This is let's be clear with Shannah Dorny. Hi everyone, We're back with doctor j Oranger. Here we go. There are doctors with different personalities. It doesn't mean that they don't care. It just means there are some that and this is really interesting. I'm gonna give my mom as a really big example. Compare my mom myself. She has amazing doctors. Some of them are different than mine. Reason being is because a she has different issues than I do.
She doesn't really have that many issues, but she's had an aneurysm. She's you know, her surgeon that she chose is a wonderful surgeon, one of the best at seaters, and he's very much a handholder and comforts and we'll spend a lot of time. Interestingly enough, you are the only doctor I've ever wanted that from. And I don't know if it's because it was reconstruction. I don't know if it's because it was such an extended period of time. You know, I felt like it was a big hug
every single time I saw you. But traditionally, I like my doctors to be a little bit more distant, not distant in the sense of that they don't spend the proper amount of time that I need them to spin with me. But I don't like sympathy. Maybe that's what it is from a doctor. I don't want sympathy. I don't want to feel like, you know, there's some pity involved. I want you to tell me it's like every single time that you know, a scan doesn't come back good.
I have a way of getting that news, so I don't have to encounter a nurse in the room looking at me with pity or anything else. I just want give me the facts and then let's immediately go into what's next, what's next protocol? Because I'm very and maybe it's the cancer that's really done this for me, where my brain has just set into okay. I don't want to talk about what has transpired. I don't want to talk about like why that med stopped working. I just
want to move forward constantly. I just want one foot in front of the other. And so I don't really need a hugger or a handholding doctor, but you I needed it because it felt scary. But it was also to have drains was very you know, a very odd feeling. There were you know, blistering that sometimes happened because as we know I'm super allergic to adhesive and the fact that you would show up at my house on weekends
to make sure I was okay felt very reassuring. And again, you'd do that for every single one of your patients. But you know, it's up to the individual to pick what kind of a doctor they want. I feel like I got an amazing team because I picked everybody individually and their personalities and what fit me for that particular surgery or experience.
Great point. That's a fantastic point. I think everybody needs to do that, you know, Shannon, Sympathy is one thing that I personally wouldn't want, but I would always want empathy.
Yes, thank you, empathy correct, sympathy no, thank you. I love when someone like you can instantly zone in on what it is because some people hear like, wait, you don't want sympathy and that seems odd to them, but you just fixed it by yeah, sympathy no, thank you, empathy yes, and compassion right. But I think there's a way of giving that to someone like me with my particular personality where I don't feel because I always turn, for some reason, sympathy into pity in my own brain.
I get that. I think the point that every patient deserves empathy caring that I do think is extremely important. I want my doctors to be empathetic. What I'm going through for sure.
Who recommended you to me is actually really interesting. I think I read an article written by Angelina Julie where she talked about her surgeries, and she talked about all of her surgeons, and she mentioned you and what the process was and everything else. And then just through meeting with different surgeons, I also got recommended to you. So that's how we met. Do you recall that being the same.
No, I don't recall the details along happy we met.
Were you worried about my career considering the emphasis that is put on women's looks. I wasn't worried esthetically, because I knew I was in really good hands. I was more worried about the cancer diagnosis and what that would do to my career versus interesting. Yeah, I wasn't worried about.
I was worried about the aesthetic.
I know, but I knew you worried enough for me.
That's my job exactly, and that's what I often say to patients. Please you have enough to think about. Let me assume this worry to the best of my ability and as best I can take it off your shoulders. It's important that every it's really important that every patient, whether she is a wonderful successful actor, or whether she is a school teacher, a wonderful teacher or whatever, whatever, or a very important housewife, whatever she does, very important that in my mind that I mean, I strive for
her to still feel beautiful. You know, there are limitations to what we can do. But yeah, the aesthetic is always important to me. It wasn't important. Yeah, I knew that as soon as you were well, I mean, you're a dynamo, you were going to be gone, and I needed you to look good, even with the expander. I needed you to look good, you know. So what's so I was concerned about the aesthetic.
And the aesthetic is something to be concerned about because it's so hard if you're getting all these surgeries and having chemo, because now you lose your hair. Most women a lot of their identity. Certainly this was the case with me. A lot of my identity was tied into my hair. So now a sudden I'm bald. I couldn't imagine if I you know, and I know how that wreckd with sort of my self esteem, the baldness, all of it. I didn't feel very attractive. I didn't I
didn't feel like my partner found me attractive. Other reasons for that apparently, but you know, they're just so. It was incredibly important to me. Yes, that it looked good aesthetically, but I felt with you that I was able to release that concern because you were handling it.
That's my privilege. I'm very happy that you felt that. That is always my goal.
So I think we kind of answer this of like, why did we wait so long after having the breast removed to actually have reconstructive surgery? Can you expand on your answer?
Yeah, let's let's touch upon a couple of points. Okay, in your situation, as with all my every patient in my practice, we started the reconstruction immediately. Super important in my mind, the results of an immediate reconstruction, whether it's with an expander or an implant or a flap, are almost always superior to the results of a delayed reconstruction
for a number of reasons. Let alone the fact that it's so much psychologically more uplifting to have a reconstruction immediately, and in your case, we started the reconstruction.
Immediately, but with the expander.
With the expander, so that is it is.
M expanders only supposed to stay in you max how long?
I mean, expanders typically will stay for a year or longer. I'm not really aware of a reason per se that it can't be more than a year. And I've had some patients rare patient she just said, oh my expander looks good and not on my advice, but kept it for more than five years. At some point you think the expander is probably going to break down in my leak. You know, it's not a permanent implant, but we generally say, let we try to replace some you know, within a year.
That's not etched in stone. And there's some people whose medical conditions aren't optimal at a year where they need to get stronger or some further treatment, and so it can go well beyond a year. But in your situation, Shannon, you had more important therapy that had to take place. You had to do the key radiation. That was why your ultimate reconstruction with your own tissue was necessarily delayed. As I mentioned, following the initial injury from radiation, we
like to wait at least six months. It's not that those shapes will totally reverse, but a lot of the immediate injury from the radiation will improve. And if you if you wait six months, we generally feel that it's it's usually safe to proceed with the next phase. If you go much earlier than that, you may be more
prone to healing issues. So that was the reason that you you didn't have your final reconstruction after let's say three months from the time of the first It's very common if chemotherapy or radiation isn't necessary, if we use a tissue expander or the temporary adjustable volume implant. After about three months, it's common that we'll put in the implant, or if someone decides she wants her own tissues used, it can be an implant of her own tissue after
three months. Therapies needed, that must be done first. If radiations needed, that should be done first, and then we proceed with the next phase.
I also like that you clarified and said that reconstruction started immediately, because a lot of people don't think that getting the expanders, doing those final stitches, all the things that you did for me and for all of your patients is part of reconstruction. Like, I didn't even really consider that part of reconstruction, but it is because you're helping to try to ensure that the final result is the best result humanly possible. So you start right away and to get the best result at the end.
Shannon that the reconstruction starts with the first stroke of the general surgeon's life. In other words, the plastis surgeon really, in my opinion, should plan that incisional location because that's a very integral part. How the scar is or isn't concealed is very important. So reconstruction, in my mind, theoretically starts as soon as the messtheticy begins.
That's because you're you. How as a surgeon do you manage your patient's expectations of what is attainable and what is actually reasonable?
Yeah, I mean I really listened to what my patient is telling me in terms of I'll have a patient for a example, we'll say, well, even though I'm sixty five years old, I was a model when I was twenty five. And then I see a picture and it's like I so appreciate that. But it's been forty years. The tissues have changed, so if you're expecting that tight round breast that's going to look the same as she did twenty five years ago, it's not going to be achieved.
If someone says, I don't want scars. I've heard you're good at what you do, and I don't want scars, that's clearly not attainable. If you make an incision, there's going to be a scar. As the patient gets to know me and decide is this someone who I want to honor with my care, I also have to get a sense am I likely to make this individual happy? And I'll show them some pictures of what I've done. It's not going to be identical to them by any means,
but perhaps clinical situations that are similar. And I'll try to show similar clinical situations as they're experiencing. And if they look at it and they say that's a great result, if I were anywhere near that, I'd be happy. The likelihood is that patient's going to be happy. You know, having done this for so many years, I can see how someone responds. And if someone says they look at the pummy operation and the patients abdominal onto or look
so much better than before, and everybody acknowledges that. But what they say is look at the scar and not look at the contour. Then I know that's probably someone who shouldn't have that particular operation unless she absolutely needs it, right, you know, So at this juncture of my career, I'm fortunate to be able to key into responses of what people say about common results. And I look at it, and you know, I if someone says, you know, I want to I want to breast that has no round
in this to it. I want an implant, I want no round in this at all. I currently used implants around. Now if we place them, well, we can often achieve a result that looks fairly anatomic not the same as your own tissue. And so if someone says, I don't want any I don't want any round quality to my breast at all, but I want an implant, well that's probably not realistic. Now, again, there are really pleasing results we can achieve with implants, but I have to hear.
I have to really tune into what the patient's saying. And you know, I will say to someone, if you expect that they're going to be exactly the same, you can't achieve.
It, right, So you manage expectations.
I have to. That's what I do my bestution, you know, I just really try very hard to I would I would far or rather exceed someone's expectations and fail to meet them.
Are there times where you have to fix other doctors' surgeries?
Sure, all of us do our best, you know, as I mean, I like to believe and I truly hope that every doctor genuinely cares. We do our best, and all of us, despite our very best efforts, sometimes don't achieve the outcome for a variety of reasons that we wanted. And so of course I'll see patients who have been operated on by some very capable surgeons and they didn't
achieve the result that they wanted. And it's always it's always a privilege to try to help, you know, I think that you know, again, Shannon, we all have results that we really tried hard and it just didn't accomplish exactly what we wanted. And there's so many variables that are involved with reconstructive surchy than even the finest of surgeons as results that he or she wish could have been better. And when that happens, sometimes it's better to
see another surgeon. You know, there are times when really good surgeons try to fix what is displeasing for a patient, and again they don't succeed. Sometimes it's probably better to what I call change the energy. You know, Sometimes another surgeon isn't necessarily a better surgeon, but maybe thinks a little differently, may have an idea that will make that
unhappy patient happy, you know. So yeah, of course, I mean we all see situations where we of other colleagues, again often very good colleagues, perhaps we can improve at times.
Wow, thank you, Mike. Am I ready for my facelift.
Yet pretty fantastic?
Thank you so much for driving to my house, for that beautiful smile, for your compassion, for the love that you have for every single one of your patients, for how well you took care of me, the results that you gave me, for you know, making me feel like part of your family really, with your wife, with your staff, with everyone. I deeply appreciate you and thank you. And for the listeners. Doctor Jay Oranger one of the absolute best Premiere plastic surgeons, just a fantastic human being. And
I hope you guys learned maybe a lot. I think there was a lot to learn from this episode and thanks for listening once again. And doctor J, thank you so much for being on Shannon.
Thank you for the privilege of knowing you and caring for you and being involved. It wouldn't be a greater honor.
Thank you, sir. All Right, that's let's be Clearishana Doherty and doctor J. Bye, guys,