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Speaker 1: This is let's be clear with Shannah Dorny. Hi everyone,

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Speaker 1: We're back with doctor j Oranger. Here we go. There

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Speaker 1: are doctors with different personalities. It doesn't mean that they

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Speaker 1: don't care. It just means there are some that and

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Speaker 1: this is really interesting. I'm gonna give my mom as

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Speaker 1: a really big example. Compare my mom myself. She has

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Speaker 1: amazing doctors. Some of them are different than mine. Reason

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Speaker 1: being is because a she has different issues than I do.

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Speaker 1: She doesn't really have that many issues, but she's had

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Speaker 1: an aneurysm. She's you know, her surgeon that she chose

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Speaker 1: is a wonderful surgeon, one of the best at seaters,

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Speaker 1: and he's very much a handholder and comforts and we'll

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Speaker 1: spend a lot of time. Interestingly enough, you are the

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Speaker 1: only doctor I've ever wanted that from. And I don't

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Speaker 1: know if it's because it was reconstruction. I don't know

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Speaker 1: if it's because it was such an extended period of time.

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Speaker 1: You know, I felt like it was a big hug

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Speaker 1: every single time I saw you. But traditionally, I like

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Speaker 1: my doctors to be a little bit more distant, not

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Speaker 1: distant in the sense of that they don't spend the

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Speaker 1: proper amount of time that I need them to spin

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Speaker 1: with me. But I don't like sympathy. Maybe that's what

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Speaker 1: it is from a doctor. I don't want sympathy. I

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Speaker 1: don't want to feel like, you know, there's some pity involved.

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Speaker 1: I want you to tell me it's like every single

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Speaker 1: time that you know, a scan doesn't come back good.

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Speaker 1: I have a way of getting that news, so I

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Speaker 1: don't have to encounter a nurse in the room looking

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Speaker 1: at me with pity or anything else. I just want

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Speaker 1: give me the facts and then let's immediately go into

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Speaker 1: what's next, what's next protocol? Because I'm very and maybe

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Speaker 1: it's the cancer that's really done this for me, where

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Speaker 1: my brain has just set into okay. I don't want

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Speaker 1: to talk about what has transpired. I don't want to

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Speaker 1: talk about like why that med stopped working. I just

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Speaker 1: want to move forward constantly. I just want one foot

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Speaker 1: in front of the other. And so I don't really

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Speaker 1: need a hugger or a handholding doctor, but you I

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Speaker 1: needed it because it felt scary. But it was also

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Speaker 1: to have drains was very you know, a very odd feeling.

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Speaker 1: There were you know, blistering that sometimes happened because as

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Speaker 1: we know I'm super allergic to adhesive and the fact

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Speaker 1: that you would show up at my house on weekends

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Speaker 1: to make sure I was okay felt very reassuring. And again,

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Speaker 1: you'd do that for every single one of your patients.

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Speaker 1: But you know, it's up to the individual to pick

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Speaker 1: what kind of a doctor they want. I feel like

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Speaker 1: I got an amazing team because I picked everybody individually

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Speaker 1: and their personalities and what fit me for that particular

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Speaker 1: surgery or experience.

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Speaker 2: Great point. That's a fantastic point. I think everybody needs

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Speaker 2: to do that, you know, Shannon, Sympathy is one thing

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Speaker 2: that I personally wouldn't want, but I would always want empathy.

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Speaker 1: Yes, thank you, empathy correct, sympathy no, thank you. I

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Speaker 1: love when someone like you can instantly zone in on

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Speaker 1: what it is because some people hear like, wait, you

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Speaker 1: don't want sympathy and that seems odd to them, but

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Speaker 1: you just fixed it by yeah, sympathy no, thank you,

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Speaker 1: empathy yes, and compassion right. But I think there's a

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Speaker 1: way of giving that to someone like me with my

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Speaker 1: particular personality where I don't feel because I always turn,

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Speaker 1: for some reason, sympathy into pity in my own brain.

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Speaker 2: I get that. I think the point that every patient

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Speaker 2: deserves empathy caring that I do think is extremely important.

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Speaker 2: I want my doctors to be empathetic. What I'm going

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Speaker 2: through for sure.

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Speaker 1: Who recommended you to me is actually really interesting. I

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Speaker 1: think I read an article written by Angelina Julie where

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Speaker 1: she talked about her surgeries, and she talked about all

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Speaker 1: of her surgeons, and she mentioned you and what the

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Speaker 1: process was and everything else. And then just through meeting

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Speaker 1: with different surgeons, I also got recommended to you. So

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Speaker 1: that's how we met. Do you recall that being the same.

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Speaker 2: No, I don't recall the details along happy we met.

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Speaker 1: Were you worried about my career considering the emphasis that

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Speaker 1: is put on women's looks. I wasn't worried esthetically, because

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Speaker 1: I knew I was in really good hands. I was

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Speaker 1: more worried about the cancer diagnosis and what that would

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Speaker 1: do to my career versus interesting. Yeah, I wasn't worried about.

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Speaker 2: I was worried about the aesthetic.

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Speaker 1: I know, but I knew you worried enough for me.

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Speaker 2: That's my job exactly, and that's what I often say

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Speaker 2: to patients. Please you have enough to think about. Let

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Speaker 2: me assume this worry to the best of my ability

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Speaker 2: and as best I can take it off your shoulders.

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Speaker 2: It's important that every it's really important that every patient,

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Speaker 2: whether she is a wonderful successful actor, or whether she

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Speaker 2: is a school teacher, a wonderful teacher or whatever, whatever,

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Speaker 2: or a very important housewife, whatever she does, very important

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Speaker 2: that in my mind that I mean, I strive for

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Speaker 2: her to still feel beautiful. You know, there are limitations

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Speaker 2: to what we can do. But yeah, the aesthetic is

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Speaker 2: always important to me. It wasn't important. Yeah, I knew

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Speaker 2: that as soon as you were well, I mean, you're

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Speaker 2: a dynamo, you were going to be gone, and I

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Speaker 2: needed you to look good, even with the expander. I

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Speaker 2: needed you to look good, you know. So what's so

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Speaker 2: I was concerned about the aesthetic.

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Speaker 1: And the aesthetic is something to be concerned about because

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Speaker 1: it's so hard if you're getting all these surgeries and

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Speaker 1: having chemo, because now you lose your hair. Most women

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Speaker 1: a lot of their identity. Certainly this was the case

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Speaker 1: with me. A lot of my identity was tied into

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Speaker 1: my hair. So now a sudden I'm bald. I couldn't

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Speaker 1: imagine if I you know, and I know how that

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Speaker 1: wreckd with sort of my self esteem, the baldness, all

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Speaker 1: of it. I didn't feel very attractive. I didn't I

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Speaker 1: didn't feel like my partner found me attractive. Other reasons

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Speaker 1: for that apparently, but you know, they're just so. It

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Speaker 1: was incredibly important to me. Yes, that it looked good aesthetically,

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Speaker 1: but I felt with you that I was able to

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Speaker 1: release that concern because you were handling it.

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Speaker 2: That's my privilege. I'm very happy that you felt that.

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Speaker 2: That is always my goal.

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Speaker 1: So I think we kind of answer this of like,

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Speaker 1: why did we wait so long after having the breast

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Speaker 1: removed to actually have reconstructive surgery? Can you expand on

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Speaker 1: your answer?

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Speaker 2: Yeah, let's let's touch upon a couple of points. Okay,

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Speaker 2: in your situation, as with all my every patient in

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Speaker 2: my practice, we started the reconstruction immediately. Super important in

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Speaker 2: my mind, the results of an immediate reconstruction, whether it's

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Speaker 2: with an expander or an implant or a flap, are

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Speaker 2: almost always superior to the results of a delayed reconstruction

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Speaker 2: for a number of reasons. Let alone the fact that

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Speaker 2: it's so much psychologically more uplifting to have a reconstruction immediately,

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Speaker 2: and in your case, we started the reconstruction.

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Speaker 1: Immediately, but with the expander.

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Speaker 2: With the expander, so that is it is.

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Speaker 1: M expanders only supposed to stay in you max how long?

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Speaker 2: I mean, expanders typically will stay for a year or longer.

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Speaker 2: I'm not really aware of a reason per se that

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Speaker 2: it can't be more than a year. And I've had

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Speaker 2: some patients rare patient she just said, oh my expander

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Speaker 2: looks good and not on my advice, but kept it

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Speaker 2: for more than five years. At some point you think

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Speaker 2: the expander is probably going to break down in my leak.

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Speaker 2: You know, it's not a permanent implant, but we generally say,

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Speaker 2: let we try to replace some you know, within a year.

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Speaker 2: That's not etched in stone. And there's some people whose

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Speaker 2: medical conditions aren't optimal at a year where they need

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Speaker 2: to get stronger or some further treatment, and so it

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Speaker 2: can go well beyond a year. But in your situation, Shannon,

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Speaker 2: you had more important therapy that had to take place.

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Speaker 2: You had to do the key radiation. That was why

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Speaker 2: your ultimate reconstruction with your own tissue was necessarily delayed.

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Speaker 2: As I mentioned, following the initial injury from radiation, we

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Speaker 2: like to wait at least six months. It's not that

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Speaker 2: those shapes will totally reverse, but a lot of the

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Speaker 2: immediate injury from the radiation will improve. And if you

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Speaker 2: if you wait six months, we generally feel that it's

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Speaker 2: it's usually safe to proceed with the next phase. If

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Speaker 2: you go much earlier than that, you may be more

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Speaker 2: prone to healing issues. So that was the reason that

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Speaker 2: you you didn't have your final reconstruction after let's say

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Speaker 2: three months from the time of the first It's very

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Speaker 2: common if chemotherapy or radiation isn't necessary, if we use

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Speaker 2: a tissue expander or the temporary adjustable volume implant. After

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Speaker 2: about three months, it's common that we'll put in the implant,

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Speaker 2: or if someone decides she wants her own tissues used,

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Speaker 2: it can be an implant of her own tissue after

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Speaker 2: three months. Therapies needed, that must be done first. If

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Speaker 2: radiations needed, that should be done first, and then we

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Speaker 2: proceed with the next phase.

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Speaker 1: I also like that you clarified and said that reconstruction

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Speaker 1: started immediately, because a lot of people don't think that

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Speaker 1: getting the expanders, doing those final stitches, all the things

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Speaker 1: that you did for me and for all of your

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Speaker 1: patients is part of reconstruction. Like, I didn't even really

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Speaker 1: consider that part of reconstruction, but it is because you're

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Speaker 1: helping to try to ensure that the final result is

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Speaker 1: the best result humanly possible. So you start right away

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Speaker 1: and to get the best result at the end.

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Speaker 2: Shannon that the reconstruction starts with the first stroke of

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Speaker 2: the general surgeon's life. In other words, the plastis surgeon really,

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Speaker 2: in my opinion, should plan that incisional location because that's

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Speaker 2: a very integral part. How the scar is or isn't

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Speaker 2: concealed is very important. So reconstruction, in my mind, theoretically

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Speaker 2: starts as soon as the messtheticy begins.

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Speaker 1: That's because you're you. How as a surgeon do you

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Speaker 1: manage your patient's expectations of what is attainable and what

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Speaker 1: is actually reasonable?

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Speaker 2: Yeah, I mean I really listened to what my patient

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Speaker 2: is telling me in terms of I'll have a patient

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Speaker 2: for a example, we'll say, well, even though I'm sixty

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Speaker 2: five years old, I was a model when I was

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Speaker 2: twenty five. And then I see a picture and it's

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Speaker 2: like I so appreciate that. But it's been forty years.

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Speaker 2: The tissues have changed, so if you're expecting that tight

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Speaker 2: round breast that's going to look the same as she

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Speaker 2: did twenty five years ago, it's not going to be achieved.

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Speaker 2: If someone says, I don't want scars. I've heard you're

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Speaker 2: good at what you do, and I don't want scars,

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Speaker 2: that's clearly not attainable. If you make an incision, there's

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Speaker 2: going to be a scar. As the patient gets to

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Speaker 2: know me and decide is this someone who I want

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Speaker 2: to honor with my care, I also have to get

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Speaker 2: a sense am I likely to make this individual happy?

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Speaker 2: And I'll show them some pictures of what I've done.

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Speaker 2: It's not going to be identical to them by any means,

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Speaker 2: but perhaps clinical situations that are similar. And I'll try

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Speaker 2: to show similar clinical situations as they're experiencing. And if

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Speaker 2: they look at it and they say that's a great result,

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Speaker 2: if I were anywhere near that, I'd be happy. The

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Speaker 2: likelihood is that patient's going to be happy. You know,

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Speaker 2: having done this for so many years, I can see

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Speaker 2: how someone responds. And if someone says they look at

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Speaker 2: the pummy operation and the patients abdominal onto or look

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Speaker 2: so much better than before, and everybody acknowledges that. But

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Speaker 2: what they say is look at the scar and not

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Speaker 2: look at the contour. Then I know that's probably someone

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Speaker 2: who shouldn't have that particular operation unless she absolutely needs it, right,

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Speaker 2: you know, So at this juncture of my career, I'm

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Speaker 2: fortunate to be able to key into responses of what

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Speaker 2: people say about common results. And I look at it,

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Speaker 2: and you know, I if someone says, you know, I

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Speaker 2: want to I want to breast that has no round

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Speaker 2: in this to it. I want an implant, I want

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Speaker 2: no round in this at all. I currently used implants around.

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Speaker 2: Now if we place them, well, we can often achieve

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Speaker 2: a result that looks fairly anatomic not the same as

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Speaker 2: your own tissue. And so if someone says, I don't

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Speaker 2: want any I don't want any round quality to my

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Speaker 2: breast at all, but I want an implant, well that's

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Speaker 2: probably not realistic. Now, again, there are really pleasing results

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Speaker 2: we can achieve with implants, but I have to hear.

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Speaker 2: I have to really tune into what the patient's saying.

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Speaker 2: And you know, I will say to someone, if you

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Speaker 2: expect that they're going to be exactly the same, you

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Speaker 2: can't achieve.

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Speaker 1: It, right, So you manage expectations.

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Speaker 2: I have to. That's what I do my bestution, you know,

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Speaker 2: I just really try very hard to I would I

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Speaker 2: would far or rather exceed someone's expectations and fail to

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Speaker 2: meet them.

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Speaker 1: Are there times where you have to fix other doctors' surgeries?

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Speaker 2: Sure, all of us do our best, you know, as

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Speaker 2: I mean, I like to believe and I truly hope

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Speaker 2: that every doctor genuinely cares. We do our best, and

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Speaker 2: all of us, despite our very best efforts, sometimes don't

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Speaker 2: achieve the outcome for a variety of reasons that we wanted.

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Speaker 2: And so of course I'll see patients who have been

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Speaker 2: operated on by some very capable surgeons and they didn't

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Speaker 2: achieve the result that they wanted. And it's always it's

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Speaker 2: always a privilege to try to help, you know, I

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Speaker 2: think that you know, again, Shannon, we all have results

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Speaker 2: that we really tried hard and it just didn't accomplish

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Speaker 2: exactly what we wanted. And there's so many variables that

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Speaker 2: are involved with reconstructive surchy than even the finest of

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Speaker 2: surgeons as results that he or she wish could have

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Speaker 2: been better. And when that happens, sometimes it's better to

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Speaker 2: see another surgeon. You know, there are times when really

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Speaker 2: good surgeons try to fix what is displeasing for a patient,

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Speaker 2: and again they don't succeed. Sometimes it's probably better to

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Speaker 2: what I call change the energy. You know, Sometimes another

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Speaker 2: surgeon isn't necessarily a better surgeon, but maybe thinks a

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Speaker 2: little differently, may have an idea that will make that

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Speaker 2: unhappy patient happy, you know. So yeah, of course, I

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Speaker 2: mean we all see situations where we of other colleagues,

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Speaker 2: again often very good colleagues, perhaps we can improve at times.

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Speaker 1: Wow, thank you, Mike. Am I ready for my facelift.

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Speaker 2: Yet pretty fantastic?

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Speaker 1: Thank you so much for driving to my house, for

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Speaker 1: that beautiful smile, for your compassion, for the love that

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Speaker 1: you have for every single one of your patients, for

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Speaker 1: how well you took care of me, the results that

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Speaker 1: you gave me, for you know, making me feel like

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Speaker 1: part of your family really, with your wife, with your staff,

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Speaker 1: with everyone. I deeply appreciate you and thank you. And

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Speaker 1: for the listeners. Doctor Jay Oranger one of the absolute

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Speaker 1: best Premiere plastic surgeons, just a fantastic human being. And

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Speaker 1: I hope you guys learned maybe a lot. I think

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Speaker 1: there was a lot to learn from this episode and

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Speaker 1: thanks for listening once again. And doctor J, thank you

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Speaker 1: so much for being on Shannon.

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Speaker 2: Thank you for the privilege of knowing you and caring

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Speaker 2: for you and being involved. It wouldn't be a greater honor.

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Speaker 1: Thank you, sir. All Right, that's let's be Clearishana Doherty

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Speaker 1: and doctor J. Bye, guys,