September 2010


I saw a patient today in clinic who wants to change her breasts.  She has been unhappy with their size and shape as long as she can remember. 

Perfect candidate for breast surgery! Sign her up?!

Not quite.  She should consider waiting.

Why?  She is in her mid thirties. She wants to have kids.  Even when she said, “I won’t breastfeed because I want to minimize changes in the breast” (which I don’t recommend due to the overwhelming evidence of the benefit of breastfeeding, but those are topics for other blogs), your breasts still change.  She is not a 20 year old who has a good decade before having children.  She is in her mid 30s and will have them in the next year or two.  I could make her breasts perfect- exactly what she wants- and pregnancy and/or breastfeeding will change them. 

What do we see?

  • Loss of volume (Rarely increase in volume)
  • Skin laxity/droop
  • Stretch marks
  • Sensory change
  • Shape change

 

Other thoughts…

Pregnancy is tough.  It is hard to work on making your body look good for decades and then lose control of it in pregnancy.  I don’t want you to ever regret or have negative feelings about having a child and breastfeeding because it is doing “damage” to your breast.  If you are in my office you are not adverse to doing surgery to improve things.  Great! So time your surgery well.  If you are on the cusp of your babymaking years, go have that baby. Breastfeed.  Enjoy it.  When you are done with all your kids, your issues with your breast will have changed.  Your breasts will be different.  Let’s address it then.

If you live in Northern California as I do, women breastfeed.  I would even venture to say there is peer pressure to breastfeed.  When I had my first child I went to a mommy and me gathering for new moms at Stanford.  All these moms from Palo Alto, Menlo Park, Atherton, and Woodside gathered in a circle to discuss their babies.   A mom took out a bottle to feed her child. As people looked, there was almost a hush in the room.  I could feel her discomfort- she wasn’t breastfeeding her baby.  My girlfriend advice (I’m putting on my girlfriend hat, not my doctor hat) is to see how you feel when you have your baby, perhaps even try breastfeeding, before you decide you will or will not do it.

Now if you are 20, flat chested, and self conscious about your breasts, I would advise differently.  For you  it makes a lot more sense.  You could easily have a decade until you even think about babies.  And I have women who understand everything I mentioned above but still want the breast augmentation now.  That is fine. 

I believe in choice.  I am here to educate you and to help you understand the issues.  I will support you (and be honored to be your surgeon) regardless of your choice.

California is having an epidemic of whooping cough.  I just got a memo from Sequoia Hospital, which followed my memo from Stanford.  This is real.

The number of cases is at the highest level since 1958.

Why do we care?

  • Case rates are highest in infants
  • Adolescent and teens follow close behind
  • 12% of cases required hospitalization
  • 8 deaths have been reported, all in babies less than 2 months of age, and none had been vaccinated yet.

 

Whooping cough is spread by inhaling respiratory droplets (ie it gets into the air you are breathing) and is highly contagious.  On average they think most patients infect 12 other people!  Whooping cough in adults does not have the severe whooping cough characteristic of infants and young children, therefore it frequently goes undiagnosed.

Infants are very vulnerable.

Infants are protected for the first few months of life from maternal antibodies during gestation.  Unless recently immunized though, most pregnant women have little immunity to pertussis, so they are not giving sufficient protective antibodies to their fetus.  As a result, the California Department of Public Health is recommending

  • all women of childbearing years be vaccinated with Tdap. (Tetanus, Diptheria, Acellular Pertussis) Pregnancy is not a contraindication to vaccination, though usually women are vaccinated in the 2nd /3rd trimester or postpartum. 
  • Anyone in close contact with infants– family members, caregivers, and health workers– should be vaccinated at least 2 weeks before contact.

 

Provide a cocoon of safety for your infant and your family. The first dose of DTaP is given at 2 months of age, but may be given as early as 6 weeks to provide protection earlier in life.