October is Breast Cancer Awareness month, so check your breasts and follow-up with your healthcare provider for any abnormalities. Men get breast cancer too, so everyone needs to check. Getting started is simple and painless.
Breast Cancer Awareness
October is Breast Cancer Awareness Month. We all, women and men alike, need to take a few minutes to take care of ourselves. We have all heard the sound bites. One in eight women get breast cancer, and only 20% have a family history of breast cancer.
Breast Cancer in Men is rare. One in 1000 men will develop breast cancer, and less than 1% of all breast cancer cases develop in men. This may be because men have fewer breast cells and lower estrogen levels. On the other hand, early detection in men, while somewhat easier, is even more important than for women. Smaller breasts mean that the cancer cells can escape the breast faster and invade locally more quickly, especially when treatment is delayed by assuming men don’t get breast cancer.
According to the American Cancer Society, there will be about 3000 new cases of invasive breast cancer in men in the U.S. this year and about 500 men will die from the disease, and black men tend to have a worse prognosis.
Breast Cancer Detection
The most common presentation of Breast Cancer in men is a hard, painless lump underneath the nipple and areola. The lump can be fixed and it may be hard to determine the edges as the cancer invades the surrounding normal tissues. For 67-year-old Mathew Knowles, perhaps know better as Solange and Beyonce’s father, the first indication that something was wrong was when he and his wife noticed small dots of blood on his shirts and bedsheets.
Matthew Knowles, seen here with his daughter Beyonce, was recently diagnosed with breast cancer.
Mister Knowles was on Good Morning America last Wednesday with host Michael Strahan, sharing his experiences and encouraging men and women to do their breast self-exams and get tested promptly. He had surgery at the end of July, and in his words is doing “really good.”
“I’m hoping by me coming here today, speaking out, letting folks know that you can survive this. But it has to be early detection. And I can’t overemphasize the word early,” he said. Well done Beyonce’s dad. Well done.
Breast Cancer Genetics
Although treatment outcomes are very similar to women at the same stage of detection, a man diagnosed with breast cancer should also consider seeing a genetics counselor for a consultation. If a man tests positive for a defective gene like BRCA1 or BRCA2, it can lead to a future diagnosis of breast cancer and his children have a 50% chance of carrying the gene. These statistics come from the National Breast Cancer Foundation.
KISS drummer Peter Criss is an outspoken advocate for male breast cancer awareness. In his words, “You don’t need boobs to get breast cancer.”
Peter Criss found a lump in his left breast after a workout in 2007. The legendary KISS drummer survives after successful treatment, and he remains an outspoken advocate for male breast cancer awareness.
A male child of a man with breast cancer who inherits the defective BRCA2 gene has an approximately 6% chance of eventually developing breast cancer and just over 1% chance with BRCA1. A female child of a man with breast cancer who inherits the defective gene has a risk between 40% and 80% of eventually developing breast cancer. Men with a genetic predisposition to breast cancer are also at a higher risk of getting prostate cancer at a younger age.
Macho Men Get Breast Cancer Too
Richard Roundtree, the actor and model, exploded onto the big screen in 1971 as John Shaft, an action hero who took no guff. As an actor, Richard Roundtree’s Shaft is as macho as a man can be. He was diagnosed with breast cancer in 1993 and underwent a double mastectomy and chemotherapy. I am happy to report that he is alive and well at age 77. Early detection and treatment are key. I can dig it!.
Richard Roundtree was diagnosed with breast cancer in 1993 and underwent a double mastectomy and chemotherapy, and is alive and well at 77. According to the theme song, “Who’s the cat that won’t cop out when there’s danger all about?” Can ya dig it?
Rod Roddy, Come On Down
You may not recognize the name, but if you are old enough to remember Bob Barker on the Price is Right, you will remember Rod’s voice. As the hyper-energetic off-stage announcer he would call out an audience member’s name followed by one of the most iconic catchphrases to grace daytime game shows, “Come on down! You’re the next contestant on the Price is Right!” Even though the “Come on down,” was first uttered by Johnny Olson, Rod Roddy belted it out for 17 years, longer than any other announcer.
The Price is Right announcer Rod Roddy had both breast and colon cancer during his lifetime.
Breast cancer and colon cancer can travel together. On September 11, 2001, Mr. Roddy was diagnosed with colon cancer, and in 2002 had a recurrence. In March of 2003, he was diagnosed with Breast Cancer. In the last few years of his life, he became a spokesperson for early detection of cancer. In an interview with CBS, he said, “I could have prevented all this with a colonoscopy, and of course, that’s the campaign I’ve been on since I had the first surgery. To everybody out there, get a mammogram! It can happen to men, too.”
Breast Cancer and Politics
Edward William Brooke III was an American Republican politician. In 1966, he became the first African American popularly elected to the United States Senate, and he represented Massachusetts in the Senate for 12 years, from 1967 to 1979. In September 2002, he was diagnosed with breast cancer and assumed a national role in raising awareness of the disease among men.
In 1966, Edward Brooke became the first African-American elected to the US Senate. He is seen here with his mother after receiving the 1978 Man of the Year Award. In September of 2002, Senator Brooke was diagnosed with breast cancer. (AP)
Brooke experienced pain under his right nipple. Most breast cancer is painless, but pain harder to ignore than a lump. His first thought was that he had pulled a muscle from gardening, but it was more serious. It was breast cancer. He underwent a double mastectomy, and remained cancer free until his death in January 2015 at age 95.
You Better Check Yourself…
There are expected to be about 3000 new cases of male breast cancer diagnosed this year. For women it is closer to 300,000 cases, and, an estimated 42,000 women will die from breast cancer in the U.S.. The good news is that 62% of breast cancer cases are diagnosed early when they are still localized. In localized cases, the 5-year survival rate is 99%.
I tell all my patients, “If something doesn’t seem right; it might be wrong. Call me.” Early detection and intervention is key for all medical issues. It allows more options for treatment and better outcomes. There is little downside. If there’s nothing wrong, you wasted a little time to find out that you are alright, plus you get peace of mind. On the other hand, if you have a problem, treatment can begin. All breast lumps and bumps need to be evaluated by your physician in a timely fashion, so if you have a lump in your breast, contact your physician today.
This month, Allergan® has updated their warranty for the affected BioCell® Textured Breast Implants. The following information comes directly from Allergan®, and is correct at the time of publication. As with any warranty, be sure to check with Allergan® directly if you have questions about their products.
What Implants Are Covered?
The BioCell® Replacement Warranty covers all BioCell® textured implants that were manufactured under the brands McGhan®, Inamed®, Allergan® or Natrelle®. Both saline and silicone gel-filled textured implants are covered. This coverage will be available through July 24, 2021. Please note that Natrelle® smooth breast implants are not subject to this withdrawal.
What Are The Replacement Options?
The FDA web site has up-to-date breast implant and BIA-ALCL information.
The FDA recommends not to remove devices if you do not have symptoms. However, if you and your plastic surgeon decide that replacing your device(s) is in your best interest, you can choose any Allergan® smooth breast implant(s) as a replacement on or before July 24, 2021.
You should bring your current patient ID card or any other information available about your implants with you to your appointment. You and your plastic surgeon will decide on the best size and style as a replacement option for you. Your plastic surgeon will request your replacement implants from Allergan® on your behalf.
Are Surgery Fees Covered?
No. As part of this program, Allergan® will not provide surgical fee assistance. This decision is aligned with the FDA’s recommendation not to remove textured implants or other types of breast implants in patients who have no symptoms of BIA-ALCL.
What If I DO NOT Explant My Textured Implants?
If you choose not to explant your BioCell® textured devices, you will continue to be covered under the Natrelle® ConfidencePlus® Warranty, which includes comprehensive coverage including rupture, capsular contracture and late seroma. More information about the Natrelle® ConfidencePlus® Warranty can be found at Allergan.com.
How Do I Know If My Implants Are Textured?
Allergan Smooth and Textured Breast Implants
Most breast implants used world-wide are Smooth Breast Implants. All teardrop shaped implants are textured, so if you have teardrop shaped breast implants, you have textured implants. For Allergan®, these are called style-410. Some round implants are textured. You will need the catalogue number for your breast implants to know if they are textured.
Please visit Allergan.com to understand how to read your product ID card. If you don’t have a card, or would like to speak to someone at Allergan, please contact Allergan Medical Information at 1-800-678-1605, option #2, or email IR-Medcom@allergan.com.
How Do I Learn More About BIA-ALCL?
I am constantly updating my blog with new information about BIA-ALCL and other Plastic Surgery News. So keep tuned to the San Francisco Plastic Surgery Blog for more information. Additional reading is available on the FDA Website.
Textured Implant Removal or Exchange Consultations
If you are concerned about your breast implants and are considering changing size or style, be sure to consult with a Board Certified Plastic Surgeon near you. In the San Francisco Bay Area, call our Walnut Creek Plastic Surgery Center at (925) 943-6353 to schedule your appointment.
Joseph Mele Has Been Nominated and Accepted as a 2019
American Institute of Plastic Surgeons’ 10 Best in California For Client Satisfaction
The American Institute of Plastic Surgeons has recognized the exceptional performance of California’s Plastic Surgeon Joseph Mele as 2019 10 Best Plastic Surgeons for Client Satisfaction.
The American Institute of Plastic Surgeons is a third-party rating organization that publishes an annual list of the Top 10 Plastic Surgeon in each state. Surgeons who are selected to the “10 Best” list must pass American Institute of Plastic Surgeons’ rigorous selection process, which is based on patient and/or peer nominations, thorough research, and American Institute of Plastic Surgeons’ independent evaluation. American Institute of Plastic Surgeons’ annual list was created to be used as a resource for patients during the surgeon selection process.
One of the most significant aspects of the selection process involves surgeons’ relationships and reputation among his or her patients. As patients should be a surgeon’s top priority, American Institute of Plastic Surgeon places the utmost emphasis on selecting surgeons who have achieved significant success in the field of Plastic Surgery without sacrificing the service and support they provide. Selection criteria therefore focus on surgeons who demonstrate the highest standards of Client Satisfaction.
We congratulate Joseph Mele on this achievement and we are honored to have him as a 2019 American Institute of Plastic Surgeons’ Member.
You can contact Dr. Joseph Mele directly at 925-943-6353.
Over the years, I have posted more than 500 articles about a wide variety of Plastic Surgery Procedures. They are easily accessible and categorized in the side column under the “Search By Category” menu. Each post provides specific information about the procedure; however, this post is dedicated to the recovery process.
Generic Plastic Surgery Recovery
Before getting into the generic recovery rules, I provide the following disclaimer: Every procedure has specific post-operative instructions, and your plastic surgeon will provide you with post-operative instructions paired to the specific methods that they employ during your surgery. We plastic surgeons shape how we do each procedure to each patient based on our experience. I will try to provide some general guidelines. It goes without saying, but I’m going to say it: If you choose an Experienced Board Certified Plastic Surgeon because you trust them and you like the results they achieve, the best course of action is to do things their way.
Surgery is a form of injury and the common acronym for treating injuries is RICE. RICE stands for:
All of these can help ease discomfort and speed your recovery, when used appropriately.
The R in RICE stands for Rest.
Rest: Avoiding vigorous activity, heavy lifting and sudden movement helps prevent increased swelling and further injury. Immediately after surgery, rest prevents elevated blood pressure and post-operative bleeding. In the weeks after surgery, movement is good, but rest allows you to heal with increased comfort and a more predictable outcome.
The I in RICE stands for Ice.
Ice: Ice therapy is effective, especially for the first few postoperative days, and it can be continued if it feels good. I recommend using it for 15 minutes and then leaving it off for 45 minutes. Always keep a thin cloth between you and the ice to prevent frostbite. I had a patient fall asleep with ice directly on the skin and it froze causing blisters. He recovered fully, but prevention is the best medicine.
The C in RICE stands for Compression.
Compression: Compression garments are very important to control swelling and keep the skin smooth for many procedures. After procedures like Liposuction, the skin loses support as well as stuffing, so the garment is important for keeping the skin flat and smooth. It should be worn 24/7 for the first two weeks.
The E in RICE stands for Elevation.
Elevation: Elevation helps the surgical site drain. During the day this is easy, as our face and body are elevated. At night, laying flat will cause some increased swelling; however, sleep is very important. If you can sleep with the operated body part elevated for a few days, it helps.
Common Sense Recovery Advice
RICE therapy is based upon common sense, and it is a proven treatment. While it provides a grounded framework for comparing treatments, before starting any new therapy, it should be approved by your surgeon. Your surgeon has the most information and the greatest experience with your procedure. It is a good idea to discuss recovery during your initial consultation appointment, because while the surgery may be elective, once the procedure is performed, the recovery becomes mandatory.
If you are in the San Francisco Bay Area and want to learn more about a cosmetic plastic surgery procedure, feel free to use the contact form on this page, check out my main website: DrMele.com or call my office directly at (925) 943-6353, to schedule a personalized consultation appointment today.
Special Announcement Regarding Textured Breast Implants From The ISAPS
As of tomorrow, the use of Textured Breast Implants will be restricted in France.
From the ISAPS:
We have been informed today that the French health regulatory authorities (ANSM) have announced the following regulations regarding breast implants, and have summarized the most important information for you. You can read the full text of their announcement here.
As a precautionary step, ANSM decided on April 4, 2019, to withdraw macrotextured breast implants and polyurethane-coated breast implants from the market, as certain macrotextured implants and implants with polyurethane-coated surfaces may be a risk factor for the development of BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma). Given the rarity of the risk to exposure to BIA-ALCL, ANSM does not recommend preventive explantation for women with these implants, due to the very rare risk of serious disease. This decision will go into action on April 5, 2019. The purpose of this precautionary approach is to prohibit the sale, distribution, use, and withdrawal of this type of breast implant in the French market.
The ANSM reiterates its recommendation to use smooth breast implants as the preferred method of cosmetic or reconstructive surgery.
Since 2011, 59 cases of BIA-ALCL have been reported in France, with approximately 400,000 implants implanted annually in the country.
In addition, ANSM would like to reiterate the importance of proper information for women who wish to receive breast implants of all types. The patient and the surgeon should jointly discuss the advantages and disadvantages of the various implants available and alternative techniques in cosmetic surgery or post-breast cancer reconstruction.
An informed consent form containing the identification of the implant surface (smooth, microtextured, etc.), its limited life span, and the possible resulting need for re-intervention and medical care, must be submitted to all women prior to the placement of breast implants.
In the case of functional or physical symptoms in a woman with breast implants (such as abundant periprosthetic effusion, increased volume, pain, inflammation, mass, ulcers, or changes in general condition), particularly in the time since the postoperative phase, the diagnosis BIA-ALCL must be taken into account and ruled out by an analysis of the periprosthetic fluid (CD-30 testing, culture, cytology, and flow cytometry).
For women with breast implants and without clinical signs on the breast, the expert group recommends an annual follow-up examination of the breasts.
The International Society for Aesthetic Plastic Surgery
While ISAPS respects the decision reached by ANSM, we would like to point out that this disease BIA-ALCL is rare and, above all, easily treatable with total capsulectomy in early stages or Brentuximab in more advanced cases. Fortunately, compared to the high number of breast implants that are performed on a global scale, there are only few deaths worldwide. We are concerned about the recommendation to only use smooth implants, as we know from evidence-based data that the complication and reoperation rates are higher for smooth implants. Through this decision by ANSM, we plastic surgeons are effectively taken back to the time when there were no anatomical implants. This will affect breast reconstruction outcomes.
We believe that this is the wrong approach and less satisfactory for our patients. It is more important to inform our colleagues, family doctors and gynecologists about the early symptoms of the BIA-ALCL and how to evaluate patients. Patients must also be informed about the possible risks and symptoms of BIA-ALCL at the time of implantation. The information here should be cautious and always show the relation of an extremely rare disease.
We hope that the decision in France will remain on a case-by-case basis and that treatment options using macrotextured implants will not be taken away from our patients and us, as this would be a huge step backwards. Current opinion indicates that macrotextured implants can be safely used when appropriate precautions are taken to mitigate surface biofilm contamination, according to published data.
Dirk Richter, MD,
The response from the European Association of Societies of Aesthetic Plastic Surgery (EASAPS)
ANSM (agence national de sécurité du medicament et des produits de santé) stated April 3th, 2019 that macrotextured and surface-coated polyurethane implants from different labels are prohibited in France.
EASAPS opinion is that this is an regrettable decision that is not based on scientific data.
We need evidenced-based and statistically convincing studies for proper patient information on adverse events and the rare disease of ALCL.
What we know about Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is evolving. We learn more as each new case is identified. Right now, there are just too few cases to know many of the specifics; however, today I will go over the data currently available.
ASPS and ASAPS summary of BIA-ALCL in 2019
Much of this information comes from the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS). Thanks to its members voluntarily reporting and collecting information on BIA-ALCL, these US based national plastic surgery organizations have the best database on BIA-ALCL in the world.
What is BIA-ALCL?
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and treatable type of T-cell lymphoma that can develop around breast implants. BIA-ALCL is not a cancer of the breast tissue itself. It is not breast cancer, but it is found in the breast, around the capsule which surrounds breast implants.
When Does It Present?
The time between breast implant insertion and diagnosis of BIA-ALCL varies greatly. It ranges from 9 months to 27 years, with an average delay in presentation of 9.2 years.
Who Gets BIA-ALCL?
Cases seem to be concentrated in patients who have, or who have had textured breast implants. It seems to be related to the aggressiveness of the texturing and has occurred in patients with both silicone and saline filled breast implants.
When in doubt; check it out. Early diagnosis and treatment are key to curing BIA-ALCL.
After reviewing all available case series, case reports, and registries, BIA-ALCL is more common with textured implants. Textured implants are used less frequently than smooth implants. Textured implants are also used more often for breast reconstruction after breast cancer, because shaped implants are more desirable in this population and texturing is used to reduce breast implant rotation for shaped implants.
To date, no cases of BIA-ALCL have been verified in patients who have had exclusively smooth breast implants. However, it is not possible to exclude the appearance of BIA-ALCL in association with smooth implants at this time. The FDA reports that they are aware of smooth breast implant only cases; however, they warn that this information is “unverified” and potentially “inaccurate.”
The association of BIA‐ALCL and textured implants may be related to the increased surface area of the texturing; however, this has not yet been definitively proven. The variation in surface texturing among breast implant manufacturers may mean there are variable risks for the development of BIA-ALCL.
How Does BIA-ALCL Present?
The majority of patients present years after their initial surgery with one breast gradually increasing in size. The increased size is from fluid, serum, collecting around the breast implant. This collection of fluid is called a seroma. Seromas are normal right after surgery; however these seromas appears later and are thus called a delayed seromas. A few patients have presented with different symptoms such as a mass, skin rash, fever and night sweats, and lymphadenopathy.
How Is The Diagnosis of BIA-ALCL Made?
BIA-ALCL usually presents as increased breast size due to fluid collecting around a textured breast implant.
Diagnosis is based on analysis of the fluid in the seroma. Most commonly, ultrasound‐guided fine needle aspiration of the peri-implant fluid is assessed with immunohistochemistry for CD30-positive large anaplastic T-cell lymphocytes.
How Is BIA-ALCL Worked Up?
PET‐CT is performed following a positive diagnosis. Mammograms are not helpful for evaluating lymphoma, but are important for the evaluation of breast cancer. Often, a multidisciplinary team approach including, when required, an oncological breast surgeon and an oncologist specializing in lymphoma.
How Is BIA-ALCL Treated?
The treatment of BIA-ALCL is evolving. In most cases, cure is obtained by removal of the breast implant and the capsule surrounding it. Incomplete capsular resection has been associated with both recurrence and significantly lower survival. Rarely, patients may present with a mass and have an increased risk of requiring radiotherapy and chemotherapy. Treatment approach should follow international guidelines established by the National Comprehensive Cancer Network (NCCN) for BIA-ALCL, available at nccn.org.
Current treatment recommendation is for bilateral complete capsulectomy and implant removal, as a small number of women have had contralateral disease found incidentally; however, it cannot be stressed enough that the treatment is still evolving, and each patient must be individually evaluated. If you suspect you have BIA-ALCL, do not delay, and contact your plastic surgeon or primary medical doctor immediately.
Summary Statement On BIA-ALCL From The ASPS
I have included below a statement released by the American Society of Plastic Surgeons (ASPS) this week. It summarizes well what we currently know about BIA-ALCL. The ASPS has also published an 2019 online BIA-ALCL summary.
“Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of lymphoma that can develop in the scar capsule near saline or silicone breast implants. This disease is currently being investigated as to its relationship with breast implants. The family of ALCL is a rare cancer of the immune system, which can occur anywhere in the body. Based on adverse event reports, the United States Food and Drug Administration (FDA) estimates the total number of cases of BIA-ALCL to be over 450 cases.”
“It has been noted that the majority of BIA-ALCL patients have a history of a textured-surface device. An exact single-number estimate of the risk for both textured and non-textured implants is not possible with the currently available data. Lifetime risk of BIA-ALCL has been estimated at 1:1,000 to 1: 30,000 for women with textured breast implants, and BIA-ALCL risk is currently under investigation. BIA-ALCL usually involves swelling of the breast at an average of 3 to 14 years after the initial breast implant operation. Most cases were cured by removal of the implant and the capsule surrounding the implant; however, rare cases have required chemotherapy and/or radiation therapy for treatment.”
“Patients with breast implants should be followed by a surgeon over time and seek professional care for implant-related symptoms such as pain, lumps, swelling, or asymmetry. Patients should monitor their breast implants with routine breast self-exams and follow standard medical recommendations for imaging (e.g. Mammography, Ultrasound, MRI). Abnormal screening results or implant-related symptoms may result in additional expenses for tests and/or procedures to properly diagnose and treat your condition. Tests and procedures could include but may not be limited to: obtaining breast fluid or tissue for pathology and laboratory evaluation, surgery to remove the scar capsule around the breast implant, implant removal, or implant replacement.”
The above Breast Reduction Before and After Side View Photos show improvement in breast shape, size and nipple position after Reduction Mammoplasty Surgery.
Today, I am posting the latest episode of KRON 4’s Body Beautiful. This video segment continues where the last post left off, discussing Breast Reduction for Women. This new Breast Reduction Video Presentation contains:
Recovery information and tips for after Reduction Mammoplasty
Narration of specific examples of Breast Reduction
Breast Reduction Video Presentation
You Are Not Alone
The above Breast Reduction Video is intended to provide general information about the procedure. However, there is no substitute for an in-person consultation with and experienced Board Certified Plastic Surgeon. Years of learning, practice and experience have shaped how I perform Breast Reduction. Many thousands of women have breast reduction surgery annually, but each case is different. Your plastic surgeon is here to guide you through each option and help you achieve the best possible results.
The Best Breast Reduction for You
There are several methods of Breast Reduction which may or may not apply to your specific needs. I tailor my approach to each individual patient, by choosing the option that will achieve the best result in the safest and most predictable manner.
These Breast Reduction before and after pictures demonstrate the amount of reduction and enormous lift possible with the inverted T-technique. You will notice that the breast hangs well below the level of the mole visible anterior to the crook of her elbow in the before photo, while in the after photo, the base of the breast is well above it.
Breast Reduction Consultation Appointments
For your Breast Reduction, you will want an experienced and well qualified Board Certified Plastic Surgeon. Members of the ASAPS (the American Society for Aesthetic Plastic Surgery) are particularly well suited for breast reduction surgery, as they are Board Certified Plastic Surgeons who specialize in Cosmetic Plastic Surgery, including all aspects of Breast Enhancement.
If you are in the greater San Francisco Bay Area and would like to schedule a personalized consultation appointment, call (925) 943-6363 today. Learn what is possible in a safe and private plastic surgery office that specializes in Cosmetic Plastic Surgery.
The cost of plastic surgery procedures will vary. There are many variables including:
Type of procedure
Plastic surgeon’s fee
Location of surgery
Outpatient vs. inpatient surgery
There are also indirect costs like time off from work, child care and transportation.
Bargain Basement Procedures
When you buy a television, where you buy it matters little. All brand name TVs are made the same way at the same factory. If you are buying the same model number, you are getting the same product. Some outlets sell the same product for less, and who doesn’t like a bargain, right?
However, if you are having plastic surgery, the same rules do not apply. You are paying for a service, not a product. Your outcome is dependent on the labor put into the procedure more than the name of the procedure.
While it is good to know your options, try not to get too specific about the best procedure. Your time will be better spent looking for the best doctor. A good doctor will guide you through the process, from selecting the best procedure through the recovery process.
Variations In Procedures
The best way to keep costs down is to select the correct procedure. The most expensive procedure is the one that doesn’t work, even at half the price. Let’s use facelifts as an example. In over 20 years of practice, I am not sure I have done two facelifts exactly the same. Faces all have different structures. They are asymmetrical. They move differently, and as a result, they get loose in different places. The goals and expectations associated with the facelift can vary from person to person. Additionally, each face responds differently to the components of a facelift.
Often the facelift procedure is modified during the operation in order to get the best possible results. As a patient, you want an experienced, board certified plastic surgeon, who understands your goals and who has a variety of techniques at their disposal. Beware of providers bearing “name brand” facelifts, and those claiming to be “the only one” who performs their procedure. Plastic surgeons are always looking to improve their results, and good procedures and tricks spread quickly.
Lifestyle Lift, now bankrupt, marketed low cost facial rejuvenation in every major television market. Their glossy, if not outright deceptive ads, promised a quick fix at a low price. With such unattainable expectations, it is no surprise that they failed. However, the appeal of cheaper, faster and better is a powerful motivator. Some doctors will advertise quick and cheap procedures, and spend your consultation up-selling you to something that may actually work, also know as bait and switch.
You will see over and over on the Internet doctors explaining to patients that the best procedure for them cannot be determined until after an in-person consultation. It is not a ploy to get you into their office. It is because the feel of the skin is as important as the appearance. Pictures can help, but often, do not tell the whole story.
Now You Have Selected The Best Procedure
After you have selected the best doctor and the best procedure you want to know what is included. Estimates should include the surgeon’s fee, the operating room costs, anesthesia costs where applicable, and office visits. Surgeon’s fees will vary depending on years of experience and the demand on their time. Some surgeons spend more time with each patient, and will charge more accordingly. Surgery “mills” will often have technicians doing everything except the surgery (hopefully), and you may not see your doctor at your appointments.
Operating room costs vary by location and include the facility and staff. Hospital operating rooms tend to be more expensive than outpatient surgery center operating rooms, because hospitals have higher overhead. Anesthesia will vary by type of anesthesia. For local only cases, an anesthesiologist is not required. For procedures performed under general, there will be a charge for the anesthesiologist. Depending on the institution, this may be lumped in with the operating room charges.
Medication costs are usually minimal. Pain medication and antibiotics may be required. These are not usually supplied by your doctor, and you will need to pick them up at your local pharmacy, hopefully, before your surgery. If special garments are required, you may need to buy these separately, or they may be supplied during surgery.
Operations require follow-up. I follow most my patients for a year after surgery. Other doctors may only see their patients once or twice. Some doctors have an assistant do the aftercare. You should find out what is included in the cost of your procedure. How often will you be seen after surgery? Who does the follow up? What happens if you need to be seen after hours? What to do if there is an emergency? How are revisions handled? These are all good questions to ask before committing to a procedure.
Questions For Your Cosmetic Surgeon
Thanks for reading the five questions to ask your Cosmetic Surgeon. I hope it helps prepare you for a successful operation. Links to the posts covering the other four questions are listed at the top of this post. Next week we get back into specific procedures with the latest Plastic Surgery Videos from my TV show, Body Beautiful.
Today, we are discussing question number four, “What Is The Recovery Like?” After learning about your plastic surgeon’s training and experience, and how the procedure is performed, you need to know what to expect during the recovery period. Plastic surgery is elective; recovery time is not. You will need to budget some recovery time to get the most out of your surgery. Doing too much, too soon after surgery leads to more problems and increases your chance of needing additional revision surgery.
When Can I Get Back to Normal?
The bottom line is,”How long will it take to get back to normal?” The answer depends on two things: the procedure you are having and what you consider normal. Not every plastic surgeon does the same procedure, and not every surgeon uses the same recovery plan, but you can’t mix and match. If you choose Dr. X because you like their results, you need to follow Dr. X’s recovery instructions. The recovery plan goes with the procedure. Even my own recovery plans can vary depending on factors determined during surgery. My goal is always to get you back to your normal activities as quickly and as safely as possible, without compromising your results. The recovery times and activities listed below are general examples, but you should consult with your plastic surgeon for your specific recovery plan.
Recovery By Procedure
Some procedures require more physical limitations than others. For almost every procedure, you want to limit bending over, straining and activities which increase your heart rate and blood pressure for the first week after surgery. This is to prevent bleeding and other complications that bleeding may cause.
Movement, weight bearing and lifting may be restricted in the weeks immediately after your procedure. Be certain to ask your surgeon what restrictions should be expected and for how long. Overhead reaching may be restricted after breast surgery. Sitting may be retracted after Brazilian buttocks lifts. Lifting may be restricted after Tummy Tucks. Understanding why these restrictions exist may help you recover faster and achieve better results. If light duty is available, or you have a good helper, you may be able to resume work activities sooner.
Sometimes, returning to normal is limited primarily by your postoperative appearance. For many facial plastic surgery procedures, physical restrictions are lifted after a week, but bruising and swelling may still persist and limit your activities. If you work from home, you may be able to return to work in a few days after eyelid or nasal surgery. On the other hand, bruising and swelling can last 7-10 days after surgery, making face-to-face meetings much more difficult.
Recovery By Activity
If you have a desk job, returning to work is faster than if you perform manual labor. Working on a computer is usually not a problem a week after gynecomastia reduction, but lifting heavy objects is not recommended. Normal activities vary from person-to-person. Be certain to let your plastic surgeon know what type of work or activities you perform on a daily basis, so they can let you know when you can expect to return to normal. Be certain to ask specific questions of your plastic surgeon so you can properly prepare for you recovery.
Sometimes it takes longer than average to recover. By definition, about half or all patients will take longer than average to heal. Resist the self-defeating tendency to think you will heal faster than average. It will stop you from planning properly, and will make you feel like something is wrong, when it takes the expected amount of time to heal. If you give yourself a little extra time to heal, chances are you won’t need it. On the other hand, if you think you can return to all your normal activities sooner than your plastic surgeon tells you, you are likely to be disappointed, and you may end up hurting yourself or compromising your results. Surgery is a form of injury, and even carefully planned elective surgery requires the proper amount of recovery time.
Additional Treatments During Your Recovery Period
Follow-up visits are an important part of your treatment plan. Most surgeries are enhanced by proper follow-up care. When problems are recognized promptly, they tend not to progress and are easier to treat. Your plastic surgeon has years of training and experience which they use to recognize problems and prevent them from growing. Sometimes, additional treatment is required to keep your recovery on track. Ask your plastic surgeon about follow-up appointments early in the decision making process, so that you will know what to expect and can prepare accordingly.
How will your cosmetic plastic surgery procedure be performed?.
If you have been reading the Questions For Your Cosmetic Surgeon post sequentially, now you know the questions to ask about your Plastic Surgeon about their training and experience. The next topic is about the Cosmetic Plastic Surgery procedure itself. This post explores question three of the five questions you should always ask before having Elective Cosmetic Surgery – How will my procedure be performed?
The Internet is a good place to get a general idea of what plastic surgery involves; however, there are variations on every theme. Variations are necessary for obtaining the best results. Some variations are driven by your anatomical needs, and others are driven by your surgeon’s experience. During your consultation, ask about the who, what, where, when, why and how of your procedure.
Who Does the Procedure?
After asking the first two Questions For Your Cosmetic Surgeon, you should have a good idea about your surgeons training and experience, but are they actually doing your surgery? Patients often ask me who is in the operating room. I am the one doing the surgery, but usually, there are four people in the operating room: me, an anesthesiologist, a scrub nurse/tech and a circulating nurse. My job is to perform your procedure and guide the rest of the team. The anesthesiologist is there for your comfort and safety. The scrub is garbed sterilely, and assists me with the procedure, while the circulating nurse helps everyone and can open additional items that may be needed for the operation.
Some plastic surgeons will use a physician’s assistant (PA) or registered nurse (RN) as the first assistant during surgery. These are medical professionals who have received additional training, and they may do some of the suturing. In teaching institutions, interns and residents may be involved with your procedure. You should be informed before scheduling your procedure if someone other then your plastic surgeon is doing part of your procedure. Your surgeon is required to be present and provide supervision at all times.
What Procedure is Planned?
This may sound simple, and really it is. but there is nothing wrong with confirming what is planned. In fact, before every surgery, I take a “time-out” and review the particulars of your procedure with my team. Your name, procedure, allergies, medical conditions and status of prophylactic therapies (antibiotics, sequential compression devices and warming blanket) are reviewed, and everyone must be in agreement that everything is correct before surgery starts.
Before surgery you should know what is being done; what is being fixed, how much it can be fixed and what cannot be fixed. The risks, benefits, procedure, alternative, recovery and limitations of your surgery should be reviewed as apart of your informed consent.
Where is the Procedure performed?
If your surgeon is a member of the American Society for Aesthetic Plastic Surgery (ASAPS) or the American Society of Plastic Surgeons (ASPS), you can be certain that your procedure will be performed in an accredited surgical facility. This is a requirement of membership for these societies. If you cosmetic surgeon is not a member, be certain to ask about the facility in which you will be having surgery.
When Can We Do Surgery?
After a procedure is selected, scheduling your procedure at the appropriate time is important. Your surgeon will ask about your medical history, medications you take and other procedures you may have had. Be honest. Your answers to these question need to be accurate in order for you surgeon to provide you with the safest and most predictable experience. You will want to schedule your surgery at a time which allows for you to have the best experience and results. Fewer preoperative distractions allow you to concentrate on yourself and your results. The most common reasons for cancelling surgery are taking blood thinners, eating or getting a cold before surgery. Two of these three are completely preventable. For the best results, follow all your preoperative instructions.
Post-operative care is equally important. Good support from friends and family help. It starts with them getting any last minute post-operative care instructions. You may not remember me visiting you in the post-anesthesia care unit, or the instructions the nurse may give you there, but your designated driver will. Having someone to help you, especially the first few days after surgery, is recommended. How much help you will need depends on the type of surgery you are having. Follow-up visits are important and should be considered when planning your surgery.
Why Are You Choosing These Variations For Me?
Options are good, but can also be a source of confusion. For example, there are several choices of breast implants; additionally, there may be multiple ways to the procedure, like with breast lifts and tummy tucks. I like talking about options. Usually, after a brief physical examination, the number of acceptable variations is significantly reduced, allowing us to focus on the approaches which are most likely to work best for you. Your plastic surgeon is there to guide you to the procedure which will provide the most improvement and the least risk.
How is the Procedure Performed?
The Consultation Appointment: Consultation appointments are the time for planning your surgery. Selecting your procedure and planning how your procedure is going to be performed takes the most thought. It takes into account the answers to all the questions above. This is what consultation appointments are for. Your questions should be answered, and you should feel confident that the correct operation has been selected before going to the next step. If you are still confused, repeat the consultation appointment.
The Pre-operative Appointment: Pre-op visits are for making your surgery predictable. Once the best procedure is selected, the remaining steps are much more linear. A pre-op visit is scheduled a week or two before your surgery date. The details of your procedure are reviewed again, consent forms are signed, pre-operative photos are taken and your preoperative instructions are given. To maximize the benefits of your pre-operative visit, you should be past the planning stage. If you have questions, write them down, so that they can be answered during your visit.
The Day of Surgery: The day of surgery goes by quickly. You need to arrive one or two hours before you scheduled surgery time, depending on the surgical facility. There will be more paperwork. Your procedure and health will be confirmed. If anything has changed since your pre-op visit, be certain to let the staff and your surgeon know. An IV will be started for anesthesia and other needed medications. Once in the operating room (OR), you will be asked to breath oxygen through a mask, preoperative antibiotics and anesthesia are given through the IV, and the next thing you know, you surgery is completed.
You will wake in the post-anesthesia care unit (PACU). If you are going home the same day, you will likely remain in the PACU for an hour, until you are fully awake. If your procedure is performed under local anesthesia with sedation, you will feel normal. If you have general anesthesia, you may nor remember everything that happens in the PACU, including my visit, but this is a normal effect of the anesthesia. For larger procedures, staying the night is common.
Follow-up Visits: After care is equally important to good results. They are included in the cost of your surgery, because they are part of the procedure. Be certain to keep your appointments. Patients who disappear after surgery, are taking unnecessary risks. Medical tourism, while not uncommon, sells you short on follow-up care. Being near your surgeon, makes it easy to get care if problems arise after surgery.
The fourth question to ask you Plastic Surgeon is about recovery. We will cover this in the next posting. In the mean time, if you would like to learn more about your options for Plastic Surgery, in person, give me a call at (925) 943-6353, and schedule a private consultation appointment at our SF Bay Area plastic surgery clinic.