Archive for Breasts

Costochondritis and Breast Pain

After writing a previous article on breast pain, I came across several postings on a women’s health message board about costochondritis as a possible cause of breast pain. Costochondritis is a painful condition caused by inflammation of the cartilage of the ribs where the ribs connect with the breastbone (sternum).
Although the inflammation of costochondritis does not occur within the breast itself, it can cause pain that feels as if it’s located in the breast. “When men get costochondritis, they think it’s a heart attack; when women get it, they think it’s breast cancer,” says Susan M. Love, M.D., in Dr. Susan Love’s Breast Book, 2nd ed. (91).

Love calls costochondritis an arthritic pain. “You can tell it’s arthritis,” Love says, “by pushing down on your breastbone where your ribs are—-if it hurts a lot more, that’s probably what you’ve got. Similarly, if you take a deep breath and the middle part of your breast hurts, it’s probably arthritis” (91). Women with breast pain caused by costochondritis often describe their pain as a burning sensation in the breast.

There are a number of possible causes of costochondritis: heavy lifting or any other activity that stretches the upper body, trauma to the rib cage, poor posture, aging, a recent viral upper respiratory infection, and pneumonia or other lung disease. “A nurse practitioner noted several new breast pain patients in the freshman class one fall and traced the cause to the sudden unaccustomed use of heavier backpacks,” reports Dr. M. Ellen Mahoney, medical director of the Community Breast Health Project in San Francisco. However, in many cases the cause of the inflammation is unknown.

Treatment of costochondritis involves avoiding any activity that strains the upper body. Over-the-counter anti-inflammatory medications such as aspirin or ibuprofen taken regularly for several days should reduce the pain and inflammation. The pain of costochondritis usually subsides, writes Dr. Nancy Snyderman, but it may take several weeks or up to six months to go away. And, she adds, some people “suffer chronic or recurrent bouts” of costochondritis.

Careful strengthening of the upper body may help prevent a recurrence of costochondritis. “As the pain starts to subside and movement becomes more tolerable, you can begin gentle exercise, which can include strengthening your upper body muscles,” writes Dr. Snyderman. “Be sure to get proper instruction on exercise technique so you don’t cause additional muscle or joint injuries and you don’t re-injure the ribs,” she warns.

Important Note

The material here is offered for general informational purposes only. You should discuss any breast pain you experience with your physician.

Breast Lift (Mastopexy)

The final article in our series on breast surgery covers the breast lift—known technically as mastopexy—a surgical procedure to raise and reshape sagging breasts. As a woman ages, her skin loses elasticity and breast tissue loses some of its firmness. The result is sagging breasts. Pregnancy, nursing, and, over time, the force of gravity all contribute to breast sagginess. During mastopexy a surgeon can also reduce the size of the areolae—the pigmented circles surrounding the nipples—which tend to enlarge over time.

Mastopexy can also be combined with the insertion of breast implants to reshape and firm up the breasts.
According to the American Society of Plastic Surgeons, the best candidates for mastopexy are women who understand that, while the surgery will improve their appearance, it will not make their bodies perfect. Having realistic expectations beforehand will increase a patient’s satisfaction with the results of the surgery. Women with small sagging breasts usually have the best results from mastopexy. A surgeon can perform the surgery on breasts of any size, but the results may not last as long in larger, heavier breasts as in small breasts.

Mastopexy doesn’t usually interfere with breast feeding; however, women planning to have more children are advised to postpone mastopexy because subsequent pregnancies are likely to stretch the breasts and offset the results of the procedure.

As with all surgery, mastopexy carries the possibility of complications, which your doctor should discuss with you if you’re considering this surgery. The procedure leaves permanent, noticeable scars, although the scars usually can be covered by a bra or bathing suit. Smokers often experience poorer healing and more scarring than non-smokers. Mastopexy may also produce unevenly positioned nipples and the loss of sensation in the nipples or breasts.

The procedure can be performed in a hospital, an outpatient surgery center, or a doctor’s office-based surgery facility. It is usually performed on an outpatient basis, which means that you will return home the same day. If you’re having outpatient surgery, you should arrange to have someone drive you home afterwards. In some cases mastopexy patients may be admitted to the hospital for a day or two.

Mastopexy is usually performed under general anesthesia—being “put to sleep”—and commonly takes from one and a half to three and a half hours. There are several mastopexy techniques, but the most common one involves an anchor-shaped incision that begins on the top of the breast and moves toward the areola, then radiates from the area around the areola toward the inside and outside of the breast, following the breast’s natural contour. The surgeon removes excess skin from the area of the incision, moves the nipple to a new higher position, and then brings the edges of the remaining skin together underneath the areola to reshape the breast. The stitches that close the incision are usually located around the areola and in a vertical line extending downward from the nipple and along the lower crease of the breast. Patients with smaller breasts usually require less extensive incisions than women with large breasts.

After surgery, the breasts will be bruised and swollen for a couple of days. Patients normally wear an elastic bandage or surgical bra over gauze dressings for a few days, then switch to a soft support bra that they must wear over a layer of gauze 24 hours a day for three to four weeks. The stitches will usually be removed after a week or two. Patients should plan on missing a week of work or more, depending on how they feel and how strenuous their job is.

The results of mastopexy will not last forever. Eventually gravity, the aging process, and weight fluctuations will make the breasts sag again.

Reconstructive Breast Surgery

Introductory Note: As always, the information given here is for general informational purposes only. All women about to undergo treatment for breast cancer should consult their health care team about the options appropriate for their particular medical situation.

The American Cancer Society estimates that about 192,200 women in the United States will be diagnosed with invasive breast cancer in 2001. Many of those women whose treatment involves mastectomy (surgical removal of a breast) will have the option of reconstructive breast surgery. According to the American Society of Plastic Surgeons (ASPS), “Nearly 79,000 breast reconstruction procedures were performed last year, a 166 percent increase since 1992.”

The ASPS says that most women who have mastectomies are candidates for breast reconstruction. So the first choice a woman facing a mastectomy will have to make is whether or not to have reconstructive surgery. Some women choose not to have reconstructive surgery and decide instead to use a prosthesis, a breast-shaped form that can be inserted into a bra.

Women who decide to have reconstructive surgery will then have to consider whether to have the reconstruction done at the same time as the mastectomy or later. Some women may choose to wait because they don’t feel they can adequately consider all the reconstructive options while coping with a cancer diagnosis and treatment regimen. Also, delayed reconstruction may be necessary for women who will be having radiation therapy after their mastectomy. But the ASPS says that women who want breast reconstruction are increasingly choosing to have it done as the time of mastectomy.

When the two surgical procedures are done at the same time, a surgeon will perform the mastectomy and a plastic surgeon will perform the reconstruction. Several reconstructive techniques are available, including skin expansion followed by an implant or reconstruction with tissue from another part of the patient’s body such as the back, hip, abdomen, or buttocks.

The most common breast reconstructive procedure is skin expansion followed by insertion of an implant. In this procedure, the plastic surgeon inserts a balloon expander under the skin and chest muscle. The doctor then periodically injects salt water into the expander so the skin covering the expander will stretch. It may take several weeks or months for the skin to stretch adequately. Once the skin has expanded, the expander is removed and an implant is inserted. Some expanders are designed to be left in place as the permanent implant.

Other implant approaches involve using a flap of skin from another part of the patient’s body to create a pouch into which an implant can be inserted. In some cases tissue from the patient’s body can also be used to create the breast mound, eliminating the need for an implant.

After the initial reconstructive operation, the plastic surgeon may, if a woman desires, perform another procedure to construct a nipple and areola (the dark circle around the nipple). But a reconstructed breast will not have the same sense of feeling as the original breast. Also, a reconstructed breast may be undetectable when a woman is clothed, but it will always be obvious when she is nude.

The Women’s Health and Cancer Rights Act of 1998, a federal law, requires that medical insurance plans cover the cost of breast reconstruction and alteration of the other breast for symmetry for women who have had a mastectomy.

Breast Reduction Surgery

Although many women desire bigger breasts, there is also a significant number of women whose large breasts cause them both physical and psychological harm. According to the American Society of Plastic Surgeons (ASPS) 84,780 women underwent breast reduction surgery, also called breast reduction mammaplasty, in 2000. The ASPS says that breast reduction surgery has increased 111% since 1992.

Benefits of Breast Reduction

In a study conducted by the University of Pennsylvania School of Medicine and reported in 1999, women who had undergone breast reduction mammaplasty gave the following reasons for wanting the surgery:

  • back pain
  • shoulder grooves from bra straps
  • trouble finding clothing that fit properly
  • breast pain during exercise
  • skin irritations
  • shoulder pain
  • personal embarrassment

The same women reported these improvements after the surgery:

  • 83% improvement or elimination of breast pain during exercise
  • 83% improvement or elimination of shoulder grooving
  • 78% improvement or elimination of back pain
  • 78% improvement or elimination of shoulder pain

Eighty-four percent of the women said that they were very satisfied with the results of their surgery, 92% would have the surgery again, and 98% would recommend the procedure to others.

Several other studies have found similar results. For example, a recent review and analysis of 29 studies involving more than 4,000 patients notes that reduction mammaplasty decreased back, neck, and shoulder pain, headache, breast pain, and numbness and pain in the hands. This review was published in the May 2001 issue of Mayo Clinic Proceedings. In addition, a study presented at the ASPS annual meeting in October 1998 found that breast reduction surgery can also improve breathing and lung function.

Breast reduction is generally not recommended for women who intend to breastfeed, says the ASPS, because the surgery removes many of the milk ducts that lead to the nipple.

Reconstructive vs. Cosmetic Surgery

According to Plastic Surgery Update (summer 1996), a publication of ASPS, “the following definitions of cosmetic and reconstructive surgery are approved by the American Medical Association and the American Society of Plastic Surgeons.

Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient’s appearance and self-esteem.
Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate appearance.”
Procedures such as facelifts and breast augmentation, which are done for non-medical reasons, are cosmetic procedures—also called aesthetic surgery—and are therefore not covered under most medical insurance plans.

Reconstructive procedures, however, are often covered by insurance. In many cases reduction mammaplasty may be covered if it is done for physical, rather than cosmetic, reasons. Women considering this surgery should therefore check with their insurance provider. The ASPS generally considers reduction mammaplasty to be reconstructive surgery, calling it the fifth most common surgical reconstructive procedure performed in 2000.

Surgical Procedure

There are several surgical techniques that can be used in reduction mammaplasty. The most commonly used procedure involves an incision around the areola (the pigmented circle surrounding the nipple) that extends downward over the breast and then follows the crease where the breast joins the chest. Through this incision the surgeon removes excess glandular tissue, fat, and skin. The surgeon then moves the nipple and areola into their new position and places the skin from both sides of the incision around the areola to shape the breast’s new contour.

If possible, the surgeon will probably leave the nipple and areola attached to their blood vessels. However, if the breasts are very large and pendulous (hanging downward), the surgeon may have to completely remove the nipple and areola and graft them onto a new position higher up on the breast.

Reduction mammaplasty usually requires two to four hours (although some cases may take longer) and can be done in either an outpatient surgery center, an outpatient surgery department of a hospital, or a surgical suite at a doctor’s office. The operation is usually done under general anesthesia (being “put to sleep”).

After the surgery there will be stitches around the areola, along the vertical incision below the areola, and along the lower crease of the breast. The patient will be wrapped in an elastic bandage or a surgical bra over gauze dressings covering the incisions. There may be a small tube in each breast to drain off blood and fluids for a couple of days after the surgery.

The surgeon will provide detailed instructions about resuming normal activities after reduction mammaplasty. Most women will be up and about within a day or two after surgery, and most return to work (if the job is not too strenuous) and to social activities in about two weeks.

Reduction mammaplasty leaves noticeable permanent scars, although these scars are in areas usually covered by a bra or bathing suit. The surgery may produce slightly mismatched breasts or unevenly positioned nipples. Some patients experience permanent loss of feeling in their nipples or breasts. In rare cases, the nipple and areola may die because of loss of blood supply to the tissue. (If this happens, the nipple and areola can usually be rebuilt with skin taken from elsewhere on the body.)

Breast Reduction in Men

Men with over-developed breasts, a condition known as gynecomastia, may desire breast reduction surgery. According to the ASPS, gynecomastia affects an estimated 40% to 60% of men, and breast reduction surgery in men increased 84% between 1992 and 2000. Breast reduction in men involves removal of excess fat and glandular tissue and, sometimes, excess skin. The best candidates for male breast reduction are men with firm, elastic skin.

Being overweight may cause an increase in breast size in men, so overweight men with gynecomastia are usually advised to lose weight before deciding on surgery. Other possible causes of gynecomastia include heavy use of alcohol, marijuana, or anabolic steroids. Discontinuing use of these drugs may eliminate the gynecomastia and, therefore, the need for surgery.

Breast Augmentation (Enlargement) Surgery

In the past implants filled with silicone gel were used in breast augmentation surgery. When questions about the safety of silicone-gel implants arose, their use was banned in the United States. The controversy over silicone-gel implants is a large issue that is too complex to be treated in a short article here.

Breast augmentation surgery in the U.S. today uses one of two brands of implants filled with saline (salt water) approved by the FDA (Food and Drug Administration) for use in the U.S.

According to the American Society of Plastic Surgeons (ASPS), breast augmentation was the fourth most popular invasive surgical procedure among cosmetic plastic surgeries performed in 2000. In a press release dated July 12, 2001, the ASPS says that breast augmentation was performed on 212,500 women last year.

Breast augmentation surgery uses saline-filled implants to enhance the size and shape of the breasts. Women often desire breast enhancement surgery if their breasts have lost volume and changed shape after weight loss or childbirth or as a result of aging. Surgery can also correct cases in which a woman’s breasts are of significantly different sizes.

Augmentation can be performed at any age after the breasts have finished developing, but, according to the American Society for Aesthetic Plastic Surgery (ASAPS), federal regulations that took effect in May 2000 prohibit breast augmentation for purely aesthetic (that is, non-medical) reasons in women less than 18 years old.

Although breast augmentation will enhance the appearance of the breasts, it will not necessarily produce an ideal body. The ASPS says that the best candidates for breast augmentation surgery are “women who are looking for improvement, not perfection” in the way they look. When consulting a plastic surgeon about breast augmentation, women should be prepared to discuss their expectations about the results of the procedure as well as their past medical history and current health, including any family incidence of breast cancer.

The procedure can be performed in either an office surgical suite, a free-standing surgery center, or a hospital out-patient department under general anesthesia (being “put to sleep”) or with local anesthetic supplemented by medication for sedation. The doctor will then make a small incision either in the crease of the breast (just above where the breast joins the chest), below the areola (the pigmented skin around the nipple), or in the armpit—all places where the scar will be the least conspicuous. The doctor will insert the implant through the small incision, then fill it with sterile saline. The implant can be placed either behind the breast tissue (on top of the pectoral muscle, which sits between the breast tissue and the chest wall) or underneath the pectoral muscle.

Most women will be up and about within 24-48 hours after surgery. Most women return to work within a few days to a week, although the timing will vary with the job and the type of physical activity it requires. Swelling of the breasts should subside within 3-5 weeks after the surgery. Some women experience numbness or loss of sensation in the breasts or around the nipples, but this is usually temporary.

The most common complication of breast implants is capsular contracture, a tightening of the scar tissue that the body produces around the implant as a natural part of healing. Additional surgery may be required either to remove the scar tissue or to remove—and perhaps replace—the implant.

The FDA warns that a breast implant is not a lifetime device. The implant may rupture, causing the saline to leak out. Although the saline will be harmlessly absorbed by the body, the size and shape of the breast will again be reduced. This occurrence may require additional operations for removal and/or replacement of the implant. The FDA says that some implants rupture or deflate within the first few months, while others remain intact 10 or more years after surgery.

There is no evidence that breast implants affect pregnancy or the ability to breast feed.

There is also no evidence that implants increase the likelihood of breast cancer.

However, implants make both taking and reading mammograms (special low-dose x-rays used to detect breast cancer) harder. Women with breast implants should have regular mammograms at the interval prescribed for their age and medical situation. They should tell the radiology technician about the implants because the technician will have to take special additional films of the breast.

Growing Your Own New Breast Tissue

Women desiring either reconstructive surgery after a mastectomy or breast enlargement without implants may some day be able to grow their own new breast tissue. Researchers working in the field of tissue engineering are developing ways to stimulate new tissue growth from cells from the patient’s own body. Because the cells are the patient’s own, their growth does not stimulate an attack by the body’s immune system that can lead to rejection of the new tissue. Results from recent experiments in mice are promising, but researchers caution that testing of the procedure in humans is at least 5 years away.

A recent article in New Scientist magazine reports on research presented at a meeting of the Royal Australasian College of Surgeons. At the meeting tissue engineer Kevin Cronin described the technique that he and his colleagues at the Bernard O’Brien Institute of Microsurgery in Melbourne, Australia, used to grow new breast tissue in mice. The new tissue was originally grown on the groin of a mouse, then transplanted to the animal’s chest area.

To get new tissue to grow, the scientists implanted a cylindrical silicone chamber on top of a blood vessel in the mouse’s groin. The chamber contains a small amount of the tissue to be augmented supported by a “scaffold” of biological material. Within about 10 days small blood vessels begin to sprout from the large vessel and infiltrate the scaffolding gel. Shortly afterwards, the breast tissue begins to grow into the gel. As the breast tissue continues to grow, nourished by the new blood vessels, the biodegradable scaffolding gel dissolves, leaving a section of healthy new tissue.

As promising as the new technique is, it is not without drawbacks. One great concern is that, in women who have had a breast removed because of cancer, growing new tissue from the woman’s own breast tissue may stimulate the growth of cancer as well. “In the case of someone who has already had breast cancer, it would be difficult to ensure that the cells used to regenerate the breast tissue did not also contain the cancer-causing genetic machinery,” tissue engineer Julia Polak from Imperial College School of Medicine in London told New Scientist, according to the Australian publication The Age.

For this reason Cronin’s colleagues think that fat tissue, which can be grown in the same way, will be a better choice than breast tissue for breast reconstruction or augmentation. (Breasts contain both breast tissue and fat.)

And the applications of tissue engineering are not limited to breast reconstruction or augmentation. Researchers envision using these techniques to create new cartilage, livers, hearts, and bladders.

A New Method for Natural Breast Enlargement

For women who’d like bigger breasts but don’t want to have surgery, there’s now a nonsurgical alternative, the Brava® Breast Enhancement and Shaping System. Developed by Dr. Roger K. Khouri, a plastic and reconstructive surgeon, the Brava System applies the concept of tension-induced tissue growth, a long established procedure in reconstructive surgery, to stimulate the growth of new breast tissue.
The Brava System consists of two semi-rigid domes with silicone gel rims and a small computer, all held together with a sports bra. The self-regulating computer increases the tension inside the domes. This increased tension gently stretches the tissue of the breasts and causes new tissue to grow to fill the expanded area.

This sounds and even looks like science fiction. But the Brava System’s effectiveness is backed up by scientific evidence from clinical trials. Representatives from Brava demonstrated the device at the annual meeting of the American Society of Aesthetic Plastic Surgery (ASAPS) last month (May 2001). And the U.S. Food and Drug Administration (FDA) has approved the apparatus for sale as a nonregulated medical device.

The device is designed for small-breasted women. “It’s not for women who already have a C-cup,” Khouri told MSNBC. “It’s for A’s and B’s who don’t want surgery but want to be a little bigger.” Most women who completed the clinical trials added about a cup size to their breasts, and many of the first trial subjects have maintained their new size 18 months after they stopped using the system. Brava says that its research has indicated that 16 million American women between the ages of 18 and 49 think their breasts are too small; further, Brava claims, 80% of these women indicated they would be satisfied with an increase of one-half to one full cup size.

Achieving this increase, though, is neither cheap nor easy. A patient must see a doctor who has been trained by Brava in proper use of the system. The company estimates that the cost of the system, including the frequent required office visits, will be between $2,000 and $2,500. And, for the system to work, a woman must wear it for 10 consecutive hours every day for 10 weeks. (And you can’t cheat. The same little computer that regulates the tension inside the domes also records the amount of time the user wears the device.)

Besides the cost, the biggest drawback to the system would seem to be the 10-consecutive-hours requirement. According to news reports, many women who participated in the trials chose to wear the device at night, which necessitated sleeping on their backs. This can be a difficult adjustment for someone not accustomed to sleeping in that position. The only risk associated with the system, according to Brava, is the possibility of dermatitis, or irritation of the skin, caused by an allergic reaction to the materials used to make the device.

Brava says that women who are pregnant or breast feeding, who have had breast cancer or a mastectomy, or who are under age 18 or whose natural breast development is not yet complete should not use the system.

Regular Mammograms Save Lives

Organized mammographic screening reduces the number of breast cancer deaths by 63%, according to a study presented by Robert A. Smith, Ph. D. Smith, director of cancer screening for the American Cancer Society, presented the study findings at the Cancer Society’s Science Writers Seminar in California on April 23, 2001.
In a long-range study conducted in Sweden, all women in two counties between the ages of 40 and 69 received an invitation for a free mammogram every two years. Between 1988 and 1996, among women who got mammograms the death rate declined 63%. This decline is significantly higher than the 30% reported in previous studies of the effectiveness of mammograms, Smith says in a news story on the ACS Web site.

“What I hope these data will do is, first, refute some recent studies that are inexplicably calling into question the very clearly demonstrated benefits of mammograms,” Smith says in the ACS news story. He adds that those studies had flawed methodology: their study periods were too short, and the results did not filter out deaths caused by cancer discovered before the mammographic screening started.

Smith says that screening mammograms save lives by reducing the number of cases of advanced cancer. Regular screening means earlier discovery of cancer. “We find breast cancer earlier,” Smith says. “That way we can treat it earlier. By treating it early, before it has a chance to spread, we can save lives.”

The Swedish study has been going on for 29 years. During the study, women have been regularly invited to receive free mammograms. Women who did not respond to the first invitation received a reminder that they could receive the free service. The United States, because of its decentralized system of medical delivery, has no way to perform a similar invitational program, Smith says.

However, Smith adds, in the U.S., HMOs and other insurers are encouraging women to have regular mammograms. Since one criterion that employers use in evaluating a health care plan is the number of women over the age of 50 in the plan who have had a mammogram, HMOs and insurers have an incentive to notify women about the benefits of such screening.

According to the ACS news story, all states except Utah require insurers and HMOs to cover the cost of mammograms. Medicare and Medicaid also pay for this screening.

Exploring Early Puberty

Last month’s article looked at the scientific method at work in two cases, one of which questioned the methodology of a 1997 study concluding that girls are going through puberty at earlier ages than previously. Now comes the report of another study, partially based on the 1997 one, that produced unexpected results.

Dr. Fred Kadlubar of the U.S. Food and Drug Administration’s National Center for Toxicological Research thought that genetics might play a part in the declining age of puberty in girls. When he heard about a study exploring the possibility that environmental pollutants might be to blame, he asked to collaborate. His hypothesis was that a gene controlling the levels of the female hormone estrogen would be responsible for the onset of early puberty.

To his surprise, Kadlubar reported in March at the annual meeting of the American Association for Cancer Research, he found that a gene that produces a liver enzyme responsible for lowering the body’s level of the male hormone testosterone was responsible. Girls who have the gene break down testosterone as a rate faster than usual. As the testosterone level falls, the level of estrogen relative to testosterone rises.

The beginning of breast development is considered the first sign of puberty. Girls usually begin breast development about a year before they have their first period. The average age of puberty is about 12 for African American girls and 13 for whites.

The earlier girls mature sexually, the longer they will be exposed to estrogen over their lifetimes. Since prolonged exposure to estrogen is associated with an increased risk of developing breast cancer, the presence of this gene could help predict which women have a higher than average chance of developing the disease.

The Scientific Method at Work

In the last article we looked at how the scientific method works, with researchers constantly checking and rechecking each other’s work. Two news stories from February 2001 illustrate how this process works.

Case 1: Doctored Data?

The medical journal Surgical Laparoscopy, Endoscopy and Percutaneous Techniques has rebuked two well-known Stanford researchers, Dr. Farr Nezhat and Dr. Camran Nezhat, and retracted two articles by the brothers. The doctors claim to have developed a new surgical technique for women with endometriosis of the rectum. Endometriosis is a condition in which uterine tissue grows outside of the uterus.

Stacey Mullen, a woman on whom the Nezhats performed the surgery, claims that the doctors destroyed her bowels and ruined her life by performing the operation on her. Mullen has sued the Nezhats in Atlanta, saying that they lied about her complications in the journal articles. Experts hired by Mullen and her attorneys examined the patient records on which the articles were based and found major discrepancies between the data in the patient records and the data reported in the articles, according to Linda Carroll and Alfred Lubrano reporting for MSNBC.

Moreover, report Carroll and Lubrano:

In June of last year, an MSNBC examination of the original Nezhat patient records revealed that the actual length of time it took to perform the surgeries was far longer than what was reported in the paper. Similarly, the amount of blood each patient lost during the procedure was significantly greater than what the Nezhats wrote. […] Even many of the patients’ ages listed in the journal article differed from those in the original records.
Experts say that the retraction of an article by the journal that published it is unusual. More often articles are retracted by their authors because further investigation has raised doubts about the validity of their research methods or analysis of data. This controversy surrounding the Nezhat brothers calls into question every other article the brothers have ever published or will try to publish in the future, the experts say.

Case 2: Flawed Theory?

Gina Kolata, well-known science writer for The New York Times, reported on February 20, 2001, that “a widespread belief about the onset of puberty in girls is coming under vigorous attack, led by a group of medical specialists who say that it is based on flawed science and that it can have dire medical consequences.”

The belief that girls are now starting puberty as early as age 6 or 7 came from a study by Dr. Marcia E. Herman-Giddens. While working as a physician’s assistant in North Carolina, Dr. Herman-Giddens, whose degree is in public health, noticed that girls as young as 7 or 8 were coming in with breasts and pubic hair.

Herman-Giddens formulated a hypothesis, and between July 1992 and September 1993, 225 pediatricians, nurses, and physicians’ assistants in private practices across the United States collected data on 17,077 girls between the ages of 3 and 12 who came into their offices. The data suggested that girls were entering puberty about a year before textbooks said was normal. In 1997 Herman-Giddens published her findings in the journal Pediatrics.

Critics say that the study’s conclusions are dangerous because “if doctors assume that girls who start developing at 6 or 7 are normal, they might miss serious medical problems like tumors or genetic disorders that can cause early puberty.” Furthermore, the critics say, a single study is not sufficient to demonstrate the hypothesis. Many of the girls in the study may have been brought in by their parents for examination because they were experiencing early puberty due to an underlying medical condition.

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