Donda West Death Results in New Law
December 10th, 2009
In response to the death of Donda West, Kanye West’s mother, the California State Senate recently approved a requirement that patients must be given a physical exam before elective surgery, according to the Los Angeles Times. The new law, AB 252, passed by an overwhelming margin. The vote was 37 to 1. This new California statute requires a history and physical examination be done prior to any elective cosmetic surgery or cosmetic medicine procedure that is performed in physician offices. The goal, of course, is to reduce the risk of death or serious impairment associated with surgery. Unfortunately the law does not address cosmetic surgery done in dentist offices or surgery related to body modifications carried out in non-medical facilities or surgery done by unqualified personnel.
I have always insisted that my patients have a History and Physical completed by their primary physician before having elective surgery. The most important philosophy guiding most surgeons, in an effort to avoid complications from cosmetic surgery, directly relates to patient safety. Risks are present in all medical procedures and surgical treatments, but certain steps minimize this risk. Yet complications occur and cannot be eliminated entirely. It is important to know that your surgeon has made every effort to reduce the risks and incidence of complications for any cosmetic surgery.
One of the cornerstones making cosmetic surgery safer is the pre-operative History and Physical. This medical evaluation is usually completed in advance of having cosmetic surgery. I require this evaluation to be done within two weeks prior to a patient’s surgery date. It was my practice as I began my career as a surgeon and it is a policy that I have continued for the past twenty-five years. However, I do not do pre-operative history and physicals on my own patients. I prefer that an independent, unbiased physician complete the examination, order necessary laboratory tests and finally interpret the results and confirm that the patient is healthy enough for surgery. I like to think of this division of patient care as an effective tool used to uncover any underlying medical condition that might lessen the safety of having elective surgery.
Whether or not your state requires this extra step, please consider having a pre-operative medical examination before all elective surgery.
Buttocks Surgery Causes Death of Miss Argentina
December 1st, 2009
My wife, Lindsay, brought this unfortunate case of cosmetic surgery in the news to my attention today. CNN was among the media outlets who ran the story. Gluteoplasty or buttocks enlargement has been popularized by the cultural emphasis on a round, protruding, and firm butt. Both men and women consider this surgery when they want a fuller buttocks. Because of safety issues and concerns, I do not offer this surgery to my patients.
There are two ways to achieve “butt enlargement.†First is by injection. The most popular injectable material has been fat. Fat is first removed using a liposuction technique. The fat is then injected in to the buttocks, after it is purified. Theoretically, this should work, as the buttocks are primarily fat. Unfortunately, there are many reports of sudden death when this technique is used. Extreme caution should be exercised when considering this type of cosmetic surgery, because there appears to be no clear explanation as to why the patients have died. Anytime anything is injected into the body there is a risk of intravascular injection. Antibiotics, anesthesia drugs, and intravenous fluids need to be administered intravenously or into the vein. Immunizations, insulin, local anesthetic, and fat should not. If fat is accidentally injected into a vein in the buttocks, the fat will travel to the heart. The heart pumps the venous blood and fat into the lungs, because this is just how our plumbing works. The lungs filter the fat in its small blood vessels near the aveoli. Small amounts of fat or emboli are usually inconsequential. However, if there is a large amount of fat in the blood or if the blood begins to clot around the injected fat, the resulting pulmonary embolus would most likely be fatal. Sadly, Solange Magnano, Miss Argentina 1994 suffered a fatal pulmonary embolus due to complications from the fat injection into her buttocks.
Another way to enlarge the buttocks is an alternate technique where a solid silicone implant is placed beneath the skin and fat. Solid silicone implants have been around for many years in other shapes. They are used to enlarge the chest in men, calves, and chin. They have been proven to be relatively safe and effective. The surgery to place such implants in the buttocks is not complicated, although the skill of the surgeon is important. The results are generally acceptable to many patients. However, there is a significant risk of a very serious gram negative infection. Because of the posterior location of the surgery and the adjacent location of natural occurring bacteria, risk of infection is considerable.
Some of these bacteria are home to the intestinal tract. Such infections frequently require hospital admission and have a high risk of death. In addition, coloform bacteria can also result in an infection known as synergistic gangrene. In this case, multiple bacteria types infect the tissues together and lead to skin and fat death. Extensive reconstructive surgery, including skin grafts and terrible scars may result. At its worse, synergistic gangrene can lead to death.
I chose not to do either of these surgeries. I do not feel that the risks of these very serious complication are worth the benefits of the surgery for my patients.
Sometimes it’s better to just hit the gym!
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