This is a guest article by Silvio Aladjem MD.

I have a physician friend who once told me that a patient of his asked: “what is the difference between minor and major surgery?”

I can only imagine the face expression of the patient when my friend answered: “it’s minor surgery if it’s performed on you, it’s major surgery if it’s performed on me!”

This answer was not meant to be funny. In his answer, my friend showed wisdom and experience that only comes with a lifetime practice of medicine.

As a society, we have become accustomed to surgery as being “safe”. Who could have dreamed, at the turn of the 20th century, of open heart surgery, kidney transplants, face lifts, breast implants, brain surgery, corneal transplants, and a myriad of other surgical procedures. Today we need a book to codify them all, so that these procedures can be reimbursed by insurance or Government programs. Many are entirely elective, that is they are performed upon patient’s demand and not because they are sick. The majority of plastic surgery, those that are not done to restore a disfigurement due to disease or accident, are elective. Surgical centers have spread all around the country to accommodate such patients and perform these surgeries on an outpatient basis, rather than in a hospital environment.

While the majority of such centers provide quality medical care and are staffed by competent surgeons of various specialties, some centers cut corners and perform surgeries that they should not.

Not too long time ago, I read the news of a young lady who went to Florida to a clinic to have plastic surgery. She wanted her buttocks to be different from what they were. Enhancing the size of the buttocks is a procedure known as Brazilian Butt Lift. Don’t ask me why, but the name stuck. It involves liposuction to take fat from elsewhere in the body (usually the abdominal wall) and then transfer it to the buttocks. Of course the procedure is not covered by insurance, and it costs in excess of $ 6,000.

Something must have happened, but the young lady died as a consequence of this “minor” surgery.

Unfortunately, many such stories are more common than one would like to see.

Surgery is safe, but not foolproof. Even in the best of hands and the best of circumstances, things happen. The term “minor surgery” is a misnomer, It may be minor because it’s performed in a relatively short time, it does not involve major organs, and usually the patient goes home after a few hours of observation. But it is not “minor”. It is surgery no matter how you look at it. Surgery itself is an invasion of the integrity of our body, and our body may react in unexpected ways. Our body doesn’t like surgery, no matter where or why. Minor surgery also involves anesthesia, whether local, general or sedation. But we are not meant to be anesthetized either. Our body’s reaction may be unpredictable here also.

You may have heard of the occasional individual who goes to the dentist and chooses to be put asleep because he/she “hates needles”. As a result he/she has an unexpected cardiac arrest and dies.

My physician friend spoke with an understanding of the seriousness of surgery, any surgery. It’s life savings for many, but it is not to be taken lightly. Minor surgery is not to be interpreted as meaning safe surgery.

Before you undergo such surgery, or any surgery for that matter, ask questions, the most important being: do I really need it? The second question: is the surgeon the best for this surgery? Finally, who is going to be the anesthesiologist who may have to put me to sleep?

Anesthesia is just as important as the surgery. There is this story of an anesthesiologist that talked to patients before surgery –like they all do- with a twist. He introduced himself to the patient not as “I am the anesthesiologist” but as the “I am the doctor who will wake you up when the surgery is over”. That tells you everything you need to know.

Sometimes we buy a car on an impulse: “it’s beautiful”. “I like the color”, “I always wanted such a car”. You assume it has a good engine and good brakes. Don’t assume anything when you are going to have “minor surgery”, and certainly don’t agree to it on an impulse. You can buy another car, but you can’t buy another you!

Silvio Aladjem MD

SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so at:

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