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(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

Denver Convention Center

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.