Holiday Party Fun - yes, the woman pointing her tongue is Mrs. Wigod
I continue to answer Plastic Surgery questions every Tuesday morning on KTVB. I have tried to shape each segment into a mini consultation to educate viewers about deceptively complex cosmetic and reconstructive issues. The station has allowed the videos to be placed on my web site under the new page “Video and Media.” Unless there is something particularly timely and important, I will use the Web Log to summarize the segments presented in the previous month.
The first topic was Breast Reduction, one of Plastic Surgery’s highest patient satisfaction operations.
The second topic was Doctor Consultation Questionnaire. There are some important questions to ask before, during, and after your plastic surgery consultation.
The third topic was Fat Grafting, its applications, and how it is different from stem cell grafting.
The fourth topic was an approach to Early Facial Aging and how surgery may be a better option than fillers, Botox, and lasers in certain patients less than 50.
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.
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
KTVB - 7 has begun a “HealthSmart” segment weekday mornings on their Channel 28 - 24/7 local news. Each day, a local doctor representing a particular area of interest (such as women’s health, men’s health, etc.) will address viewer directed questions. I will be appearing every Tuesday morning between 7:30 to 7:45 to answer Plastic Surgery questions for three to five minutes. Tune in to watch - or cringe - as the case may be.
I have been asked to serve a two year term on the local Komen Boise affiliate Board of Directors. I recently went to my first meeting and was amazed at what happens to all of those race donations and the sophistication of the organization. Komen is very efficient; 75% of the money collected stays local and goes to missions such as breast cancer education and screening in under served areas of our state. Did you know that despite all the dedicated effort, Idaho ranks very last in the nation for the percentage of women getting mammograms? Remember that October is Breast Cancer Awareness Month and encourage the women you know over 40 to get their screening mammogram.
In September, I traveled to Denver to attend the American Society of Plastic Surgeons annual meeting. Fat grafting for the face and breast was a very popular topic. There are some really interesting techniques which are not quite mainstream yet, but look promising. I was taught that you never want to be the first or the last to do a procedure so that you protect your patients while still offering up to date care. With that in mind, we get a number of calls about Plastic Surgery… um… down there, so I will be offering Labioplasty. Women seek surgery to address enlargement and asymmetry problems. The procedure has been performed by gynecologists for years, but more and more plastic surgeons are applying our techniques to the area with nice results.
Below is a portion of a letter sent to members of the Aesthetic Society of Plastic Surgeons to provide an update on the FDA’s silicone gel breast implant hearings. This shift in surveillance advisory should be a welcome change for women considering silicone gel implant use. We, the plastic surgery community in the United States, still await approval for use in this country of more very useful silicone gel implants that have been on the market internationally for up to a decade.
The Food and Drug Administration’s (FDA) General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee conducted a panel hearing on silicone gel-filled breast implants last week. The purpose of the hearing was to evaluate the progress of long-term post-approval market studies mandated when silicone gel-filled breast implants were approved by the Agency to return to market in 2006. A key focus of the hearings, which included testimony from breast implant manufacturers, plastic surgeons and the public, was discussing innovative approaches to gathering data for future post-approval studies.
After two days of discussion and testimony about how to improve silicone breast implant study compliance, agency officials said silicone breast implants were safe and the studies would continue. “Women should feel assured that the F.D.A. continues to believe that currently marketed silicone breast implants are safe,” said William Maisel, MD, MPH, chief scientist in the FDA’s Center for Devices and Radiological Health, in remarks after the meeting. “The current post-approval studies will continue. The FDA is committed to seeing them completed and making sure the follow-up rates improve.”
Many experts at the hearings sighted the current labeling for MRI screening as unrealistic for healthy, asymptomatic patients. The panel agreed that patients should no longer be told that they should get an MRI three years after getting implants and every two years following. “F.D.A. continues to believe, as does the panel, that M.R.I. is the gold standard for evaluating breast implants for silent rupture,” Dr. Maisel said. “But there was consensus among the panel that the requirements for ongoing M.R.I.’s should be removed.”
Towards the end of the final day of the hearings, the FDA panel commented that they were impressed by the organization of the two plastic surgery societies, our message and our efforts to generate data and address important issues such as international registries, labeling compliance, patient confidentiality, and informed consent.
Mark D. Wigod, MD, FACS
Plastic Surgery for Boise, Meridian, and the greater Southeastern Idaho Region
After graduating medical school, Dr. Wigod completed eight years of formal General Surgery Residency and Plastic Surgery Fellowship training. His 16 years of higher education allows him to perform both Cosmetic and Reconstructive Plastic Surgery and to treat the whole patient without being limited to one body part or technique. Broad surgical training, large volume practice experience, and continuing education assist Dr. Wigod in his efforts to provide optimal care for his patients. Dr. Wigod has experience in all aspects of Plastic Surgery, but now specializes in Cosmetic Surgery of the Breast, Body and Face, as well as Breast Cancer Reconstruction.
After graduating medical school, Dr. Wigod completed eight years of formal General Surgery Residency and Plastic Surgery Fellowship training. His 16 years of higher education allows him to perform both Cosmetic and Reconstructive Plastic Surgery and to treat the whole patient without being limited to one body part or technique. Broad surgical training, large volume practice experience, and continuing education assist Dr. Wigod in his efforts to provide optimal care for his patients. Dr. Wigod has experience in all aspects of Plastic Surgery, but now specializes in Cosmetic Surgery of the Breast, Body and Face, as well as Breast Cancer Reconstruction.
