Dr. McLaughlin’s Personal Blog

The Titty Whisperer

This is my reality. I am the Titty Whisperer. Why, you ask? Let’s discuss…

I had breast cancer a couple of years ago. That sounds so casual, as if it was no big deal. It was a big deal and it affected me very, very deeply on many levels. As a female Plastic Surgeon, I have spent my career meeting with patients that have either recently received a breast cancer diagnosis or have lived with that reality for many years and have not quite settled their reconstruction to their satisfaction. Throughout those years, patients have asked me what I would do if I was faced with the same diagnosis. I always knew what I would do but never imagined I would be forced to verbalize my plan.

In late May 2016, I heard those words that I was dreading from the time the abnormal mammogram crossed my desk. Cancer. A very dear from of mine who endured the reality of cancer and all its horror including chemotherapy and multiple reconstructions said it best: do not ever dignify cancer with either a capital C or proper spelling. We therefore refer to the terrible, awful as ‘cancir’. It does take the edge off the littlest bit.

My approach to cancer was what I often refer to as the surgical apocalypse: double mastectomies and implant reconstruction for non-invasive cancer on one side. The scorched earth approach worked for me as I came through it stage 0 and did not require the horror of chemotherapy or radiation. I had junior varsity cancer or the equivalent of sitting at the children’s table at Thanksgiving or Christmas…but it was cancer nevertheless.

I processed my journey in the most public forum: social media. It helped me to share, vent, cuss, scream and sometimes even laugh when appropriate. I am a firm believer that laughter is the best medicine. What I quickly discovered through the process of sharing was that others responded. Others that had endured a similar diagnosis and journey but were not inclined to share in such an outward fashion. I received private messages of gratitude for voicing what I felt like when I looked in the mirror post mastectomy…. the idea of someone thanking me for saying out loud what perhaps they wanted to say all along or maybe to acknowledge that others were indeed feeling that way struck me as absurd. But since it seemed like it was indeed helping someone, somewhere, I continued to share. I shared pictures of scars, drains. I posted about the frustration of not being able to do what I wanted to do when I wanted to do it. I posted about additional surgical procedures for different situations that I was not happy with. I pretty much lived on Facebook for over a year, daily…sometimes even every hour on the hour. I recall my dear husband questioning this at some point. “Why do you want to share this?’, he asked. Because I felt a responsibility to do so, I told him many times. I am a Plastic Surgeon. People come to me to rebuild them and help them through this journey. When I felt myself taking the exact same journey, I felt I was a hypocrite if I was able to help others and was not willing to do whatever it takes for me and for them. Arrogant? Perhaps. Effective? Apparently.

About 4 months after my double mastectomy, my brain was in hyperdrive to do more for those searching for answers and assistance through their cancer journey. I voiced my interest and concerns to a group of precious friends that had rallied around me from the beginning. Some of these friends are very successful entrepreneurs in the Fort Worth community: the Heims and the Rahrs. Barbeque and beer friends are good to have around for many reasons but when an idea is born, they are the very best friends to have around. 

My surgeon and friend, Danielle LeBlanc, had mentioned at some point an idea she had heard and tried to launch locally-BoobieQue. The parties she had approached were not able to move forward with the idea so I effectively took the ball and ran. My breast cancer story, Heim barbecue and Rahr beer: the trifecta for a perfect afternoon. BoobieQue was born.

If I thought I had an audience for my incessant need to overshare my breast cancer experiences, BoobieQue blew that up completely. More people were aware of the story, more people continued to reach out privately about their own experiences. I treasure this…the opportunity to help someone process their new reality, discuss options for reconstruction, give them talking points for their surgeons is a privilege I never could have imagined and I take very, very seriously.

Almost a year after my first surgery, I remained dissatisfied with a phenomenon related to breast reconstruction: animation deformity. One the mainstays of breast reconstruction is tissue expanders that are ultimately replaced with breast implants. Because the breast tissue is removed during the mastectomies, the remaining breast skin and underlying tissue is generally too thin to adequately cover an implant over the muscle. As a surgeon, subpectoral reconstruction is the same technique I had performed hundreds of times before my own surgery. I never questioned the approach when I was the patient. The first time my chest flexed and my reconstructed implants were effectively displaced to my armpits, I wasn’t sure whether to laugh or cry. Quite the party trick, animation deformity. Think about John Cena in that Hefty® bag commercial…his pecs are jumping all over the place and it’s funny. Not so funny when you’re pushing up to get out of the bathtub and your bionic boobies flatten out.

Danielle and I made the decision to return to the operating room in March 2017 to convert my reconstruction to prepectoral, or above the muscle. To make a long story short, home run and I’m thrilled. I was so thrilled that within about 9 days of the surgery-still with drains in clipped to my belt for all the world to see because I’m an over sharer, remember-I stood up at a meeting of the Fort Worth Plastic Surgery Society after a guest surgeon presented his work on prepectoral reconstruction and simply applauded. The applause was in the style of T Rex that has come to be my spirit animal because I have learned that keeping your arms by your side with drains in place helps reduce drainage. If you have breast drains: be T Rex. You’re welcome.

Back to Titty Whisperer. The company that was sponsoring that talk was interested in the idea that a female Plastic Surgeon who had conventional breast reconstruction and was not satisfied with the results and the animation deformity pursued conversion to this progressive new technique. I have since given many talks from Newark and Seattle to New Orleans and Chicago about my experiences. I remain amused and confused that people seem to want to hear my story but they do. In November, I am flying to Costa Rica to give another talk. I can now put International Titty Talker on my CV…I am sure that will open many doors. The exposure in giving these talks is just more opportunity for me to reach people and offer whatever they might need from me to help them in their journey. This has become my passion.

October is Breast Cancer Awareness month and I am conflicted about this. Before I had breast cancer, I always paid heed to the cause, wore pink, made donations. As a survivor, or as many on my side of this diagnosis prefer a THRIVER, I increasingly realize that pink fatigue is real. Who is NOT aware of breast cancer? Really? Who in the world does not know someone or many ‘someones’ with breast cancer? The statistics used to be 1 in 8 women will be diagnosed with breast cancer. In my world, the number is far higher than that. Literally not a week goes by that I don’t hear from someone that I know who knows someone that was just diagnosed. A couple of weeks ago, within a matter of days, two personal friends of mine reached out with their new breast cancer diagnoses. We are aware of you, breast cancir…you suck and need to be done with.

While I’m on my soap box about Breast Cancer Awareness month, I must mention the darkest side of this disease-metastatic breast cancer. This is the cancer that kills. This is the cancer that needs an awareness month and unwavering support for research. I have several personal friends that are living with metastatic breast cancer and I have very real survivor’s guilt when I talk about my experience with this disease.  During the month of October when you are faced with promotions about breast cancer and pink this and that, pay attention to the causes you are supporting. If METAvivor is a recipient of the fun tickets you’re spending while you’re being ‘aware’, good for you and shop on. This is not to say that so many other organizations are not worthy but supporting research that could one day make breast cancer a distant memory for everyone sounds like about the best thing in the world to me.

Back to Titty Whispering. BoobieQue is now in its third year. We have raised over $200,000 since the inaugural event. We are now officially organized as a 501(c)3 nonprofit organization, Fighting Right. BoobieQue is our primary event but we have several other programs under development to expand our reach in the coming years. We have been proud to partner with an extraordinary organization in Fort Worth for over 70 years, Cancer Care Services. They provide support across a broad scope of categories to patients facing all types of cancers and their families. As a young nonprofit, we are so proud to have a much more established organization to donate our proceeds to effect a change.

I move through the world going Mach 2 with my hair on fire, to paraphrase a line from Charlie to Maverick in Top Gun. Between my practice, my nonprofit world and my little speaking gigs, there is little time to think about much else but when the call comes that someone needs to talk about a new diagnosis or someone knows someone with a bad mammogram and they don’t know their next move or perhaps someone needs more information on the reconstruction options available to them, I will always make time. This is my purpose and my joy…the Titty Whisperer. Wish I had the equivalent of the Bat signal that went up when someone was in need: a Bralet in the sky. I hope you never need me but if you do, just reach out.


Here’s up to it…


BoobieQue 3 is October 28, 2018 @ 12:00pm - 4:00pm. Click here to purchase your tickets!

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…