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

Category: Plastic Surgery


Should you travel for breast explant surgery ?????

August 29th, 2019 — 2:00pm

This post is based on a phone consultation from earlier this week.  I’ve changed a few unimportant details to protect patient privacy.

That bag is gonna be a killer to get into the overhead bin after surgery!

This lady has smooth, saline implants that are about 10 years old.  She is part of the Pacific Northwest Breast Implant Illness (BII) Facebook group and she thinks her implants are making her ill.  Her augmentation was done by the (IMHO) very best plastic surgeon in her state who lives and practices in the patient’s hometown.  She has seen her plastic surgeon for explant and her plastic surgeon has agreed to do her explant and remove as much capsule as can be safely done.  So why, I ask, does this patient want to come see me???  Am I an explant expert?   Well, sort of in that I have done about a bajillion explants (mostly reasons other than BII) over the 28+ years I’ve been in practice.

But……………….explant and capsulectomy is not specialized surgery.  This is a procedure that just about any plastic surgeon who does a lot of breast surgery is capable of doing.  Now, I would not expect, say, a craniofacial surgeon to have any great expertise (or interest) in this but most “general” plastic surgeons are very capable of doing this.  Promoting myself for explant and capsulectomy is sort of like Gordon Ramsey promoting himself as the ultimate chef for grilled cheese sandwiches.

So how about the fabulous explant experts who can guarantee an “en bloc” and offer “detox” products?  Well…………………………….I’m not gonna throw anyone whom I have never met under the bus.  But I will say this:  There is zero, nada, zilch, nichts, niet, nula, noll, odo evidence that an en bloc resection is absolutely necessary or that detox does anything other than slim down your bank account.  It’s super nice (and sort of fun) to do an en bloc in cases of silicone gel rupture but there is no evidence in peer reviewed surgical literature that there is any difference in clinical outcome.  The same goes for cases of BIA-ALCL.  Would I recommend a careless surgeon who is not thorough or does not endeavor to keep things as clean as possible?  Of course not but I must say the vast majority of plastic surgeons are pretty damn thorough and meticulous.  It’s in our DNA.

We plastic surgeons are always ragging on surgical tourism and espousing the danger of going to a distant land for el cheapo plastic surgery but we should also be ragging on traveling within the United States for routine procedures.  Travelling adds a lot of complexity to the whole surgical process from initial evaluation to final follow up.

There are plastic surgeons being promoted as some sort of super experts by the breast implant illness activists.  I have zero evidence that money is changing hands but isn’t it a little weird that this sisterhood, who should want what is best for other women, to recommend traveling hundreds and sometimes thousands of miles for a routine surgical procedure?  Oh, and waiting sometimes up to a year to have their toxic bags of death removed?  And as for detox?  Zero evidence of necessity or efficacy. You can get your detox package from your local woo woo health provider who is happy to lighten your wallet.

So think global, buy local and support your probably very capable local plastic surgeon!  Just make sure your plastic surgeon is the real meal deal and certified by the American Board of Plastic Surgery.

Thanks for reading and I would be thrilled if you followed me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implant Removal, Breast Implants, My Plastic Surgery Philosophy, Patient Safety, Plastic Surgery

En Bloc Resection of Breast Implants and Capsules

April 2nd, 2019 — 9:20am

I get a lot of requests from breast implant illness patients to do an en bloc resection of their implants and the surrounding implant capsule.  The term en bloc refers to a procedure that removes the structure in question in one piece or all together.  This term is used most commonly in cancer surgery where a tumor is removed in its entirety without actually cutting into the tumor itself.  Except in cases of BIA-ALCL, implant capsules are not cancer.

The photo below shows an en bloc resection of two ruptured breast implants and the surrounding capsule.  In cases like this, doing an en bloc makes a lot of sense in that it prevents any spillage of silicone and makes for a much cleaner explant.  Fortunately it is cases like this where an en bloc is usually doable.  The thick, nasty and calcified capsule often just peels away from the adjacent breast tissue, muscle and chest wall without causing any collateral damage.  Doing a clean and slick case like this is what surgeons live for and believe me, I wish every explant would go just like this!

But……….it is not always possible to do an en bloc resection.   Sometimes the capsule is very, very thin and fragile (sort of like a wet Kleenex) and it is not possible remove it unbroken.  Sometimes the capsule is very adherent to adjacent structures such as breast tissue, ribs and chest muscle.  It is just not worth the damage to those normal structures to get an en bloc resection.  Sometimes, with implants under the muscle, the patient is at risk for a collapsed lung when trying to peel a very adherent capsule from the rib cage. In cases like this, the capsule can be removed with curettage.  And sometimes, with really large implants or those put in though the axilla (arm pit), the upper part of the capsule cannot be visualized with the implant in the way.  And if I cannot see it, I will not cut it.  In those cases, I remove the implant and then am able to safely remove the capsule.  I am very careful about minimizing or, in most cases, eliminating spillage of any leaking gel.bessss

 

I am aware that the breast implant illness community is obsessed with en bloc capsulectomy.  I’m not sure why because for clean, intact implants, there is no compelling reason to do an en bloc, except maybe to show off and promote oneself, and yes, I am guilty of that!   Many patients are lead to believe that there is some sort of evil humor or miasma that exists in the space between the intact and clean implant and capsule.  The space (which is actually what we call a potential space because it contains nothing) contains nothing!

It is really easy to pontificate for a potentially dangerous procedure when one has zero responsibility for any downside.  Who is responsible for harm to the patient – the surgeon holding the sharp instruments or the social media pundit?

And I am also aware that there are surgeons out there who guarantee an en bloc, every implant, every time.  I honesty don’t know how they can.  I also provide a guarantee… I’ll do my best.

Thanks for reading!  Dr. Lisa Lynn Sowder

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

Breast Implant Illness, Breast Implant Removal, Breast Implants, Patient Safety, Plastic Surgery

Will there be plastic surgery under your Christmas tree?

November 30th, 2018 — 3:11pm

Seattle plastic surgeon encourage the gift of plastic surgery.How to give the gift of plastic surgery.

Looking for the perfect gift this holiday season?  That perfect gift may just be a plastic surgical procedure.  Here are a few tips if you are considering this most thoughtful and personal of presents.

  • Only consider this if your loved one has confided in you that he/she is considering “doing something” or that he/she just wishes that he/she could just “get rid of this ______(fill in the blank)”.  Remember, it’s about him/her, not about you.
  • Make sure the lucky recipient is a good candidate for surgery.  Good candidates for surgery are in good heath (physically and mentally) and are in a socially stable place in their life.   If in doubt, shoot me an email and I can probably make an educated guess.  Do not, I repeat, do not give the gift of liposuction as a substitute for weight loss.  Need convincing that doing so is a bad idea?  Check out my blogs on obesity.
  • Make sure that you can afford the surgery!  You wouldn’t want to have to back out because of sticker shock.  I have a lot of ball park prices posted on my web site.  Or feel free to shoot me an email and I can give you a financial idea of how much this could set you back.
  • Make sure that lucky guy/gal will be able to take enough time off of work and/or household duties to recover.  It’s misery to try to get back to work too soon.  You want your gift to be a positive experience.  I have recovery times listed for most procedures on my web site.  Or shoot me an email.
  • Make sure you have nice package to present.   You can’t wrap up a tummy tuck or eyelid lift, but you can wrap up something they might love to wear or use after all the discomfort and bruising is gone.  Maybe something sassy from Hanky Panky for that mommy makeover patient or a pair of beautiful Firefly earrings for that eyelid lift patient.  Or for that dude of yours, how about a nice pair of Ethica boxer briefs You can include one of my practice brochures and a procedure brochure.  Oh, I can just hear the shrieks of joy now!

And just think, your gift of plastic surgery will last years, even decades.  You and your loved one will be enjoying the benefits much longer than a new car or television or laptop.  Do the math.  It could end up being a great value as well as a great gift!

HAPPY SHOPPING AND THANKS FOR READING!  Dr. Lisa Lynn Sowder

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

Mommy Makeover, Now That's Cool, Plastic Surgery, Postoperative Care

Happy Thanksgiving

November 21st, 2018 — 10:17am

 

’tis the season of Thanksgiving. 

Here are a few things that this plastic surgeon is thankful for……….

  • Modern Anesthesia.  This makes for painless surgery.  And the surgeon can take her time to do a really, really nice job.  During the Pilgrims’ time, the main qualification for being a surgeon was to be really, really, really fast. Yikes!
  •  The Germ Theory and Antibiotics.  Surgery used to mean infection.  Now surgical infections are rare.  Not rare enough, but rare.
  • The Bovie.  This is the electrical gizmo that seals blood vessels as it cuts.  This is why you don’t need a blood transfusion when I do your Mommy Makeover.
  • Surgical Scrubs.  It’s like working all day in my pajamas.
  • My Dansko Clogs.  It’s like working all day in my slippers.
  • Surgical Loupes.  These are my silly looking magnifying glasses that allow me to see important teeny tiny things like nerves and blood vessels.  They also come in handy for reading the newspaper when I can’t find my reading glasses.
  • My Battery Powered LED Surgical Headlight.  Now I don’t have to be attached to the light source by a fiberoptic tube (which is how my dog must feel on her leash).
  • Power Assisted Liposuction a.k.a. PAL.  This PAL is a true friend.  It makes liposuction so much better for the patient and the surgeon. 
  • My Wonderful Staff and Colleagues.  They keep me on my toes.
  • My Wonderful Patients.  They are why I love coming to work!
  • My Wonderful Husband and Children and Dog and Cat.  They are why I love going home in the evening.
  • My Freakishly Good Health.  I’m 62 and still running, skiing, biking, and just starting with tennis lessons.  I’d like to take full credit for this but really I think I’m just lucky. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Now That's Cool, Plastic Surgery

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

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

Capsular Contracture 102: Treatment

April 19th, 2018 — 3:59pm

My last blog discussed the difficult and frustrating problem of capsular contracture of breast implants.  As with just about every problem known to mankind, prevention is the best approach. But despite doing everything correctly pre-operatively, intra-operatively and post-operatively, a small number of patients will experience capsular contracture.

First a little history:  Way back when the Earth was cooling and breast implants were the newest and coolest thing, surgeons would treat capsular contracture by “popping” the breast, the so-called manual or closed capsulotomy.  Here is how it worked.  The surgeon would take his great big strong paws and basically mash the poor breast until there was a pop and the breast went soft as the scar capsule ruptured and released its pressure on the implant.   As you can imagine, there was a lot of moaning and screaming in the exam room during this process.  It wasn’t long before surgeons realized that: 1. the capsular contracture always came back, 2. this can rupture a breast implant, 3. this can cause acute bleeding and 4. women don’t like being manhandled this way.  I was just starting my training in plastic surgery just as manual capsulotomy was falling out of favor.  I’m happy to say that I have never done this crude procedure and it is likely that I would not have succeeded had I tried.  I have teeny tiny and not-so-strong hands.  I would have likely ruptured one of my tendons before rupturing a capsule or implant.

Okay, that was then and this is now.  For early capsular contracture, it’s worth trying medication.  A dozen or so years ago it was observed that implant patients on a certain kind of asthma medication has a very low rate of capsular contracture.  These medications are leukotriene receptor antagonists and they work for asthma by reducing inflammation.  And inflammation is thought to be the final common pathway to capsular contracture.  The two medications used are zafirlukast and mohnelukast.   Accolate and Singular are the brand names respectively.  I have had several patients resolve an early capsular contracture with these medications. I have also had a few patients who did not respond to these medications

These implants were 41 years old and had a grade 4 capsular contracture. I removed them and the capsule and inserted new implants. She is shown 18 months after surgery.

Once a capsule is well established, surgical intervention is the only way to resolve it.  Complete capsulectomy removes the scar tissue and then the question  is how to prevent a recurrent capsule.  And does it make sense to just pop in another implant right away?  This is just such a difficult question because none of us has a crystal ball to tell the future.  Sometimes capsulectomy and a new implant works great but sometimes another capsular contracture starts forming despite doing everything right.  Sometimes we create a new pocket and make a pocket under the muscle if the over the muscle implant had a capsular contracture and vice versa.  Adding Accolate or Singular makes some sense.  Sometimes adding a piece of acellular dermal matrix like Strattice (which should be spelled  $$$$trattice) will decrease the chance of another capsule.  And whenever there are several different approaches to a difficult problem, you can be sure that none of them works every time.

The only surgery I know of that will for sure prevent another capsular contracture is implant removal and total capsulectomy without implant replacement.  This definitive treatment is readily accepted by many of my older patients who are sick and tired of their nasty, rock hard and uncomfortable implants.  They look forward to being implant free.  For younger patients, however, this can be a very, very difficult thing to accept, especially if they were really, really flat to begin with.  I have at least one patient that comes to mind who had several capsular contracture related surgeries by me and finally we just threw in the towel and removed her implants along with her capsules.  Her breasts returned pretty much to their preoperative size and shape but let me tell you, her wallet was never the same.  A problem with capsular contracture can be very, very expensive and result in a lot of down time – off work, off exercise, off fun.  This particular patient went on to have some fat transfer several years later and did well.  She and I are both glad to have her implant saga behind us.

Just writing this post makes me feel like I never want to do another breast augmentation!  And then I think of the patient I saw in clinic this morning.  She was very, very flat chested and was too lean to consider fat transfer.  I inserted 250 cc low profile cohesive gel implants last week and this morning I could not wipe the smile off her face.  I think as long as there is Victoria’s Secret, there will be a demand for breast augmentation.  I am just grateful that implant technology keeps improving as does our surgical technique.  Hopefully sometime in the near future capsular contracture will be of historical interest only.

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, Plastic Surgery, Uncategorized

Silicone injections are deadlier than ever.

March 13th, 2018 — 2:34pm

Silicone has quietly become beauty’s own modern-day scourge. Here’s what you need to know about the infamous injectable.

From Haper’s Bazaar, January 30, 2018 by

We often write about—and unapologetically enjoy receiving—popular cosmetic injections, like line-relaxing Botox and hyaluronic acid fillers. Thankfully for our foreheads and lips, the FDA has deemed these injectables safe and effective. And we trust our board-certified dermatologists and plastic surgeons to administer these treatments 100 percent appropriately.

Marilyn Reed is spending 8 years in prison for her buttock enhancements done with industrial grade silicone and a calking gun. Her patients didn’t get off so easily.

But a disturbing number of news reports have surfaced detailing unlicensed providers injecting all kinds of life-threatening stuff—from industrial silicone to lamb fat—with the goal of Kardashianizing women on the cheap. The FDA issued a safety alert late last year warning the public of the catastrophic risks involved with liquid silicone injections in particular.

All over the country, “people are dying from these shots,” said Beverly Hills liposuction surgeon Aaron Rollins, echoing statements in the FDA alert. Silicone, a permanent synthetic substance, is not FDA-approved for cosmetic purposes, but since it was greenlighted in the 1990s for certain uses in ophthalmology (serious stuff, like retinal detachment), injecting it into the skin to plump and fill lips, breasts, and butts is technically considered “off-label”—i.e. not illegal.

Still, the insidious goo is an infamous troublemaker. “I wouldn’t touch it with a ten-foot pole,” adds Rollins. “It may look good at first, but over time, the body forms scar tissue around it, so the injected area keeps growing and growing, as the silicone weaves its way into your tissues, becoming lumpy and hard, and nearly impossible to remove.”

Subtract an experienced injector from the equation, and silicone goes from dicey to deadly. “You hear about these so-called pumping parties at hotels, where unlicensed doctors visiting from other countries are injecting patients with massive doses of silicone,” says Dr. Clyde Ishii, president of the American Society for Aesthetic Plastic Surgery (ASAPS). “They’re literally buying it from Home Depot or Lowe’s,” he explains, “because it’s so much cheaper and easier to get than medical-grade silicone.” To lower their cost even more, some of these unlicensed doctors mix in toxic filler-type materials, like cement and motor oil, says Miami dermatologist Manjula Jegasothy. “Even in Beverly Hills,” notes Rollins, “there are people using caulk guns to inject stuff into women’s bodies, and tragic things are happening.”

It’s not uncommon for these unlicensed practitioners—inexperienced with human anatomy—to inadvertently shoot silicone into a blood vessel. And when they do, it can travel to the heart or lungs, blocking blood flow, and causing sudden heart attacks and strokes. The risk is especially high when injecting the vascular buttocks. Yet, for some, silicone’s price tag is just too good to pass up. According to Atlanta plastic surgeon Wright Jones, “Silicone butt injections may cost a tenth of the price of a legal gluteal enhancement using one’s own fat”—which is currently regarded as the most effective way to boost a backside. A Brazilian Butt Lift, using liposuction and fat transfer, can cost upwards of $10,000.

In light of the recent wave of silicone horror stories, and with butt augmentation fast becoming one of the most popular plastic surgery procedures in the U.S., not to mention a burgeoning business for untrained injectors, the Aesthetic Surgery Education and Research Foundation (a division of ASAPS) felt compelled to publish a safety protocol for gluteal fat grafting in the current issue of the Aesthetic Surgery Journal.

That’s not to say fat is the only safe solution for a shapeless bottom. Many dermatologists and surgeons do use FDA-approved cosmetic fillers “off-label” here— to either produce an immediate, yet temporary, lift from hyaluronic acid gels; or a gradual, long-term improvement from the collagen-stimulating Sculptra (which is currently only approved to soften the appearance of nasolabial folds). But such shots can be wildly expensive.
Which brings us back to silicone and its unfortunate recipients, many of whom are millennials, says Jones. At age 22, Heather*, a model in Los Angeles, visited a Koreatown medical spa for silicone butt injections. “I was booked to do a big photo shoot, and wanted my bum to look perkier,” she says.

About six months later, she noticed several golf ball-size lumps in her bottom, a common side effect of silicone. On the advice of a trusted friend, Heather says she went to see Rollins, who was able to camouflage the hills and valleys by liposuctioning fat from her arms and injecting it into her butt—an $8,000 fix.

Lips have long been another hot spot for silicone. Tired of having to draw on a juicer pout each morning, Madeline paid $50 to have her lips injected with silicone in a salon basement in Queens when she was 26 years old. Now 40, she says, “I feel like I messed up my mouth for the rest of my life.”

The size and shape of her lips change daily, often with the weather. “Usually in summer [the silicone] lays okay, but in the colder months, it moves around a lot, and concentrates in one area, bulging out.” To have her smile repaired will cost roughly $10,000, she’s been told, and surgeons can’t promise a total improvement.

Cosmetic injections should only be performed by board-certified dermatologists or plastic surgeons. If your injector is not, ask thorough questions about their training and experience. How many years have they been injecting patients? What formula are they using? If you’ve found the injector through a bargain website or coupon—the deal is likely too good to be true. The bottom line: Heed the warnings. “Don’t allow silicone into your body—ever,” says Rollins. At best, “you’ll be buying a problem for the rest of your life.”

Now a word from Dr. Sowder:  The above article is very well written and is not, I repeat, is not alarmist.  People are dying from these injections and others are being maimed for life.  I have taken care of a couple of ladies who had silicone injected into their breasts in Asia and cleaning this up is such a mess.  Whenever I hear about another silicone injection disaster, usually done by a non-physician in some hotel room, I just shake my head.  I mean, really, how dumb can you be?  I do not endorse blaming the victim but in cases like this I think the person allowing a charlatan to inject their butt or breast with silicone bears some responsibility.  Those on the other end of the calking gun need to go to jail and many in fact have.  The lesson here is that you get what you pay for.

Kudos to Ms. Edgar for a cautionary tale and to Harper’s for publishing it.  Thanks for reading and don’t let anyone get near you butt or breast with a calking gun!  Dr. Lisa Lynn Sowder

 

Body Contouring, General Health, Patient Beware, Patient Safety, Plastic Surgery, This Makes Me Cranky.

Being a woman and a surgeon isn’t always easy but it sure beats the alternatives: Being a woman and not being a surgeon or being a surgeon and not being a woman.

January 16th, 2018 — 2:36pm

I participate in a few doctor only on line message boards and forums.  A topic that has been front and center the past few months has been the #METOO movement and some of the challenges women in medicine face.  I’d like to share a few of my own stories.  Fortunately none of them include Harvey Weinstein.

I finished medical school in 1983.  1/3 of my graduating class were women.  These days women comprise more than 50% of most medical school classes.  I did my general surgery residence at the University of Utah, not exactly a bastion of progressive ideas.  Surprisingly about 20% of the surgery residents were women.  I felt very little discrimination but maybe I was just to busy and exhausted to notice?  I did get a couple of evaluations that I thought were just hilarious and still do. They were both from the Latter Day Saints (Mormon) Hospital.  One described me as “defensive, argumentative and with a chip on my shoulder”.  The other described me as “a sharp little gal”.  My boyfriend at the time just about split a gut laughing when he saw these. He was also a general surgery resident and never got such amusing reviews.

I had a few interesting experiences with male patients.  When I was doing an Intensive Care Unit rotation as a wet behind the ears intern at the University Hospital, I helped with a middle aged Mormon Elder who was crashing badly from acute pancreatitis.  (If you have never heard of this disease, count yourself lucky).  I was cleaning his penis in preparation to place a catheter so we could monitor his urinary output.  This man was very ill and a little delirious.  He looked at me and said “Doc, I’ll give you 10 minutes to stop that”.  It never crossed my mind to take offense at this.  It added a bit of levity (ha, ha) to a very serious situation.  I got to know this gentleman quite well during his ICU stay and he was a totally stand up guy.  On the gastroenterology rotation during my third year, I was doing a colonoscopy on an elderly man and he twisted his torso and neck to look me right in the eye and asked “What is a pretty little thing like you doing here?”  At the time, I thought that was actually a very good question!  This fellow grew up in a time where women rarely worked outside the home and certainly did not become surgeons.  Again, since I was the one with the scope, I felt no animosity towards him.

Dr. Henry Neal in 1990 with his girl residents, me, Sue Wermerling and Kimberley Goh. Can you tell that he secretly loves us?

My first year of my plastic surgery residency (after 6 years of general surgery) three of the four residents were women.  This was a fluke of the computer based residency matching system.  The chairman of plastic surgery, Dr. Henry Neale was a good old boy from the south.  He kept a bull whip in his desk drawer.  Really.  He was a great surgeon and ran a powerful department.  We operated our brains out and he had our back every day.  Dr. Neale was very, very politically incorrect.  He pondered if Sue, Kim and I would start cycling together and once stated he should put a Kotex machine in the resident’s office.  Well, the three of us just dished it right back at him and we did end up cycling together.

There was one occasion where I really felt harassed.  I was a 4th year general surgery resident on call at a private hospital in Ogden, Utah.  Late one night there was knock on my call room door.  I opened it to find an elderly staff surgeon with alcohol on his breath with a fifth of Southern Comfort (yuck!) in his hand.  He wanted to know if I wanted to party.  This scene was so ludicrous that I laugh out loud just thinking about it.  Most residents given the choice of sleep vs. party would pick sleep no matter whom was holding the bottle.  This man’s son was a medical student who had rotated on my service a few months previously.  I told the party hound horn dog that he had three seconds to leave or I would tell his son.  I think he was gone before I hit “two”.  I never assisted him on a case again which was no loss on my part because he was a lousy surgeon.  No, I did not file a complaint or make a fuss of this.  Again, he grew up in a different time.

I’ve had a few really weird patient encounters in private practice related to my gender.  Years ago when I was pregnant with my twin sons and could barely fit through a door, I had a mentally unstable older man with a skin cancer on his scalp the size of a poker chip.  This, gentle readers, is what we surgeons call a GREAT CASE.  The mentally unstable older man was quite the cad with many comments about my huge belly and the certain studhood of my husband.  He also had many bizarre ideas about selenium deficinecy and sexual function.  I was not sad to send him on his way once he had healed.  A few years later I had an elderly woman come in with another neglected and ginormous skin cancer who shrieked when she saw me and declared that “women are stupid and I won’t have one for my doctor”.  Oh well, that great case went to my partner who has a Y chromosome.  She was nasty to him too.

As I write this blog, I can’t really think of any weird encounters in recent years.  I think in the 26(!) years since I started practice that being a woman surgeon or woman astronaut or woman programmer or even race car driver has become sort of a no big deal which suits me just fine.  Recently my 17 year-old daughter took a field trip with her computer science class to the Microsoft campus just outside of Seattle.  She attends an all girl high school and they were given a tour by an all female coding team.  The advice given to these bright young students by these bright young and not-so-young techies was to work hard, advocate for yourself and don’t take things too personally.  I think that is good advice regardless of your gender or your workplace.

Thanks for reading and follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder, girl surgeon.  And there will be an upcoming blog about delayed childbearing which is something I don’t recommend but sure worked for me.

General Health, Government and Politics, It's All About Me., Plastic Surgery, Surgical Eductaion

Happy Thanksgiving

November 15th, 2017 — 8:49am

 

’tis the season of Thanksgiving. 

Here are a few things that this plastic surgeon is thankful for……….

  • Modern Anesthesia.  This makes for painless surgery.  And the surgeon can take her time to do a really, really nice job.  During the Pilgrims’ time, the main qualification for being a surgeon was to be really, really, really fast. Yikes!
  •  The Germ Theory and Antibiotics.  Surgery used to mean infection.  Now surgical infections are rare.  Not rare enough, but rare.
  • The Bovie.  This is the electrical gizmo that seals blood vessles as it cuts.  This is why you don’t need a blood transfusion when I do your Mommy Makeover.
  • Surgical Scrubs.  It’s like working all day in my pajamas.
  • My Dansko Clogs.  It’s like working all day in my slippers.
  • Surgical Loupes.  These are my silly looking magnifying glasses that allow me to see important teeny tiny things like nerves and blood vessels.  They also come in handy for reading the newspaper when I can’t find my reading glasses.
  • My Battery Powered LED Surgical Headlight.  Now I don’t have to be attached to the light source by a fiberoptic tube (which is how my dog must feel on her leash).
  • Power Assisted Liposuction a.k.a. PAL.  This PAL is a true friend.  It makes liposuction so much better for the patient and the surgeon. 
  • My Wonderful Staff and Colleagues.  They keep me on my toes.
  • My Wonderful Patients.  They are why I love coming to work!
  • My Wonderful Husband and Children.  They are why I love going home in the evening.

Thanks for reading!  Dr. Lisa Lynn Sowder

Now That's Cool, Plastic Surgery

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