By SARA ARTHURS
As soon as Dr. Subhash Patel tells someone he’s a plastic surgeon, “the first thing that comes to mind” is people getting their nose fixed, he said.
But plastic surgery involves a lot more than just nose jobs and tummy tucks, although that is part of the work, too. Plastic surgeons also help patients with damage caused by burns, dog bites and skin cancer.
“In reality, unless you are in Beverly Hills, most plastic surgeons do more than 50 percent of their work which is medically necessary,” Patel said.
Patel, who performs surgery at Blanchard Valley Hospital and the Findlay Surgery Center, said his practice is about 80 percent medically necessary procedures and 20 percent cosmetic procedures.
Medically necessary procedures might include treating skin cancer or injuries such as burns or lacerations, and breast reconstruction after a mastectomy. Cosmetic surgeries may include breast augmentation, abdominoplasty (tummy tuck), liposuction or rhinoplasty (nose surgery).
Nationally, the American Society of Plastic Surgeons found an increase in both cosmetic and reconstructive procedures in 2013 compared with 2012. The society reports a total of 15.1 million cosmetic procedures, including not only surgery but other procedures such as Botox injections, and 5.7 million reconstructive procedures.
Blanchard Valley Hospital and Bluffton Hospital have not seen an increase but both are kept busy with plastic surgeries, with skin cancer treatment and breast reconstruction among the most common.
Dr. Mark Mathieson, based in Lima, performs plastic surgery at Bluffton Hospital. Mathieson said much of it is cosmetic surgery including breast augmentation and liposuction, especially in the spring and early summer. He also does breast reconstruction and treats people with skin cancer.
He has encountered the same assumptions as Patel.
“Sometimes they forget we do breast reconstruction … lots of major skin cancer surgeries and melanoma surgeries,” he said.
Increasingly, women who have a mastectomy are able to get “tissue expanders” at the same time. Patel works closely with general surgeons to coordinate these surgeries.
With a tissue expander, the patient is given a temporary prosthetic breast, stretching their own muscle and skin to prepare for a permanent prosthetic.
A breast cancer diagnosis is “a big shock” and there are many uncertainties, such as whether the cancer has spread and whether surgery or chemotherapy are needed.
“Those are life-and-death decisions,” Patel said.
But he said breast reconstruction, while not life and death, is a big “quality of life” issue. Patients who have had a mastectomy “do feel that they have lost a body part” and their body image may suffer, he said.
He said it used to be that a woman couldn’t get breast reconstruction until six months after her breast cancer treatment was complete.
Not all women who have had a mastectomy will pursue breast reconstruction and “there’s no right or wrong choice,” he said.
Patel said “there was a time when people didn’t want to talk about it,” but today, celebrities like Angelina Jolie have spoken publicly about undergoing breast reconstruction, which has increased awareness.
After a breast reconstruction in which a “breast mound” is created, smaller additional procedures may follow for nipple reconstruction.
Patel has performed breast reconstruction on patients ranging in age from 25 to 75.
“The expectations are different” for women of different ages, he said.
Mathieson finds it particularly rewarding to do breast reconstruction on women who have had mastectomies as it helps improve their self-image.
Patel also offers treatment for multiple types of skin cancer including melanoma, basal cell carcinoma and squamous cell carcinoma.
When Patel is treating a skin cancer patient, the first step is to remove the skin cancer and confirm that all of the cancer has been removed. Then it’s time for reconstruction of the area, which could include a few sutures or might include a skin graft, in which skin is taken from one part of the body and attached to another. This is usually outpatient surgery.
Patel said plastic surgeons also treat people who have suffered injuries, especially to the face, such as car accidents and dog bites. The “golden period” is within the first 12 to 24 hours, Patel said, meaning treating the injury within that time reduces the risk of infection and improves the chance of proper healing.
Kristie Jolliff, operating room supervisor at Blanchard Valley Hospital, said plastic surgeons are often called in for children suffering injuries like dog bites, particularly if the injury is to the face, to lessen scarring.
Mathieson, when training at Mercy St. Vincent Medical Center in Toledo, often cared for patients who had suffered burns, although he does this less frequently now.
Jenn Hiester, clinical manager of perioperative services at Bluffton Hospital, said when the surgery is for “aesthetic services,” meaning it is cosmetic and not medically necessary, health insurance won’t pay for it so the patient must pay privately. Some patients have “saved up their whole life,” she said. There are some cases where a medical reason might be found for a seemingly cosmetic surgery, such as a woman who has a breast reduction to treat back pain.
Hiester said common cosmetic surgeries include breast augmentation, liposuction, abdominoplasty and trunk lifts, where the surgeon works around the trunk of the body to remove excess fat and improve appearance. Rhinoplasty, or surgery on the nose, is less common, she said.
Hiester hears from patients in other communities who say they like coming to Bluffton for their surgery because it is a smaller hospital and offers more privacy.
The patients range in age, and include men as well as women. Hiester said men who have unusually large breasts may schedule reductions, and men who have lost a lot of weight ask to have excess skin removed.
Some surgeries are outpatient but others are more extensive. Hiester said an abdominoplasty is a time-consuming surgery and patients often must stay overnight at the hospital.
Mathieson said he was drawn to plastic surgery because “I just like the idea of being able to move tissue on somebody’s body and make some significant improvements” from an injury or problem.
“It’s pretty rewarding,” he said.
He has been in practice for 12 years.
Patel’s favorite part of the work is spending time with patients.
“I love talking to people, learning about them,” he said.
With a breast reconstruction, he might see a patient almost every week for several months, so “either we need to become good friends or good enemies.”
Patel had always wanted to be a surgeon and at first was training as a general surgeon. But as he went through his training, and became the father of a child who had a cleft lip and required plastic surgery, he found himself gravitating toward plastic surgery.
Arthurs: 419-427-8494 Send an E-mail to Sara Arthurs
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