Tuesday, 26 March 2013



Treatment of Flat Inverted Nipples

I viewed a presentation by a visiting dermatologist at IMCAS, Paris earlier this year, who was discussing the use of dermal fillers for the treatment of flat inverted nipples.
He suggested the careful placement of filler around the edge of the nipple itself, and felt that it worked very well in those clients treated, as the surgical correction of this problem is fraught with difficulty and often doesn't have satisfactory outcomes.

It all sounded quite interesting so I thought I'd ask him some questions about the procedure afterwards, thinking that there are no doubt a number of female patients in Australia who may be interested in this.
My first question was whether the filler procedure had caused any breastfeeding or mammography problems.  You know, my number one concern with any new treatment is ALWAYS: IS IT SAFE?
He responded that he had only done the procedure in younger women, under the age of needing screening mammography, so couldn't comment on whether it caused any radio-opacity.
As for the breast-feeding/mastitis concern, his response surprised me:
"the milk only comes out of the duct in the centre of the nipple, so it shouldn't effect breast-feeding, though I'm not sure how many of the women I've treated like this have needed to breast feed.."

I'm afraid that's when he lost all credibility in my eyes.
As a woman who has breast fed my child, I can assure anyone reading this post who perhaps hasn't yet found themselves in that situation, or witnessed their wife expressing breast milk, that breast milk doesn't come out of a central duct in the nipple.  It comes out of multiple ducts throughout the nipple.

Given that the dermatologist has only treated "about 20" women with this procedure, and has no followup safety data to present to the captivated audience (judging by the number of eager male doctors asking for detailed 'how to' instructions at the end of his presentation) I had some real concerns about whether this procedure should be promoted in any way at this time.

Don't get me wrong..I'm all for treatments that help women to overcome problems that affect their self-confidence.  But experimenting on women's breasts without any regard for functional side effects or mammogram safety is really not on.  Ductal carcinoma in-situ is a relatively common cause of (sometimes bilateral) mastectomy, and it would be an absolute tragedy to have either unnecessary surgery or missed diagnosis because of a cosmetic procedure that hadn't been investigated enough before being marketed to the world.  Having said that, I think this procedure would have a place helping those who have already undergone major breast reconstruction, and need their new nipples to look a bit more 3 dimensional.  Might have to suggest it to a couple of clients who fit this category.  Will let you know how they go!

Minimising Earlobe Creases

This is something that I already perform on patients who make the request, and it really is very easy, straightforward and effective.
Interestingly, the results appear to be quite long lasting without any particular side effects of note, other than the usual possibility of bruising and temporary excessive swelling.

Earlobe creases appear in older patients, and when I was a medical student were thought to be related to heart disease, so it is interesting that some patients notice them and complain of their cosmetic appearance.  However, if you want to have your earlobe creases injected, it might also be a good idea to make sure that your GP is monitoring you for other much more reliable signs of coronary artery disease.  We wouldn't want to overlook the onset of angina would we?   

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