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SANJAY GUPTA MD

Interview With Joan Lunden; Plastic Surgery Gone Wrong

Aired June 29, 2014 - 07:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


DR. SANJAY GUPTA, CNN HOST: Hey there. And thanks for joining us today.

In a few minutes, we're going do talk about the increasing frequency of botched plastic surgery operations. You're not going to believe some of the horror stories you're going to show you today.

But, first, I grew up watching Joan Lunden. And she's the woman who co-hosted "Good Morning America" for 17 years. I'm a big fan of hers. And I'll tell you, she's one of the most gracious and sweetest people that I'm now lucky enough to know.

Even though I'm a doctor and I've done a lot of stories about cancer, it was still a punch in the gut when we heard this week that she's been diagnosed with breast cancer herself.

Back on Thursday, Joan had her second round of chemo. And today, she's joining us to tell us the whole story.

Welcome to the program.

JOAN LUNDEN, FORMER CO-HOST, ABC'S "GOOD MORNING AMERICA": I'm happy to be here with you.

GUPTA: Thank you. I just -- like I said, big fan, love watching you for so many years.

LUNDEN: Thanks.

GUPTA: How are you feeling?

LUNDEN: You know, I'm actually feeling great. I'm almost a little surprised how great I'm feeling. I do understand that there will be a cumulative effect.

But I started the chemo right away. I thought it was very important to not be paralyzed but to jump into action, get a lot of opinions, which can be very confusing, and put a team together. That's what I did. I've been very proactive.

GUPTA: Yes.

LUNDEN: And that's kind of kept -- that's put me in the right frame of mind.

GUPTA: And you're known for that, you -- with your healthy living and your advocacy around these issues. I want to talk about the confusion you describe in a second. But how did you hear -- how did this all sort of transpire? Did you get a phone call ultimately after the exam? Or what happened?

LUNDEN: I get my mammogram every year, and as soon as they started doing 3D mammograms I paid the extra money and got that, even though it's not covered by insurance. I figured, go for the best. And I was told years ago, I have dense fibrous breast tissue, like a lot of women do, and that makes it very difficult to see things in a mammogram, and I should always follow it up with an ultrasound.

So, you know, this year I came out of my mammogram they said, you're all clear. I'm like, all happy go lucky, one more year I beat it. Even though I never really expected to get it, but you always hold your breath. Every woman holds your breath, not just while the mammogram's happening, we hold our breath in the lobby, and -- while we're waiting.

And the ultrasound, she kept going back to one spot. So, they brought in a radiologist and they said, you needed to do a core biopsy. And so, they did, we'll have to send this out. And so, my husband went back with me.

And I knew the minute the doctor walked in the office. You could just tell by her demeanor. And she said, you definitely have breast cancer. And I immediately went to a cancer surgeon that she recommended and that my gynecologist -- I called a few places, got a recommendation so I could learn more.

And by the time I got to her, then I learned what the pathology was, and I learned that I have something called triple negative. This didn't come about from estrogen or progesterone, or is it the HER2. This is a subset.

One thing I've learned is that breast cancer, you think of it as one thing -- every woman has a dinner kind of breast cancer, as far as how the pathology comes out, where it is, and you really need to get a lot of opinions, which is scary because these brilliant doctors sometimes disagree with each other.

GUPTA: Right.

LUNDEN: But you have to at some point put your hands -- self in the hands of a team, and decide what's best for you. And because -- I want to make this clear, because I mean, I've got so many thousands of people writing to me on Twitter and Facebook. What I say I'm doing doesn't mean that's what you should be doing. You can't do exactly as your mother did or your sister did or your friend did, because every woman's breast cancer is different.

GUPTA: You know, one thing, again, and this is more of a psychological question. I remember my mom went through this. One of the things she said to me was that she wondered if she had done something wrong to bring on the breast cancer. And it was a heartbreaking thing to hear from her because she -- how can you be blaming yourself? LUNDEN: But I think most women do. I think we say we must have done something wrong. And I -- it was compounded for me, because I was afraid if I come out with this, everyone's growing to say, oh, sure she's a health advocate and, look, then she goes and does this to herself.

One thing I learned is, these things just happen on their own. Especially mine, being triple negative. I don't think they completely understand how it comes about because it's not fed the normal ways through hormones. And I was scared that people would think I let them down. And that made coming out with it, but I'm going to be perfectly candid.

In the first two days or so, I just wanted to go away somewhere, and not let anyone find out. I also felt like I didn't want to tell the kids, because my younger kids would be worried. But we were advised by everyone, that that was really a mistake, and my husband knew it was a mistake.

He owns summer camps for the children. And he always says to the parents, you need to be honest. Keeping family secrets bring up trust issues later in life.

But my little ones are little. I mean, I have twins who are 11 and twins who are 9. So, you do it in kind of an age appropriate way. And they seem to be doing well with it. Fortunately, I was able to end that conversation with, because I caught it early my prognosis is excellent.

So, while I'm going to have to have all this medicine and the surgery, by the end of the year, it will be gone.

GUPTA: Well, Joan, I'm so delighted you joined us and talked about this, and so many fans out there, after all these years, we're still getting great advice from you. So, I really appreciate it.

LUNDEN: Thanks.

GUPTA: Thanks for being here.

LUNDEN: My pleasure, Sanjay.

GUPTA: I want to turn now to Dr. Valerie Montgomery Rice. She's a friend of the program. You know her well. She's dean of the Morehouse School of Medicine. She's counseled a lot of women on the issues we were just talking about.

Welcome back.

DR. VALERIE MONTGOMERY RICE, DENA, MOREHOUSE SCHOOL OF MEDICINE: Thank you. Thank you for having me.

GUPTA: I know you're a fan of Joan Lunden as well.

RICE: Yes, of course, of course.

GUPTA: I really did feel a punch --

RICE: Yes, she's someone we watch every morning getting up. And so, we understand though. That's we talk about 1 in 8, 1 in 8. You think, I think I'm hanging out with my girlfriends, there's eight of us. And I'm thinking, OK, one of us has really been diagnosed with breast cancer.

GUPTA: It's not theoretical. I mean, it becomes very real.

RICE: It's not theoretical.

GUPTA: Let me ask you some specific questions. Topics, we talked about before. Her breast cancer was not picked up on a mammogram.

RICE: Correct.

GUPTA: That is a screening test that we commonly talked about. She had an ultrasound that ultimately found this. What do we to learn from that? What do we take away from that?

RICE: Well, we know that women, particularly younger women, have more dense breasts. So, when we think about the 2D mammogram that we customarily use, we understand that, you know, there are a lot of false positives and it wasn't as sensitive. Ultrasound is what we used next to sort of get through some of that density, but again, we have a lot of false positives.

And now, we're seeing the technology that's come out, the 3D mammogram. And, you know, using the same type of radiation, more radiation. But it's able to do is to look at the breast in different layers, sort of like you think about 3D, and is able to really sort of take what may be an image and sort of look at it from all sides and all arcs, and we can then now see more of really what is a mass.

So, definitely, mammography has improved, but --

GUPTA: Is 3D mammography better? I mean, should women get 3D mammography now?

RICE: Well, can't say. It's still experimental, OK? We are seeing now there's probably one in every state, is what I read. There's a big study just came out that really show that the 3D mammogram, and a large data, they're looking at 400,000. They had about 200,000 of those, had the digital mammogram, and had the 3D, and it had 15 percent lower race of false positive, and about a 30 percent overall increased chance of picking up the breast cancer.

GUPTA: So, it's better weeding out things that weren't cancer?

RICE: Yes, exactly.

GUPTA: Joan mentioned insurance didn't cover it for her. It's not been approved in that way yet, what should a woman do? So, she get -- women are going to hear the story of Joan Lunden and say, she got a mammogram and didn't find it, she got an additional test. She's 63 years old. If a woman gets a normal mammogram, how much solace and comfort can they take in that?

RICE: You know, I think we have to continue to look at the technologies evolving. So, we still are aligning with the American Cancer Society, doing your mammograms every year at age 40. Self- breast examinations starting at age 20, doing it every month.

No one would know your breast better than you as a woman. No one would know that. So, when you feel something suspicious, go to your doctor.

If you have a family history, we started doing more sophisticated screening earlier. So, we may add the ultrasound or you may get the recommendation for the 3D mammography.

So, at this point, we cannot make any different screening recommendations based on the information. But we are hoping that we're going to see more research, and that women are going to continue to ask these hard questions of us.

Looking at tests, what's the best way for me to be diagnosed sooner? Because one thing that Joan said, the sooner you're diagnosed, get into treatment, the higher your chance of having a great success story to tell.

GUPTA: And everyone's different?

RICE: Everyone's different. And getting a second opinion, even as a physician, and I know good doctors. I would always get a second opinion.

GUPTA: I'm glad to hear you say that, I get asked all the time. It's not offensive. I think it's a good thing.

Always a pleasure to have you on the program.

RICE: Thank you.

GUPTA: Always learn a lot. Thank you so much.

RICE: All right. Thank you so much. See you later.

GUPTA: Yes, good to see you.

RICE: All right.

GUPTA: When we come back, plastic surgery gone wrong. Fifteen million operations a year, what happens when it's truly botched with some serious medical issues? We're going to meet two doctors who say they're on a mission to fix it.

(COMMERCIAL BREAK)

GUPTA: Every year, more than 15 million cosmetic plastic surgery procedures are performed in the United States alone. And most of the time, patients turn out just fine, patients and doctors are happy. But a new show brings to light what happens when plastic surgery goes terribly wrong.

Now, I do want to warn you ahead of time, some of the images you're about to see are pretty graphic.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: I feel like Frankenstein.

UNIDENTIFIED FEMALE: They're (INAUDIBLE)

UNIDENTIFIED FEMALE: At the end of the day, I still have a deformed nose.

UNIDENTIFIED FEMALE: Like a horror movie.

UNIDENTIFIED FEMALE: I got a tummy tuck 13 years ago, and my coochie is on my tummy.

UNIDENTIFIED FEMALE: I went to Mexico to get nip tuck and actually I got this.

UNIDENTIFIED MALE: How many surgeries have you had on your nose?

UNIDENTIFIED FEMALE: Six, three different surgeons.

UNIDENTIFIED FEMALE: I lost faith in anybody making it better.

UNIDENTIFIED MALE: I made incisions through the bottom of the areola. The first thing I found is the implant was upside down.

(END VIDEOTAPE)

GUPTA: Wow. You can't take your eyes of this.

And the doctors who are tasked with referring these bad operations are part of the new show on the E! Network, which is called "Botched." They join us now.

Dr. Terry Dubrow and Dr. Paul Nassif joining us from New York.

Thanks. Welcome to the program.

DR. TERRY DUBROW, E'S "BOTCHED": Thanks for having us.

DR. PAUL NASSIF, E'S "BOTCHED": Thank you very much.

GUPTA: So, how did this come about, this idea of doing a show about operations that had gone wrong?

DUBROW: Well, you know, we've been plastic surgeons for a long time and friends for a long time. We practiced together in the beginning of our careers.

And I don't think people really realize that plastic surgery is like all other forms of surgery. There's risks involved and there are complications. And the complication rate is high as 5 percent to 15 percent.

In this country, you're seeing a lot of non-board certified plastic surgeons or surgeons or doctors with no training in plastic surgery do plastic surgery, and there is some really serious complications that come about as a result of that. So we thought it would be a great idea to show, as a cautionary tale, all the problems that happened and how to fix that.

GUPTA: It's amazing. You know, I went through the board approval process for neurosurgery a few years ago. And I was sort of struck by this. You guys maybe as well, that a lot of hospitals don't actually require someone to be board certified, they should be board eligible. But it's a much more fragmented system than I think people realize in terms of actually getting board certification.

What is a complication versus a patient being unhappy with their result? How do you distinguish these things?

NASSIF: You know, even though we talk about informed consent, we tell every patient you're looking at a scar, poor results, swelling, bleeding, you know, the usual. It's like you tell your patients.

However, with cosmetic surgery, sometimes patients may have buyer's remorse or even when you try to really communicate with them well in regard to realistic expectations, it just doesn't meet their needs and it can be unhappy. So, there's completely two different things.

DUBROW: But, I mean, the most common operation in the United States for cosmetic surgery is breast augmentation, right? And breast augmentation actually results in a complication which is scarring, which distorts the implants.

GUPTA: Right.

DUBROW: As you can see, it sometimes causes pain in as many as 30 percent of the cases normally.

GUPTA: Wow. You know, curious, I get this question all the time, I'm sure you guys do as well. Can I please recommend a doctor or specialist for XYZ, whatever it may be? If someone is saying, look, how do I find a plastic surgeon who I'm least likely to have a complication with, most likely to give me a good result? You know, besides going online and reading what you can find there, what do you recommend? How do you find people who you think are really credible and are going to likely do their job?

DUBROW: I think you -- first of all, you want to look for basic things like board certification, good standing with the local medical board. You want to do some research online, and you have to be careful, there's a lot of reviews where patients in cosmetic surgery are unhappy because their expectations weren't met.

But go to their office, look at their before and afters, get a feel for their practice, see if you can potentially talk to some of the patients.

NASSIF: Yes, I mean, that's actually one of the biggest things we do, we'll actually screen the patients to make sure they're good for us. And I'll tell you, when they come in, after they found the right doctor, we want to make sure they're realistic, because if they're not, we're just not going to have a good outcome. The relationship is going to be in trouble at that point.

GUPTA: Yes. I always tell patients, I should talk to the nurses as well. And sometimes residents, if you're in a teaching hospital. They also know what's going on, I'm sure you know as well.

NASSIF: Oh, yes, we sure do.

GUPTA: Well, you give us a real peek behind the curtain at sometimes awful situations, but hopefully situations that are fixable as well in many of these cases. So, just like said, just watching that teaser reel, it's hard to take your eyes off of it. And I wish you guys great luck.

DUBROW: Thank you very much.

NASSIS: We really, really appreciate it. Thank you very much.

GUPTA: And up next, TLC reality show stars are heading to Capitol Hill. Fighting for a fix they say will help seriously ill children.

(COMMERCIAL BREAK)

GUPTA: Three million kids around the country have complicated medical conditions, often times requiring specialty care from various doctors. And what happens is many of these kids end up visiting one of 250 children's hospitals. But with so many doctor visits, sometimes there are tests that are repeated, procedures that are unnecessary and all of this can be a real drain on families, both in terms of time and money.

(BEGIN VIDEOTAPE)

DR. JEN ARNOLD, TLC'S "THE LITTLE COUPLE": The doctor's going to do tomorrow, see if you have a heart rate there.

GUPTA (voice-over): Dr. Jen Arnold says it doesn't have to be like this. You may know her as half of TLC's "The Little Couple.

ARNOLD: Hey, how are you?

GUPTA: She takes care of premature babies at Texas Children's Hospital.

ARNOLD: OK. So, how did Henry do overnight?

GUPTA: Not only that, she spent much of her own childhood going to doctor after doctor after being born with a form of dwarfism.

Last year, she was diagnosed with a rare form of cancer, and her surgery was complicated because of her dwarfism. But today she's in remission.

ARNOLD: Really fight about this new piece of legislation.

GUPTA: And this week, she went to Capitol Hill to lobby for a bill that would better coordinate medical care for children.

(END VIDEOTAPE)

GUPTA: And Dr. Arnold joins me now from Capitol Hill.

Welcome to the program, Doctor.

DR. JEN ARNOLD: Thank you so much.

GUPTA: We're used to think that you're making rounds on your patients, you're making rounds on Capitol Hill now, talking to lawmakers. What are you telling them? How are you presenting the case here?

ARNOLD: Well, I'm really excited to be here, because we're advocating for the children's health care with the ACE Act, which is advocating, or actually advancing care for exceptional children. So, we have a lot of children right now that regardless of whether or not they live in a city that has a children's hospital, may not have good access to that care.

And, you know, Medicaid funding, the majority of these patients are on Medicaid care, they -- Medicaid support depends and varies depending on the state you live in. One of the things that we found would be most challenging is that, for example, since I work at a tertiary care children's hospital, we do have patients that do come from those cities that don't have children's specialty care, and when they come to us, a lot of times, we don't have access to their records, their films, we have to repeat CT scans, other imaging.

And we have trouble just coordinating the care for when they go home, so the doctors and nurses that are close to them, are able to manage things when they're not in our care.

So, there's really a need now as this population of children is growing exponentially to have better coordination of care and sort of a medical home.

GUPTA: And, again, we're talking about things that could be addressed if the system were more coordinated. And, look, you know, the system as a doctor, but also as a patient. And, as you know, you have two of your own children that need specialty care.

If what you're pushing for goes through, how does your life change, especially with regard to your own children?

ARNOLD: Well, you know, I think it's going to change dramatically for Medicaid patients. You know, the majority of the patients that I care for as a physician are under Medicaid, because it really does help to bridge care for those medically complex children out there that don't otherwise have insurance, private insurance or commercial insurance. For my kids, it's going to really help them better coordinate their

care. So, I don't have to worry about our orthopedic surgeon in Delaware getting the scan that he needs to make decision and talk to our, you know, pulmonologist and general pediatrician, and, you know, neurologist here in Texas.

And, you know, for me, for example, as of late, you know, our insurance company told me they're no longer going to support us go to DuPont. That's scary for me, because I know the experts are there. Not all families have this knowledge, having this networking and children's hospitals working together, it becomes known. So, families can go -- you know, they're free to travel to Delaware for one thing, and Texas for another because that provides the best care for their baby.

GUPTA: Dr. Jen Arnold, thanks so much for joining us. Really appreciate it.

ARNOLD: Thank you for having me. It's a pleasure talking to you, and thanks for your time.

GUPTA: That's all the time we have for SGMD today.

CNN NEWSROOM continues right after a quick break with Randi Kaye.