Episode 25: Sunday December 06

Drs. Sam Jejurikar, Salvatore Pacella, and Sam Rhee welcome special guest Dr. Amy Alderman, MD, MPH., board-certified plastic surgeon (http://www.dramyalderman.com/) Sam, Sal and Sam all trained with Dr. Alderman during plastic residency at University of Michigan, and unanimously agreed she is one of the most talented plastic surgeons they know.

While working at University of Michigan as an Associate Professor of Plastic Surgery and Director of the Cosmetic Center for Plastic Surgery, Dr. Alderman's clinical research was dedicated to improving women’s access to reconstructive breast surgery, improving surgical outcomes, and patient safety. In 2014, Dr. Alderman’s research efforts were recognized by the Plastic Surgery Foundation, when she received the national award for Outstanding Achievement in Plastic Surgery Research.

Dr. Alderman is now in private practice in Atlanta, Georgia, where she has has been recognized as Jezebel’s Best Plastic Surgeon of Atlanta, Best Body Contouring Surgeon of Atlanta, Atlanta’s Best Mommy Makeover, Vitals Compassionate Doctor Award, and 10 Best Plastic Surgeons in Georgia for Patient Satisfaction.

Chairing multiple national meetings and symposiums, Dr. Alderman remains active as a leader in plastic surgery, currently serving as a board examiner and a Director to the American Board of Plastic Surgery.

We catch up with Dr. Alderman, who also presents a case with a special technique regarding mastopexy (breast lift). If you are interested what makes a successful plastic surgeon tick, this episode is a MUST WATCH!

Full Transcript (download PDF here)

2020.12.06 S01E25 DR. AMY ALDERMAN
Dr. Sam Rhee: [00:00:00] All right. Welcome to three plastic surgeons and our microphone where we have a very special guest today, dr. Amy alderman, fellow resident, back at university of Michigan, back where we trained for plastic surgery, before we get to, Amy, I would like to just do our, Ritual disclaimer, this show is not a substitute for professional medical advice, diagnosis or treatment.
This show is for informational purposes, only treatment and results may vary based on the circumstances, situation and medical judgment after appropriate discussion, always seek the advice of your surgeon or other qualified health provider. With any questions you may have regarding medical care and never disregard professional medical advice or delay seeking advice, because it's something in this show.
And with that, I would like a Sal. Would you like to introduce dr. Amy alderman for us? 
Dr. Salvatore Pacella: [00:00:41] Sure. Amy, so good to see you. 
Dr. Amy Alderman: [00:00:45] Thank you for having me guys. It's good to see you all again. 
Dr. Salvatore Pacella: [00:00:48] Amy alderman is an exceptional, plastic surgeon. I've known her for many years. She was my chief resident at the university of Michigan and Amy.
I don't know if you remember this, but the first, month of June, when we, when I started my residency, you were my senior resident and you took me through my first operation, which was an appendectomy. the first time I spoke to Michigan. 
Dr. Amy Alderman: [00:01:13] that's a frightening thought. Me taking you through an appendectomy. How's the patient do. 
Dr. Salvatore Pacella: [00:01:18] She did great. She did great. And so Amy ended up, becoming an attending at the university of Michigan and, was exceptionally well-published. And, you had, several research projects going at the time and you achieved. my understanding the rank of professor, correct.
Dr. Amy Alderman: [00:01:35] That is correct. 
Dr. Salvatore Pacella: [00:01:38] And then, Amy, missed the deep South from the chilling cold of Michigan and decided to relocate to, the lovely city of Atlanta, Georgia. Who, and Amy was actually looking for a position when I was a fellow there. So we communicated quite a bit about Atlanta and ended up just starting a wonderful, vibrant, and exceptionally busy private practice in the city of Atlanta.
And now she's just. She's still quoted for a lot of the research that she's done in breast reconstruction at the university of Michigan. And it's just a top-notch person as well as a exceptional plastic surgeon. So Amy, thanks so much for joining us today. How was how's everything going for you in Atlanta these days?
Oh, it's good. we're still, it's still warm down here. So the COVID cases are still a Bay a bit compared to, I think some of y'all are, it's a little bit colder. but, it's good. It's crazy. Ever since we opened, we closed the operating room for about a month, last March when COVID really hit.
And then when we figured out a way to test patients and we opened back up. We haven't gone a day without operating. I don't think it's been not. So I think everybody's sitting at home and they're either doing projects in their house or projects on their, on their selves. And, they're they realize they can do a lot of breasts and body cosmetic procedures and still beyond their business zoom call.
So Amy, tell us a little bit about your practice, what a, what's it like, what are you doing? what's your favorite type of case? 
Dr. Amy Alderman: [00:03:08] Yeah. So when I was with these guys at Michigan, I did all breast reconstruction. In fact, I think one of my last micro cases might've been with you, Sal. So it was pretty, probably pretty memorable.
so it's nice to be back in Atlanta where I am, from the South. And my practice now is a hundred percent cosmetic. It's all, it's probably 95% breast and body. my bread and butter procedures or my mommy make-overs breast reductions, breast lifts. Tummy tucks lipo. so that's, that's kinda my, my professional life.
We, built a new office about two and a half years ago. So we have our own operating room and, it's nice. Cause we don't have to be subject to the local hospital in regards to when we can operate and when we can't. And so it allows a lot of freedom in regards to taking care of patients and trying to meet their scheduling needs also.
Dr. Salvatore Pacella: [00:03:56] That's great. one of the, one of the main reasons, not only because of your pedigree, but, one of the main reasons we wanted you to join us is to tell us a little bit about, or a lot about what, what it's like to train as a female plastic surgeon of what it's like to be a female plastic surgeon now in practice.
maybe, tell us, when you, when, what first, drew you to plastic surgery, 
Dr. Amy Alderman: [00:04:21] I, my, I have a little bit of unusual, startup because I always, I wanted to be a physician. I grew up with my grandmother and she was an envelope. She had emphysema. So I always was in and out of the hospital and I knew I wanted to go into medicine.
And one of my really good friends that I used to ride horses with growing up, her dad was a plastic surgeon in Nashville and he let me go into the operating room with them when I was. A junior and high school. And as soon as I walked into the, or it was this magical experience, and I said, I, this is what I have to do.
I was lucky enough that he introduced me to dr. Louis Vasquez, who, if you're a plastic surgeon, dr.  is at UAB. and, he's the, one of the pioneers of. Our modern day plastic surgery, and he's such a sweet man. He let me spend every summer with him at the end of high school and college, just following him around.
So I just wanted to be whatever he was. He's a very amazing innovative surgeon. and unfortunately my friend's father who got me into plastics just passed away two weekends ago. So it's, thinking about him a lot right now, I wanted to go into plastics, not because I was a. Man or a woman that gender didn't really play a role.
It's just what I absolutely love. And it's who I am. It's not really a job. It's a part of me. They did tell me, early on that it would be challenging to, have work-life balance. But you know what I would like to think that's a challenge, whether you're a man or a woman. you guys are all, fathers and y'all want to spend time with your kids.
And so it's really, how do you balance work, and your family life. And I think hopefully the challenges are the same for men and, and women. 
Dr. Salvatore Pacella: [00:06:00] we, just only on, in the media, they've started this new series, dr. Nine Oh two winnow and one of the, this is a, an extension of a previous, reality TV show.
But the interesting thing is it's now all about, there's four board certified female plastic surgeons. are you familiar with the show, Amy?
Dr. Amy Alderman: [00:06:21] I'm not I'm too busy 
Dr. Salvatore Pacella: [00:06:23] work life balance. So the interesting things about the show is it's four board certified plastic surgeons, all female plastic surgeons, and they all have different types of practices.
And it's just interesting to follow them around and see what makes them tick. And the reason I bring this up is what keeps driving you. to spur your practice and be successful and what, what just makes you tick here. 
I would like to say one thing, I would like first of all, just to be considered amazing plastic surgeons, and I'm not quite sure why we have to distinguish ourselves by our gender.
I think, I'm no different than you guys and I'm not sure why there needs to be a special show just because we're women. I think. The key is that you're the best that you can be at your profession. And I don't want to let up because I'm a woman and I don't want to be discriminated because I'm a woman.
I want my opportunities because I do the best I can do. And, it should be based on the person, not on the gender. What makes me tick. this is just what I love doing. I, there's nothing better than to be in the operating room. I just love to operate. Now, if I could operate, not have to do clinic, that would be even better.
But, I think we all love to, to operate, right? my practice is nice because my practice is mostly, 90% of my patients are. Very have very similar lives as me and majority of my patients are women. Majority are either professional women or stay at home moms so I can relate to them on some level, I don't have a practice.
That's a lot of, a lot of, I don't have a large male patient population. and that kind of makes sense because I think a male, Patient would probably rather go to a male plastic surgeon if he has some insecurities. And so I think the patients that come to me, they, hopefully they come to me because they think I'm the.
We'll do the best for them, locally here in Atlanta. And then, but it's easy for me because I can relate to them, in regards to their issues and insecurities that we all have after we have kids and the changes that happen to our bodies, 
Dr. Sam Rhee: [00:08:23] I was going to ask Amy, obviously medicine is a reflection of society and society has its own biases.
Which we saw growing up in training in medicine, whether it was your ethnicity, whether it was your religion sometimes even, or whether it was your gender, depending on who you worked with or who was training you. I think it's certainly better now and we definitely have better perspectives now in 2020 than say, when we were coming up through training, do you feel that, There were challenges just be just based on your gender alone.
And do you feel like that's no longer the case in medicine or do you still think that those issues are still there if they were
Dr. Amy Alderman: [00:09:02] well? I think a lot of my. challenges occurred when I was on faculty, Michigan. Cause I was the only woman, that 13 and I did delay having kids until I, I was on faculty. So I had two kids pretty quickly back-to-back and my challenges were figuring out how to. Have the clinical schedule that you know, that we had at Michigan make the faculty meetings every week at night, make the journal clubs, and take care of all the calls.
I would calculate usually about 10 out of 10 nights out of the month. I wouldn't make it home. Okay. Does he my two babies. So that's why I left academics. Honestly, I always wanted to be an academics. I still consider myself an academic. I still I'm involved with all of our professional meetings and I'm on the board of directors for the American board of plastic surgery.
So I'm still involved, but I don't know how it is now. I'm in academics. But that was my biggest challenge is how do I do my. Day job and figure out how to get home, to see my two kids. It's definitely easier in private practice because now I have control, of when I want to end my day and what my obligations are after work. So 
Dr. Sam Rhee: [00:10:17] I will say that there are a number of women, faculty members at Michigan and in plastic surgery. I just wanted to add that in now. So my, I imagine hopefully things are continuing to improve and get better. 
Dr. Amy Alderman: [00:10:30] I would hope so. Hopefully they, some changes maybe occurred after I left. so let's hope.
Let's hope. So there are a number of women's on faculty. So either there are a lot tougher than me or they did make a few changes. So yeah. 
Dr. Salvatore Pacella: [00:10:45] Amy, I said anyway, 
Dr. Amy Alderman: [00:10:46] hopefully 
Dr. Salvatore Pacella: [00:10:49] you make an excellent point. Oh, go ahead. Go ahead. Sorry. 
Dr. Sam Jejurikar: [00:10:53] No, it's okay. I it's a with our internet connections, it's hard to sync up a little bit.  for, so for our viewers, I will just say, and the other two guys are going to share this. Amy Alderman's is an exceptional plastic surgeon. And in many ways I felt as though when you, we were going through training, Amy was a year ahead of me. I felt like you were better than so many other men that were there.
And in many ways, that sort of set the tone. Trajectory to the, where you're at right now. 
Do you feel like, particularly at the time that you were training and as an early faculty member, you were held to a different standard than a male plastic surgeon, because there were many men that didn't measure up to you and you're too humble to say that, but did you feel like you were held to a different standard as a female plastic surgeon in a specialty that's largely been controlled by men?
 Dr. Amy Alderman: [00:11:37] guys, I, me, I'm really competitive. Y'all before the show started, you talked about seeing my Peloton posts. So I, I'm, I'm just, it's just me. I'm competitive. So I want to, I want. To do the best I can do. I do think, and in a field that has been predominantly male dominated as a woman, I think that we have to really knock it out of the park.
and like I said before, I would never want an opportunity because I was a woman. I want the opportunity because I'm the best person for that job position, leadership role. we'll just leave it at that. How about that?
Dr. Salvatore Pacella: [00:12:19] Yeah, it, it's, I really want to echo what you said earlier about, the work-life balance, and that's critical for anybody, male or female. And, I find, I clearly find myself struggling with that constantly. I have two young kids, nine and eight and or nine and seven.
I can't even remember their ages. That's how. Yeah, but, it's, it's a huge challenge as a parent and as just even a person to not get on the hamster wheel and keep going and going without taking time for yourself and take time for your family. we, that's just.
it's an excellent point that you make. 
Dr. Amy Alderman: [00:12:56] and it's a little bit different in private practice versus university. The university, it's a little bit easier to take time away. You've got people to cover you. You've got certain number of days off and at Michigan, we were salaried. So if we worked more, we didn't actually.
bring out more money. So it was easier to get away. But when you were there, the demands were just intense where you, it was very hard to make it home before. your kids are in bed. Private practice is a different challenge. I can make it home, but it's hard to say no to patients. So if a patient says, I really want this procedure and I need a done, you feel this pressure that you need to provide the service for the patient, and then it's easier for that to creep into your family life.
Dr. Sam Rhee: [00:13:36] At least you get renumerated for it though. 
Dr. Salvatore Pacella: [00:13:40] Yeah,
Dr. Amy Alderman: [00:13:41] a lot better. 
Dr. Salvatore Pacella: [00:13:43] Amy, thanks so much for, for chatting with us here and now, we're gonna, we're gonna highlight some of your exceptional surgical expertise here, why don't we, let you share your case and, so go ahead and share your screen and let's talk about what kind of awesome work you do here.
Dr. Amy Alderman: [00:13:58] So I thought I would just talk quickly about a really kind of simple concept, but, and I bring it up because it seems like there's a little bit of a trend for at least in the, where I am for smaller breasts, smaller augmentations. And I have a lot of patients that just don't want an implant at all right now.
We see a lot of patients that want their implants removed. So I bring this up as a kind of an interesting idea or concept for a patient that needs rejuvenation of their breasts, but they don't want an implant. And I call it a mastopexy with an auto augmentation. I had more pictures to show, but, they didn't have hearts over the little nose, so we're going to keep it at that.
So you don't get in trouble. the concept is, when you evaluate a, a patient, we're looking at what the upper pole of the breast is doing to help a patient decide, do they need an implant or not have an implant? And the really the only way to make a significant change in the upper aspect of the breast and the volume is to add that implant.
Like you guys know. And then the other concept is that this tissue that's tabled at the fold. We need to do something with it, or it's going to want to relapse and start to hang over the fold over time. So this tissue down here, if a patient is pretty large, I'll remove it unweight the breast helps us get a longer lasting lift.
This patient would be an ideal. I ideally would have an implant. I think the three of you guys would agree. She's pretty volume deficient. She doesn't have much projection up here and she's a little bit relaxed, but not super relaxed. She absolutely did not want and fence land. So I'm trying to figure out how do we get a little bit more projection behind the nipple when we can't put an implant in.
So here's where the auto augmentation comes to this tissue down here, that where we don't want it, we use it and tuck it up behind the nipple and kind of talk it to the chest wall here and then to your left. Unfortunately, I can't show you the side picture because that one doesn't have the little hearts or the nipples, but if I could show you a side picture, she's got really nice projection, like right behind the nipple that she didn't have prior to the mastopexy.
And that's from this lower pole tissue, being turn it into a flat flip and underneath the breast, tack it to the chest wall and then do the lift as usual. So just bringing it up as a nice concept for somebody that. Needs to augment behind the nipple upper part of the breast, and doesn't want an implant.
The auto augmentation is a good option. 
Dr. Salvatore Pacella: [00:16:35] So Amy you're basically making a much like a inferior based pedicle for a breast reduction by leaving the nipple attached to the upper pole and then tacking this underneath 
Dr. Amy Alderman: [00:16:47] the breast. That's absolutely right. So that, yeah, so it's a superior medial pedicle.
Here. It was just a superior pedicle, cause she didn't need to be elevated very much if she did, you can just do a superior medial pedicle. The blood supply to the flap is deep right here. It's around the fifth intercostal, perforator. And so that tissue that you would have as a traditional inferior pedicle, you  take off the skin and then disect down around it and you have to release it in all four dimension.
So you have to release all the way to the chest wall here of top the sides and along the floor. Okay. Then this part gets lifted up and you just tuck it up underneath the nipple. 
Dr. Sam Jejurikar: [00:17:32] That's a really nice result. Amy, how do you, how do you, hold that tissue in the upper pole for a long period of time afterwards?
Like what do you do to 
Dr. Salvatore Pacella: [00:17:40] to secure that? 
Dr. Amy Alderman: [00:17:42] so it's, it's interesting cause I've talked with, I learned this from dr. Betsy hall Fenley. And she told me that tissue won't scar down to the chest wall in that it's, it will always be a little bit loose, but I'm not sure that's actually true because I did go back and I, one of these a year later that, she's you know what?
This is great. When I go ahead and be bigger, let's put an implant in. So it gave me an opportunity to go back in and see what that tissue look like. now that I was going to do an augmentation. And it did heal around the parenchyma. it wasn't like you could see it as a distinct flap anymore.
It was incorporated. But in the short term, I just take a two PDS. on the top part, I do two sutures and, just parachute them down to the chest wall, but it's interesting. It's very powerful. what that tissue can do. So before I do the final closure, I tack those, the flap down of both sides and I sit the patient upright and make sure that flap is located at the same position on the chest wall.
Otherwise you'll get some asymmetry in your projection. 
Dr. Sam Rhee: [00:18:46] So this flap is inferiorly based, correct? Okay. Cause I remember seeing, a superiorly based auto log, type of procedure with Grotting. He, dr. Grotting , 
Dr. Amy Alderman: [00:18:57] underneath 
Dr. Sam Rhee: [00:18:58] yeah. Where he flips it underneath. and I've done that. a bunch of times I've never actually thought about doing it from an inferiorly based perspective, but that would be a good idea too.
Dr. Amy Alderman: [00:19:07] It's really easy. It's a really robust, Little perforator right at the base of that, but they key to get it, to move up. As you do have to disect all the way down to just fall on all four sides of the flat and then it actually elevates pretty well. 
Dr. Sam Rhee: [00:19:23] Do you use any mesh in any of your, mastopexies or no, 
Dr. Amy Alderman: [00:19:27] I don't. I have, I really in last 10 years, I've only had two cases where I've used mesh. I'm thinking about it more in the massive weight loss patient. If you look at them and their fold is really mobile, I think their total setup for, an inferior Fairmount position over time. I do have a case where I use GalaFLEX and boy that has.
Helped tremendously. so I think that would be the patient I would think about doing an ed. 
Dr. Sam Jejurikar: [00:19:56] And do you ever use any tilt? Sorry. So I'll 
Dr. Salvatore Pacella: [00:20:01] go ahead. so Amy, I was just going to say, so this is really designed to increase lower pole projection, correct? Not necessarily upper pole projection, correct.
Dr. Amy Alderman: [00:20:14] No it's designed that flap is really sitting at the nipple and about two to three centimeters above the nipple. And then it's pretty much removed from the lower pole and advanced up. So it's really projecting. The projection is like behind the nibble. 
Dr. Salvatore Pacella: [00:20:33] do you ever do a auto augmentation with that transfer to the upper pole?
What are your thoughts on fad transfer? 
Dr. Amy Alderman: [00:20:41] I'm not a big proponent of it right now. I did a lot of it when I was at Michigan for the breast cancer patients. the promise, you can get a lot of wheel SIS and changes to your mammogram. I talked with, although local, Radiologist a couple months ago, about what changes she sees in the breast with fat grafting and, it doesn't really distort the architecture.
So I, for my cosmetic cases, I don't do much fat grafting. I'm not saying it's a wrong thing to do. I just boy, a few. if it changes their mammogram and it leads them to have increased biopsies or imaging it's a, you can't reverse that, 
Dr. Salvatore Pacella: [00:21:25] that's a great case, Amy. just. Exceptional projection here, obviously without the side view, but you can clearly see the lower pole of the breast. and just with the shadowing effect on this photograph, you can clearly see how much, intended lift and how much extra projection you've got. So great result.
Really 
Dr. Amy Alderman: [00:21:42] nice. thank you. And I think again, she would have looked great with an implant, but it's just, it's a nice. Option for patients that want to, don't want to increase their breast size and, don't want an implant, but you need to, I that's the all Findlay, someone that it taught me this, that you got to remove, move the tissue where you don't want it.
And that lower pole tissue there either get rid of it if the patient's large, because it's going to unweight the breast and allow you to. reshape them better or move it like with the Ottawa and put it where it's going to Bennett benefit her cosmetically. 
Dr. Salvatore Pacella: [00:22:20] Now Amy, a couple of times now you've mentioned, Betsy hall Findlay.
And, I know just from our friendship throughout the years, she was a, she is a huge mentor to you. tell us a little bit about your mentorship with her and just, what, what inspired you about her and maybe, talk a little bit about your, relationship today.
I think that's important for our viewers to hear. 
Dr. Amy Alderman: [00:22:44] I will. And I'm trying to, you guys know how I can stop the, share the screen so I can see you again. 
Dr. Salvatore Pacella: [00:22:50] let me call, AV support here, Sam Rhee?
Dr. Amy Alderman: [00:22:56] Does that better? So Betsy, Hall Findlay is I think just an amazing pioneer of breast surgery in our okay.
And our time she's in Banff, Canada. And, I was trained like all of us at Michigan to do breast reductions using the traditional anchor or wise pattern where there's a big incision along the fold. And I'm right out of training. I went and spent some time with her and learn how to do her vertical breast reduction and, There's pretty much not a breast surgery I do now that's not influenced by what she taught me. So I'm almost a 99.9% of vertical pattern, whether it's a reduction or mastopexy. and she's amazing. She's 70, she turned 70 this year and she still operates three days a week and works four days a week. And, it's going strong. So when w really neat thing was over, COVID.
when I couldn't operate, I called her and I said, will you review my cases? And it's very humbling to have the person that taught you how to do a procedure, review your cases. But I fixed, pick one of my best ones to show off. a lot of my, once that I wasn't, I thought could have been improved.
And so she spent two hours with me on the phone, going through what she would have done differently and, way I learned a lot from that. But it's, you have to be a little bit humble to go through that process, but it was good. That's great.
 Dr. Salvatore Pacella: [00:24:27] gents, any additional questions for our wonderful guest here? 
Dr. Sam Rhee: [00:24:32] No, it's just amazing after, hasn't really been 20 some years, you've gone through so many different iterations, of what, you've, you've done, you got through academia all the way up to full professor. You've done a tremendous amount of research, at the institution, to stay at an institution means.
They thought you were basically better than anyone that they wanted you there. They wanted to keep you there. they saw the talent, they saw you up close and personal. It wasn't an interview. It was multiple years of watching you work that determined whether or not they wanted to keep you there. and you, basically as far as you could go or you chose to go basically, and then you remade yourself.
You're still remaining in academic plastic surgery, as part of the board. And, and you've basically built your life exactly the way you wanted it. And when you look back at it, is there any regrets, anything that you feel like, you know what I really didn't, maybe I should have done this instead or taken this opportunity or something that you feel like, 
Dr. Amy Alderman: [00:25:33] I really think you shouldn't live life.
They can have regrets. And so there are definitely aspects of different jobs. I've had, I left Michigan. I was actually an employed physician, so I was eight years of a practice and I was employed and then I left that and started my own practice. So I have tried about every different, Model of practice you can have.
And instead of thinking, boy, that was a horrible experience. And I regard that, I think it's better to think of boy. I learned a lot from that and let me take that and then figure out how to make the next chapter better. So I loved my time at Michigan. I learned a lot. I enjoyed my, I still quite good friends with a lot of my colleagues back there.
and so I don't regret that and it did kickstart my career. I did have people tell me once I left Michigan, my career is over. So it's pretty nice to prove them wrong. and, and it was fine to be an employed physician for awhile. Cause my kids were really young. And so I didn't have to worry about how to manage a practice, but then there comes a time where you want to have more input on how the practice runs and you want the practice reflect.
Your values. So now it's fun because I'm learning a little bit about how to run a business and how to manage employees. And so that's, just keeps life challenging every minute. So it's all good. 
Dr. Sam Rhee: [00:26:56] So what are your future goals? What are your future challenges? What do you look forward to doing now as the next?
Dr. Amy Alderman: [00:27:02] Yeah, I'm really excited to last year. I got on as a director for the American board of plastic surgery. And I'm just to me, that's like the, my personal biggest, position or honor I could get. I think board certification is really important. And Atlanta, for example, we have a lot of physicians practicing cosmetic surgery that are not board certified plastic surgeons and patients are getting hurt.
So to be able to have an opportunity to, Help with our board certification. And our profession is probably the most important thing I think I'll do in my career. And hopefully we can continue to get the word out to the public. That board certification is really important and it doesn't matter if you're having a simple liposuction case or more complicated  procedure. You want to go to somebody that's board certified in that procedure? I think we can all agree with that. and then the other thing is I just got, to be co-chair of the Atlanta breast meeting. so that's nice cause it's in my backyard and, that's the part of plastic surgery I love the most.
So I look forward to being involved with that, with that meeting. I know Sal and I are both, sorry that we lost, dr. Mark Codner we too soon. he was a leader with this meeting and, before he passed, he had asked me if I'd be interested in getting involved with the meeting. So I'm very thankful that he opened up the door and, I will do my best to, help shape the meeting, in the future, how I think he would, foresee it to be, shaped.
 Dr. Sam Jejurikar: [00:28:41] Amy, as always, I've learned a lot. Yeah. from the case that you presented it so humbly and so simply, but it's a great idea, a really nice result. And, I can definitely speak for the other two. When I say we're seeing a lot of patients who don't want implants. That's a really nice option and a really nice result.
So thanks for sharing that with us. 
Dr. Amy Alderman: [00:28:58] Yeah. Thanks for having me guys. It's good to see you all again.