Category: Blog

It is becoming increasingly popular for people to want correct information about their food. We want to know how many calories are in our favourite coffee from the coffee shop for example, but are we aware of how much exercise is needed to burn off these calories? The chief executive of the Royal Society for Public Health says a simple icon on food packaging could be the answer.

Their idea is that with a simple, recognisable icon, people will have better understanding of the effort needed to burn off the calories in their favourite snacks. 

The idea behind this icon is not to scare people into dieting, but rather to educate them on what they eat and how this can impact their lives. It allows people to see just how active they need to be in order to burn off their tasty treats. Encouraging people to live a healthy lifestyle can only be beneficial and can help people to have a better quality of life. 

 

Encouraging people to try to be more active in order to burn off their surplus calories can help them to feel good about themselves and have a positive attitude towards a healthy balanced lifestyle. 

 

Silicone implants have been used in plastic, aesthetic and reconstructive breast surgery since the 1960’s and have long been considered as biologically inert and harmless. 

The safety of breast implants has been extensively investigated in North America specifically related to concerns related to links with connective tissue diseases such as cancer, systemic lupus erythematosis, rheumatoid arthritis, scleroderma. 

The FDA Views

Although the FDA has shown that silicone does not cause breast implant sickness, cancer or major diseases, no-one can deny that some individuals do have allergies to silicone and silicone-related products and that there are patients who develop non-specific symptoms. The FDA has shown that there is a 1-2% link to autoimmune symptoms/conditions but this is not significantly higher than the general population. 

Social Views on Breast Implant Sickness

Silicone sickness, silicone sickness syndrome, breast implant sickness are terms used throughout social media by patients describing chronic fatigue, joint pain, and muscle soreness. 

Crystal’s Hefner was one high profile celebrity in 2016 that wrote: “My Breast Implants Slowly Poisoned Me. Intolerance to foods and beverages, unexplained back pain, constant neck and shoulder pain, cognitive dysfunction (brain fog, memory loss), stunted hair growth, incapacitating fatigue, burning bladder pain, low immunity, recurring infections and problems with my thyroid and adrenals.”

Past Statistics

The bizarre collection of symptoms has previously been described in Israel in 2015 as autoimmune/inflammatory syndrome induced by adjuvant—ASIA (Ref 1). 

Those believed to be most at risk include:-

1. Those with prior documented autoimmune reactions to an adjuvant ie such as vaccination or implant. 
2. Those with established autoimmune conditions such as rheumatoid arthritis, diabetes etc
3. 75% of women had a history of allergic conditions such as eczema, hay fever, pollen and dust allergy, drug allergy, rubber or latex allergy.
4. Those with a family history of autoimmune diseases such as rheumatoid arthritis, multiple sclerosis, systemic lupus, etc.

In addition to the genetic predisposition, environmental factors have also been linked to autoimmunity. Obesity and smoking are both examples of environmental triggers that contribute to both initiation and progression of autoimmune disorders. 

Danish Breast Implant Sickness Study 

Interestingly however a long term follow up study of Danish women who had submammry smooth silicone breast implants for an average of 19 years found no consistent differences in the seroprevalences of antinuclear antibodies or other autoantibodies ie markers for rheumatoid arthritis. The authors evaluated long-term symptoms and conditions and medication use among 190 Danish women with cosmetic silicone breast implants compared with 186 women who had undergone breast reduction surgery and with 149 women from the general population. They concluded that their breast implants did not appear to be associated with other symptoms, diseases, or autoimmune reactivity. There was however a self reported increase in hormonal replacement therapy, psychotropic medications, with an emphasis on antidepressants amongst those women with breast implants.

Concluded Evidence of Breast Implant Sickness

For those that have developed unusual symptoms that they associate with breast implant sickness / silicone sick syndrome there is no guarantee that removing breast implants will resolve the symptoms. There is also no evidence that en bloc removal of the capsules with removal of the breast implants will resolve symptoms.

Mr Ross offers en bloc removal of implants and will always send the breast implant capsule for pathological analysis so that patients can be given additional reassurance. Patients however need to be aware of the pros and cons and be empowered to make the decision to proceed with removal or not.

 

References 

1. Goren I, Segal G, Shoenfeld Y. Autoimmune/inflammatory syndrome induced by adjuvant (ASIA) evolution after silicone implants. Whois at risk? Clin Rheumatol. 2015 Oct;34(10):1661-6. Epub 2015 Apr 16.
2. Breiting VB, Holmich, LR, Brandt B, Long-term health status of Danish women with silicone breast implants. Plastic and Reconstructive Surgery. 2004; 114: 217-226.

The idea of an electronic cigarette (or “e-cigarette” or “e-cig”) is traced to 1963, when Herbert Gilbert filed a patent for this type of product. 

The e-cigarette delivers vaporized nicotine to the inhaler by the use of a battery-powered device. The common components of all e-cigarette devices include a power source, a heating element (atomizer), and a liquid container. The atomizer vaporizes a liquid combination of nicotine, which may contain additional flavorings. 

From a health perspective, evidence suggests that e-cigarettes are safer than traditional cigarettes because the tar is removed, and maybe as safe as other nicotine replacement products, such as gum or patches. The long-term effects of inhaling nicotine vapor are unclear, but there is no evidence to date that it causes cancer or heart disease as cigarette smoking does. Indeed, many researchers agree that e-cigarettes will turn out to be much safer than conventional cigarettes. 

However there have been reports of adverse events involving e-cigarettes including hospitalization for illnesses such as pneumonia, congestive heart failure, disorientation, seizure, hypotension, and other health problems. 

The degree of health concerns e-cigarettes cause, for plastic surgery procedures, is debatable. In these procedures, nicotine-induced vasoconstriction in the periphery may lead to a higher incidence of partial or complete skin ischemia and wound complications. Procedures involving the raising of the skin to create a flap of tissue may be those procedures most likely to be affected.  This has been proven in an animal experimental model where an experimental group of rats were subjected to subcutaneous nicotine injection followed by transverse rectus abdominis musculocutaneous flap elevation and shown to have a significantly greater area of necrosis compared with a control group.  

In terms of cessation periods a study of 102 patients undergoing general surgical procedures showed that cessation of smoking for 3 to 4 weeks’ duration before surgery reduced the incidence of postoperative complications from 41 percent to 21 percent. There is additional level 1 evidence to suggest that the optimal duration of preoperative cessation is a minimum of 4 weeks.

The recently published review article from New York from which the information above has been derived is a valuable source of information. Mr Ross agrees with the findings of this review that patients should refrain from smoking (include e-cigarettes) for a minimum of 4 weeks  prior to any plastic surgery procedure. 

Reference

Taub, Peter J.; Matarasso, Alan E-Cigarettes and Potential Implications for Plastic Surgery. Plastic & Reconstructive Surgery. 138(6):1059e-1066e, December 2016.

 

The incidence of Venous Thromboembolic events such as Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) are undoubtedly increased by surgical procedures and these events can be life threatening. 

Factors that increase risk include congenital or inherited blood clotting disorders, a family history, of DVT/PE, high BMI, previous medical conditions such as heart failure and inflammatory bowel disease and age. 

In Aesthetic Surgery patients should also be aware that incidence is increased by prolonged bed rest and sitting for long periods postoperatively. Patients should only consider surgery when they are fit and well, weight stable and have given up smoking for 6 weeks. Preoperative assessment of patients has enabled clinicians to identify patients at high risk and in Mr Ross’s practice all patients undergo a preoperative assessment that includes an assessment of thromboembolic risk.

The treatments proposed to reduce DVT / PE risks include: – 

 

1. Non-pharmacological treatments include graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) devices which are classified as Mechanical thromboprophylaxis devices

 

1. Pharmacological agents 

 

Although mechanical prophylaxis devices have been evaluated extensively in clinical studies, their efficacy in Venous Thromboembolic (VTE) prevention remains unclear. These studies have often failed to define exactly what device was used. Frequently the devices were used in combination with other prophylaxis methods, making it difficult to demonstrate their efficacy. 

Mr. Ross does recommend the use of Mechanical thromboprophylaxis devices in his practice. Mr. Ross has never encountered a problem with a patient using these and believes that they do no harm. He accepts that there is limited evidence to support this practice and it is very rare for patients not to consent to having Mechanical thromboprophylaxis.

The recommended use of pharmacological venous chemoprophylaxis remains controversial. Dr Swanson who has written extensively on the prevention of venous chemoprophylaxis in plastic surgery has recently published his thoughts.

As Dr Swanson describes there may be an increased risk of bleeding for patients taking VTE prophylaxis and there is still a risk of developing a DVT / PE even in patients that take pharmacological agents. Mr Ross like Dr Swanson is concerned about the potential effect of bleeding in aesthetic and cosmetic surgery. Increased bruising and bleeding can lead to additional wound healing issues and complications. In aesthetic surgery where downtime is affected by increased bruising, patients need to weigh up this possible complication when opting to reduce the risk of DVT / PE by choosing pharmacological agents. 

As Dr Swanson maintains the key to prevention is early mobilisation of patients postoperatively. This is a key aspect of Mr Ross’s practice and every patient is mobilised immediately after surgery. In patients that are unable to mobilise postoperatively Mr Ross recommends pharmacological agents until mobilising and in Mr Ross’ practice this is given on the evening following surgery.

Currently however in Mr Ross’s practice over 95% of patients have aesthetic surgery as day cases, 23hr or short stay surgery due to improved aesthetic surgery techniques that have allowed immediate postop mobilisation. It is extremely rare for patients not to be able to mobilise immediately.

The question for patients that are mobilising on the day of surgery is whether pharmacological agents are necessary. With no specific evidence to support this decision, patients need to weigh up the risks of the pros and cons of using pharmacological agents to reduce the risks of thromboembolism. Mr Ross visits all his patients postoperatively and for patients who are unsure whether to have pharmacological agents this decision can be made on the afternoon / evening of surgery. 

Regardless of treatment method chosen by the patient all patients in Mr. Ross’s practice are advised regarding the need for mobilization and educated regarding VTE risk and the signs and symptoms of DVT/PE on discharge. Mr. Ross operates at a facility where patients can be seen 24/7 and can be investigated / treated as soon as possible. 

 

Reference

 

Swanson E.A Rebuttal of Published Recommendations for Venous Thromboembolism Prophylaxis in Plastic Surgery. Plast Reconstr Surg. 2016 Nov;138(5):951e-952e. 

 

Autologous fat transfer or fat grafting is an option for both breast augmentation and breast reconstruction to restore / enhance volume. It has been found that the key to fat graft retention is maximizing the surface area to volume ratio, and the vascularity of the recipient area. Closed systems and the method of harvest are also seen as essential steps. Reported graft retention following autologous fat transfer may vary from 40 to 75%. 

Mr Ross uses water assisted liposuction (Bodyjet liposuction) to aid the removal of fat and limit damage to fat cells during harvesting. The fat is then filtered within a closed system, therefore limiting the chance of pollution / infection prior to injection.

Proponents of cell assisted lipotransfer (CAL) have postulated that adding adipose derived stem cells to autologous fat transfer enhances angiogenesis / adipogenesis leading to improved long-term graft retention and lower post-operative complications,

A recently conducted systematic review of CAL in breast augmentation and reconstruction from the UK has been published on JPRAS open. The authors describe an overall complication rate of 37% with the most common side effect being calcification. They concluded that although a promising surgical technique there were high levels of bias, lack of control groups and lack of long-term follow-up data. They concluded that the potential concerns of CAL vs traditional autologous fat transfer have yet to be determined and all patients wishing to undergo CAL must be aware of the lack of evidence to support its use over traditional autologous fat transfer. 

Currently with a lack of evidence to support its use Mr Ross does not routinely advocate the use of CAL at the time of autologous fat transfer. 

With technical refinements and the possibility of CAL alongside water assisted liposuction, Mr Ross’s sees CAL as an exciting prospect for his patients in 2017. All patients considered as appropriate will need to be aware of the pros and cons and be happy to be part of a long term follow up clinical study and be empowered to make the decision to proceed on this basis.

 

Reference

Zeeshaan Arshad, Lindsey Karmen, Rajan Choudhary,
James A. Smith, Olivier A. Branford, David A. Brindley, David Pettitt, Benjamin M. Davies

Cell assisted lipotransfer in breast augmentation and reconstruction: A systematic review of safety, efficacy, use of patient reported outcomes and study quality. JPRAS Open 10 (2016) 5e20

When patients have liposuction treatments they must think about whether fat could be used elsewhere in the body. Traditionally patients undergoing liposuction are not offered alternatives and patients considering liposuction should consult with a plastic surgeon that can run through the pros and cons of liposuction, fat transfer and liposculpture. 

Patients are now able to benefit from technological advancements in liposuction. With the development of closed systems the fat harvested can be washed and filtered with minimal trauma and subsequently injected back into patients. Closed systems have been further refined so that fat during the washing and filtering process is not damaged. The purified fat can be transferred into other areas of the body. The key for fat transfer is obtaining a high rate of fat graft survival by using the most up to date technology and techniques.

Body jet liposuction allows the simultaneous injection of fluid at the same time as liposuction allowing the fat to be washed and filtered at the same time. With minimal trauma and in a closed system with less chance of infection the chance of improved fat survival is increased.

The fat harvested can be injected back into patients during the same liposuction operation and increases surgical time by only 15-30 minutes.  Many patients opting for liposuction should consider the benefits of autologous fat transfer for other areas of the body. 

In the face only relatively small amounts of fat are required to help volumize the face. Increasing amounts are required to provide a breast volume enhancement with very large volumes required to produce an enhancement in the buttock area. Patients need to prioritize the areas they wish to address.

It would appear that around 50% – 75% of fat will survive long term and injection techniques are continually improving in order to improve the amount of fat that will survive long term. It is important that during the liposuction component excessive fat is not harvested that can lead to irregularities from the harvested areas. Equally there is a safe limit of fat that can be injected back in one sitting in order to maximize survival.

Autologous fat transfer is increasingly being used as an alternative to both breasts and buttock implants. Patients need to be aware that the amount of volume that can be achieved is less than silicone based implants and is less predictable.

 

Mr Ross is able to offer the variety of liposuction techniques but for fat transfer Mr Ross prefers water assisted liposuction. Patients undergoing liposuction need to be aware of the possibility of autologous fat transfer and run through the pros and cons at a consultation. It is important that women are aware of the various possibilities and combinations so that they can be empowered to make the most appropriate decision.

 

Breastfeeding is a vital function, with numerous psychological, physiologic, anatomical, social, and cultural factors. Breast milk is an optimal and complete food for newborns up to 6 months of age, not only because of the nutrients that it provides but also because of the antibodies transmitted by the mother and the affective bond created between the mother and child, which promotes sensory and cognitive development, in addition to protecting the infant against infectious and chronic diseases, according to the World Health Organization

One of the concerns many young women face is whether to have a breast augmentation before starting their families or leave the decision until later in life. 

Mr Ross always advises patients that they should wait until after completing their families before considering breast surgery. There are however some women whose confidence is so affected by the size of their breasts that they would rather consider breast augmentation prior to thinking about having a family. In this scenario one of the commonest questions asked is whether breast augmentation can affect the ability to breast feed.

A recent study from Argentina looked at 100 patients with breast implants and compared the chance of breast feeding to 100 women without implants. The principal objective was to evaluate the incidence of breastfeeding at 30 days. The results showed that most patients with breast implants 93 percent compared to 99 percent without implants were able to establish breastfeeding. There was more chance of exclusive lactation with breast augmentation through an inframammary scar vs a periraeola scar although location of the breast implant did not seem to have any affect.

All women must be aware that there may be a decrease in the possibility of breast feeding following breast augmentation although in this study the chance of breast feeding with implants was 93%. 

It is important to consider all the pros and cons of breast surgery and be empowered to make a decision to proceed or not. Mr Ross will always take you through the pros and cons and the breast augmentation options using biodiemnsional analysis, 3D technology and Virtual Reality to help you in the decision making process.

 

Reference

Filiciani S, Siemienczuk GF, Nardín JM, Cappio B, Albertengo AC, Nozzi G, Caggioli M. Cohort Study to Assess the Impact of Breast Implants on Breastfeeding.Plast Reconstr Surg. 2016 Dec;138(6):1152-1159.

 

Breast rejuvenation surgery has long been one of the most popular surgical procedures among women. While breast rejuvenation surgery has remained consistently popular, what has changed is the number of options available to women looking to improve the aesthetic appearance of their breasts. Technical innovations and procedure improvements mean that there are more accessible tailor-made options for individual patients and less downtime after the procedure itself. Mr Ross will always discuss the many options available to a patient before they decide on the best course of action to suit that individual’s needs. 

Here are the rejuvenation options we share with out patients: 

 

BREAST IMPLANTS: 

Among the most popular choices, breast implants are available in a wide range of shapes, sizes and profiles to accommodate nearly everybody. Breast implants allow for a patient to determine the size, shape and profile she wants, and will normally give an excellent result. Breast implants do come with risks and may need to be replaced after several years.

 

MASTOPEXY:

A mastopexy procedure involves lifting the breast, and so is also known as an uplift. A mastopexy can be paired with an implant if the patient wishes to increase the breast size too. A standard mastopexy aims to rejuvenate the appearance of the breasts and provide a more youthful look. A mastopexy is common in patients who’s breasts have sagged due to pregnancy or having large breasts. 

 

AUTOLOGOUS FAT TRANSFER (AFT):

AFT to breasts involves removing excess fat from one part of the body and putting it into the breasts. This procedure rejuvenates the breasts without the use of implants. AFT to breasts can be used to increase the size and volume of the breasts, or to provide a more youthful appearance. 

 

Mr Ross will always discuss all of the available options with his patients in great detail and will always make sure that each patient is aware of the pros and cons and risks with each surgery. Mr Ross advises his patients to be in good general health and at their ideal weight before considering surgery, as it is important to be in a stable bodily condition when proceeding with cosmetic surgery. For more information on any of the procedures Mr Ross offers, book in for a consultation with and start your journey towards a more rejuvenated and youthful you.

Breast reconstruction combines all aspects of plastic, reconstructive and aesthetic practice.

The diagnosis of breast cancer can be devastating and the decisions regarding reconstruction are often seen as a secondary consideration. The pros and cons of immediate and delayed reconstruction (after mastectomy) are one of the most challenging that face patients with a diagnosis of breast cancer. A careful discussion with the patient is imperative to guide the patient in the decision making process. This often requires multiple consultations within the context of a multidisciplinary oncological team.

Breast reconstruction can be provided by both autologous and non-autologous tissue and a combination of both techniques. Non-autologous methods of reconstruction include the use of tissue expanders and implants. 

Autologous reconstruction uses ones own tissue. The advantages of using ones own tissue is that the tissue ages naturally and the reconstruction changes minimally with time. 

Initially an autologous reconstruction may be more time consuming than non-autologous reconstruction in terms of surgical time and recovery, however the benefits often outweigh the risks. It is important to discuss the pros and cons of autologous and non-autologous reconstructions with each patient individually to determine suitability.

For autologous breast reconstruction the gold standard technique is the deep inferior epigastric perforator flap (DIEP), which is a modification of the transverse rectus abdominis muscle flap (TRAM). With newer techniques to protect the muscle and its function (DIEP), tissue from the abdomen can be used to reshape the breast with minimal side effects to the abdomen. The tissue that would normally be excised during a cosmetic tummy tuck is dissected carefully with its blood supply (the diep inferior epigastric artery) to avoid damage to the tummy muscles creating a flap of tissue. Blood vessels in the chest or the armpit are also dissected free and the artery and veins of the veins in the chest and the veins in the tummy tissue are sutured together using fine suture material under a microscope. The tummy is closed in the same way as a tummy tuck or abdominoplasty (link) and the new tummy tissue is reshaped onto the chest wall to create a new breast. The use of tissue from other areas of the body can also be used such as the though and the buttock and the pros and cons of these need to be discussed at consultation. These include the TMG (from the thigh), the SGAP and the IGAP (from the buttock)

Other autologous options for breast reconstruction include the use of tissue from the back (Latissimus Dorsi flap). In this scenario the back muscle and the skin overlying it is passed onto the front of the breast and the back is closed. The back tissue may provide enough tissue to mould a breast shape but often requires an implant. 

Implant based reconstruction using autologous or non-autologous dermis may also be used to reconstruct breast tissue. This can be used in patients who wish to have a simple solution following mastectomy in the immediate phase although it is not recommended where patients require radiotherapy or where a mastectomy has already been performed.

The most important aspects of breast reconstruction include size, shape and symmetry. The initial operation provides the basis with which the surgeon can mould the final result. Often a second operation is required in order to achieve these goals. With increasing refinements a combination of lip modelling, combining liposuction (removal of fat) (link) and autologous fat transfer (injection of fat) (link) the new breast can be remodelled to give an even more natural result. This can be combined with a nipple reconstruction and areola tattooing to give a result that is similar in size, shape and symmetry. In unilateral reconstruction it may be necessary to perform surgery to the unaffected breast to give symmetry. This is often in the form of a mastopexy (link), breast reduction (link) or mastopexy implant (link)

The advent of microsurgery in the field of plastic, aesthetic and cosmetic practice has made the provision of this form of autologous reconstruction more widely available. Although it is not suitable for everyone and can never replace the original breast tissue, those that choose this form of surgery benefit from longer lasting breast aesthetics and abdominal contour. 

With all aesthetic surgery autologous breast reconstruction is not without its inherent risks and these need to be discussed with surgeons experienced in providing this highly specialised form of breast reconstruction.

The reconstructions need to be tailored to each patients individualised needs following discussion regarding the pros and cons of each technique.

 

 Breast Reconstruction following lumpectomy

Following lumpectomy there may be asymmetry between the breasts. Common treatments include the use of autologous fat transfer (link) or reshaping the affected breast in the form of a mastopexy (link). Where asymmetry is more marked there may also be a need to combine these and perform surgery on the unaffected breast to aid symmetry in terms of volume (breast reduction link). Occasionally autologous and non-autologous methods of reconstruction can be used to help reconstruct defects following lumpectomy as described above. In severe cases it may be necessary to complete a mastectomy in order to obtain a pleasing aesthetic result.

It is extremely important for everyone to check their breasts regularly, including men. October is Breast Cancer Awareness month and Mr Ross and his team would like to ensure that you know what you are looking for during your self-examination.

Do you examine your breasts?

It is essential to be familiar with your breasts, whether you have implants or not, so that you can easily notice if something looks or feels out of the ordinary.
Woman who have implants will normally be shown how to differentiate between their scar tissue and breast implant while still being thorough when performing a breast self-examination. Your surgeon or clinic nurse will show you how to identify the edges of the implants.
Do not examine your breasts for up to 6 weeks after implant surgery or during menstruation, as they can be tender or swollen. However, performing a breast examination in the week after your menstrual period is ideal for women who are on a monthly cycle.
The earlier breast cancer is picked up, the easier it is to treat and the more likely the treatment is to be successful. It is important that you go to your GP as soon as possible if you notice any worrying symptoms. Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important.

So just how easy is it to carry out a breast self-examination?

There are a number of ways to feel for lumps, you can lie down, sit down or stand up, it’s completely down to personal preference.
Lie down flat or stand up straight and put your right arm above your head. Use your left hand to examine your breast. With your 3 middle fingers flat, move gently over the whole breast, checking for any lumps or thickening tissue. Use different levels of pressure but do not press to hard or squeeze. Once you have checked the whole breast from your collarbone down to your rib cage, switch arms and repeat on the other breast. Next, raise one arm at a time and check in your armpit the same way you did your breast with 3 fingers flat, moving in circular motions, checking for lumps.

So what are you looking out for?

Stand up straight in front of a mirror looking at your breasts, with your hands on your hips. Look for lumps, new differences in size and shape, and skin or nipple changes.
Squeeze the nipple of each breast gently using your thumb and index finger, this is to check for discharge or fluid leaving the nipple.
The first symptom of breast cancer for many women is a lump in their breast, but many women have breast lumps and 9 out of 10 are benign, which means they are not cancerous.
Most benign breast lumps are:

• Areas of normal lumpiness that is more obvious just before a period
• Cysts – sacs of fluid in the breast tissue, which are quite common
• Fibroadenoma – a collection of fibrous glandular tissue (these are common in younger women, for example under 30)

It is important if you find a lump to make an appointment with the GP for them to examine you.

Early detection is vital

Early detection is vital to ensure you get the best treatment quickly, so performing a breast self-examination is the ideal symptom checker. The next stage is seeing your GP to have a clinical examination, after this you may or may not be offered a mammogram depending on the clinician’s opinion. It is important, however, that you continue with examinations at home as 1 in 8 women in the UK will develop breast cancer in their lifetime. Men should also be performing self-examinations, even though the statistics for men developing breast cancer is much lower than women, it is extremely important to learn about identifying symptoms.