Breasts are integral to womanhood. They define a woman s beauty. Well grown, firmer breasts are what every woman dreams of. However, not many women are lucky enough to have the perfect shape and size of breasts. A common belief among people is that bigger the size of the breasts, the better they are. This is a big misconception. The ideal breast size is the one that is in proportion to the rest of the body. Bigger breasts do not look good on women with smaller structure and are also prone to sagging. Apart from a disproportionate figure, many women with larger breasts complain of backache, neck and shoulder pain due to the physical burden born by the upper body. Hence, the need for a medical intervention. Such women can consider breast reduction as a permanent solution to their problem.

Breast reduction or reduction mammoplasty is a procedure that reduces the size of the breasts through surgical removal of tissues, fat and skin, thereby making it ideal as per the body structure. The procedure is performed under the guidance of a trained aesthetic plastic surgeon and takes about three to five hours.

Hospital admission is usually required and a general anesthesia is given to the patient. Healing of wounds may take a few days. Breast reduction surgery also deals with issues of sagging breasts and helps them give an uplifted and firmer appearance. Another advantage of this surgery is that it can reduce the size of areola making the breasts appear younger and better.

Like any other surgery, reduction mammaplasty is not free of side effects. There are risks associated and one has to carefully weigh the risks and benefits before taking this decision. It can cause complications like excessive bleeding and adverse anesthesia reactions. Apart from this, some of the common side effects of this surgery are loss of sensation in the nipples and areola, inability to breastfeed and scarring. Sometimes, the procedure may need to be repeated in case there is a visible asymmetry in the size of both the breasts.

In general, women considering this option are overweight, have no plans to bear children in future and are suffering from heaviness and pain in upper part of the body due to larger breasts. However, many women desire to improve their appearance. Cosmetic market delivers many new gels and creams for breast reduction, claiming them to be simpler and safer than surgery, but their effectiveness is doubtful. Women looking for a more permanent solution may consider a surgical procedure. However, following the surgeon s instructions is important pre as well as post-surgery. If you are worried about the size of your breasts, do visit a plastic surgeon and discuss your options.

Should You Get Breast Reduction Surgery? 

Hypothyroidism is a condition in which the thyroid gland is not producing the thyroid hormones adequately. This is a fairly common condition.

What is thyroid gland?

The thyroid gland is a small butterfly-shaped gland located just below Adam s apple. It encircles the windpipe or the trachea. It is about 4 cms in height and weighs about 18 gms. This gland is responsible for the secretion of thyroid hormones. Hormones are chemicals produced by special glands like thyroid, adrenals, ovaries etc. They act as messengers and are carried by the blood to the various target organs.

What are the hormones produced by thyroid gland and what do they do?

The thyroid hormones are of two types   T3 (Tri iodo thyronine) and T4 (Thyroxine). These hormones are mainly responsible for the body s metabolism - a process in which food is converted into energy in the cells. They influence growth and development and regulate various bodily functions which are mentioned below:

Heartbeat
Body temperature
Breathing
Body weight
Metabolism of fat
Menstrual cycles in females
Functioning of Nervous system
Digestion
Burning calories etc.
What is Hypothyroidism?

Inadequate production of hormones by the thyroid gland is termed as hypothyroidism. This is also called Underactive thyroid state. Hypothyroidism can make the body s development to slow down and reduces metabolism rates.

What are the causes of Hypothyroidism?

Hypothyroidism can be caused by a number of factors:

Hashimoto's thyroiditis: This is the commonest cause. This is an autoimmune disorder (normally body s defence system fight against external infections. In autoimmune disorder the defence system attacks the healthy cells of the body by mistake). In Hashimoto s thyroiditis the immune system/defence system produces antibodies that attack the thyroid gland and destroy it.
Iodine deficiency in diet. For the production of thyroid hormones iodine is very important. The body does not produce iodine normally, so it needs to be supplemented from outside. Iodine is mainly present in the food we eat. It is mainly present in shellfish, salt-water fish, eggs, dairy products. If a person does not eat iodine rich foods, he may end up with iodine deficiency leading to hypothyroidism. Currently, this causative factor is on the decline due to government initiative of table salt with iodine.
Surgery: Surgery to remove thyroid gland (for e.g. thyroid cancer treatment, overactive thyroid etc.)
Radiation to the neck (to treat cancer in the neck area): The thyroid gland cells are damaged due to the radiation.
Treatment with radioactive iodine: This treatment is used for managing hyperthyroidism/overactive thyroid, where the thyroid gland produces excessive thyroid hormones. One of the treatment modalities is by radioactive iodine. Sometimes this radiotherapy destroys normal functioning cells which lead to hypothyroidism.
Certain medicines: Certain medicines used to treat heart conditions, cancer, psychiatric conditions etc.   for e.g. amiodarone, lithium, interleukin-2, interferon-alpha.
Pregnancy: Pregnancy (the reason is unclear but it has been noticed that the thyroid may get inflamed after delivery   this is called Postpartum thyroiditis.
Damage to the pituitary gland: Pituitary gland is a gland which is present in the brain. It produces a hormone called TSH (Thyroxine-Stimulating hormone).The TSH tells the thyroid gland how much thyroid hormone it should make. If the levels of thyroid hormone in the blood are low, then the TSH will stimulate the thyroid gland to produce more Thyroid hormone.
Hypothalamus disorders: This is an organ in the brain. This produces a hormone called TRH (Thyrotropin Releasing Hormone) which acts on the Pituitary gland to secrete TSH. So any disorder of Pituitary gland will indirectly effect the production and secretion of Thyroid hormones. These are very rare disorders.
Congenital thyroid defects: Some babies are born with thyroid problems. This is due to the thyroid not being developed normally during pregnancy. Sometimes the thyroid gland does not function normal. This can be identified by screening for thyroid disorders in the first week after delivery. This is usually by a blood test using a small drop of blood from the baby s heel.
What are the different types of hypothyroidism?

One classification is based on whether the defect is with the thyroid gland or not:

Primary hypothyroidism: The problem is in the thyroid gland itself and thus there is reduced production /secretion of thyroid hormones.
Secondary hypothyroidism: Here the problem is with the Pituitary gland or the Hypothalamus. This results in abnormal production of TSH or TRH, which indirectly leads to less production and secretion of thyroid hormones.
Another classification is based on the symptoms and levels of the thyroid hormones and TSH:

Overt hypothyroidism: Here the patient is having the symptoms. Further the T3/T4 are low and TSH is high
Subclinical hypothyroidism: Here patient may or may not have symptoms. The T3/T4 levels are normal but TSH is high. In this situation the patient is at an increased risk of developing overt hypothyroidism in the future especially if he has Thyroid peroxidase antibodies on testing.
Who are at risk of developing Hypothyroidism?

Women have a higher risk of suffering from hypothyroidism than men.
Older people are at increased risk.
People suffering from other autoimmune diseases like Coeliac disease, Type-1 Diabetes Mellitus, Vitiligo, Pernicious anemia, Multiple sclerosis, Rheumatoid arthritis, Addison s disease etc.
People with psychiatric conditions such as bipolar disorder
People with Chromosomal abnormalities like Down syndrome, Turners syndrome also have a high risk of suffering from hypothyroidism.
What are the symptoms of hypothyroidism?

Symptoms vary from person to person. They may also mimic other conditions and hence be difficult to diagnose. Symptoms may also develop very slowly over a span of moths-years. Some of the characteristic symptoms of this disease are:

Depression
Constipation
Hair loss
Dry hair
Dryness of the skin
Tiredness
Body pains
Fluid retention in the body
Irregular menstrual cycle
Increased sensitivity to cold
Reduced heart rate
Increase in size of the thyroid gland   called Goitre. This is due to constant stimulation of the thyroid gland by TSH.
Weight gain
Carpal tunnel syndrome
Hoarse voice
Infertility
Loss of libido/sex drive
Confusion or memory problems especially in the elderly
What are the symptoms to look for in a baby if you suspect hypothyroidism?

Infants suffering from congenital hypothyroidism may show no symptoms or exhibit signs of excessive drowsiness, cold hands, cold feet, constipation, hoarse cry, poor growth or absent growth, poor appetite, bloating of abdomen, puffiness of face, swollen tongue, persistent jaundice.

How to diagnose hypothyroidism?

Blood tests:

TSH: This hormone is made in the pituitary gland and it stimulates the thyroid gland to produce thyroxine. If the thyroxine levels are low in the blood, the pituitary gland produces and secretes more TSH into the blood to act on the thyroid gland to produce more thyroxine. A raised TSH level indicates hypothyroidism. Other tests are not usually necessary unless a rare cause of hypothyroidism.
T4: A low level of thyroxine indicates hypothyroidism.
T3: these levels are generally not needed to diagnose hypothyroidism
Anti-Thyroid peroxidase antibodies (anti-TPO antibodies) or Anti- thyroglobulin antibodies are present in 90-95% of patient with autoimmune thyroiditis.
Other blood tests include Creatinine Kinase, Serum Lipids, Complete blood picture etc.
Ultrasound of the neck is done if the patient presents with a thyroid swelling.
What is the treatment of hypothyroidism?

Overt hypothyroidism is treated by synthetic Thyroxin hormone which should be taken every day on an empty stomach at least 30   45 minutes before breakfast. The treatment is continued for the rest of the patient s life. Regular thyroid function tests are done once every 8 weeks-12 weeks to adjust the dose of the thyroxine in the initial period of diagnosis. Once the thyroxine dose is stabilised, the tests can be done even once a year. This treatment is quite effective.

Sub-clinical hypothyroidism is only treated if the patient is a woman and is contemplating pregnancy, in patients with symptoms or if the TSH is quite high.

What are the side-effects of thyroxine medication?

There are few side effects if any. Most people tolerate these medications quite well. An important consideration before starting medication is to check if the patient has chest pain/angina. These people are started on the least available dose. If these patients are started on a higher dose they notice a worsening of their angina pains.

Side effects mainly occur if the thyroxine dose is high which leads to hyperthyroidism. The symptoms of this could be palpitations 9increased heart beat), weight loss, profuse sweating, anxiety, irritability etc.

There are some tablets which increase with thyroxine tablets. These include carbamazepine, iron supplements, calcium supplements, rifampicin, phenytoin, warfarin etc.

What are the complications of hypothyroidism?

If untreated hypothyroidism can lead to:

heart problems like heart attack due to increased levels of bad cholesterol like LDL, or heart failure due to fluid retention
obesity
infertility
joint pains
depression
A pregnant woman with hypothyroidism is at increased risk of giving birth to a baby with congenital hypothyroidism, also known as cretinism. Further, the woman may have pregnancy related complications like pre-eclampsia, premature delivery, low birth weight baby, anemia, post-partum haemorrhage (bleeding after delivery) etc.
Myxoedema is another complication where the patient has extremely low levels of thyroid hormone. The body temperature drops drastically making the person lose consciousness or go into a coma.
References:

2013 ETA Guideline: Management of Subclinical Hypothyroidism; European Thyroid Association (Nov 2013)
Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee; British Thyroid Association (2015)
The diagnosis and management of primary hypothyroidism; Royal College of Physicians and others (June 2011)
Suh S, Kim DK; Subclinical Hypothyroidism and Cardiovascular Disease. Endocrinology Metabolism (Seoul). 2015 Aug 4.
UK Guidelines for the Use of Thyroid Function Tests; British Thyroid Association (2006)
Gaitonde DY, Rowley KD, Sweeney LB; Hypothyroidism: an update. American Family Physician. 2012 Aug 1 86(3):244-51.
Bindra A, Braunstein GD; Thyroiditis. American Family Physician. 2006 May 15 73(10):1769-76.
Wilson GR, Curry RW Jr; Subclinical thyroid disease. American Family Physician. 2005 Oct 15 72(8):1517-24.
British National Formulary; NICE Evidence Services (UK access only)
Baumgartner C, Blum MR, Rodondi N; Subclinical hypothyroidism: summary of evidence in 2014. Swiss Medical Weekly. 2014 Dec 23 144:w14058. doi: 10.4414/smw.2014.14058. eCollection 2014.

Know Everything About Hypothyroidism

Your hair are a defining factor towards how you look. A receding hairline is a common problem in men of all ages as it attacks youth in their twenties itself. Although it is rare in women, it may happen because of ageing, menopause, pregnancy or illness.

Follow these simple ways to stop baldness or at least prolong it, while you still can.

1) see what you eat - if your protein intake is less, it is a good idea to increase it. Include egg, fish, bean sprouts, raisins, soy protein, walnuts, oats, green peas, and green leafy vegetables in your diet. Minerals also help reduce temporary baldness (esp. In women). Add copper, iron, potassium and magnesium to your diet through spinach, eggs, seeds and nuts. Vitamins a, b, c and e are essential for healthy hair. B complex vitamins present in cereals, potatoes, cod etc and b12 present in dairy products should be a part of your daily diet.

2) massage your hair - when hair dries, our scalp dries eventually. The dry hair follicles become inactive which weakens your hair and causes hair fall. Massaging your hair is advisable as it restores blood circulation in your scalp and ensures that your hair gets ample nutrition to be active and strong. Canola oil, sesame oil, coconut oil, olive oil as well as mustard oil are said to be beneficial for your hair.

3) take care of your hair - your hair needs as much care as the rest of your body does. Most hair styling products make your hair look good in the present moment, they will only make your hair go weak and brittle in the long run. This will lead to hair fall. Use hair products recommended by dermatologists, when needed.

If you have any further questions on hair fall, ask me by clicking on'consult.

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Excessive Hair Loss - 3 Ways To Curb It

Lupus, romantically named after the wolf, is a very dangerous disease that can often be fatal, and when it isn t, it makes the sufferers  life pretty much unlivable. Lupus is an autoimmune disease wherein the body s immune system becomes hyperactive and attacks normal, healthy tissues, thereby causing symptoms like inflammation, swelling, and damage to the joints, skin, kidneys, blood, the heart and lungs.

Signs you are suffering from lupus!

Out of proportion and persistent fatigue: This is the most common sign of lupus. Almost 90% of patients experience it, according to a research.
Slight to high fever: Low grade fever due to no justifiable cause can be another sign of lupus. The fever usually comes and goes. Talk to your doctor if you experience this symptom as this could be a sign of inflammation, infection, or imminent flare-up of the disease.
Thinning of hair: Thinning of the hair is often one of the first signs of lupus due to inflammation of the skin and scalp. Some people have hair coming out in clumps while others just have a less alarming thinning of the hair symptoms. Lupus can make hair feel dry and brittle. Doctors call this  lupus hair .
Unexplained skin rash called malar rash: Also called the butterfly rash, it appears on the cheek and the bridge of the nose. 50% of patients get this rash. It can appear suddenly or after exposure to the sun. Usually it appears just before a flare-up of lupus.
Chest pain which increases with breathing: The lungs and the blood vessels in them become inflamed. This makes breathing difficult and can also cause chest pains when you breathe. The lung size can also shrink due to lupus, causing shortness of breath.
Painful, stiff or swollen joints: Inflammation due to lupus can cause pain, stiffness, and swelling in your joints, particularly in the morning.
Blood in urine: This happens due to inflammation of the kidneys or nephritis, which causes swelling in legs and feet and high blood pressure (BP). If lupus is not treated, you can also die of end stage renal disease.
Persistent loss of appetite: Lupus causes acidity and indigestion and loss of appetite.
Thyroid problems: Patients develop an autoimmune thyroid disease which can cause both weight loss and gain. The thyroid helps control your body s metabolism and if it doesn t function properly, it can affect vital organs like your brain and heart.
Dry eyes and dry mouth: Some lupus patients develop Sjogren s syndrome, another autoimmune disorder. This causes malfunctioning of glands responsible for tears and saliva in our body, hence your eyes may feel dry and your mouth will also remain dry.
Lupus is unpredictable and patients often suffer flares, or active symptoms of the disease, followed by periods of normalcy. Because the signs of this disease are so general, it s easy to miss them; so, if you have been getting even three symptoms of lupus, it s time to see a doctor.

Lupus (Skin Disease) - 10 Signs You Are Suffering From It!

3 crucial points you must know about breast enhancement

Breast augmentation is a surgical procedure designed to enhance as well as improve the symmetry and fullness of the breasts through implants (gel-like fluid in a flexible sac); or to bring back breast volume lost as a result of pregnancy, aging or weight loss. Before opting for such a procedure, there are certain points that you absolutely must consider, which are:

1. Picking silicone or saline implants: when it comes to implants, you have two options available - saline or silicone. Providing a uniform shape and firmness, saline implants come filled with sterile salt water. In contrast, silicone breast implants contain elastic gel, giving them the look of natural breasts. In terms of elasticity, saline implants can be adjusted more easily as you can inject or remove liquid from the implant. In contrast, silicone implants cannot be adjusted as they are already filled with the gel.

2. Getting the right size: choosing the right size for breast augmentation is very important. It's wrong to believe that bigger implants are not always good. The size of implant should be decided after proper assessment of the breasts.

Mammography should be done before putting breast implants. In general, size selection is made based on your natural breast size. Whether you opt for a saline implant or a silicone one, implants come in varied sizes ranging from 120-180 cc. When you choose a size for yourself, you'll have to keep in mind your body frame as well as appearance you wish to have post surgery.

3. Incision options: depending on the results you expect, you'll also need to consider which incision (a surgical cut made in your skin before the operation) option you should select before undergoing surgery. Incisions can range anywhere from 1-4 inches, with their lengths increasing as the implants expand in size. There are also certain incisions, such as the belly button incisions that are really small and don't leave behind visible scar tissue.

Apart from belly button incision, some of the other incision options that a surgeon may employ for breast augmentation could be:
- armpit incision (incision made in the underarm area for breast implantation through the armpit)
- nipple incision (incision made on the areola, which is the circular area of pigmented skin surrounding a nipple)
- crease incision (incision made in the crease area below the breast for implantation).

Fat grafting of breasts is another alternative or a complementary procedure to the breast implant. If you're considering breast augmentation surgery, be sure to check with your doctor about these factors and which options are best suited to you, before proceeding.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: Why Breast Cancer is No 1 Cancer in India? + How To Avoid it

3 Crucial Points You Must Know about Breast Enhancement

Did you know that milk can cause acne?

Including cheese, milk, and ice-cream etc into your daily meals maybe the reason behind the painful acne on your face. Processed milk and other dairy products negatively affect your skin and trigger the formation of whiteheads, blackheads and pimples. 

Here s how milk causes acne and what you can do to get clearer skin.

How does milk cause acne?

1. Milk contains a growth hormone IGF-1 (responsible for the growth and strength of calves) in large amounts. This has an adverse effect on your skin, and is responsible for its inflammation, which results in acne. In fact, this hormone can even increase the size of the acne.
2. Consumption of milk and other dairy products also result in a sharp rise in the amount of insulin present in your body, which initiates more IGF-1 production by the liver, thereby increasing acne.
3. Excessive sebum (oil) is secreted by your skin due to the consumption of milk, which results in more number of clogged pores, causing an acne breakout. Additionally, an increase in sebum helps the acne bacteria to grow and breed, which further causes skin inflammation.
4. Consumption of milk can render your skin unable to get rid of dead skin cells, causing more acne due to clogged pores. This happens as milk sticks dead cells together inside your pores, interfering with their natural process of falling off.

What can you do to get acne-free skin?

The best way to get acne-free skin is by trying to limit your consumption of milk and dairy products. You can do so in two ways:

1. Discontinue Milk Intake: Stop consuming milk and its products completely for at least 30 days and observe the changes. If your skin improves after 30 days, you can add small amounts of high-quality dairy, like organic yoghurt, to your diet. If eliminating milk does not show any positive effects, try observing other triggers of acne and look for appropriate methods of removing them. 

2. Switch to Organic Milk Products Only - If you find it difficult to totally cut off milk from your diet, try reducing the amount of milk intake and totally avoid processed milk products. Switching to raw, grass-fed dairy products will also be beneficial.

What are the alternatives to milk which can be consumed without harming your skin?

You can also replace milk with the following products in your diet chart to prevent the occurrence of acne.

1. Organic almond milk without added sugar
2. Organic coconut milk containing no artificial sweeteners
3. Natural coconut cream

Warning: Do not consume soy milk as a milk substitute as it contains omega-6 fats, which cause skin inflammation and swelling of acne.

If you would like to consult with me privately, please click on 'Consult'.

Did you know that milk can cause acne?

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