Mothers Day Newsletter 2021


The best thing about working for PSA/AMS is the team. We have a group of talented, caring people who work together to help each other out. Patients constantly tell me how much they love the staff. We love the compliments, of course, and if a patient complains, we discuss how we could have done better. We really do take feedback to heart. The team has done an extraordinary job of handling all the changes brought about by COVID. Dr. Eric Culbertson is a wonderful addition—he fits right in.

The biggest influence on me has been…my father.He was Chief of Plastic Surgery at UC Irvine, when he took a year’s leave of absence to serve as an East African Flying Doctor. I watched him operate in bush hospitals across Kenya and Tanzania. His cases varied from lion maulings and hyena bites to burns and congenital deformities. He was an artist with his scalpel, and he tackled whatever case needed to be done. He didn’t know much Swahili, so he spoke to his patients with his kind eyes and a comforting hand on a shoulder.

3. My favorite procedure/treatment is… anything that makes my patients happy. I like the variety in our practice. I am particularly interested in labiaplasty. The difficulty can be underestimated. A well-done procedure requires attention to detail and artistry. The procedure is controversial because there are many assumptions and misunderstandings about why women seek the operation. Patients often complain of pain, tugging, self- consciousness, and hygiene challenges. After labiaplasty, nearly all are symptom-free. The improvement in their quality of life is dramatic. Dr. Canales and I have done studies, spoken internationally and published scientific papers about good technique, safety, and the patients’ perspective.

4. The best part of my next week end will be Zooming with my children I love being a plastic surgeon, but my favorite job in life has been being a mom. Our son, Diego, lives in San Francisco, where he co-founded a tech company called ClearMetal. Our daughter, Siena, is in graduate school at Columbia University in New York City. When all of us get together, even remotely, it’s like getting a big dose of joy.

5. My hidden talent is writing. I am currently working on a memoir about becoming a woman surgeon. Over the years, friends expressed surprise to find out how few surgeons were women. Currently, only 16 percent of women are plastic surgeons. I was surprised that they were surprised, and that gave me the idea for my book. I am pitching to agents now.

6. The most surprising thing most people don’t know about me is I had a Bronx accent at age five and a Scottish Glaswegian accent at age six. My father trained as a plastic surgeon at Cornell in New York City, followed by a year-long fellowship at the Glasgow Royal Infirmary

in Scotland. From a Bronx public school, where I learned to “smoke” pretzel sticks, I moved to the much more academic Scottish school system. At first, I was at the bottom of the class, but I was soon just another Scottish schoolgirl. After that, we moved to Iowa City, where I picked up a Midwestern Twang.

My all time favorite movie is. Stand and Deliver, a 1988 film based on the true story of a high school math teacher, Jaime Escalante. Mr. Escalante taught at an East LA high school, where students were far below grade level. In a place where many students belonged to gangs, he worked relentlessly until they themselves believed they could succeed. A class that had no hope of passing algebra ended up passing the AP Calculus test. Jaime Escalante saw diamonds, where others saw rocks. One year, I taught an extra- curricular algebra class for my daughter and some of her classmates. Feeling the weight of responsibility, I watched that movie 30 or 40 times.

ThewordsItrytolivebyare…“Wecandothis—wejusthavetofigureouthow.” Challenges in life are, by definition, difficult to overcome. Excuses are cheap and easy, and they don’t advance a thing. A belief that a seemingly impossible thing is possible opens up a door and lets ideas fly in.

My favorite quote is…by Eleanor Roosevelt.“You must do the things you think you cannot do.” My father encouraged my interest in surgery, but he warned it would be a difficult road for a woman wanting a family. When I was in medical school, he couldn’t name one female surgeon who was married with children. And that was my dream. Like so many women surgeons, after training long years of 120-hour work weeks and delaying pregnancy, I struggled with infertility. I was lucky to eventually have two children. Women surgeons are much less likely than their male colleagues to have children. We have significantly higher complications of pregnancy compared with other specialties, due to the physical stresses of our job. I am working with one of our societies to change this.

10. My favorite magazine isThe Economist. I read the magazine every week. My favorite section is Obituary, by the unnamed writer, Ann Wroe. In 2016, she wrote about Qusai Abtini, a 14-year-old Syrian boy who played a typical father in a low-budget TV sit-com. An 11-year-old school friend played his talkative wife. With the shooting and explosions, going to school was too dangerous. Instead, he and his friend made people laugh, showing the absurdities of war. As Aleppo fell under siege, Qusai’s father decided to get him out of the country. As they were driving away, a missile hit their car. The father survived, but not the boy. Each obituary is a thoughtful masterpiece.




Breast implants, generally speaking, contain either saline solution or silicone gel. The outer shell is made of silicone and is similar in both. If one looks up information online, the most common answer is that implants should be replaced after 10 years. That recommendation is based on studies that are now 10- 15 years old themselves. In that time, implants have continued to change, and today’s highly cohesive silicone gel implants are more durable.

One constant we see is that, after having breast implants, women’s bodies continue to change over a lifetime, so the body that may have received implants at age 30 is different from what that person’s body will look like at 45. A woman may have had children, breastfed, gained or lost weight. All these factors add to the consideration of when implants may be replaced.

Saline implants can last a very long time. I have seen intact saline implants that are 30 years old, but I have also seen saline implants rupture after as little as one year. In general, saline implants do well for 10-15 years, at which time we see patients return to the office with partial or complete deflation.

A deflation of a saline implant is easy to detect as there is loss of volume that is apparent to the patient and the physician. It is not an emergency to replace a ruptured implant, but when it happens in the middle of a vacation or at an inconvenient time for the patient there is some urgency to replacing that implant before the pocket in which it lives shrinks, making the replacement more difficult.

Modern highly cohesive silicone implants are made so that the gel stays within the confines of the shell, even if there is a small crack in the shell. Small breaks in the shell are difficult to detect by physical exam and many times require an ultrasound or MRI. In their 2011 report, the FDA recommended MRI every few years to detect “silent” ruptures. MRI is a useful tool, but it also has a certain false positive rate, which means we sometimes operate on women who have a “proven MRI rupture,” only to find an intact implant at surgery.

In general, it is best for women to do routine breast self-exams, and have annual checkups with their regular physician. If there are any concerns, we plastic surgeons are happy to see all patients at any time for follow up. If the patient detects a change in shape, develops pain, or feels a nodule, she should be evaluated promptly.

Breast implants are safe, long-lasting, and they allow women to realize the changes in their breasts that they have always desired, but they are not lifetime devices. The best course of action after a woman has had breast implants is to have that woman familiarize herself with her new breasts, do self-exams, and visit with her doctor regularly.

A woman may decide to keep her implants for longer than 10 years if there are no issues or concerns. On the other hand, if a woman decides to have her implants removed, or if she wants a change in the original size or type of implant she has, we as plastic surgeons are there to support that decision. Breast augmentation surgery has a high degree of satisfaction and we continue to see improvements in the quality and number of implants available to women.

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