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Surgeon expands practice to offer breast work

Article-Surgeon expands practice to offer breast work

San Diego — Cosmetic plastic surgeons who specialize in procedures on one area of the body are increasingly expanding their expertise to include others.

According to one plastic surgeon who took the step, the result can be an increase in professional satisfaction — not to mention a healthier revenue flow.

"There's a definite trend toward specialists like me branching out," says Mark K. Mandell-Brown, M.D., director, The Mandell-Brown Plastic Surgery Center, Cincinnati. "It's done for economic reasons, of course, but it's also being done because it offers professional challenges that can increase doctors' satisfaction in their day-to-day work."

In his presentation, "Adding Breast Augmentation to Your Practice: Analysis of the First 50 Augmentations," at the American Academy of Cosmetic Surgeons Annual Meeting here, Dr. Mandell-Brown discussed how he branched out and the extent to which it was successful.

New challenge When he decided a few years ago to expand his practice by offering breast augmentation and other body cosmetic procedures to his patient population, Dr. Mandell-Brown, an otolaryngologist and facial plastic-surgery specialist, brought in board-certified plastic surgeons.

"For a variety of reasons, it just didn't work out," he says. "It was suggested to me that I should perform the body plastic surgery myself. But I saw myself as a facial plastic specialist, so at first I resisted it, which is an ego factor that doctors considering such a move would do well to be aware of and overcome. The more I thought about it, though, the more I thought that maybe I needed a new challenge after years of subspecializing, and at the same time be able to expand my practice's offerings without having to hire other specialists."

Dr. Mandell-Brown began taking courses in breast-augmentation procedures through the American Academy of Cosmetic Surgeons, and eventually earned the required certifications. At the same time, he brought in breast augmentation specialists to serve as mentors, assisting in and observing his work.

"It's turned out to be an excellent move, even a natural one for me," he says. "I was experienced in working on the chest area when acquiring skin flaps to be used on extensive reconstructive facial procedures. Body plastic surgery is significantly less complex than the head, neck and facial procedures I'd been doing for years, so it was a relatively easy transition."

In December 2003, Dr. Mandell-Brown began doing breast-augmentation procedures on a regular basis. As a means by which to determine the success of his efforts — and the extent of patient satisfaction — he conducted a retrospective analysis of his first 50 augmentation procedures.

"Of my first 50 breast augmentation patients, I did 48 inframammary, and the other two were periareolar procedures," he says. "The youngest patient was 19, the oldest 54, and the average age of the 50-patient group was 38."

Constipation Dr. Mandell-Brown says the most frequent complication reported by members of the group was constipation.

"Actually, the constipation is more a complaint than a complication, and is related more to the postoperative medication than it is to the procedure itself," he says. "With appropriate postoperative management, this complaint can be dealt with easily."

His other findings included:

  • Five patients experienced some degree of breast numbness, which Dr. Mandell-Brown says is not unusual following such a procedure and which eventually dissipates.
  • One experienced decreased nipple sensitivity, also not unusual and which also eventually dissipates.
  • One experienced hypersensitive nipple sensitivity, which also dissipates on its own.
  • One displayed Mondor's syndrome, a phlebitis-like breast condition that eventually disappears.
  • One displayed unacceptable asymmetry, which Dr. Mandell-Brown corrected.

There were no instances of rupture or absorption, hematoma or seroma, unsatisfactory scarring or anesthesia-related complications.

In addition, Dr. Mandell-Brown asked 25 patients available for follow-up to rank their level of satisfaction on a 1-to-10 scale, 10 being the top score. Fifteen patients responded with a 10, six with a 9, three with an 8, and one with a 5. He says this breakdown compares favorably with standards in the field.

"My reason for sharing the results of this analysis is to show specialists like me that breast augmentation is a wonderful procedure in which to develop expertise."

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