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After listening to news radio on the daily commute, the world can seem like a pretty depressing place.  I only have to think for a moment, however, to remember how much I have to be thankful for.  Below is my partial list. Many I know have had a tough year, but I hope all of you have something to be thankful for as well.

I am thankful for my wife who manages both home and office allows me to practice surgery without guilt.

I am thankful for children so that my errors may be their wisdom.

I am thankful for my parents who gave me every opportunity.

I am thankful for my patients who have given me their confidence and understanding.

I am thankful for my fellow Boise Plastic Surgeons who are collegial professionals.

I am thankful for my referring physicians who have trusted me to care for their patients.

I am thankful for the best office staff that I have ever had.

I am thankful for hospital administration and staff who have facilitated my practice.

I am thankful to practice in a field where patients actually want to go to the doctor.

I am thankful that I get to do arts and crafts everyday and call it work.

I am thankful for my patients’ reminder that we cannot take our health for granted and should appreciate every day.

Best wishes for a happy and healthy New Year.

The patient is a woman with a mastectomy on the left and ptotic (droopy) breast on the right who presents for a Trans Rectus Abdominus Muscle Flap and Mastopexy (breast lift).  The ultimate goal is symmetry in the setting of a native breast on one side and mastectomy flaps on the other.  The TRAM, while a large operation, supplies natural feeling fat from the abdomen to the breast location and gives a permanent result without the potential downsides of an implant.  Not all patients are candidates, nor do all want the additional risks associated with a TRAM.

(Office) Girls Gone Wild (at Halloween)

After I finish my pre operative consent discussion, the most common additional question I get is on return to activity and exercise.  As an accidental long distance runner myself,  I understand how addictive exercise can be.  It is very important to walk as frequently as possible after an operation to minimize chances of venous thromboembolism and pneumonia.  On the other hand, too much early post operative activity- work, exercise, or travel- may put you at higher risk for complications such as bleeding, wound breakdown, seroma, and infection.

Resuming full activities of daily living at 2 weeks, aerobic exercise at 4 weeks, and heavy lifting at 6 weeks is usually safe.  Patients with specific breast implant positioning issues or those with post operative healing problems may have further restrictions.

One advice conflict I see at times is post mastectomy exercise.  After a mastectomy with or without axillary dissection, it is good to start range of motion and strength exercises as soon a tolerable.  I recently got a call from the local coordinator for Livestrong exercise program to do a webinar for their therapists.  I was happy to hear that the organization offered programs through the YMCA for patient recovering from mastectomies.   Here is an example of what they advise.  http://www.livestrong.com/article/28314-post-mastectomy-exercises/ I would encourage you to investigate the local program if you have the need.

Early aggressive motion, however, can make fluid collections (seromas) for frequent.  Seromas, while usually benign, can be bothersome to the patient and require prolonged treatment with decreased activity.  I advise limiting therapy until after drains are removed and there is no evidence of seroma.  You have to go slow early to go fast later.  In fact, I have a patient who just ran in the New York Marathon after recovering from her mastectomy and expander placement and before her implant exchange and nipple reconstruction.  With the right combination of pacing and motivation, it is amazing what patients can do.

Plastic Surgery for Boise, Meridian, and the greater Southeastern Idaho Region

The patient had a large weight loss with extra skin at her abdomen, flanks, and back.  She had a previous full abdominoplasty by another surgeon, but was dissatisfied with fullness in her mons.  Her mons, lower abdomen, flanks, and back were improved with a body lift.  The standard circumferential incision is lower, near the buttocks.  In this patient’s case, the incision was raised to remove the maximal amount of tissue.

Anterior Pre op

Anterior Post op

Posterior Pre op

Posterior Post op