There has been a lot of news recently about PIP implants   and concerns that not only do they rupture at a rate higher than other implants but the silicone inside may not be medical quality.  Fortunately these implants  were never sold in the United States.  PIP did sell prefilled saline implants in the United States for a while (apparently about 35,000 were sold). However when  the FDA asked the three implant companies ( Inamed -now Allergan, Mentor , and PIP) in 2000 to submit a formal application (known as pre-market approval) only two of the companies received approval.  The two companies that received approval -  Inamed (Allergan) and Mentor-  are still the only two companies selling silicone implants in the United States.  PIP has stopped selling its prefilled saline implants in the U.S.A.

There were several reports over the holidays about the numbers of cosmetic surgeries and even reconstructive surgeries going up.  Is this just a typical cycle or is this an indication that the economy is improving?   It is true that all hospital admissions went down during the past few years -  a direct result of the recession.    When you are worried about the stability of the job market you are unlikely to take time off from work for an elective procedure or want to dig deep to pay those deductibles.    There for it is a good sign that elective procedures were up in December.  There is also the timing factor though.  Although there is no “convenient’ time to schedule an elective procedure -  there are less inconvenient times.    Timing a surgical procedure around a holiday can allow you to “steal” some more time off work.  A lot of offices are closed between Christmas and New Years which can allow you to to recover without sick days.  There are other times during the year when you can “steal “  extra time off –  long weekends such as Memorial Day, Labor Day or even the 4th of July are examples.   Often people expect offices to be closed or  at least not fully staffed so your absence is not questioned.  Plan ahead though as lots of other patients might have the same idea!

I am excited to announce my participation in an IRB approved  study using Seriscaffold for breast reconstruction.  Seriscaffold is a FDA approved silk based product which is used to provide soft tissue support and repair during the reconstruction after a mastectomy.  For patients who are undergoing breast reconstruction with a tissue expander  Seriscaffold is used to support the lower pole of the breast and to help maintain the position of the pectoralis muscle.

I recently returned from a medical mission in Qoya Peru.    The organization sponsoring the mission was Women for World Health.  Qoya is in the Sacred Valley about 40 kms from Macchu Picchu.    We saw a mixture of patients with clefts lips to burn scars.    It was exciting to have my sister-in-law Ginger along on the mission .  Ginger is a fantastic recovery room nurse who has always wanted to go on missions but was busy raising their four sons.  At last she had a chance to go on a mission and hopefully we will be able to go on another one soon together.    As always we came home with a renewed sense of how lucky we are and how many opportunities we have .  It truly is a privilege to be able to give something back I always get back so much more than I give on a mission.

The American Society of Plastic Surgeons released their statistics for 2010 yesterday.  The overall number of cosmetic procedures increased 5 % in 2010.  This may represent some pent-up demand as patients return who had put off cosmetic work when the economy was so unstable.  Reconstructive procedures also increased 2% in 2010 with breast reconstruction up 8% !  This puts breast reconstruction into the top five reconstructive procedures for the first time .  The other top reconstructive procedures were (1) tumor removal (2)laceration repair (3)scar revision and (4) hand surgery.  Good news !  Hopefully this means that our work to get the word out to patients  undergoing mastectomies about their reconstructive options is working!

A new national registry has been established by the American Society of Plastic Surgeons and the FDA to document reported cases of a rare condition  , Anaplastic Large Cell Lyphoma (ALCL) which is possibly associated with breast implants.  Thirty four cases of ALCL  in patients with breast implants have been reported in the world and that is in the 5-10 million women who have implants world wide.  Most of the patients presented with late onset seromas ( swelling) around their breast implants .  The condition appears to arise in the capsule surrounding the implants and is not breast cancer.  Currently the recommendation for women who are found to have this condition is to remove the capsule ( scar tissue) which surrounds the implant as well as the implant.  Safety is always of first concern and I  concur with the the American Society of Plastic Surgeons , the Aesthetic Society as well as both implant companies (Mentor and Allergan) in supporting efforts to research this rare condition .

Dr Jorge Palacios just gave me the most wonderful Christmas present.  I was with Dr Palacios in Ecuador on a visiting educator trip where we were training young surgeons to do cleft lip and palate surgery.  One of the patients was a 45 year old woman with an unrepaired cleft lip.  Dr Palacios assigned her care to me.  in 45 minutes I was able to repair her lip-  a 45 minute operation for which she had waited 45 years !!  I am so grateful that I was able to do this for her.   She will be able to smile at her children and her husband for the first time .  To be given a chance to help another person like this is priceless.

I just got back from spending ten days in Ecuador.  I was a visiting Educator with Resurge( formerly known as Interplast).   This was my fifth trip to Ecuador and my third as a visiting educator.  Most medical missions that I have been on   we are just trying to get as much surgery done as well and safely as we can in our limited time. A visiting educator trip is different -  on these trips we are trying to teach local doctors to improve their techniques and help improve through our training the outcomes of many surgeries after we leave.  It is exactly like the old adage -  give a man a fish and your feed him for a day,   teach a man to fish and you feed him for a lifetime!    I always get so much more out of these trips than I give -  we are so lucky in this country with all that we have .   I am very gratefull that I have the opportunity to give back in even a small way.

A very interesting study was presented recently at Plastic Surgery 2010 : Joint Annual Scientific Meeting of the  American Society of Plastic Surgery (ASPS)  and the Canadian Society of Aesthetic Plastic Surgery (CSAPS)meeting in Toronto Canada.  The  study looked at cases of breast cancer between 1998 and 2003 and analyzed  data in the US National Cancer Institute  Surveillance, Epidemiology, and End Results (SEER) registry database.  The SEER analysis looked at more than 46,000 women who had undergone mastectomy alone and 8500 who had undergone a first stage of reconstruction at the time of their mastectomy. The analysis showed an amazing result that immediate breast reconstruction was associated with a 26% reduction in breast-cancer- specific mortality!  No one thinks that breast reconstruction is saving lives but the hypothesis is that patients who undergo immediate breast reconstruction  are usually in higher income brackets and are better educated.  This has been widely supported in the literature.  In addition patients with better access to good cancer centers are more likely to be referred to a reconstructive plastic surgeon by their breast surgeons than patients being treated outside a cancer center and they might be getting better overall care. This study certainly is interesting and more research needs to be done to sort out the reasons behind this increased survivial .  It certainly is interesting though!