I get that I am a Board Certified Plastic Surgeon, so it may seem I have bias here. But this blog is me reporting the findings of a study published in the Aesthetic Surgery Journal, January 2021, “The Potential Impact of Plastic Surgery Expertise on Body Contouring Procedure Outcomes.”
They preface the article by talking about how cosmetic surgery procedures have exploded over the past two decades, with surgeons of “diverse specialty training” performing these procedures. It reminded me of a study I read years ago of “plastic surgeons” doing liposuction in LA, where 40% of them were NOT TRAINED IN SURGERY AT ALL, and 75% of them were not actual plastic surgeons. Blog on that study HERE. Blog on what to look for when finding a surgeon so you know you are getting a well trained qualified surgeon HERE.
But does that matter? Do you need a true plastic surgeon to do your plastic surgery?
We plastic surgeons train as general surgeons before doing plastic surgery. Yup. I did tons of laproscopic gallbladder removals, mastectomies, and hernia repairs while in training for years. The converse though is not true- general surgeons do not train as plastic surgeons. But again, does it matter?
This study looked at data from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2015.
- 11,658 patients were included. 9502 were plastic surgery cases, 2156 were general surgery.
- Most were women 90%, aged 40-59, and white
- Compared to the plastic surgery patients, general surgery patients were more likely to be obese (61% vs 41%), smokers (13% vs 10%) and higher anesthesia risk classification (35% vs 19%)
Findings?
The general surgery patients had more complications.
- increased wound complications (adjusted odds ration 1.81)
- increased infections (aOR 1.81)
- increased reoperation (aOR 1.85)
- longer length of stay in the hospital (aOR 1.12)
Discussion
With increasing rates of bariatric surgery (weight loss surgery), body contouring surgery is increasing. We know that doing tummy tucks and body contouring surgery after major weight loss has significant impact on psychological, emotional and physical well being and improves their quality of life.
This study shows statistically significant differences in the outcomes of the surgery if done by a plastic surgeon instead of a general surgeon. *Please know, I am just reporting what the study found. There are great general surgeons and bad plastic surgeons.
So why was there such a difference? They postulated many thoughts in their discussion:
- Plastic surgeons are taught diverse procedural approaches to solve a problem.
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- Do plastic surgeons use a different technique?
- Do we do more cases?
- Do we select patients differently?
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- One thing of note was the plastic surgery group seemed to pick different patients than the general surgeons did. BMI, comorbidities, and SMOKING are a big deal when assessing risk. I have to say I was shocked to see either group would do a tummy tuck on a smoker. That is such an incredibly risky thing to do, and a high risk for wound healing issues, tissue loss, and infection.
- There is likely a vast difference in wound care experience and tissue handling. When in plastic surgery training, we handle the pressure sores, wound clinics, and run the burn unit. This training helps us understand blood supply and tissue handling.
My thoughts?
I don’t know. As I stated above, I have met some brilliant general surgeons and some bad plastic surgeons.
Patient selection and optimizing yourself before elective surgery is so important. I routinely make people do things before surgery to lower risk of complications. Your BMI is high? Lose weight before surgery. You will get a better result and lower risk of infection, wound issues, and blood clots. You snore? You need a sleep study to assess you for sleep apnea. If you are not getting enough oxygen at night, you won’t heal well. Get on CPAP prior to surgery. You smoke or vape? No way will I do any kind of flap surgery (tummy tuck, breast reduction, or facelift) until you have stopped. Period.
When I ask you to do these things, I am not trying to be your mom. These are not judgements. I just want to lower your risk of any issue.
But I do think the study brings up a good point. We train for YEARS in plastic surgery before we finish our residency. 10,000 hours is quoted as what you need to become proficient in something. Being able to see a flap and know- is this too much tension? does the belly button look happy? Doing multiple layered closures, how you orient the scar, closing off dead space, prepping patients with surgical soap for days ahead of surgery, making sure gastric bypass patients have enough nutrition and aren’t anemic, and staging procedures if needed.
Training does matter.