David B. Reath, MD
Knoxville, TN (865) 450-9253
HKB Knoxville Staff

Moving Plastic Surgery Forward: 2 Big Changes I’m Applying Now

evidence-based-medicineOne of the major initiatives in all of medicine is to make better decisions, not that we are currently making poor decisions. There is always a tendency for physicians to continue to do the things they have done, because that’s what always has worked for them. The thought being, it ain’t broke, so why should I fix it? And many times this can be a fair argument. The only problem is that this does not allow for advances or beneficial changes in how we practice medicine.

Recently I have made two major changes based on the scientific evidence presented at our annual meeting of the American Society of Plastic Surgeons. And, for both of these, it meant changing a practice that was not necessarily broke, so to speak. These changes involve the use of antibiotics and the use of drains.


Change 1: Fewer Antibiotics Are Better
For most of my operations, antibiotics are being used prophylactically, that is to say to prevent an infection from occurring (as oppose to therapeutic use where an existing infection is being treated). I used to prescribe several days or even a week’s worth of antibiotics for many of my procedures. Not any longer.

The evidence shows that there is no benefit to prophylactic antibiotic after 24 hours following surgery. So, if you are having an operation, you get 3 antibiotic pills, not 21. And, yes, this has prompted some calls from pharmacies. But the issue is that after 24 hours such antibiotic treatment can become detrimental because it suppresses normal bacteria in and on our bodies and could allow more virulent bacteria to set up shop and grow. Things like Methicillin resistant Staphylococcus aureus, a.ka. MRSA.

(If you have had an operation in the past and were given a longer course of antibitotic, no worries. Any danger of changes in the bacteria in and on your bodies has long since passed.)


Change 2: Drains Become The Exception
The other change I have made is to stop using drains in many operations. Specifically: breast reductions, tummy tucks and facelifts. Very good evidence shows that drains are not necessary for these operations with just a small change in how they are performed. This small change in the way I now do tummy tucks results in a big benefit to patients – not to have to mess with these drains is tremendous and well worth it. Drains are frequently one of the major concerns patients have about surgery.


Applying Evidence Based Medicine to Plastic Surgery Procedures
Both of these changes are the result of what is commonly referred to as “evidence based medicine,” where we rely on valid scientific evidence for the basis of our decision making. It’s fairly easy to conceive of this in how drugs are used in chemotherapy to treat cancer. You rely on a trial or study where compared different treatments were compared to find out which was most successful.  Such a decision is clearly based on the science, based on the evidence.

This is a little more difficult when it comes to aesthetic or cosmetic surgery. Here, as much as anywhere in medicine, are practicing the “art” of medicine as much as the science of medicine. Yet, there is some scientific evidence that can guide some of our decisions. And many of us who practice aesthetic surgery are doing our best to rely on such evidence when and where we can.

As plastic surgery moves forward, there will be other changes that should be made based on new areas of study or research. I believe it is important for aesthetic surgeons to keep open eyes and open minds to such changes. Ultimately it will be what’s best for our patients.

All the best,

Dr. David B. Reath



David B. Reath, MD

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