Let’s Be Clear About Reconstruction...with Dr. Jay Orringer (Part 2)

2024/5/16

Let's Be Clear with Shannen Doherty

Chapters

Shannon discusses her experience with Dr. Jay Orringer, her preference for doctors, and the importance of empathy over sympathy in her medical journey.

Shownotes Transcript

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This is Let's Be Clear with Shannon Doherty.

Hi, everyone. We're back with Dr. Jay Orringer. 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 going to 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. Her surgeon that she chose is a wonderful surgeon, one of the best at Cedars. And he's very much a hand holder and comforts and will spend a lot of time. Interestingly enough, you're 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 spend with me.

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 the 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 that.

a hugger or a hand-holding 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 was,

felt very reassuring. And again, you do that for every single one of your patients. But 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.

Sympathy, no. Thank you. I love when someone like you can instantly zone in on what it is. Because some people here are 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 for what I'm going through. For sure.

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Who recommended you to me is actually really interesting. I think I read an article written by Angelina Jolie 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 that,

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, although I'm happy we met. Were you worried about my career considering the emphasis that is put on women's looks?

I wasn't worried aesthetically 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. Was it 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... Yeah, 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 all of a sudden I'm bald. I couldn't imagine if I, you know, and I know how that wrecked 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, but

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 that is always my goal. So I think we kind of answer this 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 touch upon a couple of points there. In your situation, as with almost 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 not, it is not permanent. Expander is 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

of a reason per se that it can't be more than a year. And I've had some patients, rare patients who said, boy, 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 and might leak. You know, it's not a permanent implant.

But we generally say we try to replace them, you know, within a year. That's not etched in stone. And there are 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 chemo, the radiation. The chemo, the 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 changes will totally reverse, but a lot of the immediate injury from the radiation will improve. And

If you wait six months, we generally feel that 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 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. But if chemotherapy is needed, that must be done first. If radiation is needed, that should be done first. And then we proceed with the next phase.

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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, the reconstruction starts with the first stroke

of the general surgeon's life. In other words, the plastic 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. Right. So reconstruction, in my mind, theoretically starts as soon as the mastectomy 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 listen to what my patient is telling me in terms of, I'll have a patient, for example, who will say, well, even though I'm 65 years old, I was a model when I was 25 and

And then I see a picture and it's like, I so appreciate that. But that's been 40 years. The tissues have changed. So if you're expecting that tight, round breast that's going to look the same as it did 25 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 tummy operation and the patient's abdominal contour looks 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. You know, I look at it and, you know, if someone says,

You know, I want a breast that has no roundness to it. I want an implant. I want no roundness at all. The currently used implants are round. 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 round quality to my breasts 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 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 manage it. I'm being incredibly honest. That's what I do my best to do, Shannon. Yeah. You know, I just really try very hard to, 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. 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 a privilege to try to help. I think that, 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 surgery than even the finest of surgeons as a result 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. Right. So, yeah, of course. I mean, we all see situations where

We have other colleagues, again, often very good colleagues. Perhaps we can improve at times. Well, thank you. Mike, am I ready for my facelift yet? Pretty fantastic, Shannon. 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 everything

um, 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,

Dr. Jay Oranger, one of the absolute best premier 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 Dr. 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 Clear with Shannon Doherty and Dr. J Oringer. Bye, guys.