5 Things Plastic Surgeons Shouldn't Do

Karol A. Gutowski, MD; Mary Beth Nierengarten


June 25, 2014

Karol A. Gutowski, MD

This month, the American Society of Plastic Surgeons (ASPS) released a list of 5 tests and procedures that plastic surgeons should avoid. ASPS is the latest organization to join the now 60 specialty societies that are part of the Choosing Wisely® campaign that began in 2012. An initiative of the ABIM Foundation, Choosing Wisely is meant to encourage physicians to question and discuss the benefit of some commonly used tests and procedures.

Karol Gutowski, MD, a plastic surgeon who participated in the development of the Choosing Wisely list for ASPS, offered his perspective on what these recommendations mean for plastic surgeons in clinical practice.

Routine Mammogram Before Plastic Surgery

The Recommendation: "Mammograms should be ordered based on existing clinical practice guideline recommendations for patients undergoing breast surgery, including non-complicated breast augmentation, mastopexy, and breast reduction."

The Rationale: Obtaining a mammogram in patients prior to elective breast surgery is not needed in most patients and should be avoided to prevent overtesting that can lead to an increased number of false positives and unnecessary biopsies at increased cost.

Dr. Gutowski's Bottom Line: Follow established guidelines on mammography. Current guidelines, whether from the American College of Surgeons, the American College of Radiology, or the American Cancer Society, generally recommend a first mammogram at age 40 or 45 and every few years thereafter depending on risk factors. Why treat patients who undergo elective breast surgery differently from any other patient who is not undergoing these procedures? You should treat them all the same.

Use of Drains in Breast Reduction Mammaplasty

The Recommendation: "There is no evidence to support the use of drains."

The Rationale: Studies show that drains are unnecessary in patients undergoing breast reduction surgery, have no effect on postoperative complications, and cause greater patient discomfort that may lead to prolonged hospital stay. The ASPS does make an exception for patients who have liposuction as an adjunctive technique to the breast reduction. In these cases, the decision to use drains should be left to the surgeon's discretion, the society states.

Dr. Gutowski's Bottom Line: In addition to not adding any value, drains are uncomfortable for patients, cause them stress, and may increase the risk for infection. You are not doing your patients any favors by using them.


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