Thanksgiving week

No matter our religious affiliation or political creed, social status or age, all of us have much to be grateful for compared to many others in this world. But for many years when my children were young, I missed Thanksgiving at home because I travelled to Guatemala during this time of year to help those less fortunate than any of us.

I took a team of other physicians (a general surgeon, a gynecologist, an ophthalmologist and a plastic surgery resident), nurses and a few lay people volunteers to a village in the northwest corner of the country, near the Mexican border, called Nuevo Progreso – an 8 hour bus ride (in a rickety, old yellow school bus) from Guatemala City, the last hour being over a narrow, winding dirt road! On one of those trips, in 1984, I brought Dr. Deborah Ekstrom, who was a resident at the time at U Massachusetts, along with me!

This is a video link to film that was produced about that mission by Cary Silberman: https://youtu.be/5_fJCIa-yJs The hospital was built by locals with supplies and funds donated by the Hospital de la Familia Foundation from San Francisco. Before I get to the specifics of such trips, I would like to say that many physicians do similar work at home and around the globe, yet rarely are such trips reported in the press. Upon arriving in the small village, a marimba band would greet us and firecrackers went off, as the town’s people would come out to great us. The hospital is a cinder block structure with a corrugated roof – can you imagine how loud the thunderstorms sounded each afternoon?

Locals greeting medical volunteers

Photograph of the Hospital de la Familia

We lived on the hospital grounds and ate local foods, in a relatively Spartan environment. After a breakfast of papaya, beans, eggs and some coffee, we would start seeing patients and deciding, who we could help and who we could not – a very difficult experience to say the least! One year, I met a four-year-old boy who had never walked, with a painful hip and fever. I noticed a mass over the side of his hip and decided to open the area to see what the cause of his problem was – we did not have X-ray or laboratory facilities in this town and any specimens had to be sent back to Guatemala City by bus. I was surprised to find a cheesy white material in the joint and did not know what it was – a few days later, we found out that this youngster had TB in his hip joint. There was no way to help him further in Guatemala and I volunteered to take him home with me. He lived with us but was treated at the Shriners Hospital in San Francisco and recovered over a six-month period, at which time another team of volunteers brought him back to his village.
We would see patients or operate from about 7 am until 7 pm each day for about ten days straight, and during this time, performed about 150 operations. The bulk of the patients I saw were kids with a variety of birth defects or injuries. But in the early 80’s, while civil war raged in Guatemala, it was not unusual to see someone in fatigues come in for treatment of an injury, and we never asked which side they were on! We were there for the kids and neither side saw any advantage in harassing us! In fact, the government was quite helpful, expediting our trips through customs, providing us with the yellow school bus to bring us to Neuvo Progreso, and giving us armed guards for the journey.

Adult female, before and after, a cleft lip repair by Dr. Bunkis

Whenever we could, we did an adult patient as the first one for each trip – adults are more forgiving and we did not want to “test the system” on a malnourished 3 month old! A different group of volunteers went down to this village four times a year but in between, the hospital was run by the real heroes in this story, the nuns from Mexico and Spain, and the padre from Italy, who live there permanently and have given their lives for the local people!

Drs. Ekstrom and Bunkis doing a cleft lip procedure, and Dr. Ekstrom with the infant after surgery.

Young child with a bilateral cleft lip and palate, repaired by Drs. Ekstrom and Bunkis and shown here a week later when her sutures came out.

Foot of a 10-year-old boy, who has obviously never worn shoes, before and after a toe amputation by Drs. Ekstrom and Bunkis

The “Team” going for a walk through the village (Dr. Bunkis, center back row, Dr. Ekstrom far right front row).

And just for giggles, photos of Drs. Bunkis and Ekstrom for the Silberman video – you can call her Deborah or Deb, just don’t call her Debbie, she does not like it 😊

At the end of the ten days of working there, we head back to Guatemala City and fly home, fatigued, usually a few pounds lighter and as content as a person could possibly be! There is nothing more fulfilling than helping those in need!

Happy Thanksgiving from all of us at Orange County Plastic Surgery!

When choosing a breast enhancement, the size of the implant needs to be carefully considered. This decision needs to be a collaborative one made between the patient and the surgeon (or the surgeon’s trained staff). Girlfriends, sisters, mothers, and even husbands should not have a strong role.

Fat transfers can usually only give a modest increase in size and is not yet at the prosthetic implant level.

Five looks are possible:
1. Sporty
2. Body proportionate
3. Portioned but glamorous
4. Turn heads when you walk in the room
5. Stop traffic 

Thinking of breast augmentation in terms of cup size (A to DD for example) gets a little tricky. The letter of a bra cup is actually a ratio of the width of the individual breast (diameter) and how far the breast sticks out from the chest in the bra cup (projection). It is not a volume. For example, a 32 (band circumference around the chest) D-cup has about 500 grams (about 1 pound) of breast tissue. A 42 band B-cup has about 1700 grams of breast tissue, more than 3 times as much volume!

Once you have chosen your desired look from the list of 5, your surgeon will measure the width of your breasts, determine the configuration and shape of your breast, assess the tone, elasticity, quality, and texture of the breast skin, check for lumps, assess the shape and asymmetries of your chest and skeleton, and check your height and weight.

For any particular breast shapes that are a bit unusual, a flatter or more projecting implant may be recommended. Taller women can have a larger implant placed and still have pleasing proportions, but the same implant on a woman 5 feet tall may make her look like she is about to topple forward, or appear too “bulky” up top which comes off as looking overweight. The largest implant I’ve placed for augmentation was 800cc in a 6’4” tall woman. She still looked perfectly proportioned. Tall and curvy women need a larger fuller implant. More slender and shorter women need a less large, more compact, smaller volume implant.

Placement of too large or wide implants can create secondary deformities and result in disappointment with the outcome. Secondary deformities include “bottoming out”, kissing implants, webbed breasts, bridging between the implants, and bulging of the implant toward the armpit, etc. Implants that are too large for the patient’s chest that are placed through the armpit area may bulge into the pathway made to insert the implant. This can create an unappealing “tail”.

All implants stretch the chest skin somewhat and compress the breast tissue over time, making both thinner. Women with large, heavy implants may develop a ball-in-a-sock appearance as a result (think of a tube sock being held up by the cuff with a softball inside). Implants stretch the breast tissues including the nerve which gives sensation to the nipple. The larger the implant, the more stretch on the nerve, and the great risk of sensation loss.

Overall, the guidelines for choosing an implant look something like this:

• Chest width determines the footprint (diameter) of the implant that a woman can accommodate.
• Tight skin (young women, Asian women especially) may limit size as well.
• Taller women (over 5’6”) and curvy women may need a bigger, fuller implant to achieve body proportions that are balanced.
• More slender women and shorter women (under 5’4”) achieve an ideal contour with smaller implants.
• Too large an implant can create secondary deformities like double bubbles (bulge at the lower part of the implant) or push out toward the armpit and make you look overweight (no matter how slim the rest of your body appears).

Small increases in diameter from ideal can often work out fine, but pushing the limit too much can reach the danger zone. That being said, a more glamorous (fuller) breast can be achieved with a higher profile implant (sticks out to the front more than “normal”) if base diameter is already maximized. But, the skin must be elastic enough and loose enough to allow it. Women who have gone through pregnancy and nursing with an increase in breast size of a few cups (like B to a D) are good candidates. Young women with tighter skin, often, are not.

Thin, pear-shaped women sometimes watch their weight very carefully since any weight gain goes right to their hips and thighs, accentuating their body imbalance. After breast augmentation they can often gain weight for a better overall look once the hip and thigh curves are balanced (some lower body fat reduction may also be helpful: liposuction, Coolsculpting, Vanquish – “warm” sculpting for debulking) or targeted storage fat reduction with hCG diet supervised by a physician and nutritionist.

Breast implants, for the under-endowed often result in improved body proportions. Self-confidence increases with the better proportions and the patients report feeling “whole” or “complete”. Most breast implant patients seek augmentation only for themselves and report a high degree of satisfaction. Fortunately, complications are uncommon and patients and partners report improved intimate confidence and interactions.

5’2” female with 350 cc Moderate plus profile Xtra implants – proportioned but glamorous (surgery performed by Dr. Ekstrom)

5’6” female with 405 Moderate plus profile Xtra implants – body proportionate (surgery performed by Dr. Ekstrom)

5’9” female with 650 cc Moderate plus profile Xtra implants – she wished to stop traffic (surgery performed by Dr. Ekstrom)

For CA, please call 949-888-9700 or visit www.orangecountyplasticsurgery.com
Or for MA location, call 508-755-4825 or visit www.salisburyps.com

You can write to
Dr. John Compoginis at Contact Us Form
Dr. Staci Compoginis at Contact Us Form
Dr. Deborah Ekstrom at Contact Us Form
or Dr. Juris Bunkis at Contact Us Form