Feeling of giving hope to people

He did not want to be described as an exceptional specialist. But he convinced me in almost every sentence that he really is one. Doc. MUDr. Jan Měšťák CSc., speaks not only about plastic surgery…

Can you describe your way to plastic surgery? Why have you decided to work especially in this branch?

The way began in my childhood. I wanted to study a special school for hotel services in Mariánské Lázně, but it was not possible, so my parents put me out to apprenticeship at the Institute of Physics belonging to the Academy of Sciences. It was a very small enterprise, where we did many beautiful things in designing development shops. I was able to learn much about fine mechanics, which later proved to be very useful to me. I did blue collar work for five years and got to know many teams. Then I understood that it is not important whether you have a degree or not. There are many bad doctors with degrees and many highly skilled people without qualification. At that time I studied a night-school, practiced dancing and played volleyball almost professionally. I got to know that it is possible to manage many things at the same time and do them quite well. The real way to plastic surgery began with experience from the Clinic of Plastic Surgery at the VinohradyHospital in Prague. The head nurse took me, a future student of medicine running in overalls, in affection and asked me to do small repairs in the ward. There I met children with cleft palates and other defects, talked to them and learned about plastic surgery. It helped me to make the final decision.

You were awarded by a Commemorative Medal for Merit for development of plastic surgery in Slovakia and you are a holder of a Patent of Invention on the field of plastic surgery. Can you tell us something about your success?

One of my many activities is to lead in-service training of doctors for plastic surgery. I organize many training activities, one-day workshops and I am a member of the examining committee for medical attestations. Because my pedagogical activities were and are connected with colleagues from Slovakia, I was awarded by this Commemorative Medal.

As for my patent, I got it from the Ministry of Industry and Development approximately ten years ago together with Dr. Babinec for so called imbibitory gel sticks used in plastic surgery. After implanting this gel into the affected place, the gel absorbs water and its volume increases. In this way it is possible to deal with some aesthetic and post-accidental situations. My contemporary work is similar but with a much wider application in plastic surgery. I have to mention again how grateful I am to have experience on the field of fine mechanics. There are many other examples proving it. Naturally, I work on operational procedures as well.

Is there a branch of plastic surgery you are specialized in?

Generally, plastic surgery means dealing with different congenital or acquired defects, post-traumatic and post-operational situations, reattachments, it means reattaching of limb parts separated by an injury, large defects after removing epithelioma or other tumors, burns or aesthetic defects. At the beginning of my clinical practice I dealt with almost all problems, later I specialized in facial clefts. Nowadays, at the Clinic of Plastic Surgery of the First Faculty of Medicine at the Charles University and University Hospital Na Bulovce, which I lead, one of the main programs is dealing with surgical treatment of breast cancer in case of women, with an immediate or subsequent breast reconstruction after its removal.

It is necessary to mention, that there are women in the population, who have frequent cases of breast cancer in their families, which means a high potential risk for them. We have introduced a program of removing mammary gland and an immediate breast reconstruction. The woman can be at ease, without fear to get breast cancer tomorrow, in a week or in some months. Although this is our priority, we deal with other types of operations as well, for example congenital defects of hands, genitalia, different tumors. I would say there is almost no surgical field, which could work without cooperation with plastic surgery. I tell to young surgeons that this is the base and the aesthetic surgery is just at the end of the whole branch.

You mentioned reconstruction of breast after its removal in case of tumor. I came across a study analyzing the value of this demanding operation in case of an ill woman with a very negative prognosis. What is your experience with women in these types of operations?

For me there is no question. I know from my experience and from the experience of my colleagues that the reconstruction of breast is very important for the woman. I operated one young woman with an advanced stage of breast cancer. Neither the oncologist nor the specialist in breast scan recommended a breast reconstruction. The woman came one day and told me she did not want to live without the breast. I consulted the case with the president of the ethical committee of the Medical Chamber and she recommended a consultation with a psychiatrist. This consultation proved the necessity to do the reconstruction. The woman lived six more years. The six years were important for her. It is interesting how often it is not so important for these women whether the primary operation of breast removing was done properly, they are much more interested in the result of breast reconstruction. The loss of a breast is always a very difficult handicap for a woman, so these operations are more than meaningful for us.

Is it possible, in the wide range of treatments you do, to specify the percentage of aesthetic operations and reconstructive operations?

It is sometimes difficult to find the real border between cosmetic an other defects. Among the cosmetic defects belong for example too large breasts, which represent also a burden for the health of the woman – they cause headache, pain of the backbone, skin problems etc. It is however possible to say that the University Clinic specializes more in the general plastic surgery and the private clinics more in aesthetic surgery. Naturally, cosmetic defects are treated at the University Clinic as well.

What is the influence of media on the concept of beauty?

There is certainly an influence and with an increasing number of departments of plastic surgery, it is possible to deal with problems which were insolvable in the past. In my work, I meet women more frequently, it is possible to say that 94% of my clients are women, mainly because women are more sensitive in the approach to their look. Nowadays, there are however also many men, who are concerned with their looks. Women concentrate mainly on dealing with congenital defects, for example small breasts or large nose, as well as problems caused by the ageing process. Some congenital defect can represent a life-long problem. I met a sixty-eight-year old woman, who had suffered from a strange nose shape since her childhood and asked me no sooner that at this age to operate her. The increase in cosmetic operations is obvious.

Don´t you think that aesthetic operations damage the originality?

You may be right, I as a man would not undergo a cosmetic treatment. There are many people, who are interested in the same sex and that´s why they want to change themselves. This is more frequent in case of men than women. Each person has got a different sensitivity. Some women do not care whether they have lost a breast, for others it is a most crucial issue. The result of an operation must be natural, that is very important. It is incredible, how much can some operations help the women, give them strength, self confidence, improve their marriages. Some originality may get lost, but the identity must remain.

What are the most frequent motives for women who decide to undergo a plastic surgery?

It should be never caused by a man. The woman must want the change herself. I know cases of women who do not want to put off their dresses in a changing room where there are more people, because they feel ashamed of their small breasts. The first period which causes dissatisfaction with own body is the puberty. Later, after the woman gives birth, the body changes naturally and many men criticize openly these changes. The woman loses self-confidence. Sometimes there are women, whose husbands had left them, and they can be helped by the operation. An other motive can be a job, women need to look good.

What does your ideal woman look like?

During my residences abroad, I met beautiful blond women in Scandinavia with blue eyes and when i returned home i saw our Czech women. They were marvelous. So i can´t say. There are women who are not so beautiful but give you the impression to be the most beautiful of all. So i don´t classify. Even during the beauty contest there are many girls which are not interesting for you and there may be one whose beauty can be striking.

In what ways is Czech plastic surgery exceptional, what can it offer to the world?

I have experience with many work places and I know about our positive and negative sides. Important is above all academician Mr. Burian and many of his followers, who brought our plastic surgery to a high standard. I would like to mention Prof. Fára, Karfík, Bařinka and others.

When I consider it all and see your hands, I tell to myself how skilled they must be…

You need to have not only a sure and strong hand but also a lot of experience, which enables us to do our job with good results. As I have mentioned before, during many operations and during my work on the clinic, I use the skills and experiences of a fine mechanic with much gratitude.

In your opinion, what is the base of success?

Success can be individual and collective. Individual success is based on diligence, discipline, strong will, ability to overcome difficulties, anticipation and inventiveness. Here I gained experience on the field of sports, because i belonged to the best junior volleyball players in our country. I know there were some more talented players than me, but they did not have the motivation, determination and will. Unfortunately, because of lack of these qualities, many extraordinary people are not successful in sport or in their jobs. The secret of being successful lies also in the ability to distinguish important things from unimportant, useful from useless. I can compare it to a game of chess, where not the first or second moves are important, but the next. The success of a team depends on its proficiency, quality of human relations and discipline as well. Good interpersonal relations and complying with real and convincing goals are one of the most important motivating aspects of success. In my opinion, the success on the field of plastic surgery really depends on the surgeon´s ability to establish patient´s confidence in the doctor and the results of the operation. My long-time experience confirms this.

Where do you see the limits of plastic surgery and which way should this branch develop in future?

Someone has recently asked me about transplanting skin from the face of one person to another. My ethical opinion is clear. I think if someone met a person with a part of his deceased relative´s face, the emotions would be very strong. Next development of plastic surgery should use rich contemporary experience and develop them further. I always tell to young doctors, they should not attempt to do heroic operations which are connected with a high risk. I see clear limits in sobriety and caution.

Is it possible to say that the limits of plastic surgery are defined more by ethic constraints than by technical possibilities?

Definitely. And it is always necessary to practice medicine regardless of money. For me, money is always only an aid to please other people not myself. Even in the case of plastic surgeons, medicine must be more important than money.

Do you suppose that maybe in 20 years the treatments will be different, because of technical development or different materials?

The hand of the surgeon is always the same. This is the main tool and it does not change. Over the years, there has of course developed a much wider range of available operations. Nowadays we have started to use a robot for operations, but the base, the skill, it remains. I believe that many operational procedures will remain. We will use more microsurgery but I don´t expect crucial changes.

Sometimes we hear that aesthetic surgery is somehow redundant, that it does not „save lives…“. What makes the aesthetic surgeon feel satisfied, apart from reconstructive surgery?

It would be a big mistake to think that removal of cosmetic defects by a plastic surgeon is less important than dealing with some congenital defects. We know very well how important is reconstruction of a breast for a woman after a breast cancer operation. Similar is a natural enlargement of underdeveloped breasts or treatment of a large nose, which makes the person feel ridicule. The biggest reward and delight brings me the happiness and joy of a woman, whose life has changed and improved. Other values, even the material ones, are unimportant for me at the moment.