Prophylactic Mastectomy - an ounce of prevention is worth 5% of cure

Sometimes things that are so obviously intuitive still have to be validated. After a number of years of controversy, an increasing utilized surgery to prevent breast cancer is now being shown to be quite effective in both risk reduction and cancer-related mortality. The study "A Population-Based Study of Contralateral Prophylactic Mastectomy and Survival Outcomes of Breast Cancer Patients" is published in the Journal of the National Cancer Institute and can be seen here.

Contralateral prophylactic mastectomy, (CPM), a preventive procedure to remove the unaffected breast in patients with disease in one breast, clearly appears to offer a survival benefit to breast cancer patients age 50 and younger, who have early-stage disease and are estrogen receptor (ER) negative. We've known for several decades that CPM reduced the risk of developing breast cancer, but it was always more elusive to show that it actually saved lives at the end of the day. The practice of CPM has expanded significantly, with >150% growth in the number of such surgeries since the late 1990's.

How effective is CPM? Those younger than age 50 with early stage cancer with ER negative disease had a survival benefit of almost 5% at five years.  For a therapeutic intervention for cancer, 5% is really substantial. You can take it to the bank that following these patients out even farther that we will show increased survival benefit with longer follow-up in the population. This is due to the fact that

1. the patient's likelihood of getting a second breast cancer in the non-removed breast increases with time
2. patients with prior breast cancer are among the highest risk group for developing breast cancer

Women older then 50 have a little more complicated decision. In cold, hard actuarial terms you are more likely to die from something else before a new breast cancer would kill you. On the other hand, steadily increasing lifespans of adult Americans has made some of these kind of statistical bets have to be reexamined. I would guess that the reported benefit of CPM gradually increases towards 60 years in future clinical guidelines.

Rob

Study confirms that breast implants do not affect breast cancer survival

A recent Canadian study long term follow-up (see here) confirms prior observations that women with breast implants who go on to develop breast cancer have similar outcomes as women without implants who develop cancer. This is more reassurance to our patients about this theoretical concern with implants (ie. that potential difficulty with mammograms would lead to delayed breast cancer diagnosis and worse outcomes). Along a similar vein, women with implants actually have a much lower (~ 40% lower I think) rate of breast cancer as compared to peer groups in the population.

Rob

Mayweather-Mosley HBO 24/7 Episode 3

Mayweather Mosley 24/7 Episode 3.  The next installment of the HBO 24/7 documentary will be airing this Saturday on HBO.  Watch Mayweather Mosley 24/7 Episode 3 as we get to know more about the two boxers. After watching the videos of the introduction of Mayweather-Mosley HBO 24/7 Build up, Interview and Promo Videos 3 weeks ago, the Mayweather-Mosley 24/7 Episode 1 last Saturday April 10, 2010

Mike Brown vs Manvel Gamburyan Fight Video

Mike Brown vs Manvel Gamburyan Video.  One of the WEC 48 main cards will be Brown vs Gamburyan this Saturday as the two fight for the Featherweight bout.

Mike Brown is the former WEC Featherweight Champion and is currently ranked as the no. 2 featherweight fighter in the world by Sherdog.  He has fought in many different mixed martial arts events like UFC and the recent one is in WEC.  He lost

Hollywood Hating On Breast Implants

Heidi Montag's cups are currently being traded for smaller chests like Astrid Berges-Frisbey in LA castings.

Photo: StyleList.com

AOL just asked me to write a story on boob jobs.

Apparently, there's quite a bit of backlash going on about breast implants - in of all places, Hollywood.

Yep - we're talking about the town that practically invented the concept of the eternally perky, full breast.

You can read the full story here.

It brings up a very important point that I get asked a ton about: breast implant size.

As you'll see from the link, women who choose supersized breast implants are often the unfair target of harsh judgments made by other people. These judgments can even limit the possibilities of things you may want for yourself in life - like certain careers and relationships.

You don't need to be a rocket scientist to figure out that many people think that extra large breasts = dumbed down floozy.

Now I think that's totally ridiculous, but that's unfortunately the world we live in.

So when women ask me what size to go with, I always tell them to make sure they're picking one that works in all facets of their lives - from the professional to the intimate to the fun.

That DD cup that makes your husband go cross-eyed and drop everything may make you feel like you need to button up to your chin while leading a presentation at work.

And Lord knows you're not shelling out those thousands just so you can walk around looking like a nun!

So you want to be aware of the image you're projecting, because most human beings -- whether it's wrong or right -- will judge the way you 'package' yourself.

There are also added complication risks you need to consider when going for an extra large size. Your skin and tissue needs to be able to support it, and it's often not pretty what an extra large implant will do to your chest tissue after years of gravity and wear and tear.

Plus, a large rack is HEAVY and can get cumbersome and tiring to carry around. I mention in the story that Sharon Osbourne is removing her DD implants this July - and it's for exactly this reason. She says they get in her way, and she's tired of lugging them around at the expense of her back.

With all that said, if you still decide that a supersized implant is for you and you have the confidence to carry it off, then I'm totally in support of you getting what you want and enjoying them!

Just remember that you need to be EXTRA vigilant about hiring a fantastic surgeon, because anyone with anything less than the best skills who implants extra large breasts is usually a recipe for disaster and the dreaded botched boob job.

And as for the chatter in the story from casting directors about breast implants being out of vogue in Hollywood - I say sure - maybe for the next five minutes. :-)

We're so familiar with this as women. Pointy toed heels are in, then they're out. Then they're on the cover of Vogue again, but not before you already sold your old pair on eBay. Damn it.

The truth is, for all the whining people do about how breast implants are fake and terrible and the cause for every ill of humanity, they walk past women with implants every day, and are none the wiser about it.

The average woman asks for a "full C" when getting implants. And no one can tell unless she shares the secret.

Just some food for thought as you contemplate boob jobs!

And remember - The Boob Job Bible is my full guide to everything you need to know to safely get the beautiful breast augmentation you've always dreamed of.

I back it with a bullet-proof 30 day money-back guarantee, always.

CELANA ARMY

Kemaren2 banyak bgt kejadian2 yang ga enak...

Sebagai contoh, ada orang gila yang marah2 sendiri di facebook *damn*...

Hari Minggu gw jalan2 sekeluarga ke MKG, disana bokap gw ngelirik toko baju merek BALENO yang menurut nyokap gw mahal. Bokap gw emang seneng bgt sama celana tentara, beliau menganggap cewe yang pake celana tentara adalah mahluk Tuhan paling seksoy.

Makanya, alhasil, gw disuru beli celana tentara.

Kk gw yang cowo, juga, dikatain kampungan sama bokap, secara dia ga pernah beli baju yang trendy, cuma celana cargo plus t shirt gombrong.

nyokap: ALDIII (nama kk gw), kamu tuh stylish dikit dong, malu sama tmn2 kamuuu!!

kk: uda lah ma, aku ga tertarik gaya2 metroseksual...

bokap: KAMU ITU HARUS TRENDY! KAMU KAMPUNGAN! DUIT PUNYA JUGA KAYA ANAK PEMULUNG GAYANYA!!! 

nyokap: (cekikikan ngerlirik2 celana sama thirt bokap yang gayanya persis kk gw)

gw+adek gw: (geli2)

kk: kan, aku ikutin gayanya papa dri dulu...

bokap: ...

lanjut, gw masuk brg bokap

bokap dengan antusias langsung ngambil celana army trus nyuruh gw ngepas-in

gw: tapi kata mama mahal Pi...

bokap: *nyamber label harganya* gapapa!

gw: *kaget, shock*

bokap: bagus! saya beli yang ini (suaranya lantang abis, nyokap gw melotot, mbaknya cengar cengir)

nyokap: Nes, itu harganya brp?

gw: ga tau, kata papi murah..

nyokap: Baleno itu ga ada yang murah masalahnya..

gw: Pi, harganya brp?

bokap: 15orb kecil lah..

nyokap: GA MUNGKIN!

mbknya: Maaf Pak, itu..yang 150rb itu...sabuknya...bukan celananya..celananya 500rb

bokap gw: *ambeien, nyaris struk*

gw:...... 

bokap: kamu suka celananya ga?

gw: *berasa ga enak* ...ntar ya mbak, kita cri makan dulu..nanti balik lagi

gw ga balik lagi....pas jalan ke restoran

bokap: *masih syok sambil mengutuk2 merek Baleno* 500 rb, APAAN! made in CHINA jga!!! 

adek gw: ...dan celananya dipake sama mbk2 penjualnya...

bokap: GA USAH BELANJA DISITU! UD MAHAL TRUS ANAK GW DISAMAIN SAMA MBAK2 PENJAGA TOKONYA!

P.S: jangan belanja di Baleno, mahal2 500rb di mangga 2 banyak, mana made in china....Baleno, dapat menyebabkan kanker dan kerusakan janin...

Slick Deals from Allergan for Botox or Juvederm rebate

One of my favorite shopping websites is Slickdeals (www.slickdeals.net) which is a user driven collection of random shopping deals around the internet. You can find some fantastic bargains on all kinds of things, and the site is updated throughout the day by users reporting sales and promotional items.

In honor of this, I'd like to point out the "slick deal" Allergan is offering on it's products thru July. Allergan is the world's largest breast implant manufacturer, but they also make BOTOX, the dermal filler Juvederm, and the eyelash growing solution Lastisse. Thru July they are offering a $50 rebate coupon on either BOTOX or Juvederm purchases when you try Latisse. Details are available here.

Rob

FDA to mesotherapy - Put up or shut up! (but shut up first)

The FDA last week issued cease and desist orders for a number of clinics offering fat melting "mesotherapy" injections.  The drugs most regularly used in this process are phosphatidylcholine and deoxycholate. Other drugs or products such as vitamins, minerals, and herbal extracts are often mixed into the "gumbo", complicating any assessment of safety or efficacy. Phosphatidylcholine is not approved for injection into your body and has never been evaluated for that use in controlled settings. The new warning shot over the bow went out to six U.S clinics:

• Monarch Medspa in King of Prussia, Pa.
• Spa 35 in Boise, Idaho
• Medical Cosmetic Enhancements in Chevy Chase, Md.
• Innovative Directions in Health in Edina, Minn.
• PURE Med Spa in Boca Raton, Fla.
• All About You Med Spa in Madison, Ind

I would strongly advise people considering using these facilities to think again, as their disregard for patient safety with off label experimentation of these injectable concoctions should signal a general disregard for their patients. As alerts to this FDA warning went out on the ambulance chaser network of websites, expect to see ads shortly recruiting clients for lawsuits.

FYI If you are interested in reading about mesotherapy, I've written several entries about it since 2007 which can be seen here.

Rob

There's no escape from Magical Thinking on health care apparently

There's a good bit of magical thinking around the idea of preventive care. One of the most disingenuous aspects of this is the push for these measures as "free" as part of the health care reform debate. Nothing of value is free, and in health care the overhead propping up the system makes that even more true.

Now there are both cheap and expensive measures that included in what we call preventive care or cancer screening, but at the end of the day they do not save money (even if they may make us healthier). It's actually counterintuitive that some bad habits or diseases from them (smoking or diabetes) may actually save  money as they die younger and end up costing less over a lifetime. That's not a reason to not support early intervention, but it is something that has to be considered when making your countries health care budget.

The truth that the health care costs as a % of GDP are ignored by the bill passed is really scandalous. Facing those true costs was not something the  left was going to let get in the way of entrenching their goal of federal health care. A story about the effects of the health care reform bill I read (see here) seemed to forget that all costs matter until pointed out over and over by readers in the comments section. I thought this one was spot on,

Colonoscopies and mammograms are absolutely not “preventive” care, they are early detection. Having a mammography will not prevent breast cancer any more than owning an umbrella will prevent rain. It may stave off the full and most dire effects of a diagnosis of cancer by allowing early intervention, but that is far from prevention. You will have to pay for the surgery, the radiation, the medication, all the same. Talk about “magical thinking”.

The politics of  telling people NO is complicated and gets caught up in issue driven advocacy groups. A large study from Denmark touched on this obliquely by studying an area of screening efficacy (or lack thereof) when they found no evidence that screening women for breast cancer has any effect on death rates when applied to their countries women in well organized screening programs. For context, breast cancer is the most common cancer in women worldwide, accounting for around 16 percent of all female cancers and is attributed to almost 519,000 people globally each year.

How do other western countries with modern health care systems screen for breast cancer? In Denmark, women are screened every two years from age 50, while in Britain the policy is for women over 50 to be screened about every 3 years. Evidence now suggests that for every 2,000 women who are screened over 10 years, only one stands to have her life saved by the mammogram program, whereas the chance of getting an unnecessary breast cancer diagnosis is 10 times that.

If you'll remember in 2009, we had a hailstorm of controversy here in America when it was suggested that our current guidelines of starting screening mammograms at 40 was neither cost-effective nor evidence-based for affecting breast cancer mortality. There was a lot of ignorant political grandstanding on this as a woman's issue (step forward congresswoman Debbie Wasserman-Schultz D-FL) and Democrat's were furious that this kind of recommendation was coming out during their poorly-conceived sales job on health care reform. God forbid there be any notion that evidence based medicine might infringe upon you right to insist on your ______ (Mammogram, CT Scan, MRI, back surgery, etc....) without considering considering the cost or efficacy. It was a lie then and it's a lie now.

Rob

Breast Implants Without Anesthesia

Photo: www.vip-arabmedical.com

The New York Times reported a disturbing trend today: the increase in doctors offering breast augmentation without general anesthesia.

You can read the full story here.

I just read the piece, and I literally dropped everything to put together this potentially life-saving message for you. This is one of the most dangerous games I've seen cash-hungry doctors getting away with in this country yet.

The piece features Dr. Robert L. True of Colleyville, Texas as one of more than 100 doctors in the USA who perform breast augmentation under local sedation.

Dr. True is really a gynecologist though. No surprise there. Many non-plastic surgeons are picking up more lucrative work "on the side" since you get paid up front and in full when performing cosmetic surgery, and you don't have to deal with insurance companies.

Doctors who perform cosmetic surgery on the side often learn how to do the surgery in weekend seminars. Meanwhile, plastic surgeons study breast augmentation for years before they're allowed to touch a patient all on their own. I can't tell you how drastic the difference in knowledge and care is between the two camps. It's literally the difference between taking a weekend course or getting a PHD in a subject.

And I can't over-emphasize enough how dangerous it is to hire someone who is not a board-certified plastic surgeon to cut into your body with a scalpel.

It's not worth any amount of savings.

You've got one face and one body, not to mention one life - and hiring someone who isn't qualified to touch you risks all of that.

But I haven't even shared what Dr. True likes to do with his patients during their breast augmentations.

Dr. True says he actually talks to his patients while they are laying on the table getting sliced up, and even sits them up on the table in a groggy haze so they can take a look at their breasts half way through and choose their size!

Do you have any idea how 'out of it' you are when you've got all of those narcotics and drugs pumping through your system? And now you're going to make a decision that will have permanent consequences for your body?

The story doesn't even touch upon the potential complications a doctor carelessly exposes you to by moving you up and around while operating on your breasts.

I can't believe a doctor can legally get away with doing this in this country.

There is a tragedy just waiting to happen here. And I don't want you to be the one who falls susceptible to it.

Heading into your breast augmentation surgery, all implant decisions should already be made. There is no reason to have to pick your size while you're undergoing the actual surgery.

The only thing your board-certified plastic surgeon should be doing during surgery is concentrating on your safety and the skill of placing the implant properly so that he produces the beautiful results you both agreed on BEFORE the surgery!

I of course go into detail on all the decisions you should make prior to the surgery in The Boob Job Bible.

Take the time to educate yourself and do all your research so that you won't fall prey to dangerous situations like this one, and so that you can have a safe, gentle experience that produces the gorgeous results that you want.

Please pass this message on to anyone you know considering a breast augmentation so that they're warned. Let's all keep one another safe.

Growing Hacks in Cali...Cali - Underqualified cosmetic surgeons plague the Golden State

Nod to LL Cool J in the post title :)

California is an iconic part of the United States that sets many trends. Unfortunately one of these trends is the growth of under or untrained physicians performing cosmetic surgery procedures.

A snapshot of who is performing cosmetic procedures in California, published this month in the journal, Plastic and Reconstructive Surgery, examined 1,876 cosmetic practitioners from San Diego to Los Angeles. Only 495 of them were actually trained in plastic surgery. Primary care physicians with no surgical training to speak of made up the 4th group of liposuction providers following plastic surgeons, dermatologists and otolaryngologists.

Scary, Scary stuff! It seems obvious, but always look for a board certified Plastic Surgeon if you're considering plastic surgery.

Rob

24 Season 8 Episode 15-16: watch 24 Season 8 15-16 stream online

it's going to be a special episode in 24 season 8 as it airs episode 15 – 16 this coming Monday, April 5, 2010. Yup, it's a double episode on a two hours straight of 24 season 8 episode 15 & 16. For sure is full of action and excitement.

Last week, President Taylor returned and assigned Jack to get President Hassan and his family to safety as the threat of a dirty bomb detonation intensified.

Are your breast implants under warranty?

The New York Times had a story last week (see here) on how expensive orthopedic implants for knees and hips were to replace when they failed. As the cost of the devices themselves (without hospital or physician charges) can run north of $15,000, it can be more then $50K on the price tag when these patients require re-operation for premature failure. Highlighted in the story was the fact that the manufacturers did not expressly provide a warranty for replacement costs of their implants.

Much like these orthopedic devices, patients with breast implants can expect their devices to have to be replaced at some point in their life, either thru device failure or for aesthetic revision issues as their body changes. In contradistinction to the orthopedic companies, both Allergan and Mentor Corp. (whom combined sell 99% of all breast implants in the United States) have offered lifetime replacements on their failed devices for several years now. Allergan in particular has been admirable, as the parent company that makes the implants has been sold twice from it's roots as McGhan medical (later Inamed Corp.). As both Allergan and Johnson & Johnson (owner of Mentor Corp. since 2009) are huge multinationals, it would seem patients with these implants should have a good deal of security of their devices fail for replacement of their implants.

These implant companies do not however cover all other costs associated with the replacement of the devices, but have come up with a fairly generous standard program matched by both Mentor & Allergan

• 10 years of guaranteed financial assistance
• Up to $1200 in out-of-pocket expenses for surgical fees, operating room and anesthesia expenses not covered by insurance
• Silicone filled and saline filled breast implants are both covered
• Lifetime product replacement
• Automatic enrollment at the time of your original surgery

Now as a breast implant is relative expensive to design and test clinically, but inexpensive to manufacture by the unit, it's easy to see how these companies can absorb the cost. I don't know exactly their margin per device, but I think it's $600-700+ per silicone implant they sell.

Rob

BENCONG / MUMI?

PILIH BENCONG/MUMI?

Kemaren gw tlp sama Cindy, soalnya liburnya kelamaan jadi kangen sama temen :'(

Di tlp kita ngobrolin ttg rencana keluar negri

Nah kebetulan kita sepakat ke Sing/Aussie, kemungkinan besar sih Singapore, kan kita cewe (alesan apaan coba?)

Cindy: Sis, kok u pilih Multimedia sih?

Gw: Sebenernya...gw dulu pengen jadi arkeolog, kek mempelajari tulisan dan sejarah2 kuno negara2 kek Yunani, Ancient Greek, Mesir gitu2, gw bahkan punya koleksi benda2 mesir banyak bgt...

Cindy: Trus kok jadi design?

Gw: ..ga tau.......

Cindy: hah??

Gw: Gw pikir, mending bencong kan, dripada mumi?

Cindy: Hehh????

Gw: Gini cin, tadinya gw berpikir semua cowo yg ambil design itu bencong...

Cindy: Trus kenapa masih ambil?

Gw: yah, gw pilih bencong, dripada gw jadi arkeolog, nanti gw kena longsor di penggalian trus gw jatoh ke makam mumi, nah kan gw sendirian sama mumi2 gitu...sapa coba yang bisa jamin gw ga jatuh cinta sama mumi itu??? kan gw takut kesambet mumi girang....

Cindy: OOOOOO.......

Gw: Nanti malem2 gw kesurupan, napsu sama mumi, GIMANA????

Cindy: Iya sih...

Gw: nah, gw pilih bencong dah........

Cindy: Sis, uda malem, tidur gih, bsk kita lanjut kalo u udah ga pusing...

Gw: Thanks Cindy......oh ya, kamu mau ikut mobil aku ga ke kampus? aku uda punya sim loh...

Cindy: nembak ya?

Gw: iya....

Cindy: met bubu.....

P.S: makin malem makin sinting

POSER, LOSER, FAKER

Ga taw mesti ngomong apa...

Kok bsa ya orang2 kek mereka hidup...apa ga punya hidup dan gaya sendiri ato gimanaa gitu...

Gw ini ga cakep2 banget kek Lady Gaga ato Sexy Beyonce, Mulan Jameela, Trio Macan, Trio Bebek, Trio kadas kudis kurap, ato artis2 kondang lainya..tapi kok bsa ya, ada orang2 yang pake acara niru2 gaya, style, dan edit photo gw segala... swt...

Capek, BANGET.

Sebagai contoh, photo gw diatas berikut, kok bsa ya, adaaa aja orang yang niru hal simple kek gitu?? Bingung.... Mulai dari letak tulisan, font text yang kugunakan, perbedaan warna font, dan kalimat yang gw gunakan... serta letak tanggal???

ASTAGFIRULOH...

gw semprot tuh orang langsung, dan dia cma bs blg sorii, itu cma mirip SEKALI doang.. WTF? font? text? proposition? nilai sejarah? Oke..yang terakhir ga nyambung...

Dulu juga pernah ngalamin kek gini, malahan, photo gw yang dijadikan media kebohongan...sejak kapan nama gw jadi berubah jadi Siti, Tukiyem, ato sebagainya? (nama samaran dirahasiakan karena orang nya uda ketauan! F*CK U B*TCH!)

Ada lagi alay yang pas gw tegur, dia nyalahin gw, memutar balik fakta gw yang tiru dia. AMPUN TUHAN! Kok manusia kek dia bsa hidup??

Diantara gw yang terlalu famous, ato dia yang terlalu keren sampe bsa niru orang...

Begini2 di kalangan ojek, tukang sayur, sama gorengan gw cukup terkenal!!!!

Contoh:

P.S: Yah..terkenal tetap terkenal kan? meskipun kalanganya agak menengah kebawah...

SIM ABC

MULAI SEKARANG, NAIK TRUK, TAXY, ATO ANGKOT, BISA LAH!

Senangnya dapat sim! Hatiku berbunga2 sampai berasa ada bunga keluar dri hidung gw.... XDDDD

3 hari kursus, belum bsa parkir, rem lancar, dsb sudah dinyatakan lulus SIM! xDDD 

membuktikan, aku memang jenius lahir batin.

Sayangnya, disana gwlah satu2nya anak berumur 17 thn, sementara yang lain sudah berumah tangga. Eittss...jangan salah, karena gw jenius, gw bsa tuh ngobrol dan gaul dengan para ibu2 itu. malahan mereka semua ngantri add fb ku gara2 ketawa ketiwi sepanjang tes wkwkwkwk.

Di tes sim itu, semua pertanyaan goblok yang kalo kita jawab jujur itu salah, kalo bohong malah bener. Kok bisa?? Contoh..

soal 1:

Ada mobil sedang parkir, tiba2 anda menabraknya, sementara banyak massal yang melihat, tindakan yang benar adalah:

a.lari dari situ, dan tidak bertanggung jawab

b.melarikan diri dari kerumunan massal karena anda yakin akan mendapatkan penganiayaan, tetapi tetap lapor ke kantor polisi

c. membiarkan diri anda terluka karena merasa itu kesalahan anda, dan rela dihukum sesuai dengan Undang2 yang berlaku

jawab: 

bohong: B

jujur: A

sebenarnya mau jujur, tapi takut ga lulus, ya sudahlah...

pulang ambil sim, aku latihan mobil,

merasa jauh lebih pede, gw tancap gigi 2 angkat kopling, dan GAS trus

didepan ada tukang sayur, gw nyengir...

P.S: Percayalah wahai tukang sayur, saya tidak akan menabrak anda lagi... :)