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Our Reason for Being

What we are about is that we bring together a group of experienced surgeons who perform and have performed tens of thousands of cosmetic breast operations over many years. We learn from each other and we invite all surgeons who do breast surgery to come and join us in our educational efforts to improve the care and cosmetic results of surgery on women all over the world.

Breast size and shape has assumed a great social significance in our society.  Gender feelings of adequacy and self-esteem are related to breast appearance. Inadequate breast volume and contour can be caused by 1) Developmental micromastia, 2) Postpartum involution, 3) Post-surgical deformities, and 4) Breast asymmetry.  The American Society of Cosmetic Breast Surgery is dedicated to the highest standards of excellence in the evaluation and care of our patients. Knowledge of advanced surgical techniques, early recognition and treatment of complications, avoidance of risk, and the paramount importance of maintaining the safety and health of our patients is what we advocate.

There are two primary reasons for women having breast implant surgery. The most common reason is because they want a more attractive chest and were either born without much breast tissue, or they had lost breast tissue over time, such as can occur following child-bearing. The other primary reason is because of loss of a breast due to disease such as cancer.

People and women with breast cancer have been mistreated by our health care delivery system. An example of this is that more than 90% of all women with breast cancer in this country were offered only radical mastectomy for treatment of breast cancer before the Fisher study was published in 1985. 

And yet the facts that showed that much less surgery, such as lumpectomy and partial or simple mastectomy (with or without radiation), resulted in equal rates of cure and much less deformity, and have been available for two decades before 1985.

For two decades before 1985, the radical mastectomy was the only treatment offered to all the women with breast cancer in this country. This type of surgery can be a mutilating operation that leaves irreversible deformity of not only the chest, but often permanent swelling and diminished ability to use the arm. Most all of these deformities are now rare  but with the knowledge that was available at the time were common.

So why, why did every woman before 1985 have to have a radical mastectomy - a very deforming operation - and an operation that is almost never done today?

Do you know? Let me explain.

 If a surgeon got out of line and did something the others would not, he could lose all he had in litigation for not following the standard of care. It can be a slow process for agreement enough to change the standard of care.

The surgeons were guided by fear. Who can blame them for not having the courage to stand up for one woman, when if they did they would be under attack by our civil court system? This is the same system that awarded 4 million dollars to a lady who burned herself when she was served a hot cup of coffee. Or an equal amount to a lady who was portrayed as having been crippled by simply having silicone breast implants.

And so, almost all the women (hundreds of thousands) suffered this now unnecessary mutilation because of the slow process of accepting change and a little bit because of the risk of the surgeons in this country who would courageously move ahead - except for a very few, such as George Crile of the Cleveland Clinic. Those persons who were

And now.

This year 175,000 women will learn they have breast cancer according to the American Cancer Society. Breast reconstruction is an option. "In 1998, 70,000 breast reconstructions were done, with 39% performed at the same time as the mastectomy." (See http://content.health.msn.com/content/dmk/dmk_article_5962883)

So what is the problem? The tram and latissimus dorsi flap reconstructions require many hours, often requiring subsequent operations and cost in hospitalization and anesthesia, with surgeon’s fees usually amounting to more than $24,000. And there is still no nipple.

And the reconstruction of the nipple can easily cost $2,000 - $4,000 or more, depending on how it is done and if hospitalization and general anesthesia are necessary.

According to Gore and American Cancer Society, there are 44 million Americans who are not covered by any form of private or government insurance, such as Medicare or Medicaid. About half or these are women, of which 10% are going to get breast cancer.

And so for these 2.2 million women in the United States who will have breast cancer, breast reconstruction as the others are having is not an option. They simply can't afford it. Most women in the world can't afford it, either.

We have a solution so that all women can have some breast reconstruction, of which most can be done at the same time as the surgery for the cancer.

Here is an example of what we are trying to get across. Say there were two very fine, reputable surgeons in your community who specialize in the treatment of breast cancer, and both are well known to get equal cure rates with their fine, careful, and knowledgeable treatment.

And yet all of the patients of one of these surgeons are deformed for life. And all of the patients of the other look as good or better than they did before they had breast cancer. With an equal chance of cure, which one would you choose? How many women would choose disfigurement over no deformity?

And so we ask, “Is deformity and prevention and treatment of deformity important?” We think so.

All of the 2.2 million Americans who cannot afford the costs of reconstruction (and the hundreds of millions outside this country) are not being offered any reconstruction unless it is from their general surgeon. They are depending on their general surgeon for help. And these patients believe the surgeon can easily put in an in implant within less than 10 minutes, with the procedure costing no more than a few hundred dollars.

So where in the USA is the simple reconstruction of the breast with an implant and reconstruction of the nipple - all of which can be done for usually less than a cost of $2,000 - being taught to the general surgeons who do the breast cancer surgery? Please tell us. We know of none.

The American Society of Cosmetic Breast Surgery provides the only teaching programs in the world available to breast cancer surgeons everywhere so that they can fulfill the cosmetic needs of their patients who cannot afford it otherwise.

And why don't the general surgeons use implants? For a general surgeon who is skilled and competent in doing mastectomy (simple, partial, subtotal radical and all the variations), the training required to put in an implant is about as much as is needed to open a can of cola. 

Maybe you should ask. Maybe these general surgeons don't want to step out of line and come under the critical attack of those who claim these procedures as part of their territory or turf. And they know that they could lose in litigation, everything they have earned, own, or saved if they don't follow the status quo.

And who loses? The 2.2 million poor women who cannot afford the expensive doctors. They are the losers.

And maybe that is all right. Milton Friedman, the Nobel-prize winning economist, would explain that people not only suffer deformity and deprivation, but die in droves all over the world because of poverty. And thus, it is normal. The poor suffer. But should we not do what we can? Mother Theresa, when asked "What can I do?", said simply, "Start with one."

And so we believe with Emily Dickinson that if we can ease one life the aching, or cool one pain, or help one fainting robin unto his nest again, we shall not live in vain.  Our purpose is to do for others. We exist for the sake of others.

Every surgeon does some cosmetic surgery, and every surgeon should have the knowledge and ability to  perform their surgery in the most cosmetically advantageous manner possible for the benefit of their patients. And therefore, through this society, if any breast surgeon wants to know more about implants or reconstruction of the nipple, we will gladly share with all we know.

Are we surgeons stepping out of line? Yes. For the good of women who need and cannot afford reconstruction, we want to change the standard of care by offering them breast implant and nipple reconstruction at very low cost or for free if needed.

And will we be under attack by those who profit from and wish to protect the status quo? Yes. 

There are some surgeons who do not want the breast cancer surgeons to do or know how to do any cosmetic reconstruction. And they are ready to denigrate and condemn any surgeon who would do this for women, as well as this society and the faculty for teaching these principles and techniques. 

Those are the surgeons who fear the economic loss from those poor women who would be left to struggle to get the money to pay them for reconstruction. And there is some fear that if the breast surgeons begin to use implants, they will take over cosmetic breast surgery, to the economic loss of those who are doing it now.

And are we together with those breast surgeons willing to help the poor women at risk? Yes. But does that affect our doing what we know is right? No.

And finally, here is the real joy. A patient from another country who spoke no English was referred to me. She had had a complete mastectomy, so she came to me and we put in an implant and created a nipple for her.

The patient and her husband then went back to her country, but returned to see me a year later. Her husband explained to me that they agreed that they liked the reconstructed breast better than the other one. Actually,  I have received more benefit from this than they.

Web site editor
William Roy Morgan, M.D., F.A.C.S.
1419 Superior Avenue #2
Newport Beach CA 92663
949-645-6665 www.wrmorganmd.org

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  1984-2014 American Society of Cosmetic Breast Surgery  Last modified: May 22, 2014