Saturday, January 11, 2020

ENCORE #125! – The Reconstruction Era, Part 3


From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in June of 2013…

“It appears that the next event is breast reconstruction!”

Nope – it wasn’t...

After the “Get Healthy” step, there was the pre-operation step. That was a few days ago. During that meeting, the plastic surgeon was not ONLY encouraging, but also really helpful.

It put into my mind a scene from one of my favorite movies, “Doc Hollywood”. In it (in case you haven’t seen it), the young (QUITE YOUNG), Michael J. Fox plays a doctor moving from the gang violence and drug abuse of a downtown Washington, D.C. ER.

He gets the chance to interview at a fancy-pants Plastic Surgery clinic in Beverly Hills. During his first day on the job, the owner, Dr. Halberstrom (of Halberstrom’s (Plastic Surgery) Clinic), performing an obvious liposuction, “Nobody likes to admit it, but medicine's a volume business. Ninety-nine percent of what we do is boilerplate surgery. It means we can afford the one percent that's meaningful. Disfigurements, birth defects, hare lips. Cleft palates. You live for those moments.”

This is reconstruction after breast cancer – no movie stars; no facelifts; no liposuction. What nobler cause for a plastic surgeon?

What IS “plastic surgery” and why the heck is it called that?

FIRST off, “In the term plastic surgery, the adjective plastic denotes sculpting, and derives from the Greek πλαστική (τέχνη), plastikē (tekhnē), “the art of modeling” of malleable flesh.

From that, PS has a noble history, initially being used by the Indian surgeons Sushruta and Charak (in 800 BC!!!) to reconstruct noses for “resolving nasal trauma (blunt, penetrating, blast damage), congenital defect, and respiratory impediment”.

The Romans and the Greeks followed suit, then the British and the rest of Europe. The first American plastic surgeon repaired a cleft palate in 1827. During World War I, a New Zealand doctor named Harold Gillies working in London, invented many of the surgical techniques used in facial surgery today in order to rebuild the faces of soldiers injured in the war.

Two dozen other types of plastic surgery dominate the world today. In 2009, statistics were reliably gathered on plastic surgery for the first time: “The ISAPS Global Survey also establishes several important statistics with regard to the total number of board certified (or national equivalent) plastic surgeons practicing today; estimated to be 30,817. The total number of surgical procedures is projected to be 8,536,379 and the number of non-surgical procedures is estimated at 8,759,187  – bringing  the combined worldwide total of surgical and non-surgical procedures performed by board certified plastic surgeons to: 17,295,557. (This figure does not take into account surgical and non-surgical procedures performed by non-plastic surgeons.)”

As to breast reconstruction: “…dates back to the 1800s with an attempt to transplant a lipoma to a mastectomy site. Several techniques ranging from the ‘walking flap’ of Gilles to the free perforator flap using autogenous tissue for recreation of a breast ‘mound’ have been established and refined. The use of tissue expanders for breast reconstruction has also been perfected over the last three decades. Breast reconstruction, which was once admonished in the early part of the 20th century, has now become a routine choice for women undergoing breast cancer surgery.”

As Spock is wont to say (in both his past and present incarnations), “Fascinating.”


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