According to Jack Fisher, M.D., in private practice in Nashville, physicians currently learning about or considering potentially complex cases of augmentation mammoplasty see a "litany of before-and-after pictures" that offer an inadequate learning experience.
"With today's digital technology, physicians can create any image they want with the aid of a talented artist," Dr. Fisher says. "The physician designs the image, and the artist, skilled in digital technology, mechanically executes the image. Physician panelists see not only before-and-after images that are real; they also see three other 'after' images that are not real."Dr. Fisher presented the new technology at the Aesthetic Meeting 2005 of the American Society for Aesthetic Plastic Surgery (ASAPS), here.
Create discussion The purpose of the images is to create discussion among panelists viewing them, Dr. Fisher says.
"The key, especially in difficult augmentation cases, is not the surgery, but the decision-making process before the surgery," Dr. Fisher tells Cosmetic Surgery Times. "In some patients, breast augmentation is easy — you just slip in the implants and that's the end of it. But in others, it takes thought and choosing the right operation, and that's what this physician panel is about."
Four specific aspects In his presentation, Dr. Fisher focused on four specific aspects of augmentation mammoplasty: (1) inframammary folds, (2) breast ptosis, (3) modification of previous implants and (4) chest wall deformities.
"We must often make important decisions before doing breast augmentations on these patients," he says. "When a patient has an unsatisfactory result, the surgery, although executed properly, may have been the wrong operation for that particular patient. By having this wonderful imagery, we can discuss different surgical options we could not discuss with just the old before-and-after pictures."
When viewing the images, panelists see presurgical images that slowly morph into post-surgical images, according to Dr. Fisher.
"These don't just go from a 'before' to an 'after' picture," Dr. Fisher says. "We've applied a lot of motion to the images with morphing technology."
Decisions in actual surgery, of course, are usually made by the physician and the patient rather than many panelists, according to Dr. Fisher.
"But, in complex cases, physicians consult with their colleagues," he says. "That's why an interactive panel looking at different images is useful. I still learn a lot from my colleagues, and, hopefully, they learn something from me. We can also use these images to educate patients who come in with unrealistic expectations."
Imaging tools are well-suited for augmentation mammoplasty and similar procedures because plastic surgery is a "visual specialty," according to Dr. Fisher.
"It's not like taking out somebody's gall bladder that no one will see," he explains.
Dr. Fisher adds one caveat for physicians viewing both real and digitally created images and showing both types to patients.
"Today's digital technology is so sophisticated that plastic surgeons must tell patients which images are 'real' and which are 'created.' "
3-D future Down the road, Dr. Fisher envisions presurgical images in three rather than two dimensions.