Dr. Steven Robinson of the Plastic Surgery Group

April 2012

Gynecomastia, Or Male Breast Enlargement, Can Be Effectively Treated by a Qualified Plastic Surgeon

Gynecomastia is a condition of male breast enlargement that occurs in 10 percent of boys around the time of puberty. This problem is characterized by abnormal enlargement of the glandular tissue around the nipple and can become quite large and painful. Usually there is no specific identifiable cause for this condition but it can run in families. In addition, a few medications like Tagamet and certain anti-seizure drugs have been shown to cause it. In about half of the boys who develop this, it will resolve by itself within 2 years of its appearance. If the condition does not resolve within 2 years it most likely will not go away spontaneously and requires surgical intervention.

Fortunately, some Plastic Surgeons are trained in a technique that solves this problem and leaves virtually no visible scars. The procedure is done through a small incision in the lower border of the areola, which is the dark skin around the nipple. Through this incision the glandular tissue is removed and liposuction is done to smooth and sculp the chest wall. This allows muscle definition of the underlying pectoralis muscle to show. This procedure is not very painful and is done as an outpatient. That means the person goes home the same day as the procedure. I frequently perform this operation under a light general anesthetic or “twilight” anesthesia where the patient is somewhat awake. In addition, this operation requires little down time. I expect my patients to be back at work and back in the gym working out within one week or less.

While this is a wonderful operation that helps many men and boys rid themselves of an embarrassing problem, it should only be performed by a board certified Plastic Surgeon. In addition this should be done in an accredited outpatient surgery center. In such surgery centers an anesthesiologist will attend to your comfort while the surgeon concentrates on the results. This is the safest and most effective way to have this procedure. One should ask his surgeon how many of these operations he or she has performed and what facility they use. You should feel comfortable with your surgeon after the consultation and do not be afraid to seek a second opinion if you are not sure.

For more information please call us at (614) 326-4661.

Posted in for men, gynecomastia |

Breast Reduction – When is it Covered by Insurance?

Breast reduction surgery, called “reduction mammoplasty”, is one of the most popular operations performed by Plastic Surgeons. It is a very gratifying operation to perform because the women who have this done are so relieved of pain and happy they have had this procedure. This operation is also popular because it is usually covered by your health insurance carrier. Insurance companies have set certain criteria to be met in order for this to be a covered procedure. Once these criteria have been achieved, coverage is granted in the form of a letter. I have done hundreds of breast reductions and although every insurance company is different, I have found basic prerequisites that all of them want before approving this procedure.

Insurance companies want documentation that the large, heavy breasts are causing significant pain and disability. They will need to see that “conservative” treatments such as anti-inflammatory medications, physical therapy, or chiropractic therapy have been repeatedly tried over a period of several months and have failed. I ask that primary care doctors, chiropractors, physical therapists, and Ob Gyns send letters of support to the insurance company when I send my letter requesting pre-authorization. This strategy has been successful in obtaining coverage but there are other specific criteria that the companies want to see.

It is always helpful to document rashes that occur under the breasts called “intertrigo rashes”. These are more common in the Summer months and may require prescription creams. It is also useful to document grooving at the shoulders caused by heavy breasts pulling on bra straps. Insurance companies are going to want an estimate of the weight of breast tissue to be removed and I always include this in my letter to them. They are looking for at least seven hundred grams (slightly less than 2 pounds) off of each breast. Once I complete a consultation and examine the patient I can tell how much tissue by weight should be removed. Pre-operative photographs are taken of the breasts (these do not show the face) and they are submitted to the insurance company with the letter.

After the letter requesting coverage has been sent the insurance companies typically take 1 to 2 months to return a letter of pre-authorization to me. This means that you need to plan ahead and consider times for surgery about 3 months after your initial consultation. For more specific information on the surgery or recovery time please call my office in Columbus, Ohio at 614 326-4661.

Posted in Breast Surgery | Tagged |

Facelift – What is it and When is the Time Right?

Of all the operations Plastic Surgeons perform, none is as ingrained into popular culture and myth as the facelift. this may be due to the “overdone” look of the Hollywood crowd, the incessant jokes of late night comedians, or simply the “magic” of turning back the hands of time. Facelifts are frequently talked about yet many people remain misinformed regarding this effective procedure. In this article I will give you real information about the facelift as a Plastic Surgeon who regularly performs them. I want to dispel myths and help you in your search for reliable facts

First, I want to emphasize that this is not a “one-size-fits-all” procedure. Every facelift is unique because no two faces are alike and we all have different goals, desires, and dislikes. An in-depth initial consultation between you and your surgeon should be the starting point. The facelift is then designed to meet your goals. Sometimes only a mid-face procedure is necessary. This covers everything from the jawline up to the temples. Often, the neck needs attention and this can also be included as well as the eyes and brows. Again, this is an individualized operation hence no two are exactly the same.

The facelift should make you look younger, rested, even thinner, but you will still look like “you”. It should not have a tightly pulled or fake look. This is achieved by the experienced Plastic Surgeon striking a balance between your existing facial features and the re-positioning of certain structures. No matter which variation of this procedure is right for you, all facelifts have in common the removal of excess skin. This means that there must be incisions (cuts) involved, which also means scars. As Plastic Surgeons we are trained to minimize and hide scars whenever possible. Still, scars are an inevitable part of most operations. You should ask your surgeon where the scars will be, how long they will be, and how noticeable.

I feel very strongly that facelifts and most larger surgical procedures should be performed in an outpatient surgery center rather than a surgeons office, There are some surgeons who do these operations in their office procedure rooms but this is less than optimal. Surgery centers have all the resources needed should a complication arise or if more supplies are required. In addition they have dedicated sterile spaces and anesthesia personnel if needed. Many times facelifts can be done under local anesthesia with sedation and do not require a full general anesthetic, but it is always good to have an anesthesiologist available should extra comfort be desired.

Posted in Facial Surgery | Tagged |