Blending Science & Art in Breast & Body Surgery

Dr. Wu

CYNTHIA GREGG, MD
FACE & BODY SPECIALISTS

Dr. Cindy Wu, who specializes in breast and body surgery with Cynthia Gregg Face & Body Specialists in Cary, would likely agree that her work is the very definition of a blend of art and science.

Dr. Wu’s specialties, including breast augmentation and reduction, abdominoplasty, and body contouring, reflect the extraordinary technical skill—the science—required in her discipline. But she would also argue that aesthetics—the art—is of equal importance.

“The ultimate goal of the surgery that I do—in fact, the goal for any aesthetic surgeon—is to enhance the patient’s quality of life,” says Dr. Wu. “There is a powerful relationship between body image and overall health. So, addressing aesthetic body concerns has an enormous impact on patients’ self-confidence and self-esteem, which is hugely important for over-all health.   

In a conversation with Health&Healing, Dr. Wu reflects on how art and science entwine in her work and her life.

Health&Healing: You’ve suggested that it is the blend of art and science that led you to this work. What attracts you?

DR. WU: You could say that my own career is a blend of art and science. In college, I majored in biology and minored in fine arts. And my preferred media in art were photography and sculpture. I’ve always been intrigued by science, which led me to medical school, but the artist in me was still important. So, as I went through med school, I came to realize that cosmetic surgery was a perfect marriage of those two passions.

What’s both challenging and rewarding in my work is to understand each patient’s aesthetic ideal—not mine—but theirs. That’s the aesthetic part. Then the second part is trying to execute that plan. That’s where, in the operating room, I can really use my hands to recreate that aesthetic goal.

I really love my job. I can geek out on the nerdy science part of it. And then there’s the artistic part of it—the whole process of creating and molding tissue, So that’s my happy place, really, where I can do both of my passions.

H&H: Your artistic interests included sculpture. Would you consider your work sculpture?

DR. WU: It’s different in the sense that the “sculpture” is a shared art form—reflecting the patient’s goals and desires, rather than mine. The “sculpting” I do is to move and shape tissue in order to achieve the patient’s goals. That’s the technical part—the “science” if you like.

Perhaps the “art” in the plastic surgery I do is to make changes that fit each individual patient—to reshape tissue to the “right” size, shape, and contours for her anatomy, for her lifestyle, and for her stage of life. It’s such an individual process. So, in that sense, the “sculpting” I do takes many forms.

H&H: For example?

DR. WU: A common procedure is what’s called the “mommy makeover.” That term actually describes any combination involving both breast and abdominal surgery. There’s tremendous variety. It might include breast augmentation or a breast lift, combined with a tummy tuck. We may take fat removed by liposuction and use it to shape or slightly increase the breast volume. Or it could be implant removal in combination with a tummy tuck. In all these cases, the “sculpture” is a matter of moving and reshaping tissue.

I can’t emphasize enough how individual these surgeries are. They have to be, because they reflect the very specific needs, wishes, and bodies of the patients.

Explant surgery—to remove a patient’s breast implants—is a good example of this. Women have many reasons for wanting implants removed. And, whatever the reason, there are many different possibilities—depending on their anatomy—for meeting the patient’s goals. These might include implant removal alone, implant removal with a breast lift, or implant removal with a breast lift and fat grafting.

That’s the beauty in what I do. For all my patients, their goal is the same: they want their bodies to fit who they are now. How that goal is reached is different for each of them.

H&H: How do you accomplish that?

DR. WU: It’s a process. And one of the most important parts of that process is managing expectations. Among the most challenging—and the most rewarding—aspects of my work is the fundamental relationship with my patients. Yes, I bring an aesthetic perspective and certainly the technical expertise to the task of ‘body sculpting,’ but I never lose sight of my essential job—which is to meet the patient’s individual goals and needs.

And, at the heart of a successful surgery is a shared understanding of those goals and shared expectations about what’s possible and desirable. So, you could say that managing expectations is an essential part of my work.

My responsibility is to understand the goals—the needs and wishes that brought a patient to the point of seeking body surgery. I need to understand their concerns, their lifestyle issues, their questions—everything that motivates and affects them.

And then I need to help them understand their options, risks, and any limitations on achieving those goals. Typically, this is an educational process—one where the patient comes to develop a clearer picture of exactly what they want.

This is where we come together with a shared goal. For example, one common scenario is the woman who comes in wanting breast augmentation with implants, and wanting a larger cup size than her anatomy can support. My job is to help her understand not just what’s technically possible, but what’s aesthetically balanced and appropriate for her anatomy.

One of the most useful tools in this process is 3D imaging—showing before and after photos from other patients with similar bodies. And, what often occurs is that the patients will realize that the original idea of what they wanted doesn’t actually result in the body image they desire, and that a different goal will produce the desired outcome.

H&H: What other unrealistic expectations do you encounter from prospective patients?

DR. WU: A common one is when some someone comes in wanting a tummy tuck, with the goal of achieving a very flat “washboard” abdomen. But in some cases, where the abdominal fat is visceral fat, that’s not physically possible. That’s because a tummy tuck will only remove the skin and the fat above your muscles. Visceral fat—fat around your organs—cannot be removed, and the abdomen will not likely be as flat as you might wish.

Some unrealistic expectations are aesthetic, such as when a woman has a distorted image of certain breast size on her body. But in the case of removing visceral fat, it’s simply a matter of anatomical limitations.

A similar example is when someone comes in thinking they want an implant, but it turns out that a lift would be aesthetically more appropriate. That’s a common misunderstanding: that you can lift the breast by placing an implant. At most, an implant can lift the nipple maybe half a centimeter to a centimeter. And most women who come in with sagging breasts need more of a lift than that.

So, when you put an implant into a patient whose breasts are sagging, what happens? The implant is more weight on the breast tissue; and gravity will always win. So, the result will just be a larger droopy breast instead of a droopy breast.

That’s why the initial consultation process is so important. Ultimately, there need to be shared, realistic expectations about what’s aesthetically desirable and technically possible.

H&H: What kinds of constraints or limitations are there for people at different ages?

DR. WU: There’s no question that age is a factor. And the loss of skin elasticity is probably the number one issue in older patients. In terms of longevity, for example, a breast lift in an older patient with poor elasticity may not last as long as one in someone who’s younger who has better elasticity.

Another thing we have to consider is that as you get older, you generally have more medical problems. So if you’re not medically fit for surgery, then you might not be a candidate for elective cosmetic surgery.

I also find that when women go through menopause, they have a harder time maintaining their weight—not just losing weight. In fact, that issue is what brings a lot of women in for body contouring, because although they’re maximizing their diet, and maximizing their exercise, they just can’t get rid of extra skin and extra fat. So that’s when they come in for a tummy tuck. But, unless there’s a prohibitive medical condition, I don’t tell people that they’re too old for surgery. Because it gets back to the fundamental purpose of the work that I do—to enhance quality of life. And there is a powerful relationship between body image and overall health. So, if you’re medically fit, you can probably have surgery, and you might be a better candidate than an obese 50-year-old patient with diabetes and hypertension.

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