Antidepressant Use in Plastic Surgery

"Stopping antidepressants before plastic and reconstructive surgery is unlikely to reduce complications--and might increase the risk of postoperative problems related to the patient's underlying depression."

This was reported by Dr. Isabel Teo of Ninewells Hospital, Dundee, and medical student Christopher Tam Song of University of Edinburgh after making a comprehensive literature review of the PubMed and Cochrane databases.

A total of 26 studies which assessed the effects of antidepressants on different plastic surgery risks were included for comparison including: risk of bleeding, risk of breast cancer, risk of breast cancer recurrence, breast enlargement, and other uique complications.

Evidences gathered has not debarred the increase in bleeding risk, breast cancer, or other adverse outcomes, according to the research review found in the issue of the Plastic and Reconstructive Surgery Journal.

Researchers Dr. Teo and Mr. Song stated that their review did not find consistent evidence of increased complications related to antidepressants. They said that risks associated with the stopping of prescribed antidepressant therapy in "psychologically vulnerable" patients likely outweigh any increase in complications.

According to them, discontinuation of antidepressants before surgery in the absence of a careful evaluation should be avoided. "Discontinuation syndrome" may happen to patients whose use of antidepressants - particularly the widely used selective serotonin reuptake inhibitors (SSRIs) - is stopped before surgery.

In conclusion, they said that:

This review does not support the cessation of antidepressants in patients before plastic surgery, as the numbers needed to harm are low and the implications of withdrawal may prove to be detrimental to postoperative management. 

However, the use of antidepressants for mental disorders may also implicate key patient risk factors for surgical complications, and sufficient exploration into the patient’s indications for the prescription is crucial. Evidence so far does not suggest that antidepressants increase the risk of breast cancer or recurrence in general, but caution should be exercised for those specifically on concurrent tamoxifen and paroxetine treatment.

Read more on: http://journals.lww.com/plasreconsurg/Fulltext/2015/11000/Assessing_the_Risks_Associated_with_Antidepressant.32.aspx

Revolutionary Single-stage Breast Reconstruction Procedure

This new procedure preserves the nipple, areola and surrounding skin by using a vertical mastectomy incision, a dermal flap for coverage, and a definitive adjustable smooth saline implant.

Hilton Becker, M.D., a local plastic and reconstructive surgeon and an affiliate professor in FAU's Charles E. Schmidt College of Medicine, studied and developed this procedure as an alternative to radical mastectomy. His findings were published in the Plastic and Reconstructive Surgery Journal, co-authored by Jeffrey Lind II, M.D.

According to Dr. Becker,

There are numerous advantages to using a vertical incision over a horizontal incision. From the surgical perspective, it allows for ease of access, and from an aesthetic perspective this incision leads to a better cosmetic result with a scar that resembles that of a breast lift procedure. The procedure is minimally invasive as no new tissue planes are opened after the general surgeon has completed the mastectomy.

Procedures that spare the nipple and skin have been shown to be oncologically safe and allow for much more flexibility in implant-based breast reconstruction. Single-stage breast reconstruction will become more important as there continues to be increasing financial strains on our healthcare system.

Elizabeth Hopkins is an aspiring physician and pre-med student who has been mentored by Dr. Becker. She is also a patient of his and shared her personal feedback after undergoing this new procedure.

This blessing in disguise introduced me to a brilliant surgeon whose unique procedure enabled me to have a skin and nipple sparing mastectomy free from animation deformity, which happens when implants are placed beneath the pectoral muscle – mine were placed over the muscle. Being his patient and working side-by-side with Dr. Becker has changed my life and will hopefully change the lives of many others.”

During the preliminary stage of the study, 31 patients with a median age of 51 underwent the single-stage breast reconstruction procedure. They were followed over the course of four and a half years.

Both a low complication rate and implant loss were shown and reported as part of the results of the procedure. Other benefits according to the authors of the study include: elimination of animation deformities or movement of the implants, elimination of asymmetry, less postoperative pain and discomfort, and a faster recovery.

In addition, the natural position of the implant above the muscle leads to a more natural feel.

Currently, both a one-stage and a two-stage reconstruction are available for patients.

In an immediate breast reconstruction, the plastic surgeon places the implant beneath the muscle of the patient's chest after the removal of the breast tissue. A special type of graft or an absorbable mesh is used to hold the implant in place, much like a hammock or sling.

In a two-stage reconstruction (also called delayed-immediate reconstruction), a short-term tissue expander is used wherein a saline-water solution is injected by the surgeon over a period of 2 to 3 months. When the skin over the breast has stretched enough, a permanent implant will be surgically done to replace the expander. This kind of reconstruction allows time for other treatment options such as radiation therapy to be done when it is needed by the patients.

For more info, you may visit:

http://www.fau.edu/newsdesk/articles/Mastectomy%20Alternative-study.php

Your Medical Spas Commitment to Your Community

There are a lot of charitable organizations that routinely ask our medical spa for support whether it's a listing in their event program, a donation of a gift card or gift basket, or all out sponsorship of a fund raising event.

If you have a charitable heart, it's hard to choose which causes you can afford to support and which ones you cannot. Like all businesses in today's economy, medical spas have their challenges right now in keeping their businesses in the black. While making the commitment to keeping your employees and bills paid, I'm sure most of you feel an obligation to have a commitment to your community. So, instead of offering large donations to a cause, what are some other ways you can show your support for your community?

Go for a Walk! October is Breast Cancer Awareness Month and while we may not be making a large charitable donation, my entire staff bonded together yesterday to walk in a 5K Breast Cancer Awareness Walk. Wearing matching outfits and showing the sponsorship of our medical spa, my staff has made me so proud that they have given up their Saturday to walk in the freezing rain for a wonderful cause! I'm so very proud of you girls!

Put it in a Bag! At the beginning of the year I placed a large order for some pretty awesome gym rated duffle bags with lots of pockets and compartments and, of course, our logo embroidered on both sides. When someone calls for a quick donation, it's easy to fill one of these bags with some tissue paper, a Gift Card, our Menu of Services, brochures, and some little samples provided by our reps like cleansers and moisturizers.

Strategic Gifts! A campaign we really liked this year was SpaFinder's Melanoma Bracelet during the month of May for Melanoma Awareness month. In addition to our eNewsletter and Blog to educate our clients on the early detection of melanomas, we purchased these "REFLECT" bracelets from SpaFinder in bulk and handed them out to every skin consultation we performed in our office during the month of May. This special bracelet changes color when exposed to harmful UV rays.

See RED! Have your staff members wear the color red on the American Heart Association's National Wear Red Day during the month of February! We even handed out red foiled chocolate hearts to our clients and offered a special discount coupon to any client who came into our office wearing red that day! This all was advertised ahead of time on our website and eNewsletter.

While these are just a few ways you can show your willingness to get involved, I'm sure you get the idea of how easy it is to not spend a fortune and still make a difference! I encourage you to post any promotions/ideas you have to help others in our industry help show they are a part of their communities!

Author: Paula D. Young RN runs internal operations and training at Young Medical Spa and is the author of the Medical Spa Aesthetics & Advanced IPL & Laser Training course for medical estheticians and laser technicians.

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