Britney Spears recent appearance at the MTV video awards sporting a figure a notch down from a few years ago has generated a lot of publicity. When you make it as a Drudge Report headline entitled "LARD and CLEAR" you know you've had a bad week.

There have been some articles asking whether it's fair or not to criticize her for her figure and how that reflects pressure on actresses, models, or women in general to achieve unrealistic bodies. Well, my take is that when you've built up a music career centered around sexuality/physicality rather then music or voice talent, you reap what you sew.



Ms. Spears doesn't look in fact look "bad", she looks normal after having 2 children in rapid succession. Unfortunately, normal people aren't the benchmark for her field of work, and she did herself no favors wearing an outfit accentuating her body's changes.

She's got a modest "mommy tummy" which is relaxation of her muscles and fascia of the abdominal wall you get from pregnancy, weight gain/loss, and normal aging. The younger you are and the less weight you gain when you get pregnant, the less of this you tend to see.

She appears lucky enough to not have to deal with strech marks. Stretch marks represent tearing/shearing of the structural elements of you skin and are something you're individually predisposed to. Some people get them with modest weight gain or on their breast with breast feeding, but they're produced more often with significant weight gain. There is really no non-surgical treatment for strech marks and if you're lucky they confined in your lower abdomen and can be completely excised. Strech marks with redder colors may be improved by fading the color some with laser treatments, but DO NOT GET TALKED INTO BELIEVING LASER WILL MAKE THEM GO AWAY. Dermatologists are notorious for treating people this way, and I've seen a lot of unsatisfied patients out several thousand dollars.

What does someone like Ms. Spears need to do to improve this non-surgically? Strengthen her abs and watch her weight. That may not be enough however to return her to her previous figure. To do that she'd need some variation of a tummy tuck with some skin/fat excised, liposuction, and have her muscle and fascia physically tightened with sutures back to the midline.

Rob

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I'm a big Drudge Report fan and I check it once or twice a day to survey the wonderful mix of important or interesting things on the newswire. One of the stories featured today was this from the UK Daily Mail about how fat stem cells have potential to graft or grow new breast and could be used for implants to replace current saline or silicone versions.

This is really an idea not ready for prime-time in the near future. We don't have the technology to grow or implant these cells predictably. Still to be answered are what (if any) effect on the development of breast cancer these cells could have or whether their presence would affect screening mammograms. Fat grafting of the breast, a once seriously taboo topic in Plastic Surgery, has been readdressed in a number of journal articles as a way to fill in some contour irregularities in breast reconstruction.

The problem with fat is that the take of it as a graft material is historically cited as only ~50%, so getting predictable results when large volumes are required cannot be achieved. This has limited interest for it as an augmentation material. The amount of size added from these stem cell was very modest and could not achieve a useful size for most cosmetic cases where we would currently use an implant.

Despite the sexy headline, don't expect anything like this to be widely used in the near future. If you looking for the next big advance for breast surgery in the United States, look forward to the approval of the real high-cohesive form stable implants like the Inamed 410 & Mentor CPG devices.

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