Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Lawn Mower Safety

July 18th, 2017 — 11:42am

Seattle Plastic Surgeon (and mother of three) Dr. Lisa Lynn Sowder nags her children and you about lawn mower safety.blog lawn mowing

It is such a wonderful thing to get some yard work out of my offspring now that they are old enough to mow, rake, sweep, weed, water, trim, edge, poop scoop, etc.  As much as I love the smell of newly mown grass and the thought of them working (instead of me), I worry.  I worry about the lawn mower thus the little nag session each and every time one of my boys has been nagged into mowing the lawn.

Here is my list of lawn mower safety tips.

        • Only children over 13 should mow a lawn.
        • One person only should be on the lawn being mowed.  That would be the person behind or on the mower.
        • NO PETS unless it’s a rabbit you really wish you had never adopted.
        • Always wear socks and heavy shoes and gloves.
        • Always wear eye protection.
        • Ear plugs okay but not no ipod listening.  They need to hear you yell, “Watch out for the dog!”
        • No mowing until the offspring has cooled down from his/her rage at having to actually perform agreed upon chores for agreed upon bennies.  Rage and lawn mowers should never coexist.
        • If the mower malfunctions, turn it off and don’t even think about flipping it over unless a knowledgeable and responsible adult is present.
        • Leave sharpening to the experts.  Oh, unless you work in a lawn mover sharpening shop, you are not an expert.
        • No using the lawn mover for anything other than mowing the lawn.  This calls for a cautionary (and I swear to God true) tale.  Two patients in the same day present with nearly identical lawn mower injuries sustained while attempting to trim a hedge with a lawn mower.  Patient #2  happen to see patient #1 (prior to his mishap) trimming his hedge with the lawn mower while Patient #2 was driving to get gas for his lawn mower and thought “Hey, what a great idea.” Not.

Stay tuned.  One of these blogs I will tell you about my dad’s snowblower injury.  His bloody glove is still nailed to the wall of his shop some 30 years later.

Thanks for reading.  Dr. Lisa Lynn Sowder

Gardening, General Health, Trauma

4th of July Buzzkill

July 1st, 2017 — 7:45am

Seattle Plastic Surgeon and mother of two young adult men is a total buzzkill on the 4th of July.

Shall we limit the fireworks to glow worms this year?

For most people, the 4th of July is a nice holiday filled with family, friends, good food and maybe some good fireworks.  But……..for the plastic surgeon on call for the emergency room, the 4th of July can be a very, very busy day which continues into a very, very busy night.

I’m not on call this 4th of July and I feel kinda sorry for the plastic surgeon who is.  I know he or she will be waiting for that call to come in and treat the kid with the facial burns or a 25 year old computer programmer with a blown off finger.  The plastic surgeon won’t even be able to enjoy a brewski with his hamburger and potato salad because more likely than not, he’ll be working.

I love fireworks when supervised by a responsible adult and when lit by individuals who wear eye protection, long sleeves and pants and gloves.  I hate fireworks when lit by teenage boys who are by definition immortal, at least in their minds.  And if the numbers are true, the danger doesn’t end when junior turns 20 or 30 or even 40.  The most injuries occur in men over 36!  Hummmm- something to do with a Y chromosome?

Most people read about these injuries in the newspaper or hear about them on the news but this plastic surgeon and mother sees these injuries and how one lousy M-80 can ruin your musical career if it blows up in your hand or worse if it blows up in your face.

Take a look at theses stats from the Washington State Patrol and keep your eye on those teenage boys of yours.  Oh, and keep an eye on those older dudes too.  I can assure you that the plastic surgeon on call would rather not be seeing them this 4th of July.

Thanks for reading and have a happy and safe 4th of July.  Dr. Lisa Lynn Sowder

Children, Emergency Room, Hand Surgery, Plastic Surgery, Trauma

I have oldish breast implants. Should I get an MRI?

June 29th, 2017 — 3:09pm

MRI is the best test for detecting implant rupture (other than surgery) with a very high accuracy rate, much higher and mammogram, ultra sound or physical exam.  I think it is prudent for patients with gel implants, say 10 years old or older to get an MRI to make sure there is not a silent rupture.  If a patient has saline implants, there is no possibility of a silent rupture so an MRI would be worthless unless there is another reason for MRI (cancer detection for example).  I often have patients who are coming in to have their old gel implants removed regardless if they are intact or ruptured and in those cases I don’t really think an MRI is absolutely necessary.  Yes, it is nice for the surgeon to know ahead of time if there is a rupture but honestly, I approach every implant removal as if the implant is ruptured.  I try to do an en block resection and have everything ready in the event the implant is ruptured and there is silicone spillage.  We have special suction set up for ruptured implants and also some old fashioned surgical lap pads ready for clean up.  And even with a rupture, it’s usually not as messy and one might think it would be.  Even the messiest cases almost always allow the surgeon to scoop out the gel and then get all of the capsule.

“Just relax. It doesn’t hurt one bit but it is a little noisy.”

In Seattle at Swedish Medical Center, as of 2017, an out-of-pocket MRI to rule out breast implant rupture is about $1300 – $2200.  If you pay up front, you get the lower price.  The actual procedure requires the patient to lie prone (on the stomach) with the breasts hanging though these little openings in the MRI bed.  It’s important to lie really, really still for a good image.  MRI does not involve any irradiation so don’t worry about that but it can be kinda noisy with pings and dings.  When I had my knee scanned, they gave me earplugs. And after an MRI, please make sure you get the radiologist report.  It is more useful than the actual MRI itself.  Plastic surgeons are not experts at reading MRI’s although we can usually see an obvious rupture. More subtle things may not be obvious to us.  

Thanks for reading and if you are concerned about your oldish gel implants and an MRI will either ease your mind or prod you into action, you should get one!  If are ready to bid goodbye to your oldish implants regardless of their status, come on in.  I’m here to help!

Thanks for reading!  Dr. Lisa Lynn Sowder.    Follow me on Instagram @sowdermd and @breastimplantsanity.

Breast Implant Removal, Breast Implants

Breast Feeding and Breast Implants

June 24th, 2017 — 8:56pm

In a perfect world, women would wait until they were done childbearing and breast feeding prior to having breast implants, mostly because pregnancy and breast feeding can really change the breast.  In the real world, many young women opt for breast enhancement long before having children. I am often asked what effect childbearing will have on an implanted breast.  My answer?  Some ladies do great and some don’t.  I don’t have a crystal ball.  I do tell patients that whatever happens to their breasts, I can likely fix it!  

I am also often asked about the effect implants have on breast feeding and if feeding a baby from an augmented breast is safe for the baby.  Here is what I know based on reading the literature and listening to patients for 25+ years. 

In the recent “Cohort Study to Assess the Impact of Breast Implants on Breastfeeding” conducted by lactation specialists and doctors in Argentina published in the December 2016 Plastic and Reconstructive Surgery Journal (PRS Vol. 138, 1152-1159, 2016) 100 women with breast implants and 100 women without breast implants were followed from the time of childbirth through about 3 months.  All of these women received instruction and encouragement to breast feed by lactation specialists. Here’s what was found:  99 of the 100 women without implants were able to breast feed.  93 of the 100 women with breast implants were able to breast feed.  This was not found to be statistically significant.  At 3 months, more women without breast implants were breast feeding exclusively than the women with breast implants.  This was statistically significant.   The study showed no correlation in the type of implant or incision location as to the ability or inability to breast feed.  Sooo…it would appear that breast implants may impact the quantity of milk production and it may be necessary to supplement.  I have been telling my young patients for years if they will feel like a terrible mother if they are unable to breast feed, they may want to wait on that breast augmentation. I think based on this study I will change that to breast feed exclusively. I also over share with these patients that I am a lactational failure and my children (now 20, 20 and 16) have had one ear infection, 2 broken bones, one cavity, one torn thumb ligament between them and all are healthy and happy.  And I felt like a horrible mother for awhile but got over it. I also refer them to a article that appeared in the Atlantic in 2009: The Case Against Breast Feeding written by Hanna Rosen, the mother of three breast fed children.  It’s an fact filled and thoughtful look at this very prickly topic. It made this lactational failure feel a little better!

Is it dinner time?

And lately I have been questions about the safety of breast milk from an implanted breast.  I think some of this is being stirred up by the breast implant illness community which is doing its best to have breast implants banned.  One of the breast implant illness web sites has an extensive diatribe about this and there is also a recent alarmist Instagram post on this topic.  In doing a little research of the peer reviewed literature, I did come up with a paper regarding silicone gel implants and breast milk.  This paper (PRS Vol. 102, 528-522, 1998) looked at silicon levels (silicon is the element that silicone is made of) in breast milk in patients with and without breast implants and also in cow’s milk and various formulas. This study was done way back in 1997 at the University of Toronto.  The researchers looked at the milk of 15 mothers of newborns with silicone gel implants and 34 mothers of newborns without implants.  The silicon levels in the implant group was lower than the non-implant group although the difference was not statistically significant.  Now here’s the kicker. The silicon levels in cow’s milk (presumably the cows did not have breast implants although that is not stated in the paper) was over 13 times that of the mother’s milk!  Twenty six formulas were tested and they ranged from 13 times to 433 times that of mother’s mild.  The soy-based formulas had some of the highest levels!  

How can this be????  Again this study did not measure silicone (the rubbery stuff made from elemental silicon).  Silicone is a big fat molecule and cannot be dissolved in solution and therefore cannot be measured.  Silicon, the element, can be measured.  And silicon is everywhere.  Silicon is the second most abundant element on  the earth’s crust, second only to oxygen.  Silicone, the man made rubbery stuff, is also very abundant in medical devices, prosthetics, pharmaceuticals and many consumer products (I love my silicone oven glove). Oh, and it’s used to make nipple shields for breast feeding moms and bottle nipples for bambino.  

The other issue is the location of breast implants in relation to the milk producing glands and the lactiferous (great word) ducts.  Implants on top of the muscle sit under the breast tissue and are in contact with some of the milk producing gland but are well away from the ducts.   Implants under the muscle are not really in contact with the breast much at all.  I don’t have the imagination to visualize big gooey silicone blobs getting though the wall of an intact implant, thorough the fibrous scar capsule and into the milk producing glands and travelling out of the ducts.  I have removed a bajillion ruptured gel implants and have never seen or heard of leakage of gel from one of my patient’s nipples. 

Based on this information and my intimate knowledge of the location of breast implants in relation to the milk glands and milk ducts, I would not advise patients with intact silicone gel implants to forego breastfeeding because of fear of some sort of contamination of their breast milk.  If an implant is ruptured, I think it would be prudent to bottle feed.

So there you have it, my take on breast feeding and breast implants.  Mothering is a wonderful, mysterious and complex task and sometimes doesn’t include lactation (and sometimes doesn’t even include giving birth).  I think most patients are very capable of making up their own minds about if and when they desire breast enhancement with breast implants.

Thanks for reading!  Dr. Lisa Lynn Sowder 

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Clinical research is really, really difficult!

June 19th, 2017 — 6:19pm

That’s a lot of paper work!

I was doing some office spring cleaning the other day and came across two file boxes of patient charts from a breast implant study I participated in years ago. The study was the McGahn Silicone Breast Implant Adjuvant Study which was being conducted to gather information about the efficacy and safety of silicone gel breast implants which had been taken off the market in the early 1990’s. I enrolled 56 patients over about 9 years and had a study completion rate of about 80%. I remember how difficult it was to get patients to come in for follow-up although that was part of the agreement in order for a patient to participate. The follow-up was free but it still took phone calls, letters, e-mails and a little begging to get some patients to come in. During this study one of the new implants, the 153 anatomic gel, was found to have a very high early rupture rate and was quickly taken off the market. I had several patients with this implant that required removal and replacement but I had no other serious adverse events. I was happy to participate in this study even though it was a ton of work for me, my patients and my staff. It was many, many surgeons participating in studies such as this that lead to the new generation of gel implants being put back on the market and made available to patients for breast enhancement or reconstruction. Some groups that are pushing to have breast implants banned have criticized these clinic studies and have pointed out the less than perfect follow-up. I cannot speak for other study participants but we worked very, very hard to get our follow up number. I think that the difficulty of clinic studies is not appreciated by those who have not participated either as investigators or patients. And the think most of the lay public is clueless on this topic. I have done a lot of research in my career, mostly lab research in college, medical school and residency and mostly clinical in practice and I can say that I think lab research is a lot easier!

Thanks for reading! Dr. Lisa Lynn Sowder
Follow me on Instagram @sowdermd and@breastimplantsanity

Breast Contouring, Breast Implant Removal, Breast Implants

Plastic Surgery FAQ: I’m a total wreck. Where should I start?

June 14th, 2017 — 4:16pm

Seattle Plastic Surgeon answers Plastic Surgery FAQ:  I’m a total wreck.  Where should I start?

faq total wreckI often see patients who are interested in several different procedures.  They have a laundry list of things they would like to change.  A recent example was a middle aged lady who wanted hip liposuction, a face lift, a tummy tuck, a breast lift and an otoplasty to pin back her protruding ears.  Geeze, it would be unsafe and impractical to do all of those procedures in one mega 12 hour case.  It would be unsafe because that is a long, long time to be under anesthesia, multiple areas of the body would need to be exposed and that increases the risk of hypothermia, although any one operation has very little blood loss, all those procedures combined could significantly lower her blood count, and she would be sore from head to toe making her post operative recovery miserable.  It would be impractical because I really can’t stay at my best in the OR for 12 straight hours.  I just can’t.  And my nurses and techs and anesthesiologists don’t want to work a 12 hour case and we would finish the case well after dinner time.

My advice to this patient is to start with the area that bothers her the most.  In her case, it was her abdomen.  So we made the decision to do her hip liposuction and her breast lift at the same time as her abdomen.  By grouping these procedures, she saves some money and it saves her a lot of recovery time.   And – this is really important- I won’t be fatigued when I am putting in those last few stitches and the anesthesiologist will still be awake!

So if you are contemplating several procedures, try to decide which procedure you want the very most.  We can usually group procedures and still keep it safe and practical.

Oh, one more thing.  Sometimes the place to start is not the operating room.  It may be smoking cessation, getting into better shape or even a serious medical skin care program.  Sometimes surgery is the last stop on the line to improving appearance.

Thanks for reading! Dr. Lisa Lynn Sowder

If you think you are a total wreck and don’t know where to start, give my office a call to schedule a consultation, (206) 467-1101.

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsantity. See you there!

Mommy Makeover, Patient Safety, Plastic Surgery, Surgical Eductaion

Driver’s side skin damage. Check this out!

June 8th, 2017 — 8:12am

Got sunscreen in your glove box?  You should!

 This is an ABC news report written by Serena Marsh and edited for length by me.  This was originally posted in 2012.

Sunny Side Old: Pic Reveals Sun’s Aging Effects

William (Bill) Edward McElligott is two different ages, 66 and 86 yeaars old. 

If you look at McElligott from the right, he looks like any 66-year-old would expect to, but from the left, wrinkles and sagging skin place him far beyond his years. He is a living demonstration of the importance of protecting your skin from the sun.

“It would take me an hour to drive to work and an hour to come home,” McElligott said. “It was a semi route, I’d have six to eight stops. … 6 a.m. to 3 p.m. on the road.”

For almost 30 years, McElligott drove a truck during prime sun hours throughout the city of Chicago delivering milk to stores and gas stations.

“My left arm was always more tan than my right, because a lot of the time I had the window open (since) we didn’t have A.C.,” McElligott said.

The 66-year-old truck driver suffers from unilateral dermatoheliosis or photo-aging, which was caused by repeated, long-term exposure to UVA rays of the sun.

It was 15 years before he noticed any difference between the two sides of his face, but McElligott ignored it, that is until his grandchildren’s questions got the best of him.

Dr. Jennifer Gordon a dermatology resident at UT Southwestern saw McElligott while on a rotation at Northwestern in Chicago and submitted his case study, which was featured in the April edition of the New England Journal of Medicine.

“It was very stark,” Gordon said. “We are used to seeing photo damage, photo aging every day, (but) for it to be so one sided? We were taken aback.”

Gordon explained that since McElligott spent so much time in his car, his left side was exposed to UVA rays that can penetrate glass and cause the majority of photo-aging, unlike UVB rays, which cause sunburns.

“We think its because it (UVA) can penetrate more deeply into the skin than UVB and affect your collagen and elasticity,” she said. “When you destroy those that’s what gives you the aging appearance that we see.”

Dr. Mitchell Chasin, a dermatologist who did not treat McElligott, says it is extremely common to see patients that come in with more damage to their left side than their right.

“Most people are completely unaware and most people who come in to have sun damage treated, they often times will point to their left side saying they see more spots, more wrinkles, more aging, but never put two and two together,” said Chasin.

Chasin says that whenever people are outdoors, even when covered from the sun directly or on a cloudy day, they should be aware they are not safe from the reflected rays of the sun and should wear sunscreen.

“Sun block is the answer, really, for someone 365 days a year, whether it’s cloudy whether it’s sunny, whether someone is outdoors, in the car, or at the beach,” Chasin said. “If someone wants to age as best they can, sun protection is a daily regimen no matter what you are doing. Put sun block on before you leave the house.”

With summer approaching and vacations and road trips, it’s important to make sure your sunblock has protection against both UVA and UVB rays.

Last year the FDA demanded sunscreen manufacturers update their labels to offer protection for both UVA and UVB, as well as to stop the use of misleading claims such as waterproof. The agency recently extended the deadline to December for manufacturers to comply.

For McElligott sunscreen with UVA and UVB protection has become a daily fixture.

“When I’m out in the sun, when I’m going to be driving, I have sunscreen on,” he said. “I always carry it with me.”

Thanks for reading.  And do you have a favorite sunscreen?  Send me an email and let me know. lsowder@madisonplasticsurgery.net

Dr. Lisa Lynn Sowder

Follow me on Instagram: @sowdermd and @breastimplantsanity

 

Aging Issues, General Health, Now That's a Little Weird, Skin Care, sun damage

Breast Implant Illness Fear Mongering

May 23rd, 2017 — 10:01am

I came across a post on the Breast Implant Illness Instagram site recently that really made me really cranky.  And it made me want to holler, “STOP THE FEAR MONGERING!”

Let me walk you through this image.  Obviously it is a lady and in the upper left corner you can see her breasts which have been removed and placed on a serving tray.  Um, very edgy.  And you can see the chest width slash across her chest where her breasts used to be.  The Breast Implant Illness community is on a mission to ban all breast implants.  Their modus operandi is to scare the bejesus out of anyone who has breast implants, has had breast implants or is thinking about getting breast implants.  I find their IG posts mostly rather boring especially when it is the same set of moldy implants that have been posted half a dozen times already.  But this post really crosses the line.  This post implies that breast implant removal requires a double mastectomy and an incision across the width of the chest.  I have been doing breast implant removal for over 26 years and I have never, make that NEVER had to do a mastectomy or use an incision of this length.  And most of my patients look better after parting ways with their implants.  I see ladies in my office frequently with old, hard, nasty implants who have suffered with pain and tightness and embarrassment for years but have been fearful to seek implant removal because they equate implant removal with mastectomy. Disinformation like this IG post feeds that fear and is a disservice to women. 

Posting this sort of rubbish must provide a certain type of person with a feeling of satisfaction and self worth.  As for me, I prefer to satisfy myself by providing careful, competent and reality based care for women seeking breast implant removal.  If you want to see what breast implant removal really entails, I have a ton of information on this web site and also my IG:  @breastimplantsanity.

Thanks for reading.  Dr. Lisa Lynn Sowder

Breast Implant Removal, Breast Implants, This Makes Me Cranky.

MOMMY MAKEOVER A.K.A. MATERNAL RESTORATION

May 14th, 2017 — 7:00pm

motherhoodSeattle Plastic Surgeon Discusses Mommy Makeover on Mother’s Day

Ah, the joys of motherhood! I can wax eloquently about fat little feet, apple cheeks, wet baby kisses and so on but one of the joys I did not expect was a boost in my Plastic Surgery practice, especially my “mommy makeover” patients. Since becoming a mother myself, I speak “mommy” really well. I know first hand the glorious details of feeding, bathing, changing, and schlepping the baby. I can recite the stages of the toddler, the preschooler, the gradeschooler, the tween, the teenager and currently I am becoming an expert on the joys of being the mother of young adults.  

Being familiar with all that being a mother requires makes me much better at counseling patients about the process and timing of a “mommy makeover”.

“Mommy makeovers” usually combine breast surgery (augmentation and/or lift or reduction) with body surgery (usually abdominoplasty and/or liposuction). Most women are healthy enough to have a combination of procedures during one operative session. It is, however, the first couple of post operative weeks that are the most challenging for the patient.

Mommy is used to taking care of everyone but herself. After surgery the Mommy needs to take of only herself. She needs to be “Queen for a Week or Two” and resist the urge to cook, clean, change, wipe, mop, vacuum, load, unload, fold, etc. And if her youngest weighs over 20 pounds, she may not pick him/her up for at least two weeks if breast surgery was done and for at least six weeks if an abdominoplasty was done. The little one can crawl into Mommy’s lap for a cuddle but NO HEAVY LIFTING for Mommy. This also applies to the dog.

It’s very important to for patients to discuss these issues with their families. I’ve had a few ladies who have underestimated their recovery time, have done too much too soon and have turned what should be a relatively comfortable and relaxing recovery into a very sore and frustrating one.

So, calling all mothers interested in a “mommy makeover”: Plan ahead and get your husband and your children and your friends on board. Make a sign for your bedroom door. “DO NOT DISTURB – MOMMY RECOVERING”.

Body Contouring, Breast Contouring, Breast Implants, Breast Lift, Breast Reduction, Mommy Makeover, Plastic Surgery

I am pleased to offer Ideal Breast Implants

May 3rd, 2017 — 6:05am

Seattle Plastic Surgeon now offering the IDEAL IMPLANT.

I am happy to report that I am really, really liking The Ideal Implant.  And so are my patients.  This new type of saline breast implant crossed my radar screen late last year when I read an article in the New York Times about the implant and it’s inventor, Dr. Robert Hamas.  At the time the article was published, this implant was available only to those plastic surgeons who had invested in the company.  I felt a little left out!  But about a year ago the company expanded the availability of the implant to surgeons like me who are certified by the American Board of Plastic Surgery.

This implant is different from other saline implants in that it has internal baffles that dampen the sloshing around of the saline.  These baffles make the saline behave more like gooey gel.  When I felt this implant, it was a lot squishier and natural feeling than a standard saline implant.  I don’t think it was quite as squishy as a gel but it was really close.  And this implant really holds it shape.  It does not collapse and wrinkle like a saline implant does when held upright.Blog IDEAL IMPLANT

So I am pretty pumped about this new implant and I am totally in awe of Dr. Hamas who thought of this and actually pursued the idea and brought it to market.  Dr. Hamas joins my small pantheon of heroes who just don’t think of great stuff, they actually do great stuff.

Of course the question is why would a woman choose this implant over a silicone gel implant?  Aren’t gel implants awesome?  Aren’t they safe?  Gel implants are usually awesome but they can cause real problems if they leak or rupture.  I do not think gel implants cause systemic illness but a leaking or ruptured gel implant can make a pretty big mess of a breast.  I take out lots and lots of nasty old gel implants and have seen the damage they can do over the years.  In most cases, but not all, the breast can be made to look okay with a new implant and/or a breast lift and/or fat transfer.  And I have to add, the most common issue I see with breasts messed up by any type of implants is the fact that the implants were just too big for the chest in the first place.   Breast implants that are too big can cause big problems.

I also take out lots and lots of old deflated saline implants (I did two of these cases yesterday).  The saline implants usually don’t cause the same extent of inflammation, scarring and damage that gel implants do.  They just don’t.  Maybe this is because a patient with a leaking or ruptured saline implant knows she has a problem because her breast deflates and she gets it fixed in a timely fashion.  Contrast this with a leaking or ruptured gel implant that just sits there for years without any obvious change.  I’ve taken out implants that I would bet have been ruptured for decades.  Yes,  I know that an MRI will pick up a ruptured gel implant but it is a rare patient who dutifully goes in for her bi-yearly MRI as recommended by the FDA.

If you are interested in these implants, I can let you see and feel one.

Thanks for reading!  Dr. Lisa Lynn Sowder

To make an appointment, please call 206 467-1101.

Follow me on Instagram.  I have two accounts:  sowdermd and breastimplantsanity.  See you there!

 

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