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The Story Behind The Surgeon

Dr. Cassileth's Story

Dr. Lisa B Cassileth, Beverly Hills Plastic Surgeon

How did you decide to become a surgeon?

Growing up, I had a medical issue that required me to have surgery on my jaw. I was extremely nervous and reluctant to go through with the procedure but upon returning to school, I remember feeling elated and being thrilled with the results. Having this surgery changed my life and ultimately led to my decision to become a plastic surgeon.

In college, I initially studied architecture but quickly realized I could incorporate my artistic passion and simultaneously impact lives by becoming a plastic surgeon. The spatial skills I gained from studying architecture combined with my interest in the transformational power of cosmetic and reconstructive procedures allowed me to embark on the most rewarding career I could imagine: helping patients change their lives through surgery.

How did you become interested in aesthetics?

Upon deciding to become a surgeon, I was originally interested solely in reconstructive surgery, the ability to make people normal again. As I progressed in the field, I realized how many of the skills I gained also applied to cosmetic surgery. Certain cosmetic surgical work requires a solid reconstructive background and extensive surgical experience; having a background in reconstructive surgery is invaluable to being a successful cosmetic surgeon. Cosmetic surgery is rewarding because a patient usually has something holding them back from living their life fully. By removing that small part of their insecurity, you truly reveal the person.

During my first six months in reconstructive surgery, a woman came in with her daughter, a breast cancer patient. The patient's mother apprehensively pulled me aside, asking me to address her own physical appearance. She had a heavy brow and a large divot in her upper nose. She said this was making her feel old and ugly. She felt extremely guilty for being preoccupied with her own appearance while her daughter suffered from cancer. To address her concerns, I smoothed out her brow with Botox injections and straightened her nose with filler.

Three months later, I saw the mother and daughter in my office again. The breast cancer patient looked completely normal after her breast reconstruction and was feeling great. The mother had lost 20 pounds and was wearing beautiful clothing. She looked like a different person! She had taken the small improvement I had given her and allowed it to change her life.

What is your philosophy on plastic surgery?

Plastic surgery is different than other fields of surgery because every procedure requires a different approach. I do not adhere to a cookie-cutter approach for any procedure because every person is one-of-a-kind and every body type is different. For example, I don't have a “Cassileth technique” where I do every nose this way or every breast procedure that way. Every person has different goals and is proportioned in their own way. What I love about plastic surgery is that it never gets boring. Every patient and procedure are unique.

Why did you decide to focus on breast procedures, specifically breast reconstruction?

Of all the areas I work in, I have always felt that breast reconstruction has the most room for improvement. Even early on in my career, my surgical approach was markedly different from what other surgeons were doing, with clearly different results. I am constantly working on improving the standard of care in multiple areas of breast surgery. I think that the way breast reconstructions are done should be better--not just for my patients but for all patients.

Many plastic surgeons perform facelifts and rhinoplasties well. Breast reconstruction is complicated because it requires a marriage of reconstructive and cosmetic skills. I am passionate in my belief that breast reconstruction should have a pleasing cosmetic result as well. Why shouldn't you look like you've had a beautiful breast augmentation? Isn't it ok to say to a cancer patient, “you should expect a cosmetic result”? I firmly believe the standard of care should be: “It SHOULD look that good.”

There are certain techniques I have learned through reconstructive surgery including the use of internal bras and tissue matrixes to control the position of an implant and produce a pleasing cosmetic result. I have seen numerous patients who have had multiple prior breast reconstruction procedures that have failed because the surgeon neglected to consider the cosmetic aspects of the procedure. Combining the techniques of both reconstructive and cosmetic surgery provides great benefits and has allowed me to significantly improve the procedure.

The way I approach breast reconstruction should not be the alternative method. By collaborating with surgical oncologists, plastic surgeons can raise the bar for the standard of care and eliminate the need for patients to undergo multiple surgeries. One-stage breast reconstruction must become the normal standard of care. One in eight women have breast cancer; if breast reconstruction surgery results were visible and not covered by clothing, the procedure would be better refined by now. In reality, it is common for patients to have an unsatisfactory result and wear a big padded bra to deal with it and no one even knows. Most women don't sit around showing each other their breast reconstruction results.

There are many oncologists who refuse to do a mastectomy through the inframammary crease, (the natural crease under the breast where scar can be hidden). Instead, they make a long bilateral incision across the breast because it is faster and easier. It is in their best financial interest for oncologists to perform a straightforward half-hour surgery with a bilateral incision. They could perform multiple procedures like this every day. Turning a reconstruction into a tedious, multiple-hour surgery does not benefit them financially. There is no incentive for them to do a better job, but I want to ask them, “if you were a patient wouldn't you want a better result?”

Why did you choose to attend Penn Medicine?

Choosing Penn Medicine was an easy decision for me. My father attended medical school there and my sister went to Wharton (the business school at the University of Pennsylvania). Penn Medicine is the oldest medical school in the country and it has a phenomenal program that I knew would give me the knowledge and experience I needed to excel.

What is your most memorable moment with a patient?

About a year ago I was contemplating cutting back on work to spend more time with my family. A breast cancer patient came to me after consulting with another doctor who told her the only solution for her would be to have tissue expanders inserted and both her nipple and areola removed. I was able to perform a one-stage reconstruction procedure on this patient and spare her nipple and areola with minimal scarring. After surgery, this emotional patient cried, “I don't understand, this is so unfair for women everywhere! If I hadn't found you, where would I be right now? I would look terrible.” Patients like her drive me to continue my focus on breast reconstruction.

One of my guiding philosophies is: if there's a way for me to do something better, I will do it better until there's nothing new to be done better. Now, I have a procedure that works. If there is a way to do it better, I will find it and do it.

It is imperative that patients to speak up and ask questions to their surgeon. It requires hundreds of patients asking hundreds of questions to eventually change the tone of the industry and ultimately raise the bar for breast reconstruction results.

If you weren't a plastic surgeon what would you be?

I would be an architect or a landscaper. I spend hours outside until I lose myself in my garden. I love that. I drive by a garden store with my husband and I say, “Ooh ooh!” and he says, “please don't make me go in there!”

Who is your hero?

This is a difficult question to answer because my heroes have changed throughout my life. For the last decade, I have been very inspired by women who have chosen to pursue careers in industries that are typically male dominated. I highly admire Barbara Walters. She has paved her own road in the media world and has often been referred to as one of the most powerful women in media. Her response to this praise is giving credit to the editing process and not herself. In an interview with Nikita Khrushchev, Walters shocked viewers by asking the Russian politician if he had ever ordered someone's death. By asking this brave question, she risked her reputation and career, but she felt it was a necessary risk to take. Her determination and drive are qualities I find admirable and emulate in my own life.

What is your favorite pastime when you are not working?

When I am not working, I spend time at home gardening and doing projects with my three children. My daughter and I recently found some extra plywood and decided to construct a dollhouse for her American Girl doll. It is three floors and literally 6 feet tall! We just started working on little details in the stairwell, and I find myself getting carried away with the whole thing. We are having a great time; I am always doing tons of fun projects around the house.

How did you get where you are today?

After my residency, I planned to work at an institution because starting out, it is difficult to establish yourself as a surgeon without the credentials of an institution behind you. I was offered jobs at different institutions but they did not appeal to me for various reasons. I decided to consider the west coast. When I first applied for jobs in Los Angeles, I was warned I would not succeed there because it was too competitive and a male-dominated city. People told me there were no women practicing in Beverly Hills because there was no demand from patients. This inspired me to prove everyone wrong and I became determined to go into private practice in Beverly Hills.

I am the current Chief of the Division of Plastic Surgery at Cedars and I teach at UCLA, in addition having my private practice. My private Beverly Hills plastic surgery practice is my biggest accomplishment because it gives me freedom to focus on my patients and independence to hire surgeons and promote people I believe are the best. Being in private practice has allowed me to fund a breast center and granted me the ability to raise the standard of care for patients. I am determined to make even greater strides in the future to improve the field and ultimately the lives of all patients.

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