Medical News Today: What is methemoglobinemia?

Methemoglobinemia is a blood disorder that occurs when too little oxygen is delivered to the cells of the body. There are two kinds of methemoglobinemia — congenital and acquired.

Methemoglobinemia (MetHb) is pronounced met-he-mo-glo-bi-ne-mia.

Babies can inherit it from their parents; this is called congenital MetHb. Sometimes it is called blue baby syndrome, as one of the symptoms can be a blue tinge to the skin.

People can develop acquired MetHb after exposure to certain drugs or chemicals. Acquired MetHb is also rare, but it is usually mild and resolves after the person has identified and removed the cause.

How is it treated?

Methylene blue in centrifuge.
Methylene blue is sometimes used to treat serious cases of MetHb.

Some people with congenital MetHb do not have any symptoms, meaning they may not need treatment.

Mild cases of acquired MetHb do not usually require treatment either. A doctor will advise the person to avoid the substance that caused the problem.

Methylene blue is used to treat severe cases of MetHb, and doctors may prescribe ascorbic acid to reduce the level of methemoglobin in the blood.

In severe cases, a person may require a blood transfusion or exchange transfusion. Oxygen therapy will also be provided, if required.

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How is it diagnosed?

A doctor will diagnose the condition using a blood test that checks the level of functional hemoglobin in the blood.

A doctor may carry out pulse oximetry, which checks the oxygen level of the blood, and a blood test that checks the concentration of gases in the blood.

Types of methemoglobinemia

The condition occurs when the blood protein hemoglobin in a person’s body converts into methemoglobin.

Hemoglobin is present in red blood cells to carry oxygen around the body, distributing it to all the tissues and organs that need it to survive.

When a person has MetHb, the oxygen is still carried around the body but is not released effectively.

Inherited MetHb

MetHb can be passed down if one or both parents carry a faulty gene that causes problems with the enzyme cytochrome b5 reductase.

  • Type 1 inherited MetHB: This is also called erythrocyte reductase deficiency and occurs when the red blood cells do not have cytochrome b5 reductase.
  • Type 2 inherited MetHB: is also called generalized reductase deficiency, and this occurs when many cells in the body do not have the enzyme.
  • Hemoglobin M disease: This occurs when the hemoglobin protein itself is defective.

Acquired MetHB:

Acquired MetHb is more common than the inherited forms and is caused by exposure to:

  • anesthetics, such as benzocaine
  • nitrobenzene
  • some antibiotics, including dapsone and chloroquine
  • nitrites, which are used as additives to prevent meat from spoiling
  • some foods, such as spinach, beets, or carrots, contain natural nitrates which can cause MetHb if consumed in large amounts

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What are the symptoms?

Cyanosis, or blue skin, on person's foot. Symptom of methemoglobinemia and argyria.
Cyanosis, or blue skin, is a potential symptom of methemoglobinemia.

A baby born with the condition may have a bluish tinge to their skin, which is called cyanosis. This color might be apparent at birth or shortly afterward.

They may show signs of:

  • blueness around the mouth
  • blueness around the hands
  • blueness around the and feet
  • have difficulties breathing
  • vomiting
  • diarrhea

In severe cases, they may be:

  • extremely lethargic
  • salivate excessively
  • lose consciousness.

Symptoms vary according to the amount of methemoglobin in the blood, which is measured on a scale called the MetHb concentration.

The normal level of MetHb concentration in a person’s blood is between 0 and 3 percent. If MetHb reaches a concentration of 3 to 10 percent, a person’s skin may take on a blue-grey appearance of cyanosis.

MetHb levels of 15 to 30 percent lead to cyanosis, where blood starts to look chocolate brown.

Concentrations of 30 to 50 percent start to cause more severe symptoms. These symptoms may include a headache, fatigue dizziness, anxiety, and confusion, as well as temporary loss of consciousness, rapid heartbeat, and weakness.

When levels reach 50 to 70 percent, the person may experience seizures, kidney problems, or an abnormal heartbeat.

MetHb concentrations of 70 percent and over can be fatal.

Typical symptoms of the different types of MetHb are:

Type 1 MetHb:

  • bluish coloring of the skin

Type 2 MetHb:

  • developmental delay
  • learning difficulties
  • seizures

Hemoglobin M disease

  • bluish coloring of the skin

Acquired MetHB:

  • bluish coloring of the skin
  • headache
  • fatigue
  • shortness of breath
  • lack of energy

What causes MetHb?

Doctor speaking to couple to help with family planning.
MetHb can be inherited, so people with a family history of the condition should seek professional medical advice when planning a family.

The cause of MetHb is dependent on what type it is. MetHb can be congenital, meaning it is inherited or acquired, which means it is caused by exposure to certain drugs, chemicals or foods.

What are the possible complications?

Methylene blue, which is used to treat severe forms of MetHb, can be unsafe for people who have or are at risk of developing a disease called G6PD deficiency.

Cases of severe MetHb can lead to shock, seizures, and even death.

Can it be prevented?

Congenital MetHb cannot be prevented. People with a family history of the blood disorder are advised to request genetic counseling from a healthcare professional before starting a family.

To prevent acquired MethHb, people should avoid known causes, such as benzocaine, which is one of the most common initiators. Benzocaine is present in many over-the-counter medications, but the topical sprays containing the anesthetic benzocaine cause most of the severe cases.

Children under 6 months should not eat foods containing nitrates, such as spinach, beets or carrots.

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Congenital type 2 MetHb can be serious and often leads to death in the first few years of life. As such, people with a family history of the condition are advised to speak to a healthcare professional before having children.

People with type 1 MetHb and hemoglobin disease tend to do well. Acquired MetHb can be fatal, but once the cause of the problem has been identified and removed, outcomes are good. Most cases will not even require treatment.

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Medical News Today: Urosepsis: What to know about UTI complications

Urosepsis is a term used to describe a type of sepsis that is caused by an infection in the urinary tract. It is a complication often caused by urinary tract infections that are not treated quickly or properly.

Urosepsis is a serious complication of a urinary tract infection (UTI) that requires immediate medical care to avoid a possible life-threatening event. Anyone experiencing the symptoms of urosepsis should seek emergency medical attention.


Urosepsis Kidney pain
Symptoms of urosepsis include pain near the kidneys on the lower sides of the back.

Because urosepsis is a complication of a UTI, most people with the condition are likely to have symptoms of a UTI already.

The most common UTIs are bladder infections, and symptoms include:

  • frequent urges to urinate
  • a burning or itching sensation while urinating
  • feeling that the bladder is full, even after urinating
  • cloudy urine
  • blood in the urine
  • foul-smelling urine
  • pain during sex
  • pressure in the lower back or lower abdomen
  • malaise, or a feeling of being generally unwell

If the infection spreads beyond the bladder, it can reach the higher parts of the urinary system, such as the kidneys and ureters. When the infection reaches these areas, urosepsis is one possible complication.

In addition to UTI symptoms, people with urosepsis may also display more serious symptoms common to other forms of sepsis. Anyone experiencing these symptoms should seek immediate medical care.

Symptoms of urosepsis include:

  • pain near the kidneys, on the lower sides of the back
  • nausea with or without vomiting
  • extreme fatigue
  • reduced urine volume or no urine
  • trouble breathing or rapid breathing
  • confusion or brain fog
  • unusual anxiety levels
  • changes in heart rate, such as palpitations or a rapid heartbeat
  • weak pulse
  • high fever or low body temperature
  • profuse sweating

In some serious cases, urosepsis may progress to severe sepsis, septic shock, or multi-organ failure.

People with severe sepsis produce little to no urine. They may have difficulty breathing, and their heart may have difficulty functioning.

During septic shock, a person’s blood pressure drops to extremely low levels, and their organs may shut down. These symptoms are life-threatening and require immediate medical attention.

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A UTI can occur if bacteria enter through the urethra, which is the tube that urine travels through to exit the body. These bacteria may reach the urethra in a variety of different ways, including through sexual contact, inadequate personal hygiene, or a pre-existing bladder condition. Women are more prone to UTIs than men because their urethras are shorter than a man’s.

The bacteria can spread from the urethra into the bladder, where they can multiply, causing an infection. If a UTI is left untreated, it can lead to complications, such as urosepsis.

Sometimes, UTIs develop because bacteria that are already present in the bladder have multiplied to an unhealthy level.

Risk factors

Some people, including women and older adults, are at greater risk of developing urosepsis. Also, people with open wounds or devices, such as catheters or breathing tubes, may also be more at risk of getting infections and UTIs, which can increase the risk for urosepsis.

Other risk factors for urosepsis include:

  • diabetes
  • being over 65 years old
  • a compromised immune system from autoimmune disorders such as HIV or AIDS
  • immunosuppression from certain drugs, organ transplant, or chemotherapy
  • corticosteroid treatment
  • history of urinary conditions
  • catheter use


patient being rushed through hospital
Emergency medical attention is needed for the symptoms of urosepsis.

Not everyone treated for urosepsis will have complications, especially if the condition is treated promptly and effectively.

Possible complications of urosepsis include:

  • collections of pus near the kidneys or prostate
  • organ failure
  • kidney damage
  • scar tissue in the urinary tract
  • septic shock

Treating urosepsis early and following the doctor’s treatment plan are crucial steps to avoid complications.

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A doctor may diagnose urosepsis after confirming that the person has a UTI, which is done through a simple urine sample. If a UTI has been left untreated or the doctor thinks the infection may have spread, they may order immediate blood tests to help diagnose urosepsis.

The doctor may also look for another source of infection that is causing sepsis by using a chest X-ray to look at the lungs, or a blood culture to look for bacteria in the bloodstream. Sometimes, a doctor may examine the skin for rashes or ulcerations.

Doctors may also perform other imaging tests. A computerized tomography (CT) scan of the abdomen and kidney can help form a complete picture of the kidney. An ultrasound scan may also help doctors see into the urinary tract to diagnose urosepsis.


If caught early, UTIs are easy to treat with antibiotics. A person with a UTI also needs to drink plenty of fluids to help flush the urinary tract.

However, treating urosepsis is not as simple, because it may not respond to antibiotics alone. A doctor will likely start the treatment with antibiotics because it is essential to treat the bacteria that caused the original UTI.

Doctors will monitor a person closely to see how well they respond to the antibiotics. If a person has severe sepsis or septic shock, they may require oxygen.

Some people will need surgery to get rid of the source of an untreated infection completely.

Doctors may prescribe vasopressors, which constrict the blood vessels and increase a person’s blood pressure to keep their organs from shutting down due to septic shock.

If urosepsis is not treated quickly, the person may require emergency hospitalization in the intensive care unit (ICU). If urosepsis progresses and the person develops septic shock, they will need emergency medical treatment.

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person washing hands in a sink
Washing the hands before and after using the toilet is recommended to help prevent UTIs.

As urosepsis is often the result of an untreated UTI, it is essential to prevent UTIs wherever possible.

There are a variety of steps a person can take to help prevent UTIs, including:

  • wiping from front to back after using the toilet
  • washing the hands before and after using the toilet
  • wearing cotton underwear
  • drinking plenty of water daily
  • urinating immediately after sexual activity
  • not waiting longer than necessary to urinate

Anyone experiencing signs of a UTI should visit their doctor for diagnosis and treatment. A prompt diagnosis and treatment is key to avoiding complications.


Urosepsis is a serious, potentially deadly complication of a UTI. Knowing about the signs and symptoms may help people understand the importance of getting prompt treatment for infections.

Anyone who thinks they have a UTI or other problem with their urinary tract should seek medical care.

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Medical News Today: Vitamin K deficiency: What you need to know

Vitamin K deficiency in adults is rare but does occur in infants. The main symptom of a vitamin K deficiency is excessive bleeding caused by an inability to form blood clots.

In this article, we look at the function of vitamin K in the body, as well as the symptoms and treatments for a vitamin K deficiency.

What is vitamin K?

Vitamin K supplements
Vitamin K is found in some plant foods, such as leafy green vegetables, and is also produced by the body.

Vitamin K comes in two forms.

The first type is known as vitamin K-1 or phylloquinone and can be found in plants, such as spinach and kale.

The second is known as vitamin K-2 or menaquinone and is found in the body and created naturally in the intestinal tract.

Both vitamin K-1 and vitamin K-2 produce proteins that help the blood to clot. Blood clotting or coagulation prevents excessive bleeding internally and externally.

While vitamin K deficiency is rare, it means a person’s body cannot produce enough of these proteins, increasing the risk of excessive bleeding.

Most adults obtain an adequate supply of vitamin K through the foods they eat and through what their body naturally produces.

Certain medications and medical conditions can reduce vitamin K production and inhibit absorption, meaning adults can become deficient.

However, vitamin K deficiency is much more likely to occur in infants. When it does, it is known as vitamin K deficiency bleeding or VKDB.

Causes and risk factors

Adults are at an increased risk of vitamin K deficiency and the associated symptoms if they:

  • take anticoagulants that prevent blood clots but inhibit vitamin K activation
  • take antibiotics that interfere with vitamin K production and absorption
  • do not get enough vitamin K from the foods they eat
  • take extremely high doses of vitamin A or E

Other people who may be diagnosed with vitamin K deficiency have a condition that results in the body being unable to absorb fat properly. This is known as fat malabsorption.

People who have problems absorbing fat may have an associated condition, such as:

There are several reasons why newborn babies are more prone to vitamin K deficiency. These are:

  • drinking breast milk that is low in vitamin K
  • vitamin K does not transfer well from a mother’s placenta to her baby
  • a newborn baby’s liver is unable to use vitamin K efficiently
  • a newborn’s gut cannot produce vitamin K-2 in the first few days of life

Dieticians and nutrition experts recommend that adult males consume at least 120 milligrams (mg) per day of vitamin K and women consume 90 mg per day.

Foods that are high in vitamin K include green, leafy vegetables, prunes, and fermented dairy products.

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Bruise on persons arm inside elbow.
A person with vitamin K deficiency may bruise easily.

There are several symptoms associated with vitamin K deficiency, but the main one is excessive bleeding. Excessive bleeding may not be immediately evident, as it may only occur if a person is cut or wounded.

Additional signs of excessive bleeding can also include:

  • bruising easily
  • small blood clots appearing under the nails
  • bleeds in mucous membranes that line areas inside the body
  • stool that is dark black, tar-like, or contains blood

When looking for signs of vitamin K deficiency in newborn babies and infants, doctors will also look for:

  • bleeding from the area where the umbilical cord has been removed
  • bleeding in the skin, nose, gastrointestinal tract, or other areas
  • bleeding at the penis if the baby has been circumcised
  • sudden brain bleeds, which are deemed severe and potentially life-threatening


To diagnose a vitamin K deficiency, a doctor will ask about a person’s medical history to see if they have any risk factors.

The doctor may use a coagulation test called the prothrombin time or PT test. This test draws blood using a small needle. Chemicals are added to the blood, which is then observed to see how long it takes to clot.

If a person’s blood takes longer than 13.5 seconds to clot, the doctor may suspect a vitamin K deficiency.

Certain foods have high levels of vitamin K and should not be eaten before a test. These include some liver products, cauliflower, broccoli, chickpeas, kale, green tea, and soybeans.


If a person is diagnosed with vitamin K deficiency, they will be given a vitamin K supplement called phytonadione.

Phytonadione is usually taken orally, though it can also be given as an injection if a person has difficulty absorbing the oral supplement.

The dosage given depends on the age and health of the individual. The usual dose of phytonadione for adults ranges from 1 to 25 mg.

A doctor will also consider whether a person is taking anticoagulants, as these can interact with vitamin K.

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Vitamin K and newborns

newborn baby.
Newborn babies may need a vitamin K supplement.

Vitamin K administered at birth can prevent a deficiency occurring in newborn babies. It is usually given as a shot.

The American Academy of Pediatrics recommend that newborns receive a single shot of 0.5 to 1 mg of vitamin K-1 at birth.

A vitamin K shot is especially important for newborns under certain conditions. Risk factors for vitamin K deficiency bleeding include:

  • babies that are born prematurely
  • babies with mothers taking anti-seizure drugs, anticoagulants, or drugs for tuberculosis
  • babies who have fat malabsorption due to gastrointestinal or liver disease
  • newborns not given vitamin K at birth, breast-fed exclusively and exposed to antibiotics

It is up to the parents to decide whether or not their baby receives a vitamin K injection, although it is usually recommended.


Vitamin K deficiency in adults is very rare. However, if a deficiency is left untreated, it may result in excessive bleeding.

In infants, it is essential to administer vitamin K at birth to prevent poor outcomes from excessive bleeding, such as intracranial hemorrhage, brain damage, and infant death.

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Medical News Today: Diet is the key to kids’ health and happiness

A new analysis finds that children who eat healthfully are more likely to be happy, and those who are happy are more likely to eat healthfully. Interestingly, these links were independent of weight.
Child eating unhealthful foods
Childhood weight and well-being appear to be linked.

Childhood overweight and obesity is a growing problem in the United States and elsewhere.

Around 1 in 3 U.S. children and teenagers are overweight or obese. Levels have, worryingly, tripled since the 1970s.

Being overweight often goes with a number of health problems, but it also has psychological effects. Children who are overweight are more prone to low self-esteem, negative body image, and depression.

Due to the size of this issue, much research is focused on trying to understand the psychology behind becoming overweight, as well as on the impact of being overweight on children’s psychological well-being.

One such study is the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants Study. This prospective cohort study was set up with the aim of preventing obesity in children and understanding the factors that contribute to it.

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Investigating children’s diets and well-being

Recently, a team from the Sahlgrenska Academy of the University of Gothenburg in Sweden used data from this study to look at the links between psychological well-being and weight in children.

The study included 7,675 children aged 2–9 from eight European countries. These were Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain, and Sweden.

At the start of the study, parents completed a questionnaire that detailed how often specific foods were eaten each week. There were 43 food items to choose from in total.

From all of this information, every child was assigned a Healthy Dietary Adherence Score (HDAS). The HDAS score captures information about the child’s adherence to a healthful diet. It takes into account behaviors such as avoiding sugary and fatty foods and eating fresh vegetables and fruit.

Also, the children’s well-being was assessed at the start and end of the 2-year trial period. This included information regarding self-esteem, emotional problems, and relationships with parents and peers. Height and weight were also captured at the start and end of the study.

Once the data had been analyzed, a clear pattern emerged, linking diet to psychological well-being. The findings were recently published in the journal BMC Public Health.

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“We found that in young children aged 2–9 years, there is an association between adherence to healthy dietary guidelines and better psychological well-being, which includes fewer emotional problems, better relationships with other children, and higher self-esteem, 2 years later,” says corresponding study author Dr. Louise Arvidsson.

Our findings suggest that a healthy diet can improve well-being in children.”

Dr. Louise Arvidsson

The authors report that higher levels of self-esteem at the start of the study were associated with a higher HDAS after 2 years, and that the associations between HDAS and well-being were not affected by the child’s weight, which was unexpected.

Dr. Arvidsson says, “It was somewhat surprising to find that the association between baseline diet and better well-being 2 years later was independent of children’s socioeconomic position and their body weight.”

The current study is the first to have examined links between HDAS scores and well-being.

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Other findings and next steps

They also found that eating 2–3 portions of fish per week was associated with better self-esteem, as well as no emotional problems or issues with peers. Consuming wholemeal products was also linked with an absence of peer problems.

Interestingly, the associations went in both directions. For instance, children with a better sense of well-being ate fruits, fats, and sugars in line with recommendations, and those with better self-esteem had lower sugar intakes.

As other researchers have suggested, emotions can regulate eating and eating can regulate emotions.

The findings are interesting, but, as ever, the researchers mention some limitations. The study was observational and relied on self-reported data, for example, meaning that cause and effect cannot be ascertained.

Also, the children with poorer diets and lower self-esteem were more likely to drop out of the study, making conclusions a little less easy to draw.

More work needs to be done. As Dr. Arvidsson says, “The associations we identified here need to be confirmed in experimental studies including children with clinical diagnosis of depression, anxiety, or other behavioral disorders rather than well-being as reported by parents.”

Because obesity in children is such an urgent issue, no doubt further studies will be waiting in the wings.

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Medical News Today: Gua sha: What you need to know

Gua sha is a technique used in traditional East Asian medicine. It is often used to treat muscle pain and tension, but there has been limited research into how well it works. We find out more about whether gua sha is effective, and if it has any side effects.

Gua sha aims to move energy, known as qi or chi, around the body. The treatment involves using a tool to rub the skin in long strokes, applying enough pressure to create minor bruising.

Gua sha may help to break down scar tissue and connective tissue, improving movement in the joints. The treatment does not have any serious side effects but is not suitable for those with certain medical conditions.

What is gua sha?

Gua sha
Gua sha may be used to treat muscle pain and can break down scar tissue.

Gua sha is the practice of using a tool to apply pressure and scrape the skin to relieve pain and tension. This action causes light bruising, which often appears as purple or red spots known as petechiae or sha.

The name gua sha — pronounced gwahshah — comes from the Chinese word for scraping. It may also be called skin scraping, spooning, or coining.

According to traditional Chinese medicine, qi or chi is energy that flows through the body. Many people believe that a person’s qi must be balanced and flowing freely to ensure their health and wellbeing.

People also believe that qi can become blocked, causing pain or tension in the muscles and joints. Gua sha aims to move this blocked energy to relieve aches or stiffness.

Traditional East Asian medicine also views blood stasis or stagnation as a cause of pain and illness. Another aim of gua sha is to move pooled or stagnated blood to relieve symptoms.

Some physiotherapists use a version of the technique known as instrument assisted soft tissue mobilization (IASTM). Using a tool instead of the hands during a massage allows a physiotherapist to apply more pressure.

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Gua sha is most often used to relieve muscle and joint pain. Conditions of the muscles and bones are known as musculoskeletal disorders. Some examples include back pain, tendon strain, and carpal tunnel syndrome.

Practitioners claim that gua sha can also benefit the immune system and reduce inflammation. Sometimes, gua sha is used to treat a cold, fever, or problems with the lungs.

Small injuries to the body, such as the bruises caused by gua sha, are sometimes known as microtrauma. These create a response in the body that may help to break up scar tissue.

Microtrauma may also help with fibrosis, which is a buildup of too much connective tissue when the body heals.

Physiotherapists may use IASTM on connective tissue that is not working to move joints as it should. This problem may be due to a repetitive strain injury or another condition. Gua sha is used alongside other treatments, such as stretching and strengthening exercises.


Gua sha treatment for neck pain
Studies suggest gua sha may help people who use computers and suffer from neck and shoulder pain.

Researchers have carried out small studies on the following groups of people to see if gua sha works:

  • women near menopause
  • people with neck and shoulder pain from computer use
  • male weightlifters, to help with recovery after training
  • older adults with back pain

Women found that perimenopause symptoms, such as sweating, insomnia, and headaches, were reduced after gua sha.

A 2014 study found that gua sha improved the range of movement and reduced pain in people who used computers frequently compared with a control group that had no treatment.

In a 2017 study, weightlifters who had gua sha felt that lifting weights took less effort after treatment. This could suggest that the treatment speeds up muscle recovery.

Older adults with back pain were treated with either gua sha or a hot pack. Both treatments relieved symptoms equally well, but the effects of gua sha lasted longer.

After a week, those who had received gua sha treatment reported greater flexibility and less back pain than the other group.

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Side effects and risks

Gua sha causes tiny blood vessels near the surface of the skin called capillaries to burst. This creates the distinctive red or purple bruises, known as sha.

The bruises usually take a few days or a week to heal and can be tender while healing. People can take an over-the-counter painkiller, such as ibuprofen, to help with pain and reduce swelling.

A person should protect the bruised area and take care not to bump it. Applying an ice pack can help to reduce inflammation and ease any pain.

Gua sha practitioners should not break the skin during the treatment, but there is a risk it could happen. Broken skin increases the possibility of infection, so a gua sha practitioner should always sterilize their tools between treatments.

Gua sha is not suitable for everybody. People who should not have gua sha include those:

  • who have medical conditions affecting the skin or veins
  • who bleed easily
  • who take medication to thin their blood
  • who have deep vein thrombosis
  • who have an infection, tumor, or wound that has not healed fully
  • who have an implant, such as a pacemaker or internal defibrillator

Is gua sha painful?

Treatment is not supposed to be painful, but gua sha deliberately causes bruising, which may cause discomfort for some people. These bruises should heal within a few days.

Gua sha tools and technique

gua sha equipment
A hand held tool with rounded edges is used in gua sha.

Traditionally, a spoon or coin would be used to scrape the skin, but in modern practice, therapists use a small, hand-held tool with rounded edges.

Gua sha tools are often weighted to help the practitioner who is doing the procedure to apply pressure.

Practitioners of traditional East Asian medicine see some materials as having an energy that will support healing — these materials include bian stone, jade, and rose quartz. Medical grade stainless steel is often used for IASTM or when gua sha is done in a clinic.

Practitioners will apply oil to the area of the body that is being treated, which allows the therapist to move the tool across the skin more smoothly.

The gua sha practitioner will press the tool into the body with smooth, firm strokes in one direction. If gua sha is being carried out on the back, or back of the legs, a person may need to lie face down on a massage table.

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Gua sha is used to treat a range of illnesses and disorders, but research has only been carried out on a small number of specific medical conditions. More evidence is needed to confirm whether gua sha is an effective treatment.

Gua sha is unlikely to have any serious side effects, but it can be painful for some people. A person who plans to have gua sha should make sure that they go to an experienced practitioner.

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Medical News Today: How germs can make people feel insecure about their looks

A new study published in the journal Psychological Science suggests that merely thinking about germs can make some people excessively concerned with how they look.
man checking his skin in mirror
The threat of an infectious disease can make us suspicious of others’, and our own, physical appearance, suggests a new study.

When confronted with the threat of an infectious disease, people often develop “psychological and behavioral defense mechanisms.”

These reactions are all a part of our “behavioral immune system” (BIS), explain the authors of the new research, which prompts us to avoid certain people and potential pathogen carriers.

But our behavioral immune response is not just directed at the outside world. In their recently published paper, Joshua M. Ackerman, of the University of Michigan in Ann Arbor, and his colleagues hypothesized that an effective BIS should alert people not only to external threats such as germs, but also to vulnerabilities of the self.

So, the researchers set out to examine the effect of being concerned with germs on self-image. “By examining self-directed evaluations and decisions,” write the authors, “this research expands our understanding of how infectious disease impacts our psychology and highlights a consequence with relevance for stigmatization and mental health.”

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Germ threat triggers self-image insecurity

To explore the psychological aspects of germ aversion, Ackerman and colleagues designed seven experiments with hundreds of participants.

In the first experiment, 160 participants (83 of whom were male) were asked to read one of two stories designed to manipulate how they felt about germs.

One story was a control scenario about workspace organization, while the second one was about volunteering to work in a gerontology ward at a hospital. The participants’ emotional states were assessed after both scenarios.

In the second stage of the experiment, participants were asked to spend a fictitious budget on “design[ing] your ideal self, that is, who you want to be today.”

Subjects were also told that they could spend the money on 11 traits, only one of which was related to physical appearance. These 11 traits were “physical attractiveness, creativity, kindness, work ethic, intelligence, romantic ability, sense of humor, virtuousness, social status, nonwork talents/skills, and yearly income.”

The researchers also evaluated the participants’ aversion to germs, as well as asking them to report on how concerned they were about four aspects linked to germ threats: physical appearance, hygiene, fitness, and “what other people think of you.”

It was found that participants who were particularly germ-averse and were confronted with the hospital scenario chose to spend significantly more money to improve their appearance, and they reported feeling more worried about their looks than the control group.

Further experiments revealed that these participants were specifically interested in behavior and products related to physical appearance, such as cosmetic surgery, rather than being concerned about health or fitness.

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Physical looks, not health, are the main worry

“Our findings show that when people are worried about pathogens,” explains Ackerman, “they also evaluate their own physical appearance, which motivates them to pursue behaviors and products intended to improve appearance, including exercise, makeup, and plastic surgery.”

“Perhaps the most surprising element in our findings,” he adds, “was that infectious disease threat more consistently influenced evaluations of people’s own physical appearance than it influenced their evaluations of health.”

“We might expect that worries about disease would have lead people to care strongly about their own well-being and take steps to improve it, but this was less common than changes in how people saw their own appearance.”

How physical appearance influences mating opportunities may explain these results, speculate the researchers, but further work is needed to ascertain this.

This work is important because it demonstrates situations when people may engage in problematic health behaviors and spending, but also because it suggests that we might improve some of the negativity people have about their appearance by alleviating their concerns about infectious disease.”

Joshua M. Ackerman

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Medical News Today: Is marriage the key to long-term happiness?

Married people exhibit higher levels of happiness and well-being than those who are single, according to recent research by the Vancouver School of Economics in Canada. Happiness levels were found to be even higher in people who consider their spouse to be their best friend.
older couple at a Christmas market
Marriage could provide the answer to long-term happiness and life satisfaction.

Shawn Grover and John Helliwell conducted the study using information sourced from the British Household Panel Survey, which collected data between 1991 and 2009 from around 30,000 people.

They also used the 2011–2013 United Kingdom’s Annual Population Survey, which collected information from around 328,000 people.

Their findings were published in the Journal of Happiness Studies.

Previous studies have shown that being married, and living as if married, is associated with higher life satisfaction levels than being single, divorced, separated, or widowed.

Other research has indicated that while this rise in life satisfaction continues for the first few years of marriage, it “eventually falls back to pre-marriage levels.”

Grover and Helliwell’s new study aimed to determine the effects of married life on well-being and evaluate their permanence. Furthermore, the researchers wanted to delve deeper into the source of the impact of marriage on well-being and explore the role of friendship in marriage.

Echoing the findings of previous studies, the researchers found that married couples reported the highest levels of life satisfaction, with similar levels for people living as couples. Couples remained more satisfied with life from the early stages of marriage through to old age.

“Even after years, the married are still more satisfied,” comments Helliwell. “This suggests a causal effect at all stages of the marriage, from pre-nuptial bliss to marriages of long-duration.”

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Benefits are ‘unlikely to be short-lived’

Next, the team wanted to examine the different stages following marriage and age to test whether the enhancement in well-being that comes with marriage is temporary.

The scientists hypothesized that if the benefits to well-being from being married are fleeting, then they would expect the differences between married and unmarried people to be greatest at ages when more people typically marry and smaller at ages when fewer people get married.

On average, couples in the U.K. marry at around age 30.8 for men and age 28.8 for women. Therefore, the scientists expected to see the differences between married and unmarried people to be greatest in the 20s and 30s. However, this was not the case.

Other studies have demonstrated that there is a U-shape correlation between life satisfaction and age. Life satisfaction is high before the age of 25, dips during mid-life, and then rises back up through the later years of life.

Although the same mid-life dip in life satisfaction was observed among married and single people, the slump was more significant among unmarried people.

“Marriage may help ease the causes of a mid-life dip in life satisfaction,” explains Helliwell, “and the benefits of marriage are unlikely to be short-lived.”

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Benefits of marriage higher for best friends

Marriage and friendship are both linked to life satisfaction. The team aimed to assess whether there are interactions between marriage and friendship in achieving life satisfaction.

The research team noted that if friendship explains most of the benefits to well-being in marriage, then life satisfaction should be higher among those who list their spouse as a close friend. About half of married and cohabiting couples reported their partner as their best friend.

Being married or living with your best friend was shown to boost the benefits to well-being even further and were more pronounced for women than men.

The well-being benefits of marriage are much greater for those who also regard their spouse as their best friend. These benefits are on average about twice as large for people whose spouse is also their best friend.”

John Helliwell

The authors conclude by saying that although all friends play an important role in happiness, those who are married or share beliefs are “super-friends,” with the increased effect on well-being being much more substantial, on average, than for friends alone.

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Medical News Today: Conduct disorder: What you need to know

Conduct disorder is a mental health condition that affects children and adolescents. It is characterized by a behavioral pattern in which the child breaks age-appropriate social norms and rules.

Along with oppositional defiant disorder (ODD), conduct disorder is considered a disruptive behavior disorder and it is one of the most common mental health disorders diagnosed in young people.

Young people with this condition can be cruel and violent towards others, including pets and other animals. They may be destructive, breaking and damaging property.

The behavior associated with conduct disorder is not limited to occasional outbursts. It is consistent and repetitive, occurring frequently enough that it interferes with the child’s education, family life, and social life.


boy bullying another boy by lockers
Young people with conduct disorder can be cruel and aggressive towards others.

One of the key characteristics of conduct disorder is frequently aggressive, antisocial behavior that goes beyond what is common for a child or adolescent of that age.

A person with conduct disorder may also be driven by a need to dominate other people through acts of aggression or intimidation.

An individual with conduct disorder may appear to disregard the accepted standards of behavior, as well as the feelings of others.

Emotional symptoms of conduct disorder include:

  • Lack of remorse: This may appear as an inability to feel guilty about doing something wrong, a failure to feel bad about hurting someone, or indifference to punishment for breaking the rules.
  • Lack of empathy: They may disregard the feelings of others and appear cold, callous, or uncaring.
  • Disregards expectations: The individual may not care about performing well in school or other activities. They may seem to ignore others’ expectations of them, even if they are given clear tasks.
  • Lack of emotional expression: The individual may not display any emotions. They may appear shallow or superficial or may seem to be able to turn emotions “on and off” at will. When they do show emotion, they may use their emotional response to manipulate others.

Behaviors or actions an individual with conduct disorder may display include:

  • breaking rules at home and school
  • bullying
  • vandalism
  • getting into fights
  • stealing
  • breaking & entering
  • lying or being deceitful
  • manipulating others
  • skipping school
  • running away from home
  • cruelty to animals

When young children develop conduct disorder, the first signs are often biting and hitting.

In older children and teenagers, symptoms may develop into lying, stealing, fighting (sometimes with weapons), property damage, and sexual coercion.

Individuals with conduct disorder may have difficulty reading social cues, which can lead to further aggression.

They may be more likely to assume that someone else’s behavior is more hostile than it is. When they respond to this perceived hostility, they may add tension to a situation and create conflict.

Conduct disorder frequently co-exists with other conditions, including:

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parents attending counselling session with daughter
Family therapy has proved effective for conduct disorder.

A young person with conduct disorder may be perceived as a juvenile delinquent, rather than an individual with a mental health condition. Treating conduct disorder solely as a discipline problem is rarely effective.

The key to effective treatment of conduct disorder is early intervention. Doctors and caregivers should also be sure to address all the aspects of an individual’s life that are affected by the problematic behavior, including home, school, social situations, and the community.

Family therapy, multi-systemic therapy, and cognitive behavioral treatment (CBT) have been found to be an effective treatment for conduct disorder.

Multi-systemic therapy is a comprehensive approach, meaning that the child or teenager receives treatment in multiple situations, including their home and school.

Parent training can help family members develop effective tools for dealing with conduct disorder by showing them how to establish clear limits, encourage positive actions, and discourage disruptive behavior.

Research has documented the long-term effectiveness of parent training techniques.

As conduct disorder often develops at the same time as other conditions, such as ADHD, treatment will be more effective if it addresses all the health issues a person is facing.


There is no direct cause of conduct disorder, but researchers think it is influenced by both genetics and environmental factors.

Children have an increased risk of developing conduct disorder if one of their parents or a sibling has it. Research also suggests that there may be a genetic link for an increased risk of conduct disorder and ADHD.

A child may also have an increased risk of conduct disorder if one or more parent or caregiver has depression, schizophrenia, a personality disorder, or an alcohol addiction.

Children who have suffered abuse, parental rejection, or neglect may also be more likely to develop conduct disorder.

Living in a low-income or disadvantaged area can also increase a child’s risk of developing conduct disorder. Some researchers theorize that this is due to the effects of economic, social, and emotional instability.

The researchers state that disadvantaged parents or caregivers may lack the skills needed to intervene in problematic behaviors or early signs of conduct disorder. They recommend establishing parent training programs as a preventative measure.

Research suggests that children or adolescents that experience ADHD, as well as conduct disorder, may have neurological conditions that make it difficult for them to express themselves in words or exercise self-control.

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boy shouting and mum in background covering her ears
A quarter of those diagnosed with ADHD are at risk of developing conduct disorder.

Only a mental health professional with expertise in children’s mental health can make a diagnosis of conduct disorder.

The steps involved in diagnosis include:

  • taking a complete social and medical history of the child and the family
  • interviewing and observing the child
  • interviewing the family
  • doing standardized tests
  • examining the socio-economic context of the child’s behavior

It is important to note that almost all children will, at some point in their lives, behave in ways that are disruptive and even dangerous.

As children come to understand the effects of their behavior at school and in the family, they will all experience episodes of disruptive behavior. These temporary episodes are normal during a person’s development.

However, symptoms of a mental health condition, such as conduct disorder, are persistent, consistent, frequent, and repetitive.

In adults

If conduct disorder persists into adulthood, it can become increasingly problematic.

Adults who have conduct disorder may have difficulty holding down a job or maintaining relationships and may become prone to illegal or dangerous behavior.

Symptoms of conduct disorder in an adult may be diagnosed as adult antisocial personality disorder.

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According to Mental Health America, many young people with conduct disorder grow up to enjoy fulfilling social and work lives. The earlier treatment starts, the better the outlook will be.

Research suggests that when people develop conduct disorder as young children, instead of as teens, they are more likely to exhibit criminal behavior as adults. This is not always the case but is something for parents and caregivers to be mindful of and discuss with a doctor.

According to Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), children diagnosed with both ADHD and conduct disorder are “twice as likely to have difficulty reading, and are at greater risk for social and emotional problems.”

The long-term outlook improves when parents or caregivers take part in a behavior-based parent-training program.

According to one study, 63 percent of children whose parents participated in such a program showed a small improvement in their behavior, 54 percent showed a large improvement, and 39 percent showed a very large improvement.

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Medical News Today: How to keep your gut healthy over the holidays

This year has seen a steep increase in our appreciation of the trillions of microbes that share our bodies. So, here are our tips for keeping your microbial passengers happy over the holidays.
Holiday food and gut health
This holiday, don’t forget your gut microbiome.

Gone are days when we saw the plethora of microorganisms that colonize our bodies as mere hitchhikers.

Today, we appreciate that our gut microbiota plays a crucial role in our health. We need to keep our tiny partners-in-crime happy; if we don’t, things can go sour rather quickly.

Dr. Sven Pettersson — a professor of metabolic disorders at the Lee Kong Chian School of Medicine in the Nanyang Technological University in Singapore — and colleagues explain in a review article in the journal Cell, out earlier this month, that our gut microbiome naturally changes throughout our lifetime.

What starts out as a simple collection of a handful of bacteria matures into a complex microbial ecosystem, heavily influenced by factors including our diet, lifestyle, hormones, and immune system.

Imbalances in our gut flora are linked to a steady rise in conditions such as food allergy, eczema, asthma, autism spectrum disorders, chronic fatigue syndrome, irritable bowel syndrome, and cancer.

So, as the year draws to a close and we sit back and take stock over the holidays, let’s look at what can we do to look after our gut microbes, especially at a time marked by calorific excesses.

1. Don’t forget your fiber

While we cannot digest fiber ourselves, microorganisms readily use it as a food source. If there isn’t enough fiber in our diet, microbes start to gobble up the mucus barrier in the gut as an alternative food source. This allows microorganisms to cross the now “leaky” gut barrier, causing havoc.

A leaky gut can put us at risk of colitis, inflammation, and metabolic syndrome, among other conditions.

Writing in the journal Cell Host & Microbe, two research groups report what happens when we switch to a Western-style diet — which is low in fiber — even just for a short period of time.

Within just 3–7 days, mice fed a low-fiber diet showed signs of a leaky gut, drastic weight gain, high blood sugar, and insulin resistance. This was accompanied by widespread bacterial death in the gut, which tipped the balance in favor of some of the more unsavory bacterial species, such as Bacteroides and Actinobacteria.

“Diets that lack fiber,” explains study co-author Gunnar C. Hansson, a professor in the Department of Medical Biochemistry at the University of Gothenburg in Sweden, “alter the bacterial composition and bacterial metabolism, which in turn causes defects to the inner mucus layer and allows bacteria to [encroach], something that triggers inflammation and ultimately metabolic disease.”

Add fiber to reverse symptoms

Prof. Hansson and colleagues found that bacteria that degrade fiber, such as Bifidobacterium, were greatly reduced on the Western-style diet. But, they also showed that adding Bifidobacterium or inulin — a type of prebiotic plant fiber — to the mice’s diet could improve gut health.

The second research group, which was led by Andrew Gewirtz — a professor at the Center for Inflammation, Immunity & Infection at Georgia State University in Atlanta — found that inulin supplementation can restore gut health and reduce the signs of metabolic syndrome to some extent.

However, before you rush off to stock up on inulin to counteract the excesses of your holiday diet, Prof. Gewirtz issues a warning.

Simply enriching processed food with purified fibers might offer some health benefits, but we’re not ready to recommend it until we understand more of the very complex interplay between food, bacteria, and host.”

Prof. Andrew Gewirtz

Instead, you could opt for holiday foods that naturally pack a fiber punch instead. Check out these handy recommendations in the American Heart Association’s (AHA) Holiday Healthy Eating Guide.

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2. Treat your gut to some chocolate

Cocoa — which is the dry, non-fatty component of chocolate — contains a host of molecules that are increasingly making health news headlines. Rich in antioxidants and fiber, cocoa has been linked to a string of health benefits, from lowering cholesterol to benefiting fetal development during pregnancy.

When it comes to our gut health, cocoa consumption has been shown to reduce inflammation, potentially alleviating the symptoms of inflammatory bowel diseases (IBD) such as Crohn’s and ulcerative colitis.

Earlier this year, we reported on research that showed that cocoa components can reduce bacteria in the Clostridium family, which are often found in the guts of those with IBD. When human study subjects drank high-cocoa chocolate milk over a period of 4 weeks, Lactobacillus and Bifidobacterium species shot up in numbers in their guts.

However, it is also worth remembering that not all chocolate is created equal. Unsweetened cocoa powder and dark chocolate with a high cocoa content are the closest you can get to the cocoa formulations used in scientific research.

So, why not pick out a nice piece or two of dark chocolate when the boxes of festive treats are making the rounds.

3. Work your holiday pounds

Earlier this month, Medical News Today reported on two studies that demonstrate the power of exercise: it can directly affect the diversity of your gut microbiome.

One of the studies looked at the effects of exercise in mice. One group was active, while the other was sedentary. The researchers transplanted fecal material from both groups into the colons of mice bred under germ-free conditions.

The results showed that the mice that had received fecal transplants from exercise mice had more bacteria in their colons that can metabolize fiber into molecules called short-chain fatty acids (SCFAs), which are beneficial to health. These mice also had lower levels of inflammation.

In humans, similar findings hold true. The second study revealed that just 6 weeks of exercise led to an increase in SCFA levels and SCFA-producing microbes in both lean and obese individuals.

However, while both experienced this increase, it was more pronounced in lean individuals.

Don’t let that put you off, though, whatever your weight. Whether you are off for a brisk walk after a big family meal or dancing around the living room to silly Christmas songs, get moving to give your gut a head start.

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4. Don’t let the holiday stress get to you

Now, this last point may be easier said than done but bear with me. A couple of months ago, we brought you a study that showed how detrimental stress can be to our gut microbiome.

Writing in the journal Scientific Reports, a research team from the Department of Microbiology and Molecular Biology at Brigham Young University in Provo, UT, found that when female mice were exposed to chronic unpredictable stress, their gut microbiome changed drastically.

The bacterial diversity shifted in favor of members of the Lachnospiraceae, Ruminococcaceae, and Peptococcaceae families. In fact, this profile resembled the microbiome of mice fed a high-fat diet. So, even with the best diet in the world, stress may still tip the balance in your gut microbiome.

While the researchers observed these particular changes only in female mice, holiday stress is a ubiquitous phenomenon that both sexes are known to experience.

But fear not: we have put together this handy guide on “How to reduce Christmas stress” for practical tips to manage over the holidays.

Your gut health in 2018

With this collection of tips, your gut microbes will — hopefully — thank you for getting them safely through the holidays and off to a good start in the new year.

No doubt 2018 will continue to see new research into how our microbiome shapes our health, and, importantly, what we can do to keep our guts in tip-top shape.

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Medical News Today: What to know about mastectomy scars

A mastectomy is a way of treating breast cancer by removing the breast or a portion of the breast surgically. Scarring is a result of the surgery.

The incision and surgical approach a surgeon takes when performing a mastectomy depend both on the amount of breast tissue that needs to be removed, as well as a woman’s desire for reconstruction after the procedure.

Mastectomy incision approaches

Woman with mastectomy scar.
The appearance of mastectomy scars will depend on the type of incision used.

Often, the appearance of a mastectomy scar will depend upon the incision and approach a surgeon takes.

To begin the surgery, a surgeon will make an incision in the chest skin to expose the inner portion of the breast.

Once the surgeon has removed the breast tissue, muscles, and lymph nodes as needed, the surgeon will suture the skin where the incision was made.

As the wound heals, a mastectomy scar will form. Despite the different approaches described in this article, the majority of mastectomy scars heal in a horizontal line across the chest, sometimes in a half-moon shape. Often, the incision type and resulting scar depend upon where the breast cancer lesion was in the first place.

Over many years of breast surgery, the approach that surgeons take to surgical incision has changed significantly. There are now a variety of surgery options available to women, and they should be sure to ask their surgeon what approach they intend to use and what the outcome may be.

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What types of mastectomy cause scarring?

While all forms of mastectomy will result in some scarring, there are a range of approaches a surgeon can take:

Partial mastectomy or lumpectomy

A partial mastectomy involves removing the tumor and some breast tissue. Sometimes the surgeon will also remove a portion of the lining that covers the chest muscles.

A lumpectomy will usually leave a small linear scar on the skin of the breast. Sometimes, surgeons can make the incision in the crease beneath the breast or around the nipple to hide the scar.

With a partial mastectomy, the majority of the breast is left intact, and therefore reconstruction is not usually needed. Women who have a lumpectomy will require radiation treatment after surgery.

Skin-sparing mastectomy

This surgical approach is typically performed on women planning to undergo reconstruction immediately afterward. It involves removing the breast, areola and nipple, and lymph node or nodes, but preserving the rest of the woman’s breast skin.

Preserving the majority of the breast skin allows for immediate reconstruction of the breast, using an implant or the woman’s own tissue. A skin-sparing mastectomy usually leaves a visible medium to large scar on the front of the breast. However, the surgeon might be able to hide the scar by making the incision in a less obvious place.

Nipple-sparing mastectomy

A woman who is undergoing a prophylactic or preventive mastectomy or has a small or early-stage breast cancer may be a candidate for a nipple-saving mastectomy. This procedure involves preserving the breast skin as well as the areola.

This technique is typically performed on women with smaller breasts and will result in a scar on the side of the breast. However, the surgeon can make the incision in the crease below the breast at the bra line so that the scar is not visible.

Simple mastectomy or total mastectomy

This surgical approach involves removing the breast, areola and nipple, and, sometimes, lymph nodes, as well as a variable amount of breast skin, depending on the plans for reconstruction.

The chest wall and lymph nodes that are further away from the breast, such as the axillary lymph nodes in the armpit, are not removed.

The surgeon typically makes an oval-shaped incision that goes around the nipple across the width of the breast, leaving a visible scar.

Modified radical mastectomy

Similar to a simple mastectomy, this approach involves removing all breast and breast tissue as well as lymph nodes in the breast and armpit. The chest wall is often left intact. A modified radical mastectomy will result in a large, visible scar on the chest.

Additional treatments

Breast cancer patient resting on sofa with partner.
Recovery can take weeks, and chemotherapy may be required.

The goal of the mastectomy or oncologic surgery is to remove only as much tissue as is necessary to treat the woman’s cancer.

A breast surgeon and oncologist will discuss the options and help a woman make the best decision for her. After the surgery, a woman will likely have drainage tubes and need several weeks to recover.

Some procedures, such as lumpectomy do not usually require a stay in the hospital, while mastectomies often require a hospital stay.

The length often determined by the type of the mastectomy a woman has had as well as the type of reconstruction.

Following the mastectomy, a doctor may recommend radiation therapy or chemotherapy to shrink or kill remaining cancer cells. This can affect the healing of the wound.

A woman should watch for signs of infection, such as warmth, redness, or drainage from the surgical site as well as fever, which can indicate a systemic infection.

Breast reconstruction after mastectomy

Breast reconstruction is a further surgical option after a mastectomy, where a surgeon will recreate the appearance of a woman’s breast or breasts either at the time of mastectomy or at a later time.

A surgeon may take tissue from another part of a woman’s body, use breast implants, or a combination of both, to reconstruct the breast.

Tissue expansion and implants

If a woman opts for implant reconstruction, a doctor will place a device known as a tissue expander under the chest muscle or breast skin.

This can be performed at the same time as the mastectomy (immediate reconstruction) or in the future (delayed reconstruction.) The woman will need to visit the doctor several times to have the implant filled with saline to expand it.

Once the chest skin has stretched and healed after surgery, a surgeon can fit a permanent implant. This usually occurs about 2 to 6 months after mastectomy.

In some women, however, a permanent implant is inserted at the time of mastectomy.

Autologous tissue reconstruction

Another option is autologous tissue reconstruction, which is also known as “flap” reconstruction. In this procedure, a doctor takes tissue from the woman’s abdomen, back, or buttock and uses the flap of breast skin that was preserved during the mastectomy to reconstruct the breast.

These can be very detailed procedures because a surgeon will sometimes have to reconstruct the circulation to the breast tissue.

Again, this type of reconstruction can be performed at the time of mastectomy or some time in the future.

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What if a woman does not opt for reconstruction?

Doctor showing breast cancer patient silicone cup used for breast reconstruction surgery.
While breast reconstruction is a common choice after a masectomy, some people may not want the procedure.

According to, an estimated 44 percent of women undergoing mastectomy do not opt to have follow-up reconstruction.

Many women choose not to reconstruct their breast for various and personal reasons. Some of these may include:

  • Health concerns that could make future surgeries dangerous or ill-advised.
  • The desire to resume daily activities more quickly.
  • Concerns about taking tissue from other areas of the body or using an implant to reconstruct the breast.
  • Concerns about cost related to reconstruction.

Some women who do not choose reconstruction may choose to wear a prosthesis or artificial breast that can be inserted into a bra, or an adhesive breast-shaped device that attaches to the woman’s body.

Some women do not like to use these options, and may refer to their decision to not use a prosthesis as “going flat.”

Reducing scarring without reconstruction

If a woman decides against reconstruction, she should talk with her doctor about surgical options that can make the mastectomy scar and resulting skin as comfortable as possible.

For example, a surgeon can ensure that the scar lies as flat as possible against the chest, which can make the chest feel smooth. Otherwise, some women are left with rolls of skin on the chest that can create a bulging appearance.

While this is not harmful, many women do not like the way it looks.

Sometimes, a surgeon may make what is known as a “Y” incision that adds two small incisions on the end of the traditional long incision. This can reduce the incidence of bulging skin.

Mastectomy tattoos

In February 2017, the Journal of the American Medical Association published an article titled “The healing role of postmastectomy tattoos,” which detailed the work of a tattoo artist who worked with women to create tattoos over mastectomy scars.

This is an emerging approach for women who choose not to have breast reconstruction.

Some women are also having breast reconstruction and choosing to have a tattoo artist tattoo a nipple that looks three-dimensional. There are tattoo artists who specialize in this approach.

Outlook for mastectomy scars

The decision to reconstruct a breast, cover a mastectomy scar, or live life without wearing a prosthesis is truly a woman’s own. It is important that she speak to a surgeon about all of her options.

If she feels like a doctor is not respecting her wishes regarding reconstruction or the decision not to reconstruct the breast, she may wish to get a second opinion.

Sometimes a woman may wish to delay the decision regarding the reconstruction process until after her mastectomy.

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