I am worried about the amount of reoperations at other clinics

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Aesthetic surgery is still more requested branch, nevertheless it has its dark sides in form of failed procedures and necessary reoperations. We have talked on this theme with asc. prof. Jan Měšťák, M.D. PhD.

Professor, today’s medicine emphasizes complex care of a patient. Although aesthetic surgery has specific position among other branches, even here patient must be treated in a complex way. What is the situation of plastic surgeons according to you? Don’t plastic surgeons see just the breasts that they should change?

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Yes, complex care of a patient is a part of aesthetic surgery. For example at our private clinic we bought very costly sonogram, where we perform complex pre-surgical and post-surgical mammography care. It is important because many women might have genetic disposition to severe disease or some suspicious finding. It can also present the reason why we cannot operate. Unfortunately many plastic surgeons perform the surgery in a woman, gets the money for that and do not take further care of her. It is important to have in mind that women with implants often avoid examination near where they live because they don’t want to get into rumours. At our private clinic we meet these wishes. We are the only clinic in Czech republic though.

In the questionnaire you state relatively high number of reoperations at other clinics. Where do you see the main reason for that?

At first it is an insufficient erudition of surgeons. It is caused by today’s popularity of aesthetic surgery. Women and men take greater care of themselves, they need to withstand in competition and they undertake aesthetic changes. Surgeons that specialize in plastic surgery must orientate mainly on classic plastic surgery, they must manage large reconstructions. Aesthetic surgery is not on the first place by attestation. Attestation serves as gate to aesthetic surgery to some of them. The problem is when you quit classic plastic surgery and deal only with aesthetics. The threat is that even though they are experts they don’t have enough experiences. When a surgeon is attested, he/she should have performed two breast surgeries. Surgeons from our university clinic have performed even 140 surgeries. I agree with this and I think it is right like that.

Failed procedures are not a problem only of young surgeons. I know many older surgeons that have 20 years of experience. And even here we do not avoid reoperation.

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Is there any reflection for these colleagues? Do you inform them about performed reoperation and reasons for it?

Yes, it should be like that. Although it happens that the surgeon does not take our notice into account. Unfortunately I know some surgeons that do the same mistakes and still they perform the procedures again. Naturally I know after which surgeon I perform reoperations most often.

What are the factors that influence the result of the surgery and patient’s satisfaction?

The effect of the surgery can be divided into four groups:

The effect of the surgery is perfect and the patient is satisfied or the effect of the surgery could be better according to the surgeon and the patient is content. Those are ideal possibilities. Problem is when the result of the surgery is perfect but the patient is not satisfied. Or when the surgery is not performed right and even the patient is dissatisfied.

In plastic surgery there are many complications starting with not keeping asepsis and antisepsis ad ending with inappropriately chosen size of implant. I always say that 70% of the success is quality of performed procedure and the rest is patient’s personality. It depends on his/her psychic stability and positive mood. After that I know that I can operate and everything will be without complications. Plastic surgeon should make difference between real defect and some possession of a person that requests surgery, which result is unrealistically expected.

What do you think of performing reoperations?

I know many surgeons that reject reoperations because they are more time-consuming and therefore even more expensive. They are also associated with certain risks. I often have patients that ask me for help. They are even three or four times reoperated. The world has ended for these women, they are not interested in anything anymore. I always meet their wishes although it is not often easy. Although the reoperation is almost always successful. After the surgery their life begins again and they are happy. That’s why I do the reoperations, although it is a hard job.

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How should the patient orientate when choosing the surgeon?

During selection of a surgeon the main role plays reputation of the clinic. It is not just about myself. We have here at our clinic great working team that must convene with results and create atmosphere. When you call a clinic a secretary should advice you, who you should book for certain type of a surgery. There are many great surgeons that I would recommend. Of course not those surgeons that I perform reoperations most often. I never give their names though. Patient can get some information also at Internet discussions.

What are the measures so that the aesthetic procedures would be performed only by truly erudite specialists? What is the control mechanism, for example by associations of CzMA JEP?

In the board of the association we try to solve these problems. We have tried to found an ethic commission, which deals with ethic problems, questions of cooperativeness and loyalty. We haven’t found yet the right way how to solve the problem in a system.

Is there a threat in plastic surgeons that commercial interests prevail the medical interests?

Unfortunately in many cases it is like that and the economic profit really prevails. It presents a problem then. I reject many surgeries. For example women with nice breasts that want augmentation or modification. When I see that the breasts are nice and there would be scars after the surgery. The result would be aesthetically less advantageous, regardless the financial profit I do not operate these women on principle.

Thank you for the interview

Petra Dvořáková

Updated: 2009-10-07

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