This Month’s Surgery Spotlight Now Available on PSEN

In our June Surgery Spotlight, Tae Chong, MD, performs an abdominal-based unilateral breast reconstruction on a patient with recurrent breast cancer. Dr. Chong describes the importance of preoperative perforator identification using Doppler imaging and outlines the key strategies for surgical dissection and selection of the best perforator to sustain the flap. An additional venous anastomosis was performed to improve venous outflow for the flap.

Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD Library
Filmed and produced by the Plastic Surgery Education Network (PSEN), Surgery Spotlights feature peer-reviewed, high-definition surgical video. It offers an excellent opportunity to study each step and technique as performed by the top names in the specialty.

A Possible Ban on Powdered Gloves by the FDA

A Message From…
Raman Mahabir, MDRMahabir
PSEN Co-Editor

On March 21st, the U.S. Food and Drug Administration announced a proposal to ban most powdered gloves in the United States.  The ban would apply to powdered surgeon’s gloves, powdered patient examination gloves and absorbable powder for lubricating a surgeon’s glove.  The FDA believes that the gloves pose an unreasonable and substantial risk of illness or injury to health care providers, patients and other individuals who are exposed to them, which cannot be corrected through new or updated labeling.

The proposed rule is available online at for public comment for 90 days.

Please see the FDA announcement letter for further details and additional resources.

FDA Warning about the Magnetic Port in Tissue Expanders Potentially Interfering with ICD/Pacemaker Devices



A Message From…
Raman Mahabir, MD
PSEN Co-Editor

On March 8, 2016, the FDA wrote a letter to health care providers warning them about potential interference between breast tissue expanders with magnetic ports and implantable cardioverter-defibrillators (ICD’s) or pacemakers.  While they recognized there is a very small population at risk, they were aware of adverse events.  They made the following recommendations:

  • Avoid, whenever possible, implanting a magnetic-port breast tissue expander in a patient with a pacemaker or an ICD.
  • If a patient has an ICD or pacemaker, a non-magnetic reconstructive option should be used.
  • When a patient with an implanted magnetic breast tissue expander requires the placement of an ICD or pacemaker, careful consideration should be given to choice of cardiac device, location and timing of implantation, the possible need for more frequent cardiac device checks and whether a different breast tissue expander might be used.
  • Warn patients who have a magnetic-port breast tissue expander and an ICD or pacemaker of the possibility of magnetic interference. Tell patients who have an ICD that emits an electronic tone when the device experiences interference to seek care if they hear the tone.
  • Report any adverse events that come to your attention. Voluntary reports can be submitted through MedWatch, the FDA Safety Information and Adverse Event Reporting program. Device manufacturers and user facilities must comply with the applicable Medical Device Reporting (MDR) regulations.  Prompt reporting of adverse events can help the FDA identify and better understand the risks associated with medical devices.

Please see this FDA letter for further details and additional resources.

December’s Surgery Spotlight features ASPS President, David Song, MD


Our December Surgery Spotlight is particularly meaningful for us at PSEN, as it showcases a VUG flap surgery by our new ASPS president, David Song, MD.

In this video, Dr. Song demonstrates the use of a VUG (Vertical Upper Gracilis) flap for breast reconstruction. The patient is a 37-year-old female, with previous attempted alloplastic breast reconstruction on the left side after a bilateral mastectomy. She has undergone radiation and lost the implant due to infection. The use of the VUG flap is the secondary option in this case, as the patient did not have enough abdominal nor buttock donor site tissue available. This video demonstrates the use of the penrose drain, used to identify both the proximal and distal portion of the gracilis muscle and to confirm that the skin and fat are centered over the muscle. The complexity of this procedure stems from the irradiated tissue, and multiple prior episodes of infection and scarring, making the anastomosis more challenging than usual.

Past Surgery Spotlight programs remain freely available to view on PSEN. Hard copies of these programs can also be purchased from the PSEN DVD Library
Filmed and produced by the Plastic Surgery Education Network (PSEN), Surgery Spotlights feature peer-reviewed, high-definition surgical video. It offers an excellent opportunity to study each step and technique as performed by the top names in the specialty.

Plastic Surgeons Need A Makeover

Plastic Surgeons Need A Makeover
By Daniel R. Solin

Plastic surgeons are acutely aware that they are in a competitive business. To increase sales in such a crowded marketplace, many have engaged marketing consultants, revamped their websites, posted video on YouTube and actively participate in discussions on and related sites.

The stakes are high. By some estimates, more than $12 billion was spent on cosmetic procedures in 2014.

What’s more, plastic surgeons are not only competing for new patients with each other, but also against dermatologists, otolaryngologists, oculoplastic surgeons and others who perform cosmetic procedures. I recently saw a billboard by a dentist advertising Botox injections!

The typical prospective patient will likely do research online and schedule a consultation with several different specialists or practices before making a final decision. That was the procedure I followed recently. My experience, however, was informed by the fact that I recently published a book on sales. I also coach professionals on how to convert more prospects into clients.

My personal experience interviewing three plastic surgeons and one oculoplastic surgeon convinced me that many need a makeover in their approach to attracting patients. Here’s why:

First impressions are instant

How long do you think it takes others to form an impression of you? It could be as short as a tenth of a second. That’s the conclusion of a recent study published in Psychological Science by Janine Willis and Alexander Todorov. Undergraduate students from Princeton University were shown pictures of male and female actors. They were then asked to give an opinion about various traits of the person portrayed. Exposure times as brief as one-tenth of a second were enough for participants to form an opinion.

First impressions are lasting

Numerous studies have established that, once we make up our mind about a person, that impression is very difficult to change. One of the problems with making determinations

predicated on very little information is that, once the judgment is made, our brain scans for information that confirms our initial impression and ignores contrary data.

If you want to convert more consultations into patients, you need to focus on insuring your first impression is a positive one.

My first impressions

In my own search for a plastic surgeon, my first impressions were generally negative. My visits started well. I was greeted professionally in three of the offices I visited, and those offices were well-appointed. This was not my first experience when I met with a plastic surgeon at a major medical center. The reception area was crowded and the furniture looked like it had been rescued from the Salvation Army. The receptionists were obviously overwhelmed and dressed poorly.

The real problems, however, began when I met the surgeons. How would you like to be perceived? Competent, professional and caring or cool, good-looking and hip?

Two of the male plastic surgeons I met with had two-day stubble and were wearing conspicuously expensive designer clothes. If I was casting for cool, hip actors, their appearance would have scored points. In the context of my visit, it was a turn-off.

One of these two surgeons was wearing green scrubs. I had a more positive impression of him, but the scrubs looked like he had slept in them. Perhaps he had just come from a surgery, but it sure didn’t look professional to me.

Lack of interest

Given my training, and if the substance of my visits had gone better, I might have been the exception to the rule that first impressions are lasting. I use a very simple litmus test. When I am asked what I do, I reply that I am an author, which is true. You would think most people would then ask at least a few perfunctory follow-up questions, like “What kind of books do you write?”

The three plastic surgeons failed my test miserably. They showed no interest in me as a person. They asked me no questions, including why I was interested in the procedure we were discussing. Instead, they launched into an account of who they were, explained why they were eminently well-qualified to perform the procedure I sought and described what was involved with undergoing it. The surgeons then dismissed me and sent me to their coordinator, who focused on cost and scheduling.

Perhaps taking a cue from the surgeon, the coordinator also asked no questions. None made even this simple inquiry: How did your visit go?

Non-verbal recommendations

Plastic surgeons should be aware of these three factors which determine first impressions:

  • Facial expression
  • Clothes
  • Gestures

Facial expressions

Studies indicate people who are perceived as open, expressive and somewhat animated make a more positive first impression than people who come across as “difficult to read.” Keep this in mind when you walk into the examining room and greet your patient.


There are a number of studies on how the clothes worn by physicians affect the way they are perceived by patients. I concur with the ones indicating most patients prefer doctors who dress professionally and wear a crisp, clean white coat. I want my surgeon to look like one, not a runway model. If you don’t want to wear a white coat, I recommend a “business casual” look, which makes you more relatable and less threatening.


A classic TED talk by Amy Cuddy, an associate professor at Harvard Business School, vividly demonstrates the importance of gestures. The bottom line is that broad, open gestures with your hands extended and palms facing your patient convey both trustworthiness and transparency.

Verbal recommendations

Here’s a tip that will likely increase your conversion rate. It’s easy to state but difficult to implement. I need to constantly reinforce it with my own clients.

At the initial visit, don’t utter a single sentence ending in a period. Just ask questions. There will come a time when the patient will have questions for you. When this occurs, answer the question as briefly as possible, and then ask: Have I answered your question or do you want more information? If you have answered the question, continue to ask more questions.

There is evidence that following this process increases the production of oxytocin, which makes us feel good and more likely to trust others.

Because surgeons have asymmetric information, many believe patients want to (or must) be “educated.” My experience indicates this is almost never true. Most people want to be heard and understood. They want to feel you understand them and took the time to listen to them.

If a prospective patient has a question, they will ask it. Just to be sure, ask this question at the end of the visit: Have I addressed all your concerns?

Dan Solin ( is the author of The Smartest Sales Book You’ll Ever Read and the New York Times bestselling author of the Smartest series of investing books.