Frequently Asked Questions

A hernia is a defect in the abdominal wall. The abdominal walls may have a multiple layers, the skin and soft tissues, underneath the soft tissues, there is the core muscle the musculature of the abdomen. And there is an opening or defect in the core muscles of your abdomen where any part of the intra-abdominal contents including the fat, the intestines can migrate out through that opening and you will see a bulge that causes pain but that’s the hernia it’s when your intra-abdominal contents starts migrating outside that abdominal wall and that’s called a hernia.

Most people complain of pain associated with the bulge that they will see. Depending on where the hernia is, it gives you a lot of the symptoms that you are having, upper abdominal hernias, within the epigastric region or ventral region of your abdomen, most people just complain about pain, especially when they are coughing and sneezing. Other people that have inguinal hernias or hernias down the groin area, they can, may complain of testicular pain or thigh pain or inner-thigh pain or may complain of pelvic pain.

I have seen women like athletic women, younger athletic women who have pelvic pain, so you go through the whole differential diagnosis of what could be causing pelvic pain in a women, and usually that would be OBGYN have gone there thorough exam, imaging studies, MRIs.  And sometimes it comes back like it’s a sports hernia where they are athletic and they have developed this groin pull, which is like when you develop a groin pull and sports hernia there is imbalance between your core muscles and your adductors and your thighs.  So, usually a core muscles do a lot of the athletic training, like when you are running on the soccer field or field, hockey field or whatever sport you are participating in, you rely a lot more on your core muscles than your thigh abductors. But if this is an imbalance, your thigh abductors starting taking over what the core muscle should be doing and you get what’s called sports hernia, is really just an injury to the abductors and your core muscles.  And so there is a surgery that we do that can help balance that out and alleviate the pain, but it’s not a true like hernia where you think, it’s a misnomer, where you think our hernia is going to opening and you have something protruding through.  Sports hernia is just like a muscle thing an imbalance between your cores and your abductors.

The a lot more like what a vaginal deliveries, women get like dysfunction of the pelvic floor.  So, they do get like cystoceles and rectoceles and that is kind of like, there is a diaphragm in your pelvis made of muscles.  So, when you give a vaginal delivery or vaginal birth those muscles are all stretched out and during pregnancy your serum levels, your blood levels of all of these collagenases, they kind of like cause the muscles to stretch out so you can have the baby, but afterward all those collagenases, they can kind of go away, they are not in your blood stream anymore, and your pelvic floor is also kind of like go back to its normal size and normal structure, but a lot of times in women it doesn’t.  So, then you get like the stress incontinences and this rectoceles, cystoceles where things kind of start dropping through the floor.  And that is a hernia because it’s a weakening of the pelvic floor.  And that’s more like urogynecologist would manage that kind of hernias.  Surgeons, you know don’t do a lot of vaginal and floor work, but there are some hernias that go through the pelvic floor that we deal with but that’s mostly a urogynecology repair, you know they would handle those kind of hernias.

During a female's lifespan, the breasts definitely undergo changes. At a very young age, during the puberty years, that's when the breast tissue's very dense. That's before the ovaries are producing any, or maybe small amounts, of estrogen hormone. As they then get into the late teens and start having active menstrual cycles. Then the breasts undergo lots of changes, because then you have more development of the ductal system and what are called the lobules of the breast.

Then, as they continue in their late teens into their twenties, with the hormone levels being higher, the breast undergo changes for possible pregnancies, possible breastfeeding. That's when the estrogen's going to play a major role to develop the ductal system, the lobules, during that part of that lady's life. Then they're in the phase of premenopausal time of their lifespan. Breasts undergo a lot of changes, pregnancy causes a lot of changes.

Then as they get older towards 50s, when they start getting into the perimenopausal period, and then go through menopause, further changes occur, because now the estrogen levels start to fall. Then what happens is, the breasts actually become more fatty replaced. You can see it on mammography all the time where a lady in her, let's say, the early 40s, you look at that mammogram, and then you look at it when she's 65, you can see it, you can see it on physical examination. It leads to potential sagging of the breast, because when the hormone levels continue to drop with menopause, it causes lots of other changes. The main thing is the fatty replacement of that breast tissue.

Estrogen plays a very distinct role in the breast changes throughout a lady's lifetime. For example, in the puberty age group where there's minimal to no estrogen being much produced at that point, the breast tissue's very dense. That's one main reason we don't do mammograms on ladies usually until they’re in their late 20’s-30’s, because it looks like a snow storm. It's so dense that you can't read it. However, as they then become actively menstruating and the estrogen levels are up and down, and they're maybe becoming pregnant, the breast tissue is very responsive to the estrogen molecule leading to increased breast duct development, increased lobules which are the parts in the end of the ductal system, and preparation for possible pregnancy. Of course, pregnancy itself leads to lots of changes, swelling of the breasts getting ready for that child, potentially breastfeeding.

Then the estrogen plays a role due to the lack of estrogen. As a lady goes through her menopausal phase of her life and the estrogen levels fall dramatically, then the breast tissue loses a lot of its integrity because it becomes fatty replaced. You can see that both on physical examination, you might see sagging of the breast because of that, and clearly on mammograms you'll see a difference as far as the density of the breast.

Changes that a lady might notice at home, for example, would include a new lump. That goes into the lady checking herself, which we still feel is important. She feels something that's new to her, if she sees any changes as far as the color of the breast, meaning if she ever wakes up someday and it looks like scalding water went to her breast causing a lot of redness, that ought to be evaluated. You just don't assume it's an infection, because there's a certain type of cancer called inflammatory breast cancer that can present that way. Other findings might be bloody nipple discharge. Another finding might be skin inversion. Anywhere on the skin, if it's all of sudden dimpled, or if the nipple's now inverted where it's sunken in, and that's new to that patient, needs to evaluated.

Male breast cancer occurs infrequently. For every 100 women, we'll have one man with breast cancer. So obviously, the odds of a man getting breast cancer is a lot less, but it's not zero. So men need to be aware that breast cancer does occur in the male population.

Breast cancer in men, it's manifested very similar to that in women. Albeit men do not get their yearly screen mammograms. The point is though, it's usually picked up by a lump. A man feels a lump in his breast, just like a lot of women do also. And then it's worked up the same way, that we will do mammograms on men, we will do ultrasounds if needed in men, just like you would for a lady with a breast lump. Ultimately, depending on those findings, the physical findings, and the imaging studies, they may get a biopsy just like we would with a woman.

A breast cancer in a man, may present differently, as far as he may or may not have pain with it, but that's true in women also. The majority of breast cancers, be it male or female, are usually painless. So it really goes back to physical examination. The patient may feel a lump, or the examining physician will feel a lump. Very similar between men and women.

For men to reduce the risk for breast cancer, it's the same as for women. The three things that we have control over is your weight management, exercise, and alcohol in moderation. Those three things put together have been shown to decrease the risk of developing breast cancer.