Author Archives: Lexington Plastic & Reconstructive Surgery

Gynecomastia surgery is on the rise: is it right for you?

More and more men are opting for male breast reduction, also known as gynecomastia surgery. The American Society of Plastic Surgeons has reported the number of surgeries is up 5% from last year. And, for the first time, men makeup 40% of  breast reduction patients nationwide. But why are more men choosing gynecomastia surgery?

Gynecomastia: Another Surgery Benefiting from Social Media Exposure?

The rates for plastic surgery and non-surgical aesthetic treatments like BOTOX are up across the board. Many attribute this to the daily exposure to pictures of perfected bodies being shared on social media. Maybe these “perfected” images are the work of filters or Photoshop, but clearly many Americans are opting to make a change in their appearance through aesthetic treatments and procedures. This has given rise to trendy marketing gimmicks like the FaceTime FaceLift and the Engagement Hand Lift.

Men are no exception to jumping on a trend: the rates for gynecomastia are up a whopping 173% since the 90s. Still there is a wide gap between the number of female cosmetic surgery patients and their male counterparts. The 2014 report from ASPS stated that a woman was the patient in 92% of all cosmetic surgeries performed.

Who Is a Good Candidate for Gynecomastia Surgery?

While any man with excess breast tissue may consider himself a candidate for gynecomastia surgery, there are two distinct groups that have driven the demand for the procedure: men with hormonal imbalances and body builders.

Gynecomastia for the physical correction of hormonal imbalances

Many men suffer from hormonal changes and imbalances. Some because of their genetic makeup, others because of medication. In a tragic irony, some men have traded one body image problem for another: the hair loss drug Propecia may cause gynecomastia. There are other drugs that cause changes in testosterone levels, which in turn, has an effect on the growth of breast tissue. The simplest solution is the excision of the breast tissue, gynecomastia surgery. Because hormonal changes are often associated with weight changes, the breasts may have also become fattier and can require additional liposuction for contouring.

Body Builders Looking for that Finishing Touch

Another group the procedure is popular with are the body builders and fitness fanatics. Men often mistake the signs of mild gynecomastia as simply being out of shape. After rigorous workout regimens, the fatty or puffy breast still persists because it’s a glandular issue. Through message boards and forums, body builders have discovered gynecomastia surgery and its benefits. The removal of the breast tissue allows for flatter pecs and a chest that better shows the results of their hard work. CrossFit enthusiasts are similarly becoming hip to the practice – hours of hard training for a hard body with puffy breasts can be disheartening.

Dr. Gerstle at Lexington Plastic Surgery performs male breast reduction and is available for consultation if you feel self-conscious about your chest. Call today or request a consultation today to make a change in how you feel.


First of all I would like to say that my experience with Dr. Gerstle and his staff has been a blessing! Dr. Gerstle was very detailed in his consultation with me. The before/after images that were done during my consultation was the deciding factor, and helped making my decision to go through with my procedure easier. Dr. Gerstle has walked with me every step of this life changing journey. I highly recommend Dr. Gerstle. Great doctor!!
Edited for spelling and readability.

5 stars; from a review on January 7, 2016 of Dr. Gerstle on

Pros and Cons of Saline Breast Implants

Dr. Gerstle performs a number of breast enhancement procedures in Lexington, KY using saline breast implants. Silicone can be a great alternative for a variety of reasons, but here we will focus on the pros and cons of saline breast implants.

A saline breast implant is an implant composed of a silicone outer shell, and filled with a saltwater solution called saline. Saline implants were created in response to an unfounded worry about silicone implants. While this worry disrupted the advancement of silicone-based implant development, we are fortunate that we have more choices to provide patients.

The Pros of Saline Breast Implants:

• Many incision placement options
• Approved for patients 18 years and older
• Saline is sterile and absorbable
• Saline breast implant ruptures are noticeable

Your choice of saline breast implant placement incision

A silicone implant is filled before insertion, whereas a saline breast implant is filled after the implant shell has been placed. This allows Dr. Gerstle to offer more options for placing the insertion incision. The options can include transaxiliary, through the arm pit, and through an incision placed on the boarder of the areola and skin. Both are small, discrete incisions that are well-hidden. A silicone implant is almost always placed through an inframammary incision resulting in a scar near the crease of the breast. While this scar is hidden, some may prefer the even more discrete incision options afforded by saline breast implants.

Saline breast implants FDA approved for youngest adults

Silicone breast implants are only approved by the FDA for use in women 22 years or older. By contrast, you can be 18 and receive saline breast implants.

Saline is a common bodily fluid

There was a panic over the safety of silicone implants which turned out to be unfounded, but saline is an alternative for those who wish complete peace of mind. The saltwater solution that fills the implant is roughly the same as the saline fluid commonly injected into dehydrated people. It’s safe.

Saline is absorbable; if there’s a leak, you will notice it

Implant rupture is a risk, though not common. For patients with silicone implants, a rupture may not be detectable without advanced imaging, like a MRI. If a saline implant ruptures, the body begins absorbing the fluid and soon the affected breast is noticeably smaller.

The Cons of Saline Breast Implants

• Silicone “feels more natural”
• Rippling is more common in saline than silicone

Feel is a matter of preference

While many claim that silicone feels and acts more like natural tissue, it is a matter of preference.

Saline may ripple

Saline breast implants have been at risk of visible rippling, a distortion that can show on the surface of the skin. Because of this, saline implants are often suggested for women who have more breast tissue already present; silicone breast implants are usually recommended for thinner, smaller breasted women.

Are Saline implants right for you?

The best way to learn if saline implants are right for you is to speak to a board-certified surgeon like Dr. Gerstle. During a consultation, Dr. Gerstle will be able to make recommendations that work for your body type and address any concern you may have over the type of breast implant. You’ll even have the opportunity to feel the implants yourself. If you are in Lexington, KY or surrounding area, schedule a consultation with Dr. Gerstle with Lexington Plastic Surgery and get your questions answered.

Pros and Cons of Silicone Breast Implants

There are two main types of breast implants for use in augmentation and reconstruction: silicone breast implants and saline. Breast implants generally have an outer shell and are filled with either saline or silicone. The silicone in a silicone breast implant is a synthetic material that is thick and mimics the feel of fat; it is inert and sterile. In the late eighties, there was a scare that resulted in FDA regulation and banning of silicone. Subsequent research proved that the scare was unfounded, and that silicone was a safe material to use in implants.

Silicone breast implants have evolved since their reintroduction to the market and there are now two varieties to choose from: silicone gel or highly cohesive gel. When weighing the options between implant types, it’s important to understand the benefits and potential drawbacks of each type.

Pros of Silicone Breast Implants: Why They May Be Right For You

• “Better” Feel
• Style options
• Less Rippling

Silicone Breast Implants Offer “Better” Feel

Silicone breast implants are often described as softer, and more like natural fat tissue. The edges of the implant are also less noticeable. Thin patients with small breasts often select silicone breast implants because they are less detectable–a consultation with Dr. Gerstle is the best way to find out what type of implant would work best for your unique anatomy.

Silicone Breast Implants Offer Style Options

Because there two varieties of silicone breast implants, there are more styles of implants. The cohesive gel implants are “gummy bear like,” and can be formed into an anatomical shape. This shape offers lower projection at the base of the breast. A regular silicone implant creates a fuller appearance at the top of the breast.

Less Rippling in Silicone Implants

Silicone breast implants are made of thicker, viscous material (or gummy-like cohesive gel) and are less prone to rippling than saline implants. This is also why silicone is preferred by smaller breasted women.

Drawbacks of Silicone Breast Implants

• Must be older than 22
• Ruptures can go undetected
• Larger incisions/limited incision placement options

Silicone Breast Implants are recommended only for patient 22 or older

The FDA has only approved silicone implants for use in patients 22 years or older. The studies in the clinical approval trials only included women 22 years old and up, so silicone breast implants are only recommended for the same age range. Silicone breast implant manufacturers stipulate in their warranties that the patient must be 22 years or older, or be considered a reconstructive or deformity patient. The device manufacturer will void the device warranty if the implants are placed prior to the patient turning 22.

MRI scanning is often required to determine if a rupture has occurred

While rupture rates are low, they do happen. Because the body absorbs water, saline ruptures are detected quickly–the affected breast becomes noticeably smaller. Silicone is not absorbed and a rupture may go undetected without the use of MRI scanning. New highly cohesive gel implants do not rupture like silicone gel implants; they stay intact should a tear occur.

The inframammary fold incision and placement is the most common for a good reason

Silicone gel breast implants are filled before placement, so a large incision is required. Under the breast, in the inframammary fold, this incision is well-hidden.

Are Silicone Breast Implants Right for You? Consult with Dr. Gerstle.

To feel the difference for yourself and speak with Dr. Gerstle about the options for your body, schedule a consultation today with our Lexington Surgeons.

Beyond Botox for Migraine Treatment: New Options on the Horizon

For treatment and management, Botox for migraines is one of the few therapies that improves the patient’s condition. Botox for migraine treatment is the only FDA-approved preventive treatment for patients suffering from chronic migraines. But, according to American Headache Society (AHS) a new class of drugs may change all that.

A recent press release by the AHS outlines research findings pointing to a possible new treatment of migraines as well as a root cause. A neuropeptide called CGRP is present throughout the body, but appears at elevated levels during a migraine, then decreases when the migraine subsides. According to the AHS, three new experimental treatments have shown to be effective at preventing attacks by blocking CGRP from binding with receptor cells in the brain. This research was presented at the annual AHS scientific meeting; the findings were preliminary and a longer-term study is needed to confirm efficacy.

How Botox for Migraines Works

Like the proposed drug treatments, the current Botox for migraine therapy acts as a block. In a Botox Cosmetic treatment, signals between the nerve cells and the muscles are blocked, which results in muscle-paralysis, albeit temporary. Normal muscle function returns after about three months. During the three month period, the skin is able to relax, deceasing the appearance of wrinkles. It is believed that the same neurotransmitter blocking-action may reduce the pain of migraines and prevent onset altogether.

Two studies in 2010 led to the FDA approval for Botox for chronic migraines. Both studies showed that Botox was significantly better than a placebo, statistically speaking, for both ending migraine attacks and reducing the frequency of migraine attacks in a 28 day period. For patients who suffer migraines more than 15 days a month and do not like daily medication because of side-effects or inconvenience, injections of Botox once every three months may provide the relief they seek.

Botox Migraine Treatments in Lexington, KY

Dr. Gerstle and Lexington Plastic Surgery currently offer Botox for Migraines treatments as part of our commitment to compassionate, patient-centered care. As more news on migraine treatments develops we’ll share the exciting news and look for ways to incorporate the latest treatments into our practice. If you or someone you know suffers from migraines, let them know that safe and effective migraine treatment is currently available at  Lexington Plastic Surgery.

New Gel Implant Options for Breast Augmentation

Medical device manufacturer Allergen recently received FDA clearance for a variety of new breast implants for use in breast augmentation and breast reconstruction. The newly approved breast implants, called Natrelle Inspira, offer a high fill ratio that allows for more shaping options. These gel-filled implants are round style implants and come in both smooth and textured versions.

If you are interested in knowing more about the differences between the styles, and the style that may be right for you, consult with Dr. Theo Gerstle, a Lexington plastic Surgery, who is experienced with Allergan breast implants.

High-cohesive gel implants for breast augmentation also approved

Allergen also recently received approval for an expansion of their Natrelle 410 line of highly cohesive gel breast implants from the FDA. The new styles offer low height styles and additional lower projection. Both low height and low projection give the breast a natural-looking slope, or tear-drop shape. The cohesive gel allows the breast implant to hold shape while still allowing for natural movement and feel. Highly cohesive gel implants are often called shaped implants. “Gummy bear implants” are also a term used by the media and in catchy marketing materials.

Another benefit to highly cohesive gel implants is its inability to rupture and leak like older styles of implants. As the nickname “gummy bear implant” implies, these gel implants are not liquid gel.

Highly-cohesive gel implants vs. round gel implants

One of the main differences between the two types of gel implants is purely a matter of aesthetics–what shape do you want your breasts to have? Round gel implants offer a fuller shape, especially at the top of the breast. The highly-cohesive gel implants are designed to offer a fuller shape in the bottom portion of the breast.

The Natrelle 410 implants are inspired by the style popular in European, where the women prefer a natural sloping look to their breasts. American women have traditionally preferred fullness higher in the chest. These Allergen breast implants offer women in Lexington their choice of style.