Pink Fatigue and the Birth of BoobieQue

I am a breast cancer survivor or, better stated, a term I recently learned, a breast cancer thriver. I live with this reality every day of every month and I am proud to say that I am indeed really living…and thriving. I’ve got a lot on my mind about the month of October and here’s why…

The month of October is Breast Cancer 'Awareness' Month. It is an entire month dedicated to all things breast cancer. It has become more of a Hallmark Card holiday than anything else... just my opinion. We are all 'aware' of breast cancer. Nobody doesn't know someone touched, affected, altered by breast cancer. It is my opinion that this month has become more of an opportunity for retail sales of pink merchandise than anything else. Sure a ‘portion’ of sales may be contributed to some cause somewhere that has something to do with breast cancer. But do you know where your money really goes, where it’s needed?

I had stage 0 breast cancer. I really don't even get to come to the table to discuss, participate. I'm like the kid's table at Thanksgiving....JV breast cancer. But I still had a diagnosis and an operation... and another operation, and a couple more. No, I did not need chemotherapy or radiation and for that I am grateful. Because I am the proud owner of a pathology report that says ‘cancer’, I do get to have a say in the matter.

I recently searched for what cancers have an ‘awareness month’ dedicated to them. Indeed, it is a long list and many, many cancers are represented. I think most would agree that breast cancer gets more attention during the month of October than, say, Brain Cancer Awareness Month…which happens to be May. I wonder why that is? I have known many people diagnosed with brain cancer and many people that have lost loved ones to this disease.  

It seems to me that October has evolved into a marketing blitz by so many: buy and wear pink in the month of October and a portion of proceeds will be donated to someone, somewhere. I believe people are generous by nature. If something is advertised in this month and all indications are that your money will go to a good cause, many don’t think twice and make the purchase. You’ve done good, no questions asked, and your heart was in the right place. Is your money in the right place?

When I was proceeding through the system to work through my diagnosis and planning for surgery, I was really surprised how unfriendly the system is for the patients and their loved ones. I am a surgeon: I am on staff at the hospital where my mastectomies and reconstruction was done. Yes, there were some small concessions made for me on the day of surgery for this reason. But for the most part, the experience was sterile and scary and lonely and it pissed me off. I have had surgery before, many times. Mostly my history is elective cosmetic surgery because, let’s face it, I’m a female plastic surgeon and I believe in all of it. I was in control, for the most part, for the other surgeries and the experience was relatively effortless.

BoobieQue was born from the desire to help others navigate the unknown, to be very general. A surgeon having surgery...a reconstructive surgeon having reconstruction...is an anomaly. Breast cancer lit a fire in me...a fire that doesn't just burn in the month of October. I did not set out when my biopsy results came back to launch a fund raiser and a nonprofit organization. As the process unfolded and I emerged on the other side of surgery, I was compelled to do something to try to make a difference for those experiencing what I did. Our inaugural event in 2016 was created literally over the course of 6 weeks. Through the generosity and support of many friends and this amazing community, a fun day came together and a lot of money was raised. $85,000 to be specific. Wow. Who knew what we were capable of?!?

Cancer Care Services came to my attention at the time we were creating the event. If you set out to raise money, you must have a plan for what you will do with the funds. A nonprofit that has been in Fort Worth for over 70 years, Cancer Care Services is the epitome of putting your money where your mouth is. With the desire to organize as a nonprofit of our own…having realized our potential and with big expectations for the future…I started researching nonprofit organizations to learn more. Charity Navigator is a website dedicated to ‘grading’ nonprofit organizations. It looks at many parameters for each organization but the bottom line is the overall score and rating. Cancer Care Service’s rating is excellent: they have 5 stars. If you know nothing else, which is generally my reality, this helps you appreciate that funds donated to this organization are indeed used for the intended purpose.

The nonprofit that was created after the success of BoobieQue is Fighting Right. Our mission is to raise awareness for women’s issues in a very general sense beyond ‘just’ breast cancer. From education, preventative measures for health and wellness, cancer support and awareness and domestic concerns, our goal is to establish a reputation for consistent fund raising through a series of events hosted annually with funds distributed to a variety of worthy causes. Broad spectrum? Perhaps. We are up for the challenge.

Breast cancer as a disease has tremendous support nationally. When I bristle at the term ‘Breast Cancer Awareness’, this is the root of my angst. Pink has become the color of breast cancer. I don’t wear pink because I survived breast cancer…I choose pink, when I do, because it was my mother’s favorite color. If her color had been chartreuse, I would embrace that so guess I’m lucky it was indeed pink. In the month of October when pink is utilized as a marketing tool for everything from license plate covers to beanie caps, I always follow through to see where the ‘portion of proceeds’ is donated. I check that organization’s rating on Charity Navigator to assure the funds have historically been properly utilized.  

For all the attention that breast cancer as a disease gets in the month of October what does not have enough support is research for metastatic breast cancer…the breast cancer that actually kills women and men. There are many organizations dedicated to research exclusively for metastatic breast cancer. METAvivor is one such organization. They are not yet graded on Charity Navigator because they are too ‘young’: you must have at least 7 years under your belt to qualify for grading. This is also why Fighting Right is not yet listed. Give us 6 years: I guarantee you will see a 5-star rating. In the meantime, we align ourselves with established, successful and above-board organizations that use funds donated for just what they say they will…in our case, Cancer Care Services.

BoobieQue is not retail sales of pink merchandise...it's a party for a purpose: to get funds to those that are completely 'aware' of their cancer but just need more resources. Maybe it’s assistance with paying for medications, insurance premiums. Maybe it’s care for the support system of the warriors battling cancer. Maybe it’s a simple as a day of play for the children of those ‘aware’ of their cancer diagnosis…an escape from reality. Fighting Right has aligned with Cancer Care Services because we know where the funds are going and how they are utilized.

So many in our community, our world, need so much and it takes relatively little to make a tremendous difference. Please come to BoobieQue for a fun day of barbeque and beer, live music, live and silent auctions, raffles and games. You can rest assured the money you spend is going to an established, appropriate organization that supports all cancer patients and their caretakers locally.

You can wear pink to BoobieQue2 but you don’t have to. We acknowledge that you are ‘aware’ of why you’re there and we are grateful in advance for the generosity of everyone participating on every level. Let’s raise a glass to survivors and thrivers, loved ones and their support system with my battle cry: Fanculo al cancro!

Here’s up to it!


Empathy: can't you just stock up on Amazon if you need some more?

I had surgery last week. Easy procedure…feeling stronger every day. But it was surgery nevertheless which is called ‘reality’ when you have had breast cancer and reconstruction or really any other surgery for that matter. The most prevalent word in my recent life when telling others about pending surgeries for myself has been ‘empathy’. As in ‘this will give you more empathy for your patients’. Let’s break that down…

I feel I have been naturally blessed with tremendous empathy for my patients. As a female Plastic Surgeon, I can relate to my patients more personally and professionally than some other surgeons. Not because I’m extraordinary or special but because I have literally had most of the procedures I offer and can speak to the process from a patient’s standpoint. I have always been very open about my surgical history because I don’t know why I wouldn’t. My opinion of hypocrisy is to have tested the waters but be coy about the experience. Just my opinion.

I’ve had 2 rhinoplasties, the first at 16 years old because my nose was just genetically awful and I’m certain my parents had many late-night secret conversations about no one ever wanting to date or marry me because of my ugly nose. (That’s made up crap. My parents were awesome and generous and the fact that the allowed me to have cosmetic surgery over 30 years ago when this just was not the norm for teenagers is so beyond extraordinary I cannot even describe my gratitude.) My heritage is Italian and Scotch-Irish. That makes me a stubborn hot head…and gifted me with a most unattractive nose. That was baseline before 3 breaks. My nose was broken so many times before my first rhinoplasty that unfortunate nose I was born with was further disfigured by life. How does a teenage girl break her nose so many times if she is not in the Mob or a linebacker or a prize fighter? Life. Playing with friends, pulling a suit case off a closet shelf that hit me in the face…who knows. It’s a miracle to me that everyone on the planet has not broken their nose because it sticks out from the middle of your face just begging to be crushed.

I had my first rhinoplasty when I was 16 and was marveled at the difference. My nose healed well and for 6 beautiful months, I had a 1980s cute little nose unlike I could have ever imagined. I was so confident and proud. To wrap this story up, I was at a high school Super Bowl party with friends 6 months after my procedure, a pillow fight turned into a left hook to the face and my beloved nose broken again. I tried to hide it from my mother for a couple of days but she was WAY smarter than that. They allowed me to return to the operating room to fix the mess and it was much better after that but never like it was. Since that time, I have carried the words my surgeon said: ‘another break and your nose will slide right off your face…’. Dramatic? Yes. Poignant? Indeed. My first experience with ‘empathy’, whether I realized it at the time or not.

That experience is how the world of Plastic Surgery became known to me and the rest is history. Back to the relevance of my personal history and empathy and this blog post. I have had a tremendous amount of elective surgery. When I started my breast cancer journey and was filling out the paperwork, the ‘Surgeries’ line on all the intake forms was too short. I laughed. At least I practice what I preach. I’ve had the two rhinoplasties, liposuction (multiple rounds), a mastopexy. I’ve had fillers, Botox and Dysport, lasers, peels, skin tightening. There is not too much that I offer as a surgeon that I have not experienced myself. Is that not empathy if you know what you’re communicating with others about…you can speak to the experience, the decisions, the recovery…elective or essential?

When my breast cancer diagnosis was delivered, my reaction was instinctively surgeon mode. Here’s what we’re going to do, I said. Met with Anita Chow and Danielle LeBlanc: here’s what I want, what do you think? Let’s do it, they said. Decisions were made and the process was underway. Plan executed to great success. I am cured. I was stage 0, noninvasive cancer. I avoided chemotherapy and radiation. I do not have any indications for adjunctive therapy. One and done, as we say in surgery.

Or not so much.

There has never been a patient in my practice that I consulted with about surgery where I told them they would never need another operation. In fact, it would be extraordinary if a patient had a procedure and in their lifetime never needed some sort of adjustment or revision. Our preference as surgeons is that if any return to the operating room was indicated, it would be years later. For patients with implants, this reality is most relevant. You cannot implant what is simply a foreign body into someone and tell them, ‘this should be it…good luck for your lifetime.’ With breast implants, cosmetic or reconstructive, there are a myriad of concerns we discuss with our patients. The most important things that could evolve are animation deformity and capsular contracture. Let’s discuss…

The decision for an implant to be placed under the muscle in both cosmetic augmentation and reconstruction is a function of the amount of tissue coverage in the upper part of the breast. ‘The muscle’ is the pectorals major muscle, a relatively thin muscle that lies on the chest wall and serves to cover the top part of the implant if a patient happens to have tissues sufficiently thin that the implant would be more visible in this area. In cosmetic augmentation, if a patient naturally has very thin tissues, subpectoral placement is a very good decision. In reconstruction, with the breast tissue surgically removed, very little tissue remains so the implant has historically been placed beneath the muscle for the same reasons.

Animation deformity is a phenomenon related only to patients with implants under the muscle. Because the muscle is still functional and contracts, it can move the implant. This isn’t a functional concern and it’s harmless but it is not what one would consider ‘normal’. Before my mastectomies, I do not think I knew how to flex my pecs on command. Once your pec has been elevated and draped over an implant, you quickly discover that pretty much everything you do activates your pecs. Pushing down on arms to lift out of a chair, getting out of the bathtub, doing pushups…most anything…activates this muscle and can distort the shape of your implant. Again, doesn’t hurt anything and when you relax the muscle the effect is gone but nevertheless…very unexpected and unnatural. Natural breasts or implants placed over the muscle do not have this effect for obvious reasons.

Progressive modern surgical thinking and planning has made this ‘there is really no other choice for your implant placement’ less stringent. If a patient does not have sufficient tissue coverage, cosmetic or reconstructive, and desires correction of animation, fat grafting to enhance the tissue coverage in top part of the breast makes conversion to subglandular implant placement a reality. No more dancing boobies. I had animation after my mastectomies; my reconstruction was subpectoral because that was indicated and that’s what I would have done if I were the operating surgeon as well. The animation was sufficiently bothersome to me that Dr. LeBlanc and I agreed on a plan to address it. I went back to the operating room for fat grafting 3 months after my initial procedure. 5 months after that we went back to the operating room and converted to the prepectoral plane. I am completely thrilled with the improvement. Much more natural, no motion when you muscle flexes, way better for me…awesome!

As a surgeon, I empathized with my patients that have had this and we got through it. As a patient, I have now experienced animation deformity and the beauty of eradicating it.

A capsule is a necessary and expected consequence of an implant; it is natural scar tissue that anchors the implant internally in the pocket. Capsular contracture is an incompletely misunderstood phenomenon where your body creates more scar tissue than necessary. It can be no big deal and your implant just a little hard or a big deal and your implant very hard and uncomfortable, even asymmetric with the other side. Strangely, contracture is usually a one-sided phenomenon, which is another level of ‘what in the world’. I have had many patients through the years, both cosmetic and reconstructive, with capsular contracture…low grade and high grade. I’ve treated it conservatively and I’ve operated on it.

It is known that implants under the muscle have a slightly lower rate of capsular contracture, attributed to the constant massaging action of the muscle throughout daily life. Implants over the muscle do not have this constant effect and although the rates of capsular contracture are not significantly higher than the alternative, there is a known slight increase in risk. I was moving through the world just fine, thrilled with my decision to convert to over the muscle…until I started to notice a capsular contracture on one side. It was subtle at first, then more dramatic. A little uncomfortable, a little asymmetric in my clothing, nothing serious…just changing.

For all the patients that I have managed through capsular contracture over the years, I listened and made recommendations but until I developed it, I could not relate to what they were really experiencing. Externally, as the surgeon, you note a difference that may or may not be significant. Internally, as a patient, it becomes a foreign body that does not feel like part of your person. My experience has been that prior to capsular contracture, there were times when I literally forgot about the implants…they are just part of me now and there was really nothing to think about daily. Once the contracture evolved, it became unreal, separate from me. I made the analogy that it was like a pebble in the tread of your shoe: you just need to release it, get rid of it, because it feels so unnatural.

The decision was made to return to the operating room to address it. The fix is to take the implant out, release the scar tissue to allow the pocket to expand so it’s no longer tight around the implant and compressing it, and replace the implant. The operation was a tremendous success with immediate improvement in the look and feel of the breast and I was thrilled.

As a surgeon, I empathized with my patients that have had this and we got through it. As a patient, I have now experienced capsular contracture and the beauty of eradicating it.

Recovery uneventful, drain out in 5 days…. I was cleared to return to the operating room less than two weeks after my surgery. That first day back in the OR I did 4 breast augmentations, all did great. More than ever before in my practice, the potential for future sequelae was on my mind. All patients did just great, day was great, I felt great. Yeah, me! A little tight after the day, I went to my office and enjoyed a good shoulder stretch. That’s when the hematoma started…

There are about a hundred potential complications or sequelae of breast implants beyond capsular contracture and flexion deformity. Common surgical complications are failure of incisions to heal, hematoma, seroma. It goes on for pages. That night I noticed my right breast was swelling. Bigger and bigger…it quickly became obvious that my innocuous little stretch pissed something off inside the pocket that bled. And bled. Double the size of the left in a couple of days. Awesome.

Last Friday we went back to the operating room to drain the hematoma on my right side. We had a little wager going: how big was the hematoma? Danielle and I both guessed 250cc. Made me smile that she and I separately picked the exact same number: great minds think alike. Turns out there was 325cc in there. The most common breast implant size I use in my practice happens to be 325cc. I like that size…not too big, not too small for most patients. (For the nonclinical, a shot glass is about 30cc…so imagine 10 shots and change in that breast. Side note: my implant is 450cc so I almost doubled down on that side. 325cc alone would have been just fine with me…325+450=675cc: not so much. Everything is bigger in Texas but there are limits…)

As a surgeon, I empathized with my patients that have had this unexpected postop sequela and we got through it. As a patient, I have now experienced postoperative hematoma and the beauty of eradicating it.

So that’s that. I stand by the need to understand what your patients experience and feel. I embrace Plastic Surgery in every form and have experience as both a patient and a practitioner, cosmetically and from a reconstructive perspective. It is so often the case that people just don’t know what to say when you’ve had cancer or it’s because it’s breast cancer and maybe that’s awkward and uncomfortable to consider. I have experienced all of this. I live out loud with my experience because that’s how I have processed it all. What I have been most effected by over the last 3 weeks with two relatively unanticipated but not entirely unexpected procedures are how many have said to me, ‘this will give you more empathy for your patients.’

Well, I already had a lot of that. Maybe I needed more and I’m OK with getting that if necessary. I don’t think you could have too much empathy. I don’t think those of us in the world of Plastic Surgery must experience everything the field has to offer to relate to our patients. I do think it is helpful to my patients when I can speak to the experience personally and I am happy to do so.

If there is an Empathy Meter on Amazon I haven’t yet discovered it. They sell everything else in the world so it’s just a matter of time. I will purchase a subscription for monthly Empathy delivery if it makes me a better person and a better surgeon. What I will really be OK with is no more life experiences for quite some time in the operating room as a patient. I welcome the life experiences of travel to Italy and seeing Steven Tyler in concert and Zoo Ball and Hot Box Biscuit Club brunch with great friends, I am full to the gills with gathering more empathy otherwise.

Today I celebrate a successful surgery last week at the hands of my amazing surgeon…who is as frustrated with my body’s need to gain more empathy and life experiences as I am…and am enjoying life on the other side. Healing and happy I leave you with this…

Here’s up to it!


Change is good. Unless it refers to your marital status...

As I sit here at my desk thinking that a blog is overdue with all the recent changes in my personal and professional life, I am shocked to discover that it has been 3 months since I last checked in. It’s a good thing no one’s life hangs in the balance with my posts given my inconsistency but I have been very busy so hopefully you’ll forgive me and keep reading.

On June 30 of this year….18 short days ago…I left the multispecialty group that I had joined when I first started my Plastic Surgery practice. The reason I joined the group 13 years ago was pure and simple: I had no idea how to run a business and that affiliation offered me the resources that I didn’t have. As the years and my practice evolved, it became clear that I was indeed able to handle the day to day functions of my office. Separation from a group like that is a massive endeavor and I started planning my exit two and a half years ago. In the end, the split was relatively painless for all and I am free and clear on my own: how it was always meant to be when I made the decision at 16 years old to become a Plastic Surgeon. To enter my office, you would not know anything is different…except for the joy and levity I have embraced since I have been free.

We have seen changes during this transition that I admit I never would have imagined. Anyone at all familiar with West Magnolia Plastic Surgery knows Becca. She and I have been together since the very beginning, literally. At one point in a prior transition, West Magnolia Plastics was just the two of us…our desks touching at the corners in a tiny shared office. We had to keep our voices down when talking on the phone as we sat side by side. We moved offices together twice, finally to our home here. I could not have fathomed a practice without her running the show but her happiness is far more important than our alliance and she made the decision to leave here to pursue her Master’s degree in counseling. The world needs her out there more than I need her here and she is forever a part of this practice. Becca…how I love you and am so proud that you are pursing your dreams.

With Becca relinquishing the reins as Office Manager, I was tasked with finding someone to come in and take on the job. The idea of managing a growing and expanding practice that is on the cusp of leaving a multispecialty group after more than a decade with new computer system, new personnel, new payroll…SO much new…would be daunting to most anyone. I can attest that I would have turned and run in the other direction. I cannot even believe my good fortune in finding Ashley to run this office. She came across our world first in an entirely different capacity that was not a reasonable fit for her skills and experience. It broke my heart because at the time there was not another position here for her. Everyone that met her loved her and we were certain when the time was right it would work out. Within weeks of that first meeting, Becca had made the decision to pursue further education and in the meantime, I received an email from Ashley that remains one of the most elegant compositions I have ever read. She is everything and more and I am blessed beyond all description to have her by my side moving forward.  

There has been ample rearranging around here and I don’t just mean the furniture. Most of you that have stuck with us through the years (how I love your loyalty, trust and friendship!) are probably used to seeing the ‘usuals’ where they always were. Tiffany at the front and Patty just inside the door in her little cubicle. No more…but only for the positive. Patty’s space is now a corridor to The Retreat and she has assumed the role within the entire office of Patient Care Coordinator. Her calm kindness and gentle demeanor is unwavering and I am so proud that she is overseeing scheduling of all my patients, cosmetic and insurance. Tiffany…awesome, amazing Tiff…is now our Marketing and IT genius. She just earned her Associates Degree after years of attending classes before and after work and online. It’s a tough reality when you become the old guard in a group and all your techie questions are directed to the young ones. Tiff has been instrumental in launching the new practice between social media management, configuring our new electronic medical records, trouble shooting an entire new computer server between what is now a huge physical space. We have added people to our team and we are very excited to introduce them to everyone. Reyna is at the front and doing a great job of welcoming our friends when they come to see us at West Magnolia. With additional services available, we now have a full-time aesthetician, Emilie, and a massage therapist, Belinda. I feel like the mother hen with all the pretty little chickens running around.

I would be remiss in not mentioning Carina and Travoya. It takes both to keep me in line and even then, it’s a handful but I am so grateful. Carina runs the operating room at West Magnolia Surgery Center and Travoya runs the clinical office. Travoya had her beautiful baby boy earlier this year and although I imagined he would be the office mascot, she did not share the same image. I love you Carina and Travoya and I absolutely, unequivocally could not maneuver my professional life without you. I wouldn’t want to.

Many of you that have been to the office over the years certainly noticed that we were stuffed to the gills in this historic space. When I took over this space 10 years ago, I made a fateful decision to allow part of the first floor to go to another office suite. I never could have imagined that my practice would grow so much over the years: novice mistake. I regretted that decision almost immediately for so many reasons, not the least of which was that I now needed the additional space. The front corner of this building has the original honeycomb tile on the floor and the beautiful French doors at the entrance. The suite was leased by an attorney that became a friend. I loved seeing him when we parked at the same time on Magnolia and visited in the morning. I told him in no uncertain terms that I loved having him next door…but if he ever left the space I wanted dibs on taking it over. That became a reality in the fall when he announced he was relocating his practice to downtown Fort Worth. Opportunity knocked…

My vision for additional office space was to expand the non-surgical arm of my practice. As a surgeon, I love to do surgery. Having a surgical suite on site is a gift and a dream and I would love it if everyone that came through the front door wanted a tummy tuck and breast augmentation. Sadly, that is not reality and some people just wish to have a more uniform complexion or tighter skin. Sometimes people just want a facial or a massage. I love to have facials and massages. I also love smooth, tight skin. The additional space was clearly earmarked for a med-spa to allow me to expand non-surgical services. The challenge was what to call it…until I started construction and found myself retreating over there for the beauty and the Zen of the space. Hence, The Retreat on West Magnolia.

The space is a beautiful (if I say so myself) reinvention of an antique space. With the vintage tile and exposed brick comes a fully functional spa space. The laser options I previously offered now live over there with much more room to execute procedures. The Sciton® Joule laser allows for a myriad of skin resurfacing options. Fractional laser resurfacing, micro laser peel or phototherapy for pigmentation concerns. The Thermi®RF system is designed for skin tightening: face, neck and vaginal rejuvenation are the most popular options. These procedures are offered with local sedation or topical anesthesia and with little down time. SkinPen is a micro needling device that creates a microscopic injury in the tissue with the resulting effect stimulation of collagen and elastin and overall improved skin texture and tightness. I have had each one of these procedures done in multiple over the years and can attest the the brilliance of each of them. Great things can happen without having to have surgery.

As I was outfitting this beautiful space on this most exciting corner (Magnolia and Henderson), I watched the happy people walking by between Cat City Grill and Melt and Heim Barbeque and Kent&Co. Wouldn’t it be nice, I thought to myself, if there was an option for these people to enhance their day on the Magnificent Magnolia Mile. I wonder if it’s a mile or more than that and if anyone has coined that term yet? I will be measuring it in my car from one end to the next after I leave here today…

Facials and massages are the bread and butter of any spa atmosphere. Bringing these services to The Retreat became an obvious inclusion. The option to have a relaxing procedure without any evidence that you indulged yourself…except for the blissful look on your face…meshes perfectly with the phenomenal atmosphere along West Magnolia. With an affection for facials and massages at other spas through the years, I am quite familiar with the nuances that make an experience extraordinary. A glass of champagne is always lovely but the artsy world that I am positioned in here demands more. We offer a full bar here to launch your experience…have a nice Scotch on a rock or a sip of good tequila to start your relaxation. Of course, we have champagne as well but sometimes it’s nice to have options. Put on your warm lavender booties and your soft robe and disappear into a nap while your massage evolves or your HydraFacial progresses. When you’re done with your experience, finish your sip and head out into the world. I feel certain the barbeque will taste even better (IF possible) and the company at Kent&Co will be amazed at your Zen.

I am now the co-founder of an amazing non-profit, Fighting Right, that evolved from the tremendous success of BoobieQue last year. The friendship, compassion, dedication of Carrie Carter, Matt Wallace, Laurie Bates, Emma Heim and Erin Rahr to make that dream a reality is unparalleled.  My one-year cancerversary was June 22. The past year has been a whirlwind of amazing opportunities and overwhelming grace and generosity on the part of so many. I have cemented a lifelong bond with Gabriel Starling who, at 9 years old, has done more to help others than many can declare in a lifetime. He is unstoppable and I am baffled that I have the privilege of being by his side for all that he does. I have been blessed with awards that I could never have imagined this time last year: HealthCare Hero, Community Advocate of the Year. If I had known when I was 9 years old how powerful and fulfilling it was to give back and help others, I would hope I would have had the insight and heart and soul of Gabriel Starling to do so. I have said it many, many times but without any hesitation, cancer gave me far more than it took away from me.

What else is new? Oh yes…had to get remarried a couple of weeks ago. What? Yes, you read that right.

When I left the multispecialty group, I lost my insurance. I knew this would happen but somehow imagined it would be more of a gentle process. Tried to fill a prescription for the sexy reflux I was recently diagnosed with. Aging is not for sissies, people. When the Pharmacy alerted me to the insurance status, Jeff’s answer was to jump onto his coverage as his spouse. Seemed like a brilliant idea. All we had to do was provide his insurance company with proof of our marriage. We were married in Belize 9 years ago. An official, legit, honest to God marriage with two officiants to boot, one of which was my beloved Poppy, Joe Lewis. We were unable to locate our copy of our marriage license at home so called the Tarrant County clerk’s office to provide us a copy. And that’s when the party started…

It seems we never filed our marriage license with the county. The solution, we were told, was to present to the Courthouse, fill out some paperwork and pay a nominal fee and they would date the certificate our original wedding date. That was easy, we took a selfie with the new certificate and faxed it the insurance company. Disaster averted, we thought.

Turns out you can only retro date a common law marriage and although that is legally binding in Texas and perhaps perfection for many couples, not OK for me after being Mrs. Nipples for the past 9 years. Back to the Courthouse that same afternoon, completed a formal license application and found a District Court judge to sign the 72-hour waiting period waiver. Our beloved friend Travis Heim had offered the preceding day to officiate our ceremony, largely as a joke because who would have imagined we would be getting married. Again. Well, he did officiate that night and although we had reached out to Chester Cox at Kent&Co for some real estate on the patio there to complete the obligatory paperwork, our amazing friends turned this into a real wedding. I walked down the ‘aisle’ to some Aerosmith playing on the sound system on the arm of my fairy godfather, David Lewis and my fairy godmother Toni Lewis was my matron of honor. Beautiful words were spoken, kisses were exchanged, a cake was cut and bubbles were poured. Some fried chicken factored in there somewhere, too. In 2018, Jeff and I will be celebrating both our 10th and our 1st wedding anniversaries. Who says life is not an adventure. What I say more often than that is ‘you cannot make this shit up’.

To complete the update of personal and professional lives, our beloved Lucy just clicked over her 16 and a half birthday on July 10. Amazing. She remains in general good health for a canine centenarian but is slowing down. I know we are on borrowed time with you, sweet Lucy. May your days be filled with naps and snacks and the occasional slab of Heim brisket, lean cut of course to help keep you fit and trim. Tucker, the little white ‘we got you at an auction on a Sunday night while drinking red wine’ is 6 years old and awesome. I am a big dog girl but you’ve opened my eyes, little one. If only you knew how to brush your teeth and would do it daily. Whew…little dog breath!

Keeping my eye on the prize right now with a trip to Italy in October. It’s very powerful to have something to look forward to, to work for. I will welcome a little break when the time comes but until then there is much work to be done here.

I start most every day here at my desk before anyone else arrives, before the sun is up. I walk through this space and marvel at the opportunities I have been given and am filled with gratitude for so much. For the women that make my world go around here in the office, the OR and The Retreat. Sometimes good things fall apart so better things can fall together. Nothing fell apart here, but change and growth are inevitable. We have such a GREAT thing here at West Magnolia Plastic Surgery…I long to share it with you in every capacity. Come by for your massage and enjoy your little cocktail. Raise your glass while you’re here and utter the mantra of my beloved mother:


Here’s up to it!




I am writing this in a plunge pool in our room in St. Lucia, looking at the Pitons. Is that necessary to document? Yes, because it is essential to this post.

I am tired. I am exhilarated but tired. Life is hard. Business is hard. I needed a little break and I’m getting it. I am so grateful for this opportunity. This is a surprise trip from my husband for our upcoming 9th anniversary. That is awesome. Who gets surprise trips? Wouldn’t have mattered where we ended up…but knowing our destination after months of guessing and speculation, this is perfection.

Why am I tired? Because a lot is going on. Let me catch you up….

West Magnolia Plastic Surgery is experiencing a very exciting and much overdue expansion. I love my office SO much. I love the look of my office, I love the feel of my office. I love it when patients come to my office for the first time and comment on the surroundings. I have wanted to do so much in my space but real estate was a restraint. We were stuffed to the gills years ago. I laugh…and cringe…when I recall the opportunity almost 13 years ago to take the entire first floor of our building. ‘I’ll never be that busy’, I said. Aaaarrrgggh.

Several months ago, a friend of mine who was my office neighbor approached me with some news. He was relocating his office to downtown Fort Worth. If I wanted the space, he wished for me to have right of refusal prior to notifying the landlords. Bittersweet as it was that my office neighbor was no longer next door, I was euphoric because suddenly there was a chance to stretch our legs and add services I have wanted to offer for years.

The Retreat on Magnolia is my idea of a Med Spa. I won’t call it a Med Spa because I don’t like that phrase. It’s overused and nondescript. Are you getting a facial or an operation? Maybe both. Maybe neither. The Retreat is about 1000 square feet of magnificent. It is laser resurfacing, photofacials, Hydrafacial MD®, microneedling, plasma facials, skin tightening…other things tightened (more to come about this…ThermiVA®!) The Retreat is a glass of bubbles, a comfortable couch, an exhale. I decided to call it the Retreat because although there is no place in my office that I don’t like to be, the idea of retreating to that new delicious space is very appealing. Grand opening: coming very, very soon.

How could something like that make me tired? Well, back to life is hard. Adulting is hard. Finances are hard. It is a lot of work to grow your business. It’s not OK to rest on your laurels. Yes, my practice is busy. I am facing 13 years in business this July. I am so grateful for the business I have, for my patients, my office. I am grateful for the chance to expand and offer more to my patients, to my friends. I embrace this kind of fatigue. I’ll take the long hours, the stress, the efforts to make it happen. I am excited for the future of West Magnolia Plastic Surgery.

That little matter of breast cancer coming up on 10 months ago is officially behind me. That took its toll, I think we can all agree on that. My family, my friends really got their butts handed to them with my poor processing of that little diagnosis. I wanted to make everyone proud with my decisions throughout that unforeseen reality. I feel like I was brave on the surface. I think we can all agree I lived out loud. I overshared. My drains hung out in the open. I posted pictures, shared my feelings…both good and bad.

I wasn’t brave and I wasn’t a hero. I acted like I was handling it all very well but I was kicking and screaming the whole time. For someone who didn’t even have invasive cancer, I do not have a lot to be proud of in my behavior. I avoided chemotherapy and radiation. I had 3 operations in 9 months but only 1 that was entirely essential. The last 2 were semi-elective to make some changes that I wanted to see. It’s easy to be bossy in directing how you want your body to look when someone else is in charge. I need to learn to be bossy with myself for what I am responsible for. I am learning.

I have learned a lot in the last year. About myself. And I didn’t like what I saw. I am fixing it. It is a process. Stick with me…

Back to that surprise trip from my husband. That in itself is a blessing. Not everyone gets to be whisked away for days in the middle of life. My husband, we all already know, is the love of my life. I cannot believe my dumb luck in crashing into this amazing soul on this huge planet. Did you make a list when you were little about your Mr. Wonderful? I did and it’s funny that I did because I was not a traditional little girl in that sense. I did not imagine my life as a wife or mother. I did not imagine my wedding. I imagined being a Plastic Surgeon since I was 16…so it’s a good thing that worked out for me.

Most girls make Mr. Wonderful lists, or at least I imagine they do because I did. It’s the perfect guy punch list. No reason to go into what was on mine in detail but suffice it to say that if you made a list of Jeff Knipper’s attributes, it would look a lot like my list. On April 19th, we will be married for 9 years. A lifetime? No. Do I wish it were 59 years? Yes. But I’m only 48 so that’s a physical impossibility.

He has planned this trip for months. Partly because of our anniversary, partly because he is aware of the adulting the past several months that I may or may not be processing well. It was a complete surprise. He communicated with my amazing office to block me out and be sure the schedule allowed my departure. He directed my packing and gave me very few clues. He has always said I’m impossible to surprise because I’m nosy. I admit there was a time in my life that I couldn’t wait to be surprised…I have cracked into more Christmas presents under the tree than I care to admit to. Not good. There are not a lot of great surprises in life. That little ‘you’ve got cancer’ surprise was not a great surprise. This trip was an AWESOME surprise.

Yesterday in the car from the airport to our present destination with this plunge pool overlooking the Caribbean, he realized that today...this day…would have been the 37th anniversary of his first marriage. I raise a glass to that because for whatever reason that did not work out, he was out there for me.

From this vantage point in paradise, I raise a glass to anyone reading this for every reason in the world. Because life is hard but you endure and you survive and you succeed. In business, health and love…my gratitude is overwhelming. Thank you life for all you’ve brought my way. More, please. I am learning every day to handle it the best way I can.

I just survived the 8th anniversary of the loss of my mother: the benchmark for magnificent in my life. In her words…

Here’s up to it!


P.S. I started writing this 2 days ago. I’m not tired anymore. I am rested, refreshed and ready to get back to work. Crazy how a little break from reality will restore your soul. Remember that little mention of The Retreat on Magnolia above? A lot of excitement has happened while I was gone. Be waiting for a big announcement coming very soon…


So much comes to mind with this word. My absence from this blog has a lot to do with recovery. In many ways, I am recovered. In many others, I am recovering.

In the most literal translation, recovery brings to mind ‘getting over it’. The actual definition describes recovery as a return to a normal state of health, mind, or strength. I don’t know about you, but I don’t know who determines what ‘normal’ is so perhaps recovery in the literal sense is unattainable. That’s a little too deep for my purposes here so I’ll let that go. Let’s explore the different situations that recovery can be applied in our lives:

Maybe one is recovering or recovered from surgery. As a surgeon, I see this every day in my work life. As anyone that knows me is aware, I have recovered from 2 surgeries in the past 4 months and am doing very well from that standpoint. Post mastectomy life is business as usual with the exception of the absence of sensation from your neck to your navel. Many have heard me say I cannot go to bars with dart boards as one errant dart could shut me down and I’d never know it. On the up side, bras are SOooo last season for me because these perky little twins are right where they belong. It’s easy for me to kid about it since I’m cured. I’m stage 0 with no plans for any further surgery on the horizon…that sounds like recovered to me. In retrospect, that recovery was a piece of cake. It’s all that cake (and the champagne and tater tots, of course) that transitions me to the next interpretation of the word…

I have approached fitness sporadically my entire life. I will embark on a fitness plan, diet and exercise, and hit it 400%. After about 2 days of that, I generally cannot walk without a limp. You must hydrate after a workout but the when the terror of sitting down to tinkle because it means you have to stand back up eventually precludes you from doing so….not good. All or none has been my mantra my entire life and this is evidenced in situations like this. Recovery means Aleve, water and time in this case. Once recovered, I return to it in one form or another. I am trying to teach myself moderation. After 47 years, it is a slow process but at least I am trying.

Recovery is very often from a mental or emotional situation. I do not know anyone that has not endured grief, strife, despair in their lives. I am somehow soothed by the reality that without sadness there can be no happiness. If you did not know despair, how could you truly embrace joy? The thing about recovery in a situation like this is that I do not believe it is ever a complete transition. You can recover from trauma and find the capacity to move through the world naturally once again, even be truly happy, but scars remain. That’s OK; scars are part of life, both real and figurative.

Perhaps recovery means from addiction of some kind. This is so prevalent in our world; it would be unusual for someone to not have someone in their lives touched by some type of addiction. Drugs, alcohol, gambling, smoking….regretfully, I am addicted to Amazon Prime. There is not a 12 step program to help me here but I am trying to keep it in perspective. When recovery is applied to situations like this, it is one step at a time, one foot in front of the other, but can absolutely be attained.

My world has been rather crazy for the past several years but more so the past 4 months. The greatest despair, grief in my life was the loss of my beloved mother almost 8 years ago. I acknowledge that loss is part of life but sometimes, when you’re not yet ready for reality…in losing my mother I was NEVER going to be ready for reality…it completely knocks the life out of you. I believe that I have recovered on many levels from her loss in the sense that I can laugh when telling stories about her, look for hours at pictures of her, hold her belongings peacefully and think of her.

We all have stories in our past that color our present. My way has always been duck and run. I am not proud of that. I am often a little delusional that the world can be butterflies, unicorns and rainbows and can’t we all just get along? That is not reality. It has taken a series of events in my life to realize that my inability to process anything that I find ‘unsavory’ is not effective. What I have been missing for longer than I can even remember, indeed perhaps never even had in the first place, is faith.

That is hard to acknowledge but very true. I long for faith. When I was losing my mother, I relied on many around me that I knew had a strong faith to help me endure. Pray with me, pray for her, I would beg. And they did…never any question when you ask for someone to pray that they do. I always marveled at the inner peace and calm that those individuals maintained without ever faltering. Prayer with them always made me feel calmer soothed. What is interesting in retrospect with some realizations I have recently made was why was I looking to others for their faith? Why couldn’t I pray for calm and peace for myself, my beloved mother, my family, my friends on my own?

In my practice, it is not at all uncommon for patients and their families to wish to pray together before surgery. I have always wondered who in the world would deny someone that? Yes, for heaven’s sake, please let’s pray. I don’t know how many times every single day you read a request on Facebook to pray for someone and their family. What do you do? You share the post and pray. I will ‘like’ a post as if to acknowledge I am doing what you ask but admit here that I may or may not have actually said a prayer. That’s cheating and that’s not OK and that is no more.

So if I have indeed been longing for faith, what was I waiting for? My little light bulb had to go off for me to realize that you can say you’re a good person all day long, you can believe you are doing good things in this world, you can make people laugh and do whatever it takes to disguise the angst that might be your reality within but until you calm those waters through building and strengthening of your own faith, you are never going to win the battle. My interpretation of faith is that it’s all going to be OK because it is, in fact, all going to be OK. Perhaps the means of getting to a specific endpoint is not what I might have imagined and every moment in time might not be completely delightful but I realize that pretending that every moment in time is going to be completely delightful is completely out of touch with reality. The peace and calm of resting in the knowledge that God will protect me and those that I love has given me a sense of calm that I have never previously known.

I am a work in progress. Faith has to be learned, practiced and strengthened. I am actively trying, learning. You might say I am in recovery mode. It feels really, really good. Please pray for me to continue to grow and learn. I welcome that more than I could articulate.

I have already said my prayers this morning for God to protect my family, my friends, my decisions, my patients…and also my patience. I might also be praying that I can stay away from Amazon Prime today. No promises but I’ll try…

Here’s up to it!

Fanculo al cancro

I have breast cancer. Better stated, I HAD breast cancer.

I am 47 years old and healthy. Very healthy...the old idiom 'healthy as a horse' just makes me feel like I need to ramp up the workouts but can't do that right now with my drains in so let's just go with 'I am REALLY healthy'.

I hate to go to the doctor. Doctors are the worst patients in the world. There was simply nothing wrong with me or no concerns physically when I called my Gyn to inquire why I hadn’t had a well woman exam in over a year and seemed like a good idea. I wanted to get the idea of it out of the way so I could just worry about it again next year. After my tubal ligation in December 2014 I was doing great. I ordered a mammogram on myself in April of 2015 simply because I thought I fell a lump and scared myself. That exam was normal, exhale, nothing to worry about. I have no family history whatsoever of breast cancer. I had not felt a lump and I do check, even though when you drink as much coffee as I do, it is cyst city and hard to tell. Yes, I was due for my routine checkup and it was scheduled. I passed the Pap smear with flying colors (know you’re glad you know that…nothing like a good oversharing) and was not remotely concerned with the mammogram.

On June 2nd when I got the call that those pesky little calcifications on my mammogram were not benign, I questioned my health, my reserve, my future. That crap lasted about 30 seconds because I got the call in the middle of a mommy makeover. That requires some explanation: surgeons do not always have the luxury of fielding news at their convenience. That is not to say that my office, my friends and family haven’t gone to lengths in my life to protect me from something I may not want to know about when I am in surgery. In this case, we were braced for the results of the biopsy done 2 days earlier but did not know that the phone call was coming when it did.

Funny true story: on the day of the biopsy result, I was in the operating room, doing my thing, with my bestie Toni at the head of the table doing the anesthesia thing. Despite the knowledge some results were coming our way, we were having a great case, doing what I love to do most: operating. About 2 hours into the 6-hour case, my cell phone rings and Toni answers it for me, on speaker so I can participate. It’s a local phone number as evidenced by the area code but an unknown number. After the obligatory pleasantries, the man on the other end states ‘”…this is Ed from Coleman…” All I heard was ‘Komen’ as in Susan B. Komen, as in breast cancer. “The hot tub cover you ordered is in.” No one has ever been more relieved to have a new hot tub cover than me. We laughed about the irony and kept operating.

30 minutes later, reality hit. The radiologist called himself and gave me a quick pep talk, I recall he might have even said, ‘are you ready for this?’ or something like that. Remind you, I am on speaker phone with Toni holding the phone to my ear. He goes on to tell me it was indeed DCIS on the left side, high grade. Nothing invasive, very small area. Got it, thank you, have a tummy tuck to do.

The next phone call I asked Toni to make for me was to Danielle LeBlanc, a very close personal friend and fellow plastic surgeon whose practice happens to be centered on breast reconstruction. She is a PHENOMENAL surgeon…I have admired her results for years and always told her that if, God forbid I ever needed breast reconstruction, she’s my girl. She knew about the mammogram and pending results so when I got her on the phone to tell her, her reply was simply ‘dammit’. I asked her to please contact Anita Chow, the bad ass breast surgeon I selected to do my mastectomies, and find out between them if I was a candidate for bilateral nipple sparing mastectomies with straight to implant reconstruction. Love you, mean it, gotta go finish this tummy tuck…

The patient that was the recipient of that mommy makeover is aware of all the events that transpired that day while she was taking her anesthesia nap and is a friend of mine. Here’s the deal with processing unfortunate news when you’re in the middle of a surgical commitment: laser focus. It was actually a relief to have anything to think about that was not my left breast. Her case came together great, she has since recovered right on schedule and we are forever bound by the reality that my life changed at the same time hers changed. Am I overstating the power of a mommy makeover? Nope…it’s pretty great and she is rocking the fitted dress right now while I have a surgical bra and drains. But I’m getting ahead of myself…

A little education about breast cancer. It is either noninvasive or invasive which basically means noninvasive stays put and doesn’t show up anywhere else. If you have to have cancer, it is what you want. Breast cancer is either ductal or lobular which is a description of the cells it derives from. If someone has LCIS, that means lobular carcinoma in situ (noninvasive)…that is considered a pre-pre cancer and really not a big deal: that is what the radiologist that found the calcifications originally believed I had. DCIS is the same thing but ductal, a little more serious than LCIS…but still better than the nasty invasive cancers. One option to treat this tiny focus of mean cells in my left breast would have been to pluck it out (a lumpectomy) and radiate everything around it remaining and leave righty alone. The alternative to that is remove all breast tissue both sides and never have another concern that breast cancer is going to hurt me again. I have deemed this the surgical apocalypse because it is a lot for a little: but the answer I needed to live with this diagnosis because I cannot live in fear of when it will come to the right and will it recur in the left and might it be invasive. Aaarrgh!  

Toni told me only after she, myself and Jeff had our consult with Dr. Chow that she originally thought I’d lost my mind after that phone call in the operating room when I requested consideration of this surgical approach. Dr. Chow confirmed that for someone my age…young (smiling)…with this diagnosis in the location is was (close to the muscle, away from the nipple), this surgical approach is absolutely reasonable and is a surgical cure for me. No anticipation for chemotherapy or radiation. My breasts will match as closely as possible because they will be reconstructed at the same time with the same technique. Yippee! But wait a minute…double mastectomies? Damn.

After my consult with Danielle, again accompanied by my constant companions and care takers Toni and Jeff, the plan was set, the implant size selected and nothing to do but wait for surgery. 5 days before surgery I had a preoperative appointment at the hospital. Per usual, Jeff insisted on accompanying me. All the financial pleasantries taken care of…side note-if you happen to have a credit card with miles or points or anything the you benefit from while spending money, use it for your out of pocket expenses before your insurance kicks in because in some small, stupid way you get a sense of  ‘I’m earning miles through American Express toward our next flight to Italy or somewhere exotic.’…they pull me to the back to do blood work, EKG. I asked if Jeff could come with me; after all, he accompanied me to support me so extracting me from him counter intuitive, right? Her first answer was that he could wait in the waiting room but then she relented. This was one of my first moments of, ‘Really?’ I have not played the surgeon card through this experience. I did not tell her I know the system and there is no reason he cannot be with me during this. Boy, I’ve learned SO much about our medical care systems in the short time I have lived this. Things are going to change, people, but once again, I’m getting ahead of myself…

I operated, saw patients, tried to tuck everything in before my surgery because in my almost 13 years in practice, I have NEVER been away from my office as long as this stretch. The days before my surgery were busy with all of that as well as getting ready personally: mani/pedi, bikini wax, grey roots covered, a facial. Dramatic and unnecessary you say? Nope. Essential. If I’m going to be poked, prodded, cut, drained I am going to do it as the most well-groomed client the hospital has ever seen. ‘Client’, you say? Yes, try that approach next time you, regretfully, are going through something you didn’t look forward to or plan. I refused to ever be considered a ‘patient’ because that, to me, sets up a state of mind that isn’t positive. A client is someone you have negotiated services with. Not unlike contracting with a financial planner, a designer. Whatever. Call yourself a client and see how your surroundings respond…I think it’s a good thing.

We arrived at the hospital at 5am for surgery. Actually, since I hate being late, we arrived at 4:45am…always the overachievers. Around 5:15 I was taken to my room where I was asked to change into my purple paper gown and hospital issue slippers. I chose to sit in the chair next to the stretcher because that is what a client would do: remain as non-vulnerable for as long as possible. When there is so much going on you cannot control, do whatever you can to control something. Bossy? Perhaps. The process of getting a surgeon ready to have surgery is complicated.

At 6:15 I was loaded into a wheelchair for transport to radiology to have a needle placed into the tiny area of calcium. It is important during surgery to remove a margin of normal tissue surrounding the evil calcium and even the most elegant surgeon with the best dexterity could not have found the DCIS without the assistance of a small wire right in it. That process, the needle localization, was very well tolerated technically. Very little pain in the left breast but a lot of brain pain as, per protocol, I was alone in a dark waiting room, waiting for the transporter to come back and get me. Alone with my thoughts: scared. Dislike. Back to my people and support system. By this time, one of my dearest girlfriends had made the pilgrimage from Dallas to Fort Worth with custom T shirt emblazoned with my battle cry through this process: Fanculo al Cancro. The girlfriend is Christy Milkereit and the translation is ‘Fuck Cancer’ in Italian. My mother, my heritage, is Italian…hence the adoration for the language…and I think we can all agree that sporting a shirt with ‘Fanculo’ is more socially acceptable than ‘Fuck’.

My next field trip was to Nuclear Medicine to have a radiographic tracer injected into my left breast so Dr. Chow could find the sentinel lymph node to biopsy and prove that, for sure, no concern for this little cancer making a move. I asked if Jeff could come with me on this one. Yes, he was allowed to push my wheelchair and that made me smile. Good thing since the injection did not. There is a lovely program at the hospital here I believe most hospitals offer: Breast Nurse Navigator. A RN named Kim had called me before that preop appointment on Friday to introduce herself. She explained she and her partner had a list of all breast surgery patients and followed them through the process. She mentioned her partner was out and she was spread a little thin; my reply was that I happen to know the process as a surgeon myself that is actually on staff at this hospital and I have a great support system intact…please focus your attention on the other patients that may not have such great support. She agreed but showed up at the injection to hold my hand. I was told it was like a bee sting, a mosquito bite...worst case scenario, a wasp sting. Dr. Chow does her injections herself and she is a friend of mine who I admire and respect tremendously. When getting ready to do the injection she asked the nurse, ‘may I have some alcohol’ to prep the skin. My reply: “I have been asking the same question all morning…” but I clearly meant a strong cocktail instead. At least I got a giggle out of her. The injection does not feel like a bee sting at all. It feels like a hot poker right into your nipple. If I ever come across a bee or a wasp that might sting like that, I am going to shoot the little ‘fanculo’. Ouch.

Next step: operating room. I remember very little here. The nurses are my friends and know me here. They absolutely recognize that a surgeon on the other side of the game is not natural. Side note: I have had surgery many, many times before. I have been under anesthesia multiple times for unnecessary, fun, elective cosmetic surgery. I have never been coy about what procedures I’ve had done: rhinoplasties (yes, two), mastopexy, liposuction. I have had an appendectomy and a tonsillectomy. I had a tubal ligation. None of these procedures were scary, not even those that were not elective. I have never feared general anesthesia. I have also never had breast cancer facing bilateral mastectomies before. I was scared. Really scared. The anesthesiologist asked me if I wanted Versed once my IV was started. Who in the hell would say no to that, I asked. The nurse asked me if I wanted local anesthesia where she was going to start my IV. Who in the hell would say no to that, I asked. IV in, Versed in, off to surgery. I awoke about 8 hours later in recovery. I remember very little here. It was late enough that all other patients were out of the recovery room and they let my people come in. All good news: the sentinel lymph node was negative as anticipated, the flaps were healthy and Dr. LeBlanc was able to put in implants instead of expanders and save my nipples.

Let the recovery begin. I was in the hospital overnight and was paroled for good behavior the next day. It has come to my attention that I have had only sporadic good behavior since. Oops. Back to that doctors are the worst patients. I am compliant with my restrictions, whether or not those that know me best believe me. I am embracing my good fortune and the blessing that I no longer have cancer. I am frustrated with the drains and my shoulders are stiff. I cannot sleep on my side or stomach as I love to do. I have ‘breasts’ and ‘nipples’ but it is not normal and real. I am trying to make light of it, I am using humor and sarcasm to cope which works for me.

Yesterday I had a complete come apart. I asked my beloved Jeff to check things out for me…make sure that where I was hurting that there was nothing he could see of concern. Secretly in my mind I wanted him to say, ‘Damn, Boo…you’re so hot’. I stood there in front of him, topless, with drains clipped to a lariat around my neck. He inspected as I requested. He didn’t scowl, he didn’t look away in despair, he didn’t vomit. But I perceived my reality in front of him and burst into tears. ‘Don’t look at me, I’m hideous’ was my reality. I’m sorry I made you look. I’m sorry I don’t have real breasts anymore I’m sorry there are areas on my nipples that are not going to survive and they are discolored. The tears wouldn’t stop. He held me, laughing, and kissed my eyes. “Sweet girl, we’re healthy”, he said. His focus and reality is that the disease is behind us, the healing is all around us and the future is wide open. I need to come to terms with that, too.

Having breast cancer was one of the best things that ever happened to me for so many reasons. I know with certainty that I have only ever been as scared in my entire life as I was during the 3 weeks from diagnosis to surgery one time: when my mother was in the ICU, critically ill. For 5 weeks it went on…she would legitimately get better on Sunday after I arrived on Friday, such that I believed she would actually be OK and I would go back to work. That was until the end of the week when she got worse again. I lived in fear of every phone call, every message. I lost her and that will forever be the darkest time of my life. I desperately wished she was here to hold my hand and take care of me through this process but it occurred to me that she would have been so concerned for me, so sad. I could not have tolerated making her sad. Having her sitting on my shoulder as my Guardian Angel is what has helped me through this. That and the army of friends and family that have supported me, loved me, fed me, dried my tears, emptied my drains, changed my dressings.

I am a better surgeon and a better person for having lived this. I got off easy: no chemotherapy, no radiation. Yes, I have incisions and drains and implants. I will need more surgeries down the road because that is part of it. I struggle with guilt for that phases of breast cancer survival that I circumvented. Would I change my reality just to experience those things? Hell no. My heart breaks for those that I know and love that are walking that walk. I did not want to ever be a breast cancer survivor but I sure as hell would never want to be a breast cancer non-survivor. I am in a position to make changes for all patients….clients…following behind me from what I have experienced. I am lucky to know many people that support me that are in a position to really help me make a difference. I am researching how to make it happen now, I will need support and input and will keep those interested in touch.

Until then, I am laying low, waiting for my drains to come out. I laugh every day, sometimes through tears. When I say raise a glass it can be a glass of whatever you want it to be. I choose champagne, but only in moderation because I am in recovery mode right now. Saying thank you could never begin to express my gratitude to so many for so much. Let my actions tell my story and let’s make big changes: attention to early detection, support for those walking the walk without adequate support, to recovery. There are so many needs out there, so many different cancers. I want to help them all. Shooting for the stars, but doing it right now without raising my arms above my shoulders.

Love those around you, embrace the day. Smell the roses, ignore the weeds. More to come, have to go enjoy brunch with my beloveds now. Until the next time…

Here’s up to it!

#fanculoalcancro #raiseaglasstokickcancersass




But I Don't Want to Look Plastic

plas·tic sur·ger·y

[ˈplastik ˈsərj(ə)rē]


The process of reconstructing or repairing parts of the body, especially by the transfer of tissue, either in the treatment of injury or for cosmetic reasons.

It has nothing to do with actual plastics. Silicone sometimes…yes, but not actual plastics. I think most people do realize this. I am occasionally asked by patients why it is called plastic surgery and share this definition. The reason this is on the forefront of my mind today is because of something that a new consult said to someone in my office yesterday, ‘But I don’t want to look plastic.’

No one does. OK, maybe some people do. I am not interested in aligning myself with that clientele. I believe that those people moving through the world with a completely unnatural, surgical appearance are the victim of a surgeon or physician that didn’t know when to say when. This lady’s concern was looking too ‘done’. She had been to another physician for injections, nothing surgical. Good thing since he wasn’t a surgeon….although that is not always a deterrent for some physicians. I have had patients present to me to discuss mole removal and in discussing their history relate they had liposuction by a Dermatologist. And you’re coming to a Plastic Surgeon for a mole? This is a topic for another blog. Let me stay on point…

I loved the reply that Patty came up with when the patient stated her concerns about looking ‘plastic’.

Do I look plastic to you?


She went on to tell the lady what she had previously had injected. Those injections were done by me because I would beat her mercilessly if she came in here with evidence of someone else working on her. Not really beat her but it would break my heart. She knows that…my office is amazing and loyal and great. Doubt they would cheat on me. But I’m watching, ladies…

Two points are very relevant to me regarding this exchange. The first is my drive to use the proper tool for the job and the second is when to know that certain tools are not the right one for the job. In this lady’s case, and in the case of many other patients I see, the injections she had done were not the right fix for the job. That is my opinion and I think most know what you can say about opinions. Everybody has one, just like something else. And I believe most of you know what that other thing is that everybody has.

You could present yourself to 100 plastic surgeons and likely come up with 100 different plans. One of the many, many things I love about Plastic Surgery is the variety. There are more fillers on the market than I even realize. There are multiple ways to do every procedure that anyone could come up with. I love that Plastic Surgery allows you to address literally every area of the body. Last Thursday my surgical schedule was a lower blepharoplasty (eyelids) then augmentation mastopexy (implants and a breast lift) then a brachioplasty (arm lift) then liposuction then a laser with fat grafting. 5 different patients, 5 different things: one of the best surgical days ever. Plastic Surgery is the love child of art and science. Figure out what needs to be corrected to make someone happy then figure how to execute the correction. Sometimes it is surgical, sometimes it is not.

Some patients desire an aggressive approach. I am all about instant gratification. I could only ever have been a surgeon because the alternative-life as a medical doctor-would have driven me batty. Let’s change this medication and check back with me in 6 weeks. Aaargh! Dislike. Here’s an idea: let’s cut it out and see immediate results. Excellent!

Some patients are not interested in jumping in with both feet. I have mad respect for that. The beauty of fillers and injectables is that there is little if any down time. Many people have little bruising or swelling and are moving through the world the next day...no big deal. I wish that had been my recent reality: I injected fillers into my face 2 weeks ago to correct some things I didn’t like. I am still swollen beneath my eyes and on my cheek. Oh well, goes with the reality of being a female plastic surgeon and practicing what you preach.

What does not make a lot of sense to me is someone that desires an aggressive result but is not interested in taking the plunge. With risk comes reward is a mantra that I often repeat. Perhaps more relevant to this conversation is ‘with lack of aggression comes disappointment’, at least in some cases. It’s not that the physician that did the injections knew he couldn’t deliver the results she wanted. I seriously doubt that is the case. I believe that too many physicians don’t know how to shut up and listen. Let the patient really explain what they want. After talking to this patient, it was clear to me that the plan to inject fillers was not going to deliver what she wanted to see corrected. After I discussed with her the options that would result in the difference she wanted, she expressed that the recovery from those procedures was more than she could take on right now. Totally acceptable, but not a reason to default to another technique that will not get the job done.

So back to her comment about looking plastic…I know what she means. A lot of people pursue so much ‘correction’ that they lose their natural appearance. I believe that this can result from the propensity to apply the wrong fix for the job. Clearly I’ve circled back to my opinion. If someone, for example, has significant volume loss in their face that sometimes comes with age and with this volume loss comes skin laxity and wrinkles, it is my opinion that trying to correct that conservatively with fillers is an exercise in ‘looking plastic’. Either accept that a face lift is the answer or accept that an incomplete, but believable and more natural, correction can be achieved with a different approach.

Do not be afraid of what it takes to maintain your youth, or at least the appearance of youth. Age is but a number. My beloved husband always says that he will continue to get older but he will never grow up. I LOVE that…I don’t want to grow up either. But I also don’t want to necessarily look like I am getting older if I can help it. Many that know me know that I abide by less is always more. You can always put more in or pull it tighter but you can rarely back it up. I love that the ladies in my world embrace this philosophy as well.  

I leave you with this quote from one of Plastic Surgery’s greatest advocates:

‘I’ve had so much plastic surgery, when I die they will donate my body to Tupperware.’ –Joan Rivers

Don’t be a Tupperware donor. I, for sure, will help talk you down if you find yourself headed in that direction. But also do not be afraid to maintain, correct, enhance. Remember, less is more. I look forward to the opportunity to help you find your way through the magnificent world of Plastic Surgery. You can find your own Tupperware.

Here’s up to it!


Where Have You Been?

I admit it has surprised and delighted me that some have asked why I haven’t written a blog in so long. So as I sit down this morning to write, imagining in my mind that the last one was a couple of weeks ago, I am startled to see that it was December 1. What?!? There are three drafts that I started that were never finished…the third entitled ‘Champagne’, the second one ‘Love, Loss and Champagne’ and the first just ‘L’. It would appear I was very distracted…and had champagne on the brain. December was an extraordinary month, and not in an entirely positive and holiday festive way. I feel compelled to explain my absence by explaining what reality put on my doorstep these past few months.

The first unexpected loss was December 10, the last was January 20. There were 4 total. After each loss someone would comment, ‘and especially at this time of year.’ There is never a good time for loss but I do agree that it is extraordinarily hard at the holidays.

What did I learn, gain or gather from the losses I endured? There has to be a silver lining to everything that happens. If you can’t find a message, something positive in every event I find it impossible to process what has happened. I still find it impossible to process some of what happened but I am trying.

Our friend Rod was killed in a motorcycle accident on December 10. He epitomized ‘life of the party’. The man never met a stranger, never had a cross word. He lived hard and fast: to paraphrase from Top Gun ‘Mach-2 with his hair on fire’ was his way, if only he’d had hair. He would have embraced the irony in that. The message of Rod’s loss is live like today is your last day. No regrets, no excuses. Sometimes this is not realistic or responsible. But as we gathered to raise glasses to our friend, the general sentiment was that he didn’t miss much and squeezed a TON of life into his years. Would we all have preferred another 20 or more years with him? Absolutely. Cheers to you, Rod. You are missed.

The next friend I lost was a long time patient of mine that had evolved into a dear friend over the years. I had not had the privilege of seeing her for many years but when our paths crossed it made me smile. She was elegant, funny, fun. What did I learn from her loss? Don’t waste time if you feel you need to be in someone’s company that you haven’t seen in a while. Maybe you saw them yesterday but they are on your mind: reach out, let them know. Many have the same policy that Jeff and I do: do not part company with discord or without ‘I love you’. God forbid you didn’t have the chance to let someone know.

The loss that affected me most deeply was Tim. He died on December 30.  Tim was my assistant in the operating room but more than anything Tim was my friend. He was a very, very dear friend…one of my closest friends. We had a bond many didn’t understand but was so effortless to us. His girlfriend, who I love, told me after we lost him that I was like the other woman and she was OK with that. That may not sound like a compliment but it meant so much to me. Tim is survived by his three children that I love. I love his mother. I love his girlfriend. I am really struggling to find the message here. He was Buddhist and I have learned a lot about Buddhism since his passing. Much of what I have learned is soothing in a time of loss. His loss has brought me closer to those that also loved him; I have spent more time with his mother and children than I had while I had him here. I confess I am struggling to learn the message regarding Tim’s loss. I confess there are many days that I reject reality and believe I will talk to him tomorrow. I am searching.

The fourth loss was Grady. Have you ever met someone later in life that you instantly like so much that you are excited about learning more about them in the future…someone so talented, interesting that their dress, style mesmerizes you. Grady was an artist, a musician. He was truly one of the coolest dudes I have ever met and there is just no other way to sum it up. He had been a high school friend of Jeff’s and I had just had the privilege of meeting him and his wife in November. Jeff has a shirt that Grady admired…his wife Lisa had reached out to me to learn where we bought it and Grady had found one. Lisa said it was his favorite shirt. The message from his loss is to cultivate your funky, your fun…your art. Make a presence that will endure when you are no longer here to create. I will never forget Grady and I just had the smallest glimpse into his greatness. Cheers to you, Grady…thank you for the honor of your company and the privilege of being able to say I knew you.

This is not an uplifting blog. Many have probably stopped reading already and opted to clip their toenails or take out the garbage because that is more exciting. My office has mentioned to me many times that I need to write. They have suggested many topics that are relevant to my practice that might be helpful or interesting. But I feel I must explain my absence before I move on to levity and education and beauty and all things pretty. Loss is part of life and I know that. How can you appreciate happy if you have never known sad? It would be impossible.

I am still trying to process my world without these four in it. As is reality, some of the losses are much harder to endure on a day to day basis than others. I will take this from each of them:

Live large and embrace every opportunity you are granted, as there is no guarantee of tomorrow.

Do not let the sun set on absence or regret or apology…if it crosses your mind, do it: because you may not get another chance.

Cultivate your art, your story…make your world a place that others thrive in and want to visit.

Regarding my Timmy…I am still searching, my friend. I was so blessed to have the friendship that we shared. The lessons with your loss are complicated and painful. I choose just to love you and believe that the meaning in your reality will come to me in time. I will never again operate without you over my shoulder and in my heart and mind.

How did champagne sneak into the story? Because I started this writing during the holidays and that’s champagne’s time to shine. If you know me you know I love champagne…any time is the right time. It is festive and happy. Over the course of this past December, many glasses were raised. I celebrate you, friends and loved ones, and raise my glass to you. Cheers! Now for heaven’s sake send me an idea to write about that will generate giggles and smiles and hopefully hordes of people running to the office to book surgery. Which brings us to my beloved mother’s favorite toast…

Here’s up to it!



So it is now 5 days after Thanksgiving Day. Back to work yesterday and the catch up game continues but that is OK with me because I had a great little break and much time to ponder the innumerable things I am thankful for.

I am thankful that people actually read this blog and many have asked when the next post was coming. If you’re telling me this to flatter and charm me, please continue because it is working. I know I am not a great humanitarian or changing people’s lives here, but if this is entertaining or educational or just a distraction from something you might be doing you need a break from, I’m here for you.

I am thankful for my laptop computer because I am sitting at my dining room table, Christmas tree to the right, the Today show on to the left. I often have to bring homework to my annex office here as the paperwork and computer drudgery is just too overwhelming to complete before I ‘clock out’ at the end of the day. That sounds more dramatic than the reality: I prefer to work here although my office is amazing. Dorothy was right: there’s no place like home.

I am thankful for my beloved dog, Lucy. This sweet, almost 15 year old beauty follows me everywhere I go in this house and plops down next to me. Such a simple gesture but arguably one of the most precious things ever. I read a hideous post the other day about a man who took his dog to a shelter and when asked why he was relinquishing the dog he stated, ‘she is always by my side.’ Yea, that’s awful….dog has to go. There’s a special place in hell for people like you, mister.

I am thankful that I am wearing size 6 jeans right now (especially on the heels of that long holiday…whew!), that I can actually sit and stand in them, that I can feel my feet as the blood flow is not strangulated. I am thankful that denim manufacturers have started adding enough elastic to denim that sizes previously unattainable to me are now an option. For girls like me that were once associated with Butterball and not only when buying a turkey, things like this matter.

I am thankful that the sun is going to shine today after many days of cold, wet rain. I am thankful for the cold, wet rain because that means a chance to bring out the cozy rain boots and sweaters.

OK. Enough of that frivolity. All of those things matter. It is a great thing to sit in your world alone and look around and feel happy, satisfied. Thankful. But those things I listed aren’t really what it’s about and I know that. Giving thanks for the tangible things is important. You should appreciate things. But it’s the intangibles that really matter. Let me continue to embrace what I am thankful for:

My health. I am so thankful that Jeff and I have good health. I am thankful that my family and friends, for the most part, are in good health. There are some very dear to me that are struggling with their health right now. Breast cancer is an exceptionally evil monster in the world of many that I love right now. I am recovering from a stupid calf injury and a cut thumb. If that’s the worst thing going on with me, it’s all good.

My work. I am heading into my 12th year in practice and cannot believe the beautiful world that surrounds me. The amazing women…and Tim…that make it all happen. The gorgeous patients that trust me with their concerns. The gift of a surgical suite in the office that is dedicated to the memory of my amazing mother. I am thankful that I have personal relationships with my patients and consider so many friends after the work is done.

My home. I think I might take for granted having a place to call home. Some days I don’t even process where I am headed when I go there. But then I get there and a smile consistently comes over my face. It’s not much, our small little bungalow. But it’s ours, mine and Jeff’s. And Lucy and Tucker’s, I suppose, but they rarely invite friends over or have mail delivered so I tend to exclude them. So sad. Many know we renovated our house a year or so ago and it is all that we imagined. I always laugh when I tell people what David Lewis, our friend and builder, first came over after we had really moved in and decorated. ‘It’s a visual orgasm’, he said. ‘A lot going on here.’ I like that. A visual orgasm. Who wouldn’t be thankful for that?

My family. My real and extended family. I will never recover from the loss of my mother now almost 7 years ago. That forever changed the landscape of my family. We are geographically scattered about the nation and do not get to spend holidays together. I love my family and I miss what our unity once was. My Texas family is a blessing that I can hardly comprehend. The love of so many and the time to spend together is priceless. My friends are so precious to me and I am grateful for every one of them, near and far. There are some that I haven’t had the privilege of face time with in quite some time but feel certain that when the time comes, it will be like just yesterday.

I am so thankful for so many blessings in my life. My world is not perfect but it’s pretty damn close as far as I am concerned. I am hopeful for the future, grateful for the present, nostalgic for the past. I wish for everyone grace, gratitude, peace and joy as we embark on this holiday season. Our world is a frightening place right now but I choose to focus on that which I can control here in my little world. I focus on thanks. If you’re reading this, I am thankful for you.

Here’s up to it!


Perspective...or, imagine how you'd feel if you really had a problem

I am in a foul mood. I have had a run of dumb luck so epic I cannot even believe it: a series of freak injuries that I have not experienced ever before in my life.

As a surgeon, I pride myself on good hand-eye coordination and technical skills. I do not consider myself clumsy and I am sufficiently proficient around the house that I once installed a new garage door opener, built an above ground garden, and once installed a light fixture in my kitchen…all by myself.

In the past 3 weeks, I have sustained more traumas to myself than I call ever recall. Three weeks ago I was getting ready to do an office procedure when I cut myself with a surgical knife…held in my right hand and into my left thumb. It was deep enough and in just the wrong spot to require 3 sutures. Thank God I know how to get to someone to sew me up. I was asked why I didn’t just sew myself up…putting the sutures in wouldn’t have been a problem but tying the knots with one hand would have been an exercise in frustration and futility.

Two days after the assault on myself, I was between cases in the operating room and had just pulled up some local anesthesia for the next case. Let me clarify something here: the sutures on my left thumb were covered with surgical glue so I could safely and effectively scrub for my cases that day and there was never any concern for loss of function of my thumb so not a big deal. The syringe of anesthesia that I was carrying still had the rather bulky needle on it that I had used to pull up the medicine…for those of us in the business, it was an 18G needle. Anyway, I somehow dropped the syringe during which time the cap came off the needle and it landed in my right second toe: right through my shoe, like a lawn dart. I still wish I had the wherewithal to have taken a picture because it was just too fantastic to believe. Yes, that needle and syringe were discarded and the patient received fresh anesthesia. I didn’t think much of the injury at the time as it bled just a little but the next day my little piggy was purple.

I had an uneventful week after that until 3 days ago. I was at our house hanging a clock in the kitchen. I have always been very competent to handle matters around the house. The clock was not heavy, not even bulky. I measured where I wanted it, made a special trip to the store to purchase appropriate hardware to accommodate it. Once I got it on the wall I had a sense that it was a little squirrely. I imagined if and when it fell it would bang up the wall, the cabinet and the floor. Yes, all of those things happened when it fell. I had just turned around to clean up my tools when it fell…I spun around and lunged to grab it (unsuccessfully) and in the process sustained a partial tear in a muscle in my calf. Yes, profanity ensued. Now I am wobbling around trying to conceal my limp as the reality of the injury is so uncool. I am on crutches for any distance as it is just not fair to society to watch me hobble and it would take me hours to get to where I am trying to go. I had a case at the big hospital here yesterday which necessitated my crutch walking, with a bag holding the patient’s chart strapped around my neck…and my recently lacerated left thumb banging into the crutch handle and my bag with every step. Good times.

I had agreed to participate in a marathon relay a month from now and had started running again after many years. It felt good to run and I was ready to start increasing my mileage after surviving 3 miles last week. I had gotten into Zyn22, a local sexy spin class, pretty regularly and had stepped away only to try to focus on running. I was ready to go back and ramp it up…get cute and fit for the holiday.

Nope. Not going to happen right now. Have to let my bum leg heal while I watch the world go by.

I have been tripping over my lower lip pouting. I have complained to anyone that will listen how irritated I am that I cannot do whatever I want to do without dragging my sore leg around. Today I was complaining that the sun was too bright when I was trying to do injections on a friend in the office. I complained that the chair she was sitting in wouldn’t anchor in one place. I complained about the service at lunch so slow after my sweet Jeff surprised me midday to take me to lunch after a dramatic text to him stating that I was having a mini nervous breakdown and that I needed him. (I am not having a nervous breakdown…it was a cry for attention. Fear not.)

Do I need a vacation? Perhaps a financial windfall so I can sit at home and eat bon bons while I pay the bills out of my money market account would ease my angst. Do I need a personal assistant or better disability insurance?

Nope. What I need is a big fat dose of perspective.

My leg will heal. My thumb is fine. There will always be road to run on and there is a race every weekend on the calendar if I feel the need to compete. The clock in the kitchen is where we wanted it and the painters will fix the wall and the cabinet. My little purple piggy is long since recovered.

I have a dear friend that is facing surgery next Friday….double mastectomy for advanced breast cancer. She is enduring chemotherapy, radiation, pain all over her body. She is widowed after losing her husband ridiculously prematurely over a year ago. I have another friend that just announced she was diagnosed with breast cancer last week…she has a beautiful young baby girl. I am not a county music fan but have followed the story of Joey Feek, fighting terminal cervical cancer now on hospice care. Heart breaking.

I have an office full of amazing women that are tripping over each other to help me navigate the halls here without injuring myself further. I have patients that ask me about my injury (because of the damn limp…so embarrassing) before I can even ask them how they are. I have family and friends that field my complaints and concerns and pep talk me through it. I have a beautiful home to return to every night. I have food in the pantry, wine in the bar. I have a car to drive to get me to my beautiful office and to the hospital to do surgery when I need to and to get back to the hospital to check on my patients.

I have the most amazing husband I could dream up that runs around the house to get me what I need and save me the steps right now and surprises me at my office when he thinks the Blue Funk Demons are really getting me down. I’ve got it so good. Sometimes you really do need a little hiccup in your world to allow you to truly grasp what crisis is…or isn’t.

‘Sometimes a change of perspective is all it takes to see the light.’ –Dan Brown

My light bulb is shining pretty brightly right now. That’s a good thing because I probably shouldn’t get up on a ladder until this leg heals…

Here’s up to it!


Here's up to you, Pammie...

Some may wonder why my sign off on every blog is ‘Here’s up to it!’ Many that are close to me already know. They are the lucky, lucky ones and not because they are close to me but because they likely know the origin of the phrase from my mother herself: the one, the only, my beloved Pamela McLaughlin. Those of you not lucky enough to have had my mother in your world deserve a small piece of her because you’ll just be better for it. That’s not delusion or arrogance, that is fact. This is her story from my perspective.

My mother was born in Montgomery, Alabama, a half Italian beauty. Her father, my beloved Papa…Michael Mascia, was instrumental in building housing in the city where I grew up…Oak Ridge, Tennessee. Many might know the story of Oak Ridge, the Secret City built as part of the Manhattan Project during the war. Mom grew up in Oak Ridge where she met my father, Victor, her high school sweetheart. They both graduated then got married after Dad had started medical school in Memphis, Tennessee. Ultimately my father’s Cardiology practice returned him to Oak Ridge after years of training in Virginia and Ohio so I grew up in Oak Ridge until I graduated high school.

Her upbringing is important because it’s part of her story but the relevance of my mother…besides the obvious fact that she was my first best friend, my hero and the love of my life…was her presence, her personality. It is widely acknowledged that Pamela, or Pammie as those of us in her world called her, was one of the finest women that anyone had ever known. There are SO many facets to her personality and greatness I can only pretend to scratch the surface describing her. But I’m sufficiently tenacious as my mother’s daughter that I am going to try.

Mom had the greatest sense of humor you could imagine. She loved a good joke. And she was naughty. SO naughty. It was part of her dichotomy. Mom was always perfectly dressed and always with beautiful jewelry. You might think she was a diva at first glance: a ladies’ lady. And she could certainly be that. But she really lit up when the chance arose to show her naughty side. She was truly the love child of a Southern Belle and a sailor. Imagine the brilliance of telling a joke that would make grown men blush and doing it in a St. John suit. When I would call to tell her a dirty joke she always said, ‘tell me again!’ as she would try to be sure she remembered the punch line to tell it again later.

I remember when she saw the first Jackass movie. As I recall she was travelling somewhere and it seems like I recall she was with my sister. They might have even watched it in a hotel room somewhere. She called to ask me if I’d seen it and I hadn’t yet. Didn't even really know what it was about at the time. She was laughing so hard on the phone…’you have to see it’, she said. When I did see it, while I was in tears laughing, I recall just wishing she was sitting next to me, hand in hand. I treasure that my mother dug the Jackass franchise. Who can say that?

I talked to Mom on the phone at least 6 times a day. I do not recall why I would have ever gone a day without talking to her. I called her when I woke up, I called her when I left the house, and I called her when I was driving between hospitals. It was just part of my routine. We talked about nothing…it was just a stream of consciousness. After I lost her, it was months before I stopped picking up the phone to dial her. 

One of my most favorite memories was the mail. Good old fashioned snail mail. My mother would send letters, mailer envelopes, boxes to myself and my sister and brother every day. The mail was covered in stickers, hand written notes, drawings, and jokes. Before you even opened the mail you smiled. The mail carrier smiled. You would smile the next day when the open letter was still on the desk. She would send cartoons, coupons, stories from the paper. She was the master of the hand written note and we would get them all the time but for no other reason that we were on her mind. I cannot describe the joy of going to the mailbox knowing there was a little surprise there. I would give anything, ANYTHING in my life to have that surprise again.

My mother loved so hard you felt it from a distance. Her voice was a hug, her laugh was a kiss. She did this thing with us that was so precious to me: eyelid kisses. Sounds odd but it is the most precious experience I can imagine: very gentle kisses where her soft Italian lips would fill up your entire orbit. It makes me tear as I type thinking about it. My mother had multiple orthopedic procedures over the years and was plagued with debilitating pain from stenosis in her neck. She was the most fragile piece of iron you could imagine….I wanted to hug her until I would fear I would break her, truly concerned I might break or hurt her. That’s break her physical self, never her spirit.

Mom was the person that never met a stranger. She and Dad traveled all over the world before her health became more fragile. After every trip, she would tell stories of the driver that took them around the city. By the end of the trip, she knew the driver’s family and story and continued to receive cards and communication from these people through the years. She didn’t even realize that she was doing this…touching strangers that just ‘got’ her and wanted to be part of her world moving forward. She was completely unpretentious, totally approachable, and magnificently kind. She had the quickest wit I have ever encountered. She had apples on her cheeks when she smiled and a grin that made your heart warm. Many tell me now that I closely resemble my mother physically. I hear often that my personality most closely channels hers. There is simply nothing more flattering that anyone could ever say to me than that. 

I lost my mother 6 and a half years ago. There is no reason for any details of how or why because it changes nothing. Suffice it to say it is and will forever remain the darkest, most awful loss I have endured and there are parts of me that will never recover. For many years after I lost her, which happened 4 days after my 40th birthday, I chose to not celebrate my birthday. It eventually occurred to me that I only have a birthday because of her and she would have never tolerated that behavior from me. She loved wine, laughter, love…that is her legacy and that is how I will honor her.

I recall longing for a sign from her after I lost her. Two things happened that I will never forget. Shortly after I lost her I was at a meeting in California with Jeff. We were at dinner at a restaurant on the coast. I was watching the waves and walked toward the water. I heard her voice in my head: ‘I’m OK’. I cried. I have listened in the wind for another message since and have never heard it again. I am grateful that I heard what I did. The second time I felt her was on a motorcycle. This story makes my father crazy…he’s not a fan of motorcycles. I did not grow up on bikes, never really had an interest. My husband is a fan so I started riding with him. It was again not long after I lost her that we were on a road trip somewhere. I was on the back of Jeff’s bike that time; it was before I had my own bike. As the passenger, I was able to close my eyes, stretch out my arms and feel the wind all over me. In my mind I was completely surrounded by Mom…as if I was traveling through a cloud of her. When we stopped after that moment for fuel, I recall all the hairs on my arms tingling. Every time I get on my bike and ride, I am riding with her, longing to feel her all around me again. She would have hated this perspective of mine but it is my truth. 

As I write, this seems like such a futile objective: to describe the beautiful genius that was my beloved mother in a matter of paragraphs. It is absurd that someone that did not have the privilege of knowing her would understand her magnificence after reading this. My hope is that if this is read by anyone who knew her, they will reply with a story about her. This is a tribute from all of us to her. There are just SO many stories to tell. My mind is racing thinking of so many...too many to include here. So many I have omitted by necessity but none ever leave my mind.

Every time we talked to Mom, before she would hang up the phone she would say, ‘Have I told you today how much I love you?’ She said it so consistently that eventually all she had to say was, ‘Have I told you?’ There was never any question of her love for us. She was simply perfection and the best mother, companion, woman a girl could imagine.

Back to the toast and ‘Here’s up to it!’ At every gathering when we would raise our glasses, she would toast the group with her most favorite naughty toast. I will not write it here, I will let those that do not already know it decide for themselves what the rest is. Most who were familiar with her know her other infamous line, 'Hooray, hooray the first of May!' Inside jokes? Perhaps. Part of our good fortune to have had a piece of her? Definitely. Let that be part of her mystery. ‘Here’s up to it!’ is the first line, and that’s all that I often even need to say. 

So to you, Pammie…

Here’s up to it!

I love you so much.



I had a conversation with a new patient just yesterday regarding modesty. She was getting ready to change into a robe for a breast and body consult and she made reference to her inherent modesty. This topic is very relevant to me as a physician, specifically the kind of physician that requires new patients to bare themselves in a very intimate way to formulate a plan to address their concerns.

I just looked up the definition as I could not properly define the concept of modesty in my mind:

mod·es·ty  (mŏd′ĭ-stē)  n.

1. The state or quality of being moderate in the estimation of one's own abilities, accomplishments, or value.

2. Reserve or propriety in speech, dress, or behavior: Modesty prevented her from wearing that dress.

3. The state of being unostentatious or moderate in size, quantity, or range.

In the world of plastic surgery, or at least in my office, modesty is the protection of one’s exposure physically. It is not normal to meet a stranger, even if you’ve booked an appointment with that stranger to discuss your aesthetic concerns, and change into a robe and some delightful disposable panties. I know how I feel when I have my obligatory annual female exam…this terrorizes me dramatically as I cannot imagine how anyone could feel more exposed and vulnerable than during this experience. Because I am so traumatized by this, I am steadfast in my protection of the women, and the occasional men, that trust me with their concerns.

My modesty story starts about 46 and a half years ago. I am rather certain I was born into a fabric tube and have never once been unnecessarily exposed in my life. That is just how I am. Not right or wrong, just my way. This little insight into my psyche is riddled with one primary problem…I am only addressing one of three definitions of modesty.

Regarding the first definition:

The state or quality of being moderate in the estimation of one's own abilities, accomplishments, or value.

OK. I believe that I exhibit this quality. I would have described this a being humble, but I do understand how this is modesty. This behavior brings to mind how one reacts to a compliment. I do not field compliments well and I am not sure why. When someone is gracious enough to commend a performance, a gesture, a trait…there is no reason to not accept that. When you force feed your accomplishments down the throats of your peers seeking commendation that indeed does not reflect modesty. The pendulum in this case can clearly swing in the other direction which can be perceived as self-deprecation. Not good. Modesty is a positive trait in this case. Keep your pendulums in the middle.

Regarding the second definition, I think that has been addressed. Am I always dressed appropriately? Absolutely not. Is my behavior always demure and reserved? I think most that really know me know the answer to this. ‘Propriety in speech’? If that means avoidance of profanity and the occasional naughty innuendo….nope, not my reality. But for the most part I do believe that my average is, indeed, modesty in this definition.

The third definition: The state of being unostentatious or moderate in size, quantity, or range.

I interpret this as what some might call ‘even keeled’. Does this define me? I feel like it does but cannot articulate exactly why. I am a firm believer in less is more.  In my life as a plastic surgeon, I am very open in my passion for less filler, average sized implants, MODEST interventions. For the most part in my personal life, my demeanor is rather consistent. If you ignore bad days, mood swings, bouts of depression…I am very, very even keeled. Hey, I’m human. And it appears I am indeed a modest human, in three definitions of the word.

Why might this matter to me…to be defined as modest? Rarely a consult transpires that I don’t explain to a new patient my penchant for protecting my patients’ modesty. It is apparent to me now I might not have been using the word in an entirely appropriate form. But my intent and spirit are pure. I acknowledge without hesitation how surreal it is to be exposed, physically in the case of my daily professional life. Patients sometimes express their concerns for what might happen once they are under anesthesia in the operating room. What happens is that I remain my patient’s greatest advocate and fiercely protect their presence and, to continue the theme of this thought process, their modesty.

I have to get cleaned up now to go to the office. I went for a little jog this morning after years of not running regularly. You can compliment me on that endeavor and I will accept that….modestly. I will probably wear something comfortable to the office as it is a day of office procedures. My attire will surely be modest in the second definition of the word. I will strive today to remain unostentatious in my behaviors, whatever that might truly mean.

One final offering as your friendly local word smith to end this thought: I wish you a magnificent and unlimited day, full of self-confidence…all the opposite of modesty. Ironic?

Here’s up to it!


Laughter-Truly the Best Medicine

My husband and I went to a comedy festival in Dallas last night and as I sit here with my cheeks still a little sore from all the laughter, my mind is set on this topic.

I remember the first career I ever wanted to pursue was to be a comedienne. I remember very vividly watching the Carol Burnett Show and thinking what a great thing it would be to make people laugh. I remember as I got older and had already started down the path of a surgical career watching the late night reruns of the Dean Martin Roasts. A few years ago for Christmas Jeff surprised me with a series of Johnny Carson Tonight Show episodes: I can watch them over and over and always laugh at the same things.  

I remember early Ellen DeGeneres stand up…she was always one of my favorites. What a gift to be able to stand in front of a group of strangers and make them laugh. I longed for this but was deterred by a few relatively minor matters:

Not funny enough and too shy.

No one believes that I am shy. My decision to become a surgeon necessitated that I project confidence. I don’t think anyone wants to negotiate reconstruction when the surgeon cannot make eye contact or carry a conversation. I do not think if you were able to select your cosmetic surgeon you would electively proceed on a surgical journey with someone meek and shy, even if they had the very best surgical skills and reputation. It is a game that I play with myself every day…act confident and people will believe that you are. I am confident in my surgical skills and do believe I have a talent for this path I have chosen. But sadly that doesn’t translate to the capacity to successfully perform stand up comedy.

The funniest comedians in my opinion are the intelligent ones. The capacity to relate current or historical events in a humorous manner is a gift. Robin Williams, George Carlin, Dennis Miller are or were some of the greats because of quick wit and great intelligence. Eddie Izzard is one of my favorites for the same reasons. There are so many as I sit here thinking about it…too many to list.

Jimmy Fallon…there’s a brilliant one: so much talent, so funny, great wit. I have often said that one day I wish to do something sufficiently important that I am offered a trip to the White House for acknowledgement. Sorry for the political sideline but I have no interest whatsoever in an audience with our current President so I will use my opportunity to secure tickets to the Tonight Show with Jimmy Fallon instead. I’m still working on my great bravery or humanitarian event to pull this off and will welcome any suggestions.

I have a naughty streak…this is not a surprise to anyone. Suffice it to say I am my mother’s daughter and that is one thing of which I am most proud. One of my most favorite funny ladies out there right now is Amy Schumer. She is predominately the reason we went to this festival last night. I watch her show, loved her movie and laughed so much last night that my girl crush has ascended to all new levels. Having said that, and with a capacity for profanity that I can control but don’t always chose to, smart and improvisational humor is far more sophisticated than tacky cheap shots and dirty jokes any day.

The thing about laughing and making people laugh is that laughter is a physical manifestation of happiness. There have been times in my life that I was so sad, depressed…my spirit broken. Everyone in this world has had those times. When I lost my mother I grieved so deeply and for so long that the idea of laughter was completely foreign to me. I remember feeling guilty if I laughed because that would mean I was happy and how can you be happy when you’re devastated? My mother was the funniest person I have ever known. A life without laughter would have been completely foreign to her and she would have never stood for it. Laughter is effectively raising a glass to her spirit…when I was able to laugh again I know she was sitting on the edge of a cloud smiling down on me, relieved that I had found it again.

The ebbs and flows of life sometimes crush your spirit. It might not always make a lot of sense financially to make a pilgrimage to a comedy festival. But then you get there and for about 5 hours you laugh SO MUCH that your face still hurts a little the next morning. And you forget your worries and cares for just a little bit. That is medicine that the best doctor could not provide.

‘There is a purifying power in laughter. It is truth in palatable form. It is instant vacation. Seeing the comical side of many situations makes life a great deal easier. It's like riding through life on sensitive springs that ease every jolt.’ ~Eugene P. Bertin, 1968

I wish you laughter on this day and every day.

Here’s up to it!


Titty Bar and Breast Press

Why am I writing about a strip joint you might be wondering? I am not. I am thinking about the rather infamous wall of breast implants that I have in my office that I have lovingly and appropriately named the Titty Bar. The Breast Press is an amateur piece of art created by myself and the women in my world with acrylic paint and our breasts on a piece of canvas that hangs in surgery center. Let me explain…

When a patient comes to the office for a breast consultation, if it involves the addition of an implant for their desired result, we allow them to try on a range of implants in an attempt to determine their desired size. With hundreds of implants available in many different volumes and profiles, this lends itself to a magnificent visual display. At one time I had samples of breast implant in each of the exam rooms for patients to see and feel. As you can imagine, these all grew little legs and walked off over the years…hence the need to keep our beloved implants in one place in the office: on display at the Titty Bar.

I got the idea for Breast Press from a children’s art project I once saw with handprints on canvas. It is such a happy thing to look at…colorful and innocent. We could have certainly done a handprint canvas here but when you’re an office full of females, with breasts, and your predominant patient population is females, desiring rejuvenated breasts: I think the answer to that art project became obvious very quickly. It was a more discrete endeavor than you might imagine. I selected paint colors that complement the office and purchased a reasonable sized canvas. One by one we went alone into the bathroom, applied our paint and pressed ourselves into the canvas. I do not think I’m overstating it when I say it is a wonderful thing to behold. Many patients and friends and expressed their desire to add to the canvas but I feel strongly it must remain in its original condition. Perhaps I could offer individual presses to future patients once they’re healed?

There are so many incredible things about being a female plastic surgeon. The most obvious reason is that I can relate very personally to my patients interests. One less obvious reason is my ability to embrace the tools of the trade…both real and artificial breasts in this case…for art. Breasts are beautiful in every form. It would not be appropriate for a male surgeon to display implants and announce to the patients browsing the shelves in delight and awe (it happens here every day) that it is called the ‘Titty Bar’. It might be appropriate for a male surgeon to have breast art in his office but probably not if he had the women if his office create the piece then advertise to his patients ‘that’s my team!’. I’m OK with playing the female card whenever I need to: surgery is a man’s world and we all know it. I am going to embrace my stance and stake my claim as a girl with the goods and the capability to use it to my advantage.

October is Breast Cancer Awareness Month. I think this is very important as it brings attention to a very serious disease that has certainly affected someone that everyone knows. In my world it is a chance to bring attention to breast surgery in its various forms and use that to support foundations and causes dedicated to breast cancer patients and their families. For every five breast surgeries that I complete from the month of October through the end of the year, I will donate $1000 to a local organization, Bras for a Cause. Patients who join Team Ta-Ta will receive a specially designed T shirt and a chance to bring family and friends to the team by purchasing additional shirts with proceeds donated as well.

If you join Team Ta-Ta you will get your chance, perhaps, to visit the Titty Bar and I may just launch another art project: Breasts to ImPress. Until then…

Here’s up to it!


Mr. Nipples

I mentioned to my husband last night I was going to write a blog about him. He responded by saying, 'There's nothing to say about me that could help your practice.' I could not disagree more.

The purpose of this blog is to introduce myself, my practice, to a community of individuals with an interest in plastic surgery, Fort Worth, female concerns, perhaps even me. In the first several months of this blog adventure, I feel the ongoing introduction of those most important in my life are essential to explaining who I am. There are not too many people in this world as important to me as Jeff Knipper, or as he has become known around these parts, Mr. Nipples. I'll explain that later.

Jeff and I have been married for seven and a half years. That I need to claim credit to the half year is testimony to my love for this man. We were introduced by mutual friends at a party...his birthday party...on a Saturday night, we had our second meeting the following Tuesday night and we have been together ever since.

Jeff is that guy that everyone has in their life...the guy that no one can find real fault with. The guy that people look off fondly into the distance and smile when mentioning. His travel buddies from years in the BVI, his guy friends from years on South Padre island. I know two of his former girlfriends and even they only ever had kind things to speak of this man. I think that is extraordinary. Is he perfect? No. I am not delusional. No one is perfect. But he's pretty close.

My husband grew up in Waco, went to Baylor then to dental school in Houston. He moved to South Texas (McAllen) and practiced dentistry for a number of years, but was not fulfilled. He struggled with his decision to walk away from his career for almost three years, largely because of the sacrifices his parents had made for his education. He wrote a letter to them explaining his thoughts and they gave their blessing for him to pursue whatever might help him find happiness. Shortly after he made this decision, word of his redirection from life as a professional to essentially unemployed made its way to the Wall Street Journal and he was subsequently part of a feature article about other individuals who made such a decision with their lives.

Jeff either gave away or sold all he owned with the exception of a bag of T shirts and shorts and a ten speed bike. He moved to Cozumel where he found work as he could to exist. He led a simple, easy life and was very happy....but again not completely fulfilled. He returned to Fort Worth after reconnecting with David Lewis, a long time friend from his South Padre years. Jeff worked many different jobs before becoming established as a personal trainer and ultimately found his satisfaction in construction safety. He has been with Manhattan Construction for almost 10 years now. He has worked on many huge projects including the Ritz Carlton in Dallas, the George W Bush Presidential Library, Rangers ballpark and Cowboy stadium, now AT&T Stadium.

When I was growing up, as many girls might do, I had an idea of what the perfect guy for me might be. He would be smart, kind, funny. I have never been drawn to a physical type but I guess Mr. Wonderful would be handsome and fit. That magical list is a dream and that person could never exist. I certainly did not set out to find Mr. Wonderful and did not let that check list define my relationships. I was married before Jeff. I married my medical school boyfriend right after we graduated and before we started our surgical residencies. As is the reality of so many relationships, we divorced after seven years. It was then that I left Augusta, Georgia, where I had lived for eight years and moved to Texas.

That was the beginning of the best thing that ever happened to me.

Jeff and I met as I described above on a Saturday night. We talked, texted and emailed from that night but had made no plans to get together. My fairy godparents, Toni and David Lewis, had known Jeff for almost 25 years. They were certainly glad I was interested in their long time friend but no one imagined what was to be. The Tuesday night after our first meeting, after I had told them we were talking, Toni suggested I ask Jeff to join us for a Dallas Stars' hockey game that night. She told me later it was a bit of a joke because everyone (but me) knew that Jeff NEVER made plans on a weeknight because he awoke every morning to workout at 3 am then go to the construction site. He quickly accepted the invite for that night. I recall the look on Toni's face when I told her that he was indeed joining us. As they say, the rest is history...

We were married in Belize in April 2008. We chose Belize because Jeff is an accomplished scuba diver, as are the Lewises and many other friends and family that attended our wedding. The migration of the whale sharks, a tremendous sighting for all scuba divers, coincided with that time. Desperate not to be the girl left alone on the boat while the others dove, I certified to join them. I had no preexisting desire to scuba dive prior to that time. I am a hideous, awful scuba diver...anyone can attest to that. We did not see a whale shark on that adventure, probably because I secretly prayed we would not...out of sheer terror at the idea. I'm sorry, friends, that I potentially screwed that experience up for you all (audible sigh of relief).

So why is my husband relevant to my practice? Because I am happy. My personality changed significantly after I met and married Jeff. Surgeons are hot heads, brats, ego maniacs. I am not an ego maniac, I do think I am a brat. I do know that as a young surgeon without the years of experience I have since gained, I was prone to angst and irritation. That can make for a long day in the operating room for your team. I was divorced, lonely and frustrated that in my late 30s I did not have a companion. I have never defined myself by the need to be married or in a relationship. I do think it is human nature to seek companionship. After my divorce, I did declare that I had no intention to remarry because my faith in the institution of marriage was so shaken. I had boyfriends, I had dates. It was not until I met Jeff that I felt the need to be aligned with someone. I hesitate to say 'belong' to someone because I do not feel that a person can have ownership of another. But I do 'belong' to him....in every way that matters to me.

We went to Dallas this weekend for an event. As we were driving down I-30 in the convertible, talking about everything and nothing at the same time, I asked him if he remembered taking his wedding ring off after his first divorce. Jeff was married for about a year and a half maybe 30 years ago. Many in his social circle were sure he never had plans to marry again. He told me, and I was unaware, that he had not worn a wedding ring ever before. Should that make me smile? Maybe not. Did it? Yes.

It is truly a blessing when your personalities, likes, dislikes are so ridiculously well aligned you could not possibly imagine any other option for your life. We laugh at the same things, we very often speak the same word at the same time. Yes, millions of others in this world have the same story so I do not think we're special. But we are special...because we had the dumb luck to find each other. Thank God for dumb luck.

He is legitimally the smartest man I know. Despite what he might tell you, I have beaten him at Scrabble at least twice in our lives together. I have occasionally introduced him to a word that he might not have been familiar with. That is VERY unusual, but it has happened. I can hold my own on my Harley alongside him and know that he digs that since he was the one that encouraged me to get my own bike and I subsequently embraced it. I had never fired a gun before Jeff but we got our concealed carry permits together and I have learned enough to keep up with him on the range. We are kindred spirits.

Regarding why he is known as Mr. Nipples: I was at a meeting at a restaurant in downtown Fort Worth one night without Jeff. I left my car at the valet and when I started to tell them my name, they declared no need...they knew. OK. After the dinner meeting, which was a physician event and I'm introduced as Dr. McLaughlin, we leave to go home. The valet says, 'I'll have your car right around, Mrs. Nipples.' My instinct was to look down and double check that a cold wind had not created a situation prompting the valet to misspeak. Clearly through the many visits to that restaurant over the years, they had heard his name and did not think it might be 'Knipper'. When I got in the car I called Jeff. 'I've got good news and bad news...the good news is the valet knows who we are. The bad news is we are Mr. and Mrs. Nipples.' I think it is hysterical.

So what is his relevance to my practice, my life, this blog you might ask? I think it's obvious. I somehow found my Mr. Wonderful and he happens to be Mr. Nipples. As a female plastic surgeon, I could not have designed it better.

I love you, Jeff Knipper.

Here's up to it!



Yesterday morning my office had our standard Monday morning ‘huddle’ to discuss the events of the week. Part of the itinerary was promotions, one of which will be for Breast Cancer Awareness Month which starts on October 1. As a plastic surgeon, I have seen enough breast cancer patients in my career that I, regretfully, cannot recall every single one by name. There are many, many patients that have completed reconstruction for breast cancer and remain friends of mine to this day. For that I am eternally grateful. The person on the forefront of my thoughts this morning is Marsha. Let me tell you why…

Marsha Mudge is a very dear friend. She is also a patient of mine. She is 36 years old, a mother of two young boys. She is a nurse. She is a widow. She is battling stage 4 breast cancer.

If I didn’t have your attention from the start perhaps I do now. Yes, you read that right: a 36 year old widowed single mother with advanced breast cancer. I have always adhered to the belief that we are not faced with what we cannot handle. I also have always believed that everything happens for a reason. I am struggling to understand what the reason for Marsha’s reality is. I am baffled every single day to think how Marsha continues to fight with grace, humor and strength. I am in awe of her as so many others are.

Marsha has earned a tremendous following on social media from friends, family and strangers that are now fans and supporters. The hashtag ‘mudgestrong’ is linked to all benefits, events, and fund raisers. Please search for it to help support her and her boys. Marsha recently posted her story in her own words and I feel sharing that is far more appropriate than me trying to relate the story on her behalf:

‘Hello, my name is Marsha Mudge. I am 36 years old and this is my little story…..

John and I met in college at Midwestern State University. We married in August of 2004. We moved to New Braunfels, Texas in 2008 when he became the defensive coordinator for the New Braunfels Unicorns. Life seemed perfect. We welcomed two sons Tanner, in 2009, and Jackson, 2011. We were just an everyday family. In March of 2013, is when my world started flipping upside down. On Easter Sunday, John woke up with a stomach bug. The vomiting dissected his vertebral artery and my 32 year old, 6-foot 5 inch, 250 lb husband suffered a cerebral stroke. This was just a shock. John was one of the healthiest men I knew. He was active and threw around more weight than most young college kids. The stroke left John in a wheelchair and with a feeding tube. Through his amazing strength and determination, John fought back. Through months of therapy and countless hours of hard work, John walked on the football field and coached the 2013 season. He amazed his players, the community and myself with his courageous attitude and fighting spirit. I thought that would be our hardest challenge. Well I was very wrong. On March 21, 2014, I woke up with my 4 year son laying between us to find my husband dead in our bed. I tried to revive him even though I knew it was too late. While giving John CPR, I told Tanner to cover his face with his blanket and we sang twinkle twinkle little star until help arrived. I will never forget that night. I remember every haunting detail. So at 35 years old, I was left a widow to raise our 2 and 4 year sons. I don’t know if I really have ever gotten use to the idea of losing John, but the boys and I were starting to get into a routine. On April 13, 2015, the right side of my face went numb. I figured it was nothing and it was something that would just go away. Well after about two weeks it just kept lingering. I finally went to get it checked out and once again my world was jolted. A mass was discovered behind my eye orbit on my skull and after further testing the mass was only secondary to the cancer growing in my body. On May 5, at 36 years old I was diagnosed with stage 4 breast cancer that had metastasized to my skull, my c-spine, right rib, left underarm lymph, sacrum, and liver. From that moment on I have been fighting for my life.

In the middle of May, I started aggressive chemotherapy to start shrinking the cancer that was attacking my body. I had to take a two month break from the chemo because of how hard it was on my body. To date, I have had four round of chemo, the tumors are shrinking but I still have a long journey ahead of me. My next chemo is scheduled for September 11. After chemo, in the next few months I will have 3 or 4 major surgeries. Since my cancer is estrogen, progesterone and her-2 positive, I will have to get a hysterectomy. Due to my age and the aggressiveness of the cancer I will have a double mastectomy. After radiation, I will get reconstruction. I also may have to have a surgery to remove the tumor from my skull. While going through all the treatment and surgeries, it is still my job to raise my 3 and 5 year old boys. Due to medical bills and being a single mom, I am currently working full time as a school nurse not only for the income but also for medical benefits for me and the boys. This is my crazy life story in a few words. When my husband died, his quote became instantly famous. “If winning was easy….losers would do it.” He was right. Cancer is hard and painful and challenging but I am not a loser. I am ready to fight with all that I am and all that I have. I won’t go down easy….in fact, I won’t go down at all. Through this battle, I am going to smile and be as positive as I can be. I want to show my boys that even though life is hard we can get through anything and we will come out on top. I am so excited about the Party in Pink. I am so honored and grateful to be selected by Baby Face Too Salon and Spa. I don’t even have the words to describe how truly blessed I am.’

I remember the phone call on a Friday night in April from Marsha when she first got the report of the CT scan of her head. She had asked her primary care physician to please get a CT scan because of her symptoms, never to imagine what the report would read. She called to ask me to reassure her that when I had done her breast surgery 2 years prior that I found nothing of concern in her breasts. Indeed I absolutely had not. I was out of town when she first called me…the day I got back to Fort Worth I came to my office to pull her chart and pathology report: completely benign tissue, no concerns.

Three days after that initial call I was on the phone with her as she was waiting to be called back for a mammogram. It was Monday morning and I was in my car right outside my office, waiting to come inside for the Monday morning meeting. I remember asking her if she had felt or noticed anything at all…anywhere. No, nothing. We had a little pep talk, do not worry about anything until you are sure you have something to worry about. Within an hour, she called to tell me about the tumor in her left breast. Within the week she had the rest of the story, which she outlined in her own words above.

She has completed multiple rounds of chemotherapy so aggressive it has landed her in the hospital with dehydration, vomiting and diarrhea several times. Her concern while she was in the hospital was not about herself as much as her sons and about the idea she might miss a round of chemotherapy while her body recovered.

Within the past several weeks, scans have indicated that the tumors in her bones, specifically sacrum and skull, have not responded to the chemotherapy as the soft tissue tumors have. She started radiation to these areas a week ago today. In her efforts to educate, she posts pictures of her on the table with her green mesh face mask. She posts pictures from chemotherapy. She posts pictures of her with her boys at the zoo, at the pool. I am stunned, amazed at this woman’s drive, outlook, strength.

About a month ago I hosted a fundraiser for her in Fort Worth. As is the way of social media, her story has gone viral and friends of my friends follow her posts daily. People that have not met her ask me about her every day. Marsha lives four hours south of here in New Braunfels. The night of the benefit, she drove herself to town to attend then turned around and drove herself home that night so she could be with her boys and not miss work the following day. I begged her to stay the night, tried to find someone to drive her but no…she said the drive allowed her to think, to listen to music, maybe to cry. The event here was a success and I am planning another in a couple of months as her journey is a marathon not a sprint and financial support is all that I can possible offer to ease some of her concern. I am so grateful to so many that have funded and supported her.

Marsha is ALWAYS on my mind. When I am having a bad day, don’t want to do something, when the workout hurts or I’m too tired: Marsha. I have had so many amazing patients that have affected me very deeply…patients from many years ago that I might not have seen for so many years. Patients for breast cancer reconstruction, skin cancer reconstruction, cosmetic procedures…I am touched by all of them and so very grateful that so many have remained in my life both personally and professionally. Marsha has moved me the most and forever changed my perspective on so many things. In anticipation of Breast Cancer Awareness month I would ask your support for Marsha and for every other person you know battling breast cancer. Please pursue a mammogram if you have any family or personal history and have not yet done so. Please do what you can to support breast cancer research in your area. As a personal plea, consider donating to this amazing woman and her children.


Here’s up to it…and I specifically mean you, Marsha!




The Wonderful World of West Magnolia

It’s 5 o’clock in the morning and I am sitting here in my office alone. And that is a truly wonderful thing for so many reasons. Let me elaborate…

The first reason is that I have this beautiful office to come to and work. My office is in a renovated, historic building erected in 1931. The name of the building is the Max Mehl building because it was built by Max Mehl…a famous coin collector from that era. My personal office within my office is Mr. Mehl’s original office. It’s a comfortable space with settees, rugs, and a fireplace. I even have room in here for a my big incline treadmill that sometimes I even use. The office up front is exposed brick, stained concrete floors. It’s a perfectly professional space for what I do but an inviting, warm environment to greet the patrons of the plastic surgery world.

Within my office is our surgery center, West Magnolia Surgery Center. This is the second reason that it is so wonderful that I am sitting here right now. It is a fully accredited surgery center where I perform all of my cosmetic procedures from face lifts to abdominoplasties to breast augmentation. As extraordinary as it is to have a surgery center on site, it is tremendous for me as the space is dedicated to the memory of my mother, Pamela McLaughlin. I lost my mother six and a half years ago and that is the greatest tragedy of my life. That she was the epitome of fun and fabulous and so full of life and joy is her ongoing gift to our patients…her operating room is where many great transitions take place. She would indeed be very, very proud.

All the great office space and operating rooms in the world are worthless without two very important things: patients and personnel. Which is the third reason I am so blessed on this and every day. Let me introduce you to some of the people that make what I do a blessing and a gift every day.

Toni is my best girlfriend. I met her when I moved to Fort Worth over 11 years ago. She is a nurse anesthetist which means she was first a nurse then an ICU nurse then trained beyond that to administer anesthesia. She has given me anesthesia perhaps 5 times over the years when I pursued personal renovations. She has put my husband, my mother, my father and my sister to sleep for various procedures over the years. She truly has a gift for the art of anesthesia and I feel qualified to say this as a surgeon who has worked with SO many anesthesiologists and anesthetists over the years. I trust her with my life, literally. When we are not in the operating room working, we are probably out there in the world playing. Toni and her husband David introduced me to my beloved husband Jeff so they are my fairy godparents. You’ll hear more about them later.

Tim is my right hand man. Literally. He is left handed which means we mesh perfectly across an operating room table. I have known Tim since I moved to Fort Worth when I was a young, scared little surgeon. Tim is a surgical technician which means he pretty much runs the show from getting the whole set up together then participating in the entire procedure as a first assistant. I found out years after I started that Tim’s routine was to operate with the new surgeons and help show them the ropes, sense their likes and dislikes and diffuse the bombs which, stereotypically, all surgeons are. So it came to my attention that I was an assignment at first but we were meant to be, I believe, and have been fast friends ever since. He has more talent in the operating than many surgeons I know. I have assumed a role of bossy big sister to him…I would hope he wouldn’t say ‘mother’ as I’ve only got him by 10 years. In the all girl world of West Magnolia Plastic Surgery, he is the only boy allowed.

Becca is my office manager. And my friend. She has literally been in my practice longer than I have if that is possible. I moved to town about 11 years ago and initially joined another surgeon in practice. She was already in that office for about a month before I arrived. When I left that office to establish solo practice, she came with me. She is genuinely one of the smartest women I know and has one of the strongest faiths I have ever encountered. I have leaned on her for many things over the years and have always found comfort and answers. She runs my life here and that is not an easy job to do. I accept that.

Patty has been in my practice for almost 8 years. When Becca and I set up shop we clearly needed help. The day Patty interviewed, Becca was so impressed that when it was my turn to interview Patty she begged me not to screw it up. I didn’t screw it up; Patty came on board and has evolved into the insurance genius and the skin care expert in this office. She has the sexiest speaking voice I have ever heard and if she read you the phone book you would be fascinated.

Tiffany and Carina complete our office world. They have been her between 1 and 3 years and I love them both. My office is laughter and happiness. Every day? Not so much. But just a couple of days ago I was doing office procedures and two separate patients stated that it must be so great to work here because it’s a happy place. Isn’t that amazing? I wonder how anyone in this office would address that comment if I wasn’t standing right there? Hmmm.

In the operating room, I am blessed to have some of the finest nurses helping us in the recovery room. All of these women are grossly overqualified to care for our patients, and that is a great thing. Jamie and Leslie are both nurse managers in the Trauma department at the big hospital down the street. They call their days here in the recovery room their princess shifts because it is a notch down from trauma patients in the emergency room. Alice is a former ICU nurse that has seen and cared for more critically ill patients that I will ever encounter in my life. She is also overqualified to help patients wake up and go home but isn’t that what you would want?

The fourth reason I am so blessed and happy to be sitting here in the early morning hours is my patients. Without patients there would be no West Magnolia Plastic Surgery. Today I have 5 cases. I am doing a tummy tuck, 5 breast augmentations, breast lifts and liposuction. We start early and work late. And that is the greatest gift I could imagine. For patients to come to my office in the first place, discuss their concerns with me, trust me with their surgery is what defines my life.

I am filled with gratitude and love. It may not sound appealing to many others to be up in the middle of the night getting work done before the day starts but for me this is what it is all about. If would be my privilege to introduce anyone to my world here and the people in it.

‘I’m going to make everything around me beautiful-that will be my life.’ –Elsie de Wolfe

Here’s up to it!



As a female plastic surgeon, this should be my reality: perfection. I have access to all the tools and tricks. I have lasers, fillers, local anesthesia and knives. I shouldn’t have a line, a wrinkle or any cellulite. I should have a tight tummy and perfect boobs. I should be flawless.

But I am so far from that, I will never be flawless and here’s why…

I like life too much.

I don’t think I’m lazy. I made it through some pretty rigorous surgical training with crazy long hours and very little sleep. I am not afraid of hard work and physical labor. My best girlfriend has told me that I’m one of few people she would ever help during a move because I’ll actually lift as much as anyone else. I’m proud of that. When it’s time for yard work, I’m balls to the wall. (That’s a strange phrase because what does that really mean…balls to the wall? Guess it’s universal and understood.) We have bamboo behind our house and one weekend it was overdue for pruning. Hours in the heat, working away…when I emerged from the project I had mud under my fingernails, blood all over both arms, bamboo in my hair. And a smile on my face. Hard work feels good.

I exercise somewhat routinely. I go through phases as I think most do. Many years ago I started running with a dear friend that was already an accomplished runner. I was a little like Forrest Gump: I just started running. From a sedentary couch dweller I became an actual runner and completed 3 half marathons, one alongside that runner girlfriend during which we posted her personal record time. It was only my first half so it was my best time, too. I remain very proud of that. I go through bursts of workout fads: I’ve done P90X, Insanity. I do a killer ab workout about every three weeks. Can’t hit it again until it stops hurting and I can get out of bed without weeping. I wonder why I’m not seeing those results….hmmm. I tried CrossFit but it was not my cup of tea. Currently I’m obsessed with Zyn22 and am proud to have stuck with it so far. Those that know me know I’m all butt and thighs so spin seems like a good fit. Yeah!

I was thin once. It was AWESOME. Man, did I feel great. I lost enough weight that at one point someone suggested perhaps I need not lose anymore. As the lifelong chubby girl that had never happened to me. I was proud of that, really…to be thin enough that someone noticed. That’s not healthy or realistic, I get it. But it was so foreign to me. And now it’s foreign to me because I need to lose weight…again. The life of the yo-yo I think is familiar to so many of us. Dammit.

I have had a significant amount of plastic surgery myself to improve how I look and feel. I have had 2 rhinoplasties (there is actually a good story there), liposuction EVERYWHERE, a mastopexy. I get Dysport™ whenever I see frown lines, I have filler all over my face. I have had lasers, peels and use buckets of skin care. I have Latisse™ on my eyelashes. I practice what I preach as I tell my patients. I think that’s a positive because I live out loud and can connect to so many with their concerns personally as well as professionally.

So what’s with my inability to look perfectly perfect? I posted something this morning in a Facebook thread I was involved in that resonated with me:

Some days you eat salads and go to the gym, some days you eat cupcakes and refuse to put on pants. It’s called balance.

I love that. It would be fantastic if balance was easy to achieve. If you swing the pendulum too far in one direction, you are fit but perhaps unfulfilled. Too far in the other and you’re fat and unfulfilled. It is not easy. When I say I love life, I love the happiness that food and drink brings. It’s communal, it’s social. After a long day in the operating room we rarely search for a juice bar for happy hour. Wine is not bad for you, vodka is not evil. Pasta should not be considered sinful and sometimes there is nothing more magnificent that a peanut butter and jelly sandwich…on actual bread. I suppose the problem is too much of that goodness with less of the due diligence.

I am very, very happily married to a sexy dude 17 years my senior that has taken great physical care of himself his entire life. He competed as a bodybuilder for years, worked as a personal trainer for many years after that. Although I complain that he wakes up at 3:30 in the morning to work out pretty much every morning, I applaud his dedication. I remain amazed that he married a girl riddled with cellulite and without a six pack but he said something to me once shortly after we met and before we were married. I spotted a super fit sexy girl and when I pointed her out to him I stated, ‘now she looks like someone you should be with.’ To which he replied, ‘perhaps, but at some point I’d have to talk to her.’ That still makes me smile.

I suppose the definition of perfection is not just how you look getting out of the shower. Don’t get me wrong: I’m all about helping anyone who desires to look perfectly perfect naked achieve that. Yes, if I were to ramp up my game and scale back on the carbs I can surely peel off a few pounds. But if I have Jeff by my side, maybe at spin class or maybe at brunch, and we are laughing together watching the world go by, then I have found my balance. So far today I’m on a clean run after an early workout and a bottle of water. I’m wearing size 6 jeans and can still feel my feet and bend over…that’s victory for a girl like me. But there is probably a cupcake on my horizon somewhere.

Here’s up to it!


Surgeon at the Computer

I was recently asked when and what I would write about in this blog. I said I’d know whenever it hit me. In this case, I know because it’s what I wanted to hit: this computer.

The reality of medicine is not cutting edge science, robots, minimally invasive procedures or a tiny incision as distant as possible from the site of interest. It’s electronic medical records or EMRs. That’s what some call it. In my office, we refer to it as PITA. I don’t mean a tasty little sandwich…I mean a pain in the ass.

I spend more time sitting here at my computer typing in an encounter for a patient than anything else I do in my office, and that includes actual surgery and other office procedures. The way medicine used to be was you would meet a patient, visit, perhaps take some notes. I would routinely write in the phonetical spelling of their name if it was a tricky pronunciation or write myself a note about their job, their family so next visit I am sure to make a personal reference. You looked people in the eye when you met them, shook their hand.

The ‘paperless’ world of electronic records has killed that reality. In some offices, you talk to the back of someone’s head while they type what you tell them or the top of their head while they enter into the laptop. In my office I forbid that: too impersonal. I have created cheat sheets to take into the room to make notes. Mind you, ‘paperless’ has turned into three times as much paper around here for this reason but so be it. I can visit like I always did. Let the time get away from me…talk about anything but surgery sometimes. It is so great.

Until I have to come back here and type it in. I am a good little typist. It’s a funny thing for people of my generation. I’m only 46 but even when I was in high school we took a semester of typing. Good old fashioned typewriter typing. There were no computers then…it was pre-1987. Just one semester of typing and I remain pretty good at it. And that’s a good thing since it defines my day. I have a cheat sheet in front of me right now with someone’s breast measurements on it that I wrote down during a breast augmentation consult. The computer is SO SLOW today that I have been trying to get this information entered for over an hour. I gave up and came over here because this is fast….I can get words out as quickly as they enter my stream of consciousness. Lucky for you I can filter the four letter words here that I emit regularly while in the electronic medical record.

The tools of my trade are really supposed to be a scalpel, some instruments, maybe a syringe of liquid youth. It would appear I should just consider myself lucky when that’s what my hands are doing, not strapped to this keyboard entering statistics, data, and numbers. There is nowhere in the electronic record to document the personal details. I remember much of it myself: if you spend time genuinely getting to know someone, even if it’s a brief encounter, you should remember. But no side notes about your last conversation, nowhere to document that phonetical cheat for the proper pronunciation of a name so someone feels special. There is a template we have to use to record an office visit or an office procedure. It is a template derived from General Surgery because the system does not recognize Plastic Surgery as an entity of its own. Wow, we feel even more personal and special now.

I am too young to be set in my ways and young enough to have sufficient technically savvy that I know my way around a computer. As noted, I’ve got pretty sexy typing skills for that one semester almost 30 years ago. The rub with the world of EMRs is that this is not what I signed on for when I decided to go to medical school to be a surgeon many, many years ago. Wasting my time waiting for the computer to process my entries then hit ‘Plan’ after I link it to the diagnosis code then write out an assessment and determine a visit code is not my cup of tea. Give me a pen and paper and a chair to sit across from someone while I get to know them and their concerns any day. Since I cannot control or avoid this, I will suck it up, buttercup, and keep typing.

So ends this fury blog. Back to work…

Here’s up to it!



Joy Behar is an idiot. I think by now most have heard her comments following the Miss America pageant when Miss Colorado, a nurse, chose to use her talent window as a platform to discuss her profession. “Why does she have a doctor’s stethoscope around her neck?” Joy Behar asked. Wow. As a doctor, I am embarrassed for her. As a human being, I am embarrassed for her. I have never watched The View and if I had considered doing so before this point, I won’t bother now.

Here’s my two cents about the world of nurses from a physician’s standpoint:

We are nothing without them.

I read a post from a nurse friend last night that broke down how often medical professionals actually use their stethoscopes. She stated a doctor might round on a patient in the hospital once every 24 hours, a respiratory therapist every 8 hours or so but your nurse…pretty much every hour. Checking on you and listening to your heart, lungs, abdomen with their stethoscope. Not one they borrowed from a doctor, mind you, but their actual very own nurse’s stethoscope.

As a plastic surgeon, I have a stethoscope. It was a gift from my Cardiologist father when I graduated from medical school. It’s an amazing, high end stethoscope…a Littmann™ Master Cardiology. I sheepishly asked my father when he gave it to me, ‘what does that mean….Master Cardiology?’ He explained it has a floating diaphragm to allow you to pick up first and second heart sounds by applying differing degrees of pressure. Huh? If you see a Plastic Surgeon wearing a stethoscope around their neck, it’s OK to laugh. Because all that a Plastic Surgeon is really accomplishing with that stethoscope is to perhaps hear that the heart is actually beating to circulate the Ancef they were given prior to incision. Important side note here: no one should ever ‘wear’ a stethoscope around their neck. It’s not jewelry. Convenient to have available, perhaps, but nasty because just think about what it might have been dragged through over the course of a day. Gross.

Back to nurses, which is actually my point here, not stethoscopes. I am smart enough to know that if you have the nurses on your side, your life will be eternally better. As a new doctor, you are green and dumb…and scared. If someone says they aren’t or weren’t, they are lying. I remember very well being on call my first night as a newly minted General Surgery intern on the Cardiovascular service. In the ICU, with patients so sick and an so many drips, I was terrified and completely overwhelmed. The nurses for the most part have been doing their job for many, many years. I would imagine it would suck to have to wait for ‘suggestions’ from the snotty nosed brat young doctor when they know exactly what to do with their patients. I was handed a blood gas and did not have a clue what to do. I was smart enough to ask for help. And that was the difference between life and death for me for the duration of my training. I learned SO much from these nurses. They took care of me….no one really needs an order for a stool softener at 2 am but some young bucks fielded those type of phone calls because they were the ‘doctor’.

My father, the Cardiologist, is a bad ass with a stethoscope. Sincerely. He could probably guess your weight, tell your fortune and pick your lottery numbers just by listening to you. I’m sure there are many others with the same skills. Not me. How unusual that one little piece of equipment to those that are uninformed…and I mean you, Joy Behar…is iconic as belonging to only a doctor. All the stethoscopes in the world cannot make you a better doctor if you don’t have nurses to help you, to guide you. I hope that Ms. Behar does not find herself in an emergency room in the near future because I think the only thing her nurse might do with her stethoscope is to resist the urge to wrap it around her neck.

So cheers to you, my nursing friends. I am eternally grateful to all that have taught me, me protected me, loved me. I am a better doctor because of all of you and completely worthless without you. Too many to mention here but you know who you are. Don’t let the dummies get you down. As we all know, you can’t fix stupid. Even with your stethoscope.

Here’s up to it!