Gina Kaye (Host): Welcome to the FirstHealth & Wellness Podcast by FirstHealth of the Carolinas. I'm Gina Kaye. And with me is Dr. Will DeBrock, plastic and reconstructive surgeon. Our topic today is how innovation is making plastic surgery more personalized and restorative than ever. Welcome, Dr. DeBrock. It's great to have you on the show.

William DeBrock, MD: Yeah, thanks for having me. I've never done anything like this before. So, I'm looking forward to it.

Host: Great. We're excited for it too. We have some amazing content to cover, so let's just dive right into our questions.

William DeBrock, MD: Sounds good.

Host: When people hear "plastic surgery," they often think only of cosmetic procedures. How do you explain the full scope of what plastic and reconstructive surgeons do?

William DeBrock, MD: Yeah. So, anyone who is a plastic surgeon has gotten training in both plastic and reconstructive surgery, and it's the same field. So after medical school, you try to match into a residency, and it's for plastic and reconstructive surgery. They're combined. And during your training, most of your training is actually in reconstructive surgery since those are more technically difficult surgeries.

And what we think of as plastic, so breast augmentations, tummy tucks, those sort of things, is a smaller percentage of your training. So, it's one and the same. You know, you learn to do both. And once you graduate from residency, some people go one path or the other, or some people like me choose to do both.

Host: Are there common misconceptions people have about plastic surgery?

William DeBrock, MD: Yes, absolutely. So more than probably any area of medicine, plastic surgery is televised and splattered all over social media. And again, the things that most people see or are exposed to are the cosmetic side of things. So again, breast augmentations, tummy tucks, breast lifts reductions, those sort of things.

But a lot of us, including myself, do many, many insurance-based procedures that are designed to improve quality of life. And so, people like myself want to make sure that patients know everything that's available to them. You know, not everyone has $7,000 to $10,000 to spend on a breast augmentation. Not everyone has $8,000 for a breast reduction. But insurance, if you have the right symptoms, will cover a breast reduction. And so as part of advocacy for the field, I want to get the message out to people to let them know that some of these services are available to them.

Host: And we all know that surgeries, healthcare changes constantly. So, what advanced techniques or technologies are helping patients achieve better outcomes?

William DeBrock, MD: Yeah. So, the most obvious one in our field is the breast implant. So, we're currently on the sixth generation of breast implants, which are far superior to the ones before them, and they're all aimed at minimizing long-term complications while improving aesthetics. So, that's the most obvious one. I would say the second innovation really isn't a technology, it's just more of the way we're trained now. It's much more of a collaboration with the patient than it has been in the past. It was sort of a paternalistic model of the patient-physician relationship. And now, we're transitioning to more of like an interpretive model. That's what excites me the most. It's more of a partnership now with the patient.

Host: And speaking of changing, how are patient expectations changing? Have you seen the field change to meet those needs?

William DeBrock, MD: Yes, absolutely. So again, with the social media plastic surgery boom that we saw around COVID, patient expectations are much higher than they've ever been. Not to say that's wrong, of course. You know, patient expectations, the higher they go, the more it makes us improve and adapt. So, it's a good thing.

And the trend of higher expectations has also transitioned to something like breast reconstruction, where again, it's not truly a cosmetic procedure, but people are wanting better outcomes than there's been in the past. And again, with newer implants, newer techniques, we are evolving to meet those needs.

Host: So, let's switch focus a little bit. We'll keep talking about that. What innovations in breast augmentation have had the biggest impact on patient care and satisfaction?

William DeBrock, MD: Yes. So, two things. So first, again, the implants. The newest implants we have lower the rate of what's called capsular contracture, which is when your breast gets this really firm scar tissue around it. We are seeing lower rates of that now with these newer implants. They move better than the old implants. If they rupture, it's not as big of a deal.

So, the improvement in implant technology is making outcomes for patients better. And because we have better implants, we can start to use different techniques that we couldn't before. So, we used to put implants below the muscle. Now, more often than not, we're putting them on top of the muscle so that we don't have to disrupt the muscle at all, which is leading for quicker recoveries.

Women are more active now than ever, so it doesn't affect them in the gym or sports, whatever they want to do. We're using minimally invasive breast augmentation now. And along those lines, you know, we're starting to put the implants through different locations. So because of these new implants, we have a range of new techniques that are now available to us.

Host: For patients facing breast cancer treatment, what should they know about reconstructive options that may not have been available a generation ago?

William DeBrock, MD: The biggest advocacy thing for me is to let people know about their breast reconstruction rights. So actually, since 1998, there's been a law in place that requires insurance to pay for a variety of procedures for people who have had a mastectomy, and that's expanded over the years. So, most procedures that women want for breast reconstruction are covered by insurance, whether it's on the breast that had the cancer or the breast that didn't have the cancer, and that's the biggest thing. I want people to know that whether you had cancer in 1966 or 2026, all these options are available to you. And so, if you've ever had breast cancer, if you haven't consulted with a plastic surgeon, you should. And if you have a new cancer that hasn't been treated yet, you should be seeing the breast surgeon and the plastic surgeon before deciding on your cancer care plan.

Host: How do you help patients choose the procedure that's right for their body, their goals, and their lifestyle?

William DeBrock, MD: Yeah. So, we can kind of divide this into a, you know, cosmetic bucket and a reconstructive bucket. For cosmetics, you know, what they want to look like is the chief thing. And nowadays, again, there's so many pictures online. There's specific websites where you can find women who have had plastic surgery and see photos of what you might want to look like. We call them wish pics or goal photos. So, people will bring us that. And based on that, we'll tell them, like, "You can have this, this, and this to look like this. Here are the upsides of each, here are the downsides of each."

In a reconstructive world, it's similar to that, but it's more of, number one, you know, and we're focusing on breast reconstruction here, like, what is the best way to treat your cancer? That is chief among anything. And then two is based on what you're going to have for your cancer treatment, what reconstruction option fits your goal lifestyle? So, it's different technically for each. But again, just the collaboration between the patient and between me, whether you're having aesthetics or reconstruction, the relationship is what's driving better outcomes.

Host: This is one of my favorite questions, because I think there's probably a lot of chatter and maybe controversy surrounding it. So, let's talk about patient experience from the standpoint of how do you help patients separate social media trends from realistic expectations?

William DeBrock, MD: Yeah. It's a tough thing to do sometimes, but that's part of the job. So, you know, step one is, again, we're talking about wish pics. So when someone brings in a wish pic of what they want to look like, it's important for me to point out any way that photo could have been altered or the way the picture is taken, how that affects what that picture looks like.

You know, again, anything that's posted online by a surgeon or a patient is probably gonna be a really good outcome, and it could be altered, like they could have airbrushed it, used a different filter, whatever. The way you position your arms, the way you angle your chest, all these things change what that goal picture looks like. So, pointing that out is super important.

And letting patients know that based on their—we call it the breast footprint, which is basically what their chest anatomy is like. You know, based on your height, your breast footprint, how muscular you are, like, all these little things matter about how you'll look afterwards.

And so, we need the wish pics to have a starting point. But then, yes, it's my job to be like, "Based on this picture, I think this is what's realistic. And I know in this picture it looks like this. Here's why your outcome might not look like this or why this might not be realistic." And so again, that's our job as a surgeon to help patients work through their wish pics to understand what's great on social media versus what you can actually expect.

Host: I'm sure you have a bunch of patient success stories, but can you highlight one specifically and tell us what the impact that procedure had on somebody's quality of life?

William DeBrock, MD: The one I'll tell you is probably the most common one I saw during residency, which was a woman who had had breast cancer long time ago. Sometimes we were more liberal with giving radiation in the past than maybe we are now. And so, what happens is when someone gets radiation, their breast is essentially frozen, and it doesn't age like the other one does.

And so, dozens and dozens of women will come in and say, "Hey, I'm lopsided. I had cancer in, you know, whatever, 1996. This breast had radiation. It's way up here. And now my other breast is way down here." And they're ready to pay cash to have, you know, a lift or a reduction on the other side. And me or whoever getting to say, "Actually, by law, insurance is gonna cover your lift or your reduction or your augmentation on this side." and to see the relief in their face that, you know, they just saved $10,000 or however much it is, I mean, that's probably the best part of the job, as far as breast reconstruction go, is to see relief on people's faces when they know all the options they have. And again, that's a story that can be told over and over and over and over.

And again, that is my main goal here, and the reason that I wanted to come on and talk to you all is people have a lot more options than they might know of

Host: That's great. And I think educating the public on their options is job one, because I don't think we know all of the options that are out there. So, that's great.

William DeBrock, MD: Absolutely.

Host: So, what gives you the most optimism about where the field is headed?

William DeBrock, MD: Our techniques is number one. Again, as our implants improve, we get to develop other technologies to make our procedures less invasive, quicker, faster recovery, less expensive, all that. I think something maybe not so obvious is that being part of this younger, newest generation of plastic surgeons, I think our mission to be partners with the patient is refreshing and going to be welcomed by the patients.

You know, it's not a shop anymore, so to speak, where a patient comes in and, you know, you see dollar signs or whatever. I think this younger generation, including myself, what we care about most is the patient having a great outcome. It's not about the bottom line. It's not about how much can I make off this procedure?

How many of these procedures can I do, you know, in a day? It's about I see you as a person. How can I help you? How can I make your life better? I'm here for you. What gives me satisfaction and joy, the reason that I became a physician is that I could help people in the community. I want to be seen as a friend, as a healer, and I think I share that view with most of the newest generation of plastic surgeons. And so, I'm really excited to see what good we can do for communities, including the one that I'm a part of now here in the Sandhills.

Host: That's fantastic. Dr. Debrock, thank you very much for sharing both your vast knowledge and your time. It is very much appreciated.

William DeBrock, MD: Thank you very much. This was great. I really appreciate it.

Host: Thank you for listening to the FirstHealth and Wellness Podcast from FirstHealth of the Carolinas. If you found this information helpful, please share it on your own social media channels. To learn more about plastic and reconstructive surgery or to schedule a consultation, please call 910-235-4038. Thanks for listening.