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Some Things that Your Surgeon Should NOT Do

Recently the American Society of Plastic Surgeons (ASPS) caused some hubbub and hullabaloo in the medical community by publicly releasing a listing of the top 5 tests and/or procedures that cosmetic surgeons should avoid.

According to an insider report compiled by Medscape, “ASPS is the latest organization to join the now 60 specialty societies that are part of the Choosing Wisely® campaign that began in 2012. An initiative of the ABIM Foundation, Choosing Wisely is meant to encourage physicians to question and discuss the benefit of some commonly used tests and procedures.”

Medscape consulted Karol Gutowski, MD, a plastic surgeon who has collaborated directly with the American Society of Plastic Surgeons. The following represents the findings of the American Society of Plastic Surgeons as well as Dr. Gutowski, to help ensure both patients and doctors they are given the results they want and the treatment they deserve.

Routine Mammogram Prior to Plastic and Cosmetic Surgery

One of the primary ASPAS statutes in the list states that “Mammograms should be ordered based on existing clinical practice guideline recommendations, for patients undergoing breast surgery, including non-complicated breast augmentation, mastopexy, and breast reduction.”

Apparently, obtaining a mammogram is not only unnecessary before surgery but purportedly should be possibly avoided to prevent over-testing resulting in more money spent by the patient. Says Dr. Gutowski, “Why treat patients who undergo elective breast surgery differently from any other patient who is not undergoing these procedures? You should treat them all the same.”

The Application of “Drains” in Breast Reduction Surgery

The ASPAS reports that “Drains” are not vital to Breast Reduction Surgery and apparently have no impact on postoperative complications. Furthermore, the use of drains causes the patient a greater feeling of pain or discomfort that could even extend their hospital stay.

Obtaining a Mammography of Reconstructed Breasts Post-Mastectomy

ASPA says that "Current clinical practice guidelines recommend regular clinical exams for detection of breast cancer, and imaging studies are not recommended as a part of routine surveillance." A physical exam is enough to detect local recurrence. A Mammography would only involve more time and money.

Dr. Gutowski concurs unless, he says, the patient has opted to undergo a partial mastectomy. If this is the case, “that breast should still undergo mammography per clinical guidelines.”

Facial Trauma X-Rays

ASPA also states the rather than getting x-rays for facial trauma, "Maxillofacial CT is available in most trauma centers and is the most sensitive method" readily accessible today. Technology in Maxillofacial CT has largely surpassed X-Ray and rendered the latter superfluous.

The only time x-ray may be beneficial for facial trauma, says Dr. Gutowski, “is for a suspected mandible fracture or for dental issues. Isolated nasal fractures are a clinical diagnosis and typically do not require any imaging studies. “

Taking of Prophylactic Antibiotics 24 Hours After Surgery

Lastly, the American Society of Plastic Surgeons reveals "Discontinuing antibiotic prophylaxis within 24 hours or less after surgery is sufficient in preventing surgical site infection compared to continuing antibiotic prophylaxis beyond 24 hours after surgery." In other words, extended use of antibiotics may lead to risk for other infections. “There is no evidence that antibiotics after surgery offer a benefit, and they can cause unwanted side effects such as Clostridium difficile colitis,” affirms Dr. Gutowski.

If you are interested in receiving plastic surgery and would like to know more about your options, contact one of our representatives from the portal below. We can arrange for you to meet with a board-certified specialist uniquely qualified to your needs and expectations. Call or contact us today to get started.



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