Women's Plastic Surgery blog is an informational and educational blog discussing the latest in Plastic Surgery and non-surgical aesthetic techniques and trends for women, breast cancer survivors, and the public in general.
I interviewed three fantastic local (Bay Area) Breast Surgeons with whom I work closely on breast reconstruction cases. Each was asked a short series of questions about their opinion of the new guidelines, and how their practice may be affected.
Read on! (click on each page for a larger, more clear version of the magazine text)
The full article including links to my website and additional information can be read here:
INTERVIEW QUESTIONS DR. KAREN HORTON:
Q: WHAT PROMPTED YOU TO START YOUR OWN PRACTICE, AND HOW LONG HAVE YOU BEEN IN BUSINESS?
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 www.womensplasticsurgery.com 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.
Q. WHAT IS YOUR AREA OF EXPERTISE?
I am a Board-Certified Plastic Surgeon and Reconstructive Microsurgeon, practicing in the PacificHeights 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.
Q: WHAT WOULD YOU SAY IS THE MOST SIGINIFICANT ADJUSTMENT THAT WOMEN HAVE AFTER SURGERY?
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.
Q: IT SEEMS THAT PLASTIC SURGERY IS A MALE DOMINATED INDUSTRY HOW HAVE YOU BECOME SO SUCCESSFUL?
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.
Q. WHAT HAS BEEN THE MOST CHALLENGING PART OF STARTING YOUR PLASTIC SUGERY BUSINESS?
In MedicalSchool 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.
Q: WHAT ARE SOME OF THE MILESTONES YOU HAVE ACHIEVED IN THE PAST YEAR?
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".
Q. WHAT IS THE MOST COMMON MISCONCEPTION ABOUT PLASTIC SURGERY?
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".
Q. WHAT ADVICE WOULD YOU GIVE TO A YOUNG WOMAN LOOKING TO WORK IN YOUR FIELD?
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 MedicalSchool, 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.
Q. WHAT IS THE REWARDING PART OF YOUR OCCUPATION?
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!
Q. WHAT TRENDS TO SEE HAPPENING IN YOUR INDUSTRY?
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!
Q. HOW DO YOU SEE YOUR PRACTICE EXPANDING IN THE NEXT 5 YEARS?
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!
Q. HOW HAS SOCIAL NETWORKING AFFECTED YOUR FIELD?
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!
A breast reduction is a wonderful procedure and is one of the MOST satisfying operations a Plastic Surgeon offers!
What is a breast reduction?
Breast reduction is also called "bilateral reduction mammaplasty" (BRM)
A breast reduction will relieve symptoms from excessive breast size and weight (hypermastia)
Following breast reduction, breasts are more proportional to the rest of the body, and clothes fit better
Breast reduction has tremendous psychological benefits!
What are the symptoms of hypermastia?
Breast pain
Back pain
Shoulder pain
Shoulder grooving from bra straps
Rashes beneath breasts (intertrigo)
Poor posture
Inability to do sports or physical activities
Self-consciousness about breast size
Inability to fit into clothing
How is a breast reduction done?
Breast reduction surgery takes around 3 hours and is done in the hospital under general anesthesia (GA). An overnight stay is usually recommended.
During surgery, excess breast tissue, some skin and fat are removed. The nipple and areola are often reduced in size and are moved to a higher, more aesthetic position on the breast.
A good blood supply, nerve supply and ductal supply is maintained to the nipple so that it retains as much sensation as possible and to encourage the ability to breast feed in the future.
All stitches (sutures) are dissolving.
Who is a good candidate for a breast reduction?
Women who have breasts that are very large in proportion to the body frame
Heavy, pendulous breasts with nipples and areolas that point downward (breast “ptosis”)
One breast much larger than the other
Symptoms of hypermastia
Dissatisfaction or self-consciousness about breast size
What is the recovery like after breast reduction?
After surgery, avoid lifting more than around 5 pounds for 2-3 weeks. You can expect some swelling and bruising that will gradually resolve.
You will likely have IMMEDIATE relief of your symptoms of hypermastia! Most women feel immediately lighter and often exclaim, "Why did I wait so long?!"
You will have a temporary decrease in sensation that will take months to years to recover. You may not regain full sensation, depending on the amount of tissue removed and the original size ad shape of your breasts.
The incisions will initially be bumpy and raised, and flatten within 6 weeks. After this, they form scars that take up to a year or more to "mature".
What are some of the potential risks of breast reduction surgery?
Sensation change
Scars
Breast asymmetry
Ability to breast feed
Things to remember about breast reduction:
Breast reduction will make your breasts smaller, lifted and firmer.
Reduction of breast size often enables greater enjoyment in playing sports and engaging in physical activity.
This procedure often makes a dramatic change in appearance. It can take some time to adjust to your new body image. Be patient and allow your body to heal for up to one year until you accept the results as 'final'.
For additional information, please visit:
American Society of Plastic Surgeons (ASPS) website
American Society for Aesthetic Plastic Surgery (ASAPS) website
d areola are often reduced in size and are moved to a higher, more aesthetic position on the breast.