Plastic Surgery Interactive Resource

Surgery : The Concept
by John Di Saia, M.D.

One of the things I have experienced in interacting with patients (and attorneys) is a fundamental misunderstanding with regards to what occurs at surgery. Patients that come to consultation frequently believe that surgery is a "solid-state" item; that they are buying a good result.  The concept of surgery is important to understand especially for the potential patient considering an operation.

What is Surgery (an Operation)? 

An operation is an invasive controlled procedure designed to have a particular effect. The word "controlled" should elicit thoughts such as: "OK, so what exactly is controlled?"

The key answer here is "Not everything."

Surgery involves several very important and sometimes unpredictable elements including: HEALING. The way in which a particular patient may heal after an operation can only be predicted, but is never completely understood.

This problem is complicated somewhat when surgery involves an area in which surgery has occurred before (such as in revisional surgery) because scar tissue heals differently and less predictably than normal tissue. If your surgeon doesn't want to operate to improve the result of another operation, there is probably a reason. Who wants to operate unless the result will be predictably better than where you started?

There are other events (or complications) that can make things go more poorly. These are a matter of probability. Things can be done to minimize the potential that they might occur, but not eliminate it:

(1) Infection: Surgery is usually performed using aseptic technique. This reduces but does not eliminate the potential for infection. Infections particularly when a foreign material is involved (like a breast implant) can be very troublesome, usually making it necessary that the implant be removed for a period of time before it can be safely replaced.

(2) Bleeding: Again there are aspects of technique that make this less likely to occur. They do not however make it impossible. To reduce the potential for bleeding, doctors frequently discuss withholding certain medications (that encourage "thining" of the blood) for 7-10 days before a major procedure.  

(3) Scar Formation: Surgery more often than not involves incisions that must heal after the procedure. The formation of scar tissue in incisions or around implants is absolute: it always happens to some extent. There are elements of surgical technique that can improve the potential for scarring to appear less obvious. There are laso people who genetically have tendencies top forming very poor scars. The best surgeon in the world cannot make all scarring disappear. Surgeons are not magicians. A very important point here is that patients with breast implants can form tight scars around the implants. While this is rare in cosmetic breast surgery, it is quite common is reconstructive surgery (breast reconstruction after removal such as in breast cancer).

People have a natural tendency to blame the surgeon when things don't turn out as they had hoped. By the same token, patients tend to credit a surgeon when things turn out well. To do so is to not take all factors into account:

* Surgery involves technique. Your surgeon has this.

* Surgery involves healing. Your surgeon has little control over this. This one's to an extent up to you.

* Healing involves probability. You and your surgeon have no control whatsoever over this. 

Good results have something to do with the surgery itself, your healing from it and the probability of the things that could go wrong not going wrong. Think about this before surgery.

What can you do to optimize healing?

(1) Don't smoke. Cigarette smoking has a bad effect on the healing process. It tends to increase the probability of infection, bleeding and poor scar formation. If you do smoke, you are at a disadvantage before you start. You might decrease this a bit by withholding smoking at least two weeks before and two weeks after the procedure.

(2) Eat healthfully after surgery. The time to go on a diet is not the time just following surgery.

(3) Do not delibrately expose healing wounds to sunlight. Sunlight can cause poor pigmentation within the scar. It does not improve healing common to popular belief.

What can you do to optimize probability?

Not a thing. If you think you can manipulate probability, you should go to Las Vegas and try it there. If you are right, you will get rich on every visit and never lose.

Note: This piece is written for the general information of those seeking Cosmetic Surgery. It is presented freely in this format for this purpose. No other rights are granted. It may not be duplicated, cited or otherwise copied in any form without the written consent of the author. 



©1996-2004 John Di Saia, MD... an Orange County California Plastic Surgeon       Dr John Di Saia, an orange county california plastic surgeon