WEBVTT NOTE This file was generated by Descript 00:00:11.326 --> 00:00:11.897 Heather Ly (Host): Hi there, everyone. 00:00:11.897 --> 00:00:15.574 Thanks so much for joining us for this latest episode of Medically Speaking. 00:00:15.574 --> 00:00:17.075 Joining me today is Dr. 00:00:17.075 --> 00:00:20.256 Raymond Schultz, plastic surgeon here in Western New York. 00:00:20.261 --> 00:00:21.504 Thanks so much for being a guest. 00:00:21.566 --> 00:00:22.602 Dr Raymond Schultz: It's a pleasure to be here. 00:00:22.874 --> 00:00:24.289 Heather Ly (Host): we got a lot to talk about today. 00:00:24.290 --> 00:00:27.819 I guess we'll l- first let's start, a little bit about your background. 00:00:27.820 --> 00:00:31.796 What made you decide to become a plastic surgeon, sort of geared 00:00:31.799 --> 00:00:33.038 you in, in that direction? 00:00:33.408 --> 00:00:35.407 Dr Raymond Schultz: Well, for that, I think you really have to understand 00:00:35.408 --> 00:00:36.922 what plastic surgery is all about. 00:00:37.574 --> 00:00:39.832 So when people a- ask me, "Why are you a plastic surgeon? 00:00:39.832 --> 00:00:40.767 What do you do with plastics?" 00:00:41.277 --> 00:00:43.078 Do you think there's any plastics in plastic surgery? 00:00:43.925 --> 00:00:44.265 No. 00:00:44.406 --> 00:00:44.477 Yeah. 00:00:44.821 --> 00:00:50.202 So plastics came from the word plastikos, which is Greek meaning to mold, and 00:00:50.204 --> 00:00:52.507 that's basically what plastic surgeons do. 00:00:52.516 --> 00:00:57.281 We mold tissue, we change tissue to either fix a problem or solve 00:00:57.281 --> 00:00:59.456 a problem or recreate something. 00:01:00.462 --> 00:01:04.001 our specialty really grew up at the end of World War I, where all 00:01:04.001 --> 00:01:07.433 these were craniofacial defects from soldiers who survived their injury 00:01:07.705 --> 00:01:09.542 but were severely misf- disfigured. 00:01:10.029 --> 00:01:13.057 And that's what basically plastic surgery came out of. 00:01:13.059 --> 00:01:16.710 And then it changed over the years to encompass all areas of the body. 00:01:17.152 --> 00:01:21.907 So what drew me towards plastic surgery was it gives you the ability to see 00:01:21.908 --> 00:01:26.970 a problem and solve a problem, and each surgery we do is kind of unique. 00:01:26.973 --> 00:01:28.269 It's all, it's all different. 00:01:29.250 --> 00:01:32.512 we talk to ourselves as basically the service of last resort, so 00:01:32.716 --> 00:01:35.295 when someone has a problem they can't solve, who do they call? 00:01:35.444 --> 00:01:36.542 They call plastic surgery. 00:01:36.569 --> 00:01:36.789 Heather Ly (Host): Yeah. 00:01:37.074 --> 00:01:39.298 Dr Raymond Schultz: And, and I found that just fascinating, and then that's what 00:01:39.307 --> 00:01:40.731 drew, really drew me to the specialty. 00:01:40.789 --> 00:01:43.852 Heather Ly (Host): When you talk about plastic surgery, I, I think people always 00:01:43.862 --> 00:01:46.682 think that it's always about looks. 00:01:46.746 --> 00:01:50.969 Certainly, you want things to look nice, but is it also about restoring 00:01:50.981 --> 00:01:53.142 functionality in, in some cases? 00:01:53.364 --> 00:01:54.604 Dr Raymond Schultz: It's m- more than looks. 00:01:54.606 --> 00:01:58.147 I mean, it's restoring form and function, and there's a quote by a plastic 00:01:58.147 --> 00:02:00.477 surgeon, it's also to bolster the spirit. 00:02:00.813 --> 00:02:03.295 So yes, we do augment things. 00:02:03.295 --> 00:02:06.457 We do make things better, but we fix children with 00:02:06.460 --> 00:02:07.882 cleft lips and cleft palates. 00:02:08.682 --> 00:02:12.871 breast reconstruction is a big portion of my practice, so we give back to these 00:02:12.888 --> 00:02:14.867 patients what was lost from cancer. 00:02:14.877 --> 00:02:20.014 So yes, cosmetics is a big portion of our practice, but restoring form and function 00:02:20.018 --> 00:02:21.763 is probably even better portion of it. 00:02:22.058 --> 00:02:24.281 Heather Ly (Host): I know that this might be a tough question to answer, 00:02:24.284 --> 00:02:26.641 but do you have a favorite procedure? 00:02:27.249 --> 00:02:28.994 Dr Raymond Schultz: I kind of like everything, but I said a 00:02:28.994 --> 00:02:31.876 major portion of my practice is devoted to breast reconstruction. 00:02:32.173 --> 00:02:34.343 So that is one of my specialties. 00:02:34.343 --> 00:02:35.824 It's one of the things we're really devoted to. 00:02:36.150 --> 00:02:37.940 Not to say that I don't enjoy everything else. 00:02:38.650 --> 00:02:42.674 I do a lot of body contouring after people have lost massive amounts of weight. 00:02:43.294 --> 00:02:43.977 I enjoy that, too. 00:02:43.977 --> 00:02:47.475 But I would say one of our major focuses is breast cancer reconstruction. 00:02:47.577 --> 00:02:48.928 Heather Ly (Host): And I would think that that does a lot 00:02:48.932 --> 00:02:51.671 for … You, you sort of talked about that, like, somebody's spirit. 00:02:51.683 --> 00:02:54.078 You know, if they, they look better, they feel better, and 00:02:54.079 --> 00:02:56.024 especially after a cancer diagnosis. 00:02:56.025 --> 00:02:59.721 And everything that cancer, in, in a lot of cases breast cancer, 00:02:59.722 --> 00:03:03.779 can take away from a patient, you help to make them feel whole again. 00:03:04.121 --> 00:03:04.954 Dr Raymond Schultz: Well, that's very true. 00:03:05.012 --> 00:03:09.931 And when you think about it, if a woman loses her breast, while she 00:03:09.932 --> 00:03:13.882 doesn't lose entire self, part of her image is gone because- Sure … it's 00:03:13.882 --> 00:03:16.961 not necessarily who she is, but it's how you relate to the world. 00:03:17.340 --> 00:03:20.764 And seeing my patients when they come in, they have no idea what 00:03:20.764 --> 00:03:24.122 they're g- about to go through, and then watching them walk out in the 00:03:24.122 --> 00:03:25.970 end say, "Hey, I feel whole again. 00:03:25.970 --> 00:03:29.543 I don't really look that much different than before my breast 00:03:29.543 --> 00:03:30.543 was taken away for cancer." 00:03:30.712 --> 00:03:33.637 Heather Ly (Host): How Long do these surgeries take? 00:03:33.639 --> 00:03:35.662 How detailed are they? 00:03:35.956 --> 00:03:38.443 I mean, I guess every case is a little bit different, but, 00:03:39.529 --> 00:03:41.177 how complicated can they be? 00:03:41.180 --> 00:03:41.970 Dr Raymond Schultz: Well, it depends. 00:03:41.976 --> 00:03:44.656 I mean, there are multiple ways of reconstructing a breast. 00:03:45.506 --> 00:03:48.267 our most common way of doing it is using some type of implant. 00:03:49.277 --> 00:03:52.090 and in that case, we'll initially put in a device which will basically 00:03:52.092 --> 00:03:53.833 stretch the skin back out again. 00:03:54.333 --> 00:03:56.990 And then a couple months down the road, remove that and 00:03:56.990 --> 00:03:58.083 replace that with an implant. 00:03:58.512 --> 00:04:01.881 That's probably the least invasive way of reconstructing breast, and 00:04:01.881 --> 00:04:04.542 that really doesn't add on a whole lot to the time of the mastectomy. 00:04:04.567 --> 00:04:07.274 Probably about another half hour of putting that device in. 00:04:07.541 --> 00:04:07.743 And the se- 00:04:07.745 --> 00:04:10.984 Heather Ly (Host): Do you do it all i- in this, in one One surgery? 00:04:11.024 --> 00:04:13.242 Dr Raymond Schultz: We would try to do some of it in all in one surgery. 00:04:13.242 --> 00:04:14.586 We would at least place our expander. 00:04:14.587 --> 00:04:16.366 And sometimes we'll go right to our implant. 00:04:17.731 --> 00:04:20.627 but even the second surgery where we stretch the skin out first and 00:04:20.627 --> 00:04:23.634 then convert to an implant, that second operation is really simple. 00:04:23.636 --> 00:04:26.475 We're s- opening up the skin and taking one device out and 00:04:26.479 --> 00:04:27.711 putting the device back in again. 00:04:28.104 --> 00:04:29.371 That's the simple way of doing it. 00:04:29.746 --> 00:04:32.771 But there are much more complex ways of reconstructing the breast too. 00:04:32.782 --> 00:04:36.020 For a woman who doesn't want an implant, who has problems with implants, 00:04:36.232 --> 00:04:39.688 we can actually remove tissue from their tummy along with an artery 00:04:39.688 --> 00:04:43.400 and a vein, and hook those back up again using an operating microscope. 00:04:43.455 --> 00:04:43.786 Wow. 00:04:43.830 --> 00:04:46.218 And while that's not a big portion of my practice, many 00:04:46.218 --> 00:04:47.484 of my colleagues do do that. 00:04:47.828 --> 00:04:52.203 But now you've added on, oh, probably six hours or so to your procedure. 00:04:52.215 --> 00:04:55.931 Much more complex, but these women like it 'cause they get a tummy tuck out of it. 00:04:56.622 --> 00:04:57.841 Heather Ly (Host): A little added bonus, right? 00:04:57.842 --> 00:04:58.308 Dr Raymond Schultz: Exactly. 00:04:59.316 --> 00:05:01.376 Heather Ly (Host): what kind of conversations do you have with 00:05:01.378 --> 00:05:06.985 your patients before you do really any procedure, to prepare them, to 00:05:06.985 --> 00:05:10.580 make sure that that's really what they're looking for, maybe to prepare 00:05:10.580 --> 00:05:13.723 them for the recovery, you know, what they're about to go through? 00:05:13.724 --> 00:05:17.591 Because I, I don't imagine it's just, "Yeah, I'd like a augmentation," 00:05:17.594 --> 00:05:18.467 and- No … and here we go. 00:05:18.470 --> 00:05:19.753 There's got to be some conversations. 00:05:19.812 --> 00:05:21.408 Dr Raymond Schultz: Oh, there's actually a lot of conversations. 00:05:21.566 --> 00:05:24.841 So the very first thing you need to do, no matter whether you're seeing a patient for 00:05:24.843 --> 00:05:29.485 a reconstructive procedure or a cosmetic procedure, is you really need to determine 00:05:29.496 --> 00:05:34.595 what their expectations are, what their goals are, and can either myself or 00:05:34.610 --> 00:05:36.582 anyone deliver what they actually want. 00:05:36.942 --> 00:05:39.701 'Cause it's not uncommon to have someone who walks in and they want 00:05:39.701 --> 00:05:40.829 to be turned into a Barbie doll. 00:05:41.052 --> 00:05:42.558 Well, that's not possible. 00:05:42.570 --> 00:05:42.817 Heather Ly (Host): Yeah. 00:05:43.053 --> 00:05:46.230 Dr Raymond Schultz: So you need to determine what their expectations 00:05:46.260 --> 00:05:50.017 are, what they're looking for, and can I deliver what they're looking for. 00:05:50.030 --> 00:05:51.396 So that's first step in it. 00:05:52.052 --> 00:05:55.720 Once we figure out what you may want, we then need to talk about what are 00:05:55.720 --> 00:05:57.007 the risks and what are the benefits. 00:05:57.015 --> 00:05:57.354 Heather Ly (Host): Sure. 00:05:57.418 --> 00:05:59.611 ' Dr Raymond Schultz: Cause everything we do in life, there are bad things and 00:05:59.614 --> 00:06:02.928 there are good things, and some risks are trivial and some risks are not trivial. 00:06:03.452 --> 00:06:05.543 So we discuss what you want. 00:06:06.245 --> 00:06:08.951 for example, if it were a tummy tuck, we talk about, "Okay, this is the 00:06:08.951 --> 00:06:10.604 way your stomach is going to look. 00:06:11.455 --> 00:06:13.861 you're probably not gonna have a six-pack abdomen when I'm done, 00:06:13.861 --> 00:06:14.968 but your tummy will be flat. 00:06:15.494 --> 00:06:17.365 But there's always a possibility you could get a blood clot. 00:06:17.429 --> 00:06:19.704 We're gonna take every effort we can to prevent that. 00:06:20.207 --> 00:06:22.798 We're gonna give you antibiotics to try to minimize risk of infection, but 00:06:22.798 --> 00:06:24.143 there's always the possibility of that." 00:06:24.749 --> 00:06:29.243 So after we discuss what we can do, obviously we've examined the patient 00:06:29.243 --> 00:06:31.284 to make sure that this is indeed what can be delivered to them- Yeah 00:06:31.616 --> 00:06:34.054 talk about the risks, the benefits, and then I send them away. 00:06:34.539 --> 00:06:37.615 I let them go home, let them think about it, because if you're gonna go buy a 00:06:37.619 --> 00:06:40.457 brand-new car, the last thing you're gonna do is walk in the lot, write the 00:06:40.457 --> 00:06:41.793 check, and walk out with your car, right? 00:06:41.794 --> 00:06:42.159 Exactly. 00:06:42.159 --> 00:06:44.058 You want to, you want to take a look at some of your options. 00:06:44.543 --> 00:06:47.978 So I ask them to go home, think about it, and then I bring them a second time. 00:06:48.466 --> 00:06:50.768 And you'd be amazed, most people forget a half of what I've told them. 00:06:52.368 --> 00:06:54.804 but we do provide them with literature and encourage them to read that 00:06:54.804 --> 00:06:55.827 and write down their questions. 00:06:56.304 --> 00:06:58.568 And when they come back a second time, we start anew and we 00:06:58.571 --> 00:06:59.985 go through every point again. 00:07:00.350 --> 00:07:03.325 And at that point, if someone really is interested in proceeding with surgery, 00:07:03.421 --> 00:07:05.524 then we go ahead and, and schedule them. 00:07:05.524 --> 00:07:06.983 Heather Ly (Host): Do some people have a change of heart? 00:07:07.277 --> 00:07:07.691 Dr Raymond Schultz: Yes. 00:07:08.361 --> 00:07:08.914 It's not uncommon. 00:07:09.717 --> 00:07:11.955 Heather Ly (Host): Well, I mean, that's a, there's, it's a big deal to be going 00:07:11.955 --> 00:07:15.186 through, you know- Mm-hmm … a, a, a serious and sometimes complicated surgery. 00:07:15.202 --> 00:07:15.212 Yeah. 00:07:15.763 --> 00:07:17.426 what about social media? 00:07:17.441 --> 00:07:20.986 Do you get a lot of people that come in and they, they show you a person or, 00:07:21.209 --> 00:07:24.469 "I wanna look like this," or, you know, "Do this to me," where, like you said, 00:07:24.469 --> 00:07:26.272 not everything- Yeah … is possible. 00:07:26.464 --> 00:07:29.344 Dr Raymond Schultz: That's not uncommon to some walk in with a portfolio of pictures 00:07:29.346 --> 00:07:30.769 and say, "I wanna look like this." 00:07:31.352 --> 00:07:34.039 And a lot of times I tell them, "Hey, if I'm building a 00:07:34.046 --> 00:07:35.907 house, I have a foundation." 00:07:36.010 --> 00:07:36.275 Heather Ly (Host): Mm-hmm. 00:07:36.293 --> 00:07:38.065 " Dr Raymond Schultz: Your body is my foundation. 00:07:38.443 --> 00:07:41.961 If I was trying to build a skyscraper, I couldn't build it on a foundation 00:07:41.971 --> 00:07:43.592 for a small little bungalow." 00:07:43.650 --> 00:07:44.118 Heather Ly (Host): Sure. 00:07:44.169 --> 00:07:46.740 Dr Raymond Schultz: So they have to understand I'm starting out at 00:07:46.740 --> 00:07:50.046 a point, and I can only go so many areas from where I'm starting out. 00:07:50.846 --> 00:07:53.813 so though while they do walk in with social media, again, it's all 00:07:53.813 --> 00:07:57.674 about managing what is actually doable and what's not doable. 00:07:57.691 --> 00:07:58.964 Heather Ly (Host): And what's safe, right? 00:07:58.965 --> 00:08:02.354 Because I would imagine that there are procedures that maybe somebody 00:08:02.366 --> 00:08:05.796 could do them or would do them, but it's not in their best interest. 00:08:05.816 --> 00:08:06.948 Dr Raymond Schultz: Well, it's, it's very true. 00:08:06.948 --> 00:08:09.490 And unfortunately, right now, there's a lot of medical tourism. 00:08:09.914 --> 00:08:14.628 So there are people who will go down to the Dominican Republic or Mexico, and 00:08:14.628 --> 00:08:17.909 for that matter, there are actually some places in Florida, and they will seek 00:08:17.947 --> 00:08:22.770 out procedures from doctors who are not plastic surgeons, and they will come back 00:08:22.770 --> 00:08:25.058 to Buffalo with horrible complications. 00:08:25.147 --> 00:08:27.219 Heather Ly (Host): That's if there aren't more serious. 00:08:27.245 --> 00:08:30.519 I mean, I've heard of people getting, you know, different injections 00:08:30.525 --> 00:08:33.866 because, you know, they want their behind to be bigger, but it's not… 00:08:34.406 --> 00:08:37.265 One of them was, like, a caulking compound. 00:08:37.480 --> 00:08:38.420 Dr Raymond Schultz: You- Oh, it's silicone, yes 00:08:38.437 --> 00:08:40.850 … Heather Ly (Host): s- y- yeah, but it wasn't, you know, medical grade. 00:08:40.866 --> 00:08:41.178 Dr Raymond Schultz: No, no, no. 00:08:41.178 --> 00:08:41.898 It's industrial. 00:08:41.903 --> 00:08:44.045 This, this happened- Yeah … a lot in Mexico. 00:08:44.067 --> 00:08:44.641 Heather Ly (Host): That's scary. 00:08:44.641 --> 00:08:47.558 Dr Raymond Schultz: It was basically industrial grade silicone. 00:08:47.915 --> 00:08:50.627 You basically go to Home Depot, you pick up some silicone to lubricate 00:08:50.635 --> 00:08:53.925 your- Yeah … your door, and they would inject this into their breasts. 00:08:54.139 --> 00:08:56.718 They would inject this into their butts. 00:08:56.733 --> 00:08:58.231 So- Wow … yeah, it, it was a horrible thing. 00:08:58.328 --> 00:09:00.932 Heather Ly (Host): Because people go to great lengths to look a certain 00:09:00.933 --> 00:09:03.961 way, but- Correct … I wish they would go to great lengths to talk 00:09:03.961 --> 00:09:07.966 to you and, and other professionals about, you know, the consequences of- 00:09:07.999 --> 00:09:09.174 Dr Raymond Schultz: It, it would be great. 00:09:09.180 --> 00:09:09.200 Yeah. 00:09:09.204 --> 00:09:11.731 But I said, sometimes cost does drive people. 00:09:12.930 --> 00:09:13.339 Heather Ly (Host): For sure. 00:09:14.257 --> 00:09:17.795 we had some really exciting news here in Western New York over the past 00:09:17.814 --> 00:09:20.184 couple of months, with a procedure. 00:09:20.185 --> 00:09:24.493 I guess before we get into the procedure when it comes to breast reconstruction, 00:09:24.725 --> 00:09:29.466 let's first talk about the technology, something called Applacor 3D, and it 00:09:29.467 --> 00:09:32.353 was originally created for wound care? 00:09:32.353 --> 00:09:32.363 For 00:09:32.363 --> 00:09:32.639 Dr Raymond Schultz: wound care. 00:09:32.694 --> 00:09:33.035 Heather Ly (Host): Okay. 00:09:33.438 --> 00:09:36.603 Dr Raymond Schultz: So the idea behind this is, basically, we use liposuction 00:09:36.617 --> 00:09:39.992 to remove fat, and that fat is purified. 00:09:39.992 --> 00:09:44.017 It goes through multiple filters, which gives us a very, very fine layer of 00:09:44.017 --> 00:09:45.502 tissue, which is essentially fat cells. 00:09:45.895 --> 00:09:49.005 And what's interesting about that, stem cells are included in that. 00:09:49.098 --> 00:09:49.339 Oh. 00:09:49.352 --> 00:09:53.812 Stem cells are very potent cells that can go on to become almost anything. 00:09:54.151 --> 00:09:56.112 But what they really are great at is healing wounds. 00:09:56.384 --> 00:09:56.932 Heather Ly (Host): Ah. 00:09:56.948 --> 00:10:00.158 Dr Raymond Schultz: So the idea behind it was to take and make a picture of 00:10:00.168 --> 00:10:04.555 the wound, and then print out a very thin layer of fat cells, and that was 00:10:04.557 --> 00:10:07.674 placed on the wound, and actually was the very, very first patient we tried it on. 00:10:07.675 --> 00:10:08.499 We did it for wound care. 00:10:09.286 --> 00:10:11.891 and then those stem cells will actually stimulate healing for the wound, 00:10:12.132 --> 00:10:13.165 and it works very well for that. 00:10:13.233 --> 00:10:13.573 Heather Ly (Host): Wow. 00:10:13.818 --> 00:10:16.035 So then at what point did we think… 00:10:16.751 --> 00:10:19.752 I, I say we as if I had any part of this- … this procedure. 00:10:20.245 --> 00:10:24.743 you and your team, did you go, "Okay, if it works for this, we 00:10:24.745 --> 00:10:28.521 could take it to the next level and use it for breast reconstruction?" 00:10:28.731 --> 00:10:30.914 Dr Raymond Schultz: Well, actually, I got kind of the advanced notice 00:10:30.915 --> 00:10:31.964 this printer was coming out. 00:10:31.964 --> 00:10:34.062 So even before it had made it into the United States, it was 00:10:34.062 --> 00:10:34.967 actually developed in Korea. 00:10:34.968 --> 00:10:34.983 Okay. 00:10:36.290 --> 00:10:38.824 they told me what was going on, and I was talking to the company. 00:10:38.827 --> 00:10:41.454 Said, "Well, why can't we print out fat for anything?" 00:10:42.454 --> 00:10:44.935 so I had been talking to them about that, and then w- finally, when the printer 00:10:44.935 --> 00:10:46.657 was introduced, I said, "Well, okay. 00:10:46.920 --> 00:10:50.713 You know, I'll, I'll give a run for a wound, and we'll see what we can do." 00:10:51.328 --> 00:10:55.694 So the idea behind printing something that has structure in putting the 00:10:55.694 --> 00:10:58.974 breast, and I'll, I'll get to why you'd wanna do that, was very intriguing. 00:10:59.586 --> 00:11:04.003 So we're mainly using this for women who have a very specific defect in the 00:11:04.003 --> 00:11:06.326 breast, and that often is a lumpectomy. 00:11:06.337 --> 00:11:09.865 So in a lumpectomy, you're going to remove a very small portion of 00:11:09.865 --> 00:11:13.103 breast tissue, sometimes the size of a golf ball, sometimes an orange, 00:11:13.530 --> 00:11:15.387 which creates a hole in the breast. 00:11:15.954 --> 00:11:18.509 Now, if you're thinking about that, I can't just put a breast implant there 00:11:18.512 --> 00:11:19.765 'cause the breast implant is round. 00:11:19.766 --> 00:11:20.703 Heather Ly (Host): Almost like a divot, right? 00:11:20.713 --> 00:11:20.833 Dr Raymond Schultz: Correct. 00:11:20.833 --> 00:11:20.843 Okay. 00:11:20.859 --> 00:11:21.778 I'm making a divot. 00:11:22.304 --> 00:11:25.819 But what if I had something that had some structure and form, and 00:11:25.819 --> 00:11:27.444 I could place that into the hole? 00:11:28.130 --> 00:11:30.247 Now, before we did this, we'd simply inject fat. 00:11:30.835 --> 00:11:34.680 So you basically have a small little cannula and you inject the 00:11:34.681 --> 00:11:36.238 fat to try to fill the hole up. 00:11:36.808 --> 00:11:39.405 Well, the problem was that the fat was basically a liquid. 00:11:39.413 --> 00:11:43.103 It had no stability to it, so it wouldn't necessarily go where you 00:11:43.103 --> 00:11:45.386 wanted or it wouldn't fill the divot in. 00:11:45.398 --> 00:11:46.703 Heather Ly (Host): Does it lose its shape at- 00:11:46.704 --> 00:11:47.109 Dr Raymond Schultz: It loses- … at a 00:11:47.109 --> 00:11:47.642 Heather Ly (Host): certain point? 00:11:47.657 --> 00:11:48.704 Dr Raymond Schultz: It loses its shape. 00:11:49.038 --> 00:11:51.683 And these patients who have lumpectomies, they've been irradiated. 00:11:51.931 --> 00:11:54.606 So radiation causes scar tissue forming, causes the tissue to 00:11:54.606 --> 00:11:56.425 become very fibrotic and hard. 00:11:56.755 --> 00:11:59.172 So if you're trying to inject into that, imagine you've got an 00:11:59.182 --> 00:12:02.210 orange and you're trying to expand that orange peel, it don't move. 00:12:02.257 --> 00:12:03.328 Heather Ly (Host): It's, yeah, it's not going anywhere. 00:12:03.406 --> 00:12:04.025 Dr Raymond Schultz: Exactly. 00:12:04.347 --> 00:12:07.524 But if I had something that had some structure to it, something that 00:12:07.525 --> 00:12:10.872 would actually hold its shape and push that skin back out to where it 00:12:10.872 --> 00:12:12.271 was before, well, that's different. 00:12:12.297 --> 00:12:12.917 That's new. 00:12:13.424 --> 00:12:15.047 And that's what this printer allows us to do. 00:12:15.328 --> 00:12:18.684 Heather Ly (Host): So this particular patient, that was the first that you 00:12:18.686 --> 00:12:23.887 performed the, performed the procedure on, did she have anything prior? 00:12:23.914 --> 00:12:26.123 You know, was there a different type of procedure that didn't 00:12:26.123 --> 00:12:29.843 work, or this was her first sort of attempt at, at correcting that? 00:12:29.872 --> 00:12:32.603 Dr Raymond Schultz: So she had actually had a reconstruction before, 00:12:32.976 --> 00:12:36.123 and the whole lateral side of her breast was just flat as can be. 00:12:36.565 --> 00:12:39.543 So if you imagine half of your breast was just gone. 00:12:39.621 --> 00:12:39.725 Heather Ly (Host): Mm-hmm. 00:12:40.621 --> 00:12:41.999 Dr Raymond Schultz: we had tried to inject fat in her 00:12:41.999 --> 00:12:43.182 before, and it just didn't work. 00:12:44.149 --> 00:12:47.607 so I presented this to her and she said, "Well, nothing else has worked. 00:12:47.607 --> 00:12:48.379 Let's give it a try." 00:12:48.479 --> 00:12:48.775 Heather Ly (Host): Yeah. 00:12:49.182 --> 00:12:51.430 Dr Raymond Schultz: And the idea behind what we're using, there's nothing 00:12:51.431 --> 00:12:53.930 necessarily new about what we're doing. 00:12:53.931 --> 00:12:55.713 We've been injecting fat for years. 00:12:56.439 --> 00:13:00.023 we use a piece of absorbable mesh that actually helps hold that together. 00:13:00.292 --> 00:13:02.066 We've been putting that in the breast for years, too. 00:13:02.424 --> 00:13:05.396 But to combine these two in this procedure, that's unique. 00:13:05.799 --> 00:13:08.320 Heather Ly (Host): So this is 3D printing, right? 00:13:08.321 --> 00:13:10.840 It's taking that purified liquid fat. 00:13:10.859 --> 00:13:12.345 How long does it take? 00:13:12.707 --> 00:13:16.170 And I mean, is it a 3D printer the, the way I think of a 3D printer? 00:13:16.170 --> 00:13:18.529 Dr Raymond Schultz: It's a 3D printer the way you think of a 3D printer. 00:13:18.553 --> 00:13:18.839 Heather Ly (Host): Wow. 00:13:19.410 --> 00:13:20.293 Dr Raymond Schultz: we're limited sometimes. 00:13:20.293 --> 00:13:24.008 We can't print a big, huge glob of fat, 'cause the problem with that is this 00:13:24.008 --> 00:13:28.271 fat we're putting in, from the minute we suck it out, is dying, and it needs 00:13:28.272 --> 00:13:30.022 to develop a new blood supply with it. 00:13:30.273 --> 00:13:30.393 Oh, okay. 00:13:30.393 --> 00:13:33.193 So we're limited in how thick we can print these. 00:13:34.148 --> 00:13:37.171 we usually print them about a centimeter, so about a half an inch or so thick. 00:13:37.524 --> 00:13:39.315 And sometimes we go back and do it again. 00:13:39.317 --> 00:13:41.564 In fact, one of our patients had her second go-around 00:13:41.564 --> 00:13:42.734 with it to finish things off. 00:13:42.854 --> 00:13:43.047 Heather Ly (Host): Wow. 00:13:43.816 --> 00:13:45.321 Dr Raymond Schultz: but we actually print the fat out. 00:13:45.321 --> 00:13:49.157 It prints a mold first, and then it goes back and it slowly 00:13:49.158 --> 00:13:51.093 injects the fat into the mold. 00:13:51.854 --> 00:13:55.985 we put in two substances, fibrinogen and, and thrombin, which actually 00:13:55.991 --> 00:13:57.982 causes that fat to form a jelly almost. 00:13:59.069 --> 00:14:02.696 Heather Ly (Host): And w- since you're using, you know, the, the body's, the 00:14:02.696 --> 00:14:06.690 person's own, the patient's own fat, and you're using mesh and things that, you 00:14:06.692 --> 00:14:10.968 know, are already working or, you know, can be tolerated by the body- Mm-hmm 00:14:10.976 --> 00:14:14.629 does it help with rejection since it would be, you know, that person's fat? 00:14:14.639 --> 00:14:19.326 Does the body recognize it, or can there still be rejections or complications? 00:14:19.358 --> 00:14:20.668 Dr Raymond Schultz: Well, basically you're injecting itself, so 00:14:20.668 --> 00:14:22.270 your body recognizes it itself. 00:14:22.569 --> 00:14:25.172 The mesh we implant is absorbable, so that eventually will go away. 00:14:25.220 --> 00:14:25.643 Heather Ly (Host): Oh, okay. 00:14:26.098 --> 00:14:27.595 Dr Raymond Schultz: the biggest problem with any fat graft, whether 00:14:27.595 --> 00:14:30.472 we're doing a 3D-printed fat graft or we're just injecting fat into 00:14:30.482 --> 00:14:33.875 the breast, is it coming back to life, is revascularization of it. 00:14:34.375 --> 00:14:38.062 And the downside of my technique with this or any fat graft is that 00:14:38.063 --> 00:14:39.689 fat or a portion of it will die. 00:14:40.449 --> 00:14:43.852 and in fact, we've been, going back now and looking at the couple patients we did. 00:14:43.852 --> 00:14:46.904 We've had good results, but we do see little cysts, you know, kind of like 00:14:46.904 --> 00:14:49.712 the size of a dime or so in those areas where our fat didn't make it. 00:14:50.406 --> 00:14:52.909 we actually followed one of our patients up with an MRI so we could see 00:14:52.909 --> 00:14:55.939 these little tiny cyst areas, but the majority of fat seems to have taken. 00:14:56.064 --> 00:14:56.351 Heather Ly (Host): Yeah. 00:14:56.665 --> 00:14:59.818 you talked about a, a timeframe because the fat cells die. 00:14:59.821 --> 00:15:02.704 So what are we looking at in terms of when you remove the fat, you 00:15:02.704 --> 00:15:05.300 purify it, you print it, surgery? 00:15:05.434 --> 00:15:07.290 How quickly does that have to happen? 00:15:07.847 --> 00:15:11.391 Dr Raymond Schultz: so it, the time it takes to put the fat in, suck the fat out, 00:15:11.404 --> 00:15:14.451 put it into the printer and inject it back to the patients, that's not a critical 00:15:14.451 --> 00:15:16.387 time in terms of our fat cells dying. 00:15:17.224 --> 00:15:19.747 it takes us a long time to do this, and that's the biggest 00:15:19.766 --> 00:15:21.353 downside to this technology. 00:15:21.722 --> 00:15:23.868 I've already talked to the company about that, and we're hoping that the 00:15:23.868 --> 00:15:27.264 round two, the next version of the printer, will go a little bit faster. 00:15:28.176 --> 00:15:31.632 'cause we basically, it takes us about a half-hour to remove the fat, 00:15:31.632 --> 00:15:33.290 and that's standard old liposuction. 00:15:34.206 --> 00:15:37.570 from that it takes us about 15 minutes, and I, we have a whole team doing this. 00:15:37.572 --> 00:15:40.614 We have a surgical technologist who's very good at filtering it, 00:15:40.614 --> 00:15:43.978 and they basically pass the fat back and forth between two filters. 00:15:44.999 --> 00:15:46.128 so that takes a little bit of time. 00:15:46.535 --> 00:15:49.661 Then the fat is put into a printer, and the printer is not fast. 00:15:50.497 --> 00:15:54.618 so it's making micro droplets of material it's placing into our mold. 00:15:55.156 --> 00:15:59.021 And then comes the hardest part We wait about 25 minutes for it 00:15:59.021 --> 00:16:00.590 to solve, to turn into a solid. 00:16:00.970 --> 00:16:03.638 And that's the big downside to it, 'cause we're sitting there twiddling our thumbs. 00:16:03.680 --> 00:16:06.442 Heather Ly (Host): When you talk about surgery, how invasive? 00:16:06.466 --> 00:16:08.546 Is it, you know, large incisions? 00:16:08.547 --> 00:16:09.961 Is it small incisions? 00:16:09.964 --> 00:16:11.430 How do you get this piece? 00:16:12.561 --> 00:16:15.537 you know, how big was the piece for the, for the first case? 00:16:15.649 --> 00:16:18.907 Dr Raymond Schultz: Her piece was about maybe four inches or so in diameter. 00:16:18.960 --> 00:16:19.299 Heather Ly (Host): Okay. 00:16:19.903 --> 00:16:23.048 Dr Raymond Schultz: so it depends upon how big the defect we're m- dealing with. 00:16:23.691 --> 00:16:25.915 the incisions to get the fat out are, are, are minimal. 00:16:26.543 --> 00:16:30.069 and the fat, where it's going depends upon how big our lumpectomy defect is. 00:16:30.290 --> 00:16:31.173 The fat's not solid. 00:16:31.173 --> 00:16:33.768 It's not like I need to p- We can actually kind of roll this piece up 00:16:33.768 --> 00:16:36.516 and then put it into the hole and expand it once it's back in again. 00:16:36.570 --> 00:16:36.842 Heather Ly (Host): Okay. 00:16:37.074 --> 00:16:39.858 Dr Raymond Schultz: So it depends upon how big their lumpectomy defect is. 00:16:40.241 --> 00:16:42.657 And I'm gonna say usually these incisions are gonna be about maybe 00:16:42.658 --> 00:16:43.811 two inches long, give or take. 00:16:43.886 --> 00:16:44.185 Heather Ly (Host): Okay. 00:16:44.236 --> 00:16:45.570 So not terribly large- 00:16:45.586 --> 00:16:45.740 Dr Raymond Schultz: No, 00:16:45.740 --> 00:16:46.826 Heather Ly (Host): no … in the grand scheme of things. 00:16:46.826 --> 00:16:46.836 No. 00:16:47.075 --> 00:16:49.192 What is recovery like for these patients? 00:16:49.528 --> 00:16:50.865 Dr Raymond Schultz: Liposuction hurts. 00:16:51.120 --> 00:16:51.778 Heather Ly (Host): Really? 00:16:51.799 --> 00:16:52.303 Dr Raymond Schultz: Yes. 00:16:53.224 --> 00:16:54.958 people will complain about the liposuction. 00:16:54.971 --> 00:16:56.558 Usually the breast they don't complain about all. 00:16:56.654 --> 00:16:56.880 Heather Ly (Host): Yeah. 00:16:57.112 --> 00:16:58.883 Dr Raymond Schultz: And it's not like there's gonna be a long recovery 00:16:58.885 --> 00:17:02.834 with it, but, it's muscle soreness that you get from the liposuction. 00:17:02.847 --> 00:17:04.813 Heather Ly (Host): Is it the long … Like, I've seen videos. 00:17:04.822 --> 00:17:07.269 Is it the long tube and that you're just kind of poking- Mm-hmm … and 00:17:07.269 --> 00:17:10.736 prodding to … Are you loosening the, the fat as you're sucking it 00:17:10.738 --> 00:17:10.882 Dr Raymond Schultz: out? 00:17:10.888 --> 00:17:12.395 No, we're basic- we're basically just sucking it out. 00:17:12.450 --> 00:17:12.842 Heather Ly (Host): Okay. 00:17:12.847 --> 00:17:14.696 Dr Raymond Schultz: So liposuction, I mean, it's, it's 00:17:14.714 --> 00:17:15.984 kind of a barbaric procedure. 00:17:16.257 --> 00:17:19.840 It's basically a long metal tube with a little hole in the bottom of it, 00:17:19.851 --> 00:17:23.436 and we place suction on that, and that basically just sucks the fat globules out. 00:17:24.035 --> 00:17:25.982 Heather Ly (Host): And then is there … What is 00:17:26.041 --> 00:17:28.672 Wherever you're taking it from, let's say your leg or, 00:17:28.686 --> 00:17:31.675 or your butt- Is it misshapen? 00:17:31.680 --> 00:17:34.934 Do you have to be careful about where you take it and how you take it so that- 00:17:35.185 --> 00:17:36.383 So- … you're not lopsided or like? 00:17:36.383 --> 00:17:36.882 Dr Raymond Schultz: Exactly. 00:17:37.551 --> 00:17:41.071 so we wanna make sure we have an area we're taking our fat from where we can 00:17:41.075 --> 00:17:42.844 take it without leaving a defect behind. 00:17:43.453 --> 00:17:46.089 but usually we're taking from an area where someone don't want their fat. 00:17:46.671 --> 00:17:51.373 And saddlebags, lower abdomen, baby pouch, these are all great areas. 00:17:51.545 --> 00:17:53.867 So basically, we wanna even it out. 00:17:53.867 --> 00:17:55.205 We're not gonna take it from just one leg. 00:17:55.206 --> 00:17:58.337 We're gonna balance what we take off from each leg, and sometimes we take 00:17:58.338 --> 00:18:01.341 a little bit more than I need just to make the woman a little bit happier. 00:18:01.472 --> 00:18:01.838 Heather Ly (Host): Yeah. 00:18:02.322 --> 00:18:04.062 Again, sort of like a, a two for one. 00:18:04.122 --> 00:18:04.608 Dr Raymond Schultz: Exactly. 00:18:05.021 --> 00:18:08.413 Heather Ly (Host): when it comes to aplicorn, that, that 3D-printed fat 00:18:08.414 --> 00:18:13.319 graft, this was the first, not even in Western New York, the first not in 00:18:13.319 --> 00:18:15.825 the country, the first in the world? 00:18:15.842 --> 00:18:16.252 Dr Raymond Schultz: Correct. 00:18:16.863 --> 00:18:19.396 Heather Ly (Host): That's, incredible to happen right here at home. 00:18:19.499 --> 00:18:20.438 Dr Raymond Schultz: It's kind of cool. 00:18:20.810 --> 00:18:22.644 Heather Ly (Host): And so that was the first one. 00:18:22.644 --> 00:18:27.613 That was a couple of months ago, but more since, and more sch- on the schedule? 00:18:27.728 --> 00:18:31.021 Dr Raymond Schultz: Yeah, so we did our first ones back in January, and we 00:18:31.023 --> 00:18:32.442 wanted to follow those patients closely. 00:18:32.442 --> 00:18:34.669 Before we started to do it to anyone else, we wanted to see, 00:18:34.716 --> 00:18:36.160 is this actually going to work? 00:18:36.995 --> 00:18:38.013 so we followed those up. 00:18:38.013 --> 00:18:40.959 The very first patient I did, she's been very great about this. 00:18:41.503 --> 00:18:43.851 She allowed me to go back and biopsy it just to say, "Hey, 00:18:43.852 --> 00:18:44.938 is this fat still alive?" 00:18:44.995 --> 00:18:45.479 Heather Ly (Host): Oh, okay. 00:18:45.840 --> 00:18:46.395 Dr Raymond Schultz: so we went in there. 00:18:46.395 --> 00:18:48.207 We actually found some viable fat. 00:18:48.751 --> 00:18:52.653 The very first one we did, we did not add the mesh to it, and, she's 00:18:52.679 --> 00:18:55.836 actually gonna come back in for a second go around because I w- wished 00:18:55.838 --> 00:18:57.978 I would've had the mesh to provide a little more structure for her. 00:18:58.712 --> 00:18:59.547 but it seemed to work. 00:18:59.587 --> 00:19:00.726 The fat was alive. 00:19:01.622 --> 00:19:04.254 we followed that up with another patient who actually got an MRI. 00:19:04.266 --> 00:19:06.169 Her MRI was being followed up for breast cancer. 00:19:06.416 --> 00:19:08.789 But that allowed us to take a look and see what our fat graft looked like, and 00:19:08.789 --> 00:19:10.513 we could see our fat graft alive on there. 00:19:10.996 --> 00:19:13.757 So with that, with those first two, we've done three more. 00:19:14.703 --> 00:19:17.946 all of those are doing quite well, and I've got two more coming up. 00:19:17.963 --> 00:19:20.373 Heather Ly (Host): So if the fat lives- 00:19:20.446 --> 00:19:20.820 Dr Raymond Schultz: Mm-hmm 00:19:21.596 --> 00:19:24.196 Heather Ly (Host): Could this, does this last forever? 00:19:24.299 --> 00:19:26.359 For, for as long as the fat lives? 00:19:26.377 --> 00:19:26.615 Is there 00:19:26.616 --> 00:19:27.522 Dr Raymond Schultz: a chance- They don't always live forever. 00:19:29.061 --> 00:19:29.866 But does the fat… 00:19:29.866 --> 00:19:30.308 Yes. 00:19:30.537 --> 00:19:33.407 So the, once the fat's there, it's going to behave basically as 00:19:33.408 --> 00:19:34.674 fat cells no matter where it was. 00:19:34.679 --> 00:19:36.368 So if you gain weight, it's gonna grow. 00:19:36.632 --> 00:19:38.221 If you lose weight, it may shrink. 00:19:38.270 --> 00:19:38.997 Heather Ly (Host): Oh, okay. 00:19:39.838 --> 00:19:43.967 So n- somebody doesn't need to get the same procedure again as 00:19:43.968 --> 00:19:47.897 like a, a touch-up or, or a redo if all goes according to plan? 00:19:47.897 --> 00:19:47.927 Dr Raymond Schultz: If all goes… 00:19:47.957 --> 00:19:48.184 No. 00:19:48.583 --> 00:19:50.799 And the other advantage, I mean, we d- really don't know that, so we're also 00:19:50.799 --> 00:19:53.948 putting stem cells in there, which may actually help with the healing process 00:19:53.948 --> 00:19:57.330 and help that tissue to take, and maybe even have the lumpectomy de- defect 00:19:57.354 --> 00:19:58.803 kind of go away with that as well. 00:19:59.105 --> 00:20:03.322 Heather Ly (Host): So this is for, breast reconstruction, patients 00:20:03.322 --> 00:20:04.420 who have had breast cancer. 00:20:04.464 --> 00:20:04.871 Dr Raymond Schultz: Correct. 00:20:05.053 --> 00:20:07.316 Heather Ly (Host): Do you envision this being used for 00:20:07.367 --> 00:20:09.810 cosmetic procedures as well? 00:20:09.813 --> 00:20:11.484 Where does the future of this go? 00:20:11.699 --> 00:20:14.341 Could it be used in other parts of the body potentially? 00:20:14.670 --> 00:20:15.478 Dr Raymond Schultz: It possibly could. 00:20:15.557 --> 00:20:18.161 I haven't really thought about this, but I mean, Brazilian butt 00:20:18.161 --> 00:20:19.547 lift has always been in vogue. 00:20:19.553 --> 00:20:24.821 I don't know why, but, if someone wants to put more in the caboose, this may 00:20:24.821 --> 00:20:26.363 actually be beneficial over there, too. 00:20:27.209 --> 00:20:29.029 it could work well for lip augmentation. 00:20:29.033 --> 00:20:31.773 So there are, there are multiple areas that right now I haven't explored those, 00:20:31.789 --> 00:20:33.402 but there are, there are possibilities. 00:20:33.431 --> 00:20:33.770 Heather Ly (Host): Yeah. 00:20:33.936 --> 00:20:36.103 One, one, area at a time. 00:20:36.180 --> 00:20:36.585 Dr Raymond Schultz: Correct. 00:20:36.685 --> 00:20:38.764 Heather Ly (Host): When you did that procedure for the first time, 00:20:38.765 --> 00:20:42.677 what goes through your head, you know, being the first in the world? 00:20:43.683 --> 00:20:44.425 Dr Raymond Schultz: is this gonna work? 00:20:45.036 --> 00:20:46.478 Am I, am I gonna hurt my patient? 00:20:47.380 --> 00:20:51.304 luckily she was the wife of a dentist, and had a really good 00:20:51.315 --> 00:20:52.996 background into what I was doing. 00:20:53.316 --> 00:20:56.549 So, she kind of knew what the risks and benefits were. 00:20:56.551 --> 00:20:57.547 I said, "Hey, it's just fat. 00:20:57.547 --> 00:20:59.914 Worst case scenario, we're just gonna, it's gonna liquefy on us." 00:21:00.815 --> 00:21:02.618 but the biggest thing is am I, is this gonna work? 00:21:04.100 --> 00:21:05.111 and it did. 00:21:05.112 --> 00:21:08.293 So I'm kind of happy with it, and we're gonna, gonna go from there. 00:21:08.596 --> 00:21:11.883 Heather Ly (Host): As a surgeon, especially working with cancer patients, 00:21:11.910 --> 00:21:15.950 what is, the reaction from the patients? 00:21:15.986 --> 00:21:20.080 And that's got to make you feel awesome when they come to you and say, "You 00:21:20.777 --> 00:21:22.640 helped to restore the way I look. 00:21:22.653 --> 00:21:26.902 You've restored my confidence, and you've given me back something that, that at one 00:21:26.903 --> 00:21:28.479 point was taken away because of cancer." 00:21:28.526 --> 00:21:29.363 Dr Raymond Schultz: Yeah, no, it's just highly… 00:21:29.410 --> 00:21:33.396 That's probably the most rewarding part of our specialty, is going back and seeing a 00:21:33.397 --> 00:21:35.368 woman that's, "Hey, I'm, I'm whole again." 00:21:35.633 --> 00:21:38.863 I know one woman walked in one day with a picture of her, and she 00:21:38.864 --> 00:21:41.719 was in a bikini on the beach, and she'd had bilateral mastectomies. 00:21:41.948 --> 00:21:42.307 Heather Ly (Host): Wow. 00:21:42.650 --> 00:21:45.867 Dr Raymond Schultz: so th- that's, that's really rewarding to see that, hey, we've 00:21:45.911 --> 00:21:49.450 given them something back, because 30 years ago, that never would've happened. 00:21:49.878 --> 00:21:52.403 Heather Ly (Host): So with, you know, a few procedures like this under your 00:21:52.404 --> 00:21:56.634 belt and, and more to come, are you hearing from more people as word spreads? 00:21:57.331 --> 00:21:59.842 have you heard from any doctors in, in other areas? 00:21:59.872 --> 00:22:03.042 I would imagine that this is piquing people's interest. 00:22:03.120 --> 00:22:05.785 Dr Raymond Schultz: So actually we've had a coup- the company, Alcor, has 00:22:05.787 --> 00:22:09.498 been managing this, and, I've got phone calls from two other doctors, 00:22:09.500 --> 00:22:14.131 one from Mayo Clinic and the other from Cleveland, who are interested in this. 00:22:14.376 --> 00:22:17.501 We will be presenting our findings at the American Society of Plastic 00:22:17.501 --> 00:22:20.401 Surgery meeting in Houston next month, and I'm sure that's gonna 00:22:20.403 --> 00:22:21.545 generate a bit of interest too. 00:22:22.061 --> 00:22:22.774 Heather Ly (Host): That's amazing. 00:22:23.203 --> 00:22:26.624 What was it about Buffalo or you and your team? 00:22:26.670 --> 00:22:27.940 I guess, why Buffalo? 00:22:27.960 --> 00:22:32.389 Because this company could have gone anywhere, and was it the 00:22:32.389 --> 00:22:34.754 willingness to, to be a part of this? 00:22:35.306 --> 00:22:37.716 Dr Raymond Schultz: I think I presented with an idea no one else 00:22:37.716 --> 00:22:39.767 had, and they said, "Run with it." 00:22:39.897 --> 00:22:40.271 Heather Ly (Host): Yeah. 00:22:40.610 --> 00:22:42.704 Dr Raymond Schultz: So, and the company has been extremely supportive 00:22:42.704 --> 00:22:43.848 of, of everything that we've done. 00:22:44.529 --> 00:22:47.580 Heather Ly (Host): So there's only one of these printers that exists? 00:22:47.641 --> 00:22:48.591 Dr Raymond Schultz: Oh, there's many printers. 00:22:48.591 --> 00:22:50.425 There are people who are using it for wound care. 00:22:51.216 --> 00:22:54.592 right now Buffalo General has the only printer in the region. 00:22:55.387 --> 00:22:58.824 and out of all the printers that exist in the world, only one printer 00:22:58.824 --> 00:23:01.887 has actually printed out fat to be implanted into a breast, and that's ours. 00:23:01.995 --> 00:23:02.266 Heather Ly (Host): Yeah. 00:23:02.719 --> 00:23:07.144 As you do procedure after procedure, have you learned anything from 00:23:07.146 --> 00:23:09.895 the first one to the second one, the second one to the third one? 00:23:10.683 --> 00:23:12.445 and again, kind of where do we go from here? 00:23:13.041 --> 00:23:15.506 Dr Raymond Schultz: I think from the first one we learned that we needed something 00:23:15.507 --> 00:23:18.639 to actually make this a little bit more solid, hence adding our mesh to it. 00:23:19.840 --> 00:23:22.671 from that, from the first to the second went very smoothly. 00:23:23.611 --> 00:23:26.344 from this one I think we've become a little bit more aggressive of how much 00:23:26.344 --> 00:23:28.192 scar tissue we're releasing in there. 00:23:28.990 --> 00:23:31.803 I think I know how much of thickness we can actually put in. 00:23:32.135 --> 00:23:34.222 And I do tell these women, I said, "It may not, it may take more 00:23:34.224 --> 00:23:36.612 than one procedure to give you the result you're finally looking for." 00:23:36.739 --> 00:23:37.057 Heather Ly (Host): Okay. 00:23:37.059 --> 00:23:38.437 Dr Raymond Schultz: So I always tell them that if you do too 00:23:38.438 --> 00:23:40.237 much, fat ain't gonna live. 00:23:40.278 --> 00:23:40.552 Yeah. 00:23:40.552 --> 00:23:41.880 And then we got a bigger problem on our hands. 00:23:41.880 --> 00:23:42.404 Heather Ly (Host): Exactly. 00:23:42.404 --> 00:23:44.935 And it's better probably, I, to err on the side of caution and- 00:23:44.950 --> 00:23:46.256 Absolutely … go in gently and- 00:23:46.641 --> 00:23:47.084 Dr Raymond Schultz: No matter- … and 00:23:47.084 --> 00:23:48.260 Heather Ly (Host): then build on it if you have to. 00:23:48.508 --> 00:23:50.767 Dr Raymond Schultz: No matter what you're doing, you want to do what's safe first, 00:23:50.767 --> 00:23:52.413 and you don't want to push the technology. 00:23:52.639 --> 00:23:53.168 Heather Ly (Host): For sure. 00:23:53.412 --> 00:23:57.557 Let's talk a little bit, I guess, sort of I'll call it the lighter side of surgery. 00:23:57.867 --> 00:24:00.944 I've heard of surgeons preparing for procedures by playing video 00:24:00.944 --> 00:24:05.238 games or certain, you know, surgeons have a, a playlist. 00:24:06.175 --> 00:24:09.713 Other than, you know, the things that you have to do medically to prepare 00:24:09.717 --> 00:24:14.260 for a procedure, do you have sort of a, a game day ritual, if you will? 00:24:14.699 --> 00:24:15.719 Dr Raymond Schultz: Sorry, Heather, I'm boring. 00:24:17.307 --> 00:24:20.295 I will tell you that I'm not allowed to choose the music in the operating room. 00:24:20.295 --> 00:24:23.283 The surgical technologist in the case actually chooses our playlist. 00:24:23.292 --> 00:24:23.480 They 00:24:23.480 --> 00:24:23.958 Heather Ly (Host): trump you? 00:24:24.234 --> 00:24:25.616 Dr Raymond Schultz: Yes, absolutely, because- How does 00:24:25.619 --> 00:24:26.260 Heather Ly (Host): that happen? 00:24:26.428 --> 00:24:27.958 Dr Raymond Schultz: Because they're the ones who are running the room. 00:24:27.958 --> 00:24:28.942 It's really not the surgeons. 00:24:28.942 --> 00:24:30.427 They're the ones who control what's going on. 00:24:30.712 --> 00:24:32.895 And if your tech isn't happy, you're not happy. 00:24:33.586 --> 00:24:36.219 Heather Ly (Host): And so what typically is the playlist, or does it depend 00:24:36.220 --> 00:24:37.656 on which tech is in there that day? 00:24:37.656 --> 00:24:39.801 Dr Raymond Schultz: It depends which tech is in there, but it usually either 00:24:39.803 --> 00:24:43.979 goes, if they're being nice to me, it's going to be an oldies playlist. 00:24:43.998 --> 00:24:45.383 Now oldies are like 90s. 00:24:45.645 --> 00:24:45.872 Heather Ly (Host): Oh, 00:24:45.935 --> 00:24:46.163 Dr Raymond Schultz: gosh. 00:24:46.200 --> 00:24:47.404 And if it's n- Don't do that 00:24:47.404 --> 00:24:47.779 Heather Ly (Host): to me. 00:24:47.807 --> 00:24:48.335 Dr Raymond Schultz: Sorry. 00:24:48.705 --> 00:24:51.633 And if it's not, I'm getting music from today, so I'm 00:24:51.634 --> 00:24:53.030 listening to Post Malone and… 00:24:53.697 --> 00:24:55.602 Heather Ly (Host): How do you concentrate? 00:24:55.629 --> 00:24:58.547 Is it, does it, do you kind of just tune it out and it's just almost like 00:24:58.556 --> 00:25:00.075 white noise at that point- It's kind of white noise … and you're in the 00:25:00.075 --> 00:25:00.483 Dr Raymond Schultz: zone? 00:25:00.575 --> 00:25:02.681 It's kind of white noise in the background, but it, there are actually 00:25:02.681 --> 00:25:05.650 some studies which, actually done here at Buffalo, that show that 00:25:05.650 --> 00:25:09.019 music in the background actually helps the surgeon relax and makes 00:25:09.021 --> 00:25:10.316 the procedure go a little bit faster. 00:25:10.375 --> 00:25:10.677 Heather Ly (Host): Yeah. 00:25:10.738 --> 00:25:13.582 And then anything to warm up, again, like video games, or how do you make 00:25:13.583 --> 00:25:17.196 sure that your hands are warmed up and, and skilled before you go in and 00:25:17.196 --> 00:25:18.667 do these really delicate procedures? 00:25:18.728 --> 00:25:20.326 Dr Raymond Schultz: I press the snooze button three times. 00:25:22.297 --> 00:25:24.610 Heather Ly (Host): I, I would say a well-rested surgeon 00:25:24.625 --> 00:25:25.925 is probably a good thing. 00:25:26.450 --> 00:25:27.360 Dr Raymond Schultz: I, I would think so. 00:25:27.450 --> 00:25:27.677 Heather Ly (Host): Yeah. 00:25:27.912 --> 00:25:31.860 What else can you say, before we wrap up, just about, the technology, the 00:25:31.876 --> 00:25:36.116 advancements, the fact that this is happening at Buffalo General here 00:25:36.116 --> 00:25:40.242 in Western New York, and really the, the sky's the limit it seems like 00:25:40.243 --> 00:25:43.572 when it comes to, when you have the technology, the ways that we might 00:25:43.572 --> 00:25:44.962 be able to use it in the future. 00:25:45.467 --> 00:25:47.492 Dr Raymond Schultz: The fact that we have something new is always exciting. 00:25:48.246 --> 00:25:52.722 and I think that plastic surgery as a field has been the pioneer in everything. 00:25:52.722 --> 00:25:55.745 We pioneered microsurgery, we pioneered hand surgery. 00:25:56.402 --> 00:25:59.278 some of the stuff that is actually being done here for craniofacial 00:25:59.278 --> 00:26:03.897 surgery, is all exciting technology, and things that are being done 00:26:03.899 --> 00:26:06.924 today would never even been thought about when I was in medical school. 00:26:07.313 --> 00:26:10.207 And to have something too that I'm using and no one else has 00:26:10.207 --> 00:26:11.682 used it is really exciting too. 00:26:12.209 --> 00:26:14.364 And the fact that we're getting good results from it 00:26:14.559 --> 00:26:15.734 is really, really exciting. 00:26:15.786 --> 00:26:18.351 Heather Ly (Host): And the fact that you're going to teach others about it 00:26:18.364 --> 00:26:21.665 in other parts of the country, your… 00:26:22.052 --> 00:26:26.195 By sharing your knowledge, you are by extension helping other people, 00:26:26.437 --> 00:26:29.409 y- you know, at other medical centers, helping other doctors. 00:26:29.980 --> 00:26:34.117 it's that network of, of knowledge that is going to expand because of you. 00:26:34.154 --> 00:26:34.315 Dr Raymond Schultz: Yeah. 00:26:34.329 --> 00:26:36.408 Well, that's the way medicine is no matter what. 00:26:36.432 --> 00:26:39.512 I think even going through medical school, we all have our mentors. 00:26:39.513 --> 00:26:43.239 I can remember when I was a medical student which surgeons I looked up to. 00:26:44.043 --> 00:26:48.780 then as a resident you, learn from the attending surgeons, and then the senior 00:26:48.781 --> 00:26:50.418 attending surgeons teach the juniors. 00:26:50.663 --> 00:26:51.913 So medicine is kind of like that. 00:26:51.914 --> 00:26:54.569 We stand on the shoulders of giants, and everything that's gone 00:26:54.569 --> 00:26:58.716 before us is going to, groom and, and change who we are tomorrow. 00:26:58.840 --> 00:27:01.659 Heather Ly (Host): For somebody that is an aspiring plastic surgeon, 00:27:01.670 --> 00:27:05.115 what is your best advice to them if they're in the medical field but 00:27:05.405 --> 00:27:07.206 want to take the path that you did? 00:27:07.262 --> 00:27:08.476 What, what, what would you say to them? 00:27:09.255 --> 00:27:11.841 Dr Raymond Schultz: for medical students trying, study hard, do 00:27:11.841 --> 00:27:14.213 some research, and be dedicated. 00:27:14.802 --> 00:27:15.091 Heather Ly (Host): Great. 00:27:15.147 --> 00:27:16.692 Well, dedicated you certainly are. 00:27:16.692 --> 00:27:16.702 Mm. 00:27:16.702 --> 00:27:17.610 Thank you so much, Dr. 00:27:17.611 --> 00:27:19.345 Schultz, for joining us here today. 00:27:19.399 --> 00:27:21.226 A, a lot of exciting things to talk about. 00:27:21.226 --> 00:27:25.270 You can go to our website to learn more about these procedures and all of the 00:27:25.270 --> 00:27:26.647 exciting stuff that's happening here. 00:27:27.167 --> 00:27:28.452 And thanks for being our guest. 00:27:28.454 --> 00:27:29.127 Dr Raymond Schultz: Oh, it's been a pleasure. 00:27:29.129 --> 00:27:29.557 It was fun. 00:27:29.597 --> 00:27:30.726 Heather Ly (Host): Yeah, I learned a lot today. 00:27:30.764 --> 00:27:31.300 Dr Raymond Schultz: I'm glad. 00:27:31.341 --> 00:27:31.652 Heather Ly (Host): All right. 00:27:31.654 --> 00:27:33.687 Thanks for tuning in for this episode of Medically Speaking. 00:27:33.687 --> 00:27:34.595 We will see you next time.