Our Reason for
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.
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
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
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
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
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
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.
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.
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
Web site editor
William Roy Morgan, M.D., F.A.C.S.
1419 Superior Avenue #2
Newport Beach CA 92663