According to the estimates of the International Society of Aesthetic Plastic Surgery (ISAPS), in 2015, 9.6 million plastic surgeries were performed in the world. Breast augmentation regained the world and retained the all-Russian leadership in the number of operations performed, pushing aside blepharoplasty - surgery to change the shape of the eyelids - to the second line. The domestic top 5 is rounded out by facelifts, rhinoplasty and liposuction.
You can look at this as a boom in the "improvement" of appearance, but you can - as the development of the medical field, which is by no means reduced to aesthetic "edits". Russian plastic surgeons are making serious strides, which, however, are side by side with a number of problems - from difficulties in the development of research activities to the frequency of deaths in clinics. Two doctors told us about the peculiarities of plastic surgery in Russia: Dmitry Melnikov, specialist in mammoplasty (breast augmentation), and Irina Marinicheva, specialist in cruroplasty (plastic surgery of the legs, hips and buttocks).
Dmitry Vladimirovich Melnikov
Irina Gennadievna Marinicheva
Candidate of Medical Sciences, Plastic Surgeon, Associate Professor of the Department of Maxillofacial Surgery at FPKMR PFUR
Two months ago, surgeons of the Moscow State Medical University for the first time in Russia restored the breast with the help of the patient's tissues, that is, despite everything, the domestic practice does not stand still. What is the real situation with plastic surgery in Russia?
Dmitry Melnikov: The specialty "plastic surgery" has officially existed in Russia since 2012. Before that, there were oncologists or general surgeons who had undergone professional retraining in plastic surgery, but there was no single guide to organizing the work of plastic surgery clinics. Since the specialty was accepted by the Ministry of Health four years ago, the position of a specialist in plastic surgery by protocol can be in any government institution.
This happens all over the world, because plastic surgeons are the so-called finishers, they do not exist within the framework of a specific department. The clinics simply have a plastic surgery service, and it comes when necessary: for example, to restore the breast after a mastectomy or to operate on the urethra with microsurgical technique. In general, ideally, a plastic surgeon is a highly skilled and highly erudite specialist who can solve any problem - both aesthetic and reconstructive. This is now the foundation of education in the industry, including domestic education.
Irina Marinicheva: At the same time, a somewhat simplified system of retraining of personnel showed some disadvantages: many young inexperienced doctors appeared in the ranks of plastic surgeons, often without any clinical practice, without experience in general or maxillofacial surgery. The problem is that the danger to the patient's life is carried primarily by general surgical complications, which must be able to recognize in the early stages and, accordingly, be able to treat. Fortunately, this has become obvious to everyone, and now it is necessary to complete a clinical residency for several years to obtain a specialist certificate. It is also planned to create a scientific council for the specialty "plastic surgery".
Now in our specialty, many scientific works are being carried out, but due to the lack of a scientific council, they are carried out within the framework of other specialties: surgery or traumatology. As for the practice, you will be surprised, but perhaps the greatest experience was gained by our, now plastic surgeons, just in the zero years.A large number of people who wanted to improve their appearance, a limited number of specialists, low prices - all this provided an extensive practice. The average Russian plastic surgeon performed more operations per month than an American or European one for the whole year.
Are there any significant differences between public and private plastic surgery clinics in Russia? It is primarily about the characteristics of the profile and qualifications of specialists
Dmitry Melnikov: I specialize in breast reconstruction and plastic surgery. My practice is balanced, which is quite rare: I work at a university clinic at the First Moscow State Medical University, and I am a leading researcher at the Research Institute of Plastic Surgery. In addition, I have a plastic surgery department in a private clinic. Accordingly, in a private clinic I deal mainly with aesthetics, while in a university clinic, I mainly deal with reconstruction. Perhaps this is a fairly traditional distribution for Europe. True, our state clinics are now trying to develop towards aesthetics.
In fact, there are not very many plastic surgeons in state institutions, although state clinics are striving to increase the number of paid services (in fact, all Russian medicine is moving to a paid basis and self-sufficiency). On the other hand, the share of reconstructive interventions in oncology is increasing, and many oncologists are undergoing residency or retraining in the specialty of plastic surgery. Often, interventions in oncology - whether it is an operation on the mammary gland or on the facial area, when there is a large defect after removal of the tumor - must inevitably end with plastic surgery: in a sense, these are two satellites.
Plastic surgery often becomes a necessary measure after surgery, but do Russian therapists, oncologists and general surgeons adhere to this position?
Dmitry Melnikov: Oncology in our country is a very specific story, because in Russia an oncologist is a person who concentrates in himself the maximum of possibilities. This is most often a clinical oncologist and a surgeon, and sometimes the one who prescribes chemotherapy. So, in relation to plastic surgery, oncologists are divided into two groups: those who believe in plastic surgery, in the fact that defects should be minimized, and those who do not believe are old-school oncologists. Supporters of plastic surgery often try not to call for help from plastic surgeons, but to become them themselves.
With varying degrees of success, you have to understand
Dmitry Melnikov: Quite right, and that's the problem.
IF THE DECISION TO MAKE PLASTIC IS PRODUCED NOT BY FORCED MEASURES, BUT BY PURE AESTHETIC CONSIDERATIONS, WHAT SPECIALISTS STILL BE CONSULTED BEFORE GOING TO A PLASTIC SURGEON?
Irina MARINICHEVA: This question has something in common with the problem of the "education" of the plastic surgeon. First, before planning the operation, the patient needs to be examined for possible contraindications. In case of any doubts, you will definitely be referred to a general practitioner - a therapist, surgeon. The therapist will dispel the surgeon's doubts or prescribe corrective therapy, the endocrinologist will determine the reasons for the distribution of adipose tissue, the surgeon - hernias or vascular diseases, the ENT will understand the difficulties of nasal breathing. Accordingly, the plastic surgeon faces a decision: to independently perform a combined intervention or invite another specialist for the operation, for example, for hernioplasty or septoplasty. In addition, in our practice, colleagues from other specialties often recommend that patients perform some kind of plastic surgery or advise a specialist.
Does Russian plastic surgery exist in a global context or is it rather developing in isolation?
Dmitry Melnikov: The adoption of world experience and the interaction of doctors of different specialties are slowly taking place, but this is a long process. I studied in the United States at the Mayo Clinic, where a clear distribution of functions among doctors successfully coexists with teamwork. There, unlike many Russian clinics, an oncologist is a kind of manager who prescribes treatment. Then the surgeon gets to work: if he does a mastectomy, he has one task - to remove the breast. Then a plastic surgeon comes and does his part - breast reconstruction. Beforehand, doctors discuss the details of the intervention, agree on which areas are best left, and so on. Now we are trying to organize work in the university clinic according to this principle. Our fellow oncologists invite us to cooperate: after they remove the tumor, we can “make it beautifully”.
Irina Marinicheva: World plastic surgery was opened for doctors in the zero years: specialists actively studied, attended international conferences and clinics, and learned from experience. I interned twice at the Institute of Reconstructive Plastic Surgery at New York Medical University under the guidance of the legendary Joseph McCarthy - first during my graduate school, and then, a few years later, after starting independent practice. Nikolay Milanov and Alexander Nerobeev influenced the development of domestic plastic surgery and the introduction of international experience - in the early 90s they stood at the origins of the Russian Society of Plastic, Reconstructive and Aesthetic Surgeons, their organizational skills made it possible to unite specialists in our country, hold regular congresses and conferences, to organize the release of the first professional peer-reviewed journal "Annals of Plastic, Reconstructive and Aesthetic Surgery".
Sergei Nudelman achieved a lot: he became the first Russian national secretary of the International Society of Aesthetic and Plastic Surgeons (ISAPS) and organized the annual ISAPS training courses in Russia. In addition, Russian surgeons practice abroad, however, mainly in the former Soviet republics. Some are offered contract work in the Middle East, in Asian countries, and only a few work in Europe. This is largely due to the difficulty of confirming a diploma and passing an exam in a specialty, and in the United States - also with the difficulty of joining the professional community.
How do the patient's wishes and beauty standards form a “request” for a particular operation? Is there a plastic surgeon ethics?
Irina Marinicheva: The main feature of plastic surgery is precisely the fact that operations in our specialty are performed at the request of patients, that is, the main indication is their aesthetic dissatisfaction. Indeed, often this dissatisfaction is due either to the peculiarities of development, or to changes due to a past pregnancy or injury, or age-related changes. Often, the patient's decision-making is influenced by glossy publications that instill certain standards of beauty in society. The absolute reason for refusing patients to undergo surgery is the presence of contraindications when surgery or anesthesia pose a risk to a person's life. However, more often than not, we refuse patients in case of their unrealistic expectations from the operation: for example, when the patient believes that liposuction is a method of losing weight.
In general, it is necessary to use the following formula: if there is any doubt about the success of the operation, it must be abandoned. To obtain a good aesthetic result, the surgeon and the patient should work in tandem: the surgeon must understand the reasons for the patient's dissatisfaction, offer various solutions to the problem, the patient, in turn, must adequately assess the possibilities of surgical treatment methods and the predicted result.Only in this case, the maximum effect of the plastic surgery is possible.
Dmitry Melnikov: It all depends on the particular school. I come from a school that has developed in Russia since the 60s from microsurgery. Academician Nikolai Olegovich Milanov, my teacher, also belonged to this school. According to her principles, common sense is first of all, and, of course, we often refuse patients despite the financial benefit. But in the commercial part of our industry, surgeons often follow the lead of patients in pursuit of momentary profits. This often affects their practice: patients remain dissatisfied and go to court. This is typical, in particular, of young surgeons: at the beginning of their careers, many try to take on everything at once. The most common reason for the refusal of a patient is the overestimated expectations from the operation or very strange requests. In any case, the only reason for refusal in my practice is lack of contact with the patient. If we do not understand each other, the motivation of the person is not clear to me, or I feel distrust of me on the part of the patient, I can refuse.
I have had several patients with very strange requests, but upon closer examination, these requests ceased to be strange. We are all very different, and the reasons for choosing a plastic surgeon are very different for everyone. If suddenly my patient tells me that she wants a 10-size breast (I'm exaggerating, but still) and this goes against my professional concept, but she can explain to me why she needs it, the likelihood of getting a positive answer from me increases significantly … On the other hand, if this is a 19-year-old girl who wants big breasts just to please the guys, or even “for the company” with her friends, I will most likely refuse. In general, from my point of view, plastic surgery is
50% ability to operate, 25% aesthetic vision and 25% ability to listen to a person and understand who he is and why he needs an operation.
Photos: Khorzhevska - adobe.stock.com (1, 2, 3)