When no available option is good enough, make a new option. So says Dr. Bob Allen, the New Orleans-based, South Carolina-born plastic surgeon who reconstructed surgical breast reconstruction. While some of his colleagues were muddling through the post-operative minefield of the old method, Allen was inventing the industry's current gold standard.
Before he modified the procedure that was current a decade ago, women seeking breast reconstruction risked lasting consequences in the aftermath of their operations. Surgical options were few, and the drawbacks were evident.
"Ten years ago, the options that women had for breast reconstruction were essentially either to have silicone implants or to have a muscle-flap transfer, usually from the lower abdomen or the back," he says. "The problem with implants for reconstruction are well-known: foreign material; the body tries to reject it; its hard, painful: doesn't match the other breast often. Then, to take a muscle flap - where you take muscle from, say, the abdomen - it can have a severe consequence on the abdomen. You're missing that muscle, so you have weakness, frequent hernia, bulge, chronic pain. It's a high price to pay."
Unwilling to have his patients settle, Allen, currently the chief of plastic surgery at Memorial Medical Center and LSU Medical Center, went to work on a new method. He started thinking of ways to form a natural, permanent breast without the damage of a muscle transfer. After extensive research and experimentation, he found an easier way to get the tissue from the abdomen or the thigh or the buttock or the back.
"I figured out through anatomical dissections on the cadavers that it could be done without taking the muscle, lifting only the skin and fat, which is essentially what the breast is made of," he says. "I started doing those procedures first at Charity Hospital, and then I brought them into other hospitals and teaching centers."
When his procedure caught on in the medical world, Allen became the Christopher Columbus of surgical breast reconstruction. He had successfully eliminated the shortcomings of the old transfer method, in effect pioneering a much healthier path to the same result. Patients and doctors alike embarked on pilgrimages from around the world to benefit from his developments.
"They've become accepted around the world now as kind of the state of the art. Some people will want to go to the source," he says in explanation of his global following. "The world is smaller and smaller in terms of travel and people don't think as much about traveling. It's a major decision to have a reconstruction of a breast." he says, "so when they look at the big picture of just buying an airplane ticket, doing something significant to their body makes travel less of a decision."
Something of a world traveler himself, Allen still credits New Orleans with providing an environment that fosters creativity, a necessary skill in plastic surgery. "It was kind of like a gumbo. I had the right mix. New Orleans, with the music and everything, it's just kind of a creative environment, in my opinion," he says. "I really think that that particular environment appealed to me.
"I think it would have been much more difficult, for instance, if I was in New York or Boston or L.A. or something. They're a lot more conservative, surgically restrictive," he says. "I like New Orleans music. We always listen to New Orleans music in the operating room."
For his lasting contributions to medicine here and abroad, Allen is truly one of New Orleans' top doctors.
"You can make a natural breast, yet the patient can still be active: they can exercise, run marathons, have a quicker recovery, less pain, shorter hospitalization. So it appeals to the women," he says. "Now they've got a much better choice." -G.W.
New Orleans Magazine Volume 36, Number 11, August 2002