Thursday, February 25, 2010

Online Article with Dr. Karen Horton of Women's Plastic Surgery - Neko Cheri and NC Mag Online

I was recently interviewed by Neko Cheri about my experience being a woman Plastic Surgery and in starting my practice and business in San Francisco.  



Neko Cheri is the creator of NC Mag, "The intelligent woman's guide to sophisticated living", an online publication for women, by women.

She also hosts a live online talk radio show, Neko Cheri LIVE on Blog Talk Radio.  Check her out!

The full article including links to my website and additional information can be read here:

            I completed a long, but very rewarding 16 year road of University study to become a Plastic Surgeon, and started my private practice in Plastic Surgery in 2006.  I am one member of a unique, all-woman Plastic Surgery practice, "Women's Plastic Surgery".  See our website for more information. 
            Starting your first job at the age of 35 was quite different from many of my friends from college and peers in the community; however I wouldn't have done it any other way!  I am exciting to get out of bed each day and to go to work, something that many others can't relate to! 
            When considering the options for employment, I considered different types of practice, including academic University life, an HMO setting (like Kaiser Permanente), a large group practice, or private practice. 
            For me, private practice was the best fit, in that it enabled me to develop a specialized practice, focusing on the areas of Plastic Surgery I am most passionate about, and to deliver the best patient care, in a personal setting. 

            I am a Board-Certified Plastic Surgeon and Reconstructive Microsurgeon, practicing in the Pacific Heights area of San Francisco.  I specialize in both reconstructive surgery and cosmetic surgery for women.  Visit my bio for additional info about my background and training. 
            At least half of my practice focuses on breast cancer reconstruction, using new techniques that are not yet widely performed in the United States.  One technique for reconstruction of the breast involves a single-stage procedure using an implant, giving women a natural result without the need for multiple surgeries.  Another novel technique involves Microsurgery to reconstruct the breast using the body's own tissue, usually from the lower abdomen or inner thigh area.  This option avoids the use of implants, and provides a permanent, soft and living tissue reconstruction, while adding the benefit of a tummy tuck or a thigh lift! 
            The other part of my practice focuses also on women, many of them Moms!  The "mommy makeover" spectrum of procedures rejuvenates a woman's body after she has completed childbearing.  This type of surgery usually focuses on the breasts and body.  There are permanent changes after pregnancy such as breast deflation or drooping, loss of abdominal muscle tone, and/or excess skin and fat in the middle section or thighs.  Many of my patients are personal trainers, who also need a little help once they are mothers!
            A mommy makeover can include a breast lift, breast augmentation or breast reduction, depending on the changes of pregnancy and your specific aesthetic goals.  Because the muscles of the abdominal wall are permanently separated after pregnancies (particular after multiple children or twin pregnancies), a million sit-ups will not help!  A tummy tuck ("abdominoplasty") and/or liposuction is often recommended to bring the abdominal muscles back together in the midline, and to recreate a flat belly.
            Lastly, I see patients for general Plastic Surgery concerns: moles, skin cancers, and other body concerns.  Labiaplasty is one procedure I particularly enjoy!  Redundant labia minora tissue (inner lips of the female external genitalia) that hangs lower than the labia majora (outer lips) is trimmed for both cosmetic concerns and sometimes for pain during intercourse. 

            Any body-modifying surgery can have a major impact on body image and self-esteem.  Hopefully, the change is a positive one!  However, just like a drastic haircut, there can be a "body image adjustment" period or temporary feeling of remorse after surgery.  I counsel my patients at their initial consultation that this adjustment period of potential feelings of uneasiness, anxiety or "what have I done?" is completely normal and common after surgery.  It can take some time to adjust to your body after any surgery, and the most healthy approach is to acknowledge how you are feeling and to communicate this to your loved ones who are assisting you after surgery. 

            Many women come to see me after doing an internet search because I am a woman Surgeon.  I think many women feel most comfortable discussing their bodies, their body image and self-esteem, and their personal goals for surgery with another woman - with the same anatomy, and who can relate to them as a peer as well as their doctor. 
            I give every single patient who walks through the door or my practice my full attention and absolute care.  I get to know my patients intimately, and strive to understand them as a whole person.  I explore how their desire to modify a part of their body will affect their life, health, wellness and spirit, and I encourage realistic goals and objectives for surgery. 
            Each of my patients is given my personal cell phone number, and my patients are encouraged to contact me directly with any questions or concerns, no matter how big or small. 

            In Medical School and Residency, we are given NO business teaching or training!  Subsequently, it is a crash course in self-employment for most Physicians.  I am still learning about running a business, managing employees, hiring and firing, overseeing the books, etc!  Sometimes I wish I could just wake up with an MBA degree and naturally understand it all.  My business aptitude is a work in progress, but I'm enjoying the journey. 

            In the past year, I have helped literally hundreds of women become whole again after breast cancer, feel sexy and youthful again after pregnancy or aging, and to be more comfortable and confident in their own skin.  This provides such gratification to me; it's almost a bonus that I get to make a living doing this!
            Within five months of starting my practice in July 2006, I was covering my overhead and starting to make a profit, which is a feat in itself!  Since then, I have maxed out my practice schedule, and am fully booked in the operating room and in the office.  I now officially need to focus on "working smarter, not harder". 

            Any Plastic Surgery operation is a major deal.  Each procedure involves cutting and sewing, bruising, downtime, discomfort, and healing time.  Reality shows and celebrity gossip magazines often portray Plastic Surgery in an unrealistic light, minimizing the downtime and sensationalizing the results.
            In addition, many Hollywood celebrities who have had more than their share of cosmetic procedures (no names needed!), look abnormal and have lost their natural beauty.  The best Plastic Surgery does not make you look different, does not distort your facial features, and is not overtly obvious to any passer-by.  Most women seeking surgery in my office want a natural result, without looking "fake" or "done". 

            I had very few female Mentors during my training.  My father is a General Surgeon and was a breast cancer specialist, who undoubtedly influenced me, although he was a workaholic and hardly ever around!  My mother held a Ph.D. in Biochemistry, and instilled in my sisters and me the conviction that "you can be anything you want in life, except a Daddy!"
            I was raised to believe that I could achieve just about any career goals I wished, as long as I received good grades in school and worked hard.  My parents encouraged me to investigate other career fields, based on my interests of art and drawing, such as architecture and fine arts.  However, medicine and surgery was the best fit for me, based on my fascination with the human body, science and figuring out the way things work!
            A career in Plastic Surgery is difficult to enter and is fiercely competitive.  In Canada, my birthplace and location of training, only ten training spots are available each year, and the competition is intense.  Four years of undergraduate University, four years of Medical School, five to six years of Plastic Surgery Residency, and often a final year of Fellowship training are necessary before you can start your own practice. 
            I encourage students who are interested in learning more about Plastic Surgery to shadow me in the office and the operating room, and I regularly mentor young females who are considering a career in Medicine. 

            The most rewarding aspect of my career is helping people in an intimate and emotional way, every single day!  Plastic Surgery enables me to use my brain, my hands, my creativity and artistic talents, and my compassion and caring nature in the best possible way.  Helping others truly is my calling, and Plastic Surgery is the venue!

            Many non-surgical aesthetic treatments are increasingly being offered as an alternative to, or as an adjunct to surgery. 
            Examples are Botox, Dysport and other injectable agents that decrease muscle contraction and eliminate wrinkles, injectable fillers that help to fill lines in the face, that decrease the effects of aging around the eyes, and plump the lips or cheeks, and "laser"-type treatments that can help to tighten skin without surgery and to improve abnormal pigmentation of the skin.
            Nonsurgical treatments such as these can be a little less expensive than surgery, and can be a great option for women who are not ready for a facelift or eyelid lift surgery.  However, the effects are usually temporary, and over time, the expenses can add up!   Surgery sometimes is the correct answer; your Plastic Surgeon can help to determine which options will best achieve your goals!

            I will always be committed to breast cancer patients, and I intend to continue to perform breast reconstruction for women facing cancer throughout my career.  At this point in my practice, I am already extremely busy, I'm tired, but I'm thrilled about this! 
            I would like to expand my "mommy makeover" cosmetic practice and help many more Moms achieve their body image and self-esteem goals via surgery (once they have achieved their maximal results with a health diet and regular exercise).
            I am now ready to train a "Fellow" (fully trained Plastic Surgery graduate) and teach them all I know, and to eventually take on a Junior Associate in my practice!  I also plan to hire a Physician Assistant to enable me to be as efficient as possible and to share my responsibility with inpatient hospital rounds, office preoperative visits, phone calls, and weekend call. 
            I hope to start my own family soon, and having someone I have personally trained and trust to care for my patients in the same manner and degree as I do, will enable me to best juggle work and a family life.  I look forward to that challenge!

            There is a great deal of inaccurate information and gossip on the internet, particularly regarding Plastic Surgery.        
            I am active on Twitter and Facebook, and I use these resources as a way to reach out to other and to educate, inform and empower women (and men!) about what Plastic Surgery is and isn't, to discuss some of the latest controversies in Plastic Surgery, and to get the word out there about new surgical techniques that are the latest and greatest!
            I think social networking is great, as long as it is used with respect and professionalism.  Many of my patients "follow" me online, and it's important to remember that once an opinion or message is posted, it is out in cyberspace forever! 

Step-by-step animation about breast augmentation surgery!

The American Society of Plastic Surgeons (ASPS) has developed a new series of videos that detail the steps in many different Plastic Surgery procedures.  

One of my favorites is the animation on breast augmentation using silicone implants and a subglandular (under the breast approach).  This is the technique that I most commonly use for breast augmentation in my patients. 


Watch the animation here! (silicone implants, under breast incision)

The ASPS is a wonderful resource for individuals interested in learning more about Plastic Surgery in an unbiased approach, without emphasizing one particular surgeon or technique.

Only Board-Certified Plastic Surgeons can become members of the ASPS.  Learn more here.

To see additional before-and-after pictures of breast augmentation, visit our website gallery!

Monday, February 22, 2010

How are breast implants put in the body?

1.       In the fold under the breast (inframammary)
2.       Around the areola (periareolar)
3.       Through the areola and around the nipple (transareolar)
4.       Through the armpit (trans-axillary)
5.       Via the belly button (trans-umbilical)

Inframammary fold (IMF) incisions preserve the function of the function of the breast, namely breastfeeding and pleasure.  I use this incision most commonly for breast augmentation surgery.  

When an incision is made in the fold under the breast, the scar lies in a natural crease and does not tend to stretch or be raised, as can happen in other areas.  All structures leading to the nipple and areola (milk ducts, nerves, blood vessels) remain intact.  In addition, once an implant is inserted, it is probable during a woman's lifetime that another surgery may be required (to change the implant, remove it later in life, perform a breast lift with drooping, etc.).  Therefore, the scar is already present and this can be used again as an incision in the future.  

Many other incisions used for breast augmentation are only a one-time option, with the IMF incision required in the future.  The IMF scar is hidden in bras and even triangle-top string bikinis, and will only be visible up close when the breasts are lifted.

Peri-areolar incisions are usually around the bottom of the areola, the pigmented circle that surrounds the nipple.  There are bacteria that live in this area, and vital milk ducts and nerves in this region.  By definition, some of these structures will be divided (cut) during surgery, resulting in a higher risk of complications (infection, numbness, inability to breast feed, etc.).  In addition, if a woman makes raised scars, they may be visible beneath a tight shirt or through a bathing suit. 

Trans-areolar incisions also cut through breast tissue and/or ducts, blood vessels or nerves.  Nipple retraction can also result from scar tissue that normally forms after surgery.  For these reasons, I would not recommend this for most women. 

Trans-axillary breast augmentation makes an incision in the armpit, or axillary area.  This is often a one-time incision, that creates a scar in the area where most women shave, and is also a site of normal bacterial growth (hence deodorant use!).  The incidence of infection can potentially be higher, and this incision cannot be reused in the future for addition other surgery. 

Trans-umbilical breast augmentation (TUBA) is more of a gimmick than routine approach.  A long tube and scope with a camera must be tunneled beneath the skin of the belly button all the way to the area under the breast.  If there are any complications during surgery such as bleeding, or if the surgeon cannot adequately visualize what they are doing, a second incision must be made in the IMF.  Only a tightly rolled up saline-filled breast implant can be used (not silicone implants), it is also a one-time incision, and a long band of scar tissue beneath the skin is possibly visible after surgery - a permanent deformity.  I would never recommend this option to any of my patients. 

Thursday, February 18, 2010

The SAFETY and science of breast implants and SILICONE!

Most women who come to see me in consultation for breast augmentation have one major question:  "Is silicone safe???" 

I spend a great deal of time and effort in my practice educating women about their options for surgery, and when discussing breast augmentation, I emphasize that all implants, both saline- and silicone-filled, are SAFE.

In fact, silicone breast implants are the most extensively studied implantable medical device in the history of medical devices! 

All breast implants have a silicone shell; the fill material is what differs.  For most of my patients, I recommend silicone specifically, because it can have a more natural look and feel. 

The website is an excellent resource for women to learn all about breast implants.  I send each woman I see in consultation to this site to do some "homework" and to learn more about this medical device.

Here are some excerpts from the site (I encourage you to also visit the website for additional information):

The History and Uses of Silicone

Silicone is a highly versatile substance that has many medical uses. Different types of silicone have been used for decades in a variety of medical devices, such as pacemakers and artificial joints.

The Safety of Silicone and Silicone Gel-Filled Breast Implants

Silicone gel-filled breast implants are among the most extensively studied FDA-approved medical devices in existence. In the United States alone, Allergan has examined the safety of silicone gel-filled breast implants in more than 80,000 women.

Silicone and Silicone Gel-Filled Breast Implants: The FDA's Evaluation

The United States Food and Drug Administration (FDA) approved silicone gel-filled breast implants after reviewing a vast amount of scientific data. These data consisted of results from extensive preclinical testing, four years of data on 715 women from Allergan's Core Clinical Study, and a European study that evaluated implant rupture prevalence rates beyond 10 years1. In addition, countless published, peer-reviewed studies and research support the safety of silicone and silicone gel-filled breast implants. The FDA also considered in their decision the opinions of advisory panels made up of outside experts.

Free bonus gift (value $225) for my patients who choose silicone breast implants!!!

 I am happy to announce that Allergan, the company that manufactures Natrelle silicone breast implants, is offering a free bonus gift to each of my patients who receive silicone breast implants, effective January 2010!

Call my office and speak to Mary at 415-923-3067 for more information. 

Choose Natrelle® Gel and get your Bonus Gift* worth over $225 Natrelle®

Schedule your appointment now.
Ask your doctor if LATISSE® (bimatoprost opthalmic
solution) 0.03% is right for you. Prescription only.

Get free trials of VIVITÉ® Vibrance Therapy and

*Offer expires 6/30/10 or while supplies last.
Good for augmentation patients only.
Safety Information Natrelle®