THE BLOG
10/22/2012 05:18 pm ET Updated Dec 22, 2012

Two Bad Weeks for My Patients

In the past two weeks, I've diagnosed four patients with breast cancer. That might not sound like a lot for a busy doctor, but I am a plastic surgeon. My patients see me voluntarily and our interactions are full of happiness and optimism. This isn't supposed to happen. It is wrenching to tell just one patient they have cancer, so this cluster has overwhelmed me.

All of these women had scheduled plastic surgery and their cancers were detected during their pre-surgical work-up. One was diagnosed by mammogram; another had a mass that had been dismissed; one traveled from a country with socialized medicine where she had been waiting months for an MRI; and on another I biopsied a suspicious lump.

What does this mean for them? It requires a 180-degree shift from being enthusiastic about having surgery to look better to being scared about having surgery to excise a cancer. For some it will mean chemotherapy. But for all it will mean a better chance at a cure.

Over the years, pre-surgical testing has revealed patients of mine with abnormal clotting problems, kidney disease, impending cardiac events, colon cancer, and a variety of other problems. Those patients thereby had treatment initiated sooner which gave them a better chance of a cure.

But it should never be forgotten that plastic surgery itself has significant risks, including even death. According to the AAASF, the premiere accrediting body of operating rooms, there were 23 deaths in 1.14 million plastic surgery procedures.

The nation's largest plastic surgery organizations are laser focused on lowering that number. The ASPS and the ASAPS have developed specific patient safety educational initiatives. Research funded by ASERF provides data upon which to upgrade those standards. As knowledge grows and operating room technology develops, AAAASF updates its requirements.

No data is collected on problems found during the preoperative work-up, but in speaking with colleagues it is clear that my experience is typical of board certified plastic surgeons. One can only imagine how many bad diseases were discovered when doing preoperative clearances on those 1.1 million patients. No doubt there were more than 23 "pick-ups." Good plastic surgeons save lives.

This emphasizes the importance that plastic surgeons be well-trained. Did you know that a plastic surgeon does not even have to be board certified? Did you realize that there are even bogus boards that offer mail-order bogus "board" certificates? The American Board of Plastic Surgery (ABPS) is the only board that counts. Fortunately there is an easy way for patients to check on their doctor. Every bona fide American plastic surgeons is listed here.

One reason for board certification is that the weekend courses the docs with the bogus boards might take are insufficient. But it is also important that a surgeon have a deep knowledge of the anatomy and pathology of the body part upon which they are operating; no one should do cosmetic breast surgery unless they are experienced treating breast cancer. While plastic surgeons are portrayed as artists and sculptors, the very best plastic surgeons are also fabulous physicians.

In any case, no one should be waiting for plastic surgery to be screened for cancer. Everyone needs a great internist, and all must follow through on their doctor's advice. Living in denial only results in a greater problem in the future. Your doctor won't force you to return to their office for a follow-up. Don't wait for your insurance company to send a town car to take you for a scan. You are responsible.

My quixotic view is that our culture will evolve to the point that we speak to one another as much about health issues as we do about Snooki and Honey Boo Boo. There is room for friends to discuss doctors, tests, scans and the importance of maintaining their health without divulging their own secrets or disrespecting each other's privacy.

There were more important things to have been discussing in the summer of 2001 than shark attacks in Florida and overage little leaguers. Can't we learn a lesson from that?