Welcome to our October Newsline

Yes, We’re Still Here

A number of you have contacted us inquiring about why they hadn’t received a newsline in quite a while. Frankly, we have been remiss, but along with a busy schedule and a number of competing outside obligations, the time has flown by.

Hopefully, we will be a little more regular in the future, but we do appreciate the nice comments we have received about our newsletter. It seems like the electronic age is passing us by. We still have no Facebook or Twitter presence but, thanks to our loyal patients, we still seem to be in pretty good contact.

Cosmetic Surgery and Birth Control Pills

BirthcontrolThere has been a great deal of interest and concern regarding major cosmetic surgery on patients who are taking birth control pills.

First a little background. Past research has indicated that hormonal birth control pills can increase the risk blood of clots forming in the leg and dislodging to form cardiovascular complications. How much risk is increased remains uncertain in spite of extensive FDA studies.

Now questions have arisen as to whether patients who are on birth control pills are at even greater risk of forming clots when they have cosmetic surgery. The main concern arises in regard to tummy tucks, which are known to have a small risk of leading to VTE (venous thromboembolism).

Since the birth control pills themselves are associated with a slight increase in VTE, the question to be answered is whether the risk is even greater when the patient has a tummy tuck, or, of even greater concern, when the tummy tuck is combined with additional surgery.

Frankly, we simply don’t know. This will be a major topic of conversation at this years meeting of The American Academy of Cosmetic Surgery, and we may have more to report at a later date. At the present time, we are simply advising patients who are having tummy tucks of the possible added risk and suggesting that they discontinue their birth control pills for a month prior to the surgery.

“Mommy Makeover” Surgery

Mommy MakeoverIt seems like everyone is talking about “Mommy Makeover” surgery. If you Google mommy makeover, you get nearly 2,000,000 results. On the other hand, if you Google mommy makeover risk, you get only 85,000 results. My point is that often surgeons are exposing their patients to significant increased risk by combining too much surgery at one time.

The basic concept of Mommy Makeover is combining breast and body surgery for patients who have experienced problems with shape or volume after pregnancy. The most common combination is tummy tuck and breast augmentation – a combination we have been offering for years. The question is when does the addition of procedures become unwise. The answer is not as simple as one might think.

Many studies have shown that for elective procedures, surgical and anesthetic risk is pretty steady for the first four hours. After that, the risk of several potential problems begins to rise including anesthetic problems, bleeding, infection and the possibility of VTE which we discussed above. Other factors also come into play such as the patient’s weight, smoking history or associated medical problems.

For a relatively thin healthy patient with no smoking history, it certainly might be reasonable to plan surgery that is slightly longer, but remember, we never can figure with absolute certainty how long the surgery might take. Problems can arise that can require longer time.

Sometimes, safety may dictate that we stage the operation. While we realize our patient’s desire to accomplish as much as possible at one time, our commitment to safety may dictate against doing as much as the patient desires at one time. This is why it is so important to have a thorough evaluation and consultation prior to planning combined procedures. While combining procedures often makes good sense, it is not always the wisest choice.

Austin Scheduled Visits Discontinued

We regret that we have found it necessary to discontinue our Austin scheduled visits.

Despite our practice continuing to remain as busy as ever, the number of patients coming from the Austin area has decreased to the point where the time and expense of flying there monthly can no longer be justified.

For those who wish to see us in Austin and are flexible with their schedule, we will try to set up visits on an individual basis. Otherwise, we are happy to see you in Abilene or at one of our regular San Angelo or Midland visits.

That’s all for now. Thanks for your interest


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

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