Monday, October 15, 2012


1846:  Anesthesia first used in patient care

1918:  Surgical Leadership and innovation advances in the care of wounded warriors
           during WW1. Dr Franklin Martin, the Mayo brothers, George Crile and
           William Halsted were instrumental in organizing field hospitals for the American
           Expeditionary Force.  Plaster casts were used to treat fractures.  Advances in
           the treatment of open chest wounds and empyema.

1924: Doctors Cole and Graham devise new method (X-rays combined with contrast media)
          to detect gall bladder disease.

1935: "Whipple Procedure" introduced by Allen O. Whipple, M.D. of Columbia University
          was used to treat pancreatic cancer.

1937: "Blood Bank" opens at Cook County Hospital in Chicago under the direction of
          Bernard Fantus, M.D.

1938:  First Congenital Heart Defect (ligation of a patent Ductus Arteriosus) corrected in a 7 year old girl in
           Boston by Robert E. Gross, M.D.

1939: Study published by Alton Oshsner, M.D. and Michael DeBakey linking tobacco use to Lung Cancer.

1939: Segmental lung resection by Edward D. Churchill, M.D. of Massachusetts General Hospital
          to treat tuberculosis.

1940:  Michael DeBakey invents roller pump for a direct donor-to-patient transfusion.

1942: Albumin is used to save burn victims in Pearl Harbor attack.

1942-1945:  Many advances in military medicine: early debridement of contaminated wounds; delayed
                    closure of wounds; improved air evacuation process for treating wounded soldiers.

1945:  "Blue Babies" successfully treated by Alfred Blalock, M.D., Vivien T. Thomas (surgical
            assistant) and Helen Taussig, M.D. (pediatric cardiologist).

1945:  First Surgical Procedure to correct coarctation of the aorta performed by Robert E. Gross, M.D..

1952:  First Open Heart Operation performed by John Lewis at the University of Minnesota.

1953: "Heart-Lung Machine" used to perform open heart surgery

1954: First successful Human Organ Transplant (Kidney) perfomed by Joseph E. Murray, M.D. at
          Boston's Peter Bent Brigham Hospital.  In 1990, Dr. Murray received the Nobel Prize for Medicine.

1954:  First Carotid Artery Surgery successfully performed

1954:  First Cross-Circulation Procedure successfully performed in which a patient's father was used as a
           living oxygenator during a procedure on a 13 month old boy.

1959:  Endoscopsy vastly improved through application of Hopkins rod-lens system.

1961:  Successful repair of a brain aneurysms reported by Canadian Neurosurgeon Charles Drake, M.D.

1962:  Hip replacement becomes established procedure with Sir John Charnley, M.D. leading the charge.

1964: First Coronary Artery Bypass graft procedure performed by H. Edward Garrett, M.D. and

1966: First Gastric By-pass procedure for weight reduction performed by University of Iowa Surgeon,
          Edward E. Mason, M.D.

1966: Prostate cancer treatment discovery captures Nobel Prize in Physiology and Medicine by Canadian
         Charles Huggins, M.D., professor of Urology at the University of Chicago.

1967: First Liver Transplant performed by Thomas E. Starzl, M.D. at the University of Colorado.

1967: First Human Heart Transplanted by Christiaan Barnard, M.D. in South Africa.

1968:  Infant kept alive through intravenous feeding: Stanley J. Dudrick, M.D. published a benchmark report
           in the J.A.M.A. on the use of intravenous feeding which proved that an infant could receive all
           nutrients by vein and still grow and develop.

1969: Artificial Heart successfully implanted by Denton Cooley, M.D. at Baylor College of Medicine.

1972:  First toe-to-thumb transplant by plastic surgeon Harry J. Buncke, M.D.

1972:  First Cochlear Device implanted by William House, M.D.

1972-1974: U.S. implements Emergency Medical Service System (EMS)

1973: Greenfield Filter introduced by Lazar J. Greenfield, M.D. which allowed trapping of clots
          to prevent pulmonary embolus.

1975: Radical Mastectomy no Longer a Standard Treatment for Breast Cancer

1981:  Burn Patient saved by artificial skin ("Integra")

1985: Robot-assisted surgery debuts to biopsy a brain lesion

1986:  Double Lungs successfully transplanted

1989:  General Surgery Revolutionized by the introduction of Laproscopic Techniques

1991:  Endovascular Technique introduced to repair aortic aneurysms.

1994:  First Face Replant Peformed by plastic surgeon  Abraham G. Thomas, M.D.
           when a 9 year old boy's face and scalp were pulled when caught in a thresher.

2011: Landstuhl Regional Medical Center's Trauma Center in Landstuhl Germany, an overseas military
          hospital treating American civilians and military in Europe achieved a Level I trauma status, the only
          medical center outside the U.S.A. to achieve this status.

2011:  Face Transplant performed in Boston during a 20 hour operation with a 30 member surgical team
           transplanting a new face to Charla Nash who loss her face in a vicious attack by a friend's pet

2012:  Nerve Transfer surgery gives quadriplegic patient partial use of his hand, performed by plastic  
           surgeon Susan McKinnon, M.D. at Barnes-Jewish Hospital in St. Louis.    

Thursday, October 11, 2012


Houston, Texas: From the Department of Plastic and Reconstructive Surgery, University of Texas M. D. Anderson Cancer Center.  Steven J. Kronowitz, M.D.; Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center, Unit 1488, P. O. Box 301402, Houston, Texas 77230-1402,

Background: Increasing numbers of patients with breast cancer are being treated with postmastectomy radiation therapy. The author reviewed the literature to determine the clinical impact of this increasing use of postmastectomy radiation therapy in patients with breast cancer who desire implant-based breast reconstruction.

The author searched the MEDLINE database for articles on breast reconstruction and radiation therapy published between January of 2008 and June of 2011 and reviewed the abstracts of those articles to identify articles with information about the impact of irradiation on implant-based breast reconstruction. This subgroup of articles was reviewed in detail.

Results: Two hundred eighty-five articles were identified. Nineteen articles were reviewed in detail. Eight articles provided level III evidence; one provided level I or II evidence from high-quality multicenter or single-center randomized controlled trials or prospective cohort studies. Two articles provided level IV evidence from case series and were included in the review because they offered a novel approach or perspective. The most recent studies find a significant need for unplanned or major corrective surgery in irradiated breasts reconstructed with implants. Although breast implant reconstruction in irradiated breasts is associated with high rates of complications, only a minority of patients require conversion to an autologous tissue flap.

Conclusion: Although the majority of patients who undergo implant-based reconstruction and irradiation ultimately keep the implant reconstruction, patient surveys show that irradiation has a significantly negative effect on patient satisfaction.

Wednesday, October 10, 2012


In the quest for perfection and amid a growing obsession with body image, it seems women now have a new part of the anatomy to worry about - their vaginas. Genital plastic surgery is one of the fastest-growing areas in cosmetic surgery, and one of the most popular procedures being requested - mostly by young women - is a labiaplasty. A labiaplasty - or labial rejuvenation - is a procedure whereby the inner labia, or labia minora, get trimmed back so they look more "tucked in". The surgery is generally done under a local anaesthetic, so the patient is awake while it is being performed. The process takes around 90 minutes and you can walk out of the surgery, returning to normal activities within a few days - except for sex, which you should hold off having for four to six weeks. The reason for the rise: "There has been a huge surge in the past five years of people looking to get genital surgery, and the vast majority of these are getting a labiaplasty, vaginoplasty (vaginal tightening) or liposuction in the pelvic area or labia," says Dr Laith Barnouti, a leading Sydney plastic surgeon. Barnouti says that currently around 20 per cent of his clients are coming in for genital surgery. The youngest to date was 14, the oldest in her mid-60s. A 2010 report also found that the number of clinically necessary procedures - that is, not solely for cosmetic reasons - performed by private practitioners nearly doubled in recent years.

So why are women requesting this procedure? There are a few reasons, says Barnouti, including feeling "socially embarrassed… people can’t wear certain types of bathers, people feel embarrassed in intimate situations". But the reasons go beyond the aesthetic, he claims.

"Labiaplasty and vaginoplasty are often performed due to a medical condition - people actually have it for a functional reason," Barnouti says. "Labial hypertrophy - enlargement or sagging of the labia - can be unhealthy and unhygienic."

Vaginoplasty, which is usually performed on women who have a weakened perineum after giving birth, is a "restorative, reconstructive procedure", says Barnouti. "This is something completely different from, say, liposuction, which is a purely cosmetic procedure."

What is normal? But are women having genital surgery for other reasons - to please a boyfriend perhaps, or because they feel their vagina is not normal? Do women actually hate the appearance of their vulvas so much that they will have parts of them surgically removed? The 2008 UK documentary The Perfect Vagina explored the reasons why women opt for this type of surgery, and found that many do it because they’ve been teased by someone close to them about the way their genitals look, or have just decided their vagina looks abnormal. In the documentary, Professor Linda Cordoza, a leading UK gynaecologist, says while women are much more aware of what’s available in terms of plastic surgery procedures, it doesn’t necessarily mean they know what’s normal.

"There’s been a huge trend towards bikini waxing, doing things with your pubic hair as well as the hair on your head. So [women think] if you can have cosmetic surgery done to your face, you can also have cosmetic surgery done on your genitals," Cordoza says.

"I sometimes get two or three generations of women in the same family coming in saying they want their labia trimmed."

The role of pornography:
Our perception of what is normal is most definitely clouded by the proliferation of pornographic images featuring women with smaller, tucked in - and often heavily airbrushed - private parts.As women, we don’t often see vaginas other than our own, so if the only images we see are of highly airbrushed genitals, naturally many of us are going to assume that what we have is "different" or "abnormal".

Melinda Tankard Reist is a media commentator and author of Big Porn Inc and Getting Real - Challenging the Sexualisation of Girls (Spinifex Press). She believes pornography is a big driver in the rise in cosmetic surgery."Girls are made to feel inadequate and think that there’s something wrong with their perfectly natural, healthy bodies. And boys are expecting girls to provide the porn star experience," Reist says.
Reist adds that it’s important women pass on positive body image messages to their daughters, and that cosmetic surgeons should play their part by refusing to operate on very young women, rather than "capitalising on the body angst of girls".

Barnouti says women contemplating any type of cosmetic surgery should be doing it for themselves, not anyone else. "What we do here is for the patient, not their partner," Barnouti says. "If you’re going to have a procedure, have it for yourself. Just because someone makes a negative comment doesn’t mean you should change your whole body."

"I had this surgery and love the results": Lisa Smith, 23, recently had genital surgery at the Ashley Centre in Melbourne. "Labiaplasty is something I’ve wanted to do for years. I have never had a problem with how I look, nor have I received any negative comments from partners. For me it was about feeling discomfort and swelling in that area, particularly after sex. The procedure wasn’t uncomfortable and I was surprised by how minimal the pain was, especially considering how sensitive that area is. I am a dancer and I’ve talked to a lot of friends about it and many say they have also had it done. It’s just not something people are talking about very openly yet."

Did you know? This type of surgery gets 74,000 global monthly internet searches on Google.


A Florida woman's quest for more youthful skin turned deadly this past July when her face became dangerously swollen after she received vitamin injections at a day spa.

Isabel Gonzalez paid nearly $900 for "facial rejuvenation" injections at Viviana's Body Secrets Spa in Doral, Fla. After receiving the treatments, her face started to swell and became infected, and she soon landed in the hospital, where she spent more than two months. Doctors fear her face may be permanently deformed.
The spa owner, Viviana Ayala, was arrested this week on charges that included aggravated battery and practicing medicine without a license, according to a report from the Doral Police Department. Ayala wasn't trained or certified to deliver facial injections. She wasn't even a licensed massage therapist as she advertised on her website. Ayala, according to the Miami Herald and other news sources, has denied all charges against her. Neither Ayala nor her lawyer, Milena Abreu, could be reached for comment.

Experts are alarmed at the increasing number of people seeking such cosmetic procedures. According to the organization Cosmetic Plastic Surgery Research, more than 8 million people underwent cosmetic treatments to freshen up their appearance last year. Treatments included Botox, chemical peels and laser skin resurfacing, and consumers migtht not be aware of the risks. Isabel Gonzalez remains in the hospital after  after receiving facial rejuvenation treatments from an unlicensed spa owner.

"Cosmetic procedures are now so mainstream there's a misperception that it's like getting your hair done," said Dr. Leo R. McCafferty, a board certified plastic surgeon who is president of the American Society for Aesthetic Plastic Surgery. "They are inherently safe, but this is predicated on [their] being delivered by properly trained professionals in a properly equipped facility."

ASAPS recommends that cosmetic procedures be performed only by board certified plastic surgeons or dermatologists in an accredited facility, although some states al/so allow registered nurses and physician's assistants to deliver therapies under doctors' supervision. Members of the ASAPS, and similar professional organizations, are required to operate only in certified centers or hospitals.

Some spas meet these criteria, but even if a facility brands itself a "medispa," that's no guarantee of proper oversight. A clinic may claim it's affiliated with a board certified plastic surgeon, but a surgeon might only show up to check charts once a month. Or a spa may try to pass off a practitioner who has no medical training as a cosmetic surgeon. Although this is illegal in some states, McCafferty said, no one's really checking.

Dr. Nima Patel, a plastic surgeon at Maimonides Medical Center in Brooklyn, N.Y., said spas can mislead consumers in other ways, too.
"Most people know they probably shouldn't get an injection from the same person who gives them a massage but don't think twice about letting a dentist or a physician who doesn't have intensive training in a cosmetic specialty give them an injection," she said. "In some spa settings, this is who is delivering the services."
Patel also emphasized the importance of making sure the attending professional maintains privileges at a nearby hospital and remains on the premises when cosmetic procedures are done. If there are side effects or complications, a patient can be transferred to the emergency room.

Dr. Felmont Eaves, a Charlotte, N.C., board certified plastic surgeon in private practice, advised any consumer considering any type of cosmetic touch-up to do their homework. "Check out the credentials of anyone performing or overseeing your treatment and know the risks of the product you are considering," Eaves said. As for bargain hunting, Eaves warned against it.


During October, pink ribbons seem almost as ubiquitous as jack-o'-lanterns. If that's any indication of breast cancer awareness, knowledge of the disease must be at an all-time high. However, one aspect of recovering from breast cancer remains obscured by lack of information and a degree of stigma: breast reconstruction. A 2008 study revealed seven out of 10 breast cancer patients are not told their options for post-mastectomy reconstruction.

  "We don't do an adequate job informing patients about what's going on," says Dr. Scott Sullivan, a general and plastic surgeon and co-founder of the Center for Restorative Breast Surgery. "The general surgeons are the gatekeepers (for reconstructive surgery), and they may not know the options or may choose not to discuss it. A community hospital may not have a plastic surgeon around, and even in some big cities, the quality of the surgery is not what it should be."
  Two-time breast cancer survivor Kim Sport knew about her reconstruction options because she was an active volunteer in the cancer community. It wasn't until after her mastectomy and reconstruction that she learned this made her a bit of an anomaly.
  "I didn't know that doctors weren't telling their own patients they didn't have to live with disfigurement after a mastectomy," says Sport, who created Breastoration, an organization that sheds light on breast reconstruction. "I was so outraged by it. I can't imagine looking down and dealing with disfigurement as a daily, constant reminder that at two times, I had a life-threatening disease."
  Sport and Dr. Malcolm Roth, president of the American Society of Plastic Surgeons (ASPS) and chief of the division of plastic surgery at Albany Medical Center, say that some surgeons may intentionally or unintentionally lead women to believe that breast reconstruction is an unnecessary or narcissistic cosmetic procedure.
  "The fact that we have mandated insurance coverage takes (reconstruction) out of the realm of cosmetic surgery and makes it medically necessary procedure for a woman's physical and emotional well-being following her mastectomy," Sport says.
  Roth says not only does reconstruction pose no risk to survival in suitable patients, it also aids recovery.
  "Women who have immediate reconstruction are more likely to return to work and social situations faster, have less chance of depression, and the quality of life gets back to normalcy much faster," Roth says. "So it may actually be better to do it immediately, though in some cases it is better to wait. A board-certified plastic surgeon is knowledgeable about that and collaborates with the oncologist, the breast surgeon, about what the best road for her may be."
  There are a number of sophisticated techniques for breast reconstruction, with implants being the most common, according to Dr. Frank DellaCroce, co-director of the Center for Restorative Breast Surgery. Cohesive silicone gel or saline implants and supportive collagen are placed immediately following the mastectomy. Often, the skin and nipple can be spared, though sensation and functionality are lost. Fat transplant procedures involve transferring fat from the stomach or hips to create a natural feeling breast from living tissue that responds to weight gain or loss. The operation and recovery are longer than with implants — five or six hours in surgery compared to one or two, and a hospital stay that's two days longer — but fat transplants never wear out or need to be replaced.
  "Plastic surgeons are at the ready with super-sophisticated technology that women need to know about," DellaCroce says. "And they need to know about them before they need them, ideally."