by Elyse M. Rogers
PLASTIC AND RECONSTRUCTIVE SURGERY
As resident foreigners we’ve learned that in Japan every year is the “Year of…(some animal).” Last year was the “Year of the Rabbit,” and now it’s the “Year of the Dragon.” I seem to be having another kind of year, which I perhaps should call the “Year of Plastic Surgery,” since I’ve had more letters, calls and questions on the subject since I arrived in Japan in 1980.
In a later column I’ll be profiling a private establishment that specializes in Cosmetic Surgery (Jujin Hospital), but today I’d like to concentrate on a rather more serious type of plastic surgery—reconstructive work. To do that, I talked with the eminently qualified and delightfully candid Dr. Toyomi Fujino, Professor and Head of the Department of Plastic and Reconstructive Surgery at Keio University Hospital in Tokyo.
TOYOMI FUJINO M.D., D. Med. Sc., F.A.C.S.
Dr. Fujino is an interesting man, even if you forget the fact that he’s a top-notch plastic surgeon. As you can see by the initials after his name, he’s not only a medical doctor, but a doctor of medical science and a Fellow in the prestigious American College of Surgeons. He is also a diplomat in the American Board of Plastic Surgery.
In addition to his credits in international professional and academic circles, he has significant clinical credentials as well. I’ve already mentioned that he heads up Keio’s Department of Plastic and Reconstructive Surgery, but he is also Director of the Institute of Microsurgery at Keio. (Microsurgery uses microscopes so that very, very fine, detailed surgery can be accomplished.)
Although he protests he’s “out of practice with English,” he obviously understands English well and speaks it competently. You’ll know why when I explain that he spent seven years of postgraduate medical study in the U.S. After graduation from Keio Medical School and interning at Yokosuka, he went to the University of Wisconsin for a year of additional internship, three years of general surgery and one year of plastic surgery.
When I asked how he liked Wisconsin, he said he really enjoyed it and, with a smile: “I learned to ice skate.”
Following that stint he went to Roswell Park Memorial Institute in Buffalo, New York. Roswell Park is a very fine cancer hospital and research center. Since I had also studied there as part of my graduate program, we had fun comparing notes.
What I recall most vividly about Roswell Park was my reaction to those patients who had had unbelievably dramatic surgery for cancer, I was heartsick at seeing such badly deformed patients and began to wonder if such massive surgery, even if it were life-saving, was really worth it.
A friend, a plastic surgeon on the staff, learned of my despair and dragged me into his office for a slide show of “before and after” pictures, showing the same kind of patients I’d been working with after they received reconstructive surgery.
I couldn’t believe those pictures. Patients with half of their face gone, and no ear left, were restored to normal. That “show” did wonders for my morale and gave me a healthy respect for the skilled hands of the plastic surgeon.
But I’m digressing. After Buffalo, Dr. Fujino went to New York University where he spent another year in reconstructive surgery.
He returned to Japan in 1965 and earned chairmanship of the Keio department about ten years ago. Six years ago he became full professor.
TYPES OF PLASTIC & RECONSTRUCTIVE SURGERY
When I asked for a list of his most-often-performed surgical procedures, Dr. Fujino gave me an impressive list:
• Surgery for Congenital Problems. Children are frequently born with congenital defects such as cleft lip and palate and these can be repaired by the plastic surgeon. Most people are aware of the cleft lip because it is a defect that can be seen, but the cleft palate is actually a more serious problem. Without repair of a severe cleft palate a child could either starve to death or have food go down “the wrong way.” Today repairs are done in infancy, so we don’t hear much about this defect today.
Another congenital defect is microsia, or the malformation of the skull. Although not really a “common” problem, the doctor often gets referrals from the National Children’s Hospital in Tashido, because he has become kind of a specialist in the procedure of rebuilding or reforming the skull.
• Repair for Accidental Injury. Car accidents and other types of accidental injuries can result in deformities or scarring. Particularly in facial, disfiguring injuries, plastic surgery is performed.
• After-Cancer Surgery. As I mentioned above, with severe cancer surgery the patient may be left disfigured. Plastic surgery can help minimize or even eliminate that deformity.
One of the interesting new developments is the current trend toward reconstructive breast surgery for women who have had removal of a breast because of cancer. With the skinflap technique (using skin taken from the back or the abdomen) the plastic surgeon can literally create an artificial breast. That’s good news for the many women who have been not only physically, but emotionally, wounded from breast cancer. (And, unfortunately, the number of breast cancer cases in the U.S. is still high and among Japanese women is growing.)
• Cosmetic Surgery. This includes the whole range of elective plastic surgery, such as face-lifts, eyelid-fold creation, breast reduction and liposuction. Dr. Fujino and his team actually do very little of this, and do “no liposuction at all.” (Liposuction is the procedure where fat cells are suctioned from the body for cosmetic weight problems.)
One reason for this is that these procedures are not covered by National Health Insurance (kenko hoken), and are best “left to others who specialize in those procedures”according to the doctor. He will see patients for consultation, however, and in certain situations will perform surgery.
KEIO UNIVERSITY HOSPITAL’S SYSTEM
To see Dr. Fujino or any other member of his team, you would go through the Keio Clinic system. I’ve covered the clinic before, and it’s in the same location (you can’t miss it when you walk into the complex — it’s the obvious entrance to the main building) but the entrance area has been remodeled and most of the clinic examining rooms are in the new building.
Clinic hours are 9-11 a.m. Monday through Saturday, but most patients get there by 9 a.m. to register. (New patients should get there about 8:30).
It’s a busy place and, despite all my pleas, is still very Japanese in that the forms you must fill out are in Japanese only. So are the signs. Dr. Fujino proudly told me about some English language signs that I did find, but they are posted where you get to the specific department and there is a maze you must go through before that point.
However, everyone is helpful and kind, so if you are patient and persevere you can do it. For most mortal folk, however, who do not speak Japanese, I’d suggest taking a Japanese-speaking friend along at least for your first clinic visit.
If you want to see Dr. Fujino personally, he’s in the clinic only on Monday and Thursday. On Friday, his associate Dr. Kiyoizumi, who also speaks good English, is on duty. He also has U.S. training and is married to an American.
“All our doctors speak some English,” Dr. Fujino assured me, so on any clinic day there should be someone to take care of you. Remember, this is a clinic, so you must go and wait your turn. With a busy clinic like Keio, two- and three-hour waits are common, so take either a friend or a good book or maybe both.
Costs for consultations vary, but the average private patient (without national insurance) pays ¥3,000 for a routine visit during clinic hours.
Keio is one of the hospitals that has 24-hour emergency care available, and it’s comforting to know that a plastic surgeon is always available (on call) if needed. Even a child who needs sutures, if the wound is facial and severe, can have the scar minimized by a plastic surgeon’s skill.
Costs for the emergency room consultation or treatment are higher in the emergency room than in the regular clinic. During afternoons, evenings and holidays the basic cost is ¥6,500 and after midnight the cost goes to ¥10,000. (Keep in mind that any basic cost covers only the consultation; treatment, tests and drugs are extra.)
Keio University Hospital is across the street from the Aoyama Twin Towers. (Well, about a mile “up the street.”) Since there are no English-language signs to get you through the clinic registrar ask for the Kei Sei Ge Ka (plastic surgery) department.
The plastic surgery clinic is actually on the second floor, so after registering you go up a floor in the new building to a different waiting room. (Stairs and elevators are just behind the clinic waiting room.)
FABULOUS ROOF-TOP RESTAURANT
Forgive me if I pull a “Dave Jones” here in my medical column, but Keio’s new rooftop restaurant is really something. If you have a few minutes after your consultation you might want to go up to the 11th floor of the new hospital building and peruse this restaurant complex that rivals those in Tokyo’s major hotels. (Perhaps that’s because it’s run by the well known Palace Hotel.)
From 10 a.m. to 8 p.m. you can get a cup of coffee, a snack or a full meal and even a drink to soothe your nerves if need be. From 10 to 11 a.m. it’s only coffee and juice—after that the more robust menu kicks in. The view and ambience are magnificent, and it’s open to the public.
Even if you don’t have time for a snack, the large windows front and center after you step off the elevators give a great view, and many just go up for a moment to gaze over the city.
Dr. Toyomi Fujino, Department of Plastic and Reconstructive Surgery, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160. Phone 353-1211.