INDEPTH

Master
Class
Plastic surgery founding
father Ivo Pitanguy, MD,
on life, learning, and legends
By Lee Seng Khoo, MB, CHB, MRCS Ed, and Vasco Senna-Fernandes, MD, PhD
vo Pitanguy, MD, was born in 1926 in
Minais Gerais, Brazil. The son of a general surgeon, Pitanguy followed in his
fathers footsteps. He studied under J.J.
Longacre, MD, of Cincinnati; Marc Iselin,
MD, of Paris; and Sir Archibald McIndoe
and his cousin, Sir Harold Gillies, in the
United Kingdom.
Upon his return to Brazil, Pitanguy set
up the first hand surgery service in Latin
America at the 19th Infirmary at the Santa
Casa General Hospital in Rio de Janeiro,
Brazil. He also became the head of the
Department of Burns and Plastic Surgery
at Souza Aguiar Hospital
in Rio de Janeiro, Brazil.
In 1960, Pitanguy
opened the 38th Infirmary
Department of Plastic and
Reconstructive Surgery in
Rio de Janeiro, where it
continues to serve some
of the countrys most disadvantaged citizens. The
38th Infirmary, in conjunction with the Clinica
Ivo Pitanguy, are Centers
of Excellence for the trainIvo Pitanguy, MD
ing of international plastic
surgeons.
At 88, the Michelangelo of the scalpel
oversees a staff of 70 at the Clinica Ivo
Pitanguy. Here, he shares much of what he
has learned during his lengthy and legendary career.

Why did you choose plastic surgery?

After qualifying as a general surgeon,
I worked in an emergency hospital in
Rio de Janeiro for 3 years. I noticed that
although emphasis was given to life-saving
procedures, little importance was given to
restoring a normal appearance. For example, a mans face could have been slashed
by a knife, but the subsequent stigma of
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the scarring was not considered important. To fight to have a normal appearance
was not considered necessary in that era.
And it was at that time that I realized I
wanted to improve my knowledge to be
able to perform surgery to restore not
just form and function, but also a normal
appearance.
At that time, there were no formal
residency programs in plastic surgery. We
had to learn by going to different places. I
went to learn under Dr John Longacre, a
distinguished plastic surgeon in Cincinnati
who also worked with Sir Harold Gillies in
London. This was in the 1950s. I realized
I liked the detail and creativity that could
allow the surgeon to restore an appearance
closer to normality. This is what plastic
surgery is all about.
I returned to Brazil and worked in
many hospitals and services trying to apply
the various flaps and techniques that I
learned. However, I felt I needed to learn
more. I went to France to learn under Marc
Iselin, a hand surgeon, and others in Paris.
After my stint in France, I won a scholarship from the British Council and went to
England to learn under Sir Harold Gillies.
It was here that I met David Ralph Millard,
Jr, MD, a visiting surgeon in England. I
also studied under Sir Archibald McIndoe,
who instilled the importance of aesthetic
surgery in me. At that time, aesthetic surgery was not taught in public hospitals
just private practices, where Dr McIndoe
and many others were kind enough to
invite and teach me.
When I returned to Brazil, I felt that I
had a responsibility to share the knowledge that I gained from the masters. I
believed that aesthetic surgery should not
only be available to the elite, but to
everyone. A deformity should not just be
judged by its appearance. The psychological impact also matters.

I set up the Ivo Pitanguy Clinic in Rio

de Janeiro because I realized I needed a
structure to be able to teach and transmit
the knowledge. I set up a library and auditorium with a secretary. I also started a
department at a teaching hospital in Santa
Casa General Hospital in Rio de Janeiro to
treat patients with various deformities and
aesthetic concerns.
A formal residency program in plastic surgery was offered. I trained many
residents who, in turn, became professors
and instructors in my department. Our
training program continues to this day.
Of course, we dont gain anything by this
except the opportunity to teach.
In my opinion, aesthetic and reconstructive surgery are one. We cannot separate one from another. What gives me
great joy is when those who have been
trained by me become teachers themselves
not only in Brazil, but also in many other
countries.

Tell us what you learned from the

luminaries you studied with.
J.J. Longacre, MD:
In general surgery, one often rushes to
complete a surgery very quickly. But in
plastic surgery, one has to be very meticulous and patient.

Sir Harold Gillies:

When I first met him, he said, Ive
never seen a Brazilian, and he looked at
me from head to toe like a novelty. He
was a great man. He taught me the joy of
teaching. He was the one who gave me that
pleasure. To teach is one thing, but to like
to teach is another. For Sir Harold Gillies,
teaching was pleasurable and something
he enjoyed.

Sir Archibald McIndoe:

He taught me to understand the structure before even touching it. For example,
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understanding the nose inside and out,

interpreting what needs to be done, and
respecting what can or cannot be done
within the nasal form and anatomy is
essential. That had a great impact on me.

Marc Iselin, MD:

He taught me about the French cultures way to treat a patient: approaching
them not just as a doctor, but also as a
human being, giving life and hope.
In life, I am always learning; we are
always learning. We should always be
open to knowledge.

Why is broad-based training in

plastic surgery so important?
When you are going to do plastic surgery, you need to have a broad vision of
the specialty. The challenge we face today
is the services or departments of plastic
surgery are becoming very subspecialized.
Just the other day, a patient presented
with a secondary hare lip deformity. And
my assistant surgeon, who was very
well-trained, requested that I perform the case as she had little exposure to hare lip repair.
In my residency program, my
residents rotate through other services or subspecialties of plastic
surgery. Back in my day, a single
plastic surgeon would operate on
a very broad spectrum of plastic
surgery, from trauma and hand to
burns to pediatric cases. I had the
pleasure of operating on a wide
variety of reconstructive cases
during my career. In a way, the
reconstructive aspects gave me the
tools necessary to perform aesthetic
surgery.
I believe a plastic surgeon needs a broad
formation to have a deeper understanding
of reconstructive surgerylike microsurgery, for example. The aesthetic concepts
are applied to reconstructive cases, and
the reconstructive concepts are applied to
aesthetic cases.

How has plastic surgery evolved over

the years?
There has been great improvement
in reconstructive surgery. Many modern
tools and biologic materials have been
developed. In aesthetic surgery, if you
try to do too much, the results may not
be desirable. There has to be limitations.
For example, in the face, if you overdo
it, the end result would not be natural.
It is a dangerous thing, progress without
digestion.

What is the Ivo Pitanguy philosophy

of plastic surgery?
In many cases of breast, abdomen,
and other types of surgery, you dont just
learn the technique but also need to learn
the philosophy. You need to know how
to approach the surgery, what to do, and
master the technique. Each time you go to
February 2015

a plastic surgery meeting, you will try to

adopt a new technique. But if you have a
basic knowledge and technique that comes
from a solid experience, the procedures we
create or adopt will have the best results
in our hands. We pass the knowledge to
others. After you graduate, you can do
whatever you want to do, but you should
come out with a solid knowledge of basic
principles and apply them.
For example, when I started doing
abdominoplasty in the early days, I always
made it a point to tighten the muscles.
This was one of the main points of my
technique. If you follow the basic principles, they give you the possibility of
developing other techniques.

What is the secret of your success

talent or hard work?
No talent is needed at all. All you need
is a good interpretation of what needs to
be done and what you need to do. Even if

you have a hand like this [he contorts his

right hand in a malformed position] and
you interpret the case and operation correctly, you can do it better than someone
with well-formed hands. It is a matter of
knowing what you are going to do.
If you are not very gifted, do it slowly.
And in this way, you can always do it
wellif not betterthan anyone who
does not pay importance to interpretation.
Of course, manual dexterity is also important, but even more important is the ability
to interpret. Dexterity comes with practice.

Are you concerned about aging and

retirement?
Aging and retirement are never my concern. They are the concern of others. If you
are not concerned, you should keep going
professionally. There is always a reason of
why we are here; everything has a meaning. Everything is moving, and we should
keep moving forward.

Can you define beauty?

Beauty is very difficult to define. Beauty
can be looked upon and approached in
many different ways, even in a religious
way. If you listen to Santo Tomas Aquino,

who quotes, Beauty is a gift from God,

it carries the meaning that if you are not
beautiful, you are not gifted from God.
True beauty comes from within. Only
truth is beautiful.
As the poet John Keats says, A thing
of beauty is a joy forever: its loveliness
increases; it will never pass into nothingness. But one can also say, beauty lies in
the eyes of the beholder.
The concept of beauty differs based on
culture. Voltaire, the French philosopher,
quoted, Ask a toad what beauty isgreat
beauty. He will tell you that it is his toad
wife with two large, round eyes sticking
out of her little, flat face, a yellow belly,
and a brown back.
I feel today there is a notion of imposing one cultures concept of beauty
onto anothers. Beauty has been manipulated by marketing. Think about the beautiful model that you see in the shampoo
ads with very long legs. If we put an
amputee in place of her, the people
will go crazy.
In my opinion, one can be short
and one can be tall, but harmonious
in many different ways. Everyone
has a different biotype. You dont
have to change your biotype to be
beautiful. You can aim for a harmonious look with your biotype. A
woman can be slightly plump, but
beautiful with aesthetic harmony.
Ultimately, beauty is a sense of
well-being.
As plastic surgeons, we dont
have the ink of the painter, the
stone of the sculptor; we dont have
the vocabulary of the poet. We have
the creativity and the interaction
with others, and with that we learn what
we can do, what we can improve, but
always acknowledge our limitations.

What matters most?

The most important thing in life is your
family. One needs a family regardless of
social class. My wife, my daughter, and my
two sons and close friends are my family.
When one cultivates a good close family,
one can develop a very good comprehension of life. We are part of the world. Our
limbic system is intertwined. So if we love
our family, we should love the world as
well. They are our extended family.

Any advice for aspiring surgeons?

If you like and love what you are doing,
you should do so with pleasure and love.
Do so responsibly on your chosen path,
however long it may be, and you will
always be happy. Q
Lee Seng Khoo, MB, CHB, MRCS Ed, is a
senior resident in plastic surgery, and Vasco
Senna-Fernandes, MD, PhD, is a professor
of plastic and hand surgery, both at the Ivo
Pitanguy Institute. They can be reached via
PSPeditor@allied360.com.
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