The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There is no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome back to Meet the Doctor. My guest today is Plastic surgeon Kat Gallus. She's in San Diego, California. Welcome to the show.

Hi. Thanks for having me.

Now, have you ever been on a podcast before?

Not an actual podcast. I've done IG Live and some recordings for, actually I have, I've done some recordings for A S P S. So they're podcasts.

That's right. That's a good podcast. And then you have a friend that you do a lot of kind of pseudo podcasts with that you guys make videos together?

We do an IG Live. We had been doing 'em pretty frequently. She's a plastic surgeon in Ohio, but we have similar practices even though we're in different areas of the country. So we would shoot the breeze about different plastic surgery concerns.

How did you get to be friends?

Through Women's Plastic Surgery? It's a group, an international society and it's been a really awesome opportunity to network with other women.

And you were for a while, I know we're already on a tangent here. Are you serving that group in a leadership capacity of some kind?

I am. I just stepped down from being chair. I had been chair of the committee for a couple of years. I was vice chair prior to that. I've helped co-chair the annual symposium, and so I'm helping with that symposium. We do one every year for women plastic surgeons. I'm helping out, they didn't want me to quite step away from the committee I'm helping out for. They tried to make me a legacy or a trustee. I'm like, that's not a thing for this committee. But for our upcoming meeting, which will be in February of next year, and when I started, yeah, there was about 35 women that attended and we have now are at the point where it's capped at 150 to keep it small.

Oh, that's the old, was it the North Face that discovered it was 150? It was like a clothing company and when they got to 150, they would open another building and put 150 people in the next building because they didn't want to go over. Yeah, I was going to say, they should just title you Chair of the Curse of the Capable or something because they don't let you go. It's because you did a great job.

Yeah, thanks. Was very rewarding.

What did you like about it?

So one of the things I really, really enjoyed about it is connecting with other plastic surgeons and then finding these women out there that do great work and aren't connected in any way and so aren't invited to speak at national meetings. And so we're not tapping into that resource. And so initially I started converting the meeting to more of a presentation style. And so we weren't just talking about wellness and burnout, which is great, but I wanted people to present their findings, how they do certain surgeries. And so we started moving in that direction and some of the surgeons had never presented and were super nervous and you were like, where have you been? It's so amazing. And so then as soon as we saw them present, we're like, you need to speak at the national level for everybody. And three or four of them I can think of have gone on to continue to present and sought after. And it's just nice to be able to find that.

So many questions in my mind. I once read about Angela Merkel or Angela Merkel or Chancellor of Germany, that she over-prepared for everything. There was never anything that she did not over prepare for. And it was because she was always so worried about being in these high powered environments with men who were on the same level as her and she would just smoke 'em every time because she was in this habit of being over prepared. And I think about in our world, and I've been at the meetings as long as I've been working in this space too, I know a lot of people who just stand up there and throw their slides together the night before. And I can't imagine any of the female surgeons that I know approaching it that way.

Oh no, absolutely not. Even amongst us, there are some surgeons who tend not to want to present. So there's a couple older plastic surgeons that have been around for a while and they've offered, I'm helping coordinate the aesthetic face panel for our upcoming national meeting. And somebody that I invited to speak is I'm really nervous about speaking, so she's going to have her slides prepared. This other surgeon's going to review her presentation with her. She's done that multiple times for other people so that they're comfortable presenting. Oftentimes we'll go to those presentations for moral support. But you're right, all of that leads into just usually an overwhelmingly fantastic presentation. And some of the guys just phone it in because I don't know, they don't have that same internal stress.

There's probably a lot to unpack there.

Yeah, there probably is.

Well, this is really meant to help patients get to know you, so let's figure out how we can tie this to them. And I think one easy way to ask that be, how does the work that you're doing serving other female surgeons end up helping your patients too? Can you think of any ways that it does that?

Absolutely. I think a lot of times plastic surgeons will practice in isolation and not really chat with other surgeons. You feel uncomfortable asking a question or probing some sort of nuance to people's techniques. And I think networking with other surgeons and knowing if I'm trying a new procedure or a new technology to ask those who might have done it already, I feel really comfortable texting my friend in Tampa or my friend in Rochester who's had it for six months before I have and ask about, Hey, what have you learned? What's going on? There are certain surgeons that are usually quicker to take on new technology, and I am a little bit more conservative than that, so I don't jump on every new thing, but I do like the benefit of having somebody I can reach out to after a product or technology has been out for six months and get honest feedback. They're not paid consultants for the company. They're really going to tell me, oh yes, and don't forget that there's this little plug at the end of the syringe that needs to be dealt with before you inject that or whatever it is. Little stuff that makes you a better surgeon and a safer surgeon. So it's really great to have that resource.

I was just listening to an episode of another podcast that's not out yet where Tiffany McCormack was saying almost exactly what you're saying right now.

We had a virtual meeting during COVID for our WPS symposium, and that chat was hilarious because women are so specific and we'll, if they feel comfortable, we'll ask questions about anything. So we were dialing it down to the type of surgical marker you use. We want to know which one doesn't erase. What kind of prep do you use if you're using a white eyeliner to mark faces, what white eyeliner and people will say in the chat, here's the Amazon link to the white eyeliner I use.

It's eyeliner? It's not like some secret thing, only doctor, can get?

No, for face markings, a lot of times if you're doing Botox and injectables, if you want to mark out certain landmarks, using a purple pen is not a good idea because it doesn't come off. So white eyeliner is a great option because you can clean the skin, it comes off easily, and it's a great way of marking landmarks. So silly stuff like that is really helpful.

That's so interesting.

And you wouldn't think, if you don't have teenagers, you might not know that there is white eyeliner. You're supposed to line the inside creases of your eyes for

That's what that's for?

Yeah.

Oh, I just learned something.

You're welcome. When your daughter's ready for homecoming in a while and years, you can do that. You can offer that tip.

So we're looking at your girls right behind you on the wall, and are there teenagers now?

Yes. The oldest one is now 17, the middle one is, this is five years ago, and it's just remarkable how much kids change over that five years. Middle one's 15 and the little one's 11.

So have you always been in San Diego?

Yes, pretty much. I did 12 years with the Navy here in San Diego as a plastic surgeon, and then went into private practice going on five years now. So that photo that you're looking at

Right before Covid, it was great timing.

Yes. Yeah, 18 months I think before Covid. Planned well for that.

So you kind of crossed from one world into the other then still doing probably most of the same work, but how did your practice change once you were out of the Navy?

So my Navy practice was overwhelmingly, largely reconstructive and a small percentage of cosmetic, although there's a loss, a lot of crossover in between. And then now I started out as mostly cosmetic with a little bit of reconstructive and I'm almost completely cosmetic at this point. So definitely switched from one direction to the other, which has been nice. I was frankly a little burned out by the time I left the Navy in terms of reconstructive care. It just can be challenging In terms of the patients, it was hard for me to see breast cancer patients that were becoming younger and younger, so we would deal with them and their reconstructive options. And then of course, the wounded warriors are predominantly young guys, so.

I never even thought of that.

Yeah.

There's a lot to unpack there too.

They're great. They're some of the best patients, just really motivated to get better and get through whatever it is. But sometimes you just take a step back and think, oh my gosh, if that was my kid or my brother, if you think about it too much and don't focus on just making them better, it can be daunting.

People who work with little kids who are hurt aren't going through things like cancer, challenges that little kids shouldn't have to go through. That's really hard for lots of people too. So these days, are you becoming known for any certain kinds of procedures or parts of the body?

I do a lot of breast work, so I would say that's probably my number one procedure is, and by breast surgery, I just think it's such a great area to operate in because you can make breasts smaller, you can make them larger, you can lift them, you can take implants out, you can put implants in. I mean, it really is, there's a lot of options. And so it's fun working with patients to figure out what direction they're going in, what their goals are, and then come up with an execute a plan. I also do, interestingly, a lot of labiaplasty, which is nice for my patients because there's very few female plastic surgeons in San Diego, and so they really have a comfort that comes with just coming into my clinic, talking to us. We have it pretty well oiled and it's almost a pleasant experience in terms of as pleasant as that procedure can be in such a personal area. But multiple patients have been like, that whole thing was way better than just going to the dentist. And I'm like, well, we try to make it as fun as possible.

On labiaplasty.

Yeah.

I have heard that it's actually much easier than people expect it to be. And I mean once you've had kids, you kind of get it. I always was scared of it before I had kids, and now I'm like, I've seen worse.

Right, right. Yeah, the area does really well with numbing. It's an easy area. I think overwhelmingly people don't feel anything while I'm doing the procedure, which I can't say the same for a awake liposuction for example. Sometimes people are just a little trickier to get comfortable, whereas I just don't have that issue with labiaplasty and I think it's just a tissue is different.

It's a pretty quick procedure?

Yeah. In and out in about, it takes us about an hour and a half just because again, we like to make it a relaxed pace, relaxed environment. Nobody wants to be rushed through anything, so.

No, that's true. We don't want to wait too long, but we also don't want to be forced to go too fast. In terms of breast surgery, there's been a lot of controversy in recent years around taking them out, and if you're comfortable talking about it, I'd love to know what your take is on that right now.

Oh, sure. So I think of it in two major categories of issues with implants. There's a group of patients or there is a concern for A L C L. So breast associated lymphoma that has been tied to textured implants and is a real cancer that's diagnosable under the microscope, has real implications, can potentially cause death, and like I said, was mostly associated with textured implants, specifically a one company which recalled their implants. So now you have patients that are concerned that their implants are recalled, they have textured implants, they want them removed. What's the safest way to do that in that particular arena? Some people have developed that A L C L cancer after having the textured implants removed and replaced with smooth implants. So the concern is that it's the capsule surrounding the implant that ends up harboring the cells that turn into cancer.

(15:01)
So there is still an unanswered question about whether or not that capsule needs to be removed completely for a patient that has a textured implant. Certainly if there's a concern or diagnosis of A L C L, then it needs to come out and they need other sorts of testing to make sure the cancer hasn't spread anywhere. Luckily, that's pretty rare. It's a pretty rare occurrence. So that's one aspect. In general, the women have had the implants in for eight years or more. The implant is textured, it's usually associated with a fluid collection. Those are all things that the average patient, if that's you should not ignore just like you wouldn't ignore hopefully a lump or something that pops up on your breast and you're overdue for your mammogram or whatever. So that's one category of patients you have to take care of and at least have that in the back of your mind for treatment.

(15:52)
And then the other major category is breast implant illness. And so these are women who've had their implants for a variable amount of time, sometimes as short as six months sometimes for years, and then have a series of symptoms that they can't inexplicably link to a diagnosis. So fatigue, brain fog, sometimes rashes, joint pain, the list of symptoms is about 40 and not everybody has every symptom and some people have most of the symptoms anyway. In general, those women have done their due diligence and don't have a diagnosis, and in those patients it's attributed to their breast implants that are making them ill, or maybe it's more like a foreign body reaction. Again, unfortunately for this, we don't have a test for it. So without knowing what is causing them sick, you can have an educated conversation, say, we can remove these implants and you may get better, you may not, but at least if we've ruled out a life-threatening condition by your primary care, then you understand that I can't guarantee you that removing implants is going to change your life or make everything go away, then it's your body and your choice to remove the implants.

(17:10)
So I do a fair amount of those for lots of reasons. Patients have them are tired of them, they're too large when they put 'em in, there's a problem with the implant. Either it has scarring around it or it's kind of misplaced, it's too lateral, too high, whatever it is they're done and they just want to get rid of 'em. Some are coming in strictly with B i symptoms. We just have that conversation about what the expectations are. I will say they've done studies that have shown over 50% of women will feel better if they remove their implants, if they attributed the symptoms to that the people who tend not to get better are actually ones with a diagnosis prior to coming in with breast implant illness. So if you have your implants in and you develop lupus or rheumatoid arthritis or some arthritis symptoms that's testable and then have your implants removed, that won't reverse those disease processes. Maybe you feel a little bit better, but your rheumatoid arthritis, your lupus is not going to disappear. So I feel like that's important for them to understand whatever's triggered that immune response is not going to remember it. So I think there's a lot about the immune system we don't know. So really it's incredible and most of my patients feel way better after having their implants removed if they're concerned that that's making them sick.

Is there a lot of research still going on in this area?

There was a huge grant to study that they published two major papers in the last or three major papers in the last couple of years, looking at the rate of symptom freeness afterwards, how many women actually got better. And then also looking at the type of surgery performed, whether it was the straight implant removal or whether they took some of the capsule or all of the capsule or the capsule as a whole out and in general, women did better with removal and it didn't actually matter what type of surgical procedure it was.

It's fascinating,

And the national societies have come out with statements also advocating that implant removal is a viable option, but that it's not a requirement to get an N block. That's what they call taking out the implant and the capsule all out at the same time. There's no science to prove that that is the gold standard. And so if someone's telling you that, then maybe do more research.

Do you think anybody's looking at that in particular too?

Whether the en bloc is more helpful? Yeah, I mean it was covered in that study. They looked at women who had block removal, women who had total caps, colectomies women who had partial caps. So the numbers didn't bear out one way or the other.

One of the things I've learned this year is if there's a group for something, there's going to be another group for the opposite thing, and then there's even going to be a group for the thing that you did that you wanted to undo, that you want to redo, and then there's going to be one after that. There's a group for any position you want to take. And everyone in that group, these are all on Facebook, they'll tell you that you're right if you're in that group and if you're wrong, they'll throw you out.

Yes. So they become echo chambers of information. And I mean, I don't think anybody can say with a hundred percent certainty in any way, either way. And it really makes, that's why I think it's a personal for patients. I do think though you have to understand some of the downsides of doing an N block resection. It's not an easy procedure. It can be very invasive and it can leave quite a large deformity depending on the patient. But again, it's so depends on the patient because it matters how much breast tissue you have matters how large your implants are. It matters whether the implants were under the muscle or under the breast tissue. It matters whether they're textured or not. All of those things are so different for every patient. So somebody who had a fantastic result with a small sub glandular breast implant that was removed and block, that was probably pretty easy to do and is probably going to have a nice result no matter what you do. But somebody who has super large submuscular implants that have been in for a while, that might be a bigger challenge and you don't want to risk having injury during surgery to try and remove capsule that may or may not make you feel better.

Well, and then let's say you're getting them out and the very next thing is, what am I going to look like once they're out? So you move from being worried about getting them out to, I would think very quickly once they're out.

What's it going to look like?

Moving right onto what do I look like now?

Yes. Yeah. And so I think for some women, they're pleasantly surprised because they didn't feel comfortable with their current breast size or implants. Some people are a little mortified. They're way smaller than they thought they were going to be. Again, it just depends on what your motivations are and how important it is to you, what your breasts look like. I mean, I did a lot of breast reconstruction for breast cancer during my time in the Navy, and it's similar. I feel like there's very, there's a lot of parallels. Breast cancer is funny. It has a lot of options. If you have a breast cancer, you can choose to do a lumpectomy. So just take the breast cancer out, leave both breasts and then do radiation afterwards. Radiation's going to change what that breast looks like for whatever reason. It might look good. It might not look good.

(22:58)
Obviously, I tended to see the patients that didn't look good after radiation and lumpectomy, but many women had a nice result afterwards. And then your patients who have the teeniest tiniest breast cancer and want both breasts removed, double mastectomy and reconstruction because they don't want to deal with it. So again, if you're going to lie awake at night because you had a breast cancer and you still have your breasts, then sure, I would remove them if you're also not super tied to them as well. Some people are going through the lumpectomy and the radiation because they don't want that self image of themselves without breasts. It's important to them. And other women would rather just be like, forget it. I did actually a couple of surgeries that where they were just done with the reconstruction and done with their implants and just wanted to be completely flat. That was hard because there's no going back after that. But both women that I performed that surgery for were so happy afterwards, but it has to be the right patient.

There, is it, like I was saying earlier, there's an entire group and the going flat group is a really positive and supportive group. Well, what are you looking forward to today? It's the last day of August and we're about to start Q four. Is there anything coming up that you're excited about?

I would say that we're excited in my practice about some non-invasive things that we're doing. So we have Aveli, which is cellulite reduction. It's a little wand. We love doing that procedure. It's very satisfying. We're revisiting Sculptra, which is an injectable for facial rejuvenation as well. I had not really looked into it since I left the Navy, but circled back around, they've changed some ways of how we reconstitute it and deliver it. That makes it much more user-friendly. And I had originally worked with it again when I was in the military, and we had an, if you can believe it, people are always surprised. But an H I V clinic that patients who had H I V were on H I V medications, they get a really hollowed, drawn out look to their face. They get facial atrophy. And so Sculptra's original indication was for treating that, and it was very effective. And it lasted two years, but it was a little bit difficult to inject. And so things have come a long way since then and it's obviously found more indications and it's a really nice product that we're going to launch.

That's great. Away from the office, I know your kids are probably the rest of most of your free time. Is there anything else you like to do?

I'm a pretty huge yoga enthusiast, so I go daily almost. Yeah, I love my little

Hot yoga? Regular yoga?

Yeah. It's through core power yoga. It's a studio that's kind of a franchise, and so they have several studios all across the country, but the rooms are usually heated. So my gateway drug into yoga was Bikram's Hot style yoga. And so now I do more traditional yoga, but the rooms are warm and I really like that.

So do you get up early and go before work?

There's a class at 6:00 AM during the week, so I usually go at six, and it's really hard to get up at that early in the morning. And then you get to the studio and it's everybody's there. This morning there was probably 30 or 40 people in my class, and you're like, who are all these other crazy people up at 6:00 AM And then there's a couple other,

All must be on to something.

Fitness classes that are at the same studio that are more like HIIT training. So today's class was more like that. So again, there is no way I would be getting up and at 6:00 AM doing burpees unless I was with like-minded people not going to get up and do that in my house and somebody yelling at me. So yeah, it's fun. You feel so good when you're done.

That's why you keep going.

Yes.

Yeah, I was just reading about training toddlers. I was listening to someone talking about taking them outside, spending time outside camping, hiking, fishing. They complain they don't want to go, but when they come back they say, thank you. I'm so glad we did that.

Yeah, I think kids in general, everybody is like that. It's inertia. I'm sitting on my couch, why I'm in my bed, I'm happy here. Why move? But once you get going, you're usually happy about it.

So true. If someone's listening today and they want to reach out and find out more about you or potentially come see you for a consult, how should they do that?

So if you go to my website at Restore SD, the SD is San Diego Plastic Surgery. You can sign up for the newsletter, you can fill out a contact form, and then you can also find me on Instagram and TikTok at Restore SD plastic surgery.

TikTok, are you doing anything fun on TikTok?

Not really, but I'm on there. I did get called out by Dr. Colleen. She's in Beverly Hills and she's very active on TikTok, very active, and she does a lot of answers questions. And so she was talking about breast lift and people are like, well, I live in Michigan or whatever, who should I see? And like I said, we have this network. So somebody asked about San Diego and she's like, oh, Kat Gallus San Diego is my alter ego, which is not untrue because we've hung out together a few times and we're pretty,

Oh, that's awesome.

It's pretty hilarious how many similarities we have and personality. And then I said, yeah, that's me. Although I'm not TikTok famous like she is. I am in San Diego. If you want to find me.

Well, I'll put all those links in the show notes so they're easy to find. Thank you for coming on the show today, Dr. Gallus. It was great talking to you.

Yeah, it was great to talk to you. Thanks for having me.

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