WEBVTT - Let’s Be Clear About Reconstruction...with Dr. Jay Orringer (Part 2)

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

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<v Speaker 1>We're back with doctor j Oranger. Here we go. There

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<v Speaker 1>are doctors with different personalities. It doesn't mean that they

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<v Speaker 1>don't care. It just means there are some that and

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<v Speaker 1>this is really interesting. I'm gonna give my mom as

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<v Speaker 1>a really big example. Compare my mom myself. She has

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<v Speaker 1>amazing doctors. Some of them are different than mine. Reason

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<v Speaker 1>being is because a she has different issues than I do.

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

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

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<v Speaker 1>is a wonderful surgeon, one of the best at seaters,

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<v Speaker 1>and he's very much a handholder and comforts and we'll

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<v Speaker 1>spend a lot of time. Interestingly enough, you are the

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<v Speaker 1>only doctor I've ever wanted that from. And I don't

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<v Speaker 1>know if it's because it was reconstruction. I don't know

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<v Speaker 1>if it's because it was such an extended period of time.

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<v Speaker 1>You know, I felt like it was a big hug

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<v Speaker 1>every single time I saw you. But traditionally, I like

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<v Speaker 1>my doctors to be a little bit more distant, not

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<v Speaker 1>distant in the sense of that they don't spend the

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<v Speaker 1>proper amount of time that I need them to spin

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

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<v Speaker 1>it is from a doctor. I don't want sympathy. I

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

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<v Speaker 1>I want you to tell me it's like every single

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

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<v Speaker 1>I have a way of getting that news, so I

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<v Speaker 1>don't have to encounter a nurse in the room looking

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<v Speaker 1>at me with pity or anything else. I just want

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<v Speaker 1>give me the facts and then let's immediately go into

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<v Speaker 1>what's next, what's next protocol? Because I'm very and maybe

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<v Speaker 1>it's the cancer that's really done this for me, where

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<v Speaker 1>my brain has just set into okay. I don't want

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<v Speaker 1>to talk about what has transpired. I don't want to

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<v Speaker 1>talk about like why that med stopped working. I just

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<v Speaker 1>want to move forward constantly. I just want one foot

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<v Speaker 1>in front of the other. And so I don't really

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<v Speaker 1>need a hugger or a handholding doctor, but you I

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<v Speaker 1>needed it because it felt scary. But it was also

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<v Speaker 1>to have drains was very you know, a very odd feeling.

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<v Speaker 1>There were you know, blistering that sometimes happened because as

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<v Speaker 1>we know I'm super allergic to adhesive and the fact

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<v Speaker 1>that you would show up at my house on weekends

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<v Speaker 1>to make sure I was okay felt very reassuring. And again,

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<v Speaker 1>you'd do that for every single one of your patients.

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<v Speaker 1>But you know, it's up to the individual to pick

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<v Speaker 1>what kind of a doctor they want. I feel like

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<v Speaker 1>I got an amazing team because I picked everybody individually

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<v Speaker 1>and their personalities and what fit me for that particular

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<v Speaker 1>surgery or experience.

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<v Speaker 2>Great point. That's a fantastic point. I think everybody needs

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<v Speaker 2>to do that, you know, Shannon, Sympathy is one thing

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<v Speaker 2>that I personally wouldn't want, but I would always want empathy.

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<v Speaker 1>Yes, thank you, empathy correct, sympathy no, thank you. I

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<v Speaker 1>love when someone like you can instantly zone in on

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<v Speaker 1>what it is because some people hear like, wait, you

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<v Speaker 1>don't want sympathy and that seems odd to them, but

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<v Speaker 1>you just fixed it by yeah, sympathy no, thank you,

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

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<v Speaker 1>way of giving that to someone like me with my

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<v Speaker 1>particular personality where I don't feel because I always turn,

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<v Speaker 1>for some reason, sympathy into pity in my own brain.

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<v Speaker 2>I get that. I think the point that every patient

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<v Speaker 2>deserves empathy caring that I do think is extremely important.

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<v Speaker 2>I want my doctors to be empathetic. What I'm going

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<v Speaker 2>through for sure.

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<v Speaker 1>Who recommended you to me is actually really interesting. I

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<v Speaker 1>think I read an article written by Angelina Julie where

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<v Speaker 1>she talked about her surgeries, and she talked about all

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<v Speaker 1>of her surgeons, and she mentioned you and what the

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<v Speaker 1>process was and everything else. And then just through meeting

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<v Speaker 1>with different surgeons, I also got recommended to you. So

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<v Speaker 1>that's how we met. Do you recall that being the same.

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

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<v Speaker 1>Were you worried about my career considering the emphasis that

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

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<v Speaker 1>I knew I was in really good hands. I was

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<v Speaker 1>more worried about the cancer diagnosis and what that would

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

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<v Speaker 2>I was worried about the aesthetic.

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<v Speaker 1>I know, but I knew you worried enough for me.

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<v Speaker 2>That's my job exactly, and that's what I often say

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<v Speaker 2>to patients. Please you have enough to think about. Let

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<v Speaker 2>me assume this worry to the best of my ability

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<v Speaker 2>and as best I can take it off your shoulders.

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<v Speaker 2>It's important that every it's really important that every patient,

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<v Speaker 2>whether she is a wonderful successful actor, or whether she

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<v Speaker 2>is a school teacher, a wonderful teacher or whatever, whatever,

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<v Speaker 2>or a very important housewife, whatever she does, very important

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<v Speaker 2>that in my mind that I mean, I strive for

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<v Speaker 2>her to still feel beautiful. You know, there are limitations

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<v Speaker 2>to what we can do. But yeah, the aesthetic is

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<v Speaker 2>always important to me. It wasn't important. Yeah, I knew

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<v Speaker 2>that as soon as you were well, I mean, you're

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<v Speaker 2>a dynamo, you were going to be gone, and I

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<v Speaker 2>needed you to look good, even with the expander. I

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<v Speaker 2>needed you to look good, you know. So what's so

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<v Speaker 2>I was concerned about the aesthetic.

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<v Speaker 1>And the aesthetic is something to be concerned about because

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<v Speaker 1>it's so hard if you're getting all these surgeries and

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<v Speaker 1>having chemo, because now you lose your hair. Most women

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<v Speaker 1>a lot of their identity. Certainly this was the case

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<v Speaker 1>with me. A lot of my identity was tied into

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<v Speaker 1>my hair. So now a sudden I'm bald. I couldn't

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<v Speaker 1>imagine if I you know, and I know how that

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<v Speaker 1>wreckd with sort of my self esteem, the baldness, all

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<v Speaker 1>of it. I didn't feel very attractive. I didn't I

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<v Speaker 1>didn't feel like my partner found me attractive. Other reasons

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

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<v Speaker 1>was incredibly important to me. Yes, that it looked good aesthetically,

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<v Speaker 1>but I felt with you that I was able to

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<v Speaker 1>release that concern because you were handling it.

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<v Speaker 2>That's my privilege. I'm very happy that you felt that.

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<v Speaker 2>That is always my goal.

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<v Speaker 1>So I think we kind of answer this of like,

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<v Speaker 1>why did we wait so long after having the breast

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<v Speaker 1>removed to actually have reconstructive surgery? Can you expand on

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<v Speaker 1>your answer?

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<v Speaker 2>Yeah, let's let's touch upon a couple of points. Okay,

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<v Speaker 2>in your situation, as with all my every patient in

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<v Speaker 2>my practice, we started the reconstruction immediately. Super important in

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<v Speaker 2>my mind, the results of an immediate reconstruction, whether it's

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<v Speaker 2>with an expander or an implant or a flap, are

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<v Speaker 2>almost always superior to the results of a delayed reconstruction

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<v Speaker 2>for a number of reasons. Let alone the fact that

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

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<v Speaker 2>and in your case, we started the reconstruction.

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<v Speaker 1>Immediately, but with the expander.

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<v Speaker 2>With the expander, so that is it is.

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<v Speaker 1>M expanders only supposed to stay in you max how long?

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<v Speaker 2>I mean, expanders typically will stay for a year or longer.

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<v Speaker 2>I'm not really aware of a reason per se that

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

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<v Speaker 2>some patients rare patient she just said, oh my expander

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<v Speaker 2>looks good and not on my advice, but kept it

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<v Speaker 2>for more than five years. At some point you think

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<v Speaker 2>the expander is probably going to break down in my leak.

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

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<v Speaker 2>let we try to replace some you know, within a year.

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<v Speaker 2>That's not etched in stone. And there's some people whose

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<v Speaker 2>medical conditions aren't optimal at a year where they need

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<v Speaker 2>to get stronger or some further treatment, and so it

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<v Speaker 2>can go well beyond a year. But in your situation, Shannon,

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<v Speaker 2>you had more important therapy that had to take place.

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<v Speaker 2>You had to do the key radiation. That was why

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<v Speaker 2>your ultimate reconstruction with your own tissue was necessarily delayed.

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<v Speaker 2>As I mentioned, following the initial injury from radiation, we

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<v Speaker 2>like to wait at least six months. It's not that

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<v Speaker 2>those shapes will totally reverse, but a lot of the

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<v Speaker 2>immediate injury from the radiation will improve. And if you

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<v Speaker 2>if you wait six months, we generally feel that it's

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<v Speaker 2>it's usually safe to proceed with the next phase. If

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<v Speaker 2>you go much earlier than that, you may be more

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<v Speaker 2>prone to healing issues. So that was the reason that

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<v Speaker 2>you you didn't have your final reconstruction after let's say

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<v Speaker 2>three months from the time of the first It's very

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<v Speaker 2>common if chemotherapy or radiation isn't necessary, if we use

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<v Speaker 2>a tissue expander or the temporary adjustable volume implant. After

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

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<v Speaker 2>or if someone decides she wants her own tissues used,

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<v Speaker 2>it can be an implant of her own tissue after

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<v Speaker 2>three months. Therapies needed, that must be done first. If

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<v Speaker 2>radiations needed, that should be done first, and then we

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<v Speaker 2>proceed with the next phase.

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<v Speaker 1>I also like that you clarified and said that reconstruction

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<v Speaker 1>started immediately, because a lot of people don't think that

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<v Speaker 1>getting the expanders, doing those final stitches, all the things

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<v Speaker 1>that you did for me and for all of your

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

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<v Speaker 1>consider that part of reconstruction, but it is because you're

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<v Speaker 1>helping to try to ensure that the final result is

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<v Speaker 1>the best result humanly possible. So you start right away

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<v Speaker 1>and to get the best result at the end.

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<v Speaker 2>Shannon that the reconstruction starts with the first stroke of

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<v Speaker 2>the general surgeon's life. In other words, the plastis surgeon really,

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<v Speaker 2>in my opinion, should plan that incisional location because that's

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<v Speaker 2>a very integral part. How the scar is or isn't

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<v Speaker 2>concealed is very important. So reconstruction, in my mind, theoretically

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<v Speaker 2>starts as soon as the messtheticy begins.

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<v Speaker 1>That's because you're you. How as a surgeon do you

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<v Speaker 1>manage your patient's expectations of what is attainable and what

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<v Speaker 1>is actually reasonable?

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<v Speaker 2>Yeah, I mean I really listened to what my patient

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<v Speaker 2>is telling me in terms of I'll have a patient

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

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<v Speaker 2>five years old, I was a model when I was

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<v Speaker 2>twenty five. And then I see a picture and it's

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<v Speaker 2>like I so appreciate that. But it's been forty years.

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<v Speaker 2>The tissues have changed, so if you're expecting that tight

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<v Speaker 2>round breast that's going to look the same as she

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

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

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<v Speaker 2>good at what you do, and I don't want scars,

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

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<v Speaker 2>going to be a scar. As the patient gets to

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<v Speaker 2>know me and decide is this someone who I want

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<v Speaker 2>to honor with my care, I also have to get

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<v Speaker 2>a sense am I likely to make this individual happy?

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<v Speaker 2>And I'll show them some pictures of what I've done.

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<v Speaker 2>It's not going to be identical to them by any means,

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<v Speaker 2>but perhaps clinical situations that are similar. And I'll try

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<v Speaker 2>to show similar clinical situations as they're experiencing. And if

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<v Speaker 2>they look at it and they say that's a great result,

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<v Speaker 2>if I were anywhere near that, I'd be happy. The

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

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<v Speaker 2>having done this for so many years, I can see

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<v Speaker 2>how someone responds. And if someone says they look at

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<v Speaker 2>the pummy operation and the patients abdominal onto or look

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<v Speaker 2>so much better than before, and everybody acknowledges that. But

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<v Speaker 2>what they say is look at the scar and not

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<v Speaker 2>look at the contour. Then I know that's probably someone

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

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<v Speaker 2>you know, So at this juncture of my career, I'm

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<v Speaker 2>fortunate to be able to key into responses of what

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<v Speaker 2>people say about common results. And I look at it,

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<v Speaker 2>and you know, I if someone says, you know, I

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<v Speaker 2>want to I want to breast that has no round

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<v Speaker 2>in this to it. I want an implant, I want

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<v Speaker 2>no round in this at all. I currently used implants around.

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<v Speaker 2>Now if we place them, well, we can often achieve

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<v Speaker 2>a result that looks fairly anatomic not the same as

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

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<v Speaker 2>want any I don't want any round quality to my

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<v Speaker 2>breast at all, but I want an implant, well that's

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<v Speaker 2>probably not realistic. Now, again, there are really pleasing results

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<v Speaker 2>we can achieve with implants, but I have to hear.

0:16:22.520 --> 0:16:25.680
<v Speaker 2>I have to really tune into what the patient's saying.

0:16:25.760 --> 0:16:31.520
<v Speaker 2>And you know, I will say to someone, if you

0:16:31.720 --> 0:16:36.560
<v Speaker 2>expect that they're going to be exactly the same, you

0:16:36.680 --> 0:16:37.680
<v Speaker 2>can't achieve.

0:16:37.360 --> 0:16:39.760
<v Speaker 1>It, right, So you manage expectations.

0:16:39.720 --> 0:16:44.960
<v Speaker 2>I have to. That's what I do my bestution, you know,

0:16:45.640 --> 0:16:49.480
<v Speaker 2>I just really try very hard to I would I

0:16:49.480 --> 0:16:54.360
<v Speaker 2>would far or rather exceed someone's expectations and fail to

0:16:54.400 --> 0:16:56.160
<v Speaker 2>meet them.

0:16:56.200 --> 0:17:02.640
<v Speaker 1>Are there times where you have to fix other doctors' surgeries?

0:17:03.720 --> 0:17:06.400
<v Speaker 2>Sure, all of us do our best, you know, as

0:17:07.000 --> 0:17:09.320
<v Speaker 2>I mean, I like to believe and I truly hope

0:17:09.320 --> 0:17:14.119
<v Speaker 2>that every doctor genuinely cares. We do our best, and

0:17:14.400 --> 0:17:18.760
<v Speaker 2>all of us, despite our very best efforts, sometimes don't

0:17:18.760 --> 0:17:23.240
<v Speaker 2>achieve the outcome for a variety of reasons that we wanted.

0:17:23.280 --> 0:17:27.719
<v Speaker 2>And so of course I'll see patients who have been

0:17:27.760 --> 0:17:33.320
<v Speaker 2>operated on by some very capable surgeons and they didn't

0:17:33.359 --> 0:17:38.240
<v Speaker 2>achieve the result that they wanted. And it's always it's

0:17:38.280 --> 0:17:40.960
<v Speaker 2>always a privilege to try to help, you know, I

0:17:41.000 --> 0:17:46.639
<v Speaker 2>think that you know, again, Shannon, we all have results

0:17:46.640 --> 0:17:51.120
<v Speaker 2>that we really tried hard and it just didn't accomplish

0:17:51.160 --> 0:17:56.520
<v Speaker 2>exactly what we wanted. And there's so many variables that

0:17:56.560 --> 0:18:01.679
<v Speaker 2>are involved with reconstructive surchy than even the finest of

0:18:01.800 --> 0:18:06.960
<v Speaker 2>surgeons as results that he or she wish could have

0:18:07.000 --> 0:18:10.560
<v Speaker 2>been better. And when that happens, sometimes it's better to

0:18:10.560 --> 0:18:14.639
<v Speaker 2>see another surgeon. You know, there are times when really

0:18:14.680 --> 0:18:20.840
<v Speaker 2>good surgeons try to fix what is displeasing for a patient,

0:18:22.720 --> 0:18:28.240
<v Speaker 2>and again they don't succeed. Sometimes it's probably better to

0:18:28.840 --> 0:18:32.719
<v Speaker 2>what I call change the energy. You know, Sometimes another

0:18:32.800 --> 0:18:38.119
<v Speaker 2>surgeon isn't necessarily a better surgeon, but maybe thinks a

0:18:38.200 --> 0:18:42.120
<v Speaker 2>little differently, may have an idea that will make that

0:18:42.680 --> 0:18:48.399
<v Speaker 2>unhappy patient happy, you know. So yeah, of course, I

0:18:48.400 --> 0:18:54.800
<v Speaker 2>mean we all see situations where we of other colleagues,

0:18:54.840 --> 0:18:59.720
<v Speaker 2>again often very good colleagues, perhaps we can improve at times.

0:19:00.640 --> 0:19:05.040
<v Speaker 1>Wow, thank you, Mike. Am I ready for my facelift.

0:19:04.600 --> 0:19:06.520
<v Speaker 2>Yet pretty fantastic?

0:19:08.280 --> 0:19:14.080
<v Speaker 1>Thank you so much for driving to my house, for

0:19:14.440 --> 0:19:18.119
<v Speaker 1>that beautiful smile, for your compassion, for the love that

0:19:18.160 --> 0:19:20.560
<v Speaker 1>you have for every single one of your patients, for

0:19:22.440 --> 0:19:25.719
<v Speaker 1>how well you took care of me, the results that

0:19:25.760 --> 0:19:30.480
<v Speaker 1>you gave me, for you know, making me feel like

0:19:30.880 --> 0:19:35.160
<v Speaker 1>part of your family really, with your wife, with your staff,

0:19:35.240 --> 0:19:41.040
<v Speaker 1>with everyone. I deeply appreciate you and thank you. And

0:19:41.119 --> 0:19:45.480
<v Speaker 1>for the listeners. Doctor Jay Oranger one of the absolute

0:19:45.800 --> 0:19:51.359
<v Speaker 1>best Premiere plastic surgeons, just a fantastic human being. And

0:19:51.600 --> 0:19:55.840
<v Speaker 1>I hope you guys learned maybe a lot. I think

0:19:56.040 --> 0:20:00.600
<v Speaker 1>there was a lot to learn from this episode and

0:20:01.200 --> 0:20:03.840
<v Speaker 1>thanks for listening once again. And doctor J, thank you

0:20:03.880 --> 0:20:05.600
<v Speaker 1>so much for being on Shannon.

0:20:05.680 --> 0:20:08.520
<v Speaker 2>Thank you for the privilege of knowing you and caring

0:20:08.560 --> 0:20:12.119
<v Speaker 2>for you and being involved. It wouldn't be a greater honor.

0:20:12.560 --> 0:20:15.639
<v Speaker 1>Thank you, sir. All Right, that's let's be Clearishana Doherty

0:20:15.760 --> 0:20:18.240
<v Speaker 1>and doctor J. Bye, guys,