Welcome to our May Newsline.
The Tobins with Executive Chief Mark Malowski
Gail and I have just returned from lovely weekend spent at the Blair House in Wimberley TX. It was a birthday present for Gail, and we spent the weekend having private cooking lessons. We actually took part in preparing the Saturday night dinner at the well known Bed and Breakfast. We worked with Executive Chief Mark Malowski. Mark graduated with honors from the Culinary Institute of America in Hyde Park, New York and has worked in many upscale hotels and restaurants across the United States and Europe. It was a wonderful experience and we look forward to returning.
The New Professional Chief
An article in People magazine has created a great deal of controversy. The article reported on a case in which an Austin plastic surgeon carried out an extremely large volume liposuction procedure followed by a tummy tuck on a 12-year-old girl. At a cost of over twenty five thousand dollars, with 35 pounds of fat suctioned, this certainly represents a major break with standard concepts of present day care. In general, the medical community has been rather critical of the procedure.
Rarely is more than 10 pounds. removed, because the surgery is not intended “to make fat people skinny,” says Dr. Rod J. Rohrich, chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center in Dallas. Adds Dr. Roxanne Guy, president of the American Society of Plastic Surgeons: “To say to teens or preteens that this is an okay thing to do, I think is a bad message.”
While it is not uncommon for teenagers to undergo liposuction surgery, it is important for us to remember that the procedure is a cosmetic operation and is not intended for weight loss surgery. Liposuction surgery, even with modern-day refinements, is a traumatic procedure resulting not only in fat removal, but also in tissue trauma. The more that is removed, the more injury is inflicted on the body. While, fortunately, in the case described, the outcome was favorable, it is important that we understand that this is not an acceptable treatment for childhood obesity. We have no knowledge as to what will happen in the future when children of this age are subjected to such a procedure.
Childhood obesity is a major problem, but at present, liposuction surgery should not be considered among the standard treatments for the condition.
Undoubtedly, the consultation is in extremely important aspect of the patient’s consideration regarding cosmetic surgery. Unfortunately, no matter how hard we try, we have to understand that patients do not retain everything that is discussed during the consultation. For that reason, we depend on supplemental written material which, we hope, patients will review either before or after the consultation. All of our new patients are given a copy of our information booklet entitled “Facts for Patients Considering Cosmetic Surgery.” The booklet it has proven to be very popular. In fact, we have published it, in its entirety, on our website. Additionally, we try to provide supplemental information when patients come in for consultations regarding procedures that we frequently performed. Frequently, we use visual aids as part of our consultation to help illustrate important points.
In spite of all this, we still find that patients tend to forget a lot of the information that we present to them. For this reason, we always find it helpful when patients are accompanied by either a spouse, significant other, relative or friend. It is always helpful to have the second pair of ears listening to the discussion. Often the second party will raise specific questions that may be helpful during the consultation. Certainly, the two will often discuss the issues after they leave the clinic. This can only have beneficial effects.
Sometimes, the second party may be interested in considering cosmetic surgery, also. This may be an opportunity for them to get an initial consultation at no charge. We certainly have no problem with that issue.
At any rate, no planning your consultation, think about bringing someone with you. If for no other reason, having someone with you may help to allay some of your anxiety.
Mammography and Breast Implants
A recent report in Cosmetic Surgery Times addresses the issue of whether or not mammograms are compromised in women who have breast implants. “What we know, without any question, is that performing mammograms on women with implants is more technically challenging in order to get optimum images,” says Carol H. Lee, M.D., member of the American College of Radiology (ACR) Board of Chancellors and chair of the ACR’s Breast Imaging Commission.
Whether the patient has gel or saline implants, it is still more difficult to carry out mammography. Radiologist stress that it’s important for patients to notify the technician that they have the implants when coming in for mammography. This is because special techniques have been developed to carry out mammography on women with breast implants. In general, four views will be taken it instead of the usual two. It doesn’t seem to matter whether the implants are gel or saline. The obstruction is pretty much the same with either.
Dr. Lee reports that a study in the Journal of the American Medical Association (Miglioretti et al 2004) helps to quell confusion on the issue. The authors compared the accuracy of screening mammography and found that the sensitivity of mammography was 45 percent in women with implants versus 67 percent in women without implants.
Walter Erhardt, M.D., American Society of Plastic Surgeons (ASPS) Past President and the chair of the ASPS Public Education Committee, agrees and says it is not so much where the implant is placed, but rather, how much scar tissue forms around it that can affect mammography. Firmness, or capsular contracture, regardless of the cause, makes it more difficult to to carry out mammography. This is because the technician has to compress the breast to look at the tissue, and if the capsule is thickened or contracted, compression is much more difficult. This is one of the main reasons why we continue to prefer saline implants over gel. The simple fact is that saline implants are much less susceptible to capsular contracture than are gel implants.
Dr. Lee also questions the conventional wisdom that states that implants placed beneath the muscle allow for better mammography. He actually feels that it doesn’t much matter whether the implants are placed above or below the muscle. The important issue is really how firm the capsule is.
These findings related to mammography are, of course, of concern. Nevertheless, patients can be reassured to know that repeated studies have shown that women who have breast implants are no more likely to develop breast cancer or to die of it. It is important for patients who have undergone augmentation to remember to do periodic self-examination of the breast. Routine mammography is also important even if the studies are less reliable than in patients without implants.
That’s it for this issue. Remember, we always welcome your input. Send us your questions and comments. If for any reason you do not wish to continue receiving our newsletter, there is a link below that will allow you to remove your name from our list.
Howard A. Tobin, M.D., F. A. C. S.