A Moment with...Dr. Daniel Markmann

Dr. Daniel Markmann has a way of making you feel like you've known him for years. He's warm, funny and has a gentle manner that women search for but many surgeons lack. Maybe this is why hundreds of women have trusted him with their breast augmentations. He prides himself on the comfort of his patients and they'll tell you he gives them his total attention, time and care. Though his calendar is jammed with appointments, he managed to squeeze us in for a few quick questions.

BI411: What originally interested you in plastic surgery?

Dr. Markmann: Plastic surgery is a very artistic field. It's very different from any other field of medicine or surgery. Other fields of surgery I found to be very much cookbook-like where you follow the directions and cut on the dotted line. You take out somebody's gallbladder, you close them up and they're happy that they feel better but, you have only returned them to their normal state. With plastic surgery it's fun because you not only make them feel better, but you make them look better as well. They can see the results, they're very happy and that's very rewarding. There is no other way for a woman (or man) to change their shape or body proportions like we can with Plastic Surgery. Plastic surgery is a very three-dimensional field; you really have to have a good vision of three-dimensional forms. I've always enjoyed that.

BI411: What should a woman expect during her first consultation with you?

Dr. Markmann: We usually spend about one to two hours with each new patient. Most of the time is spent trying to get an idea of what their goal is and also getting a feel for what kind of patient they are, what they're looking for, how realistic they are about their expectations, as well as letting them get to know me. I take a lot of time educating my patients on the options for the procedure, what is involved overall and what kind of expectations they should have. I give them as much information as possible.

BI411: Do you prepare them ahead of time for the possible emotional peaks and valleys they may experience after the surgery?

Dr. Markmann: Yes. Breast augmentation is a procedure that a lot of women get into without knowing much about it, except that everybody's doing it and their friends all have had it done. But, it's still surgery and that is something they have to be realistic about. They have to understand that there can be a lot of pain involved, depending on where the implants are placed. I tell them all that you're going to hate me for the first few days and a week or so later you're going to love the results!

BI411: What should a woman look for when choosing a plastic surgeon, along with the surgeon being ABPS board certified?

Dr. Markmann: The most important thing, obviously, is the results you're going to get. There are many different qualities surgeons have that should be considered and each patient is a little different as to what's important to them. In my opinion the most important thing is the outcome; what you're going to look like and that the surgery is done safely. You want to see before and after pictures in the physician's office. That's very important! You also want verification of hospital privileges and that they're credible surgeons. Also, probably one of the most important things of all is where the surgery is being performed. I will only perform surgery in Independent and certified surgery centers and hospital operating rooms. I am strongly opposed to physician owned, in office, operating rooms. I do not believe they're as safe even if they are certified.

BI411: What do you think of the Internet as a form of referral in place of the more common word of mouth?

Dr. Markmann: I think it's great when it's done well, but women have to be cautious because they really don't know who they're dealing with until they have their consultation. Anyone can put up a web site. But it is important to be sure that they are Board Certified by the American Board of Plastic Surgery, to check out their other credentials and to be sure they are experienced in performing the procedure she/he is interested in. They don't know the physician who's site they are visiting and the photos they put on there may be only their best one or two pictures.

The web is however, a great place for women to become educated about cosmetic surgery procedures, to see different options and the different approaches to putting in implants. They also learn a lot about the different incisions, the different implant placements; above or below the muscle and the risks involved. They can get a lot of information from sites such as yours. But, as far as medicine on the Internet, it's still something they have to be leery about. It's a great marketing tool, but don't base everything upon that. You still have to come in and see the physician and get the details in person.

As far as downsides, it depends on how in depth you research things. I know of an OB/GYN who markets himself on the Internet as a Cosmetic Surgeon; he's not a plastic surgeon, he has not been trained (the way we are in plastic surgery) in putting in implants aside from watching somebody do it once or twice and now he's doing it on his own. That's kind of risky! They advertise themselves as cosmetic surgeons and a lot of people don't know the difference. That's why people have to be cautious and also do further research to be sure they're seeing someone who has been properly trained to do these procedures.

Plastic surgery is more popular today than it has ever been. The problem is that there are so many physicians who are tired of dealing with insurance companies that many of them are hanging up their "shingle" and advertising themselves as "Cosmetic Surgeons", which, unfortunately, any physician can do. This is why you must be very cautious. Plastic Surgeons traditionally have always been the specialists in "Cosmetic Surgery". We spend a minimum of 2-3 years learning these procedures and techniques. These other non-Plastic Surgeons may however, also advertise themselves as Cosmetic Surgeons, but they cannot call themselves Plastic Surgeons. The amazing thing about it is that there are even dentists in my town who advertise themselves as Cosmetic Surgeons. They're doing liposuctions and facelifts and it seems like everything under the sun!

BI411: Do you find any obsession for surgery in the women you treat? And if so, how do you deal with them?

Dr. Markmann: We definitely do run across people who have Body Dysmorphic Disorder. It's hard to cure their problem by doing the surgery that they request. If they are obsessed about one thing and you fix that, either it's not going to be fixed properly in their mind, or they're going to become obsessed about something else. Those patients definitely need to have counseling to help them through this problem. It's usually something that you can identify upfront, although sometimes you can be surprised. Fortunately, most people who have cosmetic surgery do not have this problem.

BI411: Exotic dancers have been known for overly large breast implants - it's almost expected, like a uniform for them. When a woman comes to you looking for unusually large implants because of her chosen profession, do you grant her wish, or do you try to talk her out of it?

Dr. Markmann: You have to address the whole issue of why they're doing it and what their expectations really are. It's not just something where you can say, "Okay, if that's what you want, then that's what I'll do for you". They do represent our practice when they walk out the door, so we have to look at the whole picture. My first goal is to educate them as to the potential problems associated with excessively large breast implants. I've certainly operated on many women who wanted big breasts and have made their breasts the size they wanted and they've been very happy about it. There are also patients that come in with that idea and after discussing it with them they'll say, "Well, maybe I don't really want to be that big." But, if they're realistic about it and that's what they want, then I'm agreeable to make their breasts whatever size they want. Most of them need to have more of a staged procedure anyway. It's tough to go from an "A" cup to a "DD" cup safely in one procedure. I make sure they understand that once they've done it, you can't just turn back the clock and undo it. If a woman chooses excessively large implants she has to understand that once your skin has stretched to accommodate this large implant you have to deal with the scars of a lift operation at a later time if you want them removed. When they hear that, sometimes they change their mind.

BI411: I would imagine that with a career as time and mind consuming as plastic surgery, it must be daunting to balance your private life and your professional life. How do you find that balance?

Dr. Markmann: My free time is spent with my family. I have a couple of young kids, ages 5 and 7 and I love to spend any free time I have with them. It's a great pass time; it's a great release for me to put the medical part of me aside and go home and play games with the kids. My wife tells me I haven't grown up yet!

BI411: We find more and more women who come to our site searching for plastic surgeons are taking into account the age of the doctor, and are favoring younger surgeons over the more standard axiom of "looking for twenty or thirty years of experience". Do you feel it's because they may feel younger doctors may keep more up to date on technologies, or perhaps because they're doing their research on the web in the privacy of their own homes, there's a possible fantasy factor- since this is such an intimate operation that deals directly with her sexuality. Do you have any views on why many women prefer younger doctors these days?

Dr. Markmann: I think it's a combination of a lot of different things that you mentioned. Most of the women who are getting liposuction and breast augmentations are young women. Many times they want a Plastic Surgeon close to their own age, just like the women getting facelifts quite frequently request an older plastic surgeon. Whether or not it's just because they can relate to them better, I don't know. I've seen women who have gone to some of the older plastic surgeons in town who have come to me afterwards saying, "I went to him and he didn't give me all of the options, he just told me that 'this is what we do' and that was the end of the consultation." Maybe having a different mindset on how we can do things and using more modern technology is a factor. I bring patients in here all the time and I ask them what they want; they'll try different implants in their bras, they'll bring in pictures of the size they want to be and I'll try to match that. I've had patients that have had implants put in by other physicians who claim that there was no correlation between the size they requested and what they actually got. Many women say they were not even offered different size options. I think many of the older surgeons were trained differently and have a different approach to surgery. Many of them are very set in their ways and many don't feel comfortable with modern technology. Also, the younger women are doing more research online and the younger plastic surgeons are more active on the Internet.

BI411: Where do you see plastic surgery heading?

Dr. Markmann: That is a very difficult thing to predict. There have been numerous breakthroughs and advances in plastic surgery in recent years. We do a lot of the anatomic implants, (teardrop shape.) With the new technology, we have teardrop shaped implants (also frequently called anatomic or breast shaped) in saline as well as silicone. They work beautifully and the result is very nice with a more naturally shaped breast. Silicone is still available, but it's only for certain people who meet the criteria set by the FDA.

BI411: Are you involved with any of the studies McGhan is doing?

Dr. Markmann: I'm involved with studies by both McGhan and Mentor, where we do silicone implants for women who are candidates to have it. One of the biggest advances recently is in the new cohesive gel implants. These are being used in other countries, but are not yet available in the USA. I'm hoping these implants will prove to be safe and become available here in the states in the next couple of years. In my opinion, gel implants are relatively safe. Research has shown them to be safe. They have been proven by many studies to not cause the diseases they were claimed to have caused and the results feel-wise between a saline implant and a gel implant can be night and day.

BI411: If a woman wanted to be part of the gel implant study, what are the criteria she would need to meet?

Dr. Markmann: Silicone is restricted to women who have had breast cancer, mastectomy, or lumpectomy, where a significant part of their breast has been removed due to cancer or biopsies, congenital asymmetry, where one breast is dramatically bigger than the other, women who have drooping of the breast and have a lift operation at the same time, also women who have chest wall deformities, or if you've had saline implants and have had trouble with them, you can have these exchanged for silicone gel implants. There are a lot of criteria to get them into the silicone gel implant study if deemed appropriate by a physician who participates in the study. Also, if you have saline implants and need to exchange them due to problems such as rupture, silicone may be an appropriate option for you. Silicone is available for just about any woman for reconstructive purposes, but not for the woman who has a nice shape to her breasts and just wants to be bigger.

BI411: What sets your practice apart from other surgeons?

Dr. Markmann: We give the patient an old fashioned consultation; I spend a lot of time with my patients and get to know them. I want my patients to feel comfortable with me. I try to give them all of the information I can because I believe it is their right to know and because I believe some of the decisions should be made by them. I also want to be sure all of their questions are answered before they leave my office. They don't leave here feeling they were rushed through a consultation; we spend on the average two to three hours with each patient before they have surgery. The one thing that I'm most proud of is that my patients are very happy and refer their friends and family. My practice has been built primarily on patient referrals from satisfied patients.

Dr. Markmann is well known for the rapport he builds with his patients. They become life-long friends to him and very satisfied customers. His schedule is packed solid, but give him a call at (410) 465-3600 and find any opening you can; hundreds of women will tell you he's worth it.

Visit Dr. Daniel P. Markmann's profile on Breast Implants 411