Foundation - Winter 2012 | Newsletter Archive

May 19, 2012

Changing the Way We Practice

From The PSF President
Michael W. Neumeister, MD, FRCSC, FACS

As plastic surgeons, we are always asking, how we can change our approach or enhance procedures or techniques to improve the form or function for our patients. Research supported by contributions to The Plastic Surgery Foundation (The PSF) is helping us answer these questions and offer the best treatment options for our patients.

The VTEPS study is one example of how research funded by your gifts to The PSF is changing the way we practice today. VTEPS has provided data specific to plastic surgery and has given surgeons useful clinical and outcome information to help inform Venous Thromboembolism (VTE) prevention. It has also assisted plastic surgeons and hospitals in formulating or revising their VTE prevention guidelines specifically for patients undergoing plastic and reconstructive surgery.

Contributions from ASPS members and our corporate partners provided The PSF resources to proactively explore questions about a possible association between Anaplastic Large Cell Lymphoma (ALCL) and breast implants in collaboration with the Food and Drug Administration (FDA). As the next step, The PSF is developing an implant registry to study ALCL and to educate our patients about the disease. (Read New Registry to Answer ALCL Questions to learn more about how The PSF is addressing this important issue.)

The MROC (Mastectomy Reconstruction Outcomes Consortium) is another example of how research you support with your contribution to The PSF is directly connected to your clinical practice. The MROC is a breast reconstruction clinical trial that will track long-term outcomes in breast reconstruction patients. It all began with a $50,000 National Endowment for Plastic Surgery grant that resulted in funding from the NIH’s National Cancer Institute. The work of MROC will assist patients and surgeons in choosing the best and most effective surgical options for women seeking reconstruction after mastectomy.

Research sponsored by The PSF is changing the future of composite tissue allotransplantation (CTA). Today, we have to use immunosuppressant drugs that have secondary effects, but through research funded by The PSF, we are discovering ways to reduce and one day eliminate the secondary effects of the immunosuppressant drugs making transplantation safer for patients.

Just as research funded by earlier contributions to The PSF have changed the way you practice today, what you do currently will be different from what you do ten years from now because of research funded by The PSF.

Through the Drive for 75 campaign, we are working to restore ASPS member support of the Foundation to the levels seen a decade ago – when 75% of the entire membership made an annual contribution. If we all get together, we can have a greater power of research for our practices and for our patients. I invite you to join us by investing in future research and innovation that will change patient care by giving online at www.The PSF.org or contacting Susan Hacker, Individual Giving Associate, at 847-709-7542.

Meet a Maliniac Fellow: Dr. Brentley Buchele

Dr. Brentley Buchele, an ASPS member in private practice in Montana, strongly believes that plastic surgery is a noble profession. He wants the specialty to “outgrow its TV image of a cosmetic surgeon who either grubs for money, or was the murderer.” Belonging to the Maliniac Circle is one way that Dr. Buchele displays his pride in the specialty.

As the son of a Methodist minister who became a general surgeon in rural Kentucky, Dr. Buchele grew up in a time and a place “where medicine was still a profession, a part of the community. This meant you were not only making a living, but took pride in your profession and the role it played in the medical and social environment.” Past ASPS President, Dr. Elvin Zook, teacher and surrogate father to Dr. Buchele, reinforced the nobleness of plastic surgery and influenced Dr. Buchele’s decision to become a Maliniac Fellow.

The Maliniac Circle recognizes the generosity of ASPS members and other individuals who have demonstrated their commitment to the specialty of plastic surgery. Maliniac Circle Fellows have all committed $50,000 or more in cash or securities or through a $100,000 deferred gift to The PSF or National Endowment for Plastic Surgery. Dr. Buchele became a Maliniac Fellow in 2000 at the young age of 45 through the insurance plan.

Dr. Buchele has a bit of advice for young plastic surgeons. “I served on committees and was involved in national work both at ASPS and The PSF before the contribution. Before you give, get on a committee. See how the organization runs. See it from the inside. You will not agree with everything, but you will see that it is important and worthy of your time and contributions.”

Dr. Buchele sees the National Endowment for Plastic Surgery and The Plastic Surgery Foundation as tools. “Just as the scalpel is a tool for the surgeon, contributions to The PSF are tools for the leaders of Plastic Surgery. We cannot do our operations without tools, and the leadership cannot fulfill its mandate without resources." says Dr. Buchele.

Contributions to The PSF are the tools that enable the specialty to invest in research that will “strengthen our roots in reconstruction and assure that we are not marginalized from the medical community. There is no question that the marketplace puts more value on cosmetic procedures. However, no other physicians understand scarring and wound healing as we do. By investing in hand surgery, facial trauma, breast reconstruction, complex wounds, soft tissue and bony reconstruction research and trials, we will be seen as crucial to the medical community.“

While he supports and contributes to the Endowment, it is not the only way that Dr. Buchele tries to payback to society. “I take facial trauma call one week each month, knowing that often, I will not be paid. At home, we have a shelf of popcorn, since neither my wife, Diane, nor I can turn down the Boy Scouts door–to-door campaign.”

“Plastic Surgery, puts food on my table, a roof over my head, sends my daughter to college, and affords my wife and me conveniences and even a bit of luxury. I have had the privilege of a good education and a skill that allows me to help people directly, and then to use the money I have to help those endeavors, which are deserving. It feels so good to acknowledge this in a thankful way by contributing in a financial way.”

Planning for Your Future

Have you considered a charitable bequest or other planned gift to The Plastic Surgery Foundation (The PSF) or the National Endowment for Plastic Surgery, but are just not sure what type of gift to make?

A planned approach to charitable giving enables you to provide for your family while also creating a legacy that will continue your generosity far into the future and have a greater impact than you thought possible. Including charitable giving within your financial plans has many benefits. By integrating a charitable gift to The PSF or the Endowment, you may:

• Reduce capital gains and increase your charitable deductions.
• Maintain a significant degree of control over assets during your life.
• Create an income stream for your family’s future.
• Be able to contribute a larger contribution than you might have thought possible.

Nearly 100 of your fellow plastic surgeons and other friends of The PSF have explored these options and have chosen to affirm their life’s work by leaving a permanent expression of their commitment to the future of plastic surgery. You can provide future gifts that support innovation and excellence in the specialty forever by making one or more of the following commitments:

• Contributing a major gift of cash, appreciated assets or similar tangible property,
• Naming The PSF in your will,
• Making The PSF an irrevocable beneficiary of an insurance policy,
• Selecting The PSF as a beneficiary of a number of available charitable estate tools.

As you consider your plans, we want to let you know that The PSF has several recognition societies for friends who make a commitment to The PSF or NEPS in their financial or estate plans.

The Maliniac Circle - Maliniac Fellows have made a minimum $100,000 deferred gift commitment or a $50,000 outright contribution to the National Endowment for Plastic Surgery or The Plastic Surgery Foundation.

The Heritage Society – Heritage Society members have committed a deferred gift of $20,000 - $49,999.

The Legacy Club – Members of the Legacy Club have pledged a deferred gift of less than $20,000.

Every contributor makes a difference, regardless of the size of gift that is given. For more information and ideas on ways to integrate your financial planning with charitable giving, ask your financial advisor or contact:

Carol V. Wargo, CFRE, CAE
Chief Development Officer
Phone: 847-228-3358
cwargo@plasticsurgery.org.

New Registry to Answer ALCL Questions

Through funding from Allergan, LLC, Mentor Worldwide, LLC and Sientra, The Plastic Surgery Foundation (The PSF) contracted the RAND Corporation to lead an advisory council that reviewed the anecdotal case reports and conducted an independent review of the scientific literature regarding Anaplastic Large Cell Lymphoma (ALCL) in women with saline and silicone gel breast implants.

As a result, of the work of the advisory council and the result of recent research funded by the National Endowment for Plastic Surgery, Plastic and Reconstructive Surgery has published two articles to a greater understanding of this disease.

In Anaplastic Large Cell Lymphoma and Breast Implants: A Systematic Review (pub February 25, 2011) the Council identified and analyzed all reported cases occurring in patients with breast implants.
Anaplastic Large Cell Lymphoma and Breast Implant: Results from a Structured Expert (pub April 15. 2011) reported on the evaluated data for the association, its clinical significance and a potential biological model of the published evidence.

The available articles and Research Highlights published by Rand are guiding The PSF’s next steps to educate plastic surgeons and assist them in informing their patients about this disease. To gather further data The PSF is developing a national registry for breast implants in collaboration with the Food and Drug Administration (FDA).

“The registry will help to explore and resolve the issue around causality and implants,”says, Andrea Pusic, MD. “With this registry, we’ll be gathering in depth information on individual cases as well as looking at ALCL in a broader epidemiological context,” Dr. Pusic said during a panel discussion at THE MEETING in September 2011.

“The registry will help us answer important clinical questions such as: Which women are most at risk? How ALCL is best diagnosed? What’s its clinical course, and how is it best treated? It also ensures that patient education, clinical algorithms and policy decisions surrounding implants will not be based on anecdotal information, but rather on a full, high-level understanding of the epidemiology and etiology of ALCL,” Dr. Pusic said.

The registry’s creation demonstrates that the Society and The PSF commitment to ensure patient safety. “From the beginning, ASPS and The PSF have had insight on this,” Dr. Pusic said. “By taking a proactive stance and working with the FDA and breast implant manufacturers, we’ve been able to get out front to establish a path that will ensure patient safety. We’re also making sure the correct response to this issue is based in science, not hysteria,” she said. “That’s what this registry’s all about.”

“The Foundation’s committed to making this process as simple and easy as possible.” Dr. Pusic added. “It will be voluntary, but to make this work, we all need to take the time to report cases if we see them."

For more information, including resources for reporting an ALCL case in MedWatch and relevant literature about ALCL in women with breast implants, please contact ALCL@plasticsurgery.org.

How Research Impacts My Practice
with Scott Spear, MD, FACS

How does research and data influence the way you practice?

I have been actively engaged in performing and following research my whole career.
I am always open to new information that improves or provides new ways of doing things. In my own research I am constantly benchmarking what I am doing, what I used to do and what I should do.

What areas of research are you currently following?

The study of the safety and efficacy to protect and preserve the nipple after mastectomy has enabled me to offer that approach with confidence to a greater range of women.

I have actively studied and followed the value of biological matrices in reconstructive and cosmetic plastic surgery as well as the results of others materials so that today I have more comfort and confidence in using these materials in a variety of plastic surgery procedures from simple to complex.

One of the most intriguing areas has been fat grafting, adoposecytes and stem cells. Our steady and expanding knowledge in these fields has encouraged my use of these sources in a widening number of patients.

How have you used this new information in your practice?

The practical effects of performing and tracking new research results has resulted in changing my practice and solving difficult problems. For example, improving contour irregularities around margins of re-contouring reconstructed breasts with fat grafting was not something I was doing 10 years ago.

Similarly, 10 years ago, only a rare patient was offered nipple-sparing techniques as part of a mastectomy. While today, upwards of 50 percent of my patients are offered that option.

Where do you look to find your research information?

Knowledge and the results of research come from many different sources. The lion’s share that I rely upon comes from our own publications or meetings sponsored by the plastic surgery societies.

What would you like to see done in research to further your practice?

Ideally, thoughtful outcomes studies and research would allow us to derive the best and safest solutions for all the problems by which we are challenged.

What would other plastic surgeons be surprised to know about research and how data driven research can improve their practice?

It is often said that little of what we do is learned in residency. What is learned in training is judgment, surgical skills and the need for life-long learning to stay updated in one’s surgical field. One of the main reasons that knowledge becomes so quickly obsolete is that the body of knowledge from research so rapidly expands and evolves. None of the operations I most commonly do today were taught to me or were preformed thirty years ago. Today, I perform breast reconstruction and revision surgeries assisted with biological matrices, nipple sparing, liposuction, fat grafting, open rhinoplasty, injectable soft tissue fillers and perforator flaps. All these are the result of progress in research.

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