What is plastic surgery?

The term “plastic” is derived from the Greek work “plastikos” which means “moulding” or “giving form”. The medical specialty of Plastic Surgery encompasses a broad range of techniques utilized to improve function and minimize disfigurement resulting from birth defects, disease, or accidents.

Plastic surgeons operate in all areas of the body. The types of procedures performed include reconstruction following tumor removal or injury, reconstruction or reshaping of the breast, hand surgery, microsurgery, initial and long-term treatment of burns, correction of birth defects, and the management of complex wounds. The goal of such procedures is to restore maximum function with minimal cosmetic deformity.

What is cosmetic surgery?

Cosmetic (or aesthetic) surgery is an extension of the techniques which were originally utilized for reconstructive surgery. These refined techniques allow plastic surgeons to rejuvenate the aging face and eyelids, refine the nose, repair scars, reshape the breast, contour the body, and perform many other procedures designed to enhance the appearance of the patient.

Are you board certified?

Both Dr. Thellman and Dr. Keller are board certified by the American Board of Plastic Surgery. To become board certified, your surgeon must complete a standardized training program in Plastic and Reconstructive Surgery. Following completion of training, your surgeon must pass a written and oral examination. Only then can one become board certified.

How many of these operations have you done?

Both of our physicians have undergone extensive training in Plastic and Reconstructive Surgery and have met the standardized numerical requirements for board certification. Although numbers of surgical cases may vary based on practice type and location, we assure the patient that they will receive the utmost in surgical care.

How much pain will I be in following surgery?

Each surgical procedure is associated with a varying degree of pain and discomfort. Also, every patient will experience a different level of painful symptoms. You will be provided with an individualized postoperative pain control regimen. Many of our patients make the following statement: “If I knew it was going to be this easy, I would have done this a long time ago.”

Where will my procedure be performed?

Your surgical procedure can be performed at any of four possible surgical locations. Our home office in Lawrence offers two well-equipped operative suites. If your procedure requires only local anesthesia or oral sedation, your procedure may be performed at our office location. Lawrence Surgery Center and Lawrence Memorial Hospital are both conveniently located in close proximity to our office in Lawrence. Should you request or your procedure require intravenous sedation or general anesthesia, your surgical care may be completed at either of those two locations. Tallgrass Surgical Center, located in Topeka, offers an additional location for local anesthesia, intravenous sedation, or general anesthesia. Our second office is located in the Tallgrass General and Vascular Surgical Group’s suite in the Tallgrass Surgical Center (McElroy Building). Whatever location is chosen for your care, we will strive to accommodate your proximity and schedule and ensure first and foremost, your safety.

When can I go back to work?

Each surgical procedure is associated with a different recovery period. We will discuss your recovery at length and work with you to create a return to work format that is best for you.

When will I be able to exercise again?

Each surgical procedure is associated with a different recovery period. With many operative procedures, you may begin your exercise program within two to four weeks following your surgery. We will discuss in detail a plan to return to exercise based on your specific surgery and desires.

How much does plastic surgery cost?

Every surgical procedure will vary in cost depending upon type of procedure, location of procedure, and form of anesthesia. Our patient care coordinator will review your specific financial obligation with you as well as discuss many options for financing.

Will insurance pay for my procedure?

Although many reconstructive procedures may be covered by insurance, the type of procedure and insurance plan may dictate a personal financial obligation. Cosmetic procedures are not covered by most insurance policies. In either situation, we will work with your insurance provider or provide you with financial options.

What are the risks of plastic surgery?

All surgical procedures are associated with a given degree of risk. Our physicians and nurses will review with you the risks, benefits, complications, and limitations particular to your surgical procedure.

If you are considering silicone gel breast implants

I am interested in having silicone gel breast implants placed. Can I have this done at Lawrence Plastic Surgery?

Yes, but we must follow some special guidelines. Under current FDA rules, women may only have silicone breast implants placed by surgeons who are participating in ongoing FDA approved studies. Dr. Thellman is a principle investigator in the Mentor adjunct silicone gel implant study and has been utilizing silicone gel implants for the past 6 years in patients who meet the qualifications of this study. In general, patients must meet certain criteria to be eligible for silicone implant placement and agree to follow up with us at certain intervals in addition to our regular post operative visits. Patients must have one of the following conditions to qualify:

• Reconstruction following breast removal for cancer
• Severe deformity including severe breast asymmetry, tubular breasts, chest wall deformity, or following trauma.
• Significant ptosis (droop) requiring mastopexy in addition to requiring implant placement.

If you meet one of these conditions, and it is felt that saline implants would be inferior to silicone implants, we will be happy to discuss placement of silicone implants with you.

Why would I choose silicone implants over saline?

The biggest difference is that silicone implants have a softer, more natural feel than saline, as the gel material more closely matches normal breast tissue than salt water. They are typically less prone to showing visible rippling than saline. These factors are particularly important when there is minimal breast tissue available to cover the implant, such as after a mastectomy.

Are the silicone implants used now like the ones placed 20-30 years ago?

The current silicone implants represent an improvement over those used in the past. The Mentor silicone implants we are using recently were reviewed by a FDA panel which has recommended their general usage outside of the confines of clinical studies. The studies show that improvements in shell design make them less prone to leakage and rupture than many of the older implants. Final adoption of these suggestions is still pending at this time.

Q: Are silicone implants safe?

This is a very important question and has been the subject of multiple studies in the past and currently. A complete presentation of all the information available would be impossible, but we will briefly summarize here. A review of studies by the Institute of Medicine in 2000 concluded that silicone implants do not increase the risk of developing breast cancer, developing an autoimmune disease, neurologic disease, or other major illnesses. However, they can cause local problems in the breast if leakage occurs, such as pain and scarring. When these problems occur, removal and replacement is typically more involved than with saline implants. As implants cannot be guaranteed to last forever and may leak many years later, these are important considerations to discuss with us before you choose silicone implants. If you would like a copy of the Institute of Medicine report “Information for Women About the Safety of Silicone Breast Implants” contact our office. We also would recommend the website www.breastimplantsafety.org for more information.

Q: When is the FDA going to decide if silicone implants can be used for a typical cosmetic augmentation?

An FDA panel has suggested that they be approved for use. We expect a final FDA ruling in the next few months, but a firm date has not been set. Among other conditions, the panel has suggested these only be allowed to be placed by surgeons board certified by the American Board of Plastic Surgery who have completed a course in silicone implant usage. Both of our physicians meet this board certification qualification and Dr. Thellman has several years experience as a silicone implant investigator in the Mentor study. If and when these implants become generally available, we will be ready to offer them to our patients. If you would like to be placed on our waiting list, let us know and we will contact you as soon as they are available

If you already have silicone breast implants

Q: I am worried my silicone implants have a leak. How can I find out if they really do?

Silicone implant leakage will sometimes show up on a mammogram or breast ultrasound. The best test is an MRI, but even this is not 100% accurate in detecting leakage. If you are not having any problems, and the tests don’t show any evidence of leakage, then we recommend leaving the implants alone.

Q: If my implants have leaked, do they need to be removed?

Implants that have leaked, especially if the silicone has leaked outside the capsule (your body’s natural collagen “wall” that forms around an implant), generally should be removed. Over time, a leaking implant can cause scarring and other problems within the breast tissue. They can be replaced with new silicone implants, saline implants, or the implants left out all together.

Q: I am having problems with my silicone implants placed many years ago. Can you remove them?

We are happy to see you if you have silicone implants that are causing you problems and may need to removed or replaced. We will meet with you during our consultation, examine your breasts, discuss options for treatment, and order any necessary tests. Together we will develop a plan for managing your problems, which may involve simply removing the implants, replacing the implants, lifting the breasts or other reconstructive procedures. We can show you photographs of patients who have undergone these procedures and help you get an idea of your final outcome. We can also discuss insurance coverage issues with you at that time.

Q: I have old silicone breast implants and I am worried about getting a mammogram. I am afraid they might rupture. Should I avoid mammograms?

Definitely not! We would suggest getting your mammograms on a regular basis, just as a woman without implants should. The risk of a rupture is slight and this is a manageable problem. However, missing out on early detection of a breast cancer because you were avoiding mammograms could have significant consequences that would make your cancer more difficult to treat. We urge women to have mammograms performed regardless of the presence of implants and try to catch breast cancer at its earliest stage.

For answers to additional questions, please contact us by phone or visit the American Society of Plastic Surgery website at plasticsurgery.org.