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

Breast implant revision vocabulary

November 1st, 2018 — 12:05pm

Over the years, I have done a bajillion implant revision cases.  This comes with the territory of being in practice many years (27 years and counting as of this blog post!) and also with showing and voicing an interest in revisional surgery.  Implant revision is a fact of life.   Breast implants are not life time devices and in general what goes in must eventually come out.  Here a primer on the vocabulary of breast implant revision.  Your surgeon may throw around these terms.  Make sure you understand what he/she is saying and ask for clarification if you need to.  Here goes:

Capsule:  The scar tissue that forms around the implant.  This happens with ALL implants.  It’s a normal response to a “foreign body”.  Yes, breast implants (like all non-biologic implants) are a foreign body. 

Capsular contracture:  The presence of a tight and often thick and sometimes calcified capsule.  This results in a “hard implant”.   This is abnormal scarring.

Implant pocket:  The space where the implant resides.  In cases of submuscular implants, the pocket is between the pectoralis major and the rib cage.  In cases of subglandular implants, the pocket is between the breast gland and the pectoralis major.  Sometimes a change in the implant pocket is advised for implant revision.  

Implant malposition:  Implants that are too high, too low, too medial or too lateral.  This is most often corrected by modifying the implant pocket.

Bottoming out:  A condition that occurs when the implant settles too low and/or is too loose.

Inframammary fold (IMF):  The crease under the breast that is densely attached to the chest wall.   The IMF tends to go back to where it was before implants after implant removal. 

Double bubble: A condition that occurs when the implant falls below the inframammary fold.  This is often accompanied by a crease along the lower breast at the level of the native inframammary fold or the edge of the pectoralis muscle.   

Waterfall deformity: A condition that occurs when the implant stays put but the breast sags as it ages and falls over the implant. 

Synmastia a.k.a. unaboob:  Implants that are too close together.  This looks really weird and is very, very hard to fix. 

The gap:  The space over the sternum that separates the breast.  Sometimes the patients anatomy will result in a wider gap than she desires.  Trying to close the gap can result in really lateral nipples or the dreaded unaboob.  See above.   

Capsulotomy:  Cutting open the layer of scar tissue either to loosen it up or to change the position of the implant.  This can sometimes be done with a local anesthetic.

Capsulectomy:  Cutting out the capsule.  This always requires a general anesthetic.  This can be very difficult.  

Capsulorrhaphy:  Putting stitches into the capsule to either tighten it up and/or to raise the implant.  This usually requires a general anesthetic. 

En bloc capsulectomy:  Removing the implant capsule with the implant without opening the capsule.  This is the preferred method for removing a ruptured silicone gel implant.  This is not always technically possible. 

Acellular dermal matrix (ADM) and surgical mesh:  A sheet of collagen or other substance that controls position of the implant and may prevent recurrent capsular contracture.   Alloderm and Strattice are two of the ADMs I have used.  I have also used Seri surgical mesh.  Think of these as an internal bra, a very, very expensive internal bra.

Perfect symmetry:  Not possible but we try.  

Touch-up:  This term best used when referring to make-up application.  I try to avoid this term when it comes to breast implants.  It implies that it’s easy and it’s never easy. 

Revision:  This term best used when referring to repeat surgery on a breast with an implant.   

So there you have it.  Now you can translate what your surgeon has told you needs to be done.  And again, if you don’t understand make him/her go over it again until you do understand.  Tell them Dr. Sowder told you to do so.  Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder

 

Breast Contouring, Breast Implant Removal, Breast Implants

Another side of breast implant illness : one woman’s misdiagnosis and journey back to health.

October 23rd, 2018 — 8:57am

Recently I received this email from a former breast implant illness patient.  I am sharing it with her permission but she has asked me to protect her identity.  I will call her Celeste because I love that name.  I have made no changes except for correcting a few typos.

Celeste:  I read your blog post on breast implant illness and it literally brought tears to my eyes. Tears of joy!!!!  Back up three or four years ago when my life was in shambles – emotionally abusive husband, stressed out to the max at work, sex hormones had crashed, possible thyroid issue…..but yet my family physician said I was fine according to my lab tests. I wasn’t able to see what my ex husband and stress were doing to my body at the time and so I was bound and determined to find an answer. Then I found it – the BII group on Facebook. I had found my answer so I thought. Went through the surgery and wow none of my symptoms got better! It wasn’t until my divorce was final and I was able to relax and started taking a low dose thyroid medicine and got my estrogen back to a normal level that I started to feel normal again. Long story short, I miss my implants like crazy and want them back. I’m soooooo happy to see a plastic surgeon standing behind her beliefs! I totally think it wasn’t my implants at all and more stress and hormone related. I guess I’m going to be the first trial case to see what happens. lol. Thanks for the blog. I really enjoyed it.

Me:  I am very glad you are feeling better after getting your life in order and getting good medical care. Sorry about your implants, though. Have you shared your experience with the Facebook group? I am just curious.

Celeste:  Hahahah.  To spare myself the verbal attacking that would come with it, I have not. All of my friends have implants – a good mixture of saline and silicone, and none of them have issues. I even have one older friend who has had her saline implants for 20+ years to the point one ruptured and still no issues. I don’t want to fight with 18,000+ desperate women who are looking for an answer to their issues when in reality it is probably what you said, the general human condition and life itself. My mom has a lot of allergies and it is possible that my body reacted to my silicone implants (second set), but it took several years for me to feel bad. So, doubtful in my opinion. I had my saline implants for six years with no issues. The issues of general fatigue were once again a result of stress and being on birth control most likely. When I got my silicone implants I went off birth control and my stress was at an all time high. Perfect storm imo. But we shall see what happens. I’m torn on what to get again. I loved how my silicone looked and felt, but still have a slight fear that maybe just maybe it was my body reacting to the silicone (doubtful)……

I’m sure that group has attacked you. It’s like the blind leading the blind and defintely a herd mentality. I can’t bash them too much because three years ago I was one of them – desperate for an answer……and I’m a research scientist, so no dummy either ….. I was just that desperate to feel better.

Me:  Is there any advice you would give women who like their implants but think they have breast implant illness?

Celeste:  Oh geez this is a hard one. There is so much misinformation out there that if it seems pretty far fetched, it probably is.

I lived with my symptoms for years and even had my best friend, who is also my family physician, tell me that I was super stressed and THAT was my problem. The funny thing I have learned about stress in our society is that it starts out small and slow and that becomes the new normal. Then a little more stress gets added on, then that is the new normal. The cycle continues to repeat itself until something or someone stops it. In my case I got my second set of implants (silicone), stopped birth control causing my hormones to crash because I was basically dependent on it, major stress in my marriage, and I was studying for my board exams. And I was the silly one sitting in my doctor’s office telling her that I wasn’t stressed, but yet I couldn’t sleep, felt tired and heavy all the time, my weight was increasing quickly, etc. I went on like this for six years! I’m a little stubborn, ha! Removing my implants helped momentarily because all I could do was sit around and relax. That should’ve been my huge red flag. But nope, I missed it, lol. It wasn’t until just recently that all the pieces started coming together. My hormones are finally at normal levels, my stress is down, my divorce was final two weeks ago. I am finally relaxing and it feels good! I’m still going to the gym and doing strenuous weight lifting and from time to time when I don’t get enough sleep because I’m enjoying life too much and burning the candle at both ends, guess what????? My symptoms start to come back!

For me I’m skeptical that the millions of women that have implants are walking around like zombies (basically what I felt like). I was barely functioning – getting out of bed was difficult, but I didn’t want to lose my job so every morning was a struggle and a pep talk to do it one more day. And what about all the celebrities that have butt implants, chin implants, cheek implants, pec implants (men) – all silicone. I suppose one could argue that those are different than breast implants in chemical consistency, but why aren’t they feeling awful????  I’m more of a believer of an inflammatory response to implants that are too big for the body and overtime the body starts to reject them. My last set were DD and way too big imo. I’m naturally an A, so that is a big difference. And what about all the women in the bikini industry – models and competitors??? They are fine. I’m not saying breast implants are 100% safe, but causing issues almost a decade later is something that I’m not too sure on. My implants came out looking brand new with a thin capsule and no other issues. It is interesting though, the doc that took mine out says he’s seen some stuff that he just can’t explain and the lab can’t identify what it is……so maybe there is truth to it????

With all that being said, I think my biggest piece of advise is know that the mind is very powerful and when you are desperate for an answer, almost anything can be made to fit the given scenario. I wasn’t able to take a step back and evaluate my life and see that the problems I was having were self inflicted. Stress, abuse, lack of sleep, etc. had nothing to do with my implants. After years of living like this, my body was burned out and literally quitting on me. What it needed was lots of TLC! I’m still happy I got my implants removed. That set was too big, but I wish I would’ve swapped them out for a smaller set like my first set of implants. At this point I do miss my implants enough that I’m willing to risk that I’m completely wrong about all this and get implants again……..

So there you have it.  Another side of the breast implant illness conundrum.

Thanks for reading and I would be honored if you followed me on Instagram @breastimplantsanity and @sowdermd.  Dr. Lisa Lynn Sowder

Breast Contouring, Breast Implant Illness, Breast Implant Removal, Breast Implants

Fat transfer to the breast FAQ: What happens with weight changes?

August 30th, 2018 — 2:16pm

I’ve now been doing fat transfer to the breast for over seven years.  I remain enthusiastic about this procedure in patients with favorable anatomy and realistic expectations.  One FAQ relates to changes in the breast with weight changes.  So here is what I have observed so far in my practice:

Yo-yo is a no-no for fat transfer!

If patients lose weight, the transferred fat shrinks and the patient loses volume in her her breasts.  This also goes for patients who lose fat but maintain their weight.  I have seen this in a couple of patients who did not have a major weight loss but who really leaned out with vigorous exercise.  They both became Crossfitters and both lost a lot of the volume they gained after fat transfer.  One went on to have implants.  The other did not.  I am thinking about adding “do not join Crossfit” to my post-op instructions!

Conversely, if a patient gains weight, the fat that was transferred to the breasts will expand and the breasts will get larger.  I have seen this in a couple of cases.  One case was a middle aged flight attendant who gained about 7 lbs on a cruise (this is why I do not go on cruises!) and became alarmed at how large her breasts became.  I assured her that her breasts would go back to their pre-cruise size when she lost that extra weight and indeed they did.  In another case, a patient gained just a few pounds and rather than going to her saddle bags as it usually did prior to fat transfer, she was delighted to see that it mostly went to her chest!

So whenever we are moving fat around, it’s best to have surgery when you are at a healthy and sustainable weight.  I do not recommend fat transfer in patients who yo-yo.  Significant weight fluctuations make for fluctuating results.

Thanks for reading and did you notice I did not say “ideal” weight?  Sustainable and healthy weight is more important and more obtainable than ideal for most of us who are over 25 years old!

Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

 

Breast Contouring, Fat Transfer to the Breast

Maximizing Follow-Up in Cosmetic Surgery Clinical Trials – Money Helps

July 26th, 2018 — 9:05am

In a previous blog post bemoaning the difficulty of good follow-up in clinical research I sort of place most of the blame on patients who blow off the follow-up  once they have their desired implants.  This was my experience with the implant study I participated in many years ago.  I had an 80% follow-up at 5 years (which was really, really high)  mostly because I pestered patients relentlessly to come back for their follow-up exams.  I have taken a bit of flack (especially from the breast implant illness activists) for my blame-the-patient stance but now there is a recent study out that supports my politically incorrect opinion.  Check this out.  It seems if you pay the patient big bucks to show up they do!  This study has an astounding 94.9% and 96.7% follow-up compliance at 5 years.  The study has another 5 years to go and my guess is that given the size of the monetary award, those numbers will also be very high.

“Maybe I will show up for my follow-up.”

Novel Approach for Maximizing Follow-Up in Cosmetic Surgery Clinical Trials: The Ideal Implant Core Trial Experience

Mueller, Melissa A. M.D.; Nichter, Larry S. M.D.; Hamas, Robert S. M.D.

Plastic and Reconstructive Surgery: October 2017 – Volume 140 – Issue 4 – p 706–713
Cosmetic: Original Articles
Background: High follow-up rates are critical for robust research with minimal bias, and are particularly important for breast implant Core Studies seeking U.S. Food and Drug Administration approval. The Core Study for IDEAL IMPLANT, the most recently U.S. Food and Drug Administration–approved breast implant, used a novel incentive payment model to achieve higher follow-up rates than in previous breast implant trials.

Methods: At enrollment, $3500 was deposited into an independent, irrevocable trust for each of the 502 subjects and invested in a diversified portfolio. If a follow-up visit is missed, the subject is exited from the study and compensated for completed visits, but the remainder of her share of the funds stay in the trust. At the conclusion of the 10-year study, the trust will be divided among those subjects who completed all required follow-up visits. For primary and revision augmentation cohorts, the U.S. Food and Drug Administration published follow-up rates from Core Studies were compared for all currently available breast implants.

Results: Five-year follow-up rates for the IDEAL IMPLANT Core Study are higher for both primary augmentation and revision augmentation cohorts (94.9 percent and 96.7 percent, respectively) when compared to all other trials that have used U.S. Food and Drug Administration standardized follow-up reporting (MemoryShape, Allergan 410, and Sientra Core Studies).

Conclusions: This trial demonstrates the utility of a novel incentive strategy to maximize follow-up in cosmetic surgery patients. This strategy may benefit future cosmetic surgery trials and perhaps any prospective research trial by providing more complete data.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Hey, thanks for reading and I really thank Drs. Mueller, Nichter and Hamas for this awesome article.  And my hat is really off to Dr. Robert Hamas who not only thought up the idea of the Ideal implant but actually brought it to market.  And Ideal only sells its implants to surgeons certified by the American Board of Plastic Surgery.  That means if your surgeon is using an Ideal implant, he/she is actually a real honest to goodness plastic surgeon, not just poseur.

And I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity. Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implants, New Technology, Now That's Cool

Brazilian Butt Lift – A Dire Warning.

July 19th, 2018 — 9:29am
This is an email I received last week.  I want to share it here.  Please pass it along to anyone who may be considering a Brazilian Butt Lift:

Not worth dying for.

URGENT WARNING TO SURGEONS
PERFORMING FAT GRAFTING TO THE BUTTOCKS
(Brazilian Butt Lift or “BBL”)
This urgent advisory is in response to the alarming number of deaths still occurring from the Brazilian Butt Lift (BBL).The Multi-Society Task Force for Safety in Gluteal Fat Grafting (ASAPS, ASPS, ISAPS, IFATS, ISPRES), representing board-certified plastic surgeons around the world, recently released a practice advisory). Additionally, the Task Force is conducting anatomic studies to develop specific technical safety guidelines.Since the release of the practice advisory, deaths from this procedure continue to be reported. The unusually high mortality rate from this cosmetic procedure is estimated to be as high as 1:3000, greater than any other cosmetic surgery.

The cause of mortality is uniformly fatal fat embolism due to fat entering the venous circulation associated with injury to the gluteal veins. In every patient who has died, at autopsy, fat was seen within the gluteal muscle.

In no case of death has fat been found only in the subcutaneous plane.

The Task Force has therefore concluded that: FAT SHOULD NEVER BE PLACED IN THE MUSCLE. FAT SHOULD ONLY BE PLACED IN THE SUBCUTANEOUS TISSUE.

If the desired outcome might require another procedure, then manage the patient’s expectations and discuss the possibility of staging (as often done with fat injections, hair transplants, etc.)

IT IS EASY TO UNINTENTIONALLY ENTER THE MUSCLE DURING SUBCUTANEOUS INJECTION.

Therefore, stay mentally focused, alert, and aware of the cannula tip at every moment; be vigilant about following the intended trajectory with each stroke and feel the cannula tip through the skin. Consider positioning that can favor superficial approaches, such as table jackknife. Use cannulas that are resistant to bending during injection and recognize that Luer connectors can loosen and bend during surgery.

The risk of death should be discussed in your informed consent process, along with alternative procedures (such as gluteal implants or autologous flap augmentation).

No published series of BBLs done with intramuscular injections is large enough to demonstrate it can be done without the risk of fat embolism.

The subcutaneous plane has not been linked to pulmonary fat embolism. Until and unless data emerges that intramuscular injections can be done safely, the subcutaneous plane should remain the standard.

Fat injected into the subcutaneous space cannot cross the superficial gluteal fascia and migrate into the muscle; therefore, any intramuscular fat found at autopsy can be concluded to be the result of injection into the muscle.

Surgeons wishing to continue performing this procedure should strictly adhere to these guidelines. The Task Force is actively performing anatomic studies. and more specific technical guidelines will be forthcoming. We need to dramatically improve patient safety with this procedure through careful technique, or reconsider whether the procedure should still be offered. Patient safety is the number one goal of board certified plastic surgeons across the globe.

Sincerely,

 

Dan Mills, MD
Gluteal Fat Grafting Task Force co-chair
J. Peter Rubin, MD
Gluteal Fat Grafting Task Force co-chair
Renato Saltz, MD
Gluteal Fat Grafting Task Force co-chair
Co-Chairs
Multi-Society Task Force for Safety in Gluteal Fat Grafting* The information in this Advisory Statement while setting forth the strong recommendations of the Task Force, should not be considered inclusive of all methods of properly performing buttock augmentation with fat transfer or as a statement of the standard of care or as a mandate to strictly follow the recommendations of the Task Force.This Advisory Statement is not intended to substitute for the independent professional judgment of the treating plastic surgeon nor for the individual variation among patients.The Members of the Multi-Society Task Force and the participating societies assume no responsibility or liability for injury arising out of any use of the information contained in this Advisory Statement.** The Inter-Society Gluteal Fat Grafting Task Force represents leading clinical plastic surgery societies, including the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery (ASAPS), and the International Society of Aesthetic Plastic Surgeons (ISAPS). Additionally, two scientific societies, the International Society of Plastic & Regenerative Surgeons (ISPRES) and the International Federation for Adipose Therapeutics and Science (IFATS) are represented and provide scientific support. The efforts of the Task Force build upon a foundation of important work by the Aesthetic Surgery Education and Research Foundation (ASERF), the American Society of Plastic Surgeons (ASPS) Regenerative Medicine Committee, and the International Society of Aesthetic Plastic Surgery (ISAPS) Patient Safety Committee. The Task Force is an unprecedented collaborative effort to address a major patient safety concern, investigate factors that lead to increased risk with gluteal fat grafting, perform scientific studies to improve safety, and educate plastic surgeons.

 

I have been a member of the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) for many, many years and do not recall any advisory with the strong wording of this one.  I abandoned intramuscular injection a couple of years ago when the news of deaths from this procedure came trickling in.  I suspect all ASPS and ASAPS members will follow this advisory.  My concern is that many surgeons who do this procedure are not board certified plastic surgeons and therefore not eligible for ASPS and ASAPS membership.  I hope they get this message and change their techniques.  I have seen a few Instagram posts and videos of butts being pumped up to the max that make my head spin and my backside ache.  The only true way to put this dangerous procedure in the rear view mirror is for patients to stop asking for it.  There are docs (and non-docs) out there who will do just about anything if the patient is willing to take the risk.  That Kim Kardashian butt is not worth dying for!

Thanks for reading and please follow me on Instagram @sowdermd and @breastimplantsanity.  

Dr. Lisa Lynn Sowder

Body Contouring, Fat Injection, Patient Beware, Patient Safety

4th of July Buzzkill

July 3rd, 2018 — 4:00pm

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/her hamburger and potato salad because more likely than not, he/she will 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

14-Point Plan for Breast Implant Placement

June 26th, 2018 — 1:53pm

Surgical techniques are constantly evolving and breast implant technique is no exception.  In the past couple of years recommendations to minimize implant and implant pocket contamination have been developed.  This is in response to overwhelming evidence that bacterial contamination is the main cause of capsular contracture and may also be the cause of breast implant associated anaplastic large cell lymphoma (BIA-ALCL).   Both of these conditions have been linked to the presence of biofilm around the breast implants.  Biofilm is the product of certain bacteria, Staph epidermidis in the case of capsular contracture and Ralstonia piketti in the case of BIA-ALCL.  It is our hope that with the adoption of the Surgical 14-Point Plan for Breast Implant Placement the annoying and difficult problem of capsular contracture and very serious and potentially fatal problem of BIA-ALCL will drop in frequency.  If you are planning on breast implant surgery, you should ask your surgeon if he/she uses the 14 point plan.  They should!

Surgical 14-Point Plan for Breast Implant Placement, from Aesthetic Surgery Journal, 2018, Vol38(6) page 625

Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Implants, New Technology

Spectators in the OR

June 18th, 2018 — 10:30am

Occasionally I have a request from a patient’s friend or family member to come into the OR to “watch the surgery.”  Many times they tell me that they have seen it on T.V. or on YouTube and just think it will be cool to see it in person.  The answer is always no and here is why.  In the OR, what may look like a relaxed and even fun atmosphere is actually a very carefully planned and executed choreography with several participants front stage and more in the wings.  There is me and the scrub tech at the table and sometimes one of the 6th year plastic surgery residents from the University of Washington.  Then there is the anesthesiologist keeping the patient asleep and safe and then there is the circulating nurse who helps the anesthesiologist and also opens equipment and  supplies as needed.  There really isn’t any extra room for a spectator and that spectator really isn’t going to see much because the surgical field is surrounded on all sides by anesthesia, the Mayo stand with the instruments and people on both sides of the table.  And we keep OR “traffic” to a minimum because of infectious issues.  The more people in and out of the OR the greater chance of contaminating the surgical field.  And a lay person has very little concept of the sterile field and probably has not even heard the term “sterile conscious.”  Don’t take it personally but we surgery types think lay people are just walking talking fomites.

“Jesus Christ! I think you are doing that wrong!”

And then there is “going to ground” factor.  Even the most hardened lay person or even a doctor or nurse may react very differently to the sight of blood when that blood is that of a close friend or a loved one.  If that person goes to ground, then we have another patient to take care of!

I have to tell just one little story about a would be OR spectator from my residency days.  I was rotating at Children’s Hospital in Salt Lake City and doing an infant hernia case with the Chief of Pediatric Surgery, the wonderful Dr. Dale Johnson.  One could not imagine a more competent and kind and ethical surgeon than Dr. Johnson.  He was and even after retirement is a deity in surgery circles.  We scrubbed our hands and arms and went into the OR for gowning and gloving.  He noticed an extra person in the OR with a clipboard. (Surgeon’s have a visceral distrust of people with clipboards).  Dr. Johnson politely asked this lady who she was and why was she here.  She told Dr. Johnson that she was a “patient advocate” there for the patient’s protection.  Dr. Johnson politely asked her from whom she was protecting the patient and if she was going to let him know if he was doing something wrong.  She became flustered and just left the OR and I have never seen or heard of such a “patient advocate” since then.  It was very strange and makes me think if a patient or patient’s parent think they need an advocate in the OR other than their operating surgeon, maybe they should choose another surgeon.

So go ahead and ask to be an observer but just be prepared to hear “no” in the nicest possible way.

Thank you for reading and I would be honored if you followed me on Intragram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

My Plastic Surgery Philosophy, Patient Safety, Plastic Surgery

Got Sunscreen?

June 12th, 2018 — 9:47am

Seattle Plastic Surgeon comments on the results of a long running sunscreen use study from Austrailia. 

90% of this ladies skin aging is due to the sun. I hope her grandson uses sunscreen.

90% of this women’s skin aging is due to the sun. I hope her grandson uses sunscreen.

It’s that time of year when I must nag about tanning.  In rainy Seattle it is so tempting to soak up the sun once summer arrives (that is usually about July 5th).  But please, think before you rip off your clothes, don your thong and grab your beach towel.

A good study published by the Annals of Internal Medicine and reported in the Wall Street Journal  has shown that regular use of sunscreen reduces skin aging by 24%.  It had already been shown many times that sun protection prevents most types of skin cancer but now what seemed to be obvious has also got some scientific cred.   Now my nagging has some scientific backing!

I’m certain we are hardwired to love the feel of photons bombarding our skin but way back when we were being hardwired and learning to walk upright, we would die from an abscessed tooth or a ruptured appendix or (if we were lucky) a quick take down by a leopard long before we developed skin cancer or even a bad case of the wrinkles.

Fortunately, sun protection has finally caught up with our longer life spans.  We have really good sun screens and sun block, protective and comfortable clothing and don’t forget about umbrellas, cabanas and the most lovely shade of all, trees.   And lets hear it for staying indoors when the sun is at it’s strongest.  How about a nice glass of ice tea with some fresh mint leaves and a good book.  May I recommend The Storms of Denali by Nicholas O’Connell, or A Visit from the Goon Squad by Jennifer Egan, or I Remember Nothing by the late and great Norah Ephron?

And just to remind you, I nag because I care.  Thanks for reading.  Dr. Lisa Lynn Sowder

I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Aging Issues, General Health, Skin Cancer, Skin Care, sun damage

I’m anti anti-vaxer

June 4th, 2018 — 8:27am

Anti-vaxers have been on my mind lately.  I recently had a nasty comment directed at my @breastimplantsanity Instagram telling me I should be ashamed of myself for promoting these “toxic bags of death”.  Those who follow @breastimplantsanity closely know that I am not a huge breast implant fan and much prefer other options for breast enhancement but I digress.  This particular detractor’s Instagram was militantly anti-vaccination   I just about choked on my Diet Coke.  So, breast implants are to be feared but not smallpox, polio, diphtheria, mumps, rubella, measles, chickenpox, meningitis, shingles, genital warts, cervical cancer, tetanus, pneumococcal pneumonia, etc?  Give me a break.

I am being generous here when I say anti-vaxers are misguided and so very coddled and sheltered from the reality of communicable diseases of childhood in and adulthood.  They don’t know what they don’t know but they don’t know even know that. 

Take a look at this photo.  This is from a book called Sleeping Beauty which consists of medical photos taken during photography’s earliest era and curated by Stanley B. Burns, M.D.  The book was published in 1990 and unfortunately is out of print.  This photo, “Mother With Her Dead Daughter”, was taken in the early 1900’s.  This may strike the modern reader as really sicko but most working class families of that era could not afford to have a photographs taken but would often splurge for a photo of a dead loved one.  Take a closer look at the photo.  Does the daughter look dead or even ill?  Doesn’t she just look like she is sleeping in her mother’s lap?  The real give away is this poor mother’s face.  It’s just haunting with its steely resolve. The daughter looks so normal because she died so fast.  Childhood mortality in this era ranged from 30 to 50 percent (!) with most children dying quickly from a wide variety of infectious diseases.  Those diseases so common then now make the news and are almost always associated with pockets of low vaccination rates.

It wasn’t so long ago that the whole world was a low, no really, a zero vaccination rate pocket.  Back in 1990, I was touring The Breakers, the mansion owned by transportation magnate Commodore Cornelius Vanderbilt (1794 –  1877) in Newport, Rhode Island.  Our little touring group was ushered into the mansion’s library to await our tour guide.  There were many family plaques hanging on the library walls and I was really moved to see how many family members, members of this rich and elite clan who could afford the best medical care of the time, died in early childhood.  But this was before the modern era of vaccination.

I am old enough to sport a smallpox vaccination scar on my upper arm and to remember lining up in a local grade school gym to receive one of the first oral polio vaccines.  These two scourges of humanity are all but wiped out thanks to world wide immunization.   And I am old enough to remember being sicker than a dog with red measles and I still see my faint chickenpox scars when I puck my eyebrows.  And I had a college dorm buddy, only one year older than me, with legs crippled by polio.  He missed the vaccine by a year.  These are real diseases that the young whipper snapper anti-vaxers have been spared because their neighbors do vaccinate themselves and their children thereby providing herd immunity.

So little miss smarty pants anti-vaxer Instagram diva, I could wish the pox on you, but I won’t.  I wouldn’t wish the pox on anyone, not even an anti-vaxer.

Boy, I feel better having written this and thanks for reading.  Dr. Lisa Lynn Sowder

I’d be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

 

General Health, This Makes Me Cranky.

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