Dr. Capone interviewed by Pittsburgh Post-Gazette

Burned by your bra?

Long a wardrobe staple, the bra is often poorly chosen, with painful consequences

Tuesday, September 25, 2001
By Mackenzie Carpenter, Post-Gazette Staff Writer

Sara Pitzer is, by her own description, a heavyset woman who doesn't enjoy wearing tight undergarments. And so, when driving home after a particularly bad day at the office, she would often perform this relaxation exercise her mother taught her:

"I'd unhook my brassiere under my clothes, slip the straps and pull it out through a sleeve and hang it on the outside car mirror."

Pitzer, a former State College resident now living in North Carolina, says she wears a bra only when she has to, and is still looking for "a bra that doesn't hurt"

She's not alone.

As Americans age and obesity rates increase, average bra sizes are going up to a 36C, according to Maidenform (although other companies, such as Bali, still peg it at 34B, but moving steadily toward 36B and C). And whether small-breasted or large, between 65 and 85 percent of all women wear the wrong-sized bra, according to experts.

Discomfort aside, is it possible that the brassiere – a staple of the American woman’s wardrobe since the early 20th century – may actually pose a health hazard?

The answer may be yes.

A recent online dispatch from Intelihealth.com – an Internet health service that partners with Harvard Medical School – warned that the wrong bra can cause back pain, itching, rashes, headaches, and breast pain during exercise; too-loose bras can tear delicate tissue fibers and ligaments that support the breast.

And for women suffering from hypermastia - the medical term for extremely large breasts - the problem becomes particularly acute, says Dr. Raymond Capone, chief of the division of plastic surgery at UPMC Shadyside.

Capone has seen many women troop through his office with telltale “shoulder grooves” – the result of years of wearing a brassiere with straps that are too thin to carry the weight of the breasts efficiently.

While large breasts pose a problem in and of themselves, “I believe that for the past 75 years a rather curious undergarment has exacerbated these symptoms: the bra,” wrote Capone in an article published last spring in the University of Pittsburgh’s Physicians Newsletter. Indeed, in person, Capone waxes positively indignant on the subject of ill-fitting brassieres.

“Women have to be smarter consumers,” he said in a recent interview. “When you have large breasts, you should not buy these sexy narrow straps.”

It’s all a matter of engineering, he says. With the advent of bras in the 1920s, “women began suspending their breasts from very narrow straps over the shoulder girdle. This feat serves to focus the considerable torque associated with the weight of large breasts” on that part of the body.

Capone limits his critique to those undergarments designed more for cleavage than for comfort. Sports bras, he says, are generally a better choice because they feature wide straps and more support across the back.

“While the French brassiere may be a fascinating invention for the small-breasted flapper of 1920 Paris,” in inventing the bra, he wrote, “I believe mankind may have taken a wrong turn.”

It’s all in the fit

Representatives of the bra industry beg to differ.

“A lot of women do get ridges in their shoulders, but it has less to do with the strap than with how the infrastructure is made,” says Lisa Boecker, marketing manager for Barely There. She said support from a well-fitted bra should come from around the body and the underwire, not the straps.

“The straps are there to hold the top of the cups,” not to support the breasts, she said.

“If you’re relying on a strap for support, it stands to reason that wider straps are better, but the reality is you shouldn’t be relying on the strap. The bra should stay in place without it — that’s really the test.”

Maidenform officials, to some degree, agreed with Capone.

“We’ve heard complaints,” about bras that are uncomfortable, said Manette Scheininger, senior vice president of marketing. “Large-size bras should not have narrow straps,” she added flatly, noting that the company’s Lilyette brand has straps that are wider than average and increase in width with an increase in cup size.

Part of the problem, too, is that many women come into a fitting room convinced that they are a smaller size than they really are, Boecker said.

“Nobody wants to be a size 10 shoe, and a lot of women feel like that about bras. We’ll bring a bra in that’s a double D and the woman will say, “Oh that’s not my size,” when in fact it absolutely is.”

Even small-breasted women are frustrated, however, with the choices out there.

“It’s almost impossible to find an ‘A’ cup bra,” says Marilyn Yalom, a Stanford University professor and author of the 1997 book “The History of the Breast.” And a lot of them are padded because the assumption is if you’re small-breasted, you want a larger look, she said.

Would the vast number of breast implants – which end up as ‘C’ cup bra sizes, coincidentally the new average size – have anything to do with the decreasing selection of bras in the A cup size?

Certainly not, claim bra manufacturers.

“I don’t think any of us manufacture for breast implants,” said Boecker, adding that 70 percent of the market is for “average” sizes. The rest, about 30 percent, consists of full-figured women and only a tiny percentage involves women seeking an A cup.

Whatever the case, it’s becoming rarer and rarer for women to even have a fitting, even though experts say women should be re-measured by a professional every two years.

Smaller lingerie stores that feature custom fittings, though, have diminished in number. A few, such as Cheeks in Shadyside and Pussy Cat in Squirrel Hill, do remain, along with the ubiquitous Victoria’s Secret.

And while the larger department stores, Kaufmann’s, Lazarus and Saks, do have fit specialists in their lingerie departments, the vast majority of bra purchases are at discount stores like Wal-Mart and Kmart.

Still, many women resist the idea of bras that are good for you.

“Some women hate those wide-strap bras. They’ll look at them, and say, ‘who wants to wear a harness?’ “ said Laura Richardson, a buyer at Cheeks.

62-year-old Madonna

Sara Pitzer, the North Carolina woman, says she went braless in the 1970s. Not any more.

“It used to be I didn’t care who knew. Now I don’t want to scandalize anybody,” she said, noting that her efforts to find the right bra have still met with failure. Once, at a “custom” fitting, she ended up with an elaborate contraption that had Pitzer’s 40-something daughter, who was in the dressing room with her, crying tears of laughter.

“I looked like a 62-year-old wearing Madonna cones.”

Needless to say, she didn’t buy the bra.

“But I’ll never be able to drink out of a paper fountain cup with a straight face again.”


Getting the best fit

Bali Co. offers these tips on fitting a bra

Q: What’s the best way to put on a bra?

A: Slip the straps over your shoulder, bend forward at the waist and ease your breasts into the cups. Adjust your breasts so the nipples are centered into the fullest point of the cup. The cup should completely contain the breast (with the exception of push-up styles). Hook the enclosure at the middle position. Stand upright. Adjust the straps so that breasts are at a comfortable height.

Q: Why do the cups of my bra wrinkle?

A: Cups should completely contain the breast. Bulges at the top or sides mean the cup is too small. Wrinkles mean the bra is too large.

Q: My bra cuts and binds when I move. Is it the wrong size?

A: Maybe. Hook the back closure less tightly or try the next larger band size. Also, if the bra has narrow sides, it may be the wrong style for you.

Q: My straps keep falling off my shoulders. What should I do?

A: The cups may be too big. Since you’re not filling out the top of the cup, your straps slide down your shoulder. Try a smaller cup size.

Intelihealth, an Internet health news services that partners with Harvard Medical School, offers an online calculator for women to determine their correct bra size. You can find this at www.intelihealth.com. Click on Women’s Health and go down to “Finding a Bra that Fits”.


Dr. Capone featured in Maniac magazine, December 2009

NEEDLES & KNIVES – Making Aging Optional

By Jason Bittel

DR. RAY CAPONE JR. flipped the laminated page. Two pictures of a naked female torso stared back—the one on the left saggy, drooping, old. The body on the right? It wasn’t magically unrecognizable. It was thinner, tighter, the heft of its paunch drawn in and down, its breasts responding likewise, reeling up and out. And, sure, the post-Mommy Makeover body on the right looked a great deal younger, more supple and lithe. I admit the disparity between the two was rather striking, the quantifiable increase in sexiness undeniable.

Perhaps I should say that I didn’t really believe in cosmetic surgery. I mean, if it were for a cleft palate or something like that, then, by all means, carve away, but Pamela Anderson, Donda West, and Octomom had thoroughly soured me on the topic. But then I’m young, fit and without a prominent ear deformity. I don’t tan three days a week—call me conventional, but I refuse to consider “tangerine” a human skin tone—nor do I smoke cigarettes. I eat a balanced diet, have all my hair and reasonably symmetric calves. Now some of those are personal choices and others are just lucky genetics, but all of it added up to my opinion that plastic surgery was at best vain and at worst unnatural.

The reader should feel free to view me as either smug (at best) or (at worst) a self-righteous dick.

Still, I was as content in my belief as any other American who’d made a stand on an issue via magnetic, Chinese-made bumper ribbons. Without knowing the slightest thing about it, of course.

So I paid visits to three of Pittsburgh’s best when it comes to the youth maintenance business.

Dr. Capone regretted opinions like my own. “I thought we’d be much further along in assimilating what we do in this business,” he began. “We went from everyone having crooked teeth to an accepted standard where parents are expected to provide prosthetic dentistry to their children. Now that’s a cosmetic surgical procedure that’s made the transition.”

Fair enough. Nobody bats an eye when parents shell out many thousands of dollars for braces and retainers, even outlandish mouth-mechanisms with cranks and gears that seem reminiscent of Dark Ages interrogation devices. Why not a nose job?

Capone, for his part, does everything from hand surgeries to eyelid surgery to abdominoplasty to… well, you name it. “Much of what I do can be explained as redefining a client’s sexual identity. With females: enhancing breasts, liposuction, contour curves—the better I accentuate their femininity the better they like the results.”

But of all the astounding possibilities exuding from his blade, what did he recommend for the MANIAC demographic, ages 20-35? What would he do to me if I brought him a blank check and steel will?

Not all that much, it turns out. Dr. Capone said the keys to youth were sun avoidance, diet and exercise—and staying away from extreme sports. While he recommended that if you’re ever planning on getting a nose job or your ears done it’s best to do it young (age 20 or so), and admitted that filler injections (Radiesse, Botox, etc) are really effective in young people, he mostly stuck to the tried and true (and arguably more difficult) ways to stay young.

“Once you do diet and exercise and make good lifestyle choices, you certainly wouldn’t want to do plastic surgery. I’ve done facelifts in the 30s, but not often.” Dr. Capone continued, “We spend a lot of time working on people in their 40s, 50s, and 6Os to get them back to looking like they were in their 20s and 30s.”

When it comes to Cosmetic Surgery, Do your homework! Quick tips from the pros:

Dr. Capone reminds that the words “board-certified” could refer to any number of boards. Your best bet is to look for the American Society of Plastic Surgeons seal as well as the American Society for Aesthetic Plastic Surgery, Inc. If even one of those words is interchanged or missing, be suspicious.


Pittsburgh Tribune-Review reports on proposed federal tax on cosmetic surgery

Health care bill tucks in 5 percent tax on cosmetic procedures

By Robin Acton
Friday, November 27, 2009

Cosmetic surgeons say patients will continue to seek surgery despite a proposed 5 percent tax on elective cosmetic procedures that Senate Democrats buried within their 2,074-page health care bill as a way to trim its $849 billion price tag. Still, surgeons oppose the tax, arguing that it targets medical professionals, discriminates against women and most likely will fall short of the $5.8 billion lawmakers say it will generate over the next 10 years.

Every year, millions of Americans undergo cosmetic surgery to enhance their appearance, increase their self-esteem, correct physical deformities or improve conditions that adversely affect their health. The tax, which would take effect Jan. 1, targets only elective procedures and would not apply to surgeries that correct birth defects or conditions arising from accidents, trauma or disfiguring illness.

Because elective cosmetic procedures outnumber those for medical reasons, millions of patients would be required to pay the tax each year, according to statistics compiled by the American Society of Plastic Surgeons. 

Despite the worst recession since the Great Depression, there were 12.1 million cosmetic procedures performed last year in the United States, where women accounted for 91 percent of all patients, the organization reported. More than 10 million were cosmetic, minimally invasive procedures, while 4.9 million were reconstructive surgeries and 1.7 million were cosmetic surgical procedures.

Numbers for this year are not yet available.

Overall, surgeons agree most patients would not cancel surgery because of the proposed tax...

Many surgeons say the tax on beauty will have the most impact upon the aging baby boomer population and the working class, particularly working women ages 35 to 50 with an average yearly income of $55,000. That group accounts for 86 percent of cosmetic surgery procedures, the American Academy of Cosmetic Surgeons reported.

“This is not a luxury tax on the rich,” said Dr. Raymond A. Capone Jr., a board certified plastic surgeon who maintains what he describes as “a body contouring practice” in the Shadyside Surgi-Center. “In Pittsburgh, particularly, most of our patients are hardworking women with kids.”

The average patient will take a hit on procedures such as face-lifts, breast augmentation, and rhinoplasty, which cost thousands of dollars, surgeons say. The tax bite will be a little less severe for minimally invasive procedures such as Botox injections, laser resurfacing and laser hair removal.

Across the board, organizations representing cosmetic surgical professionals plan to fight the tax that they claim will open the door to future taxes on additional medical, legal and other professional services.

Any tax on surgical procedures is a bad tax, according to the 2500-member American Academy of Cosmetic Surgery, which maintains that the tax “is not the solution to funding a health care overhaul.” In a statement, Dr. Steven Hopping, the group’s immediate past president, said implementing the bill “would be a bad idea for patients and physicians.”

The 7,000-member American Society of Plastic Surgeons, whose members represent 94 percent of board-certified plastic surgeons in the United States, opposes all taxes on physicians, according to its president, Dr. Michael McGuire. He said in a statement: “Medical care should not be used as a tool to fix broken finances.”

Capone said he fears the tax could disrupt the physician-patient relationship. He said some patients inevitably will not be honest when discussing the reasons they seek surgery, in an effort to try to get insurance to pay for it and avoid the tax.

Because the lines between cosmetic and reconstructive surgeries often are blurred, the tax would leave the determination of medical necessity up to auditors or a government agency, surgeons say. They argue that those reviews would create problems with privacy issues and enforcement that would negate the benefits of revenue generated by the tax.

Similar taxes proposed in other states in recent years were rejected everywhere but New Jersey, where lawmakers in 2004 approved a 6 percent tax on an elective cosmetic procedure. Since then, the amount of money collected from that state’s tax has been 59 percent short of projected estimates, according to the New Jersey Department of Taxation.

Surgeons say the federal government should learn from New Jersey’s mistake. 


Surgery Can Ease Discomfort Caused by Large Breasts

By Mackenzie Carpenter, Pittsburgh Post-Gazette Staff Writer

Tuesday, September 25, 2001

One day several years ago, a teenager came into Dr. Raymond Capone’s office complaining about something most girls her age rarely do: “She felt self-conscious during her high school track team practices because her breasts were, in her view, too large,” he said.

But because the young patient had not yet developed bra strap depressions or rashes that are symptoms of hypermastia, the medical term for overly large breasts, he suggested she wait before undergoing breast reduction surgery.

Two years later, she was back, now complaining of back pain, neck pain, and fatigue. And when Capone asked how her track team was doing, he got a disappointing answer – she had quit, too embarrassed to run in public. In a culture obsessed with large breasts, it might be hard to believe that some women have too much of a good thing. But the problem of oversized breasts is a real one for women of all ages, whether due to genetics, pregnancy, breastfeeding or obesity.

Today, though, more and more women are opting for breast reduction surgery, an outpatient procedure that is nonetheless major surgery, involving removal of a significant amount of breast tissue under general anesthesia. Patients can return to light duty jobs after a week, and heavy-duty jobs in as little as three.

Last year, 84,780 procedures were performed across the country. This was up by 111 percent since 1992, which is when the American Society of Plastic Surgeons began tracking statistics. That increase may be tied to greater awareness about the availability of this procedure and word of mouth: breast reduction surgery has a high satisfaction rate among patients afterward.

Lucinda Menard of Coudersport, Potter County, says her daughter Onee, who had the surgery two years ago at age 19, was “thrilled” with the results. At the age of 15, all of Onee’s friends “were these tiny little petite things wearing these cute little bras, while Onee would wear these big baggy tops and slump a lot. Not anymore. She’s really gotten her confidence back.” Ten months after her daughter did it, Lucinda Menard underwent the procedure in March 2000.

“Onee talked me into it,” said Menard, 46. “It’s now easier to dress professionally. I can find clothes that fit me. I’d do it again in a heartbeat.” Most insurers will cover the procedure, as long as there is evidence of bra strap depressions, neck and back pain, and that a minimum of 350 grams of breast tissue–equivalent to one-and-a-half cups–are removed from each breast. For young women, it’s important to seek out a doctor who performs techniques to preserve the nerves around the nipple and the ducts used for breastfeeding.

But breast reduction shouldn’t be confused with a procedure called mastopexy, or breast lifting, which is a cosmetic procedure, not covered by insurance, that doesn’t involve a reduction of breast volume–only skin is removed or rearranged and is frequently accompanied by breast augmentation with implants.

For more information on breast reduction surgery, call the American Society of Plastic Surgeons at (800) 635-0635 or visit its website at www.plasticsurgery.org