Coming

Flat chests

There has been a huge push to discuss breast reconstruction following mastectomy in recent years. This effort even has its own day. Breast Reconstruction Awareness day was sponsored by the American Society of Plastic Surgeons and The Plastic Surgery Society. But what if women with breast cancer or those at high risk for this cancer aren’t that into it?

This may be the case, and we need to get onboard. It turns out that many women are forgoing breast reconstruction after a mastectomy and are satisfied with their choice, according to a recent study in Annals of Surgical Oncology.

Of 931 women who had a unilateral or bilateral mastectomy without breast mound reconstruction, 74 percent were satisfied with their outcome and 22 percent experienced “flat denial,” meaning that their choice was not initially on the table, the surgeon did not support their decision, or intentionally left additional skin just in case she changed her mind.

When the researchers took a deeper dive into the reasoning behind the choice to forgo reconstruction, they found that women wanted a quicker recovery and to avoid the implantation of a foreign body. Women also felt that breast reconstruction was not so important for their body image.

Were we wrong to think it was? Maybe, but most research suggests that those women who did not undergo breast reconstruction had a poorer quality of life. It’s time for us to realize that there is no one-size-fits all solution for people undergoing breast cancer surgery. If women do opt for a flat chest, the aesthetic outcome may not be ideal, and we can partner with their cancer team to help improve the look and feel of the chest wall as well. Keep this in mind during consults.

Going

Jeaveau, we hardly knew ye

It was a launch that many of my colleagues won’t soon forget. Evolus’ toxin, Jeuveau, came onto the cosmetic surgery scene with a bang…literally. The Company hosted a lavish, all-expenses-paid party for physicians featuring fireworks at a posh resort in Cancun, Mexico. Many attendees flaunted their experience across social media, replete with bespoke hashtags. The Federal Trade Commission requires social media users to disclose relationships with companies, but most of the revelers did no such thing, stirring a hailstorm of controversy.

And then there was the ongoing trade secrets case brought on by Botox maker Allergan, an Abbvie company. The US International Trade Commission recently upheld a judge’s finding that Evolus and its South Korean partner Daewoong Pharmaceutical Co. manufactured Jeuveau using a secret process taken from AbbVie’s South Korean partner and issued a 21-month US ban on imports of Jeuveau.

In theory, this is not nearly as bad as the 10-year ban that was first proposed, but it’s a blow to be sure. We certainly won’t have Jeuveau to offer our neuromodulator patients any time soon. We wait see if the company can survive— or maybe even thrive—after what most industry watchers consider a major setback.