March 23rd, 2011 by RamonaBatesMD in Health Tips, Research
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Physicians and surgeons all agree on the link between smoking and postoperative complications. We don’t agree (or know) how much time is required between cessation of smoking and surgery for optimal risk reduction.
Dr.Thomas Fiala wrote a nice blog post, Smoking Cessation and surgical complications, recently discussing the 3rd reference article below.
Smokers that quit smoking before surgery had 41% fewer complications. The researchers found that each week of cessation increases the effect by 19%.
Trials of at least 4 weeks’ smoking cessation had a significantly larger treatment effect than shorter trials (P = .04).
Smokers that quit had lower rates of total complications, fewer wound healing complications, and fewer pulmonary complications.
Read more »
*This blog post was originally published at Suture for a Living*
March 9th, 2011 by RamonaBatesMD in Opinion, Research
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An outcomes article in the January 2011 issue of the Journal of Plastic and Reconstructive Surgery asks the question: “Are patients making high-quality decisions about breast reconstruction after mastectomy?”
The objective of the study was to “measure women’s knowledge about reconstruction and to evaluate the degree to which treatments reflected patients’ goals and preferences.” Their conclusion (bold emphasis is mine):
Women treated with mastectomy in this study were not well-informed about breast reconstruction. Treatments were associated with patients’ goals and concerns, however, and patients were highly involved in their decisions. Knowledge deficits suggest that breast cancer patients would benefit from interventions to support their decision making.
Granted the study was small, but it left me wondering if we the medical community fails to educate these women.
The study involved a cross-sectional survey of early-stage breast cancer survivors from four university medical centers. The survey included measures of knowledge about specific reconstruction facts, personal goals and concerns, and involvement in decision making. Only 84 patients participated (59 percent response rate). Participants answered only 37.9 percent of knowledge questions correctly. Read more »
*This blog post was originally published at Suture for a Living*
February 11th, 2011 by John Di Saia, M.D. in Health Tips, Opinion
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Liposuction (aka “lipo”) is plastic surgery’s “gimmick procedure” having had more angles applied to it than a child’s toy. But there’s money to be made in fat reduction, so the gimmicks will just keep coming.
Enter “tickle” lipo, a new technology superimposed on the liposuction game. In this newer version of the basic liposuction technique, the cannula — the instrument used to remove the fat — vibrates like a whip inside your fatty layers. This supposedly helps remove the fat more evenly and with less pain.
Tickle lipo looks like a hybrid between two other forms of lipo already on the market: Power-assisted liposuction (PALS) in which a motorized cannula breaks up the fat, and ultrasonic liposuction in which sound waves do it. Will tickle lipo be better or worse than its fat-sucking competitors? That will likely depend upon the technology and the skill of those who use it.
However, a funky high-tech instrument won’t make a non-surgeon into a master plastic surgeon, just like a hot race car won’t make you into Jeff Gordon. Check the credentials of anyone who wants to use this tool on you. At this point I would consider tickle lipo an experiment.
– John Di Saia, M.D.
*This blog post was originally published at Truth in Cosmetic Surgery*
January 27th, 2011 by John Di Saia, M.D. in News, Opinion
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From the Food and Drug Administration (FDA) safety alert yesterday:
ISSUE: The FDA announced a possible association between saline and silicone gel-filled breast implants and anaplastic large cell lymphoma (ALCL), a very rare type of cancer. Data reviewed by the FDA suggest that patients with breast implants may have a very small but significant risk of ALCL in the scar capsule adjacent to the implant.
BACKGROUND: In total, the agency is aware of about 60 cases of ALCL in women with breast implants worldwide. This number is difficult to verify because not all cases were published in the scientific literature and some may be duplicate reports. An estimated 5 million to 10 million women worldwide have breast implants. According to the National Cancer Institute, ALCL appears in different parts of the body including the lymph nodes and skin. Each year ALCL is diagnosed in about 1 out of 500,000 women in the United States. ALCL located in breast tissue is found in only about 3 out of every 100 million women nationwide without breast implants.
While the FDA’s new report is interesting, as it stands it’s of little consequence. A mere 60 cases of a unusual breast cancer worldwide is a tiny number compared to the huge number who develop the much more common ductal breast cancers (about one in seven women in the U.S.) Breast implants have not been found to affect this more common cancer incidence. I do expect this statistic to be misquoted by the anti-breast implant factions online.
As an aside, I do remember a case in a fellow plastic surgeon’s mother of a lymphoma near a breast implant capsule when I was a resident. This is the only breast cancer of this type I have ever seen, however, in 14 years of practice. While I don’t doubt the association, I do focus on the significance of this report to the average breast implant patient, which is very little at this point.
– John Di Saia, M.D.
*This blog post was originally published at Truth in Cosmetic Surgery*
January 26th, 2011 by RamonaBatesMD in Better Health Network, Research
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The Science Daily article entitled Body dysmorphic disorder patients who loathe appearance often get better, but it could take years discusses the disorder as highlighted in the Journal of Nervous and Mental Disease (JNMD).
The JNMD article reports the results of the longest-term study so far to track people with body dysmorphic disorder (BDD). The study was conducted by researchers at Brown University and Rhode Island Hospital. The good news? The researchers “found high rates of recovery, although recovery can take more than five years.”
This is a small study with only 15 BDD patients who were followed over an eight-year span. An excerpt:
After statistical adjustments, the recovery rate for sufferers in the study over eight years was 76 percent and the recurrence rate was 14 percent. While a few sufferers recovered within two years, only about half had recovered after five years.
The subjects were a small group diagnosed with the disorder out of hundreds of people participating in the Harvard/Brown Anxiety Research Project (HARP). Study co-author Martin Keller, professor of psychiatry and human behavior and principal investigator of the HARP research program which has been ongoing for more than 20 years, said that because the BDD sufferers were identified through this broader anxiety study, rather than being recruited specifically because they had been diagnosed with BDD, they generally had more subtle cases of the disorder than people in other BDD studies. In comparing the HARP study with the prior longitudinal study of BDD, it is possible that the high recovery rate in the HARP study is due to participants having less severe BDD on average.
About body dysmorphic disorder:
— In its simplest definition, it is an obsessive preoccupation with a slight, imperceptible, or actually nonexistent anatomic irregularity to the degree that it interferes with normal adjustment within society. Read more »
*This blog post was originally published at Suture for a Living*
