April10 vol 9 #3

Welcome to our Spring Newsletter.

I realize that it has been quite a while since we have last put out a newsletter. I want to thank all of you who have asked about it and assure you that we are all still here and very active. In fact, part of the reason for not writing sooner has been the fact that we are so busy. While the economy remains in the doldrums, fortunately, our West Texas area has been doing well and we have certainly been fortunate to remain as busy as we have.

Staff change at the Center

LisaIt’s not often that we have a change in staff. I have always realized that it is largely the quality of our Staff that has made us so successful. While I would like to think that it is all my surgical skills, the truth is that I simply couldn’t do it without the wonderful staff that we have.

Earlier this year, we lost our great OR nurse, Kim. For a long time she had been working toward her nurse practitioner certificate, and this year completed her training and achieved her certification. We hated to lose her. However, we are delighted to have found a great replacement. Lisa Gore, RN has taken over the position and is doing a great job. Kim’s shoes are hard to fill, but Lisa is rapidly
learning the job. She is a wonderfully kind and compassionate nurse and has made a great hit with our patients.

Lisa moved to Abilene from Lubbock to take the position. She has completed her ACLS certification as well as completing a course to take over the position of Infection Control Manager. She is also traveling with us on our consultation visits to Lubbock and Midland. We are delighted to have her with us.

Breast Augmentation – why we still like saline

More and more, patients and surgeons seem to be choosing gel implants over saline. Yet our practice still utilizes saline implants in more than 90% of cases. Why are we so strong on saline? The answer is simple – safety!

While studies have confirmed that there are no major health risks due to the use of gel implants, that doesn’t mean they can’t cause problems. As we have learned in the past, over time, the lining of the implant weakens and the contents can begin to leak. That’s true of both saline and gel. Unfortunately, when gel implants leak, there is the possibility of the gel extruding into the breast tissue and that can create serious problems as well as requiring a difficult operation to correct them. If a saline filled implant leaks, its a simple replacement.

Unfortunately, we still don’t know how long the gel implants are likely to last. The required FDA studies have still not been completed. While it is true that in some cases, the gel implant may provide a more natural result, in the majority of patients that is not the case. In patients who have normal overlying skin and tissue, once the implant is in the body, there is virtually no difference in the shape or feel of the breast.

While we are happy to provide the type of implant our patients request, until there is better evidence of long term safety, we will continue to recommend saline filled implants for most of our patients.

Breast augmentation in the sagging breast

As we have discussed before, many patients seeking breast augmentation come because they have lost both volume and shape – whether from pregnancy, weight loss or simply aging. If there is significant sagging, breast implants alone may not be an adequate solution. Since the implant will eventually settle into the breast, the result may just be more sagging.

Traditionally, the solution was to combine a breast lift with augmentation. Years ago, surgeons were reluctant to combine the two operations and would recommend a two stage procedure. As we gained more experience, we were able to combine the two operations into one.

A breast lift, or mastopexy, is an operation that lifts the breast by repositioning the nipple and tightening the skin. The problem is that many women who have ptotic or saggy breasts lack sufficient tensile strength in the breast skin, and so a degree of over correction is required to allow for subsequent stretching. This results in a rather distorted appearance at first, and sometimes, even with overcorrection allows relapse over time.


A better approach, we have learned, is to combine a small breast reduction with augmentation. This allows us not only to tighten the skin, but also to tighten the substance of the breast. While it does involve more surgery, the results certainly warrant the extra time and effort. We have seen a significant improvement in our long term results since shifting away from mastopexy/augmentation to reduction/augmentation. This has now become our preferred technique.

As in the past, we insert the implant through an axillary incision using endoscopic technique. We feel it is very important to keep the implant pocket separate from the reduction field since this minimizes the risk of an infection reaching the implant.

Breast reduction/augmentation has become a very popular option at our Center and we feel the the results justify this popularity.

A rather untypical day at the Cosmetic Surgical Center

DucksOnce a month, we drive from Abilene to San Angelo to see patients. It happens that our ranch in Ovalo, TX is off of Highway 83 – the road between Abilene and San Angelo. On the ranch, we have a lovely pond that is near our house and we try to keep ducks on the pond. With the abundance of predators, that is not an easy task. Recently, we bought a dozen ducks which we planned to drop off on our way to San Angelo. As we pulled into the ranch, we saw a large wild hog in the corral with our horse and donkey. Hogs, as you probably know, are a big problem, and so we wanted to eliminate it, if possible.


HogWe had to drop off the ducks first, and then went to the ranch house to get my rifle. Surprisingly, the hog was still around and we were able to dispatch him, after which, we got back in the truck and continued on to San Angelo, arriving in time for our first appointment.

SkyOf course, we later had to dispose of the hog and by the time we finished with our appointments and drove back, we saw buzzards circling above the dead hog. We got out our excavator to dig a ditch in which we buried the hog. Then to
complete the day, we assembled a decorative windmill as well as a few other odd jobs, after which we returned to Abilene.




Wind MillNot a typical day, but certainly a fun one. Thanks to Dena for the wonderful photography, as well as for all her help at the ranch as well as in the practice. What would I do without her?

That’s it for now. Thanks to all our wonderful patients who make this practice so much fun. We are truly fortunate to have so many wonderful people who have put their trust in us over the years.

That’s all for this edition. As always we appreciate your comments and suggestions.


Howard A. Tobin, M.D., F. A. C. S.

For general information: askdena@newlook.org or n41gt@newlook.org