Breast Cancer Awareness month!

October is Breast Cancer Awareness Month, and that means lots of events benefiting breast cancer patients.  We do a lot of breast reconstruction at Plastic Surgery Institute of Washington, so these events are really special to us.  Often, our survivors come out to celebrate life and being cancer-free!

Last night, our entire office and some of our breast reconstruction patients came out for the grand reopening of Red Door Spa in Washington, DC.  The redesigned, modernized space was celebrated with a cocktail party and spa samplings.  Guests experienced mini-manis, eyebrow contouring, massages, and hair treatments, all while exploring the new digs.  Best of all, proceeds went to the Breast Cancer Patient Navigation Program at Suburban Hospital.

Check out all our photos from Red Door Spa Event here!

Some of our fabulous staff at Plastic Surgery Institute of Washington!
Gilit, me, Jenny, Crystal, Marcia
 

Breast cancer survivors!

Breast Cancer team @ Suburban Hospital!

 

 

New York Magazine explores Ethnic Plastic Surgery

Image Courtesy of Witthaya Phonsawat/ FreeDigitalPhotos.net 

In the latest issue of New York Magazine, Maureen O'Connor explores ethnic plastic surgery in an article titled "Is Race Plastic? My Trip Into the Ethnic Plastic Surgery Minefield."  She starts out in the office of a New York plastic surgeon who specializes in Asian eyelid surgery, and weaves us through a series of clinics promoting different ethnic plastic surgery procedures from Asian facial reshaping to African-American rhinoplasty.  All through the article, she debates whether ethnic plastic surgery is designed to specifically "deracinate" or whether universal beauty ideals have simply been influenced by Caucasian features.

From a plastic surgeon's perspective, I think the modern trend is to embrace ethnically and culturally diverse features.  Minority patients who come to me for plastic surgery nearly universally express a desire to maintain their ethnic appearance.  They usually want to refine a particular feature, but almost always insist that they don't want to lose their racial identity.  I think this is the result of a changing media landscape that now routinely includes mixed-race and ethnically diverse role models.  When I was growing up, there were no Indian-Americans in mainstream media.  Now, I can name a handful off the top of my head (Mindy Kaling of The Mindy Project, Kal Penn from the White Castle movies, Padma Lakshmi of Top Chef, Sanjay Gupta on CNN, and M. Night Shyamalan from The Sixth Sense).  It's not a large group, but it is a vast improvement from a television landscape that used to be completely whitewashed.  Given the weighty influence of media on cultural standards of beauty, it stands to reason that people are more interested in embracing their uniquely ethnic features.

What do you think?  Has racial diversity in the media widened our definition of beauty? Tweet me @anitakulkarnimd.

How Men and Women See Beauty Differently

Here’s an interesting take on perceptions of beauty: Business Insider reports on a survey done by Escentual.com about the perfect female face as defined by men and women. 

Credit: escentual.com

The article shows two composite faces created from ideal features selected by men and women. The amalgam chosen by men has sharper features, more defined bone structure, and blonde hair.  The womens' choice has softer features, wider eyes, and dark hair.

To me, the mens' woman (we’ll call her “M”) looks like a video game vixen, while the womans' woman (“W”) looks like someone I might actually know.  They are both striking, but W looks approachable and alive, while M looks to me like a caricature of beauty.  Of course, my perception is biased by the fact that I’m a woman, so perhaps my reaction to the faces just proves the survey’s point: that men and women see beauty differently.

Interestingly, the way that men and women see beauty affects what women ask for in the plastic surgeon’s office.  For example, when a woman comes in for a breast augmentation consultation alone, she almost always chooses smaller implants than when she comes in with a male companion.  The size difference is usually subtle, 25 or 50 cc’s, but men always seem to lean towards the slightly larger size.  Ultimately, most women are ultimately very happy with the size they choose, but it is interesting that having a man present in the room changes what she thinks she wants.

What do you think?  Do men and women really see beauty differently?  Is it a sampling error or is my perception really biased by the fact that I’m a woman?  In the article above, do men really find M more attractive on first glance?  I’d love to hear your thoughts- men and women- tweet me @anitakulkarnimd.

Racing for Impact at 2014 Susan G. Komen Global Race for the Cure

This past weekend, my partner Dr. Kathy Huang and I walked in the Susan G. Komen Global Race for the Cure in Washington DC.  This was my first Komen race, and I was absolutely blown away by the scale of the event and the enthusiasm of the thousands of participants, not to mention the sea of pink!  There was such a wonderful sense of unity around a cause- everybody there shared a passion for ending breast cancer.

I have known about the Komen foundation and their mission for years, but I never knew the magnitude of their contribution to our local area.  I learned that Susan G. Komen has given $23 million to research in the national capital region, and $35 million to local breast cancer programs in metro DC.  They are funding community outreach, research, and support of patients undergoing treatment.

I was particularly moved by the personal stories shared by survivors and supporters before the race.  We met Jackie O’Neil, an 82-year-old survivor running her 25^th consecutive Komen Global Race.  If only we could all be running races in our eighties!  The host of the event dedicated her race to her mother, another survivor.  We heard from a young mom who fought breast cancer while she was pregnant. Each story was different, but they were all woven together by the theme of lives forever changed by breast cancer.

As surgeons who specialize in breast reconstruction, Dr. Huang and I were especially proud to race alongside our patients and our colleagues from the breast center at Suburban Hospital.

Team Suburban Hospital!

Dr. Huang & me posing with Team Suburban

Survivors!

To learn more about the important work being done by the Susan G. Komen foundation, click here. 

Did any of you participate in the race last weekend?  I’d love to hear your thoughts and stories!  Tweet me @anitakulkarnimd.

21 is the new 40: Men in the tech industry benefit from looking like teenagers

Here’s an interesting regional trend in plastic surgery from an article in New Republic: men in their 30s in Silicon Valley are getting plastic surgery and non-surgical treatments to look like they are in their early 20s.  The goal is to combat the reverse-ageism in the tech industry that equates youth with intelligence and entrepreneurism. 

Here in Washington DC, we see more traditional plastic surgery goals- a desire to look refreshed, not necessarily young.  In this town, where age often correlates with experience, there is no advantage to looking very young. 

I’ve written about cultural standards of beauty and the varied aesthetic demands they create, but most of those differences are international.  This Silicon Valley trend is particularly interesting because it’s a micro-trend, a hyper-regional phenomenon that wouldn’t translate anywhere else in the country.  Here are a few other plastic surgery micro-trends that I’ve seen:

-“New York nose” circa 1980:  There was a time when every rhinoplasty in New York City looked exactly the same- a tiny, pinched ski-slope.

-“L.A. trout pout”: The Real Housewives made this one famous in the mid-2000s- For a while it seemed like every woman in L.A. was over-injected in the lips with collagen or other fillers. 

-“Texas tatas”: Everything really is bigger in Texas! 

What do you see?  Any local standards of beauty that wouldn't make sense anywhere else?

Surgical tourism strikes again... another death from cheap plastic surgery abroad

Every few months, a news report surfaces about someone who dies after traveling to another country for cheap plastic surgery.  Most recently, this Bronx woman died from a suspected pulmonary embolus after abdominoplasty in the Dominican Republic.  Proponents of travel-based medicine insist that many physicians abroad are qualified and well-trained, and can offer the same services for a fraction of the cost due to low overhead.  Patients are lured by aggressive advertising, low price tags, and picturesque locales. 

The problem with surgical tourism, as I see it, is not the lack of qualified practitioners.  It’s the lack of follow-up.  The truth is, every surgeon in the world has complications.  Any surgeon who claims to have no complications is lying.  But when a patient of mine has a complication, the patient calls ME.  I see them in my office and we make a treatment plan together to address the complication.  If there’s an infection, I start them on oral antibiotics or admit them to the hospital for intravenous antibiotics.  If there is a bleed, I take them back to the operating room emergently to stop the bleeding.  If a patient is short of breath after surgery, they go straight to the emergency room for evaluation and treatment.  I call the ER physician myself to give them the backstory on my patient before the patient even arrives.  The care of a surgical patient doesn’t end when the last stitch goes in. 

When patients travel to other countries for surgery, they don’t have access to their surgeon after they come home.  A localized infection that should be treated immediately with oral antibiotics may go untreated because the patient doesn’t know where to seek care.  Sometimes patients are embarrassed to see another surgeon after they have traveled abroad for their surgery.  Sometimes surgeons are reluctant to treat patients that do not “belong” to them.  The combined effect is usually a delay in treatment that can lead to a much bigger problem.

I believe that there are qualified practitioners all over the world who practice safe, ethical, state-of-the-art medicine and surgery.  But no amount of talent or skill can eliminate the risk of complications.  Nobody can guarantee you that you wont have a complication after surgery. What I can guarantee is that if you’re my patient, I will be the one to care for you until you’re completely healed.  Any conscientious surgeon would do the same.

The cost savings of traveling to a foreign country for surgery pale in comparison to the costs incurred by late presentation of a complication.  Unfortunately, as in the case highlighted above, some patients end up losing much more than just money.

What's Hot in Cosmetic Surgery: New Stats for 2013

Credit: American Society of Plastic Surgeons

Ever wonder which cosmetic surgery procedures are gaining in popularity and which ones are falling by the wayside? Every year the American Society of Plastic Surgeons puts out detailed statistics about all the surgical and non-surgical procedures that were done in the previous year. The new 2013 stats just came out. 

Some of the results are expected: non-invasive treatments like Botox and fillers continue to gain popularity. Some of the results are surprising: rhinoplasties (nose jobs) are down 9% from 2012. This trend has been going on for several years. Since the year 2000, rhinoplasties are down 43%. Breast augmentation, on the other hand, has been steadily rising. Primary breast augmentation is up 1% from last year, and up 37% since the year 2000. 

Other interesting tidbits from the report:

-The top 5 cosmetic surgical procedures in 2013 were breast augmentation, rhinoplasty, blepharoplasty, liposuction, and facelift.

-Lower body lift, most often performed after massive weight loss, is up 3,417% since the year 2000. (That’s not a typo- the number is three thousand four hundred and seventeen percent.) This probably reflects an increase in the number of weight-loss surgeries performed over the same time span.

-Facelifts are up 6% from last year, but show no change from 2000. I wonder if this reflects the changing economic climate. Patients often delay costly elective procedures when times are tough, so perhaps facelifts are a marker of the improving national economy.

The full report is available here. What do you think?  Why are some procedures up and others down? 

From one mom to another: All about the "Mommy Makeover"

Being a mommy :)

Today on the blog, a little education about a topic near and dear to my heart: the “mommy makeover.” As a plastic surgeon, I try not to show favoritism to any one operation, but I have to admit that I’m a bit partial to this one. “Mommy makeover” is a generic term used to describe surgery on the breasts and belly to address the changes of pregnancy. These are changes that exercise and diet alone can’t fix, because they are usually due, at least in part, to excess skin.

So, let’s spend a few minutes talking about what happens in a mommy makeover…

1. You actually make it to the office for a consultation! Most of you moms spend all your time focused on the family, the kids, the job, and everything else except yourself. You never get to think about your own needs, your body, and what might make you feel good about yourself again.
2. We figure out exactly what pregnancy did to YOUR body starting from the top down.
   1. BREASTS
      1. Almost everyone, whether you breastfed or not, has droopy, saggy breasts after having a baby. You have lots of extra skin and your nipples might point down instead of out. If this is you, then you might need a MASTOPEXY or breast lift.
      2. If you breastfed, you probably lost a lot of breast volume in addition to the stretching of your skin. So, the full breasts you had while you were nursing went away and somehow took your old breasts with them. What you’re left with is flat on top and loose on the bottom. When you bend over in front of the mirror, your breasts look like socks filled with sand. If you have no idea what I’m talking about, lucky you! If this sounds familiar, you might need a BREAST AUGMENTATION with or without a MASTOPEXY.
      3. Every so often, a woman’s breasts get huge during pregnancy and never really go back. This might sound like a good thing to those of you in category 1 or 2, but extremely large breasts are just as big a nuisance as small, droopy breasts. If this is you, then a BREAST REDUCTION might be in order.
   2. BELLY
      1. Your belly stretched like crazy to accommodate your baby, and after the baby got out, it didn’t quite go back to normal. For most women, the extra skin shrinks back down some of the way, but not all the way. There’s a little pooch of skin and fat below your belly button that never seems to go away. An ABDOMINOPLASTY or tummy tuck takes away all that extra skin and fat and replaces it with a scar. The scar is long and low from hip to hip. It’s a tradeoff that most mommies are willing to make.
      2. Your six-pack (rectus) muscles stretched out and split apart in the midline as the baby grew. For some women, the muscles never go back together completely, and instead stay a little split apart. This is called rectus diastasis, and it makes the upper abdomen stick out. In extreme cases, you still look a little pregnant even after your baby’s not a baby anymore. When you make the rectus muscle tight like you’re doing a sit-up, you can feel a gap between the muscles in the midline. That split can be fixed during a tummy tuck with a RECTUS PLICATION, or suturing together of the muscles in the midline. The added benefit of this part of the operation is that it nips in your waist and brings a little shape back to your midsection.
      3. You can’t blame this one entirely on the baby, but some women have stubborn pockets of fat in the flanks (muffin-top) that don’t respond easily to diet and exercise. LIPOSUCTION can address these pockets.
   3. MISCELLANEOUS
      1. Every woman’s body responds to pregnancy in a different way. Some women want to address other parts of their body, like the butt or thighs, at the same time. These decisions are made on a case-by-case basis.

Bottom line? The operations are different, but the goal is always the same: to restore your body so you can feel good about yourself again. It can be very hard to take a step back from everyone else’s needs and focus on your own. But let’s be honest, nobody deserves to do that more than hardworking moms!

"I'm a DC Lady and a Plastic Surgeon": Guest Post on The DC Ladies

I had the opportunity to write a guest post on The DC Ladies about being a DC lady and a plastic surgeon. You can see the full post here. Thanks, @thedcladies, for the opportunity to share my story!

2-for-1 Plastic Surgery...

The UK Mirror is reporting on a new push to regulate the cosmetic surgery industry in Britain.  The article cites widespread unethical use of cosmetic surgery including “cut-price deals that don’t allow patients to be refunded if they change their mind, and mother-and-daughter offers – two operations for the price of one.”

It may sound absurd that anyone would sign up for a 2-for-1 deal for something as serious as surgery, but I have actually seen this exact deal in the US.  When I was a resident at theUniversity of Michigan, we took care of a patient who fell victim to one of these “mother/daughter” scams.  She and her daughter had matching tummy tucks by a surgeon who offered them a 2-for-1 deal.  He aggressively liposuctioned her abdominal wall before doing her tummy tuck, which effectively cut off the blood supply to the skin on her belly.  She showed up in our emergency room with a dead abdominal wall that had to be completely removed.  This left her with a foot-long, gaping wound that required two months of dressing changes and an eventual skin graft to heal. Needless to say, her body is permanently disfigured from her botched operation.

I can tell you with certainty that no ethical, conscientious surgeon would ever offer this kind of gimmick.  The same can be said of cosmetic surgery as a raffle prize.  In fact, the American Society of Plastic Surgeons expressly forbids offering any surgical procedure as a prize. A surgeon who does this risks losing board certification (if they had it in the first place).

The UK National Health Service report brought to light a number of other issues about the lack of regulation in the cosmetic surgery industry.  You can read more about their findings here. If you read the report, you might be surprised to find out that the U.S. is not much better when it comes to regulation of cosmetic procedures.  If you ask me, we need to do better. Perhaps we should follow their lead and take a stand in protecting our patients.

Extreme Facial Reshaping- cultural trend or freaky sideshow act?

Plastic surgery trends are strongly influenced by cultural standards of beauty. Nowhere is this more apparent right now than in East Asia, where extreme facial sculpting is gaining popularity.

Women are lining up at plastic surgeons’ offices to have “V-Line” surgery in an effort to create a triangular doll-like face. While this kind of facial reshaping is rare in the rest of the world, it is commonplace in Asia. To be fair, some of the women start with fairly masculine jaws that actually benefit from a feminizing reduction. But, in my opinion, many of them are taking a natural variation in facial shape and turning it into something distinctly un-natural.

Take this South Korean reporter (click here for more images).

Before surgery, she had a full, heart-shaped face with lovely proportions. I think most people would agree that she was beautiful. After her extreme mandibular shave, her absurdly sharp chin unambiguously gives away its surgical origins. She looks cartoonish and a little freaky, especially in the photo where she doesn’t have full hair & makeup.

Obviously my opinion of this trend is shaped by own cultural bias, which favors Western beauty ideals. I’m sure that some of our routine procedures wouldn’t gain traction in other parts of the world. For example, the breast augmentation patient I saw yesterday might not notice her small breasts if she lived in Korea or Japan. Then again, she might come in demanding to have her face turned into an octagon. Maybe her jaw would end up in this crazy clinic’s thousand bone tower displayed for all the world to see. What do you think? Is facial sculpting just a different cultural choice or does it take plastic surgery too far?

Michelle Obama Not Ruling Out Plastic Surgery, Botox

Several headlines from major news outlets including ABC and CBS proclaimed “Michelle Obama Not Ruling Out Plastic Surgery, Botox.” The headline was pulled from an interview Mrs. Obama gave to People magazine regarding her 50^th birthday in which she said “never say never” when asked about plastic surgery and Botox. She shared a number of other thoughts about turning fifty, but this particular sound byte proved most interesting to the mainstream media.
I wondered why, of all the things she said, an offhand comment about not ruling out plastic surgery got so much traction. Cosmetic surgery is far more prevalent and public now than it was even a decade ago. Public figures routinely discuss personal experiences with plastic surgery, yet Mrs. Obama’s admission of “not ruling out” aesthetic surgery was surprising enough to generate a news story.

I think the media’s reaction is a direct result of the way America sees Michelle Obama. Her mission as first lady is to eliminate childhood obesity in one generation. Her “Let’s Move” campaign focuses on lifestyle changes like improved nutrition and physical activity. Perhaps because of her stance on these issues, the public expects her to reject any treatment that might be seen as “unnatural.”

It’s no secret that we place a high value on beauty and youth, but the reaction to Mrs. Obama’s comment reveals that society is deeply ambivalent about discussing it openly. What do you think? Is Michelle Obama’s attitude about plastic surgery in line with her public image? 

What's New in Breast Reconstruction?

View from my balcony in Kauai

I recently attended a conference in Hawaii (yes, I actually attended the conference!) for the American Society of Reconstructive Microsurgeons.  I was there presenting a technical paper on breast reconstruction, but more importantly, I had the chance to hear about what’s new in the field.  It was exciting to see what other surgeons are doing around the country and around the world.

I attended a fascinating lecture by Bob Allen, who is widely regarded as one of the pioneers of advanced breast reconstruction.  His talk was entitled “25 Options for Breast Reconstruction when the Abdomen is not enough.”  With a procedure like breast reconstruction, it’s important that patients know about all the possibilities before they make a decision.  Believe it or not, there are dozens of ways to re-build a breast after mastectomy.  Here is just a sampling of the list compiled by Dr. Allen for his talk.

Using your belly:

1. SIEA: Superficial Inferior Epigastric Artery flap
2. DIEP: Deep Inferior Epigastric Artery Perforator flap
3. MS-TRAM: Muscle-sparing Transverse Rectus Abdominis Myocutaneous flap
4. TRAM: Transverse Rectus Myocutaneous flap

Using your butt:

1. SGAP: Superior Gluteal Artery Perforator flap
2. IGAP: Inferior Gluteal Artery Perforator flap

Using your thigh:

1. TUG: Transverse Upper Gracilis flap
2. ALT: Anterolateral Thigh flap
3. PAP: Profunda Artery Perforator flap
4. scTFL: Tensor Facia Lata (septocutaneous) flap

Using your thorax:

1. TDAP: Thoracodorsal Artery Perforator flap
2. ICAP: Intercostal Artery Perforator flap
3. LAP: Lumbar Artery Perforator flap

These are called “flaps,” because we take a flap of tissue attached to its blood vessel and disconnect it from the body.  We then move the flap up to the chest wall to make a new breast, and reconnect the blood vessels to the vessels in the chest or armpit.  The reconnection is done under a microscope because the vessels are tiny, usually only a couple of millimeters in diameter.

Most women are good candidates to use the belly, because most women have a little extra fat in the belly area.  That fat is nice and soft, mimicking a breast beautifully when it’s moved up to the chest.  However, some women are pear-shaped, or have large abdominal scars that prevent us from using the belly.  For those patients, it’s good to have all these options to choose from based on a woman’s body habitus and breast size.

All in all, a great meeting, and a great review of all the options available to our patients!

"Beauty Recovery Room": A Series of Photos by Ji Yeo

A few months ago, I came across this series of photographs taken by Korean photographer Ji Yeo.  She depicts images of women taken immediately after cosmetic surgery.  (WARNING: The images are graphic and contain nudity).  The series makes public what is usually a very private period in a patient’s plastic surgery journey.  Ji Yeo’s purpose was to make a statement about what she believes is South Korea’s unhealthy obsession with cosmetic surgery.  The photos generated some media buzz, including an interesting discussion by David Rosenberg from Slate.

I hesitated to write about this on the blog, because it highlights a part of what we do that can be scary for patients to see.  Ultimately, I decided that the photos show a very real part of surgery, and shouldn’t be discounted just because they are unpleasant.  There is a recovery period after any surgery that is uncomfortable and unattractive.  Glossing over that fact doesn’t make it untrue.  I think that American media has gone too far in trivializing plastic surgery.  Shows like the now-defunct “Swan” and “Dr. 90210” make plastic surgery seem like just another beauty treatment.  Patients watch these quick and easy TV transformations and sometimes develop unrealistic expectations about recovery and results.  “Beauty Recovery Room” does the opposite by broadcasting some of the least glamorous moments of plastic surgery.

That said, I think the photographer took dramatic license in showing all the women looking sullen, eyes downcast, appearing melancholy or even regretful.  This is particularly interesting given Ji’s comment in David Rosenberg’s Slate article:

 Although she was surprised how devoid of fear many of the women were about going under the knife, she was equally shocked to see how pleased they were immediately after the surgeries. “During the photo shoots, even though they were in extreme pain, I could feel their excitement, the excitement of hopes realized,” she said. ‘They seemed not to have the fears that I had; in fact, most of them were planning other surgeries in the near future.’’

This sentiment doesn’t come across in the photos, which tilt towards the somber.  Of course, art is not journalism- it wasn’t her purpose to give a balanced perspective of an issue.  Her purpose was to make a social commentary in a visually interesting way.  In that, she succeeded.  However, I think her quote from the article gives a more complete description of the reality of cosmetic surgery.  There are moments in a patient’s recovery that feel the way these photos look.  But recovery is temporary.  The moments get further apart, the pain fades away, and patients’ lives return to normal, hopefully a little better than when they started the journey.

I enjoyed this series for its unusual subject matter.  The discussion of society’s obsession with beauty and the resultant billion dollar industry is another topic for another day.  Until then, I hope you find the photos as thought-provoking as I did.