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What makes ‘safe’ plastic surgery?

We all have read about nightmare stories about a young, healthy woman suddenly dying from a relatively minor procedure such as a breast augmentation, or Kanye West’s mother who passed away after abdominoplasty. Thankfully, such events are exceptionally rare. There usually isn’t one just simple reason for the accident. Often, it is a combination of several factors which add up to a culminating, large problem.

A good analogy is air travel. Plane crashes are incredibly infrequent, but when they do occur it is often a combination of up to 7 failures or ‘mistakes’, not just one. It usually isn’t the pilot falling asleep and flying a plane into a mountain. It is generally a sequence, like the fuel gauge stopped working, then the landing runway was overcrowded leaving the plane to circle longer than usual, plus there was bad wind and an ice storm, plus the traffic controller misheard something which required the pilot to keep circling when they should have made an attempt for landing, then next thing you know the fuel is running low, visibility is poor, etc. Similarly, elective surgery can be thought of a sequence of events and checks and rechecks. Thus, it is important that every item in the sequence be thoroughly evaluated.

My patients fill out a rather large health form prior to surgery, and they are all seen by another medical doctor. Following that, I use an anesthesiologist who is exceptional, and one that I would trust with my own life. Some centers do NOT use anesthesiologists for surgeries and rely on the plastic surgeon to over see a nurse administering the anesthesia. Most patients don’t even think to ask about their anesthesiologist when in fact, they are a crucial player in the team.

The next thing is the center. Some are good, some are great. A few are lousy. Avoid the lousy and good ones. Demand a great one because your life is worth it. Demand an AAAA accredited surgery center with a good reputation. A good reputation is one that is generally busy in a reputable medical building. It is one with new or updated equipment, good and experienced staff (from reception to the technician handing the surgeon the instrument).

Trust me, it all counts. For instance, a poorly trained or inexperienced technician may inadvertently contaminate the operative field leading to a post operative wound infection. This would make a rather harmless breast augmentation outcome a possible big problem. Good help also reduces operating room time. The longer you are under anesthesia, the higher the infection rate and deep vein thrombosis rate.

When I do long cases, I often have another surgeon scrubbing in to help reduce operating room time. It all matters. I do not know the circumstances behind many of the unfortunate deaths and I will not dare speculate. The point to take home is that do not skimp on your life. Ask questions about your anesthesiologist (if there is one), and the center. How long is the surgery? Anything over 6 hours should be met with an overnight stay at an aftercare facility. Who is actually ‘doing’ the surgery. Don’t laugh. You would be surprised. So, take an active role in your safety!

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