A young adult recently posted this question to a web forum:
I am 24/F and I was wondering if anyone has had reconstructive or cosmetic surgery to repair the scar from having pyloric stenosis as a baby?
And this is the reply she got from the forum doctor:
No, and I referred many infants to pediatric surgeons for this. I must confess that even 24 years ago the incision to repair this was quite small, and the scar hardly noticeable. You must be a very rare exception to have a scar so prominent that you want it revised.
Having had the same surgery as a baby and read the online blogs and comments of hundreds of others who have also grown up with a prominent scar they didn’t like, I certainly had no difficulty identifying with the questioner and what must have prompted her inquiry.
I was (frankly) rather unhappy with this off-handed and cold response. I have encountered its like before, and tried in vain several times to post a Comment of my own to exchanges on the Forum site where I read the above. Some medical pros can be “Great Gatekeepers”!
What is it about pyloric stenosis (PS) surgery that makes some of its “survivors” want to ask about corrective or cosmetic surgery?
And why is it that some medical workers are so dismissive about somebody asking an honest and clearly heartfelt question?
Cosmetic surgery for what?
Some who have had infant surgery are badly done by despite the fact that they and their parents were saved from a tragic and traumatic death.
I won’t detail here that so many parents still in these “advanced” times complain about being fobbed off by their doctor as being incompetent nursing mothers or fussing parents – only to be told a few days or weeks later that their baby was saved by surgery only just in time, at the very door of death.
Nor will I explore now the complaint by a very few parents that their surgeon was not careful enough, or that some surgeons tell their patients their job is to save life, not to do cosmetic surgery.
The fact is that judging by recent blogs, website comments and photos, even today (let alone 25 years ago), some infant surgery for at least PS (and no doubt for other conditions as well) was not skilfully done.
We must also remember that like a newborn baby, every scar takes on a life of its own: it may be affected by infections, suture and skin ruptures, and hernias that sometimes develop immediately. Some scars develop in unsightly ways because of poor or unfortunate wound repair, adhesions under the wound, and later weight gain (for which we must take at least some responsibility). All this is not the surgeon’s doing.
Let me just convey the reflective feelings of at least some of the many little infant surgery patients.
We grew up literally marked for life by something of which we have no memory, about which we could not be consulted, which deeply affected our developing self-image, and which was all too often never adequately explained to us. At least some of us were sub-consciously affected for life by trauma: by too many days or weeks of starvation that had a lasting effect on our development, by infant surgery that by current standards was crude, quite possibly performed without good anesthesia, and involved long separation from our parents (including nursing). During childhood and adolescence especially, some of us are (or were) very sensitive and self-conscious about our bodies, and many parents (like mine) had no idea about how to manage this as well as they could; some parents added to rather than reduced the damage done to their children.
Personal example and confession
It may surprise some readers that although my PS scar is about as tidy as it could be considering 1945 techniques, I spent years trying to modify and improve its appearance. I realize even more today than I did at the time that my efforts were also in part self-discovery, a coming to “own” my surgery, and to a degree some frustrated or angry self-harming.
Some PS survivors who have had other surgery later in life have commented online that the scarring from the later surgery does not bother them but the scar from their infant surgery does. I identify with this and find it telling. First, as explained above I was not an aware participant in my infant surgery. Second, because my scar is front and centre (not, say, on my back or feet) and I am a sensitive soul, it got caught up with my self-image and self-confidence.
I’d like to think that my parents could have helped me to unravel these issues as others have, but seeing one or two of my family struggle with their own sensitivities, I also grant the job may have been too much for my folks even if they had tried! So it took me years to work through this area alone. The advent of the web has been a huge breakthrough – swapping stories and images has broken down the feeling of “being different”.
Several of my co-PS-survivor correspondence friends have felt the need and had the funds to have corrective surgery. I wonder if they were aware of similar undercurrents, or have identified them since? And I wonder how many doctors have never come across such people as their patients?
So why dismiss a patient’s heartfelt question about cosmetic surgery?
Having interacted with people all my working life, I am quite aware that I don’t always “read” people with as much awareness, sensitivity and wisdom as I should. Whenever I am aware that this has happened, I go through yet another personal or wider review process. I want to learn. We all do.
Might these comments I have gleaned from the web explain the thinking of the well-meaning doctor I quoted earlier?
- “My work is to save lives, not to cater to patients’ narcissism.”
- “I am a general (or pediatric) surgeon, not a plastic or cosmetic surgeon.”
- “People should “get a life”, “move on” and be grateful for the scar that is part of their survival.”
- “PS surgery is really minor compared with many other conditions which need infant surgery. The same is true of the scar, even if it’s not pretty.”
Having written this blog, let me add that it seems that many people who have had PS or other infant surgery are able to ignore or forget they have had it. They tell us they have not been affected by the trauma that can and does accompany early surgery for some of us. They would also have a more confident and extroverted nature and/or have profited from excellent parenting that has helped them to understand, accept, embrace and even feel pride about their story and its “lifeline”.
My word to people who would like to know whether scar revision is a good idea for them?
- Damage from surgery cannot be totally eliminated, and in many cases these scars are hard to improve upon.
- In cases where weight reduction is a factor, many abdominal scars can be removed together with other excess tissue, and the scar from this surgery can indeed look better than the present appearance. It can often be well hidden at the lower part of the abdomen.
- When the scar from the incision has widened due to poor healing or when it is has become sunken, it can often be improved by good cosmetic surgery.
- Keloid scarring is usually better left alone.
- Before you consult a doctor, do your homework: read, discuss, interact and perhaps message others who have had scar reduction done. Facebook and websites like MedHelp and Topix have many comments of good value. Contact me if you cannot find these.
- If your doctor or specialist dismisses your request or inquiry without giving satisfying answers to your informed questions, consider getting a second opinion, or just look for a better doctor.
If you have questions, stories or comments on this subject, please post and discuss them here or at one of the other addresses I have mentioned. This is not an issue for everyone, but it is for some and it’s worth airing.