WHAT'S NEW

Teton Sheep

Our office has accepted the challenge to raise funds to support Susan G. Komen for the Cure in its efforts to end breast cancer forever.  This year, the local Race for the Cure will take place on May 8th in Boise.

Please help support this important project by becoming a member of our fund raising team or by pledging a donation to the cause.  We are looking for patients, friends, and family to join us in supporting this very worthwhile effort.  Becoming a team member or making a donation is easy.  All you need to do is go to the link below to get started.

http://race.komenboise.org/goto/wigodplasticsurgery

From the web page, you may join the team and then sign up to walk or run in the race (there is even a “sleep in option).  From there, Komen makes it easy for you to collect pledges.  If you would prefer to not join, but would like to make a pledge by credit card, hit the “Make a gift!” button on our team page.

Remember, one person can make a difference in the fight against breast cancer.  We look forward to seeing you on race day!

Fog in the Valley at Bogus Basin

We in the Boise Plastic Surgery community are very fortunate to have St. Lukes as a partner.  They are the only hospital which has offered reasonable prices for both inpatient and outpatient cosmetic surgery.  The have not had a price raise in 5 years.  Cosmetic plastic surgery cases are not a money maker for an OR, compared to orthopedics or other specialties.  Accordingly, St. Lukes has found it necessary to raise their prices as well as change the pricing structure.

Previously, each case had its own global price and the charge was the same whether the case took 2 hours or 3 hours, for example.  Now, there will be an up front charge for materials, which is new.  The case will then be charged by the half hour, depending on the surgeon’s time estimate.  Surgeons must be accurate, or they will not be allowed to take part in the program.  The new system takes effect today, February 1.  Patients previously on the schedule will use the old system. 

No one likes a price raise, but I think that this is reasonable.  We plastic surgeons have no bargaining power as there are no other inpatient options and St. Lukes has not abused their position.  I have the advantage of setting my own pricing for outpatient surgeries that I perform in my own facility, Meadow Lake Surgery Center.  While running my own facility is a tremendous amount of work, it is good to have some element of control over costs. 

The change may be a bit bumpy first, but my staff will work to make every step as smooth as possible.  Please call Kaye if you have questions.

Happy New Year from Dr. Wigod and Staff

Occasionally, there are true game changers in all fields.  In tissue expander breast reconstruction,  acellular dermis use has had a tremendous impact on how we approach the operation.

Acellular dermis ( ACD) is human cadaver dermis that has been washed of all cells such that is basically a dense sheet of collagen which is not rejected by the body.  This is a safe (although admittedly a bit gruesome) product;  to my knowledge, there has never been any disease transmission with its use.  Alloderm by Lifecell is the original product, but there are now many variations out there.  I used ACD in fellowship training 10 years ago for various reconstructive purposes.  A main indication was for abdominal hernia repairs where synthetic mesh was inappropriate.  In this setting, however, it was found that the product stretched and so is no longer used - other improved products have followed, however.

In my training 10 years ago, breast tissue expanders were covered by muscle both on their upper as well as lower halves.  This provided good protection, but poor expansion of the overlying skin on the lower half of the breast - right where it was needed.  When I got to Boise, my colleagues showed me great results in delayed reconstructions (performed months post mastectomy) where only the top half of the expander was covered with muscle.  But what about in immediate (at the time of mastectomy) reconstructions?  Someone smart (and then popularized by academic surgeons) thought to place a strip of ACD over the lower half of the expander instead of muscle.  In this setting, the ACD provided initial shaping, support, and protection while later stretching.  Thus, a property that was bad for hernia repair turned out to be perfect for breast reconstruction. 

This technique made immediate breast reconstruction results much more reliable, but certainly not problem free, as I have noted in previous blogs.  In controlled settings where residual disease and future radiation therapy are unlikely, such as mastectomy for pre cancerous lesions, very early breast cancer, or prophylaxis (high risk patients such as those with the BRCA genes), I am more enthusiastic about immediate reconstruction.  I also may use ACD when I am doing a bilateral reconstruction with a latissimus flap on only one side.  ACD also has applications for secondary reconstructive as well as cosmetic breast surgery.  There are various problems associated with ACD use, but are mainly related to the reconstructive operation itself.  A significant downside, however, is that the product is very expensive (approximately $3500 per piece for this purpose) and there are frequent problems with reimbursement.  This factor will become more important as health care reform evolves.

A good place to see the new movie Avatar

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

Luxury Facial, Luxury Micro, & Peel Pkg $ 200

Window Seat over Seattle