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Welcome to Medtalk Idaho presented by Surgery Center of Idaho.  We are broadcasting from Meridian, Idaho. I’m Barb Nielsen, PR/Marketing Coordinator for Surgery Center of Idaho.  Our podcast today is a “Getting to Know You” interview with Dr. Patrick Cole. Dr. Cole is a board-certified plastic surgeon as well as an orthopedic hand surgeon. Dr. Cole performs many of his cases here at Surgery Center of Idaho. Welcome, Dr. Cole. Thank you for joining us.

Tell us a little about yourself, where were you raised, your family. What brought you to Idaho?

I grew up in Dallas/ Fort worth, which is a wonderful place. I went to college at Baylor University in Texas and medical school there in Dallas at Univ of Texas Med School which I believe is still a top 10 medical school. What brought my family to Idaho? …well, Idaho is amazing. Treasure Valley is amazing. I have three little kids and along with my wife, we haven’t been here too long, but we’ve seen the Sawtooths, several natural hot springs. We saw Lake McCall… and it’s just amazing. The best part though is the people. I like people who say what they mean, and mean what they say. We feel very much at home.

Why did you choose orthopedics and plastic surgery?

I really love helping people, and my heart goes out to people struggling with really bad injuries after a car accident or cancer. I went into plastic and reconstructive surgery because I want to help those people get back to their lives…get back to the families and children.

And where did you train?

I did all 8 years of my plastic and reconstructive surgery training at Baylor College of Medicine and MD Anderson in Houston. I think MD Anderson is still considered the number institution on Earth for plastic and breast surgery.

How long have you been in practice?

I’ve been operating since about 2004…so that’s 16 years.

So Breast Implant Illness, BII….problems associated with having breast implants. What are your thoughts on this? What is your belief?

This is a topic of intense interest and research within the plastic surgery community right now. While we continue to investigate, sadly I don’t have much data to support any scientific discussion right now. That will change. There are two things that really catch my attention:

One: if you would have said only 5 years ago that breast implants could actually cause cancer, no one would have listened to you. We know for a fact now that textured breast implants without a doubt, and this is a scientifically proven fact, can and do cause large cell lymphoma. Several hundred cases have been found all over the world and there have been several deaths at this point. And that’s just something we’ve proven in the last few years.

The other thing, when you have several hundred thousand very reasonable, accomplished, believable women all saying about the same thing about the problems they’ve experienced during their breast implant experience… well, I believe that where there’s that much smoke, there’s gotta be some fire. I think we ought to listen. We need to figure this think out.

Do you have hospital privileges?

Yes. I have privileges at all St. Lukes and St. Alphonsus’ Treasure Valley locations. Of course, I love working at the Surgery Center of Idaho. I also work at Millenium surgery center, Treasure Valley, and West Valley Hospital.

How many En Bloc explants have you done?

Approximately 100-120 in the last year.

Can you provide photos of previous En Bloc / Total Capsulectomy explants?

Of course. You can few several photos at our website that highlights exactly what an en bloc capsulectomy should be. In addition, I’m happy to take photos intra-operatively and provide them to you post-op.

Are you committed to removing all capsule tissue from my chest?

Yes. I want to get every molecule of the capsule out so I can send it pathology for a full evaluation. If there’s something in there that could hurt you, I want to know immediately.

Do you have microsurgery training?

I do. I trained at MD Anderson Cancer Center in Houston, Texas: the world’s number one training facility in microsurgery. I’ve successfully performed hundreds of microsurgery cases.

Will you repair the pec muscle if it’s torn or cut?

Of course. If I see that the pec has been damaged in any way, I’m happy to repair it using sutures.

Will I receive antibiotics during the surgery, what kind will be used and how will they affect me?

The safe pre-operative standard-of-care antibiotic therapy includes 1-2 gms of Ancef for these procedures. That’s the safe option to prevent infection, and I’m all about safety.

Will you use cautery during surgery which reduces bleeding? How will you control bleeding or blood clotting if necessary to do so?

Of course. In order to prevent continued bleeding after surgery, I always use Bovie electrocautery to provide hemostasis and decrease the risks of complications.

Will any foreign materials be used such as staples, permanent stitches, mesh, etc?

No. I don’t use any permanent materials during either the explant/ en bloc capsulectomy or the mastopexy. At the end of the procedure and healing period, all I want in there is you. No more foreign bodies.

What kind of pain medication will be prescribed and how will it affect me?

I typically prescribe Percocet 5/325 1-2 tabs every 4-6 hrs and dispense 30 tabs. This has worked very well for my patients.

Are pieces of capsule tissue sent to pathology to check for bacterial and fungal infections and cancer?

I send every bit of all materials to Pathology for evaluation and documentation.\

Do you take pictures or video of the explant procedure?

Yes, and I’m happy to provide them to you post-op.

Can I have a copy of my complete file including operative reports, pictures, and tests at our first follow up meeting?

Of course.

Will you pack up and return my uncleaned implants and capsule tissue to me if I request?

Yes. Of course.

What are after surgery directions for compression, wound care, sleeping, massage and who will I call if have problems or questions after surgery?

I have a time-proven post-operative regimen that optimizes patient safety, minimizes complications, and consistently provides successful results. It involves compression dressings, drains and wound care, post-operative antibiotics, massage, and much more that would require more than a simple paragraph to address. I am happy to discuss the various aspects of my post-operative regimen during the consultation. I am also available 24/7 via my answering service so patients always have access to me.

There is a lot of interest in going out-of-state for explant surgery. What would you say to a patient who’s considering doing this?

Well, the surgery itself is only half the care you need. It’s the close follow up that’s equally important. It’s during the post-op period when patients have post-op complications. Makes sense right? So if you go to a surgeon who is far away, my question would be how are you getting the close follow up you need. What happens if you have a problem? There’ s only so much a surgeon can do on Skype. Who is there to help you in real life… not over the phone? It’s critical that not only is your surgeon a phone call away, but he or she is physically there to walk you through every step of the way.

Even scarier, I’ve heard of surgeons, who the first time they meet you is while you’re rolling into the operating room. That’s not good. Your body, your health, and your potential surgery are extremely important, and issues this important should never be “cooked up on the fly”. An appropriate, successful surgery is best, and most safely, done only after thorough patient evaluation. I mean, this isn’t cookie-cutter stuff. Everyone’s body…everyone’s needs… their goals are different. Each surgery is individually created for that particular patient. To just meet someone right before you go under anesthesia like you’re just another cookie on a conveyor belt flies in the face of everything I believe.

How long will it take for my breasts to heal and feel normal? When will the follow-up appointments be and how many?

While the operative site will usually be sore for 3-4 weeks, the completion of soft tissue healing won’t be complete for about 6 months. Technically, soft tissue continues to heal for 12 months, but you will have an approximate idea of your result at about the six-month time point. When “you will feel normal” is very difficult to answer as each case is dependent on that actual patient. Most patients begin to feel pretty normal around the two week post-op period and slowly progress back to normal life between 3-4 weeks. It’s important during this time to remember that your body is still healing, and although patients begin to feel normal and desire to return to normal activity, it’s critical to give your body the time it needs to complete the healing process.

I follow patients very closely. I typically see patients back on post-op day 2 or 3 (based on patient convenience), and then every 3-4 days for 2 weeks. Assuming the post-operative course is going very well and the drains are out, I will then see patients about once a week until week 3-4. Every case and every patient is different. Some patients desire more follow up, some prefer less. I’m happy to work with the individual patient as long as safety is maintained and a satisfying result is achieved.

I use compression dressing for the first 2 weeks, then transition to a sports bra from 2-6 weeks post-op.