Dr. Rick Silverman

Many women who engage in bodybuilding and fitness activities are seeking breast augmentation. One of the down-sides of bodybuilding, in fact, is the gradual loss of breast tissue with increased lean body mass and decreased body fat. Just what you wanted to hear, right? But never fear. If you’ve lost your girlish curves as you’ve trained and toned, you can consider breast augmentation in Boston as a safe way to restore some fullness to your figure. Most of the issues pertinent to all patients undergoing breast augmentation remain pertinent to fitness fanatics. I hope to provide a little more information specific to women who enjoy weight training and are considering breast implants.

The term gynecomastia means “female-like breast.” The range varies from puffy nipples to full-on breasts. In any case, most men don’t want their chests to look like a woman’s chest. Gynecomastia occurs due to an abnormality in the ratio of testosterone to estrogens in the body. When this ratio is low, the estrogen effect is stronger and stimulates the growth of the tissue around the breast. The testosterone which is most important is that which is not bound to protein in the blood, in other words, the free serum testosterone. This has been found to be lower in boys with gynecomastia compared to those without, while all the other hormone levels were about the same. The abnormal hormone levels can occur in the newborn period due to maternal circulating estrogens, and also in older men, where testosterone levels are dropping, resulting in relatively more estrogen. Most often, these changes are physiologic and can be explained by normal processes in the body. Sometimes they are influenced by external factors, such as medications or anabolic steroids. The male breast reduction procedure will take place at the St. Elizabeth’s Medical Center in Brighton, MA. The procedure is done in an ambulatory setting, and overnight stay is not needed. The procedure usually takes about 1.5 hours. If skin removal is required, it adds about an hour. During the procedure Dr. Silverman will make two incisions on each side when resecting gynecomastia. He makes a small stab wound incision in the armpit area, which is not visible after surgery, and a second incision along the lower aspect of the areola, right on the color change. This makes it difficult to see this incision. The procedure entails a combination of liposuction and direct excision of the mass under the nipple. Most patients go to sleep with a light general anesthetic, though the procedure can also be done with deep sedation. A type of local anesthetic, “tumescent anesthesia,” is administered to the area, and this helps to reduce general anesthetic needs. It also provides a result with less bleeding and a smoother contour afterwards. Once the tumescent anesthetic is given, liposuction is carried out through the stab wound incision in the armpit area. Then a short incision is made along the lower end of the areola, and the “gland” is excised, leaving a small button of tissue under the areola to prevent nipple loss and reduce risk of “crater” deformity. Additional liposuction is carried out, followed by wound closure and application of a dressing.

In some patients who present with gynecomastia, there will be an excess of skin in addition to the excess fat and “glandular” tissue of the breast. This is typical after weight loss and in some patients who have very significant breast development. As with all surgery, avoidance of NSAIDS and other items that can cause bleeding for 7 to 10 days pre-op is necessary. We have our patients wash with a surgical soap on the day and morning prior to the surgery. Nothing to eat or drink after midnight the night before the surgery. The recovery phase after surgery is typically considered over a six week period. When skin excision is required, depending on which technique is used, the major difference comes in the early period, when consideration must be given to extensive dead space under flaps (if a flap technique is used) or if less dissection was involved, there are still more skin incisions to tend to in the first weeks. After getting through the initial healing and once it’s clear that no fluid collections (seromas) have developed or bleeding has occurred, the subsequent management is the same as in those patients without skin removal.

Botox and Dysport, along with Xeomin, are Neurotoxins. These are medications, that when injected into the small muscles of the face, can stop the activity of the muscles for a given period of time, typically three to four months. These facial muscles are responsible for frown lines between the brows, mid-forehead lines and crows feet at the corners of the eyes. Over time, with repeated activity of these facial muscles, creases are worn into the skin of the upper face, often leaving you looking older and tired. By reducing the activity of these muscles, the lines will soften and sometimes disappear, restoring a more youthful and rested appearance. Good candidates for Botox treatment with neurotoxins are those men and women who are bothered by wrinkles of the face, which are in areas that can be treated with neurotoxins. These sites typically include the forehead, between the eyebrows, and in the “crow’s feet” laterally by each eye. Other areas, such as the lower face and neck, are treated less commonly. Neurotoxins are often administered with dermal fillers, such as Juvederm and Restylane. Other treatments, such as chemical peels or other skin care, can also help to get improvement.

Restylane is an injectable gel that contains hyaluronic acid (HA), a natural substance that is found in the body. Hyaluronic acid gives volume and elasticity to the skin, but as the body ages, HA levels decrease, resulting in loose skin and wrinkling. When injected, Restylane dermal filler is designed to plump the skin beneath lines and wrinkles, smoothing them out and making them less noticeable. The most common side effects of Restylane are swelling, redness, pain, bruising and tenderness in and around the injection sites. Typically these side effects go away within a week. Results can last for up to 6 months, at which point the hyaluronic acid is reabsorbed by the body.

Sculptra is composed of poly-L-lactic acid (PLLA) which is dissolved into sterile water for injection. It acts to stimulate collage synthesis to allow for skin thickening, improvement of folds and sunken areas, and it helps to mask fat loss in the face. Individuals who have lost volume in the face due to aging, weight loss, or other conditions, such as HIV Lipoatrophy may benefit from this product. Because it doesn’t provide immediate filling, it may not be ideal for the most severe situations, but is better for those looking for a gradual more subtle change, rather than the more rapid change in appearance of some of the other fillers. Sculptra is administered through a needle, and this is done under sterile conditions to avoid infection. The sculptra is reconstituted in sterile water along with lidocaine anesthetic, so the injections numb the treated area as they are performed. There is some burning associated with this, typical of local anesthetics. Areas treated include the cheeks and nasolabial folds as well as the temporal region. Several injection points are used, depending on the treatment areas, and afterwards the face is massaged five times a day for five minutes for five days. After the treatment, there may be some initial swelling, and as this subsides, the reactive process starts to stimulate collagen production. Treatment with Sculptra doesn’t result an a rapid change in appearance. A series of three or four treatments several weeks apart can provide improvement that lasts up to two years.

Dermal fillers help reduce facial lines and restore volume and fullness in the face. Hyaluronic acid is a substance which is found naturally occurring in the skin, which diminishes with aging causing the skin to lose it’s volume and develop wrinkles and folds. Restylane and Juvederm are formulations of hyaluronic acid, which can be injected into the skin to restore volume and reduce these signs of aging. A consultation is necessary to help you decide which areas you would like to treat and which products will work best for you. Treatment can be done the same day, and other than some swelling and possibly some bruising, the treatments are well-tolerated with minimal interruption to your daily routine. The length of duration of the effects of treatment vary by the areas treated, as well as from person to person.