Beautiful Breasts...... How to fix my sagging breasts.....

When we think about women, breasts are one of the things that pops in mind. Despite the gender differences in aspects of discussion, it will always still be a topic. Men would normally talk about cleavage and size (one of the first thing a man notices in a woman they bump in the street), whilst women would be talking about size, sag, lag, etc.... In this modern world, looking our best is now a requirement not just an option. The way you look really plays a major role in the confidence you portray. Despite what some people may say about looks does not matter, reality is, it does. We all know that. 

Breasts are part of every women. It is a differentiating anatomy between male and female and serves as feeding organ for babies. One thing that a lot of women worry about is size. Most women prefer big breasts but it needs to be proportionate to the body. Too big breasts can lead to health problems and it estimated that too large a bust can reduce a woman's lifespan by 5 years. The main problem that most women with a huge bust will have is additional pressure to the spine which causes pain in the long run. Its either they extend their back more to compensate for the weight or slouch due to gravity hence leads to long term abnormal posture thus causes spine problems and even muscle pains. Sometimes when the size is too big, women have difficulty in breathing and are unable to sleep on their backs because the breasts add pressure to the chest. It can also cause headaches and migraine due to constant strain to the surrounding structures. Too huge breasts also can have skin implications as fungal infections occur easier due to bigger folds and bigger bra straps can cause abrasions and affect skin health. There is also a more significant risk of weight gain for women with bigger breasts as the big bust limits a lot of physical activities due to strain onto the muscles, ligaments and spine from the weight. Thus there is a reduction in exercise that leads to weight gain. Big breasts also causes stress for a lot of women, especially with their own self-confidence. A study done shows that women with excessive breast size have reduced confidence due to the breast size, especially if it becomes an object of banter or joke in their society. If you have any of these symptoms, the solution to it is breast reduction surgery which should always be done by a trained plastic surgeon.

In Asia, the more problem is small breast size and breast sag especially after breastfeeding. Luckily for us, medical technology has come a long way to helping solve these woes. For breast size, despite multiple methods promised by the media I would still say if you are really decided go for surgical breast implants by a well-trained plastic surgeon. The high-grade silicone implants would be good for at least 10 years without any other complications. Low grade implants may burst and cause massive tissue scarring and would require surgical removal. Normal saline implants are still encased in silicone and may leak and reduce in size over time. Silicone injections are banned for use in many parts of the word due to the complications that arises from it. There was a hype for fillers but the effects were only a maximum 1/2 cup increase and lasts longest 1 year in terms of aesthetic effect but may cause scarring and calcifications. Not to mention the cost than is not cheap and usually I would advise my patients for permanent implants instead. Fat grafts are also used but it depends on the skill of the doctor. You may need to top up after 3-6 months and the effect can last up to 2 years. There is still risk for tissue scarring and failed fat graft, not to mention the cost.

Now, we come to sagging breasts. Why do breast sag? 

1. Age 

The most common factor is age. As we grow older, there is more gravity pull and our ligaments start to become more lax. There is no muscles in the breast, only mainly breast tissue, fat and other connective tissues. The connective tissue is also called the "Cooper Ligaments" starts loosing its elasticity as we age.

2. Running without proper support.

Over-bouncing of the breasts can make the breasts sag faster. Hence why we are recommended to wear proper sports bra to support our breasts. When a person runs or does strenuous exercises, the breasts move everywhere in an 8-like motion. Without proper support, the breasts move too freely that can lead too over-stretching of the Cooper's ligaments leading to sagging.

3. Changes in weight and/or hormones.

Extreme diets and extreme weight loss/weight gain can lead to sagging. Pregnancy causes sagging in women and is proportionate to the number of pregnancies she has. The key here is gradual changes to the body, will not affect the breasts too drastically. Breastfeeding DOES NOT contribute to breast sagging, so give your babies all the milk that he/she needs.

4. Smoking

If you love your breasts then you should quit smoking. Smoking not only causes other harmful effects to the body, it also breaks down elastin which is a protein that gives the skin elasticity. Reduce elasticity causes sagging.

So how to improve sagging?

The definitive treatment is to do a breast lift but even this surgical procedure is not permanent due to the factors which cause sagging and after awhile the ligaments are just going to lose its elasticity and sag again. Not to mention the cost, the downtime and risk for scarring. Other methods in medical aesthetics includes use of Laser to tighten the skin around and above the breast to lift it up but this also is temporary. My favourite would be to use Gentle-YAG or any long pulse ND-YAG 1064nm at a tightening setting to give that additional lift. It can be a little bit painful during the procedure as it requires a longer interval that the normal rejuvenation protocol. Cost for each treatment varies on type of laser ranging from RM 1000-RM 2500 per session. In my clinic, we have Fraxel that can also help to a certain extent for breast tightening but it would be more of skin rejuvenation over the décolletage area avoiding the breast tissue. Some places do RF tightening for breasts, but it requires multiple sessions at close intervals and results can sustain up to 6-9 months after completing the course. However, we do not recommend RF on the breast tissue areas since it may lead to reduction in volume. This method also requires good knowledge of anatomy on the person handling the RF, but at least it is a cheaper alternative. 

Threads for breast lifting.

The Korean influence has increased the usage of threads in medical aesthetic practice. Now more doctors are promoting threads for breast lifting as an alternative to surgical breast lifting. The results are quite interesting although the is still risks of bruising and pain, and some downtime. If placed correctly, you will not be able to feel the threads. Depending on what you wish to achieve, the doctor would advise you on type of threads and how many you need. The two common ones used are suspension threads and PDO threads. Other threads would require surgical anchoring to allow the threads to stay in place. Suspension threads would give you a good lift for 18-24 months almost instantly and usually you will need 2-3 per side. Cost for the procedure is anywhere between RM6-10K at the moment. PDO threads on the other hand takes up to 3-6 weeks to start showing results as its mechanism of lift is more of collagen stimulation. You may require anything from 50-100 threads per side and probably a combination with suspensory threads. PDO threads is common in Korea, China and Japan. In Malaysia, be aware of beauticians and unregistered 'doctors' also doing this procedure since it is so easy to buy it off Alibaba.com. Price ranges anything from RM 2000-RM 6000 per session but you will need multiple sessions (3-5X)  in short intervals before the end result. The complications also includes pain, swelling, bruising and possible failure or infections if not done properly. For the record, I have not started this service but if you wish to try it out, I can direct you to my colleagues who do.

PRP for breast lift and rejuvenation.

Now this is a method that I am pretty interested about. This year, I have been studying a lot on this particular technique and had the chance to tutor under a very knowledgeable senior on this matter. Dr Rahmat has been practicing for over 20 years and at one point was teaching anatomy to students. Anatomy plays a very important role in achieving good results and avoiding complications. Using his technique which involves using PRP as a natural glue to strengthen the Cooper's ligament and keeps it perked. The growth factors concentrated in the PRP also helps to rejuvenate the ligament via encouraging new cell growth and improving collagen and elastin. The real mechanism is still uncertain. More superficial injections are also done to improve the overall breast appearance and lighten the areola to for a more rejuvenated and youthful look. I have done a couple of treatments for patients and overall were happy with the treatment. I injected myself with my own PRP to observe the changes and I noticed there was initial swelling and fullness that lasted approximately a week. There was a size change, and I had an extra 1/2 cup that lasted me at least 6 weeks before shrinking again. There was definitely a lift and my nipples points a more symmetrical fashion nowadays. There was not much areola lightening since I didn't inject much at the areola (Its painful when you are doing it on yourself). I did one on my manager and she had a better lift and 1/4 size improvement and results lasted about the same. I believe that there is a cumulative effect, hence you will need repeated 3-5 treatments to get a more lasting effect. So I am getting another round today :). We charge RM 1800 per treatment and there are packages available. The procedure takes approximately 1 hour with numbing. The good thing is that its autologous, meaning that it comes from yourself, so there is less chance of allergic reactions or risk of excessive scarring. The best thing about doing this is the superficial effect on the skin. My bosom feels softer and look more refine compared to before and the skin tone is fairer. I have found very fascinating results with PRP, and am really considering to conduct a proper controlled study on this topic.

Preventing Breasts From Sagging

Recent studies have shown that wearing a bra causes more sagging to the breast. Prof Roullin from France did a 15 year comprehensive study on hundreds of women and recently published his findings. Rouillon found that women who never wore bras had nipples on average seven millimeters higher in relation to their shoulders each year than regular bra users. Apparently, the slight bounce that you get when you walk is important for the ligament's development and using tight bras from a very young age for long term impedes this process. So it looks like we have to reduce our bra wearing activities... O...o.

Cutting down and quitting smoking is another way to prevent early sagging. Nutrition has shown to play a role too. A healthy diet that consists of good proteins help to keep the breasts in shape. Vitamin C and E plays a role for skin health and helps to keep the skin around the breast firm to reduce sagging. Some people believe in phytoestrogens to perk up breast size and keep it firm. Although it may be beneficial, be careful with hormones as some preparations may increase risk for breast cancer and other problems.

Exercise is another important factor. Push ups, arm lifts, free weight lifting, resistance exercises or any form of exercise that strengthens your chest muscles (pectoralis, trapezius etc) will help to keep your breasts firm and looking good. Postural fixing, and back exercises helps with excessive weight of the chest.

For more info on the treatments mentioned here or for appointments please call Faceworks Clinic 03-21440080 or 014-2233268 or email us at faceworksclinic@gmail.com. Like us on Facebook https://www.facebook.com/FaceworksClinic to get the latest news and blogs.

Love your breasts.... October is Breast Cancer Awareness Month :)

It's October again, my favourite month. This year I have just turned 33 and I am loving every moment of my life. This is also the pink month. That's right, Breast Cancer Awareness Month. Wear the pink ribbon to support breast cancer awareness. The published statistics shows that every 1 in 19 women in Malaysia is at risk of getting breast cancer. However, we believe this number to be higher i.e. perhaps 1 in 11 as there were many late detections compared to earlier ones.

Breast Cancer may be fatal but you will be able to survive if detected early enough! So for this blog entry, I am also going to include steps for breast self examination. This simple 5 step test in the shower or on your bed could well save your life, so I hope all my readers can make this a weekly routine, especially if you are above the age of 35 or have a family history of breast cancer.

What are the risk factors for breast cancer?

Risks you cannot change:

1. Gender - Women are 100x more likely to develop breast cancer than men.

2. Age - The older you get your risk increases more.

3. Genetic risk factors - 5-10% of breast cancer cases are thought to be hereditary.

• BRCA1 and BRCA 2 are the most common cause of hereditary breast CA. Lifetime risk for families with BRCA1 is on average 55-65% with as high as 80% and more common in Caucasians. For BRCA 2 mutations, the risk is lower around 45% and more commonly found in Asians and Hispanics. Usually the disease with these mutations occur in much younger women and more often affects both breasts. Women with these mutations also have a higher risk of developing ovarian cancer.
• Changes in other genes - These gene mutations are much rarer and often do not increase the risk for breast cancer as much as the BRCA genes.
• ATM gene which helps repair damage DNA. Inheriting 2 abnormal copies of this gene causes ataxia-telangiectasia. Inheriting 1 mutated copy of the gene is linked to a high rate of breast cancer in families.
• TP53 gene gives instructions for making a protein called p53 that helps stop the growth of abnormal cells. Inherited mutations of this gene cause Li-Fraumeni syndrome which has an increased risk of developing breast cancer, leukemia, brain tumours and sarcomas.
• CHEK2 gene : Can also cause Li-Fraumeni syndrome and even if it does not, increases breast cancer risk 2-fold if mutated.
• PTEN gene normally helps regulate cell growth. Inherited mutation of this gene can cause Cowden syndrome, which people are at increased risk of both benign and malignant breast tumours.
• CDH1 inherited mutations causes hereditary diffuse gastric cancer and women with mutations in this gene also has an increased risk of invasive lobular cancer.
• STK11. Defects in this gene can cause Peutz-Jeghers syndrome which has an increased risk of many types of cancer including breast cancer.

4. Family history of breast cancer - Risk is higher among women with close blood realtives who have the disease.

5. Personal history of breast cancer - If you have had one before, the chance for a new breast cancer is 3-4x more.

6. Race and ethnicity. African American have a higher risk - Asians, Hispanic and Native-American have a lower risk.

7. Dense breast tissue.

8. Certain benign breast conditions.

• Non-proliferative lesions - no increase risk. Includes fibrosis, simple cysts, mild hyperplasia, adenosis, ductal ectasia, Phyllodes tumour, a single papilloma, squamous and apocrine metaplasia, epithelial-related calcifications, other benign tumours & Mastitis.
• Proliferative lesion without atypia (no overgrowth of cells). Increase risk slightly by 1.5-2X normal. Includes usual ductal hyperplasia, fibroadenoma, sclerosing adenosis, papillomatosis and radial scar.
• Proliferative lesions with atypia (with overgrowth of cells). Increase risk 3.5-5X higher than normal. These type of lesions include atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH).

9. Lobular carcinoma in situ (LCIS) - the cells that look like cancer cells are growing in the lobules of the milk producing glands of the breast but they do not grow through the wall of the lobules. Women with this condition have 7-11X increased risk of developing invasive cancer in either breast.

10. Menstrual period - early menarche (before 12 years old) or late menopause is also a risk factor.

11. Previous chest irradiation for other cancer treatments - i.e. higher risk when exposure given earlier in life compared to later.

Lifestyle-related factors and breast cancer risk

1. Women with no children or late childbirth has higher risk for breast cancer.

2. Oral contraceptive pills - but reduces once stopped.

3. Depo-Provera contraception injections increases breast cancer risk.

4. Hormone therapy after menopause increases risk for breast cancer. Combined hormone therapy increases risk to getting and dying of breast cancer. Bioidentical hormones although safer in handling menopausal symptoms have not shown any evidence that they are safer and more effective in breast cancer.

5. Estrogen therapy does not increase risk for breast cancer, but increases risk for ovarian cancer and formation of blood clots and strokes.

6. Breast feeding slightly reduces risk for breast cancer especially if continued to 1.5-2 years.

7. Alcohol consumption is linked with an increased risk for developing breast cancer. The more you drink in a day, the higher the risk.

8. Being overweight or obese after menopause increases breast cancer risk. The risk appears for those who gained weight as an adult, rather than overweight since childhood. Excess fat in the waist area contributes more to the risk.

9. Higher levels of insulin in the body increases breast cancer risk.

10. Physical activity i.e. exercise reduces breast cancer risk. Walking 1.25-2.5 hours a week reduces risk by 18%.

11. There is no strong evidence that taking supplements reduces risk for breast cancer.

12. Chemical compounds in the environment is thought to increase risk for cancer but studies are still inconclusive.

13. Long term heavy smoking is linked to higher risk of breast cancer.

14. Several studies suggest that women who work at night (night shifts) may have an increased risk of developing breast cancer.

     Breast cancer is a major issue due to the many deaths and disability caused by it. In Malaysia it is the number one cancer for women and the mortality is high if not detected earlier. The best way to get early detection is via breast self examination. Its a simple 5 step home examination that allows you to detect any abnormalities in your breasts. If you detect anything weird about your breasts as per mentioned in the diagrams, do not hesitate to see a doctor. Funnily, a lot of people I meet are so scared to see a doctor and get a diagnosis. I think we should encourage people to seek proper treatment as early as possible. It is frustrating to get patients at stage 3-4 whom have noticed changes earlier but ended up going to a bomoh or sinseh because they were to scared to see a doctor. And when they deteriorate and die in the hospital, it is the doctors fault. Doctors are healers based on science and evidence, we can only do so much or know as much as what the patients is willing to tell you and based on the clinical findings and examination.

So what are the 5 steps:

Your breast self-exam should be done the same time every month, 7-10 days after

the start of your period if menstruating. If not, use a fixed day each month.

Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.

Here's what you should look for:

• Breasts that are their usual size, shape, and color
• Breasts that are evenly shaped without visible distortion or swelling

If you see any of the following changes, bring them to your doctor's attention:

• Dimpling, puckering, or bulging of the skin
• A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
• Redness, soreness, rash, or swelling

Step 2: Now, raise your arms and look for the same changes.

Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).

Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.

Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage.

Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.

5 simple steps to be done every week. Early detection saves lives. I hope all my readers would make this a habit. For my next entry, I will explain about medical aesthetic methods to maintain and beautify your breasts :).