ScienceDaily (July 28, 2008) — One of the reasons people on low-carbohydrate diets may lose weight is that they reduce their intake of fructose, a type of sugar that can be made into body fat quickly, according to a researcher at UT Southwestern Medical Center.
Dr. Elizabeth Parks, associate professor of clinical nutrition and lead author of a study appearing in a current issue of the Journal of Nutrition, said her team's findings suggest that the right type of carbohydrates a person eats may be just as important in weight control as the number of calories a person eats.
Current health guidelines suggest that limiting processed carbohydrates, many of which contain high-fructose corn syrup, may help prevent weight gain, and the new data on fructose clearly support this recommendation.
"Our study shows for the first time the surprising speed with which humans make body fat from fructose," Dr. Parks said. Fructose, glucose and sucrose, which is a mixture of fructose and glucose, are all forms of sugar but are metabolized differently.
"All three can be made into triglycerides, a form of body fat; however, once you start the process of fat synthesis from fructose, it's hard to slow it down," she said.
In humans, triglycerides are predominantly formed in the liver, which acts like a traffic cop to coordinate the use of dietary sugars. It is the liver's job, when it encounters glucose, to decide whether the body needs to store the glucose as glycogen, burn it for energy or turn the glucose into triglycerides. When there's a lot of glucose to process, it is put aside to process later.
Fructose, on the other hand, enters this metabolic pathway downstream, bypassing the traffic cop and flooding the metabolic pathway.
"It's basically sneaking into the rock concert through the fence," Dr. Parks said. "It's a less-controlled movement of fructose through these pathways that causes it to contribute to greater triglyceride synthesis. The bottom line of this study is that fructose very quickly gets made into fat in the body."
Though fructose, a monosaccharide, or simple sugar, is naturally found in high levels in fruit, it is also added to many processed foods. Fructose is perhaps best known for its presence in the sweetener called high-fructose corn syrup or HFCS, which is typically 55 percent fructose and 45 percent glucose, similar to the mix that can be found in fruits. It has become the preferred sweetener for many food manufacturers because it is generally cheaper, sweeter and easier to blend into beverages than table sugar.
For the study, six healthy individuals performed three different tests in which they had to consume a fruit drink formulation. In one test, the breakfast drink was 100 percent glucose, similar to the liquid doctors give patients to test for diabetes -- the oral glucose tolerance test. In the second test, they drank half glucose and half fructose, and in the third, they drank 25 percent glucose and 75 percent fructose. The tests were random and blinded, and the subjects ate a regular lunch about four hours later.
The researchers found that lipogenesis, the process by which sugars are turned into body fat, increased significantly when as little as half the glucose was replaced with fructose. Fructose given at breakfast also changed the way the body handled the food eaten at lunch. After fructose consumption, the liver increased the storage of lunch fats that might have been used for other purposes.
"The message from this study is powerful because body fat synthesis was measured immediately after the sweet drinks were consumed," Dr. Parks said. "The carbohydrates came into the body as sugars, the liver took the molecules apart like tinker toys, and put them back together to build fats. All this happened within four hours after the fructose drink. As a result, when the next meal was eaten, the lunch fat was more likely to be stored than burned.
"This is an underestimate of the effect of fructose because these individuals consumed the drinks while fasting and because the subjects were healthy, lean and could presumably process the fructose pretty quickly. Fat synthesis from sugars may be worse in people who are overweight or obese because this process may be already revved up."
Dr. Parks said that people trying to lose weight shouldn't eliminate fruit from their diets but that limiting processed foods containing the sugar may help.
"There are lots of people out there who want to demonize fructose as the cause of the obesity epidemic," she said. "I think it may be a contributor, but it's not the only problem. Americans are eating too many calories for their activity level. We're overeating fat, we're overeating protein; and we're overeating all sugars."
Some data were collected at the University of Minnesota, where Dr. Parks worked before joining the UT Southwestern faculty in 2006.
The work was supported by the National Institutes of Health, the Cargill Higher Education Fund and the Sugar Association
Saturday, August 23, 2008
Friday, August 22, 2008
Vegetarian Weight Loss: Easy Tips to Guarantee Success!
Weight loss tips for vegetarians are surprisingly similar to tips for any other kind of weight loss journey. There are three main types of vegetarians. "Vegans" eat no animal products at all. Vegan diets consist mainly of fruits, vegetables, legumes, grains, seeds, and nuts. "Lacto-vegetarians" add dairy products to their diets and "lacto-ovo vegetarians" include both dairy products and eggs.
Consider these facts about a vegetarian diet:
• A typical vegetarian consumes 500 less calories a day than their meat-eating peers, while consuming more food.
• Vegetarians tend to be slimmer with less medical problems such as heart disease, high blood pressure, high cholesterol, and diabetes.
• Evidence indicates that a vegetarian diet causes calories to burn long after meals, which means that foods from plants are being used as fuel instead of being stored as fat.
• 6% of the vegetarian population is considered "obese" compared to 45% of the meat-eating population.
Before you decide you want to become a vegetarian and throw out all the meat in your house, understand that becoming a vegetarian doesn't automatically mean that you will lose weight! You can just imagine the calories packed into cheese, nuts, peanut butter, oils, creamy salad dressings, and sweets that can create havoc when you jump on the scale. Some vegetarian meals can be way too high in both fat and sugar. It's all about making healthy choices.
As in all diets, you must be diligent about reading nutrition fact labels and knowing exactly what you are putting into your mouth.
There are many easy tips to help you lose weight on a vegetarian diet. First of all, eat plenty of fruits, vegetables, and whole grains. Eat nutrient-dense foods that will provide the vitamins and minerals that you need daily. Broil, steam, roast, or sauté your foods and avoid all fried foods. Beware of vegetarian "convenience food." Plan your meals and snacks carefully and reduce your consumption of high-fat products such as mayonnaise, butter, and creamy salad dressings.
Use the vegetarian food pyramid guidelines to determine the proper portions that you should be eating. As with any diet, success is all about portion control! Generally, each day vegetarians should have 5-8 servings of grains, 3-5 servings of vegetables, 2-4 servings of fruits, 2-3 servings of dairy products, and 5-7 ounces total of beans, nuts, eggs, etc.
Eliminate or reduce "recreational eating." Don't fill up on empty calories. Instead, eat with intention! Making careless choices can cause your metabolism to slow down. Keep a food journal to help you stay motivated on your weight loss journey. As always, you must add exercise for weight loss, so add a minimum of thirty minutes of activity a day. The more intense the activity, the more calories you will burn. If you follow these easy steps, you will reduce your weight and improve your overall health.
Consider these facts about a vegetarian diet:
• A typical vegetarian consumes 500 less calories a day than their meat-eating peers, while consuming more food.
• Vegetarians tend to be slimmer with less medical problems such as heart disease, high blood pressure, high cholesterol, and diabetes.
• Evidence indicates that a vegetarian diet causes calories to burn long after meals, which means that foods from plants are being used as fuel instead of being stored as fat.
• 6% of the vegetarian population is considered "obese" compared to 45% of the meat-eating population.
Before you decide you want to become a vegetarian and throw out all the meat in your house, understand that becoming a vegetarian doesn't automatically mean that you will lose weight! You can just imagine the calories packed into cheese, nuts, peanut butter, oils, creamy salad dressings, and sweets that can create havoc when you jump on the scale. Some vegetarian meals can be way too high in both fat and sugar. It's all about making healthy choices.
As in all diets, you must be diligent about reading nutrition fact labels and knowing exactly what you are putting into your mouth.
There are many easy tips to help you lose weight on a vegetarian diet. First of all, eat plenty of fruits, vegetables, and whole grains. Eat nutrient-dense foods that will provide the vitamins and minerals that you need daily. Broil, steam, roast, or sauté your foods and avoid all fried foods. Beware of vegetarian "convenience food." Plan your meals and snacks carefully and reduce your consumption of high-fat products such as mayonnaise, butter, and creamy salad dressings.
Use the vegetarian food pyramid guidelines to determine the proper portions that you should be eating. As with any diet, success is all about portion control! Generally, each day vegetarians should have 5-8 servings of grains, 3-5 servings of vegetables, 2-4 servings of fruits, 2-3 servings of dairy products, and 5-7 ounces total of beans, nuts, eggs, etc.
Eliminate or reduce "recreational eating." Don't fill up on empty calories. Instead, eat with intention! Making careless choices can cause your metabolism to slow down. Keep a food journal to help you stay motivated on your weight loss journey. As always, you must add exercise for weight loss, so add a minimum of thirty minutes of activity a day. The more intense the activity, the more calories you will burn. If you follow these easy steps, you will reduce your weight and improve your overall health.
Thursday, August 21, 2008
Three Quick Weight Loss Tips to Lose Weight Fast
Rapid Fat Loss Helps Any Woman Look Great in a Mini Dress
Losing weight isn’t nearly as hard as it seems. Not according to Registered Dietitian and author, Jayson Hunter. He believes just a few quick weight loss tips can help women lose weight fast.
He explained recently, “To lose weight fast you need to make some simple changes in your life. Nothing overwhelming, just a few small changes can make a huge difference.” Hunter expanded by saying, “We make weight loss out to be this big mystery, but really, anyone who is willing to follow these quick weight loss tips can lose a significant amount of weight in a relatively short period of time.”
Hunter recommends the follow to any woman who wants to lose weight fast:
Eat a serving of Lean Protein at each meal. It helps you feel full and avoid hunger pangs. It also takes more calories to digest protein than other nutrients. And the more calories you burn the better.
Eat low-glycemic carbohydrates such as vegetables, whole-wheat products and oatmeal instead of refined processed carbohydrates which usually come in a box or a bag. Processed foods are notoriously “fattening. “ They cause calories to be stored as fat and make you feel hungry again almost right away.
Eat 4-6 small meals day a day instead of the usual 2-3 large meals. Eating frequently will help regulate and boost your metabolism to burn more calories.
The Rapid Fat Loss expert concluded by saying, “Just these small changes will make an incredible difference to any woman who wants to slim down. They are easy –to-follow and are a safe and healthy way to lose pounds and inches.”
Women who want to lose weight fast can also download a FREE copy of Hunter’s Rapid Fat Loss Starter Kit. It will help any woman who wants to lose weight fast. It is available free of charge at: http://dress-size-reduction-diet.com
Jayson Hunter, RD, CSCS is a registered dietitian and personal trainer with over ten years of experience. He specializes in helping women lose weight fast so they look sexy in a mini dress. He is available for story ideas and interviews.
Wednesday, August 20, 2008
Americans Must Diet to Save Their Economy, Get Economy Back in Shape, Go on a Diet
By CATHERINE BRAHIC
That's the message ecologists are trying to get across this week. They say the apparently looming energy crisis could be averted if US residents cut their calorie intake.
David Pimentel of Cornell University and colleagues have drawn on an extensive body of existing studies to highlight the wastage in the US food production chain. To bring their point home, they have estimated how much energy could be saved by making a few relatively simple changes to the way corn is produced.
Their conclusion is that energy demands could easily be halved. That could stave off the prospect of further rises in the costs of fuel, they say.
To do that, however, would require a considerable change in the average US diet. The average American consumes about 3747 kcal per day compared to the 2000 to 2500 kcal per day recommended by the US Food and Drug Administration.
The 3747 kcal per day figure does not include any junk food consumed.
Producing those daily calories uses the equivalent to 2000 litres of oil per person each year. That accounts for about 19% of US total energy use.
Go Veggie
Using data from the UN Food and Agriculture Organization, Pimentel estimates that half of the energy used to make food in the US is spent making animal products - meat, dairy and eggs. Farmers must produce crops to feed the animals that eventually provide humans with animal protein.
In 2004, Pimentel estimated 6 kilograms of plant protein are needed to produce 1 kg of high quality animal protein. He calculates that if Americans maintained their 3747 kcals per day, but switched to a vegetarian diet, the fossil fuel energy required to generate that diet would be cut by one third.
Reducing their meat intake is not the only way Americans can cut the nation's energy bill. And Pimentel's other suggested change to US eating habits would have the added benefit of cutting the national health bill as well.
In addition to the 3747 kcals, the average American consumes one third of their calories in junk food and Pimentel and colleagues suggest this could be cut by 80% and the total calorie intake be reduced by 30%. That could drastically cut the amount of energy which goes into feeding Americans, as junk food is typically low in calories, but energetically expensive to produce.
For instance, Pimentel calculates that the equivalent of 2100 kcal go into producing a can of diet soda which contains a maximum of 1 kcal. About 1600 kcal go into producing the aluminium can alone.
Efficient Farming
Other suggested changes to the food production process range from replacing incandescent bulbs with energy-saving fluorescent ones, to using fewer machines, pesticides and fertilisers, and more human power on farms.
Reducing the distance that food is transported could also cut energy costs: food travels 2400 km on average to its consumer in the US. This requires 1.4 times the energy actually contained in the food. Producing food locally would cut the energy expended transporting it by half.
Pimentel estimates that the amount of energy that goes into packaging foods could be halved as well, as could the amount of energy used by agricultural machines.
If his dietary and production measures were implemented, he says, the US food industry would consume half the energy it does. Whether or not the US is ready for these changes remains to be seen.
That's the message ecologists are trying to get across this week. They say the apparently looming energy crisis could be averted if US residents cut their calorie intake.
David Pimentel of Cornell University and colleagues have drawn on an extensive body of existing studies to highlight the wastage in the US food production chain. To bring their point home, they have estimated how much energy could be saved by making a few relatively simple changes to the way corn is produced.
Their conclusion is that energy demands could easily be halved. That could stave off the prospect of further rises in the costs of fuel, they say.
To do that, however, would require a considerable change in the average US diet. The average American consumes about 3747 kcal per day compared to the 2000 to 2500 kcal per day recommended by the US Food and Drug Administration.
The 3747 kcal per day figure does not include any junk food consumed.
Producing those daily calories uses the equivalent to 2000 litres of oil per person each year. That accounts for about 19% of US total energy use.
Go Veggie
Using data from the UN Food and Agriculture Organization, Pimentel estimates that half of the energy used to make food in the US is spent making animal products - meat, dairy and eggs. Farmers must produce crops to feed the animals that eventually provide humans with animal protein.
In 2004, Pimentel estimated 6 kilograms of plant protein are needed to produce 1 kg of high quality animal protein. He calculates that if Americans maintained their 3747 kcals per day, but switched to a vegetarian diet, the fossil fuel energy required to generate that diet would be cut by one third.
Reducing their meat intake is not the only way Americans can cut the nation's energy bill. And Pimentel's other suggested change to US eating habits would have the added benefit of cutting the national health bill as well.
In addition to the 3747 kcals, the average American consumes one third of their calories in junk food and Pimentel and colleagues suggest this could be cut by 80% and the total calorie intake be reduced by 30%. That could drastically cut the amount of energy which goes into feeding Americans, as junk food is typically low in calories, but energetically expensive to produce.
For instance, Pimentel calculates that the equivalent of 2100 kcal go into producing a can of diet soda which contains a maximum of 1 kcal. About 1600 kcal go into producing the aluminium can alone.
Efficient Farming
Other suggested changes to the food production process range from replacing incandescent bulbs with energy-saving fluorescent ones, to using fewer machines, pesticides and fertilisers, and more human power on farms.
Reducing the distance that food is transported could also cut energy costs: food travels 2400 km on average to its consumer in the US. This requires 1.4 times the energy actually contained in the food. Producing food locally would cut the energy expended transporting it by half.
Pimentel estimates that the amount of energy that goes into packaging foods could be halved as well, as could the amount of energy used by agricultural machines.
If his dietary and production measures were implemented, he says, the US food industry would consume half the energy it does. Whether or not the US is ready for these changes remains to be seen.
Tuesday, August 19, 2008
Winning Weight Loss Tip: It's Not Just About What You Put Into Your Mouth
have a wait problem. I hate to wait. When I want something, I want it NOW.
My wait problem also applies to my need to lose weight problem.
When I want to lose weight, I want to lose it NOW.
I am happy to report I succeeded at losing weight very quickly -- 10 pounds in 2 months on my five foot three frame!
How?
I not only focused on what I put into my mouth -- but what emerged from my mouth -- wordwise!
I created A NEW VOCABULARY MENU -- where I changed the words I allowed to enter and exit my mouth about my weight and my slim down process.
In other words...I went on a special Word Diet - beginning with banning the word "diet." After all, if you really want to get slim and healthier, you're not "on" a diet -- because this implies going "off" the diet at some point. In fact, the word diet has a lot of negative associations. I hear that word and think: "LOTS OF PAIN AHEAD!"
So I renamed the healthier eating habits I'm now forever doing as my "DO IT PROGRAM" -- not a diet program --and so I'm now really "doing it" - eating healthier for life.
Another word on MY NEW VOCABULARY MENU: "APPRECI-EAT." This word is all about slowing down the eating and thereby tasting food more - so you'll want to eat less. Studies show that if you eat more slowly, you allow your body the needed time to signal to your brain that you are full -- which is usually 20 minutes. So I no longer eat meals and snacks - I appreciEAT them!
More words on my NEW VOCABULARY MENU: "FORWARD" and "BACKWARD." Every food one chooses to eat either moves you forward to your dream weight - or backwards to gaining more weight. So when I look at a food I ask myself: "Is this a forward food - or a backward food?"
Yet more words from MY NEW VOCABULARY MENU: "THE OLD ME" and "THE NEW ME." All your actions come from your identity. If you think: "I always overeat late at night." Guess what? You do. If you think: "I'm the type of person who can resist chocolate -- the new me is great at resisting it -- the new me eats forward foods -- the old me ate backward foods!" Guess what? The new you will be very much going forwards to fab - instead of backwards to flab!
Another word on MY NEW VOCABULARY MENU: "WALLPOWER!" To hell with ordinary mere mortal willpower. When you have WALLPOWER, nothing will be able to break through your wall of commitment!
A new sentence on MY NEW VOCABULARY MENU: "INCREASING MY APPETITE FOR LIFE." If you want to be a slim, healthy person it's essential you swap the pleasure of food with life's multitudinous other delights.
FACT: If you're presently overweight, it's because you're not being hungry enough about pursuing life's other abundant pleasures - and are seeing mostly the pleasure of food.
FACT: If you want to lose weight you must make sure your appetite for life is far bigger than your appetite for mere food.
So... swap chips and salsa for salsa class! Stop eating! Start painting! Recognize the joy of taking photos lasts longer than the joy of ice cream!
Finally, here's an entire sentence of empowering words which very much helped me stay focused on my slim down goal: "NOTHING TASTES AS GOOD AS SLIM AND SEXY FEELS."
Every time I wanted to pig out -- I simply quickly reminded myself how this temporary pleasure of food was a very minor pleasure, compared to the ultimate rewarding pleasure of feeling sim and sexy!
For more weight loss tips, check out the famed ENOUGH DAMMIT book -- which explains how to break bad addictive behaviors for good.
My wait problem also applies to my need to lose weight problem.
When I want to lose weight, I want to lose it NOW.
I am happy to report I succeeded at losing weight very quickly -- 10 pounds in 2 months on my five foot three frame!
How?
I not only focused on what I put into my mouth -- but what emerged from my mouth -- wordwise!
I created A NEW VOCABULARY MENU -- where I changed the words I allowed to enter and exit my mouth about my weight and my slim down process.
In other words...I went on a special Word Diet - beginning with banning the word "diet." After all, if you really want to get slim and healthier, you're not "on" a diet -- because this implies going "off" the diet at some point. In fact, the word diet has a lot of negative associations. I hear that word and think: "LOTS OF PAIN AHEAD!"
So I renamed the healthier eating habits I'm now forever doing as my "DO IT PROGRAM" -- not a diet program --and so I'm now really "doing it" - eating healthier for life.
Another word on MY NEW VOCABULARY MENU: "APPRECI-EAT." This word is all about slowing down the eating and thereby tasting food more - so you'll want to eat less. Studies show that if you eat more slowly, you allow your body the needed time to signal to your brain that you are full -- which is usually 20 minutes. So I no longer eat meals and snacks - I appreciEAT them!
More words on my NEW VOCABULARY MENU: "FORWARD" and "BACKWARD." Every food one chooses to eat either moves you forward to your dream weight - or backwards to gaining more weight. So when I look at a food I ask myself: "Is this a forward food - or a backward food?"
Yet more words from MY NEW VOCABULARY MENU: "THE OLD ME" and "THE NEW ME." All your actions come from your identity. If you think: "I always overeat late at night." Guess what? You do. If you think: "I'm the type of person who can resist chocolate -- the new me is great at resisting it -- the new me eats forward foods -- the old me ate backward foods!" Guess what? The new you will be very much going forwards to fab - instead of backwards to flab!
Another word on MY NEW VOCABULARY MENU: "WALLPOWER!" To hell with ordinary mere mortal willpower. When you have WALLPOWER, nothing will be able to break through your wall of commitment!
A new sentence on MY NEW VOCABULARY MENU: "INCREASING MY APPETITE FOR LIFE." If you want to be a slim, healthy person it's essential you swap the pleasure of food with life's multitudinous other delights.
FACT: If you're presently overweight, it's because you're not being hungry enough about pursuing life's other abundant pleasures - and are seeing mostly the pleasure of food.
FACT: If you want to lose weight you must make sure your appetite for life is far bigger than your appetite for mere food.
So... swap chips and salsa for salsa class! Stop eating! Start painting! Recognize the joy of taking photos lasts longer than the joy of ice cream!
Finally, here's an entire sentence of empowering words which very much helped me stay focused on my slim down goal: "NOTHING TASTES AS GOOD AS SLIM AND SEXY FEELS."
Every time I wanted to pig out -- I simply quickly reminded myself how this temporary pleasure of food was a very minor pleasure, compared to the ultimate rewarding pleasure of feeling sim and sexy!
For more weight loss tips, check out the famed ENOUGH DAMMIT book -- which explains how to break bad addictive behaviors for good.
Monday, August 18, 2008
5 Steps To A Perfect Breast Augmentation
By Leonard M. Hochstein, MD
The perfect breast augmentation begins by choosing the right plastic surgeon. I think by now everyone understands board certification and some of the fake boards that are out so I will not dwell on these issues, but talk about more specifics as I have seen in my experience.
I believe that the perfect result is a surgeon’s combination of talent and experience. There is no question of some surgeons’ ability to make asymmetric breasts look beautiful while others falter. Much of this is as a result of experience while seeing every type of breast that there is. There is no question that my skill improved with my experience. This translates into few insights for the patient. It is hard to find a talented young surgeon, so go for the proven one with the necessary experience to get the job done. Unless you are in the major market, it is unlikely you will find a surgeon who does 500 breast augmentation surgeries annually like I do. So what number is considered good? I would say at least 150 breast augmentation procedures annually is sufficient. This means that the surgeon is doing about 3 breast augmentation procedures on a weekly basis. Make sure to see plenty of pictures of their results. There should be good consistency there. Be wary of surgeons who will only have a few pictures to show you. You should be able to look at books that include hundreds of patients.
The next factor to consider is the site of surgery and the anesthesia provider. There are four options for setting. I would suggest either a private, accredited surgical center which is my preference or an outpatient ambulatory surgery facility. The other two options are a non-accredited private facility or hospital. I would avoid the former because there is no quality control standards and the latter because hospitals are dirty environments with infection risk being unacceptable for my standards.
If there is a problem in the surgery, it is generally anesthesia-related, but it seems few patients asked me about who will be putting them to sleep. There are two options here. The first is a board-certified anesthesiologist and the next option is a CRNA or nurse anesthetist. I use Dr. Livschultz, a medical doctor who is a board-certified anesthesiologist. He has been working in my office for the last 2-1/2 years full time. This familiarity allows us to offer the safest experience for my patients. Most doctors, because of their inconsistency, book their anesthesia provider based on availability which puts you at the mercy of the anesthesiologist who is available on that day. This relationship fosters unfamiliarity and inconsistency. I have a very close relationship with my anesthesiologist where we are able to discuss any pitfalls and make adjustments. For example, we recently came up with a protocol of providing totally intravenous anesthesia or TIVA for first time patients thereby avoiding any risk of malignant hyperthermia. Using a nurse (CRNA) is also frequently used, but not in my practice. In this situation, the physician is overseeing the anesthesia and since I am not trained in this field, I do not believe I am qualified to do so. Be aware of this because it is a cost cutting maneuver; go for the physician anesthesiologist instead.
Now that you have picked your physician, it is time to decide on the type of implant, the incision, and the size. I am not going to talk too much about placement as implant should always be placed submuscularly and if you have chosen a competent surgeon I will assume that is their preferred placement. I am not aware of any experienced breast surgeon who would put the implants above the muscle or in a subglandular location. There are two types of implants available, saline or silicone. The shells in both are made of silicone. They only differ in that saline implants have a balance that they can be inflated once they are positioned. The shells are smooth or textured. Texturing is a process where smooth implants are given a rougher feel. The idea here is to decrease the risk of capsular contraction. The downside is that by making the shell thicker, it also raises the risk of rippling or wrinkling. I do not use textured implants unless there is a significant risk or history of contracture. In this situation, they are indispensable. The main difference is what the implants are filled with. One is filled with saline solution and the other with silicone gel. There are subcategories of each. They come in round or teardrop and the silicone also varies in level of cohesiveness. I prefer the round because they allow for better cleavage and more fullness superiority, but mainly because the teardrop implants tend to shift, which can create an unnatural appearance. I also prefer silicone as they feel much more like breast tissue and have much less wrinkling or rippling than do the saline counterparts. All silicone implants today are cohesive, meaning the silicone will maintain its shape even if there is a defect in the integrity of the shell. But there are now 2 levels of cohesiveness, namely Level 1 and Level 2. The Level 1 implants which are currently used in the United States are semi-liquid whereas level 2 (gummy bear) are semi-solid. The level 2 implants, which come in teardrop shape only are currently unavailable in the United States as the study is now over (there is a prominent plastic surgeon in the Los Angeles area who advertises that he is still using these implants which is not true, so do not be fooled). I have had the opportunity to work with some of these level 2 implants and have found them to be unsatisfactory for two reasons. The first is that they are too firm and also require a very large incision or scar to place as they are not malleable and cannot be bent to place requiring the opening to be almost as wide as the implant itself. This also limits access to the inframammary fold. I believe these implants may have a role for reconstruction in the future, but for aesthetic purposes, I prefer the level 1’s. I still see hesitance towards silicone implants due to safety issues or leak detention. But these concerns are unwarranted. Silicone implants were taken off from the market in 1991, not because they were found to be unsafe, but rather because the FDA deemed them to be inadequately studied. Since that time, there have been multiple studies which have unequivocally found them to be safe and without any links to autoimmune diseases. Simply, the women who developed these illnesses would have developed them whether they had implants or not. The other issue I regularly hear about is the risk of deflation and its treatment. Over the course of 7 years, the deflation rate for saline implants is 15% whereas for silicone it is only 2%; thus making silicone more durable. If there should be a leak, it is much easier to diagnose the saline implants as they simply go flat.
Silicone cannot be diagnosed by physical exam, but rather requires an MRI. The treatment for each is much different since the shape or volume of a silicone implant does not change, it is very easy to replace and could be done simply under local anesthesia. Saline implants are much more difficult to replace as the capsule begins to contract immediately after deflation. This is much harder and requires a general anesthetic with reconstruction of the pocket. I use Mentor implants, as I believe they are the best implant available in the market and currently they come with a lifetime warranty.
There are several access points for implant placement including transaxillary, periareolar, inframammary fold, and transumbilical. All these access points are available for saline implants but limited to periareolar or inframammary fold for silicone. I prefer the periareolar approach because the scars tend to heal better and are less visible when wearing a bathing suit. It also allows direct access to the inferior insertion of the pectoralis major muscle, the proper release of which is crucial to perfect placement.
The last discussion is the size of the implant and the profile, low, medium, or high. When I determine the implant size I begin by talking about the patient’s desired cup. I need to stress that this is only a starting point of the discussion as I do not create a cup size, but rather a look. We decide this by looking at some of my postoperative pictures, as well as having the patient bring in pictures of looks they like and then trying on an implant. Trying on an implant is more useful in smaller breasted women and less so in women who have more breast tissue or are in need of a lift as well. When the patient likes the look of an implant on her chest, I add 50 cc to it and that is the volume I use in the submuscular location. There is no perfect way of picking the size, but this has worked well for me. As a bit of final advice, if you are between 2 sizes, go for the larger one and do not listen to your friend’s advice. They are not you, do not know what you want, nor do they necessarily have your best interest at heart. If there is ever a regret it is that patients did not go bigger. I rarely hear that they are too big.
I choose the profile depending on the patient’s desired size and chest width. The three profiles are moderate(low), moderate plus(medium), and high(high). I typically use the moderate plus because it gives the best combination of projection, which gives a more defined cleavage, and enough width of diameter to avoid cleavage separation. For my patients who have narrow chests or wish to have a large cup size I choose the high profile implant. I rarely use the low profile implant as the only indication is for models who wish to have a very small augmentation and need the greatest diameter width as possible to avoid cleavage separation.
The recovery period is less than a week. Most of my patients are able to drive on the fifth day and return to work after one week as long as no heavy lifting is required. I allow my patients to reach above their head as long as they are not stretching to reach a distant object. I allow aerobic workouts as long as they limit to lower body after 4 weeks and full gym workouts after 6 weeks. I do have patients perform massaging exercises to stretch the muscle in the medial location by squeezing the implants together. This also helps for settling which is usually a 4-month process and rarely can take longer. I also recommend that a moisturizer be used on the incision after 3 weeks of healing and on the breast itself immediately after surgery. Scars do not create moisture on their own and they need help.
Breast implant maintenance is a topic which seems to be misunderstood. The biggest misconception is that implants should be replaced every ten years. This is simply not true and came about based on the data that the old (prior to 1991) silicone implants had a significant leak rate after 10 years. By mistake this has been extrapolated to the current saline and silicone implants used today. The current silicone implants made by Mentor are warrantied for life and require replacement only if a defect should develop. This is the same case for saline implants which are currently warrantied for 10 years (extended warranty is available for purchase from Mentor). Simply put, if there is no problem precautionary replacement is not required.
The horizon shows a few things of promise. Stem cells may one day be used for breast surgery. Their potential seems limitless. I am just beginning to work with them and will see what applications develop.
There is no question that I have some very strong opinions on breast augmentation. These opinions have been formed over many years and many augmentations. I sincerely hope my ideas will be of help to anyone interested in this wonderful operation.
Ask Dr. Leonard M. Hochstein Questions & Get Answers
Click here to ask Dr. Hochstein Questions Live & Get Answers
Dr. Hochstein has his own message board on Make Me Heal where he answers facial plastic surgery questions live from patients.
About Dr. Hochstein:
Dr. Hochstein, or Dr. H as he is known as, began his medical career when he applied to medical school as a merit scholar high school senior. He was able to surpass the customary four years of college and go directly from high school into medical school. The first in a long list of exceptional achievements to be obtained during his academic and surgical training. He attended the accelerated program at the Louisiana State University Medical Center where he graduated as Valedictorian of his class. It was during his time in medical school that Dr. H worked closely with the Department of Surgery and had his first scientific paper published. He received his M.D. in 1990.
Learn More about Dr. Leonard Hochstein
The perfect breast augmentation begins by choosing the right plastic surgeon. I think by now everyone understands board certification and some of the fake boards that are out so I will not dwell on these issues, but talk about more specifics as I have seen in my experience.
I believe that the perfect result is a surgeon’s combination of talent and experience. There is no question of some surgeons’ ability to make asymmetric breasts look beautiful while others falter. Much of this is as a result of experience while seeing every type of breast that there is. There is no question that my skill improved with my experience. This translates into few insights for the patient. It is hard to find a talented young surgeon, so go for the proven one with the necessary experience to get the job done. Unless you are in the major market, it is unlikely you will find a surgeon who does 500 breast augmentation surgeries annually like I do. So what number is considered good? I would say at least 150 breast augmentation procedures annually is sufficient. This means that the surgeon is doing about 3 breast augmentation procedures on a weekly basis. Make sure to see plenty of pictures of their results. There should be good consistency there. Be wary of surgeons who will only have a few pictures to show you. You should be able to look at books that include hundreds of patients.
The next factor to consider is the site of surgery and the anesthesia provider. There are four options for setting. I would suggest either a private, accredited surgical center which is my preference or an outpatient ambulatory surgery facility. The other two options are a non-accredited private facility or hospital. I would avoid the former because there is no quality control standards and the latter because hospitals are dirty environments with infection risk being unacceptable for my standards.
If there is a problem in the surgery, it is generally anesthesia-related, but it seems few patients asked me about who will be putting them to sleep. There are two options here. The first is a board-certified anesthesiologist and the next option is a CRNA or nurse anesthetist. I use Dr. Livschultz, a medical doctor who is a board-certified anesthesiologist. He has been working in my office for the last 2-1/2 years full time. This familiarity allows us to offer the safest experience for my patients. Most doctors, because of their inconsistency, book their anesthesia provider based on availability which puts you at the mercy of the anesthesiologist who is available on that day. This relationship fosters unfamiliarity and inconsistency. I have a very close relationship with my anesthesiologist where we are able to discuss any pitfalls and make adjustments. For example, we recently came up with a protocol of providing totally intravenous anesthesia or TIVA for first time patients thereby avoiding any risk of malignant hyperthermia. Using a nurse (CRNA) is also frequently used, but not in my practice. In this situation, the physician is overseeing the anesthesia and since I am not trained in this field, I do not believe I am qualified to do so. Be aware of this because it is a cost cutting maneuver; go for the physician anesthesiologist instead.
Now that you have picked your physician, it is time to decide on the type of implant, the incision, and the size. I am not going to talk too much about placement as implant should always be placed submuscularly and if you have chosen a competent surgeon I will assume that is their preferred placement. I am not aware of any experienced breast surgeon who would put the implants above the muscle or in a subglandular location. There are two types of implants available, saline or silicone. The shells in both are made of silicone. They only differ in that saline implants have a balance that they can be inflated once they are positioned. The shells are smooth or textured. Texturing is a process where smooth implants are given a rougher feel. The idea here is to decrease the risk of capsular contraction. The downside is that by making the shell thicker, it also raises the risk of rippling or wrinkling. I do not use textured implants unless there is a significant risk or history of contracture. In this situation, they are indispensable. The main difference is what the implants are filled with. One is filled with saline solution and the other with silicone gel. There are subcategories of each. They come in round or teardrop and the silicone also varies in level of cohesiveness. I prefer the round because they allow for better cleavage and more fullness superiority, but mainly because the teardrop implants tend to shift, which can create an unnatural appearance. I also prefer silicone as they feel much more like breast tissue and have much less wrinkling or rippling than do the saline counterparts. All silicone implants today are cohesive, meaning the silicone will maintain its shape even if there is a defect in the integrity of the shell. But there are now 2 levels of cohesiveness, namely Level 1 and Level 2. The Level 1 implants which are currently used in the United States are semi-liquid whereas level 2 (gummy bear) are semi-solid. The level 2 implants, which come in teardrop shape only are currently unavailable in the United States as the study is now over (there is a prominent plastic surgeon in the Los Angeles area who advertises that he is still using these implants which is not true, so do not be fooled). I have had the opportunity to work with some of these level 2 implants and have found them to be unsatisfactory for two reasons. The first is that they are too firm and also require a very large incision or scar to place as they are not malleable and cannot be bent to place requiring the opening to be almost as wide as the implant itself. This also limits access to the inframammary fold. I believe these implants may have a role for reconstruction in the future, but for aesthetic purposes, I prefer the level 1’s. I still see hesitance towards silicone implants due to safety issues or leak detention. But these concerns are unwarranted. Silicone implants were taken off from the market in 1991, not because they were found to be unsafe, but rather because the FDA deemed them to be inadequately studied. Since that time, there have been multiple studies which have unequivocally found them to be safe and without any links to autoimmune diseases. Simply, the women who developed these illnesses would have developed them whether they had implants or not. The other issue I regularly hear about is the risk of deflation and its treatment. Over the course of 7 years, the deflation rate for saline implants is 15% whereas for silicone it is only 2%; thus making silicone more durable. If there should be a leak, it is much easier to diagnose the saline implants as they simply go flat.
Silicone cannot be diagnosed by physical exam, but rather requires an MRI. The treatment for each is much different since the shape or volume of a silicone implant does not change, it is very easy to replace and could be done simply under local anesthesia. Saline implants are much more difficult to replace as the capsule begins to contract immediately after deflation. This is much harder and requires a general anesthetic with reconstruction of the pocket. I use Mentor implants, as I believe they are the best implant available in the market and currently they come with a lifetime warranty.
There are several access points for implant placement including transaxillary, periareolar, inframammary fold, and transumbilical. All these access points are available for saline implants but limited to periareolar or inframammary fold for silicone. I prefer the periareolar approach because the scars tend to heal better and are less visible when wearing a bathing suit. It also allows direct access to the inferior insertion of the pectoralis major muscle, the proper release of which is crucial to perfect placement.
The last discussion is the size of the implant and the profile, low, medium, or high. When I determine the implant size I begin by talking about the patient’s desired cup. I need to stress that this is only a starting point of the discussion as I do not create a cup size, but rather a look. We decide this by looking at some of my postoperative pictures, as well as having the patient bring in pictures of looks they like and then trying on an implant. Trying on an implant is more useful in smaller breasted women and less so in women who have more breast tissue or are in need of a lift as well. When the patient likes the look of an implant on her chest, I add 50 cc to it and that is the volume I use in the submuscular location. There is no perfect way of picking the size, but this has worked well for me. As a bit of final advice, if you are between 2 sizes, go for the larger one and do not listen to your friend’s advice. They are not you, do not know what you want, nor do they necessarily have your best interest at heart. If there is ever a regret it is that patients did not go bigger. I rarely hear that they are too big.
I choose the profile depending on the patient’s desired size and chest width. The three profiles are moderate(low), moderate plus(medium), and high(high). I typically use the moderate plus because it gives the best combination of projection, which gives a more defined cleavage, and enough width of diameter to avoid cleavage separation. For my patients who have narrow chests or wish to have a large cup size I choose the high profile implant. I rarely use the low profile implant as the only indication is for models who wish to have a very small augmentation and need the greatest diameter width as possible to avoid cleavage separation.
The recovery period is less than a week. Most of my patients are able to drive on the fifth day and return to work after one week as long as no heavy lifting is required. I allow my patients to reach above their head as long as they are not stretching to reach a distant object. I allow aerobic workouts as long as they limit to lower body after 4 weeks and full gym workouts after 6 weeks. I do have patients perform massaging exercises to stretch the muscle in the medial location by squeezing the implants together. This also helps for settling which is usually a 4-month process and rarely can take longer. I also recommend that a moisturizer be used on the incision after 3 weeks of healing and on the breast itself immediately after surgery. Scars do not create moisture on their own and they need help.
Breast implant maintenance is a topic which seems to be misunderstood. The biggest misconception is that implants should be replaced every ten years. This is simply not true and came about based on the data that the old (prior to 1991) silicone implants had a significant leak rate after 10 years. By mistake this has been extrapolated to the current saline and silicone implants used today. The current silicone implants made by Mentor are warrantied for life and require replacement only if a defect should develop. This is the same case for saline implants which are currently warrantied for 10 years (extended warranty is available for purchase from Mentor). Simply put, if there is no problem precautionary replacement is not required.
The horizon shows a few things of promise. Stem cells may one day be used for breast surgery. Their potential seems limitless. I am just beginning to work with them and will see what applications develop.
There is no question that I have some very strong opinions on breast augmentation. These opinions have been formed over many years and many augmentations. I sincerely hope my ideas will be of help to anyone interested in this wonderful operation.
Ask Dr. Leonard M. Hochstein Questions & Get Answers
Click here to ask Dr. Hochstein Questions Live & Get Answers
Dr. Hochstein has his own message board on Make Me Heal where he answers facial plastic surgery questions live from patients.
About Dr. Hochstein:
Dr. Hochstein, or Dr. H as he is known as, began his medical career when he applied to medical school as a merit scholar high school senior. He was able to surpass the customary four years of college and go directly from high school into medical school. The first in a long list of exceptional achievements to be obtained during his academic and surgical training. He attended the accelerated program at the Louisiana State University Medical Center where he graduated as Valedictorian of his class. It was during his time in medical school that Dr. H worked closely with the Department of Surgery and had his first scientific paper published. He received his M.D. in 1990.
Learn More about Dr. Leonard Hochstein
Sunday, August 17, 2008
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