Preventative Mastectomies


Actress Angelina Jolie made headlines recently when she publicly announced in the New York Times her decision to undergo a double mastectomy procedure in spite of the fact that has not been diagnosed with breast cancer. The procedure is a preventative measure intended to pre-emptivley reduce the likelihood that she will face the deadly disease.

"I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer."

Jolie, whose own mother fought a long battle with cancer, had a genetic predisposition that put her at drastically heightened risk of eventually developing the disease herself. The procedure was undertaken to reassure her family and put her own mind at ease.


"My mother fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.

We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer."

The doctors of Dunagan, Yates & Alison Plastic Surgery Center would like to take this opportunity to answer some common questions regarding preventative or prophylactic mastectomies.

When would a woman consider mastectomies if she doesn’t actually have cancer?


Some women who do not actually have breast cancer can benefit from what are called prophylactic (preventative) mastectomies if they have a very high risk of developing breast cancer. These women typically have a very strong history for breast cancer and may have been determined by testing to have a genetic predisposition for breast cancer, as was Angelina Jolie’s situation. Since there can be an extremely high risk of developing cancer,  prophylactic mastectomies can be a life saving procedure.

If a women chooses to have prophylactic mastectomies, can she have reconstruction?

Yes. Just like a women who has mastectomies for cancer, women who have prophylactic mastectomies can have reconstruction. Typically this is done at the same time as the mastectomies (we call this an immediate reconstruction), and the reconstruction can be done with tissue expanders (silicone implants are later placed after the expanders are inflated to the desired size), or the reconstruction might use the patient’s own tissues, such as from the tummy. Either way, an immediate reconstruction is nice because it provides the patient with some breast volume right away, avoiding a completely flat appearance. An immediate reconstruction also lets us use more of the patient’s own tissues and arrange the scars more inconspicuously to give a more natural result. Also, an immediate reconstruction allows the reconstruction process to proceed more quickly.

Can the nipples be saved with this type of reconstruction?

Since prophylactic mastectomies are done before the cancer has occurred, it may be possible to save the nipples, either leaving them in place or by reattaching them to the lifted reconstructed breast. If we are able to do this, this can help provide an even more natural, esthetic result. The decision whether or not to save the nipples is made by the Patient, the General Surgeon, and the Plastic Surgeon.

What is the recovery like for mastectomies and reconstruction?

Typically, the patient stays 2-3 days in the hospital, and then recovers at home, being moderately uncomfortable for a few days. Most patients can drive after a week or two, and return to work after 2-3 weeks. After the initial reconstruction, the next operation (to take out the expanders and place implants, do nipple reconstruction, or to make other adjustments) takes place a few months later.

Dr. Mike Yates 2012 Compassionate Doctor Recognition

Patients’ Choice has announced that Dr. Michael D. Yates was one of a select few physicians honored with the prestigious 2012 Compassionate Doctor Certification.

Each year nearly 100 million patients across the US access websites to provide feedback about experiences with their physicians. Only those
with nearly perfect overall and bedside manner scores, as voted by their patients, are selected for the Compassionate Doctor Recognition.

Dr. Yates has been recognized with this award for 5 consecutive years! He commented on the recognition:

"This is quite an honor for me. I am very pleased to have been selected and grateful to my patients who went out of their way to rate me and give me positive reviews.”

Ageless Beauty: Anti-aging cosmetic procedures at any age

As we age, our bodies change and so do our expectations about how we look. Young adults are the top group for rhinoplasty, breast augmentation and laser hair removal since body proportions, facial imbalances and clear, smooth skin are their top priority. For those between 35-50, Botulinum Toxin Type A in the form of Botox®, Dysport® and Xeomin® is king. Women who have had children and are trying to age gracefully are getting Mommy Makeovers (which include breast surgery, tummy tuck and liposuction) and using hi-tech laser, light and skin resurfacing techniques. The over 50 crowd wants to be competitive and are getting facelifts, brow lifts (forehead lifts) and eyelid surgery earlier, rather than later, to get ahead of the aging process and for safer surgery. But that doesn’t mean the over 65 group isn’t growing – plastic surgery for retirees (or non-retirees) has increased by almost 80% in 10 years.



Mother's Day Specials at DYA!
So many options for firming up a sagging jawline: lifts, liposuction, injections and lasers



In “I Feel Bad About My Neck,” Nora Ephron gave voice to generations of women who have been silently hiding their necks like turtles in scarves, boas, turtlenecks and chokers. Her blunt advice is to start concealing the neck at age 43. “Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn’t if it had a neck.” Sure, she had a point. But there is an equal embarrassment perched right above the neck: the sagging jaw line.   

When you reach your early 40s, you may notice that the skin between your neck and jaw, which was once a taut right angle, is now simply dropping. This “drop zone” is the subject of many heart-to-heart conversations. We have all watched at least one friend (of a certain age) pulling back the skin in front of her ears with two thumbs to illustrate how much better she would look without the drooping, wavy jaw line. She asks, “Tell me the truth, don’t I look better like this?” You answer dishonestly: “Don’t be silly. You look great the way you are.”

The aging jaw and neck are challenging. The neck is comprised of three layers: skin, fat, and muscle. Sagging muscles and bulging fat are located under the thinnest, crepiest skin on the body (except for eyelid skin). To make matters worse, a thin ropey material called platysma tends to split into a V-like formation of two cords that stick out especially when they contract. To see this phenomenon in action (if you’re over 40) look in a mirror, say “eee,” and watch in horror what happens. A Manhattan plastic surgeon comments, “Trying to fix all of that with potions and lotions is like waging a two-front war on a sheet of thin ice.” He recommends a neck lift for women in their early to mid-40s who are not ready for a facelift.

Neck Lift/Facelift

The neck lift wraps sagging muscles crosswise to the jaw to restore that all-important right angle. Compared with a facelift, sutures are smaller, there is less pulling and recovery time is much shorter. However, a neck lift has traditionally been part and parcel of a facelift and many plastic surgeons believe it should remain so. The reasoning is that, anatomically, the muscles of the neck are connected to muscles of the face, so if you try to tighten just the neck muscles, you will do you face a disservice. Using this line of reasoning, even if your big complaint is your neck, you will get better results with a facelift. If you’re confused about which procedure is right for you, have a board-certified plastic surgeon, or two, give you feedback while perusing your very own unique face and neck.

Liposuction and the double chin

The face and neck are usually treated at the same time, often in conjunction with liposuction to sculpt the area beneath the chin and jaw line. But, if you gain weight, looser skin, weaker muscles and free falling fat may contribute to your drop zone. Younger patients who have fatty necks but no significant facial aging may be treated with liposuction alone. Some plastic surgeons also might use laser or light technology to tighten necks.

Preventive Botox

It has been seen that using Botox in areas where wrinkling and creases can occur will prevent deeper lines from forming and will maintain a youthful appearance. Better to not have those angry or tired lines develop, so people will not notice that you’ve had anything done.  Botox can also soften those V-shaped platysma cords.

Your own belly fat

Another alternative is injecting fat from the belly into the jawline area to provide extra volume. This will include the bonus of your own stem cells. Extra stem cells are separated from the fat via centrifuge and then added, making the skin glow more and enhancing collagen.

Trendy approaches

Plastic surgeons were recently interviewed by W Magazine about trendier devices, such as Thermage, Ulthera and Titan. These devices deliver radio frequency, ultrasound and infrared lasers to stimulate skin layers below the epidermis, an area in which collagen and elastic production slows down as we get older. According to the surgeons interviewed the problem is that these devices don’t deliver enough energy to have a substantial effect. However, if you have mild laxity and expect modest results, they may be a good option.

A new FDA-approved radiofrequency device, Evolastin, has been getting some good reviews. Evolastin delivers heat through small injections directly into the deep dermis. The goal is to boost collagen and elastin. A typical treatment can include as many as 1,500 shots via pulses from a 10-needle cartridge; local anesthesia is used or else the pain would be unbearable. You also need patience; the results take over one month to see and then continue to appear for a year. One doctor claims the boost of elastin and collagen produced by Elastin is like setting the clock back about five years and that results are equal to about one third of a facelift. If you choose this procedure, ask a lot of questions about the recovery time. There have been reports of post treatment swelling that can persist for some time.

In still another approach, a company called Kythera is close to releasing an injectable that dissolves the double chin with human bile.

Even though you might favor one of these options, it’s a good idea to have an open mind when you go in for a consultation. Your best bet is to come in for a consultation where we can suggest the very best procedure in view of your very own unique facial characteristics.

DYA Honors Breast Cancer Awareness Month

DYA staff recently honored Breast Cancer Awareness month by wearing their favorite pinks and pearls.


Staff Spotlight: Diane Tyler


Over the years, our staff has gotten rave reviews and warm accolades for their special mix of kindess, professionalism and knowledge. We are grateful to have such a wonderful team and thought we'd share a bit about some of them here. First up is Diane Tyler, RN, and director of our Skin Health and Laser Center.

First up is Diane Tyler, RN, Skin Health and Laser Center Director, Laser and Skin Health Specialist

Diane says she was a "late bloomer," becoming a nurse at 32 after staying at home with her two children until they started to school. "Then it was my turn," she says.

After graduating from nursing school and working in a hospital setting for a few years, Diane decided to make a change and, in stroke of good luck, crossed paths with a plastic surgery group in Sarasota, Florida. "I looked in the phone book to see where I might like to work, saw the group whose name and reputation I recognized, and made a call. The office manager answered the phone and said, 'How did you know we were looking for an office nurse?' They had been looking for a while, and they took a chance on me."  Diane was the only nurse in the office, so she had the opportunity to learn a great deal from the three top-notch plastic surgeons in that group.  "We spent 9 very rewarding years together," she says.

Then Diane met het life partner, Tom. After a couple years together, they decided to move to a mountain top in Alabama, where Tom started his life. After settling in for a bit, Diane again picked up the telephone book and had another stroke of luck. "This venture took me to Dunagan Yates & Alison Plastic Surgery Center, and believe it or not, the office manager answered my initial call. A nurse who was an integral part of the Skin Health department had just given her resignation that day. Within 2 weeks I was working, again in the top notch plastic surgery practice in the area."

Ten years later, Diane became the director of the department, which has expanded from two skin health treatment rooms to two suites of treatment rooms, and where all types of laser treatments are provided, including Fraxel, hair removal, leg vein treatments, red and brown spot treatments, skinhealth treatments, Ulthera non-surgical facial tightening, Coolsculpting body contouring, and a plethora of excellent at home skin-health products that help maintain the results of the treatments DYA provides.  "We currently have an all RN staff of 4, and 3 receptionists," says Diane, "Luckily, I once again found another work 'home and family.' Without the reputation and support of our three excellent physicians, Deason Dunagan, MD, Michael Yates, MD and William Alison, MD and their staff, the Skin Health and Laser Department would not be the fine Center it is today."

Saturday Seminar in Huntsville


We hope to see you there!

Holiday Open House Week 2011

We hope you all will stop by our open house next week Monday through Thursday, Dec 5th through 8th for some refreshments and wonderful holiday specials. Please note that the 15% off is valid *only* during our holiday open house, so don't miss out!

Monday, Dec. 5th: Coolsculpting is 15% off

Tuesday, Dec. 6th: Ultherapy is 15% off. Also, receive a complimentary skin treatment at your first follow-up and a complimentary Clear+Brilliant treatment on your second follow-up.

Wednesday, Dec. 7th: Buy one get one free Latisse kits, while supplies last (one per person!).

Thursday, Dec. 8th: Clear+Brilliant specials for the Face + Neck. Check out our newest laser. Face sessions starting at $300, Face + Neck sessions starting at $400.

All laser treatments 15% off, including Fraxel, hair removal, leg veins and "spots."

15% off Botox

15% off products (excludes prescription products)


Look for This Logo When Picking a Plastic Surgeon



Plastic surgery involves many choices. The first and most important is selecting a surgeon you can trust.

Choosing an ASPS Member Surgeon ensures that you have selected a physician who:

  • Has completed at least five years of surgical training with a minimum of two years in plastic surgery.
  • Is trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
  • Operates only in accredited medical facilities
  • Adheres to a strict code of ethics.
  • Fulfills continuing medical education requirements, including standards and innovations in patient safety.
  • Is board certified by The American Board of Plastic Surgery or in Canada by the Royal College of Physicians and Surgeons of Canada®.

ASPS Member Surgeons are your partners in cosmetic and reconstructive plastic surgery. Look for the ASPS Member Surgeon logo. Learn more here.

Nip/Tuck Nightmares


Below is an except from a Health Magazine Article entitled Nip/Tuck Nightmare. The letter from the editor at the front of the magazine makes a great point: buying a discount handbag is one thing, choosing a doctor who is not a ABPS board certified plastic surgeon because he or she offers cheaper prices than the plastic surgeon is another thing. This a risky endeavor, and one that could leave you permanently scarred. Discounts do not belong on your face or body. Please see the full article here.

Untrained in the OR
Plastic surgery used to be the exclusive domain of the rich and (sometimes) famous. Now, it’s attainable for almost anyone, thanks in part to the explosion in lower-cost cosmetic practices helmed by doctors from other specialties. But just because women can get cosmetic surgery from their internist or OB doesn’t mean they should. "Anyone can call themselves a cosmetic surgeon, with very little training," says Joseph Serletti, MD, chief of plastic surgery at the University of Pennsylvania. "It doesn’t mean they have the qualifications to perform surgery safely." Felmont Eaves, MD, a plastic surgeon in Charlotte, North Carolina and immediate past president of the American Society for Aesthetic Plastic Surgery (ASAPS), says, "Doctors who are not board-certified surgeons are one of the biggest dangers in this field."

A board-certified plastic surgeon must undergo at least five years of specialized surgical training post–medical school. Doctors must then pass both oral and written exams and fulfill ongoing continuing-education requirements. "It should be the minimum of what you want from your surgeon," Dr. Zins says.

Yet none of that training is required by law. In most states, anyone with a medical license can perform cosmetic surgery. The results can be catastrophic. Dr. Serletti says he and colleagues have seen patients come in with improperly placed breast implants and damaged facial muscles after going to poorly trained doctors. And yes, people do die: A recent German study of liposuction deaths concluded that lack of surgical experience was a major contributing factor. In July, Arizona internist Peter Normann, MD, was convicted of second-degree murder and manslaughter after three patients died in his care, two after liposuction and the third after a botched fat-shaping procedure.

A different path
Gregory Alouf, MD, is one physician who created his own route to cosmetic surgery. Dr. Alouf, a family practitioner in Salem, Virginia, opened an "aesthetics" practice in 2004, offering non-surgical procedures such as laser hair removal. In 2006 he began doing liposuction, followed by breast implants and other surgical procedures. According to a reprimand issued last February by the Virginia Board of Medicine, Dr. Alouf learned the techniques primarily at medical conferences, where there was minimal hands-on experience.

Two years after he started offering liposuction, Dr. Alouf performed lipo on an obese 29-year-old woman—someone the Virginia Board of Medicine stated "was not a suitable candidate for such surgery" due to her weight. Three other lipo patients experienced complications, resulting in hard and lumpy areas and "visible contour irregularities." (Dr. Alouf claims that those are the only complications he has had in more than 500 liposuction procedures.) In 2009, during a seven-hour mini-face-lift, Dr. Alouf’s 52-year-old patient started bleeding uncontrollably from her incisions. The doctor had her sit up and applied pressure to the site while he called a plastic surgeon friend for advice. As a result of these cases, the Virginia Board of Medicine ordered Dr. Alouf to stop all "full incisional" surgical procedures, stating that he "lacks the requisite education, training, experience, knowledge, skill, expertise and competence to perform such surgery."

Dr. Alouf says the issue is not competence, but competition. "I have more liposuction training than a lot of cosmetic surgeons," Dr. Alouf says, adding that he’s never had a patient die, and none has ever filed a malpractice suit against him. "It all comes back to a turf battle," he says. "Plastic surgeons are defensive because there’s a lot of money involved, and they have very cleverly couched this as an issue of public safety to choke out the competition."

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