American Plastic Surgery Articles: More News & Views
In real life, our blogger Dr. Face is the eminent Beverly Hills board-certified facial plastic surgeon Robert Kotler, M.D. Joining the discussion is an equally eminent Beverly Hills board-certified plastic surgeon, Stuart Linder, M.D. (who blogs as Dr. Body.) Both are constant consumers of professional cosmetic plastic surgery publications and help patients – along with other American plastic surgeons – understand the importance of new scientific findings about the rejuvenation arts.
Doctors Face and Body frequently boil down the articles for News & Views, a capsulated review of the latest and greatest from the professional press.
Here is their second such offering.
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Dr. Face: (Dr. Kotler) Have you read any interesting articles about plastic surgery work on the body, doctor?
Dr. Body: (Dr. Linder) Odd you should ask. I spotted a survey, asking 500 board certified American plastic surgeons about their current breast augmentation practices.
Dr. Face: Do you mean practices like location of the incision, type of implant, length of the operation and so on?
Dr. Body: Exactly. Because I place hundreds and hundreds of saline and silicone breast implants yearly, I was very curious how other surgeons approach and do their work.
Dr. Face: Did you find any surprises?
Dr. Body: A few. For instance, I noticed that only 32 percent of board-certified surgeons can perform an operation in under an hour. Actually, a well trained, board-certified plastic surgeon should take no more than 30 to 40 minutes to complete the procedure. And that’s with minimal blood loss and operating with a board-certified anesthesiologist.
Dr. Face: Did all the respondents use a board-certified anesthesiologist?
Dr. Body: Actually, one-third of the survey group reported using registered nurse anesthetists. That may keep costs down somewhat but to insure patient safety, a plastic surgeon should use a board-certified anesthesiologist – who is another M.D. He or she knows precisely what to do in any emergency.
Dr. Face: A good point, doctor. In point of fact, the development of the nurse anesthetist position was in the military where it was designed to be under the direct supervision of an anesthesiologist. The concept was one M.D.-anesthesiologist could supervise a handful of nurse anesthetists during operations.
Dr. Body: I also note that 81 percent of the survey group report using 300 to 400 cc breast implants. That’s about what I use in my practice. And, also like in my breast augmentation practice, I note that while silicone is available, the surgeons report more patients choosing saline breast implants.
Dr. Face: There are four possible incisions a plastic surgeon can use in breast augmentation. Did the survey show any preference for any particular one?
Dr. Body: About 66 percent of the surgeons report starting a breast enhancement with an incision in the inframammary location, the place where the bottom of the breast meets the chest wall. About 25 percent say they use a periareolar, or around the nipple, approach. I was surprised the figures were not reversed.
Dr. Face: Why the surprise?
Dr. Body: The inframammary was the standard approach to breast enhancement during the 1970s and 80s and is considered outdated for extremely busy surgeons who perform large volume of breast enlargements. Also, the majority of the responders were from the American South and East. If more California plastic surgeons had returned the survey, I think readers would have seen more up to date responses. In my opinion, the periareolar approach allows the surgeon to work right over the breast. So, looking down, it is much easier to line everything up for natural looking results.
Dr. Face: I’ve read that starting a breast augmentation through the areola results only in temporary nipple numbness for a few patients.
Dr. Body: That’s true. But the medical literature of breast augmentation shows that the most common long-term complications are bleeding and then infections.
Dr. Face: Where could we find the study?
Dr. Body: In the March-April, 2009, Aesthetic Surgery Journal; it’s a magazine written and read by, plastic surgeons. The title is: Primary Breast Augmentation Today: A Survey of Current Breast Augmentation Practice Patterns.
