Saturday, April 19, 2008

Looking back to 1983 in Plastic Surgery and Pop Music

As I was leafing thru a recent Rolling Stone magazine, I noticed the list of top ten pop singles from February 1983. It's a diverse collection of songs that I actually know from being a 12 year old then who listened to the radio and watched MTV (when they actually played music). The singles in order were:

Patti Austin "Baby, come to me"
Men at Work "Down Under"
Bob Segar "Shame on the Moon"
Stray Cats "Stray Cat Strut"
Toto "Africa"
Michael Jackson "Billie Jean"
Eddie Rabbit "You and I"
Culture Club "Do You Really Want to Hurt Me?"
Duran Duran "Hungry Like the Wolf"
Phil Collins "You Can't Hurry Love"

Fast forward to Feb 2008 and I haven't heard of a single one of the top ten songs or most of the artists singing them. In fairness, the hipster in me is familiar with most of the music in the Americana Radio top ten, the "retirement home" for alternative music fans in the 1980's and early 1990's. I'll take this opportunity to plug Radio Paradise, the internet's best free streaming radio station.

My nostalgia for 1983 pop music got me to thinking
"What was going on in Plastic Surgery back then?".

Thru the archive online for our major journal, Plastic & Reconstructive Surgery, I was able to scan the "state of the state" of our field 25 years ago.

- One of the first articles on tummy tucks after gastric bypass (GBP) appeared. This was a little surprising to me as that GBP operation was fairly rare and people with experience in the plastic surgery after was uncommon. Interestingly many of the problems and concepts we act like we've just discovered were well described in that 25 year old article.

- A bunch of articles related to refinements in the traditional "open" (coronal) brow lift. The endoscopic brow lift wouldn't show up for almost another decade, whereupon the traditional operation was deemed obsolete, only to make a comeback in recent years as many have decided that "endo brows" do not last and when they do last it's in the least desirable place (the middle brow versus the lateral brow where people are complaining about). Modified open brows, incorporating lessons from the endo-brow experience, have made an impressive come back in recent years.

- The debate about whether immediate breast reconstruction after was either safe or feasible was being written about. At the time it was favorable to say that patients should "appreciate" their mastectomy defect as a rationale to do delayed reconstruction. Ugggggh! Talk about a paternalistic idea that hasn't aged well. We're actually having a related debate on more serious issues. A recent paper suggested that immediate reconstruction with either your own tissue or implants may decrease the beneficial effects of radiation (in patients requiring it) much more then previously suggested. If this hold up under scrutiny (and it may reflect how radiation therapists are failing proper technique more then the reconstruction) it could really decrease the number of women offered immediate reconstruction.

- A number of reconstructive pediatric urologic surgery procedures were still being talked about. This was a field that was really pioneered by early plastic surgeons generations ago. Since 1983 this whole area has really been abandoned by Plastic Surgery and is really almost now exclusively a Urology discipline. The last requirements for familiarity with these operation on our board certification exams were formally removed 2-3 years ago reflecting this

- Most humorously, an editorial by the chairman of an academic program frets about the ability of Plastic Surgery to attract qualified applicants compared to other surgical disciplines like cardiothoracic. That was a real swing and a miss 25 years later! Plastic Surgery is now indisputably the most competitive training pathway in all of medicine in the US while Cardiac Surgery struggles to fill 1/3 of it's training positions with US graduates.

Most striking to me of all changes is the change in editorial tone and professionalism of our flagship journal now versus then. Dr. Rod Rohrich from Dallas has been a tremendous leader in the upgrade in overall quality of articles included. With rare exception, you just don't see really dumb or inane topics thrown in in 2008.

I kid you not, in a Spring 1983 article there's a serious article "Decreased swimming speed following augmentation mammaplasty" and discussion of how breast augmentation theoretically affects the top end speed of a competitive swimmer complete with in depth mathematical hydrodynamic models.



rlbates said...

Interesting look back. Thanks for looking it all up.

Anonymous said...

Yet another item to add to the long list of potential complications we need to discuss with our breast augmentation patients...thanks for sharing the article.

Mallory said...

Anonymous said...

Good article but...
"Plastic Surgery is now indisputably the most competitive training pathway in all of medicine"
-- sorry buddy, that's really not true- Dermatology is the most competitive (see the New York Times article March 12th- I believe.) Derm is #1 - plastics is about neck and neck with otolaryngology.

Dr. Rob Oliver said...

Anon- actually you'd be wrong according to demographic data of successfull applicants as well as crunching the #'s with match %. It gets to be a little hard to compare b/w specialties as the number of spots is different, and in the case of plastic surgery, there are 2 distinct pathways into training.

The most competative specialties (in no specific order) are generally recognized as Plastic Surgery, Radiation Oncology, Derm, ENT, and Orthopedic Surgery.

Several new "integrated" programs in vascular surgery have come into the mix this year and many more applicants then positions. How competative that specialty remains if more programs open remains to be seen.

Thanks for your comments!