“We are seeing an increasing number of breast cancer patients with augmentation,” said Robert R. Kuske Jr., M.D., clinical professor at the University of Arizona Health Sciences Center and radiation oncologist at Arizona Oncology Services in Scottsdale, Ariz. “By nature, these women are concerned about their appearance and we need to have options for them.”

According to the American Society of Plastic Surgeons, breast augmentation is the most popular cosmetic surgery in the U.S. with 347,500 procedures performed in 2007. This represents an increase of 64 percent since 2000.

Approximately one in eight women who undergo breast augmentation will develop breast cancer at some point in their lives.

The most common breast cancer treatment for patients with breast implants is skin-sparing mastectomy and implant exchange. Whole-breast radiation therapy after lumpectomy is an option, but carries a substantial risk during the healing process of scar tissue wrapping around the implant, causing it to become rock-hard and extremely painful. This condition, known as capsular contracture, also distorts the appearance of the breast.

Dr. Kuske set out to determine if partial-breast radiation with brachytherapy might offer a better outcome for women with implants wishing to avoid mastectomy.

Breast brachytherapy is a radiation treatment that can be given in higher doses to a small, targeted area of the breast after lumpectomy. Radioactive “seeds” are guided into place through small plastic tubes, or catheters, with the aid of imaging and a computer. The seeds emit high doses of radiation in short bursts.

Scar tissue is minimal, the implant remains unaffected and treatment time is shortened from 6 1/2 weeks with whole-breast radiation therapy to five days with brachytherapy.

For the study, 65 women who were diagnosed with small, early stage malignant tumors were treated with brachytherapy after a lumpectomy. The women received two doses per day, separated by six hours, over a five-day period. Follow-up was six months to five years. None of the patients experienced tumor recurrence during the follow-up period. Cosmetic outcome was determined to be good to excellent in 100 percent of patients with 95 percent judged excellent. Implant hardening was not observed in any of the patients.

“Compared to traditional treatments, brachytherapy offers an excellent alternative for these women,” Dr. Kuske said. “It offers very high rates of tumor control with fewer side effects and is easier on their lifestyle.”

Notes:

Disclosure: Dr. Kuske is a consultant for Nucletron and for Cianna Medical.

Copies of RSNA 2008 news releases and electronic images will be available online at http://www.RSNA.org/press08 beginning Monday, Dec. 1.

RSNA is an association of more than 42,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (http://www.RSNA.org)

For patient-friendly information on brachytherapy, visit http://www.RadiologyInfo.org

After undergoing a mastectomy (surgical removal of the breast), many women choose to have a breast reconstruction procedure performed immediately to better cope with the psychological and esthetic side effects of the surgery. However, the reconstruction can complicate radiation therapy treatments and sometimes radiation can negatively affect the outcome of reconstruction and increase the risk of long-term complications.

With radiation therapy increasingly becoming the standard of care for high-risk breast cancer patients after mastectomy, this can cause a problem for both patients and their radiation oncologists.

Researchers at the Department of Radiation Oncology at Long Island Radiation Therapy in Garden City, N.Y., the Department of Surgery at Long Island Jewish Hospital in New Hyde Park, N.Y., the Department of Surgery at North Shore University Hospital in Manhasset, N.Y., and the Department of Surgery at Winthrop University Hospital in Mineola, N.Y., sought to determine if the type of reconstruction performed on women who were receiving radiation after a mastectomy had an impact on their long-term outcomes.

Two types of reconstruction are available for patients undergoing mastectomy for breast cancer: ATR (autologous tissue reconstruction), which involves the placement of a tissue flap - most commonly from the transverse rectus abdominus muscle - as a breast mound, and TE/I (tissue expander and implant reconstruction), which involves placing an inflatable tissue expander over the chest wall and exchanging it for a permanent implant at a later date.

This study involved the largest reported series of patients who sequentially underwent mastectomy, immediate reconstruction and postmastectomy radiation therapy. Ninety-two patients were observed for 38 months following their reconstruction and radiation treatments, and researchers found that ATR is better tolerated by breast cancer patients because it is associated with fewer long-term complications and better cosmetic results than TE/I.

None of the 23 ATR patients required surgical intervention, while 33 percent of TE/I patients needed surgery to correct a problem with their reconstruction. Eighty-three percent of ATR patients reported acceptable cosmetic outcome, as opposed to only 54 percent of TE/I patients.

“This study is useful for patients who are candidates for either ATR or TE/I and are making a decision with regards to reconstruction technique,” Jigna Jhaveri, M.D., lead author of the study and a radiation oncologist at Advanced Radiation Centers of New York in Hauppauge, N.Y., said. “Our study provides evidence that patients who undergo autologous tissue reconstruction and radiation therapy have fewer long term complications and better cosmetic outcomes than those who undergo tissue expander/ implant reconstruction and radiation therapy.”

ASTRO is the largest radiation oncology society in the world, with 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on ASTRO, visit http://www.astro.org. Visit http://www.rtanswers.org to learn more about radiation therapy.

Researchers led by Gedge Rosson, an assistant professor of plastic surgery, analyzed data on 17,925 black and white women who had a mastectomy between 1995 and 2004; 27.9% of the women had breast reconstruction immediately after their mastectomy. The researchers also analyzed data on the communities where the women lived. Researchers found that being older, living in inner cities with high black populations and having a high school education or less all were factors indicating likeliness to not have reconstruction surgery. Wealthy women, those with more education and those who did not live in inner cities were more likely to have immediate reconstruction surgery, according to the study.

Researchers noted that even white women living in poor black neighborhoods were less likely to undergo the procedure. Rosson said, “The community a patient lives in actually does influence, in some way, the access they have to breast reconstruction. We need to learn more about why that is.” He added, “People have noticed that African-Americans have fewer referrals to plastic surgeons, and if they do have a referral, they have a lower rate of going to those referrals. Strangely, even once they see the plastic surgeon, reconstruction seems to be offered with less frequency.”

Researchers believe that more education programs are needed to inform women of the benefits of breast reconstruction and a particular emphasis is needed in racial and ethnic minority communities .

The study is available online.

Reprinted with kind permission from http://www.kaisernetwork.org.

Unlike common over-the-counter and prescription medications, cosmetic injectables do not have lower-priced generic alternatives. “FDA approved, branded cosmetic drugs or devices are sold to all physicians at defined prices,” said Coalition leader, plastic surgeon Renato Saltz, MD of Salt Lake City, UT. “There are generic lower, priced brands, no sales for physicians who stock up on injectables and no bona-fide sources who sell genuine product at lower than market prices, and therefore there are no deep discounts physicians can pass along to consumers.” Some injectable brands do, however, offer post-treatment rebates directly to the consumer. The Coalition warns consumers that deep discounts or savings can potentially risk:

- Counterfeit or illegally imported substances, resulting in potential health risk, injury or serious complications
- Illegally compounded and unbranded substances, resulting in potential health risk or injury, and unpredictable outcomes
- Diluted or improperly administered substance, potentially resulting in little or no outcome, a poor outcome, or a short duration for results obtained
- Bait and switch, or pressure to elect additional or unnecessary procedures
- Unqualified providers, lowering prices to create demand, and potentially risking poor or undesirable outcomes

Consumers can find average U.S. costs for cosmetic injections listed by U.S. FDA approved brand at http://www.injectablesafety.org/html/ataglance.php.

The Coalition, charged with educating consumers on safe choices in cosmetic injections and eradicating the use of counterfeit and illegally imported cosmetic injectables suggests all consumers follow very cautious steps for both safe, and positive outcomes:

- Doctor: Ask specifically about your doctor or injectors qualifications. Choose a doctor who specializes in treating all cosmetic concerns of the face, such as a board certified plastic surgeon, facial plastic surgeon, oculoplastic surgeon or dermatology and who examines you, prescribes and performs cosmetic injections in a licensed and properly equipped medical facility. Establish a positive and on-going relationship with your doctor and follow-up as directed. A nurse or physician’s assistant may perform your injection if you elect, but a licensed physician must prescribe the treatment.

- Brand: Ask specifically the brand name of the injectable recommended for you, the approval status of regulatory agencies in the country where you will be treated (the U.S. FDA in the United States) and about any potential outcomes and the likelihood of adverse events. If your doctor does not offer, ask specifically to see the packaging and identifying marks that can verify authenticity, including the serial and lot number (which as a matter of proper procedure must be recorded in your medical chart). For reference, images of all U.S. FDA approved brand logos and packaging are available at. http://www.injectablesafety.org/html/ataglance.php.

- Safety: If you suspect your injector is not properly trained, is not following proper procedure or is injecting you with a non-branded, non-approved or unsafe substance, do not accept treatment. Follow-up by anonymously reporting suspected illegal activity to your local FDA field office that can be found at http://www.fda.gov/consumer/updates/oci072307.html.

To learn more about the benefits of cosmetic injections, the uses for approved cosmetic injectables, to plan for your treatment, see video of live, appropriately administered injectables and more visit http://www.injectablesafety.org and http://www.realself.com/injectable-safety-campaign.

The Physicians Coalition for Injectable Safety is an alliance of specialty physician organizations including the American Society for Aesthetic Plastic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, the American Society of Ophthalmic Plastic and Reconstructive Surgery, the International Society for Aesthetic Plastic Surgery and the Canadian Society for Aesthetic Plastic Surgery. The mission of the Coalition is to provide the public with unbiased and necessary information on injectable cosmetic treatments, appropriate injectors and where to safely access cosmetic medical procedures. Our goal is to promote treatment supervised by properly qualified and trained, board-certified doctors and to promote only the use of U.S. FDA-approved, appropriately administered product.

Physicians Coalition for Injectable Safety

The program provides hands-on demonstration of non-surgical techniques for facial rejuvenation using the latest advances in facial-shaping agents, and emphasizing the use of combination injectable products. Videotaped sessions will illustrate methods for facial assessment, describe how facial anatomy changes with aging, and provide insight on selecting the best agents and techniques for specific patient issues.

Drs. Weinkle, Bhatia, and Werschler share their clinical expertise in combining injectable facial products to obtain optimal results. Using patients of various ages, they demonstrate optimal techniques for the injection of facial-shaping agents, including calcium hydroxylapatite (Radiesse(R)), collagen (Evolence(R), CosmoDerm(R)), hyaluronic acid (Juvederm(TM) Ultra, Restylane(R), Perlane(R)), and poly-L-lactic acid (Sculptra(TM)).

Ashish C. Bhatia, MD, FAAD is Assistant Professor of Clinical Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. An accomplished dermatologist, Dr. Bhatia has extensive experience in dermatology, dermatologic surgery, and cosmetic surgery. His expertise includes face and body aesthetic surgery, skin cancer therapy, Mohs Micrographic Surgery, laser surgery, and skin resurfacing procedures, as well as the treatment of common and rare skin conditions.

Susan H. Weinkle, MD, FAAD is board certified in dermatology, a Fellow of the American College of Mohs Micrographic Surgery and Cutaneous Oncology, and a Diplomate of the American Board of Dermatology. Dr. Weinkle has been in solo practice since 1984, specializing in Mohs Micrographic Surgery and cosmetic dermatology. She has held academic appointments at Stanford University Hospital, the University of California Irvine Medical Center, and most recently, at the University of South Florida.

Wm. Philip Werschler, MD, FAAD, FAACS, Assistant Clinical Professor, University of Washington School of Medicine, Seattle, Washington, is a past president of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS), a Fellow of the American Academy of Dermatology (AAD), and a fellow of the American Academy of Cosmetic Surgery (AACS). Dr. Werschler has been an active leader his entire professional career in the development of selected cosmetic techniques and procedures for the concept of Non-Surgical Total Facial Rejuvenation (NSTFR), as a foundation for minimally invasive cosmetic renewal.

This CME online activity is jointly sponsored by Postgraduate Institute for Medicine and BioCentric, Inc. and is supported by an educational grant from Dermik Aesthetics and sanofi aventis.

Learn more about the latest in cosmetic treatment and view a preview for this program by visiting: OR-Live.com

A 70-minute demonstration on the evaluation and cosmetic treatment of the face.

OR-Live, Inc.

Embracing that adage, “Personal care begins with hair,” consumers now spend almost $60 billion annually on hair care products, one of the personal care industry’s largest market segments. Despite the increasing availability of new hair care products within the past century, many products are inadequate for tackling today’s rigorous hair treatments, the researchers say.

“Given all the new hair treatments out there, there’s a growing need to make hair feel more natural, especially for women,” says study co-author Eva Max, a doctoral student in chemistry at the University of Bayreuth in Germany. She notes, however, that researchers still are scrambling to put hair care on a firm scientific basis. The research involves “haptics,” the science of touch - how the subjective perception of touch connects to objective surface properties of hair and other materials

“For the first time, we present an experimental setup that allows measuring the subtle forces, both physical and chemical, that arise when single hairs slide past each other or are pressed against each other,” Max says. “The findings will help provide clearer strategies for optimizing hair care products.”

Max points out that conventional methods for testing the effectiveness of hair care products involve measuring the forces required to comb hair under standardized laboratory conditions. Test volunteers are also asked to assess hair feel, but this approach is largely subjective. A more scientific way to study hair conditioning is needed, the researchers say.

In the new study, the researchers invented a unique technology for analyzing hair that involves mounting individual hair fibers on a cantilever tip of an atomic force microscope and measuring their interactions as they touch each other. “The system will allow scientists to explore how different hair care products affect hair-to-hair interactions so that these products can be optimized in a more systematic fashion,” Max says.

The researchers used this new technique to analyze hair samples collected from volunteers. The samples, which were previously bleached, ranged from light blond to dark blonde in color.

The researchers found that hair feels rough and difficult to comb for two main reasons. On the one hand, mechanical damage to a hair’s surface, or cuticle, creates scaly projections that jut out at perpendicular angles to other hair fibers. When hair fibers slide past each other, these scales create more friction than smooth hairs, causing a rough feel and making hair more difficult to comb. To soften hair, conditioners must contain active agents to smooth-out these scales so that they produce less friction, the researchers say.

On the other hand, chemical changes occur when hair fibers interact. Negative charges build up on the surface of hair that causes repulsion between single hairs. This repulsion causes friction and makes hair rough and difficult to comb. To solve the problem, positively-charged polymers that neutralize the negatively charged surfaces are included in conditioner formula to provide a silky feel to hair.

But finding the right formula for repairing damaged hair is no easy task, notes Claudia Wood, Ph.D., a senior scientist at BASF in Bayreuth, Germany. In addition to hair interactions, many other external factors, such as humidity, water content of hair, and hair stickiness, all affect hair quality, Wood says.

The key to repairing these processes is to find the right ratio of beneficial components in a conditioner or shampoo that optimize hair feel, Max and colleagues say. This new method will allow developers of hair care products to achieve this goal more easily, giving consumers a more reliable product, the researchers say. Their study was funded by BASF Care Chemicals Division.
Charmayne Marsh
Michael Bernstein
American Chemical Society

More formally known as acne vulgaris, the skin disorder impacts almost all adolescents and is often a factor that leads to anxiety, depression, embarrassment and social dysfunction. Cynthia L. Chen, M.D. (University of California, San Francisco) and colleagues write that, “Reducing the psychosocial impact of acne is considered one of the guiding principles for its clinical management and it is important to measure and evaluate this impact.”

Results from this study come from an analysis of 266 teen volunteers with acne from four public high schools in San Francisco. Chen and colleagues administered written surveys to the students that asked them to answer hypothetical questions such as how much of their lifetime they would forgo or how much money they would pay:

• To have never had acne,
• To be 100-percent acne-free from then on,
• To have 100-percent acne clearance but with visible scarring, or
• To have 50-percent acne clearance.

The survey also included questions for parents regarding their acne history and severity. Since parents usually pay for children’s acne treatments, they were also asked about their willingness to pay.

With the teens’ responses to the time trade-off questions, the researchers calculated current acne state utility scores by dividing the participants’ reduced life expectancy in years without acne by his or her life expectancy in years with acne. The average utility score for a teen in his or her current acne state was 0.961. Scores improved to 0.978 for 100% clearance, 0.967 for 50% clearance, and 0.965 for 100% clearance but with scarring.

The median price that teens were willing to pay to have never had acne was $275. For 100% clearance of acne, they were willing to pay $100. The median price of 50% clearance would be $10, and of 100% clearance with scarring would be zero dollars. Parents had somewhat similar responses to the willingness-to-pay analysis, indicating a median of $250 for their child to never have had acne, $100 for 100%, $100 for 50%, and zero dollars for 100% clearance with scarring.

As expected, teens who believe their acne is more severe are willing to trade more time and money for acne clearance than those who rate their acne as less severe.

“Knowledge of these patient preferences may help dermatologists balance clinical trial results with patients’ expectations of therapy,” write the authors. “Randomized, blinded, placebo-controlled trials have shown that three to four months of conventional acne therapy, including topical benzoyl peroxide, topical retinoids and oral antibiotics, typically produces reductions in lesion counts in the 40 percent to 60 percent range.”

They add that, “It has also been suggested that the incidence of scarring from facial acne approaches 95 percent…Thus, adolescents’ marked preference for total clearance over partial (50 percent) clearance or clearance with scarring suggests that physicians must weigh high patient expectations against these clinical data regarding efficacy and risk of sequelae.”

In an accompanying editorial, written by Marta J. VanBeek, M.D., M.P.H. (University of Iowa Hospitals and Clinics), “Dermatologists are keenly aware of the ways skin diseases may have a substantial impact on a patient’s overall quality of life. However, in an environment in which health expenditures are allocated by non-physicians, it is critical to demonstrate the burden of skin disease relative to non-dermatologic disease to funding sources, government agencies and the lay public.”

“In terms of social value, preference-weighted questionnaires are instrumental in evaluating the extent to which increased health care expenditures lead to patient benefits because they incorporate a summary description of health status, social values and life expectancy,” concludes Dr. VanBeek. “Fundamentally, utilities measure true patient preferences, uninhibited by physician assumptions. Such measurement refocuses physicians on the primary goal of our profession: improving the care of our patients.”

A Community-Based Study of Acne-Related Health Preferences in Adolescents
Cynthia L. Chen, MD; Miriam Kuppermann, PhD, MPH; Aaron B. Caughey, MD, MPP, MPH; Lee T. Zane, MD, MAS
Archives of Dermatology (2008). 144[8]: pp. 988-994.
Click Here to View Abstract

Yesterday’s surgery was performed on a 65-year old Monmouth County man, who was left paraplegic after being caught in a gunshot crossfire several years ago. As part of the procedure, Dr. Elkwood and his team surgically removed nerves from the patient’s paralyzed legs to his chest and successfully relieved the acute pain caused by the pressure ulcers. Ultimately, the surgery is intended to stimulate sensation in the patient’s posterior.

Dr. Elkwood commented, “Our goal was to first fix the immediate problem, the pressure sores, and then attempt to fix the cause. We are extremely pleased with the initial results of the procedure and are therefore encouraged by the long-term potential for the surgery. Specifically, if this proves successful, it can be life-altering for tens of thousands of wheelchair-bound patients whose lives are subjugated by acute pressure ulcers and sores.”

Images available upon request.

About Dr. Elkwood

Dr. Andrew Elkwood, M.D., is a plastic and reconstructive surgeon who practices at The Plastic Surgery Center in Shrewsbury, NJ. He performs unique operations involving nerve transplantation and complex reconstruction. Dr. Elkwood is a pioneer in sural nerve grafting procedures, where he transfers nerves from one part of a patient’s body to another to treat life-altering injuries. He also uses this procedure to eliminate common side effects caused by prostate cancer removal, such as impotence and incontinence. Dr. Elkwood serves as the Chief of the Division of Plastic Surgery at Monmouth Medical Center in Long Branch, NJ, and is certified by the American Board of Surgery and the American Board of Plastic Surgery in General Surgery and Plastic Surgery. He is also a Fellow of the American College of Surgery (FACS) and a Fellow of the American Society of Aesthetic Plastic Surgery.

Plastic Surgery Center

“Health system strengthening must be a top priority for the new administration if 46 million uninsured US residents are to have access to health care,” say the writers of the editorial. “Obama’s plans to offer a range of payment choices, his commitment to ensure that all children have health insurance, and the requirement that insurance companies cover pre-existing conditions are positive steps towards an inclusive health system. In addition, Medicaid and Medicare must be rebuilt, reinforced, and fully supported.”

They add that, “It was encouraging to hear UK Prime Minister Gordon Brown say at last week’s international conference on the Social Determinants of Health in London that Barack Obama is committed to tackling domestic and global inequality.”

According to the editorial, Obama’s plan for global health must consider climate change, two ongoing wars, and trade relations. The writers propose six steps with which Obama can effect meaningful change:

1. “Health equity and human security should be a stated objective of foreign policy.”
2. “The DHHS Director of Global Health Affairs, Bill Steiger - who has badly hurt America’s reputation in global health - should be replaced with a more experienced and appropriate politician.”
3. “Mark Dybul, the head of PEPFAR - the President’s Emergency Plan for AIDS Relief, undoubtedly the biggest triumph of the Bush administration despite its controversies - will likely be swiftly replaced. Strong leadership from a respected international expert, such as Jim Kim, could help to negate PEPFAR’s dogmatic and damaging policies - for example, its preference for abstinence-until-marriage programmes.”
4. “Just as George W Bush reinstated the global gag rule - a law that forces recipients of federal funding to agree that they will not perform or promote abortion as a method of family planning - in his first day in office, Obama could reverse this decision as soon as he is inaugurated and so improve women’s access to sexual and reproductive health in a single stroke.”
5. “A public commitment to agree to spend the internationally agreed target of 0.7% of gross national income on aid by 2015 would set a good example to the international community.”
6. “As a signal that the USA is committed to human rights, Obama could bring the USA in line with most other UN member states by ratifying the UN Convention on the Rights of the Child and the International Covenant on Economic, Social and Cultural Rights.”

The writers also hope that Obama will not be as antagonistic towards the UN system as the Bush administration was.

“The choice of the next UN Ambassador is pivotal to improving these relationships, in health as well as in other domains,” concludes the editorial. “An increase in support - including financial support - for WHO would be a sign that the USA wishes to re-engage with the global health community. President-elect Obama is a reminder about what is great about the USA and that, indeed, ‘change can happen’. The fruits of that change will be judged by tangible improvements to the welfare and health of Americans - and those affected by American foreign policy.”

Obama and health: change can happen
The Lancet (2008). 372[9651]: p. 1708.
Click Here to View Journal Website

“Body contouring procedures for massive weight loss patients are major operations with large incisions in many areas that demand a lot of the body during the healing process,” said ASPS Member Surgeon and study co-author Dennis Hurwitz, MD. “By carefully monitoring nutritional deficiencies preoperatively and supplementing the patient with the necessary nutrients, minerals and vitamins, I have seen a significant decrease in complications and improved postoperative healing. In my practice, I won’t do body contouring procedures on this patient population without a preoperative regimen of nutritional supplements.”

The study was performed in two parts; First, medical literature regarding nutrition’s effect on healing from the 1940s to the present was reviewed. The authors then compared healing and wound problems in 75 of their massive weight loss body contouring patients from 2001 to 2005 who did not receive supplementation, with 37 patients from 2006 to present, who participated in a uniquely designed nutritional supplement program prior to surgery. The study also noted the role of each nutrient in wound healing and immune response.

The study found that complications and wound problems occurred in 66 percent of the 75 patients who did not receive supplementation before 2006. In the 37 patients on the nutritional supplement regimen after 2006, major complication rates were reduced to 19 percent. The study found specifically that improving nutritional deficiencies in massive weight loss patients improved the healing process, wound tension, and scar quality, in addition to increasing patients’ energy levels.

Because of reduced calorie intake for massive weight loss patients, they are highly susceptible to malnutrition, the study observed. At one year after bariatric surgery, most patients’ food intake remains at about 1,000 calories per day, not even close to meeting standard recommendations regarding calories and protein intake. The study also noted the role various nutrients play in wound healing: Protein, vitamins A, B complex, C, arginine, glutamine, iron, zinc and selenium promote wound healing, collagen production and immune response; Vitamin B complex has also been associated with reducing the risk of deep vein thrombosis.

According to the ASPS, nearly 67,000 body contouring procedures after massive weight loss were performed in 2007.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

American Society of Plastic Surgeons
http://www.plasticsurgery.org