mens grooming
CategoriesAesthetics

The Ultimate Guide To Men’s Grooming

By Garrett Munce. First published on aedit.com here: https://aedit.com/aedition/guide-to-mens grooming-skincare-routine

More and more men are waking up to something women have known for a long time: proper skincare is all about prevention. Here, The AEDITION lays the groundwork for the ideal grooming routine.

There’s a stereotype out there that men don’t like to take care of their skin. While it’s been said stereotypes contain a nugget of truth, we beg to differ. It’s not that men don’t like to take care of their skin — it’s that most guys don’t really know how to do it.

Times are changing. The men’s grooming industry is poised to become a $166 billion dollar business by the year 2022 and the skincare segment is the most rapidly growing. More and more men are waking up to something women have known for a long time: proper skincare is more about prevention than reaction. Taking even a few steps to cleanse and protect your complexion every day can lead to big changes in your skin and may even slow the signs of aging more effectively than even the most potent anti-aging cream. Think of it this way: if you don’t take your car in for regular maintenance, it’s going to be a whole lot harder to fix when it starts to break down.

The problem with skincare is that, if you’re just starting out, it can be incredibly overwhelming. There are thousands of products that all claim to be essential to your skin’s health. Walking into any skincare or men’s grooming aisle is a SAT-level vocabulary lesson that can leave your head spinning. That’s where The AEDITION comes in. No matter your knowledge of skincare, here lies the most important rules you should follow when creating a well-rounded and effective grooming routine. Follow these eight steps and you’ll be well on your way to the best skin of your life.

1. Put down the multi-use products

For decades, product developers and marketers thought that the only way to get men to use grooming products was to pack as many functions into a single package as possible. The idea was that men don’t want extensive routines (which is true), but the functionality doesn’t live up to the thought. The problem with these products is that they put a big emphasis on cleansing. In order to properly cleanse your body, they typically end up being too harsh for your hair and face.

The skin on your face is more delicate than the skin on your body, so irritation and dryness can occur when it’s over-cleansed. The same goes for your hair. Hair can get dry and brittle (and can fall out more easily) when the natural hydrating oils are stripped. Even two-in-one shampoo and conditioners tend to lean more heavily on cleansing — without enough conditioning agents to properly hydrate hair. Before we go any further, please throw out your multi-use products.

2. Wash your face with a facial cleanser

Once you get rid of your multitaskers, the first thing you should buy is a good, gentle facial cleanser (the SkinFix Barrier+ Foaming Oil Cleanser and REN Clean Skincare Evercalm Gentle Cleansing Milk are two of our favorites). Understanding that the skin on your face is delicate and should be treated gently is the first step in proper skincare.

Traditional soaps and cleansers contain sulfates, which are foaming agents that make soap lather. The problem is that these sulfates can disrupt what’s called the skin barrier, a protective layer of lipids that keeps moisture in your skin and bad stuff out. When harsh cleansers clean away dirt and oil, they also strip away this layer of lipids, which can leave your skin dry, irritated, and susceptible to inflammation. When you’re choosing a face cleanser, look for one that says “gentle” and “low-foam” or “no-foam.” The varieties will not lather as much, which can take some getting used to, but they will clean your skin without leaving it feeling tight. You should use your cleanser as your first step both morning and night.

3. Exfoliate smarter, not harder

When you start diving deeper into skincare, you start to hear a lot about exfoliation. It’s the idea that as your skin cells go through their life cycle, the dead cells accumulate on the surface of your skin and can leave it looking dull, flaky, and sallow; some say they can even contribute to the formation of signs of aging like fine lines and wrinkles. Exfoliation, at its most basic, is about getting rid of these dead cells. What lots of guys don’t realize is that if they’re shaving every day, they’re already exfoliating, thanks to the same razor that gets rid of their facial hair. But unless you’re shaving your entire face, you still need to exfoliate at least once a week to keep your skin looking fresh.

Most exfoliators marketed to men are facial scrubs, but remember your skin barrier? Scrubs can be too harsh, particularly if you use them aggressively, and can potentially cause damage to your barrier — even if you’re using a gentle cleanser. Instead, look for an exfoliating toner or mask that contains alpha hydroxy acids like glycolic or lactic acid (may we recommend Biologique Recherche Lotion P50 and The Ordinary Glycolic Acid 7% Toning Solution). These acids will gently break the bonds between dead skin cells and slough them away naturally, instead of relying on your hands to do the work.

4. Use an eye cream every day

Most men say that the first place they notice signs of aging is around their eyes, and, when it comes to crow’s feet and under eye bags, prevention is the name of the game. Using an eye cream twice a day will keep the delicate skin around your eyes hydrated and firm. Look for creams that contain caffeine, a natural stimulant to help wake up skin, and peptides, which are proteins to help maintain the health of skin. We’re partial to the Dr. Loretta Tightening Eye Gel and Lab Series Age Rescue Eye Therapy.

Gently apply eye cream by using your ring finger to tap the cream into the skin, instead of rubbing, and put it on after cleansing both morning and night. Bonus: it will help erase signs of sleepless or hard-partying nights, too.

5. Moisturize day and night

Aside from cleansing your face properly, the cornerstone to even the most basic skincare routine is moisturization. Even if you don’t struggle with dry skin, it’s important to keep your skin hydrated; it helps the skin cells stay healthy and work properly. A moisturizer will not only replenish hydration, but will also create a protective barrier on your skin to keep the moisture inside. When choosing a moisturizer, look for ingredients like hyaluronic acid, a naturally occurring acid that helps skin cells retain moisture, and ceramides, which are lipids like the kind found in your skin barrier. Our picks: Aesop Seeking Silence Facial Hydrator and Baxter of California Oil-Free Moisturizer.

The most common reason men say they don’t use moisturizer is because they don’t like how heavy creams feel on their face. If you’re one of those guys, look for a lightweight gel moisturizer which won’t feel like slathering your face with mayonnaise, but will still give you the hydrating and protecting properties your skin needs. Apply your moisturizer after your eye cream both morning and night.

6. Sunscreen is a man’s best friend

Many dermatologists will say the most important step in everyone’s skincare routine, regardless of gender, is sunscreen. The problem is that most men don’t use it. If you’re going to take away one thing from this list, it should be to use daily sunscreen. According to the American Academy of Dermatology (AAD), men are diagnosed with skin cancer twice as often as women by age 65 (and they also die from it at a higher rate) and the most troubling part is that it can be prevented if they would just use sunscreen.

Skin cancer prevention aside, sunscreen is also one of the most effective anti-aging products available. Studies have linked signs of aging to UV rays, and by wearing a daily sunscreen, you’re minimizing damage on a cellular level. Like moisturizer, most men who don’t wear sunscreen say it’s because they don’t like how it feels. Also, like moisturizer, there are lightweight options available — like Cardon Daily Moisturizer + SPF and Supergoop 100% Mineral Smooth & Poreless Matte Screen SPF 40 — that make this excuse a moot point. You can even find moisturizers that contain sunscreen, which is the only multi-use product we will endorse. But keep in mind that the AAD recommends a minimum of SPF 30, which is higher than many moisturizer/sunscreen combinations contain, so if you’re going that route make sure you read the label.

7. Night time is the right time

If you’re going to wear a daily moisturizer that contains SPF, you may want to use a different moisturizer at night. If you’re not, you should still consider it. That’s because, like many of our other bodily systems, our skin regenerates while we’re sleeping. It’s the perfect time for the microscopic systems to repair themselves after the onslaught of sunlight, pollution, and environmental aggressors they’ve spent all day protecting themselves from.

Night creams typically contain a higher percentage of hydrating and repairing ingredients, like hyaluronic acid and ceramides, and will also sometimes contain retinol which helps to promote skin cell turnover (the production of new cells). Using a special cream at night (we’re fans of the Ole Henriksen Goodnight Glow Retin-ALT Sleeping Cream and First Aid Beauty Ultra Repair Hydra-Firm Sleeping Cream) could mean you wake up with a brighter, smoother complexion with very minimal effort. Each night, after you wash your face and apply eye cream, apply your night cream or SPF-free moisturizer.

8. Advanced move: use a serum

You hear a lot of talk in the skincare world about serums. If your skincare routine is like a smoothie, serums are like the booster shots. They’re packed with concentrated ingredients to target a variety of issues and are ideal for address concerns like redness, uneven skin tone, hyperpigmentation (i.e. dark spots), and signs of aging. Typically, you apply them after you wash your face and before you put on your moisturizer. They’re add-on products; you can create an extremely easy and effective skincare routine without ever using a serum, but, if you want to take your skincare to the next level, try an all-around serum that addresses a variety of issues, like the Caldera + Lab The Good Multi-Functional Serum or Venn Age Reversing All-in-One Concentrate. If you like the results, consider what you want to target and look for a serum that specifically addresses that.

breast check
CategoriesOncology

What To Do If You Find A Lump In Your Breast

India Bottomley

There are no two ways about it: noticing a change to your breast can be scary. But that is not an excuse for inaction. Here, The AEDITION speaks to three women who experienced a breast cancer scare and did something about it.

Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, according to the Centers for Disease Control and Prevention (CDC), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to BCA, from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.

Because breast cancer awareness has become so mainstream in recent years with everyone from celebrities to the NFL dedicating time and resources to supporting the cause, men and women alike are increasingly aware of the warning signs. Women especially are encouraged to regularly conduct their own self breast exams and may even ask their partners to let them know if they notice any changes, too.

But happens if/when you find a lump? Because breast cancer has such a high profile and statistics like one in eight women will be diagnosed in their lifetime are well known, people are often fearful to seek medical advice after noticing a change in their breast tissue because they assume the worst.

While it is absolutely essential to get any changes checked out by a medical professional, it is also important to remember that 80 to 85 percent of lumps found in women under the age 40 are benign and caused by fibrocystic changes, cysts, fibroadenomas, or fat necrosis to name a few.

With this in mind, it is important to understand the function and importance of breast exams. We’ve already shared the resilient stories of mastectomy patients (HERE) and those who have undergone breast reconstruction procedures (HERE), and in this article The AEDITION speaks to women who found a lump and decided to do something about it.

Breast Check Basics

For women with no family history of breast cancer, the American College of Obstetricians and Gynecologists advises people in their twenties and thirties have a breast examination carried out by a healthcare provider every one or three years. The American Cancer Society, meanwhile, recommends annual mammograms for women between the ages of 40 and 55. Women over 55 can switch to mammograms every two years or continue with yearly screenings. But that doesn’t mean you should just sit around for your next trip to the gynecologist.

Women are encouraged to conduct a self examination about once a month. Because benign lumps are known to appear over the course of a woman’s menstrual cycle, it is best to perform the exam at the same time every month — ideally a few days after your period ends.

During the exam, it is important to be on the lookout for any changes in the appearance of both the exterior breast (skin, areola, and nipple) and the interior tissue. Things to feel and look for include:

  • A visible change in the shape or size of the breast or nipple
  • A change in how the breast skin looks or feels (think: dimpling or puckering)
  • Soreness, redness, or rashes on the breast or underarm area
  • Any areas that are visibly different compared to the rest of your breast tissue
  • A lump (can be a small as the size of a pea) that persists in the breast or underarm area

If you notice any of these symptoms or something just doesn’t feel like your version of ‘normal,’ it is time to consult a medical professional for a more thorough check. Chances are, it is simple to treat. But if it is breast cancer, early detection is key.

Patient Perspective

There are no two ways about it: finding a lump in your breast or noticing some other change to the chest can be alarming. But that is not an excuse for inaction. Here, The AEDITION speaks to three women who lived through a breast cancer scare about their experiences and why they encourage everyone to consult a doctor as soon as they notice something isn’t quite right.

Anna, 29, Los Angeles

The AEDITION: What caused you to become concerned about your breasts?

Anna: I was at college and aware that I needed to check myself every so often. I didn’t check as often as I now know I should, but one day I was in the bathroom and found a lump. It was probably around the size of an olive. I panicked and decided I wouldn’t tell anyone. My theory was that if I ignored it, it would go away. I would prove to myself that it wasn’t anything serious. But after a while, it was still there. A family friend had been diagnosed with cancer recently, so I guess it was on my mind. I made an appointment to see my doctor. At that point, I was convinced the only thing it could be was cancer.

The AEDITION: What happened during your doctor’s appointment?

Anna: I explained to the physician that I found this lump and that I thought I might have breast cancer. I was so anxious, but the doctor took the time to listen to me while I gave my garbled version of events. She then checked the lump herself, which was uncomfortable, but it didn’t take too long. She then asked me whether I had any pain, whether it changed during my cycle, and whether or not I’d noticed any other symptoms. I was referred for an ultrasound — my doctor explained it would give her a clearer idea of what was going on — but she also took some time to reassure me that it could very easily be something simple to treat and not cancer at all.

The AEDITION: What did the next steps look like for you?

Anna: First of all, I told a friend, which was probably the best thing I did throughout the process. She was able to reassure me and she also came with me to my other appointments. I had the ultrasound quite soon after the first appointment. Again, it was uncomfortable in that I’m not keen on being naked in front of random people, but, other than that, it wasn’t painful or anything. About a week after that I went back to the primary care doctor, who explained to me that it was a cyst. Because it was filled with liquid and not solid, I didn’t even need to have a biopsy. She told me to keep an eye on it, and if it became painful, they could offer me some other treatment options. That was about four years ago now, and I haven’t had any problems since. I do check my breasts regularly though, and I’m such an advocate for people getting any concerns checked out quickly.

The AEDITION: What advice do you have for someone who finds themselves in a similar situation?

Anna: I would say do the brave, grown-up thing and get it checked. Don’t bury your head in the sand because, if it is cancer, that’s literally the worst thing you could do. I think the awareness we have of breast cancer is amazing now, but it can make finding an issue so scary because the first thing that comes to mind is cancer. I also think people should share their concerns. Chances are a friend has been through a very similar thing — especially by the time you reach your late twenties. I know so many people who have been through the same panic. It’s best to share with both friends and doctors.

Stephanie, 58, Texas

The AEDITION: Would led you to believe you might have breast cancer?

Stephanie: I was checking my breast, which I do regularly now that I’m older. I felt something a bit different on my right side — almost in my underarm area. I had a sinking feeling when I first felt it and managed to calm myself down enough to have a Google, which, in hindsight, was not my best idea. I was pretty sure what I found could be a sign of breast cancer, and, honestly, I was scared. It took me a few days to gather together the courage to get a consult, but I didn’t want to leave it because I know how important it can be to get a diagnosis as soon as possible.

The AEDITION: What pushed you to visit a doctor?

Stephanie: I think breast cancer awareness has reached this amazing level where most of us know to check ourselves and not to mess around with it if we do find something a bit suspicious. I gave myself a couple of days to accept the potential reality of the situation and went to see my doctor. I explained the situation, and he took a look. Fortunately, the office also has an ultrasound room and I was able to sit and wait for it to come available there and then. I was told I had a liquid-filled cyst, and I was booked in for a biopsy. A couple of days after the biopsy, I received a call from my doctor, who explained what it was. He told me that I had an oil cyst, which can happen when fat is damaged. It wasn’t cancer at all. He praised me for being so reactive when I found it and told me to go and get on with my life — but to keep on checking in the future.

The AEDITION: Did you know about fat necrosis when you initially felt the scar tissue in your breast?

Stephanie: I honestly thought I was well informed about all things breasts, but apparently I was not. I hadn’t ever heard of it. I think it’s really important that, as much as we now all learn about checking for cancer, we also get told about other, far less life-altering issues we could develop in that area. I think it can be reassuring — especially for younger people — to know there are other conditions out there. Finding out quickly can save a lot of stress, but it is also important if it is cancer.

Jennifer, 34, Miami

The AEDITION: Could you give us an idea of the symptoms that led to your concern?

Jennifer: It happened not long before I stopped breastfeeding my daughter, so I was kind of acutely aware of what was going on with my breasts. One of them started to get a little painful and, over time, got somewhat swollen and warm. My main concern was getting it seen quickly. Not only was I in pain, but I was scared that if I left it, I could jeopardize my future with my daughter.

The AEDITION: What was your experience like with your doctor?

Jennifer: I went to see my daughter’s pediatrician for an appointment that had been booked for weeks. While I was there, I broke down in tears and explained what was going on. The doctor was so lovely. She told me it sounded like an infection called mastitis, which is super common for new moms. She explained to me that I just needed some antibiotics and to keep an eye on how it progressed. She was so sweet and completely understood why I was so worried about the situation. Since then, I’ve done a fair bit of research just out of curiosity, and it turns out there are so many breast conditions I had no idea even existed. I think it’s so amazing that cancer awareness pushes people to check themselves and to consult quickly. I’m certain it’s helping to save hundreds of lives every year.

The AEDITION: What advice would you give to someone who is feeling worried about consulting a doctor about a concern they have with their breasts?

Jennifer: I think the concern stems more from the fear of it possibly being something ‘big’ as opposed to the fear of consulting in itself. And I do think that people knowing there are other things the symptoms could point to — aside from cancer — is reassuring on that front. That being said, I think the urgency that has been created from awareness is crucial when it actually is cancer. I think, if you’re concerned, ask for help as soon as possible, but hold on to the fact that 85 percent of lumps and bumps that people consult about are not cancer at all.

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This article first appeared on the aedit.com on October 23rd 2019.

neck wrinkles
CategoriesAesthetics,  Anti-Aging

8 Ways to Get a Younger Looking Neck

Kate Kasbee

The skin on our necks is thinner than the skin on our faces and it’s exposed to the same wear and tear. So what are you doing about your neck?

You have your anti-aging skincare routine down to a science, you never leave the house without wearing vitamin c serum and sunscreen, and at night you refuse to let your face touch the pillow without applying under-eye treatment and moisturizer. But what are you doing about your neck? Americans spend so much effort preventing signs of aging like creasing and wrinkling in the space between their chins and foreheads. In reality, the neck often starts to look older long before crow’s feet enter the picture. The skin on our necks is thinner than the skin on our faces and it’s exposed to the same wear and tear. Unfortunately, it also tends to get a lot less TLC, if any at all. “Over time, skin loses collagen and elastin,” says New York City plastic surgeon Benjamin Paul, MD. Dr. Paul explains smoking and sun damage can also further accelerate aging of the skin on the neck. Those aren’t the only causes of neck aging. As we get older, laxity in the neck occurs due to a loss of support from connective tissue and muscle. This leads to what we commonly call a “waddle” or “turkey neck” and looks like loose skin under our chin. The appearance of sagging skin on the neck can affect everyone. Repeated pulling of the platysma muscle, which is the muscle men often flex while shaving, tugs on the overlying skin and causes it to wrinkle over time. According to Dr. Paul, thyroid or neck surgery also loosens the neck and can contribute to an older appearance. While there’s not much we can do about getting older, it is possible to slow down the physical signs of aging. Here are some ways you can prevent future sagging skin and promote a younger-looking neck.

Protect your skin from the sun

It’s common knowledge that sun exposure causes major damage to your skin. This includes the delicate skin on your neck, which is one of the first places the signs of aging can take hold. According to Dr. Paul, the single best thing you can do to preserve a youthful neck and prevent sagging skin, age spots, and fine lines is to wear sunscreen.

The American Academy of Dermatology recommends an SPF of at least 30 because it blocks 97 percent of the sun’s damaging UVB rays. Apply sunscreen to your face and neck every morning before putting on your makeup, whether you’re spending the day indoors or outside. Remember to reapply every few hours to make sure your skin is always protected.

Add a Retinoid to your skincare routine

If you’re an anti-aging veteran, your medicine cabinet is likely stocked with skincare products that promise to reduce wrinkles and give you a smooth, tight complexion. There is a huge variety of creams, for instance, that help moisturize the neck. Do they actually work? “In my experience,” says Dr. Paul, “the benefit of neck creams is quite limited.” Unless it contains a retinoid.

Retinoids, a class of ingredients that includes retinol, retinyl palmitate, and retinoic acid, can repair sun damage by reducing the appearance of fine lines and wrinkles, smoothing the skin texture, and evening the skin tone. They do it by boosting collagen production and stimulating cell turnover deep within the skin.

“Retinoids are potent, but they may be irritating,” says Dr. Paul. To minimize irritation, apply a retinoid to clean skin at night and wait a few minutes before layering on moisturizer. Because the skin on the neck is thinner than it is on the face, start with a small amount of retinoid and build up slowly. If you’ve never used one, a dermatologist can guide you in selecting the right product.

Shrink your double chin

If you’re worried about a double chin, a non-invasive treatment called Kybella® could help restore the youthful neck you desire. Kybella® is a non-surgical treatment that involves a series of deoxycholic acid injections which target and destroy fat cells in the chin. There are no incisions with Kybella® and most patients experience minimal downtime.

While the acid in Kybella® does destroy fat cells, which are metabolized and eliminated by the body naturally, it won’t help with turkey neck. “Kybella® does not change the skin of the neck or laxity that may be present in the platysma,” Dr. Paul explains. To remove sagging skin after Kybella® treatment, a skin-tightening or surgical procedure may be necessary.

Reduce wrinkles caused by aging and sun damage

We know Injectables works to reduce lines and wrinkles on the face. Similarly, Injectables can be injected into the submental area and jawline to give a “lift” to an aging neck. “Injectables may reduce vertical cording or banding on the neck that is caused by platysma muscle contraction,” says Dr. Paul. The treatment promotes a more youthful neck by relaxing the muscles that pull on the overlying skin and create wrinkles. The results of Injectables last between four and six months, and the treatment can be performed in as little as 15 minutes. It’s best on vertical lines, though. Injectables will have little, if any, effect on horizontal lines which are formed on the neck through skin creasing.

Embrace technology to improve sagging skin

It can be challenging to treat sagging skin with topical products alone. At the same time, many patients are hesitant to go under the knife to correct loose neck skin. Luckily there are several professional skin tightening options that can give them the results they desire without surgery.

“Radiofrequency and ultrasound devices aim to tighten the neck with energy,” says Dr. Paul. The treatments have been shown to tighten loose neck skin by using energy to heat the skin and boosts the production of collagen and important proteins. However, Dr. Paul cautions that the effects of these devices is limited and patients may need multiple treatments to see results.

The benefits of the laser, over the knife

We know lasers can reduce unwanted hair and remove tattoos, but these incredible devices can also be used to rejuvenate the skin and promote a more youthful look. Laser resurfacing involves directing short, concentrated, pulsating beams of light at the face or neck to remove damaged skin layer by layer.

With laser resurfacing, “the goal is to improve lines, texture, and surface irregularities,” says Dr. Paul. There are two types of lasers commonly used in skin resurfacing: ablative CO2 lasers and non-ablative (fraxel) lasers. “There is more tightening with ablative lasers, though there is a higher risk of neck scarring,” Dr. Paul cautions. “Choose your laser doctor carefully.”

Try intense pulsed light therapy for dark spots

If you have dark spots on your neck, you’re looking at the results of sun damage. Luckily, you don’t have to live with age spots forever. Intense pulsed light therapy (IPL) is similar to a laser treatment in that it uses energy to treat wrinkles, dark spots, and sun damage. But it’s different because it releases many different wavelengths of light, so is more scattered and less targeted. During an IPL treatment, pigment in the skin absorbs the light, which is converted to heat. The heat then destroys the unwanted pigment to fade the appearance of red and brown spots. According to Dr. Paul, it may take between three and five IPL treatments to see results.

When surgery is the best option

Non-invasive treatments can dramatically improve the appearance of a double chin and wrinkles, age spots, and fine lines on the neck. If you have loose or sagging skin, however, you might be best treated with surgery. Options for cosmetic neck surgery include liposuction of the neck to reduce fat or a neck lift to tighten the skin and muscle (platysmaplasty).

According to Dr. Paul, a neck lift in conjunction with a deep plane facelift is the gold standard in restoring a youthful neck and jawline. In this procedure, the deep tissues of the neck are dissected and supported to lift sagging skin on the neck and jowls. A deep plane face and neck lift is performed under general anesthesia in an operating room. The results are natural looking and can last up to 10 to 12 years.

This article was originally published in The Aedition on January 1st.

Taqtik mastectomy
CategoriesOncology

What to Expect Before, During and After Mastectomy Surgery.

When it comes to breast cancer prevention, treatment, and recovery, mastectomies play an important role — but the surgery is often deeply personal and emotional. Here, The AEDITION speaks with two preeminent reconstructive surgeons about the procedure.

Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, according to the Centers for Disease Control and Prevention (CDC), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to BCA, from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.

According to the U.S. Department of Health and Human Services’ National Cancer Institute, 268,600 women will be diagnosed with breast cancer in 2019. There will also be an estimated 2,670 new cases of invasive breast cancer reported in men. When it comes to breast cancer prevention, treatment, and recovery, mastectomies play an important role, but the surgery is deeply personal and emotional. Approaching the procedure and all the decisions that accompany it armed with the best information is key, and The AEDITION here to help.

WHAT IS A MASTECTOMY?

A mastectomy is a surgery to remove tissue from one or both breasts in an effort to eliminate cancer cells or prevent cancerous tumors from forming in the future. Not be confused with a lumpectomy, which extracts lumps of cancerous cells from the breast without removing all of the surrounding tissue, a mastectomy involves the removal of all the breast tissue. While a lumpectomy is a less invasive breast cancer treatment option — both physically and emotionally — it is not always an aggressive enough solution.

WHAT ARE THE TYPES OF MASTECTOMIES?

Whether the procedure is being used for breast cancer prevention or treatment, there are four main types of mastectomies that can be performed unilaterally (removing one breast) or bilaterally (removing both breasts). Which technique is chosen often depends on a patient’s body and diagnosis.

Simple (a.k.a. Total) Mastectomy: A surgeon removes the entire breast (including the skin, tissue, nipple, and areola) but does not perform a lymph node dissection.
Radical Mastectomy: Reserved for rare cases when the cancer has spread into the underlying muscles, the procedure removes the breast, three levels of underarm lymph nodes, and the chest muscles under the breast. In a more common modified radical mastectomy, the breast tissue and lymph nodes are removed but the muscles of the chest wall remain.
Skin-Sparing Mastectomy: For patients who wish to combine a mastectomy with breast reconstruction surgery, this technique seeks to preserve as much of the breast skin as possible — regardless of whether a simple or radical procedure was performed.
Nipple-Sparing Mastectomy: Surgeons remove the breast tissue but keep the skin, nipple, and areola to aid the reconstruction process.

DO WOMEN CARRYING THE BRCA1 OR BRCA2 GENE NEED A PROPHYLACTIC (I.E. PREVENTATIVE) MASTECTOMY?

About 12 percent of women in the general population will develop breast cancer in their lifetime. Of women carrying BRCA1 or BRCA2 mutations, an estimated 72 and 69 percent will develop breast cancer by the age of 80, respectively.

While the decision is a personal one, National Cancer Institute data shows that women with either gene who undergo a prophylactic (a.k.a. preventative) mastectomy reduce their risk of breast cancer by 95 percent. Women who have a strong family history of breast cancer, meanwhile, see their risk mitigated by up to 90 percent with the procedure.

MASTECTOMY FAQ

Nashville-based board certified plastic surgeon Jacob Unger, MD, who specializes in reconstructive surgery following trauma and cancer, answers some of the most common questions that accompany mastectomy procedures.

The AEDITION: Is a mastectomy a 100 percent guarantee to be breast cancer-free?

Dr. Unger: No, there is always a chance of recurrence. No surgery can guarantee removal of every single cell of breast tissue. Recurrence rates are usually between one and five percent, depending on multiple factors for each individual person.

The AEDITION: Can men get breast cancer and need a mastectomy?

Dr. Unger: Yes, men can absolutely get a mastectomy. Depending on the size of the man’s breast, the scar pattern will vary, but the goal is to create a flat chest with aesthetically acceptable scar patterns that are hopefully hidden in the creases of the male pectoral muscles, if it all possible.

The AEDITION: When would someone get a unilateral versus bilateral mastectomy?

Dr. Unger: There are times where bilateral mastectomy is indicated from the cancer standpoint — such as if you have cancer in both breasts or have a particular type of cancer that leads to a very high risk of having cancer in the opposite breast as well as one that is primarily diagnosed.

I typically have a long conversation with patients talking about the pros and cons of unilateral versus bilateral mastectomy. One of the common reasons for bilateral mastectomy is many women do not feel comfortable keeping one natural breast. In these cases, there is also the additional upside of being able to attain symmetry much more easily due to the fact that I, as the reconstructive surgeon, am able to create the same thing on both sides. This is more difficult to do with one natural breast and one reconstructed breast.

Young women with a higher lifetime risk or women with large and low ptotic breasts are often best suited for bilateral, from both the risk standpoint and to create better shape and more symmetric breasts.

The AEDITION: How does a patient choose between a skin-sparing and nipple-sparing mastectomy?

Dr. Unger: The data is fairly clear that, unless there is direct nipple involvement, it is equally safe to get a nipple-sparing mastectomy or skin-sparing mastectomy. The reasons to get skin-sparing mastectomy and remove the nipple are, again, if there is direct involvement of the nipple with cancer thus being unable to keep it; or if the nipple is in a very poor position — such as too low — making it an impediment for creating an aesthetically pleasing outcome. Smaller breasts and even some larger, well-shaped breasts are often good candidates for nipple-sparing mastectomy.

WHAT IS LIKE TO GET A MASTECTOMY?

Given each patient will have a unique medical history and diagnosis, everyone’s process will look a little different. After finding the right surgeon(s) and determining the best course of action for your condition (some mastectomies may be combined with radiation or other treatments), the mastectomy procedure generally involves the same course of action.

Without breast reconstruction, a mastectomy is usually an outpatient procedure that lasts one to three hours and is performed under general anesthesia. The surgeon typically begins by making an elliptical incision around the breast (more incisions may be needed for a nipple-sparing surgery) and removing the tissue and any other part of the breast (i.e. the nipple, skin, areola) decided upon. The sentinel node or axillary lymph node dissection will also be performed as needed.

If a reconstructive procedure is not being performed in tandem, the surgeon will insert surgical drains to accommodate excess fluid and close the incision (the drains will be removed during the first post-op appointment, about one to two weeks after the procedure). The entire surgical site is then wrapped with a bandage.

Mastectomy side effects are similar to those of most surgeries, and many doctors will prescribe pain medication to deal with the symptoms. Most patients experience pain and swelling, buildup of blood at the surgery site, limited mobility, and numbness. Infection is also possible, as is lymphedema (fluid build up), in cases where the nodes are removed.

Depending on the type of mastectomy performed, some patients may be able to go home the same day, while longer hospital stays (up to three days) may be needed for bilateral and reconstructive procedures.

POST-MASTECTOMY FAQ

So, what can patients expect in the aftermath of a mastectomy? The AEDITION spoke to Leif Rogers, MD, a Beverly Hills-based board certified plastic and reconstructive surgeon who is a pioneer in advanced breast reconstruction, about what to expect post-op.

The AEDITION: What does the chest look like after a mastectomy?

Dr. Rogers: How a chest looks after mastectomy is completely dependent on the oncological breast surgeon. Different surgeons have different preferred techniques. If a traditional mastectomy is performed without a skin-sparing technique, the chest has a transverse scar on it running from the axillary lymph nodes (armpit area) to almost the sternum. If skin-sparing is performed and a tissue expander or implant is placed at the time of mastectomy, the breast can look relatively normal immediately. Additional surgeries are often needed to fine tune the result for symmetry and optimal cosmesis.

The AEDITION: When it comes to breast reconstruction after a mastectomy, what can patients expect?

Dr. Rogers: There are a great many things that can be done for breast reconstruction. Many of the old limitations for reconstruction — especially after radiation therapy — no longer apply. I can build a breast using an implant or a patient’s own tissue. If a patient elects to use her own tissue, there are many different procedures to choose from. I feel the best three, in terms of cosmetic outcome of the breast and minimal donor site morbidity, are the DIEP flap (deep inferior epigastric perforator, which runs through the abdomen), the TUG flap (transverse upper gracilis in the upper thighs), and autologous fat grafting. All of these techniques can be used to create one or both breasts without the use of an implant.

Implant reconstructions have also gotten much better with the addition of autologous fat grafting. Fat grafting can smooth out the contours and make almost any implant reconstruction look like a natural breast. Nipples can also be reconstructed using one of a number of techniques and can look 90 percent like the original. Nipple reconstruction has been less often required in recent times due to the acceptance of nipple-sparing mastectomies.

The AEDITION: When do you recommend patients get reconstructive surgery?

Dr. Rogers: I always recommend starting the reconstructive process at the time of mastectomy. The cosmetic outcomes are far superior. I also recommend skin-sparing and, if possible, nipple-sparing mastectomies. I find that even if a flap procedure is the chosen method of reconstruction, a primary placement of a tissue expander improves the cosmetic outcome and decreases complication significantly.

THE TAKEAWAY

While a mastectomy is never an easy procedure for the patient or their loved ones, much progress has been made in surgical and reconstruction methods. Finding the right surgeons and treatment for your diagnosis will ensure you get the best care possible, and, for those who choose to undergo a reconstructive procedure in tandem (or in the future), natural breasts are attainable through implants, fat grafting, or a combination of the two.

TAKE THE NEXT STEP

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For more information on destinations that offer Oncology treatment contact the Taqtik Customer Care Team, or search for available packages on the Taqtik Marketplace.

This article was originally published on the Aedition website.

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