Transcription:
Plastic Surgery - Reconstructive and Cosmetic

Cheryl Martin: A look at Plastic Surgery, reconstructive and Cosmetic on this episode of Curating Care, a podcast brought to you by St. Clair, health Expert Care from people Who Care. I'm Cheryl Martin, and joining me is Dr. Edward Ru, chief of Plastic Surgery here at St. Clair Health. Dr. Ru ain. It's great to have you.

Edward Ruane Jr., MD: It's great to be here, Cheryl. Thank you so much for having.

Cheryl Martin: Doctor I mentioned St. Clair Health's tagline, expert care from people who care well as a board certified plastic surgeon and named one of the best plastic surgeons in America by Newsweek. Talk about why you care about helping patients so much.

Edward Ruane Jr., MD: Sure. Well, as a plastic surgeon, it. my pleasure to help patients both restore their normal form and function. And certainly a lot of medicine focuses on quantity of life and what we can do to, to prolong life and to cure illness. But one of the things that Has always appealed to me about plastic surgery is focusing on, quality of life.

And so, that's, the thing that I'm proud of and in helping to take care of my patients and to get people feeling and looking their best and enjoying life to their greatest ability.

Cheryl Martin: You mentioned quality of life. Are there any other reasons why you wanted to become a plastic surgeon?

Edward Ruane Jr., MD: Yeah. What appealed to me about plastic surgery is that it's really unlike any other medical specialty. Most fields are. Based off of a certain body part or organ system. But plastic surgery is just such a broad field that's basically based off of just problem solving. We operate from head to toe again at any certain place it's about putting a puzzle back together.

And so I, I love the fact that it was a bit more artistic in to scientific and medical. And also just that there's so much variety it.

Cheryl Martin: now, how would you say those driving factors have grown or evolved as you've advanced in your career?

Edward Ruane Jr., MD: Yeah. When I was first introduced to plastic surgery It was actually my first exposure was working with a pediatric plastic surgeon. And he was helping a neurosurgeon out in doing a type of surgery that's called a cranial vault reconstruction. And that's where plastic surgeons work with neurosurgeons in addressing skull deformities in kids where sutures on the skull might fuse too early and that can result in a strange head shape and.

Concerns about room for brain growth. And so, I mean, that was again, my initial introduction into plastic surgery. But I sort of quickly found my way than more gravitating more towards spending time with mentors of mine who worked mainly with breast cancer patients. and performing breast reconstruction, whether it's after mastectomy or lumpectomy, breast cancer's so common being, one in eight women.

And and so that, that opportunity to help women feel whole and like themselves still after, any sort of cancer operation, that really became the driving factor and area that I chose to focus

Cheryl Martin: I'm glad you brought that up, because St. Clair prides itself on innovative integrative services and solutions for everyone who walks through the door. So, when a patient is diagnosed with breast cancer, how do you partner with oncologic breast surgeons to determine the best plan of care for a patient?

Edward Ruane Jr., MD: Yeah. So here at St. Clair Health, we have a very close collaborative and collegial relationship, I think, amongst the different surgeons. So, As soon as I'm, meeting a newly diagnosed breast cancer patient, I'm gonna be in touch with that patient's breast surgeon and, And just deciding, I mean, we take all sorts of factors into consideration, number one, of course, patient preference on what that patient is wanting in terms of are they highly motivated to pursue what's called breast conservation therapy or a lumpectomy, or is this a woman who maybe has a strong family history?

Really thinking, you know what, I want a mastectomy. But then it's up to me and the breast surgeon to look at a variety of factors. thinking about what size tumor are we looking at as a lumpectomy possible, or based off of that as a mastectomy, really in the patient's best interest.

And there's so many different, there's different ways to perform mastectomies in terms. where do scars go? Are, is it possible to, to spare or to save the nipple as part of the mastectomy? Or if it's a, patient who is a candidate for lumpectomy, is, are they a candidate to perhaps achieve? A breast reduction or a small breast lift in combination with the lumpectomy so that not only are we treating their cancer, but also giving them the smaller, more lifted breasts that they always wanted.

And so there's always the opportunity to come back and to pursue reconstruction for those women who unfortunately maybe aren't first evaluated here. But certainly I think it's in a patient's best interest if interact both with a plastic surgeon and a breast surgeon upfront to just take all these different factors into consideration.

Cheryl Martin: That was going to be my next question. Why is this kind of collaborative environment the best way to determine the right plan of care for each patient?

Edward Ruane Jr., MD: Yeah. Yeah. So There are unfortunately plenty of women who based off of, where they're located or perhaps there isn't a reconstructive plastic surgeon nearby. Or perhaps unfortunately they go to a breast surgeon who. Who doesn't work or have a good relationship with a plastic surgeon.

And so, there's always the opportunity to still down the road, see a plastic surgeon and to try and have a concern addressed or to pursue reconstruction. But certainly most women benefit from combining and consolidating procedures and And having this sort of, the foresight on behalf of the surgeons to do things in a specific way that's going to set a patient up for a successful reconstruction and result.

Cheryl Martin: now is each care plan personalized.

Edward Ruane Jr., MD: Absolutely. I mean, when I'm looking at, I mean, I could be seeing. Three different breast cancer patients in a row in my office. And again, based off of patient desire and then patient factors cancer factors, even if all three patients have decided they want mastectomies, we might be doing those in different ways.

And that can have implications. What type of reconstruction is pursued? Sometimes reconstruction can be done in a single stage. Sometimes it takes multiple steps. And in my mind, what I'm always, personalizing the plan for is that is what's going to set that woman or that patient up for the most successful reconstruction and have the lowest risk of complications and unnecessary down.

Cheryl Martin: Do you wanna add anything else about how breast reconstruction surgery differ after a lumpectomy versus a mastectomy?

Edward Ruane Jr., MD: Yeah. I mean, so the majority of, when I think when most people think about breast reconstruction, they're thinking about after a mastectomy and rebuilding an entire breast. But it is true that there's. The opportunity to perform reconstructive procedures in combination, even with a lumpectomy or just removing a small part of breast tissue.

And that's something that we call oncoplastic surgery because it's the combination of the oncologic surgery and plastic surgery. And that's like I had briefly mentioned or alluded to earlier. That's where instead of just making you know, a, Random, one inch incision directly over where the cancer is on the breast and performing a lumpectomy.

Sometimes we get concerned about, well, what's that going to look like after it heals and maybe where you remove that cancer, it's just going to leave a divot or, some sort of deformity. And so oncoplastic surgery. Is where the breast surgeon and the plastic surgeon where we work together and I tell the breast surgeon, this woman has always wanted slightly smaller breasts or has wanted a breast lift and so. it looks on the outside, like the plastic surgeon has just done a breast reduction or a breast lift. There's, the typical scars that go along with a breast reduction or a breast lift. But after I open the breast to do that surgery the breast surgeon then does the lumpectomy. And then I finish, doing either the breast reduction or the breast lift.

So, it's a much more aesthetically pleasing result that can treat a woman's cancer and keep their breast and have things looking even perhaps better than they started in terms of mastectomy. Then that's a bigger surgery. And that's where I think most women think of breast reconstruction when we're talking about operations such as using implants or using a woman's own tissue to rebuild a breast.

Cheryl Martin: Which one is more common? Implants versus natural tissue.

Edward Ruane Jr., MD: yeah, I would say in the United States, at least 80. Or more percent of breast reconstruction is done utilizing implants, and that's because those surgeries are typically quicker surgeries to perform and quicker recoveries for patients. There are certain factors that might. Sway a surgeon to recommend tissue over an implant.

And some patients come in very motivated in avoiding the use of an implant and wanting to use their own tissue. But for the vast majority of women implant-based reconstruction is much

Cheryl Martin: And where does that tissue From your body,

Edward Ruane Jr., MD: There are if you name a spot, there is probably a described operation to take tissue from it. We call these operations. We call them free flaps or free tissue transfer procedures. And what that means is they're transplant operations where you take extra skin and fat or sometimes muscle or other tissue from one part of the body and you transplant it to another.

And so most commonly for breast reconstruction, These procedures are done where extra skin and fat is taken from the lower abdomen and then transplanted to the chest to rebuild a breast. so on the outside it might look to a woman like she has had a tummy tuck and then gotten a breast recon reconstruction out of it, but, underneath that, it's important for patients to know that it's, a lot more involved in that since it's a transplant operation, there's surgery underneath to, take out blood vessels that nourish and keep alive, that skin and fat on the lower abdomen and then, That tissue is transplanted to the chest, which oftentimes means having to remove a small segment of rib to get to blood vessels inside the chest and transplanting this tissue from one part of the body to the other.

Cheryl Martin: So there are more risks involved with the natural.

Edward Ruane Jr., MD: I would say that, The risks are potentially more serious, but actually as intimidating as what I just started to describe sounds. The rate of success on those tissue operations is very high. I mean, it's greater than 95%, and so, I would say it's, yeah the risks are potentially maybe greater. And if things don't go well then it's a much more it's a bigger price to pay in terms of recovery from a surgery like that.

But In general, I mean, it's breast reconstruction is complex and even with implant-based reconstruction, there, there can be issues with healing and whatnot.

Cheryl Martin: you know the history of plastic surgery is rooted in breast reconstructive surgery. So what role does cosmetic surgery play for your patients?

Edward Ruane Jr., MD: Yeah, It's true plastic surgery was really rooted in reconstruction. It really started back in the World Wars after World War I, with disfigured soldiers and the need to restore normal form and, as a service to those servicemen and women. But I'd just. Reconstructive and cosmetic plastic surgery just really go hand in hand.

The one really informs the other in breast reconstruction, for example. Certainly it's a reconstructive surgery, but I think that women expect out of it and deserve out of it. Something that looks cosmetically appealing and looks like a breast. And that's how you're gonna to help someone feel whole and feel like themselves.

And so yes, things that are reconstructive or are reconstructive but they also need to look good. And so reconstructive surgery needs to take cosmesis and the cosmetic and aesthetics of things and the consideration, and at the same time, Cosmetic surgery. I mean, if it's well done, I think that it's gonna be well done by a surgeon who's comfortable totally taking something apart and rebuilding it.

Someone who has the foundation in reconstructive surgery is then going to be better able to offer a more comprehensive and last. Result in a cosmetic operation as well.

Cheryl Martin: Now we've spent most of our time, of course, talking about reconstructive surgery. Tell us about the range of services you offer as it relates to cosmetic surgery, separate from reconstructive surgery.

Edward Ruane Jr., MD: Sure. So Cheryl, like I told you, that's what I love about plastic surgery is that. It is so broad and so I'm happy to to offer a variety of services here. In terms of, I mean, first we've talked a lot about surgical services we offer non-surgical services such as neurotoxins or what people call Botox or fillers, and then otherwise, I mean, head to toe.

you name it, we, a plastic surgeon can operate on it. So, I mean, I perform facelifts nose surgery rhinoplasty. in addition to breast reconstruction, a large part of my practices cosmetic breast surgery, whether that be breast augmentation or a a breast lift, breast reduction. A lot of what we call body contouring type surgeries.

So whether it's after weight loss or just after pregnancy, but abdominalplasties or tummy tucks or body lift type procedures. Again, you name it from head to toe and there's probably a surgery I offer for.

Cheryl Martin: That's great. Now, doctor, what should potential patients of yours know about the importance of seeing a board certified plastic surgeon for any reconstructive or cosmetic procedures or concerns?

Edward Ruane Jr., MD: That's a really great question, Cheryl. And a really important issue because there are a lot of non-board certified plastic surgeons out there who may call themselves or advertise as a cosmetic surgeon and. only American Board of Plastic Surgery certifies plastic surgeons, we meet the most rigorous standards in terms of, length of schooling and and then having to submit and sit for Exams in order to become board certified. And so, like I mentioned earlier, how reconstructive and cosmetic surgery really just go hand in hand. I think the reason why patients should seek out the board certified plastic surgeon is because only a board certified plastic surgeon. Is gonna, if they're offering cosmetic surgery, we're the only ones that are also trained fully in depth in reconstruction as well.

And so if you want the most lasting, comprehensive result, then you want someone who didn't just do a. weekend course in something or even a six month or 12 months, you want someone who's spent years getting comfortable with totally taking apart and putting things back together and reconstructing them.

and so that's really where I think seeing a board certified plastic surgeon is important.

Cheryl Martin: Dr. Edward Ruan, thanks so much for sharing your expertise on plastic surgery, both reconstructive and cosmetic, and it's obvious that you are passionate about this topic and. Also compassionate, so thank you so much.

Edward Ruane Jr., MD: No, thank you, Cheryl. It's been a pleasure talking with you.

Cheryl Martin: Now to contact Dr. Ru a, please call 4 1 2 5 7 2 6 1 6 4. That's 4 1 2 5 7 2 6 1 6 4 or visit st clair.org. If you found this information helpful, please share it with others, especially on your social media. Thanks for listening to Curating Care brought to you by St. Clair.