles on your forehead and around your eyes. Botox has many different off-label uses on other parts of the body. One of the most common uses is to help minimize sweating in the armpit (axilla).

Excessive sweating can be a problem for men and women. Although it is normal to sweat, when people sweat excessively in their armpits not only is it uncomfortable, but it can also be quite embarrassing. Whether you are a physical trainer in work out clothes, an actor for stage and screen or a business man or women in a suit, you need to keep your perspiration under control.

Did you know that Botox ® can be used to reduce and/or eliminate excessive sweating (aka hyperhidrosis) from your armpits? Well…it’s true! 50 units of Botox ®, when injected directly into the sweat gland-bearing skin of each of your armpits can reduce sweating for up to 6 months. Botox injections for excessive sweating are an easy office procedure with a very high success rate.  Call now…and ask how.

Botox for excessive sweating

Do you need Lip Contouring?

Let’s face it; some people just need lip contouring. If you were born with voluptuous, luscious lips, then you probably do not need to be reading this post. However, many patients that Dr. Brenner sees complain that their lips lack volume. Other patients are concerned with aging of their lips. Still others may have had too much filler placed, or perhaps poorly placed filler in the past. If any of this sounds familiar, then one of the following procedures may be right for you:

1) Lip Augmentation: This procedure is performed for patients whose lips are either too thin or lack adequate volume. Placement of a hyaluronic acid filler (i.e Restylane or Juvederm) is an easy office procedure that will help to restore lip volume.

2) Lip Lift: For women who see Dr. Brenner for facial rejuvenation (i.e. facelift and necklift), one common problem is aging of the upper lip. Sometimes this can be treated with placement of fillers and/or laser resurfacing (i.e. Pixel, CO2). However, in some patients the lip actually elongates during the process of facial aging. These patients may require a lip lift.

3) Lip Reduction: Lip reduction procedures are usually performed for patients that either naturally have too much lip tissue, or have had free silicone previously injected into their lips. Free silicone injections can be potentially dangerous. For patients who have had free silicone injected into their lips, the silicone can migrate to the edge of the lip tissue. Further, the silicone can form small lumps (known as granulomas) and require excision.

*photo pictured above is a model.

Dr. Brenner featured as Plastic Surgery Expert

Dr. Kevin Brenner was recently featured as the Plastic Surgery Expert for the Turkish healthcare website, Anne Form. Dr. Brenner was interviewed, offering insights into key plastic surgery topics such as:

1) Popular Plastic Surgery Trends
2) Mommy Makeover
3) Mommy Makeover Cost
4) Breast Augmentation Incision
5) Botox Safety
6) Cellulite treatments
7) Stretch Mark treatments

Increasingly, Dr. Kevin Brenner and ROX Center have been gaining national and international attention for the excellence that they provide for surgical health care. This is just part of an ongoing trend of patients traveling from other countries to our Beverly Hills office for their surgical procedures. Our practice routinely cares for international patients from many countries including, Russia, Saudi Arabia, United Arab Emirates, England, Brasil, Turkey, Spain, Canada, and Mexico. To help facilitate this process, we offer SKYPE consultations with Dr. Brenner, as well as travel assistance during your stay in Los Angeles. Please contact our patient coordinator Amy to learn more about:

1) Making international hotel reservations

2) Surgical aftercare options

3) Private duty nursing

4) Facilitating pre-operative care with your personal physicians

5) Our available local healthcare specialists

6) ROX center’s multi-specialty surgical options

Refer a friend for breast implant surgery

Refer a Friend for Breast Augmentation

If you have previously undergone breast implant surgery with Mentor breast implants, you may now be able to make a little money back. So, if you have a friend who is considering breast augmentation surgery, now is a great time to refer her to Dr. Brenner for a consultation.

The Mentor Refer a Friend Program rewards you for telling your friends about your breast augmentation experience. Receive a $250 Visa^® Prepaid Card when a friend has breast augmentation surgery with MENTOR^® MemoryGel^® Breast Implants or a $100 Visa^® Prepaid Card for MENTOR^® Saline Breast Implants.

This promotional program is in effect for the following dates:

Effective March 1, 2013 through December 31, 2013.

Don’t wait….have your friend contact our office right now for any of these procedures:

1) Primary Breast Implant Surgery: for women who have never had breast implant surgery before and would like to achieve a larger volume.

2) Revision Breast Augmentation: For women who have previously undergone breast implant surgery before but require a secondary operation to correct a problem that resulted after the first operation.

3) Removal and Replacement of Implants: For women who simply need their old implants updated, downsized or upsized.

4) Correction of Capsular Contracture

*above photo depicts women who are not actual patients.

ROX Cancer Center Beverly Hills Mammogram Party 2013

ROX Beverly Hills Mammogram Party

Why?

Brush up your on breast cancer knowledge and stay up to date with current screening recommendations when you join us Tuesday April 2, 2013 for our first annual ROX Cancer Center Beverly Hills Mammogram Party. Current recommendations by the American Cancer Society are for women to begin screening mammograms at age 40 (earlier for some patients with a strong family history of breast cancer). However, almost one third of eligible women fail to complete this very simple annual screening test. Meet with the experts, including breast oncologist Dr. Travis Kidner to learn more and assess your own risk.

Recommendations:

1) Women under age 40

2) Women 40 years and older

3) Women at HIGH RISK

4) Women with Breast Implants

Where? 465 North Roxbury Drive, Beverly Hills, CA 90210, suite 1001

When? April 2, 2013, 5:30 to 8:30 P.M

RSVP:  310-777-5400

Nevus Sebaceous of Jadassohn

This benign skin lesion is typically present at birth and appears on the head and neck region. Nevus sebaceous are usually superficial skin lesions that are well-circumscribed, but appear as irregularly raised yellowish plaques. These lesions commonly grow on the scalp area in kids. Noticeably, they do not allow normal hair growth so that can be quite noticeable as a small bald spot.  Most parents request that they be removed for aesthetic reasons, as they do not wish their child to grow up with a bald spot. However, there is a real medical reason to remove these nevi. Although nevus sebaceous lesions are benign, they do have a distinct risk of transformation to basal cell carcinoma that occurs in about 10%.

*photos on this post are not actual patients of Dr. Brenner.

Ultherapy has arrived to ROXSpa Beverly Hills

Ultherapy is the only FDA-approved non-surgical treatment available with an indication for lifting and tightening of the chin and neck skin. Ultherapy utilizes ultrasound technology to visualize, target and stimulate the collagen that lives naturally in our skin. This procedure initiates skin tightening that is progressive over several months time.  Ultherapy has arrived at RoxSpa Beverly Hills; don’t miss Entertainment Tonight when they feature Dr. Brenner and Orla from RoxSpa Beverly Hills performing this treatment.

Here are some of the highlights of this fantastic treatment:

1) Ultherapy is non-invasive.
2) The treatment has minimal discomfort.
3) Only one treatment is required.
4) Initial results can be seen immediately following the treatment.
5) Continuing improvement can be noted for up to 3-6 months following the treatment.
6) There is minimal to no actual downtime.

This is an excellent treatment for patients with early stages of skin laxity underneath the chin,  of the cheeks, and of the brow. Treatments are currently being performed in both our RoxSpa Beverly Hills location as well as our RoxSpa Newport Beach location. Don’t miss tonight’s episode of Entertainment Tonight to watch this treatment being performed. Check your local listings for air times.

Herbal Medicines that affect Plastic Surgery Results

Plastic surgery results and herbs; Really?

Your plastic surgery results can be affected by the medications that you normally take. During the pre-operative period, myself and my staff will review with you the medications that you are currently taking. The purpose of doing so, is to make sure that you stop taking any “medication to avoid” for the appropriate amount of time prior to your Facelift, Mommy Makeover, or Rhinoplasty. When informing my staff about your medications, it is essential that you not only mention any and all prescription medications, but that you also mention all herbs or herbal medications (and any over the counter medications) that you take.

A recent article studied well known herbal products that can contribute to high blood pressure (J. Jalil, et al. Herbal Products That May Contribute to Hypertension. Plastic Reconstructive Surgery, Vol 1, Number 1, January 2013, p168). Hypertension, also known as high blood pressure, affects over 65 million Americans. Management of hypertension prior to, during and following plastic surgery procedures is becoming increasingly common. Although most patients are very good about controlling high blood pressure with medications prescribed by their internal medicine or family doctors, many do not realize that also taking some herbal remedies can exacerbate their high blood pressure problem. Here are some of the more common herbs mentioned in the study:

Arnica: Arnica is commonly taken around the time of surgery and is known to help reduce swelling and bruising. However, it extrememly high doses Arnica can potentially have cardiac, intestinal and muscular side effects, including blood pressure elevation.

Bitter Orange: This herb contains two adrenergic agents, and when consumed at very high doses or in combination with caffeine can increase blood pressure by as much as 10mmHg.

Blue Cohosh: This herb contains glycolides and alkaloid compounds that can cause spasm in the small arteries in the heart.

Ephedra: This herb has been commonly used in weight loss formulations in the past. The FDA removed this medication from the market because of its association with hypertension, heart failure and death.

Ginko: This herb contains ginkolides, which inhibit platelet-activating factor and may contribute to low platelet counts, and bleeding disorders, including operative bleeding.

Ginseng: Ginseng is ofter taken to reduce stress and increase vitality; however it can also increase blood pressure and should be stopped for at least 7 days before surgery.

Guarana: Guarana contains purines such as caffeine and theophylline which are known stimulants.

Licorice: At larger doses, licorice root can raise blood pressure, and raise blood sodium (salt) content and lower potassium content.

Pennyroyal Oil: Ingestion of this substance can elevate blood pressure, elevate pulse rate and result in a generalized rash.

Scotch Broom: This herb contains alkaloids which has been used to help regulate heart rhythm in congestive heart failure patients. However, it can cause severe high blood pressure.

Senna: This compound is used for weight loss as it stimulates intestinal motility. However, regular use (especially at high dose) can lead to potassium depletion, high blood pressure and circulatory failure.

Southern Bayberry: At high doses, this herb can have mineralocortitoid type action leading to high blood pressure.

St. John’s Wort:  This herb is commonly used to treat depression and anxiety. However, side effects include hypertension (or even hypertensive crisis) from the monoamine oxidase activity, when foods containing tyramine are taken concurrently.

Yohimbine: This medication, taken for erectile dysfunction, can cause an increase in blood pressure, as well as anxiety.

Click here for a more complete list of medications to avoid prior to your surgical procedure. Alternatively, simply Ask Amy, to help maximize your plastic surgery results.

DVT risk Caprini Score

Important article on Deep Venous Thrombosis (Blood Clots) Risk in Plastic Surgery Patients, from The Journal of The American College of Surgeons

Validation of the Caprini Risk Assessment Model (for blood clots) in Plastic and Reconstructive Surgery Patients

Authors: Pannucci, Bailey,  George Dreszer, et al.
JACS, January 2011 212(1): 105-112.

The authors of this article were a consortium of doctors from five differenct tertiary care centers. They set out to examine the venous thromboembolism rate in plastic surgery patients. Specifically they looked at the incidence of VTE (blood clots in the legs and lungs) in patients that received no chemoprophylaxis, and also evaluated the Caprini Risk Assessment Model in plastic surgery patients. This was a medical record review study over a three year period to determine patients with symptomatic deep venous thrombosis or pulmonary embolus within the first 60 post-operative days. They included patients with a Caprini score of 3 or higher, who underwent general anesthesia and were admitted to the hospital after surgery.

What did they find?

1. The overall incidence of VTE was 1.69%
2. 11.3% of patients with a Caprini score of >8 had a VTE event
3. Patients with Caprini score of >8 were significantly more likely to develop VTE versus patients with a score of 3-4, 5-6 or 7-8.
4. For patients with Caprini score >8, VTE risk was not limited to the immediate post-operative period.

Plastic Surgery Training

Most patients know that Medicare provides insurance coverage to people who are 65 years of age or older. What most people do not realize is that the Medicare system also plays a critical role in subsidizing graduate medical education. In 2009, Medicare paid over $9 billion to U.S. teaching hospitals for resident training. These funds are roughly split with one third of them going toward direct funding for about 100,000 residency positions (across all specialties), and two thirds toward additional costs of patient care associated with the training of these physicians.

I am indeed a Board Certified Plastic Surgeon; but that title was only possible following four years in medical school, five years in a general surgery residency, one year in plastic surgery tissue engineering fellowship and another three years of plastic surgery training residency. All told, that was nine years of residency training. Nine well spent years of surgical education and experience which is necessary in a specialty as dynamic and complex as is plastic surgery. During every year of my residency training, my salary was subsidized by Medicare stipends to the residency programs and training hospitals. The same is true for every plastic surgeon, general surgeon, obstetrician, internist, orthopedic surgeon…and every other medical specialist, who has trained over the last several decades.

Unfortunately, the situation for our future physicians may not be quite the same. Currently, there is a cap on Medicare funding for graduate medical education which allows for about 100,000 residency positions. However, as our population grows, so too does the need for more physicians. Over the last twenty years, there has been an increase in the absolute number of medical schools and therefore an increase in the number of medical school graduates. The number of available residency positions has remained roughly stable overall. That means that not only are residency positions becoming more difficult to obtain, but that as we move forward there may simply be an inadequate number of them. It is estimated that by 2015, the number of medical school graduates from schools in the United States will actually surpass the number of graduate medical education (residency) positions. This may likely occur even with current amounts of Medicare funding. Imagine what will occur if Medicare actually makes cuts in funding, as is expected under the new upcoming healthcare legislation.

*photo in this blog post does not show an actual patient.

When it comes to breast reconstruction over the last decade, the use of acellular dermal matrices in conjunction with subpectoral tissue expander placement has become commmonplace. Some of the advantages that the use of acellular dermal matrices allow, are:

Acellular Dermal Matrix Breast Reconstruction

1) higher initial expander fill volumes.
2) better definition of the newly constructed inframammary fold.
3) less visible rippling of the lower pole of the final breast implant.

However, a recent study evaluated some of the risks that are also associated with
Breast reconstruction with Acellular Dermal Matrix (ADM), (Parks et al. Human Acellular Dermis versus No Acellular Dermis in Tissue Expansion Breast Reconstruction. Plast Reconstr Surgery J. Vol 130, No 4, October 2012, p739).

The Study Findings:

1) The presence of seroma, skin necrosis, and exposure to radiation increased the risk of tissue expander loss.
2) The presence of acellular dermis did not increase the incidence of tissue expander loss
3) The presence of acellular dermis was associated with a doubling in the frequency of seroma formation (30% compared with 15.7% in the no acellular dermis cohort).

This study is very important in terms of understanding both the advantages and disadvantages that certain operations may have.  In terms of acellular dermal matrix use, seroma formation can indeed be a problem. I routinely use closed suction drains (Jackson-Pratt type) in an effort to evacuate any inflammatory fluid that can accumulate during these types of procedures.

ROX Center is excited to bring you womens health Beverly Hills. We are proud to announce that ROX Women’s Health Center is now live! The surgeons of ROX Center have developed ROX Women’s Health Center in an effort to expand our committment to surgical excellence to all arenas of a woman’s health. Of course our practice has always brought to you, our patients, excellence in plastic and reconstructive surgical services. With the development of ROX Women’s Health Center, we have expanded our footprint into comprehensive breast care, breast cancer care, and gynecology care.

Additional services provided at ROX Women’s Health Center include: breast reconstruction, Mommy Makeover, tummy tuck, breast augmentation and revision breast surgery.

*photos on this blog post are not actual patients.