Interview | What to Do About Veins on Hands, Arms and Breasts

Often, clients ask me what to do about veins on hands, arms and breasts, so I made an appointment with an expert on the matter, Dr. Nicholas Hyde. His practice is called Elite Vein Specialists and he is truly a specialist. 

Dr. Hyde is Yale-trained, Board Certified Vein Specialist in the East Bay area of Northern California. He has been in practice since 1988 and has been performing advanced vein treatment procedures, such as endovenous laser ablation and ultrasound guided foam sclerotherapy.

Let’s get to it…

Dr. Hyde, I read that common causes of breast varicose veins include pregnancy and breastfeeding, oral contraceptive use, and breast augmentation.

Why do these factors increase vascularity?

In regard to pregnancy with or without breastfeeding, hormonal issues and breast engorgement can lead to a large increase in blue-green (reticular veins) as the increase in vascularity helps in the transport of increased milk production. Many of these vessels, especially after multiple pregnancies can remain very prominent even after breastfeeding has ended. With breast augmentation, many patients experience this several years later due to the implant placing pressure on the surrounding vessels. Either etiology can be very successfully treated with surface sclerotherapy, usually in 1-2 sessions. 

What is your approach for treatment? E.g., Sclerotherapy, Ultrasound, Surface and Veinlite

Most commonly for breasts I suggest surface injections and then 3 days of compression with 2 overlapping sport-style bras.

Let’s take a moment to expand on sclerotherapy. Basically, the doctor injects a solution into the widened veins, which over time causes them to be reabsorbed into the body, slowly fade away, and disappear. 

Spider veins are small, thin, blood vessels that appear just below the surface of the skin. On the other hand, varicose veins are large, swollen, and often lumpy.

Which of these conditions is more common? Are they treated differently?

Over 85 million Americans have varicose veins. Spider veins are even more common. The 3 main risk factors for these two entities are heredity, pregnancy and morbid obesity. Additional risk factors for spider veins also include in some patients birth control pills, hormone replacement therapy (HRT) and even knee-crossing. 

Dr. Hyde Before and After

True varicose veins are large flesh colored tributary branches originating off main trunks just below the surface of the legs. These main trunks are broken and no longer transport venous blood back toward the heart and lungs; the treatment approach is 2-pronged. First, the abnormal trunk veins are thermally closed with a simple 25-minute outpatient office procedure called Endovenous Thermal Ablation and is covered by most insurance companies. Then any connected tributary surface branches can be injected, closed or surgically removed through small incisions. 

Thermal ablation has replaced surgical stripping and ligation due to greater long term success, easier recovery and lack of multiple permanent incisions. Spider veins, which are the most common, require surface injections themselves, and any adjacent blue-green veins.

Take a close look at Dr. Hyde performing a vein removal procedure in this video. It’s fascinating to see the veins disappear right before your eyes!

How often do men see you for treatment? 

Approximately 20% of my practice consists of male patients. The majority of them come in due to painful, achy varicose veins.

As we age, our skin begins to lose elasticity, collagen, fat, and retains less water. This makes the veins appear more visible.

Is there anything we can do at home to help fight the appearance of varicose and spider veins in the breast and hands?

I would say patients with more melanin (pigment) have a natural tinted-window effect on their skin, which hides a greater percentage of their surface veins. If not naturally born with a nice dark olive complexion, body makeup or spray tanning, especially for special occasions, can help mask smaller surface veins. Hand veins tend to be more visible in patients with low subcutaneous fat and who also workout a lot. Varicose veins can rarely be hidden. However, exercising and keeping your weight down (including pregnancy) can lessen the future risk of new abnormal veins forming.

As hot as Madonna is, not many people seem to want her hands and arms.

How does exercise and diet play a role in hands and arm veins? 

Arnold Schwarzenegger and other bodybuilders alike have tremendous vascularity of surface veins that are not broken but they are doing intense weight training. Also, strict high-protein, low-carb diets also foster less subcutaneous adipose (fat) tissue, again revealing more veins. I would rather not suggest gaining weight and stopping workouts in order to hide veins or lessen their appearance, but if training and diet are less intense, veins will become less visible over time.

We spoke once about leg veins and how compression stockings and socks are important.

Would one use compression for hands, arms and breasts? If so, would they need to be prescribed by a doctor to ensure proper use and fit?

We can fit patients at our office, or they can be properly measured at a medical supply store, or even purchased online. Compression stockings help to do two things for vein treatment. They increase the percentage of veins that stay closed, and eventually are digested and eliminated after treatment. Plus they help decrease the very rare side effect of possible clots forming in deep veins called DVTs. For leg swelling secondary to lymph-edema, specific compression garments worn daily can greatly attenuate some of the profound swelling. For treatments on hands and breasts, tight bras or garments can be utilized post treatment. 

Is there anything that you’d like to add to this topic that I may have missed or you’d like to expand upon?

  1. Only go to someone who specializes in veins and can perform a duplex ultrasound exam to make sure you are properly treating the source of your vein issues. 
  2. Don’t go to a “dabbler” or Dermatologist who only treats veins every once in a while. 
  3. Never ever skip compression stockings post treatment. 
  4. Lastly, avoid airplane travel, hot-tubbing and high impact exercise after treatments for 5-7 days.

I want to thank Dr. Hyde for taking time out of his busy practice to answer my questions. One thought that popped up for me is moderation. Eating a balanced diet with the right amount of fat and exercising enough, but not too much, seems to be important in keeping hand and arm veins at bay.

As this interview progressed, I came up with other questions that I’d like to save for another post. Stay tuned for more expert advice from Dr. Hyde!

You can learn more or set up an appointment by visiting Elite Vein Specialists

675 Ygnacio Valley Road, Suite B214
Walnut Creek, CA 94596
(925) 937-8346

490 Post St., Suite 700
San Francisco, CA 94102
(415) 640-1500

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