Plastic Surgery: Beyond the Cosmetic
From the Show: The George Washington University Hospital
Summary:
Air Date: 7/16/17
Duration: 10 Minutes
Praful Ramineni, MD, discusses the vast arena of plastic surgery, which expands beyond what one typically connotes with the field (breast enhancement, nose jobs, face lifts, etc.) and includes procedures such as complex hernia surgeries, wound care, cancer reconstruction, removing excess skin in patients who have lost massive amounts of weight, and breast reduction. Dr. Ramineni also explains how many of these procedures are covered by insurance, and the process by which criteria is approved.
Transcription:
Dr. Michael Smith (Host): Welcome to GW Healthcast. I’m Dr. Mike Smith, today’s topic is plastic surgery beyond the cosmetic. My guest is Dr. Praful Ramineni, he’s a plastic surgeon and member of the medical staff at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Ramineni, welcome to the show.
Dr. Praful Ramineni (Guest): Thank you.
Dr. Smith: So, let’s just start off with something real simple, right? What do you mean, when you say, “Be on Cosmetic”, what does that mean?
Dr. Ramineni: So, I think the general impression that most people have about plastic surgery, in general, is that what we do is strictly cosmetic surgery. Breast implants, tummy tucks, face lifts. This really ignores the fact that the majority of the field is actually not cosmetic surgery but reconstructive surgery. Surgery that deals with correcting deformities, surgery that deals with traumatic injuries, surgery that deals with reconstructing any sort of a deformity or defect that somebody has through a variety of injuries they could sustain, whether it’s surgical or non-surgical. And so, there’s really multiple categories that this encompasses. There is where we operate on the face, the body, wound care. You name it, it’s generally part of plastic surgery.
Dr. Smith: Yeah, well let’s talk a little bit about some of the specifics. For instance, I know that you guys can offer in, like for a women after breast cancer surgery, right? There’s a lot you can do for reconstruction, tell us a little about what you offer in that case.
Dr. Ramineni: Absolutely. So, there a huge host of options, in terms of breast reconstruction, whether it’s a lumpectomy, whether it’s a total mastectomy. In terms of restoring the function, females, I think most patients will realize that that’s not considered cosmetic surgery. It’s reconstructive surgery. It is covered by insurance, and it’s actually mandated by law that is covered by insurance. Not only the primary surgery, but doing the OPS at breast, matching the symmetry, making sure that we restore our patients back to where they want to be and as close to their pre-surgery body as we can.
There’s options anywhere from implants to using your own skin, your own fatter tissue to reconstruct the breast, and that’s an hour discussion by itself to explore all the different options for breast reconstruction.
Dr. Smith: Yeah, you mentioned insurance there, and I think that’s important. Let’s go to that just for a moment, so you mentioned in breast reconstruction surgery it’s even mandated, but for some of these other things that you do, correcting a deformity, for instance. How does insurance play into all this?
Dr. Ramineni: So, a lot of insurances have certain lists of codes that you don’t even need to get a pre-authorization for, and as a surgeon, we can talk to insurance companies, get things covered because it’s not considered a cosmetic problem, if it happens from a car incident or where it happens from cancer. And so, there are some hoops for certain procedures that we have to jump through. For example, if somebody has the 200-pound weight loss after a gastric bypass, they may have hanging skin through their abdomen, which causes rashes, skin breakdown, infection. And so, that’s not a tummy tuck. That’s what’s considered panniculectomy.
So, if we meet certain criteria. We tell the insurance company, we send pictures, and kind of explaining that this is a medical issue, a lot of times we can obtain coverage for those types of services through the insurance company.
Dr. Smith: Yeah, let’s go back to the bariatric surgery for a moment, you brought that up in the context of insurance, but I want to talk about it as a procedure that you guys do. So, obviously bariatric surgery’s work very well. There’s a lot of weight loss, it could be quite rapid weight loss in some cases, and there’s a lot of left over excess skin. Again, that’s just not a cosmetic thing. Talk a little bit about, what are some of the complications from that and what you offer?
Dr. Ramineni: Well, so a lot of patients especially in the summer, get rashes, they get infection or wounds underneath these areas. They can try multiple different creams, powders, support garments, and still they have these symptoms where it’s disabling. Where about a third of the patients after any sort of mass weight loss have extra skin that causes symptoms, prevents them from going to the gym. It prevents from performing their normal activities on a day-to-day basis.
So, patients come to see me quite a bit, in terms of having these symptoms, and we talk to them about what we can do to get insurance coverage, and how we can get the insurance company to realize that this is a reconstructive and not a cosmetic surgery. It has become increasingly difficult over the last three years, but still I have several patients able to get through insurance for the skin removal operation. The belly is one of the major areas we can get coverage, but obviously there’s areas, the arms, the upper back, the thighs. Those are all other areas as well that tend to get symptoms and have… with issues with. Rashes against infections and other problems.
Dr. Smith: Again, yeah. The idea that it’s beyond cosmetic, right? And that’s kind of what we’re talking about here, and that’s, I think the stereotype that plastic surgeons have to fight against a little bit because Hollywood portrays you guys differently don’t they? When you look at the movies and the TV shows.
Dr. Ramineni: They do.
Dr. Smith: Yeah, and I’m sure that’s frustrating for you a little bit about that. So, let’s talk about some other things. So, we have a large audience that’s listening. We’ve covered a little bit of the breast reconstruction surgery, the… what you can after bariatric surgery. What are some of the other common beyond cosmetic procedures that you do?
Dr. Ramineni: So, other things are… I do tend to do complex hernias. So, I have a large population of patients that comes to me. They’ve had hernias, but other surgeons in the past have had failed treatments. For some reason mesh didn’t work on them. And I’m able to use their own tissue, and move some of their muscle to actually reconstruct their abdominal wall to fix the hernia defects without having… actually having to utilize mesh, or to minimize how much we have to use in the abdominal wall, to give them better core strength.
There are patients that are post-pregnancy that also have large-hernias in their skin, and it happened with as well. Other things that we tend to do is outside of the pediatric population where there’s cleft palate and other childhood deformities. Any sort of cancer reconstruction of other areas. If somebody has a skin cancer and has it taken off, and there’s an open wound. We can do skin grafts, we can wound care for patients that have diabetic foot wounds. Patients have open wounds from other reasons, such as trauma. A lot of what we can do is… if patients have orthopedic trauma where they get a broken bone, where they missing skin or soft tissues, or have pain from poor scars. We can re-align those areas to improve the quality of life as well. Really, it’s one of the most broad fields, in terms of being able to operate from head to toe, and patients that are babies up to people that are over 100 years old.
Dr. Smith: Right, yeah. That’s a good point because I think that, again, that the misconception is that it’s nose jobs and those kind of things, and it’s so much more than that. Tell us a little bit about when you were training to be a plastic surgeon. How much time did you actually spend in these beyond cosmetic procedures?
Dr. Ramineni: In general, in most residency programs. I would say that probably 80 to 90 percent of our time is spent in the non-cosmetic field. Cosmetic surgery in academic centers tends to be the minority of the cases that you see. So, we would go weeks, if not months sometimes, without actually doing a cosmetic surgery in residency. Generally, because a big academic center tends to be geared more towards reconstructing trauma patients, cancer patients, etcetera. When I was… plastic surgeons are all trained initially in general surgery.
So, we have general surgery training before we even go into plastic surgery. That’s a sub-specialty of the field. So, we kind of sub-specialize into plastic surgery. So, a lot of basic things in general surgery are already covered at our training as well. So, I would say that we’re more reconstructive surgery than general, than we are cosmetic surgeons, although it doesn’t make for good TV, I guess.
Dr. Smith: Right. Okay, but the work that you’re doing is fantastic. Dr. Ramineni, is there… lastly just kind of in summary, is… what would you like people to know about beyond cosmetic, when it comes to plastic surgery?
Dr. Ramineni: I think the main thing is that there’s a whole host of things that we do that are not, what are we typically known for on TV, and those things, it’s worth exploring and kind of coming to a plastic surgery to discuss or at least calling the office to find, is the service to perform, but I think a lot of people are surprised how much overlap we have with other fields. And they just kind of discount it, thinking, “Oh, you know what, I can’t do this. It’s just for the wealthy. It’s just something that I’d have to pay out of pocket.” Even things with breast reductions, I do 15 to 20 breast reductions a month, and patients always think it’s a cosmetic operation where you have to pay out of pocket. If they have pain and we can meet a certain criteria, the vast majority of breast reductions can be covered through insurance, but I think it’s worthwhile for patients to kind of explore it and to look into plastic surgeons to see if they take insurance, and then many problems are actually covered procedures that most patients don’t know about.
Dr. Smith: Well, Dr. Ramineni. I’m going to thank you for the work that you’re doing and thank you for coming on the show today. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Ramineni or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.
This is Dr. Mike Smith, thanks for listening.
Dr. Michael Smith (Host): Welcome to GW Healthcast. I’m Dr. Mike Smith, today’s topic is plastic surgery beyond the cosmetic. My guest is Dr. Praful Ramineni, he’s a plastic surgeon and member of the medical staff at the George Washington University Hospital and is affiliated with The George Washington University Hospital and GW Medical Faculty Associates. Dr. Ramineni, welcome to the show.
Dr. Praful Ramineni (Guest): Thank you.
Dr. Smith: So, let’s just start off with something real simple, right? What do you mean, when you say, “Be on Cosmetic”, what does that mean?
Dr. Ramineni: So, I think the general impression that most people have about plastic surgery, in general, is that what we do is strictly cosmetic surgery. Breast implants, tummy tucks, face lifts. This really ignores the fact that the majority of the field is actually not cosmetic surgery but reconstructive surgery. Surgery that deals with correcting deformities, surgery that deals with traumatic injuries, surgery that deals with reconstructing any sort of a deformity or defect that somebody has through a variety of injuries they could sustain, whether it’s surgical or non-surgical. And so, there’s really multiple categories that this encompasses. There is where we operate on the face, the body, wound care. You name it, it’s generally part of plastic surgery.
Dr. Smith: Yeah, well let’s talk a little bit about some of the specifics. For instance, I know that you guys can offer in, like for a women after breast cancer surgery, right? There’s a lot you can do for reconstruction, tell us a little about what you offer in that case.
Dr. Ramineni: Absolutely. So, there a huge host of options, in terms of breast reconstruction, whether it’s a lumpectomy, whether it’s a total mastectomy. In terms of restoring the function, females, I think most patients will realize that that’s not considered cosmetic surgery. It’s reconstructive surgery. It is covered by insurance, and it’s actually mandated by law that is covered by insurance. Not only the primary surgery, but doing the OPS at breast, matching the symmetry, making sure that we restore our patients back to where they want to be and as close to their pre-surgery body as we can.
There’s options anywhere from implants to using your own skin, your own fatter tissue to reconstruct the breast, and that’s an hour discussion by itself to explore all the different options for breast reconstruction.
Dr. Smith: Yeah, you mentioned insurance there, and I think that’s important. Let’s go to that just for a moment, so you mentioned in breast reconstruction surgery it’s even mandated, but for some of these other things that you do, correcting a deformity, for instance. How does insurance play into all this?
Dr. Ramineni: So, a lot of insurances have certain lists of codes that you don’t even need to get a pre-authorization for, and as a surgeon, we can talk to insurance companies, get things covered because it’s not considered a cosmetic problem, if it happens from a car incident or where it happens from cancer. And so, there are some hoops for certain procedures that we have to jump through. For example, if somebody has the 200-pound weight loss after a gastric bypass, they may have hanging skin through their abdomen, which causes rashes, skin breakdown, infection. And so, that’s not a tummy tuck. That’s what’s considered panniculectomy.
So, if we meet certain criteria. We tell the insurance company, we send pictures, and kind of explaining that this is a medical issue, a lot of times we can obtain coverage for those types of services through the insurance company.
Dr. Smith: Yeah, let’s go back to the bariatric surgery for a moment, you brought that up in the context of insurance, but I want to talk about it as a procedure that you guys do. So, obviously bariatric surgery’s work very well. There’s a lot of weight loss, it could be quite rapid weight loss in some cases, and there’s a lot of left over excess skin. Again, that’s just not a cosmetic thing. Talk a little bit about, what are some of the complications from that and what you offer?
Dr. Ramineni: Well, so a lot of patients especially in the summer, get rashes, they get infection or wounds underneath these areas. They can try multiple different creams, powders, support garments, and still they have these symptoms where it’s disabling. Where about a third of the patients after any sort of mass weight loss have extra skin that causes symptoms, prevents them from going to the gym. It prevents from performing their normal activities on a day-to-day basis.
So, patients come to see me quite a bit, in terms of having these symptoms, and we talk to them about what we can do to get insurance coverage, and how we can get the insurance company to realize that this is a reconstructive and not a cosmetic surgery. It has become increasingly difficult over the last three years, but still I have several patients able to get through insurance for the skin removal operation. The belly is one of the major areas we can get coverage, but obviously there’s areas, the arms, the upper back, the thighs. Those are all other areas as well that tend to get symptoms and have… with issues with. Rashes against infections and other problems.
Dr. Smith: Again, yeah. The idea that it’s beyond cosmetic, right? And that’s kind of what we’re talking about here, and that’s, I think the stereotype that plastic surgeons have to fight against a little bit because Hollywood portrays you guys differently don’t they? When you look at the movies and the TV shows.
Dr. Ramineni: They do.
Dr. Smith: Yeah, and I’m sure that’s frustrating for you a little bit about that. So, let’s talk about some other things. So, we have a large audience that’s listening. We’ve covered a little bit of the breast reconstruction surgery, the… what you can after bariatric surgery. What are some of the other common beyond cosmetic procedures that you do?
Dr. Ramineni: So, other things are… I do tend to do complex hernias. So, I have a large population of patients that comes to me. They’ve had hernias, but other surgeons in the past have had failed treatments. For some reason mesh didn’t work on them. And I’m able to use their own tissue, and move some of their muscle to actually reconstruct their abdominal wall to fix the hernia defects without having… actually having to utilize mesh, or to minimize how much we have to use in the abdominal wall, to give them better core strength.
There are patients that are post-pregnancy that also have large-hernias in their skin, and it happened with as well. Other things that we tend to do is outside of the pediatric population where there’s cleft palate and other childhood deformities. Any sort of cancer reconstruction of other areas. If somebody has a skin cancer and has it taken off, and there’s an open wound. We can do skin grafts, we can wound care for patients that have diabetic foot wounds. Patients have open wounds from other reasons, such as trauma. A lot of what we can do is… if patients have orthopedic trauma where they get a broken bone, where they missing skin or soft tissues, or have pain from poor scars. We can re-align those areas to improve the quality of life as well. Really, it’s one of the most broad fields, in terms of being able to operate from head to toe, and patients that are babies up to people that are over 100 years old.
Dr. Smith: Right, yeah. That’s a good point because I think that, again, that the misconception is that it’s nose jobs and those kind of things, and it’s so much more than that. Tell us a little bit about when you were training to be a plastic surgeon. How much time did you actually spend in these beyond cosmetic procedures?
Dr. Ramineni: In general, in most residency programs. I would say that probably 80 to 90 percent of our time is spent in the non-cosmetic field. Cosmetic surgery in academic centers tends to be the minority of the cases that you see. So, we would go weeks, if not months sometimes, without actually doing a cosmetic surgery in residency. Generally, because a big academic center tends to be geared more towards reconstructing trauma patients, cancer patients, etcetera. When I was… plastic surgeons are all trained initially in general surgery.
So, we have general surgery training before we even go into plastic surgery. That’s a sub-specialty of the field. So, we kind of sub-specialize into plastic surgery. So, a lot of basic things in general surgery are already covered at our training as well. So, I would say that we’re more reconstructive surgery than general, than we are cosmetic surgeons, although it doesn’t make for good TV, I guess.
Dr. Smith: Right. Okay, but the work that you’re doing is fantastic. Dr. Ramineni, is there… lastly just kind of in summary, is… what would you like people to know about beyond cosmetic, when it comes to plastic surgery?
Dr. Ramineni: I think the main thing is that there’s a whole host of things that we do that are not, what are we typically known for on TV, and those things, it’s worth exploring and kind of coming to a plastic surgery to discuss or at least calling the office to find, is the service to perform, but I think a lot of people are surprised how much overlap we have with other fields. And they just kind of discount it, thinking, “Oh, you know what, I can’t do this. It’s just for the wealthy. It’s just something that I’d have to pay out of pocket.” Even things with breast reductions, I do 15 to 20 breast reductions a month, and patients always think it’s a cosmetic operation where you have to pay out of pocket. If they have pain and we can meet a certain criteria, the vast majority of breast reductions can be covered through insurance, but I think it’s worthwhile for patients to kind of explore it and to look into plastic surgeons to see if they take insurance, and then many problems are actually covered procedures that most patients don’t know about.
Dr. Smith: Well, Dr. Ramineni. I’m going to thank you for the work that you’re doing and thank you for coming on the show today. You're listening to the GW Healthcast. Please visit GWDocs.com to get connected with Dr. Ramineni or another provider, or call 1-888-4GW-DOCS to schedule an in-person or virtual appointment.
This is Dr. Mike Smith, thanks for listening.
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