Bolitho MD

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9834 Genesee Ave Ste 311 La Jolla San Diego, California
Phone: (858) 458-5100

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21Dec, 2016

Plastic surgeons recommend cessation of e-cigs prior to surgery

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Plastic surgeons recommend cessation of e-cigs prior to surgery

In a recent December publication of United Press International, Health Day News reported how two plastic surgeons stated in the Plastic and Reconstructive Surgery December issue how stopping the use of e-cigarettes prior to surgery was highly advised. The doctors highlighted in the piece included Dr. Alan Matarasso of Albert Einstein College of Medicine and Dr. Peter Taub of Mount Sinai Medical Center.

According to Health Day News, the doctors stated, “Based on our current best knowledge, it seems reasonable to advise plastic surgery candidates to cease e-cigarette use,” they said. The doctors continued, “Refraining from [e-cigarette] use four weeks before surgery is a prudent course of action, despite the fact that it has yet to be determined if the effects are similar to traditional cigarettes.”

While the health impacts of “nicotine vapor” continue to be researched, it appears the reason for this medical recommendation underscores patient care. The doctors referred to a study which revealed how stopping traditional smoking three to four weeks prior to a procedure could significantly decrease the risk of postoperative complications.

Blood flow and blood supply is essential following plastic surgery procedures, such as breast surgeries and abdominoplasties. Tissue healing following surgery requires this blood flow.

Erring on the side of caution, it’s believed that e-cigarette users should follow the same protocol as those who use traditional tobacco products. The reason behind this cautionary advice stems from the fact that the side effect of nicotine is best described as a vasoconstrictor.

According to the American College of Surgeons, traditional cigarette smoking does increase complications both during and following surgery. It’s their estimation that following the “no smoking rule” a few weeks prior and after surgery lessens the risk of wound healing by nearly half.

Many plastic surgeons also encompass the cessation of nicotine patches and gum in this medical protocol.

In addition to nicotine, carbon monoxide is also another concern.

While carbon monoxide withdraws oxygen away from the tissue area, as mentioned earlier, nicotine constricts blood vessels which deliver oxygen and nutrients to tissues. Again, this blood flow is vital to the healing process.

If the percentages in oxygen and nutrients drop during the recovery process, there is a risk factor following surgery in areas such as infection, increased chance of scarring, and additional complications.

While some plastic surgeons follow a smoking cessation of four weeks prior and after surgery, others have a more conservative approach of six weeks. A large gap of time is highly recommended and encouraged.

During a patient’s consultation with their plastic surgeon, it’s imperative to be candid regarding any smoking history. And this includes vaping. A surgeon’s top priority is the care of his/her patients and making certain, as a doctor-patient team moving forward, all can be done for an outstanding surgical outcome.

27Oct, 2016

New study reveals breast reconstruction psychosocial effects

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New study reveals breast reconstruction psychosocial effects

While the month of October marked Breast Cancer Awareness Month, this month’s issue of “Plastic and Reconstructive Surgery,” a medical journal published by the American Society of Plastic Surgeons, highlighted a study regarding women who underwent a mastectomy. The premise of the study was to see if there was a difference in psychosocial issues between those who had immediate breast reconstruction (IBR) to those who had delayed breast reconstruction (DBR).

It’s important to note that it’s a woman’s personal choice as to whether or not she wants to undergo breast reconstruction. While some may not want to pursue it, others do. With that said, it’s imperative for those diagnosed with breast cancer to know of the reconstruction options available to her when a single or bilateral mastectomy is surgically recommended.

According to Science Daily, the study was conducted at the University of Toronto. It was also cited that when compared to the USA, breast cancer medical centers based in Canada tend to perform more DBR than IBR procedures.

It was correctly noted that sometimes not all patients are candidates for immediate breast reconstruction due to a treatment protocol. It’s indeed individualized.

Participants from the study consisted of 106 patients who underwent an autologous breast reconstruction. From this group of patients, 30 patients had IBR following their mastectomy while 76 patients had their DBR roughly three years later.

Science Daily reported, “Before and at six, 12, and 18 months after mastectomy, the two groups completed questionnaires assessing a range of psychological factors. Scores were compared to assess differences in the psychosocial impact of and recovery from mastectomy with IBR versus DBR.” The news source added, “In both groups, anxiety decreased after breast reconstruction.”

In terms of “health-related quality of life,” women who underwent IBR were able to rebound back into this category earlier than those undergoing DBR. However, roughly six months following their reconstruction surgery, DBR patients had a restored sense of “health-related quality of life.”

Science Daily went on to note, “Lessening the psychosocial impact of breast cancer and its treatment is an important goal of breast reconstruction. While the study is not the first to show psychological benefits of IBR, it provides new information on the course of recovery, compared to DBR.” The article continued, “The results suggest that, when appropriate, IBR can avoid a period of psychosocial distress associated with mastectomy.”

While this study offers insight between the differences of IBR and DBR, it’s important to underscore the support a woman should have following her breast cancer diagnosis. In addition to her medical team, including a board certified plastic surgeon if she so chooses, other areas of support also include family and friends. And support such as this will help carry a patient to that finish line called hope.

26May, 2016

Considerations for revisionary breast surgery

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Considerations for revisionary breast surgery

Through many years of practice, revisionary breast surgery has evolved into a specialty.  Those who have undergone a breast enhancement procedure will sometimes want–or sometimes need–a revision surgery. Implants may be used in procedures such as a breast augmentation, breast lift, or breast reduction.

It’s important to note that not all patients who undergo a lift or reduction may require an implant – it’s a personal choice that can be discussed at a consultation with a board certified plastic surgeon.

While some patients may be displeased with the aesthetic outcome of their initial procedure, there may be other factors which lead them to seek a revision. These reasons, both personal and medical, may include the following:

  • Symmastia
  • Capsular contracture
  • Implant rupture
  • Bottoming out
  • Symmetry issues
  • Implant disappointment
  • Downsizing implants
  • Replacing implants

 

In some instances, women who are finished having their families may have chosen to have implants placed without undergoing a breast lift. While some patients are content with the results, others may be dissatisfied with the position and want to improve their appearance with a revision.

For mothers who had an enhancement prior to bearing children, undergoing a second augmentation after building their families is also another aesthetic scenario. The effects of bearing children, such as weight gain and breastfeeding, may alter the appearance of woman’s bust line. In some instances, a lift may be recommended to address skin redundancy

Another motive may be when a woman decides that the upper silhouette she wanted to achieve many years ago through implants is not a current aesthetic goal at this point in her life. In these instances, she may decide to downsize.

As one can imagine, revisionary breast surgeries are performed for a variety of reasons.

When electing to undergo a revision for aesthetic purposes, it’s generally advised to wait four to six months following the initial surgery to ensure all healing is complete–this includes any residual swelling. If a patient decides that she does not want to return to her original surgeon for a revision, it’s highly advised that she seeks a board certified plastic surgeon that specializes in breast revision surgery. Surgeons at this level have mastered their craft.

During a consultation with a new cosmetic surgeon, be candid with the doctor when it comes to the reason, or reasons, behind the revision. At this first appointment, clear communication is necessary. It’s important that the surgeon doing the revision surgery and the patient have an excellent rapport.

Following an exam, the doctor will convey their thoughts regarding a revision. The details of the surgery, the recovery process, and realistic expectations will also be discussed.

Before or during the consultation, make it a priority to review their patient gallery photos of women who have undergone a breast revision surgery. If possible, ask the doctor if they have any “before or after” images of patients who were in a similar circumstance(s). This will provide an excellent gauge as to whether or not the surgeon’s talents are aligned with a patient’s goals.

14Nov, 2015

Antidepressants: Study Examines Meds Before Cosmetic Surgery

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Antidepressants: Study Examines Meds Before Cosmetic Surgery

A recent study published in Plastic and Reconstructive Surgery, a medical journal by the American Society of Plastic Surgeons, outlined a study indicating that there was no strong evidence suggesting that continuing antidepressants before cosmetic surgery would increase a patient’s risk intraoperatively or postoperatively. The study was conducted by Dr. Isabel Teo of Ninewells Hospital in Dundee along with Christopher Tam Song, a medical student at University of Edinburgh.

According to Science Daily which used Wolters Kluwer Health as its source, “Antidepressant use has increased in recent years, with one study reporting that 1 out of 10 U.S. adults and adolescents use these medications. Rates of antidepressant use may be even higher among patients undergoing cosmetic plastic surgery, or patients with breast cancer undergoing breast reconstruction.” It continued, “While plastic surgeons are alert for use of medications that might increase complications, such as blood thinners, they are typically not concerned about antidepressants.”

Antidepressants help adjust certain brain chemicals which alleviate a person’s mood disorder or specific behavior(s). This prescription drug can help with an array of conditions such as anxiety, depression, obsessive compulsive disorder, PTSD, ADHD, and more.

Additionally, antidepressants have been known to treat symptoms such as hot flashes, fibromyalgia, premenstrual symptoms, and neuropathy.

Antidepressants have benefited many individuals in a variety of ways, so a study such as this one is incredibly useful to both doctors and their patients.

The research article went on to say that Dr. Teo and Song crafted a comprehensive study which included various statistics and data regarding the relationship between cosmetic surgery risks and antidepressants. A total of 26 studies were part of the research. Different levels of study included:

  • Bleeding
  • Risk of breast cancer
  • Breast cancer outcome
  • Enlargement of the breasts

The study focused particularly on antidepressants categorized as SSRI, also known as selective serotonin reuptake inhibitors.

In reference to bleeding, Dr. Teo and Song assessed two groups of patients: over 34,000 breast reconstruction patients following breast cancer surgery and more than 2,500 cosmetic surgery patients. The results for bleeding were deemed inconsistent.

The report also indicated, “So while the evidence doesn’t rule out an increase in bleeding risk, stopping antidepressants before surgery–especially the widely used selective serotonin reuptake inhibitors (SSRIs)–might worsen depression symptoms…” They added, “Therefore, routine discontinuation of antidepressants before surgery in the absence of a careful evaluation should be avoided.”

In the breast cancer risk category, the results were again determined as conflicting for antidepressant users. While there was some moderate increase, others indicated no correlation.

For breast cancer outcomes, the study gleaned information about those taking tamoxifen to help reduce the recurrence of breast cancer. Researchers found no indication that antidepressants triggered a “drug combination” reaction.

Enlargement of the breasts was another area of the study. Any correlation of increased size was attributed to weight gain, a side effect of SSRI.

The report findings also cited, “While acknowledging the limitations of the available data, Dr. Teo and Mr. Song note their review finds no consistent evidence of increased complications related to antidepressants.” It added, “The risks of stopping prescribed antidepressant therapy in ‘psychologically vulnerable’ patients likely outweigh any increase in complications.

10Sep, 2015

New Strides In Breast Reconstruction

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“Pink Breast Cancer Ribbon” by scottchan

FreeDigitalPhotos by scottchan

Recently the medical journal published by the American Society of Plastic Surgeons (ASPS) released an article regarding a single-stage implant procedure for breast reconstruction patients. Generally women who undergo breast reconstruction have either lost one or both breasts due to breast cancer. Conversely, for women who are high risk for the disease may choose a prophylactic bilateral or single mastectomy.

More than ever, women are empowered to take care of their breast health and be educated on the availability of breast reconstruction.

Lead author, Dr. Mark Codner, an ASPS member surgeon of Emory University based in Atlanta, and co-author Dr. Jose Rodriguez-Feliz crafted an informative article. Since doing so, the “single-stage” implant reconstruction approach has lit up headlines and tells surgeons to “embrace the change.”

For patients who are candidates to this surgical approach, it is affording women with a shorter reconstruction process, swifter recovery, and a quicker way back to their new body image of a reconstructed breast(s).

In the article, Rodriguez-Feliz writes, “A selected group of patients will now benefit from a simplified reconstructive process with limited office visits for expansions, accelerated return to normal activities, and restoration of a natural breast with preservation of its most important landmark, the nipple areola complex.”

This advance is different than the two-stage reconstruction approach which utilized tissue expanders. After tissue expanders are inserted, saline fills are performed every few weeks at the plastic surgeon’s office.

Once the expansion is reached, another surgery is performed to replace the tissue expanders with implants.

A “single-stage” removes the need for tissue expanders which can last a few months or more.

The study which was discussed in the article followed 27 patients who underwent single-stage implantation (SSI).

The process of the surgery followed the following course.

Once the breast cancer surgeon removed the cancerous tissue, including the healthy tissue to complete the mastectomy, the goal was to then preserve as much breast skin as possible. This also included a technique called nipple sparing mastectomy which is also referred to preserving the nipple-areola complex (NAC). This is when a patient’s nipple and nearby tissue is retained.

Once the breast cancer surgeon is completed, a board certified plastic surgeon steps in for the reconstruction during the same surgery for an immediate implant based reconstruction.

The patient’s breast skin and NAC can be considered the natural shell for the procedure. Codner utilized a “teardrop” breast implant shape and acellular dermal matrix (ADM). The ADM provides the framework needed to sustain the reconstruction and promote the growth of new tissue.

Like tissue expander breast reconstruction, at the time when expanders are exchanged for implants during the second surgery, surgery, fat grafting is generally done to add fullness to the reconstructed breast. For Codner, he performed fat grafting during the SSI reconstruction procedure.

Rodriguez-Feliz added, “Preservation of the NAC and advances in technique have allowed us to achieve aesthetic results that resemble those of cosmetic breast enhancement patients. “As a result, we have limited the sense of mutilation that many patients would experience in the past with a two-stage breast reconstruction.”

The article also noted how the SSI reconstruction lowered patient discomfort and stress levels as opposed to the two-stage breast reconstruction.

However, like with tissue expander patients, it was noted that a low percentage of SSI patients did experience infection which triggered IV medication and/or surgery.

As mentioned earlier, patient candidates for SSI are determined based on their cancer, upcoming treatments, and comprehensive health.

SSI is another stride in breast reconstruction adding another level of empowerment when women need it the most.

 

29Jun, 2015

Breast Reconstruction Awareness Campaign Magnifies

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FreeDigitalPhotos.net by scottchan

FreeDigitalPhotos.net by scottchan

In a recent edition of Plastic Surgery News, published by the American Society of Plastic Surgeons (ASPS), many of its esteemed doctor members that perform reconstruction surgeries for breast cancer patients were delighted to read how the Breast Reconstruction Awareness Campaign is indeed increasing.

The campaign was founded by Mitchell Brown, M.D., a plastic surgeon based in Canada. In 2011, his vision came to fruition. And it has done a world of good for countless women. Brown’s foresight has helped empower women to learn about their options regarding different components of breast reconstruction surgery.

When a woman is diagnosed with breast cancer and requires a mastectomy or bilateral mastectomy, through a haze of personal turmoil and confusion, navigation is essential to her well-being by understanding that she does have breast reconstruction choices.

This also holds true for women who undergo a bilateral mastectomy due to a strong family history of breast cancer or being told she tested positive for the BRCA1 and BRCA2 genes.

The ability to give women surgical possibilities to rebuild their breasts can give them a sense of control.

While some women choose not to have the reconstruction, others want to undergo the procedure; nevertheless, being afforded the option is the cornerstone of the campaign.

In a recent piece written by Rosie Marszalek, “Breast Reconstruction Awareness Campaign Expands,” she reminded readers that Breast Reconstruction Awareness Day is on October 21, 2015. She went on to cite that in 2014, ASPS members throughout 44 states took part in this campaign. Among these states, a tally of 160 plastic surgery practices joined together in hopes to help women learn about their reconstruction options after having lost either one or both breasts due to cancer.

“Recognizing that women are fighting breast cancer every day, however, this year the Society is encouraging all ASPS members who perform breast reconstruction procedures to host a Breast Reconstruction Awareness event on any day throughout the entire year as part of the new ‘BRAve Face” campaign,” Marszalek writes. She continues, “In addition to local events, the BRAve Face campaign also features Patti LaBelle as its national spokesperson.”

Many have described the acclaimed singer as an ardent supporter of women who have undergone breast cancer.

In a statement, LaBelle told ASPS, “Women battling this disease need to have access to information about their rights and options to make informed choices about what’s best for them and their life following breast cancer treatment.”

As mentioned before, it is a time not only on October 21, but throughout the year, to provide resources and access to women so they can become educated. It’s the hope of ASPS that members will join together by championing events in an effort to raise this awareness.

In the past, an array of events has taken place such as:

  • Educational Receptions and Seminars
  • Art Exhibits and Contests
  • Luncheons and Galas
  • Sporting Activities and Contests
  • Flash Mobs
  • Dance Contests
  • And more….

ASPS members are encouraged to think “outside the box” and champion an event large or small. It is an opportunity for a community of like-minded and dedicated people to join together for a special cause.

Helping women who are “fighting the fight” and arming them with knowledge on breast reconstruction is a powerful movement for all involved.

5Oct, 2013

A Look Into The History Of Plastic Surgery

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Dr. Bolitho
The American Society of Plastic Surgeons (ASPS), established in 1931, is one of the leading organizations in the nation offering valuable information to its surgeons and individuals looking into various treatments and cosmetic surgeries.

It offers a sounding board for potential patients wanting to learn more about a particular procedure and a database of doctors who are part of this esteemed organization.

Dr. Gynn Bolitho, a board certified plastic surgeon in San Diego, is an active member of ASPS.

ASPS created a video on the history of plastic surgery and the role it has played over the decades. This brief video offers a montage of the medical pioneers who started it all, a look into plastic surgery today, and an eye to the future.

The video provides great insight into the evolution of plastic surgery, how techniques have become more refined, and how plastic surgeons have played an intricate part in medicine by helping people change the way the feel about themselves. It’s a simple explanation, yet it’s punctuated by a powerful outcome.

To learn more about Dr. Bolitho, please visit www.bolithomd.com. Dr. Bolitho also invites you to call his office at (858) 381-4106 or e-mail him at info@bolithomd.com to book a consultation. In the meantime, please visit the photo gallery of the plastic cosmetic procedures he has performed.

Enjoy the video….

15Jul, 2013

3-D Nipple Tattoos For Breast Cancer Reconstruction Patients

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FreeDigitalPhotos.net

FreeDigitalPhotos.net


Breast reconstruction is all about having options.

One of our breast reconstruction patients decided to take a different path when it came time for nipple reconstruction.

Dr. Bolitho is the type of person who you feel absolutely comfortable with; and, when it came time to decide on nipple reconstruction I did a lot of research regarding what would be best for me,” Christina said. “After a lot of consideration, I approached Dr. Bolitho about 3-D nipple tattoos that were performed by a top-notch artist who currently works at the Center for Restorative Breast Surgery in New Orleans and Dr. Bolitho gave me the green light.”

Christina, 47, who had a bilateral mastectomy in 2011, completed her breast reconstruction journey in 2013 with with her 3-D nipple tattoos. She had silicone gel-filled implants as part of her reconstruction procedure.

And she is thrilled with the reconstruction results and her 3-D nipple tattoos.

“Many people ask me whether or not it was painful. I had never had a tattoo before so I really didn’t know what to expect,” she said. Christina added, “My left side was virtually painless, but the right side, had a bit of discomfort.”

Meyers told Christina that not many women felt much pain because the reconstruction area often feels numb. In under an hour, the tattoos were completed.

Below is a CNN clip of Vinnie Meyers who lives in Maryland but frequently travels to New Orleans to help women at the Center for Restorative Breast Surgery.

3Jun, 2013

The Dr. Bolitho Team Garners Positive Feedback

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Dr. Bolitho
Dr. Bolitho frequently hears kind patient feedback when it comes to his front and back office staff.

When he chose his team, Dr. Bolitho shared, a great deal of it had to do with instinct coupled with their training.

“I always like to think that someone can be trained up to a level of clinical proficiency provided that they have the empathic nature to do a job,” Bolitho said. He added, “I would rather have that type of team member, than someone let’s say, who is highly trained but lacks that type of character who cannot relate well to patients.”

For Dr. Bolitho, it has always been more important to him to bring a team member onboard who conveyed special human characteristics when interacting with patients.

While Dr. Bolitho is well known for an array of different cosmetic surgical procedures, he also performs many breast reconstruction surgeries for women who have lost a breast either from a mastectomy or other condition. So having a compassionate medical team at his practice was imperative.

For Dr. Bolitho’s office, every day is a new day to treat their patients with the genuine medical care they deserve.

To reach Dr. Bolitho’s office, please call (866) 738-9360 or e-mail them at info@bolithomd.com.

21Dec, 2012

Dr. Bolitho Chosen As New Chief of Plastic Surgery

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Dr. Bolitho recently accepted the new position as Cheif of Plastic Surgery at Scripps Memorial Hospital in La Jolla.

Many congratulations to board certified plastic surgeon, Dr. Glynn Bolitho. Just this month, he was appointed as the current Chief of Plastic Surgery at Scripps Memorial Hospital, La Jolla.

Dr. Bolitho’s term as Chief of Plastic Surgery will last 2 years. Plastic surgeons on staff at the hospital voted Dr. Bolitho into this prestigious position.

With more than 22 years experience, Dr. Bolitho is considered a renowned plastic surgeon with expertise in both cosmetic and reconstruction procedures.

Dr. Bolitho looks forward to serving the hospital in his new capacity.