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Pike Street Market Fishmonger

One of the articles reviewed at our quarterly journal club was on indications for a preoperative mammogram.  Since that time, however, the U.S. Preventative Services Task Force recommended that baseline mammograms for most women begin at 50 instead of 40 years old.  This change takes into account the significant toll caused by false positive mammographic findings and the ensuing unnecessary breast biopsies.  The panel claimed that monetary factors were not a consideration in their recommendations.  When they site as supporting evidence that in order to save the life of one woman in her 40’s from breast cancer, 1,904 women would have to be screened every year for up to 20 years, it is hard to deny that cost must have entered their calculations.  From a public health standpoint, their screening recommendations may make sense… unless you are that one in 1,904 women who has her life saved.  I do not have the answers for the best way to screen the general population of women and would defer to my gynecologic and oncologic colleages for direction.  With the massive upcoming changes in health care, do expect more of these controversies. 

We Boise Plastic Surgeons agreed that when to do a preoperative screening mammogram was an entirely different question than when to do routine  population screening.  If you are operating on a breast and incidentally discover a breast cancer, this may change how the cancer is treated.  Also, if you have just paid for a breast surgery, your results may be compromised by any necessary treatment for cancer.  That said, there are no firmly established guidelines for when to do preoperative mammograms and breast cancers may definitely be missed by mammogram or may develop shortly after a normal mammogram. 

Our consensus was to obtain a preoperative mammogram for most women over 35 and for women who are younger with difficult to examine breasts or with a significant family history.  The mammogram should be within approximately one year of the planned operation.  This should not be considered a standard of care as some surgeons may order the test more or less frequently.  Ultimately, breast health is also the responsibility of the patient and her primary care physician as well.  I try to obtain indicated mammograms well before an operation so that any suspicious finding may be investigated without delaying the surgery date.

Pike Street Market on a sunny day

The patient had a left mastectomy for cancer.  She neither desired nor required any treatment to the right breast.  On the right, she had a moderate sized breast with mild ptosis (droop).  She had some abdominal fat without being obese, had no abdominal scars, and was otherwise healthy.  She was therefore a good candidate for a unilateral TRAM flap for breast reconstruction.  The flap was transferred without any perioperative problems and then allowed to mature for 3 months.  At that time, she returned to the operating room to have the volume and fullness tailored with liposuction to better match the right side, and to have a nipple reconstructed.

Pre Op

Post TRAM

Post tailoring and nipple reconstruction

Luxury Facial, Luxury Micro, & Peel Pkg $ 200

Window Seat over Seattle

Seattle at Twilight

Last month, I went to the annual American Society of Plastic Surgeons conference in Seattle.  It was a good trip where I learned some new approaches and had others confirmed.  I will just present a list things which impressed me and explore them more fully in future blogs.

- First, there was a lot of emphasis on presenting information to current and potential patients on Facebook.  I will be developing a business page soon.  I have a personal one right now which I never look at and may delete to avoid confusion, so please do not use it. 

- A course which I took on comprehensive breast reconstruction helped solidify my thoughts on this important part of my practice.

- I learned a new technique to improve liposuction results without using expensive and potentially dangerous energy sources. 

- There was an interesting discussion on if Plastic Surgeons can remain in solo practice (over half of us are, a huge number).  The conclusion was, you can, but you may need a little help from your friends.

- Fat grafting in the breast and face continues to become a more proven and popular technique.  I can confirm that I have largely been happy with the results (as have patients) as long as I understand the limitations.

- I don’t do buttocks augmentation.  Given the complication profile, I’m not likely to start.  The circumferential incision techniques for large weight loss and selective liposuction are most reliable.

- A great talk looked at common plastic surgical practices such as antibiotic use and antiembolic prophylaxis and it is surprising how little good information is really out there.

- A facelift panel concluded that a good result is largely based on proper technique and patient selection.  The technique itself did not matter so much as long as it was well performed.

- Fillers and Botox are not cure alls, but still have their place in early aging. 

That is all that comes to mind at the moment, but I am sure that I’ll think of a few more topics.  We may send out an additional e-mail if and when the business Facebook page comes to fruition.  

Seattle Storm Reflection

The patient is a post partum woman who desired a moderately large augmentation.  She had an inframammary incision to place a midrange Allergan silicone gel implant.  She maintains good upper pole fullness with no drop out of the implant.

Pre op anterior

Post op anterior

Pre op oblique

Post op oblique

Post op lateral

Post op lateral