WHAT'S NEW

The patient is a post partum woman with abdominal laxity primarily below her umbilicus ( belly button ).  She had a mini abdominoplasty ( defined as no incision made around the umbilicus ).  The upper abdomen is not optimally improved, but there is some benefit to releasing the umbilicus from below and allowing it to “float” downward when the abdominal skin is pulled.  This allows some tightening to the upper abdomen.  The biggist benefit is that there is no scar around the umbilicus and that allows the abdomen to look unoperated upon when the lower scar is covered by a bikini.  Approximately 2/3 of the abdominal wall can still be tightened ( plicated ).

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Post Op

Mad Hatter at the Curb Cup

There will be no monthly special as our esthetician is leaving the practice.  We are currently interviewing and hope to have a replacement shortly.

Youth Rocks Out at Curb Cub

Willamette Valley

Every specialty has features which make it unique versus the others.  For Plastic Surgery, it’s not the anatomic area; we go everywhere.  It’s not necessarily the procedures; other specialties like to adopt both cosmetic and reconstructive surgeries originally pioneered by Plastic Surgeons.  These observations have lead some to conjecture that Plastic Surgery is a doomed specialty.  I hope not, because what really distinguishes Plastic Surgery is its thought process. I sometimes explain it to patients with an an analogy (no, it’s not cupcakes and frosting):  procedures are like golf clubs in your bag that you can use to solve whatever problem the course (or body) presents.  There are a lot of ways to get the ball into the hole.

Much of medicine is figuring out the diagnosis (which can be very difficult).  Treatment is then often directed by an algorithmic decision tree.  So,  there are lots of diagnoses, but relatively fewer treatments for each one.  In Plastic Surgery, the diagnosis is often times as clear as the nose on your face (maybe it has a hump that you don’t like).  Then, there can be ten different ways to treat the same problem.  Some may be better approaches than others, but there often is not one “right” way.  As I’ve said, if you ask 10 different Plastic Surgeons a question, you’ll get 11 different answers.  While it may be nice not to have to remember over one hundred algorithms like I did for my General Surgery Board Exams, there is something comforting about knowing that most of the time, there is a consensus right answer out there.  Taking the more obvious diagnosis and arriving at the optimal solution as an individual surgeon is the thought process that I believe distinguishes Plastic Surgery as a specialty.  I feel fortunate to occupy this unique corner of medicine and hope it will live on in an uncertain future.

The patient is a young woman who had breast cancer on the left requiring mastectomy, but not radiation therapy.  Expander and implant reconstruction only would have left her with superior fullness on the left and significantly asymmetric versus the right.  The addition of an implant on the right for a superiorly round shape would have made the right too large for the left’s maximum potential volume.  The solution was to add a latissimus flap on the left.  This would allow enough expanded tissue to accommodate a larger implant to match the appropriately sized implant used the right.  The trade off for optimal shape and size in a unilateral mastectomy defect in this case was undergoing a latissimus flap.  The patient tolerated the process well.  Studies show at one year that patients usually have minimal residual pain and have near baseline function secondary to recruitment of synergistic muscles.

Pre Op

Post Op

Symmetry

Back to School Special : Microdermabrasion and Peel Combo $100