The development of breasts is one of the most prominent physical difference between the structure of a man and a woman. In some cases, hormonal imbalances can cause enlargement of the male breast gland, which is known as gynecomastia.  Apart from being a cause for embarrassment, it is also associated with a number of medical conditions such as kidney failure and liver cirrhosis. However, there is little need to worry if you have been diagnosed with such a condition as it can easily be treated with dietary changes, medication and surgery. Among these, surgery is the only method of treatment that guarantees a permanent and immediate solution to the problem. 

Surgical treatment for gynecomastia is of two types

Liposuction 
Mastectomy
The type of surgery suitable for you will depend on a number of factors including the extent and type of gynecomastia.

Liposuction involves the removal of fat from the breast, but does not touch the breast tissue itself. For this surgery, a surgeon makes a small incision on either side of the chest or along the edge of the areola. Excessive fat is then removed through these incisions and the skin and remaining tissue is then restructured. Liposuction can take anywhere between a week and 3 weeks for complete recovery. In the meanwhile, the patient must wear a compression garment to minimize the swelling and support the chest tissue as it heals. 

A mastectomy on the other hand is used to remove the breast tissue. A mastectomy is performed endoscopically and hence is less invasive. In this case, the incisions are located around the edge of the areola or in the natural crease of the chest. A mastectomy requires a shorter recovery period. In some cases, a combination of the two techniques may also be used. 

The results of both surgical approaches can be seen immediately after the surgery. Slight soreness and pain is a common side effect of this procedure and can be relieved with pain medication. Some men may also experience a temporary loss of sensation over the treated area. 

Though the results of both types of surgeries are permanent, it is important to maintain a healthy lifestyle after the surgery. Unhealthy eating that leads to significant weight gain can make the problem recur. Use of steroids or medication that affects the testosterone levels in the body and certain medical conditions can also lead to recurring gynecomastia.

Enlarged Male Breast Problem - Is Surgery Helpful?

4 plastic surgery alternatives for burns and wounds

The branch of plastic surgery that is generally used for the treatment of burns and other wounds is known as reconstructive plastic surgery. There are numerous surgical methods that fall under this category, which is effectively used to treat these injuries and the related issues that they cause. 

What are medical issues caused by burns and wounds?

Some of the most frequently occurring issues that stem from burns and similar wounds are as follows:

- restriction of mobility

- aesthetic disfigurement and scarring

- loss of sensation in the affected area

The different issues are caused by varying kinds of burns and injuries and, hence, each case must be approached in a different manner for remedy.

Different kinds of plastic surgeries that are used for treatment

Depending on the nature of the injury, your plastic surgeon may opt for any of the following surgical methods for treating the problem.

1. Skin grafting

In this procedure, skin is removed from one part of the body and transplanted to the affected area. This method is used for the treatment of burns. There are two types of this surgical procedure - one removes a few layers from the dermis of the donor area (split-thickness graft) while the other removes the entire dermis (full-thickness graft). Recovery time depends on the kind of procedure used. Skin grafting is occasionally used for breast and nose reconstruction as well.

2. Microsurgery

This type of surgery makes the use of a microscope in reconstructive procedures for working on minuscule veins, arteries, and nerves for repairing damaged areas. Microsurgery is often used alongside other surgical procedures for re-attaching body parts, relieving paralysis of the face and in the reconstruction of breasts.

3. Tissue expansion

This method is used to induce the growth of extra skin on the body that can be used for reconstructive purposes. This is done by inserting a balloon expander underneath the skin that slowly gets filled with saline solution and makes the skin swell. This excess skin is then used for correction or reconstruction of the affected area.

4. Free flap procedure

This procedure involves the transfer of skin, bone, muscle and blood supply from the donor area to the damaged area for repairing purposes. Microsurgery is often performed alongside this treatment method, which is used most frequently for breast reconstruction or after the removal of cancer from the neck or head.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: 6 Quick and Handy Remedies To Treat Burns

4 Surgical Alternatives for Burns and Wounds

Washing your skin with water is something that you probably do daily, but you may not know at what temperature the water should be. Using water at the correct temperature is advantageous for the skin. Water at extreme temperatures is harmful for the skin as your skin is not designed that way.

The temperature of the water should also depend on the purpose for which it is being used. Here are some tips on how to set the temperature of the water depending on the purpose: 

1. Showering: while showering, if you are using hot water, then it may strip your skin of its essential oils and make it vulnerable to dryness. This may cause various skin complications, such as cracked and rough skin. Hence, use lukewarm water while you shower.

2. Washing your hair: using hot water to wash your hair may lead to hair damage as it rids your hair of all the essential oils and makes it limp and dull. Lukewarm to normal water is recommended while washing your hair as it will allow the hair to retain its natural oils.

3. Brushing: the right temperature of water while brushing your teeth should optimally be lukewarm. Too cold or hot water can lead to teeth sensitivity and cause oral problems.

4. Washing your face: before you apply a cleansing agent on your face, use warm water to wet the face as it helps to open up your pores. After the cleansing agent is applied, then use cold water to wash your face. Cold water helps in closing the pores after the impurities are removed from the skin.

5. Shaving: if you are going to shave, then opt for warm water as it opens the pores up and thus makes it easier for the blade to glide through the skin. This also reduces the risk of razor burns on your skin.

6. Washing your feet: wash your feet with lukewarm water as it facilitates dead cell removal and also helps in getting rid of warts.

Hot vs Cold: Which Water Temperature is Best for Your Skin

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

Cancer can be very devastating, it can tear families apart. The cancer virus generally kills all the healthy cells in your body and starts to destroy your organs one by one. When a person is affected by breast cancer, their breasts have to be removed so that the cancer virus doesn t affect the rest of the body. In the society which we live in we are fed with the notion that breasts are an integral part of a woman s body and only voluptuous breasts make a woman look more attractive. Survivors who have won the fight against breast cancer have had to surgically remove their breasts for survival. 

They are left with an empty spot in their body as well as their lives. So, in such cases breast reconstructive surgery becomes extremely important. Breast reconstruction surgery implants a mound in place of the actual breast. So that it looks like an actual breast with the nipples and the areola.

How to get ready for a breast reconstruction surgery?
1. You should quit smoking if you are a regular smoker.
2. Avoid certain vitamins or supplements as prescribed by your doctor before the surgery.
3. Take someone with you to stay back during and after the procedure for moral support and to assist you with your stay in a hospital.

Possible complications:
1. Infection can occur after the surgery.
2. Hematoma or pooling of blood.
3. The implants can also break through the skin.
4. The implants can rupture and the silicon or saline can leak from the breast tissues.
5. Hard scar tissues can form around the implant.
6. It might not be enough for a woman who has had larger breasts.
7. Implants don t last life-long. It needs to be replaced after a point of time.
8. Radiation therapy might damage the implants.
9. It can leave a scar from the region where the extra tissue was taken for constructing the breast.

Methods of breast reconstruction surgery:
1. Tissue expander
2. Flap reconstruction
3. Abdominal flaps
4. Mold-assisted reconstruction
5. Direct to implant procedure

Breast Reconstruction - How You Can Prepare Yourself?

4 Common Combing Mistakes That Lead To Excessive Hairloss

You will be surprised to know that about 35 million men and 21 million women suffer from excessive hairfall in India. Excessive hair fall can be the result of certain illnesses, hormonal changes, over-use of hair products that contain chemicals or a poor diet. What you may not have considered is that you can also lose a lot of hair by combing it the wrong way. 

Check if you’re making these common combing mistakes.

1. Are you combing your hair from the roots down?
If you’re combing your hair you should always start from the middle while working it downwards. Move the comb upwards (near the roots) only when there are no more tangles remaining in the bottom half.
If you start combing from your roots, you may have to fight more tangles on the way to the bottom. This induces strain on your scalp, and increases hair breakage. The end result is weak hair and roots, and more hair fall.

2. Are you combing post the application of a hair product?
A comb should never be used just after the application of a hair paste, serum or cream for treatment or styling. You must use only your fingers to comb through your hair once you've applied a styling product.
If you use a comb post-application of a styling product, it not only loses its effect, but may also harm your hair and its texture.Consequently, it may lead to increased breakage and hair loss over time.

3. Are you detangling your hair after shampooing or washing?
Hair is known to be at its weakest when wet, which can also make it prone to tangling. Combing and excessive pulling of tangled, wet hair increases your chances of hair breakage and eventual hair loss.
To avert water-induced frowns, you can try giving a comb-through before wetting your hair in the shower. Alternatively, you can also try combing your hair during a shower. Apply the conditioner first; next, untangle the strands by using only your fingers, and then use a wide-toothed comb just before washing.

4. Are you regularly back-combing your hair?
Sometimes people back-comb their hair from the roots working towards the ends. This hair teasing technique adds volume and texture to your hair. Although it’s a great trick, its regular use may damage your hair cuticles, which as a result, may also ruin your hair’s quality, lead to frizzy hair and increase breakage and hair loss.
To get the element of volume without the damage, you can try light hair sprays, which help you in getting a similar look.




4 Common Combing Mistakes That Lead To Excessive Hairloss

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