Physician, Augment Thyself By Betsy Riley Dr. Marisa Lawrence, chief of plastic surgery at Northside Hospital, calls on her personal experience to allay women’s fears, whether of breast cancer or jiggly thighs. Plastic surgeon and mother of three, Dr. Lawrence knows how to respond to her patient's concerns.

You wouldn't know it from their glossy ads, but plastic surgeons are trained to cope with the most poignant of personal calamities, mangled hands, mastectomies, facial disfigurements. You have to wonder where they rank a woman’s jiggly thighs or sagging breasts in the catalog of human misery. How do they heal fragile egos and broken bodies with equanimity?

It helps if the surgeon is herself a woman. Dr. Marisa Lawrence, chief of plastic surgery at Northside Hospital, knows first-hand what nursing three children does to breast tissue. After her own surgical touch-ups, Lawrence fully savored the joy of ordering bathing suits from a catalog, and freely shares her experiences with her patients. But Lawrence also knows the raw fear of breast cancer.

Dr. Lawrence’s practice is a study in contrasts. She spends half of her time performing reconstruction surgery on cancer patients, and the remainder helping people achieve the faces and bodies of their dreams. Her office wall is lined with impressive credentials and certifications, but taped jauntily to her Southern California diploma is a newspaper clipping of "Barbie at 40." Her bookshelves are stuffed with serious medical texts counterpoised with silly greeting cards (two snippy Minnie Mouse types gossip that a third with large ears has had implants). On a typical Monday morning, Lawrence, dressed in a conservative, smartly tailored gray flannel pantsuit, with a pink breast cancer ribbon pinned to her lapel, greets her all-female staff like best girlfriends. Any ideas on how to get my kids tickets to the Backstreet Boys concert? Looking for a new restaurant? Try Grappa. A patient is smocking a baby outfit for Cindy (the very pregnant nurse) how sweet! How was the receptionist’s wedding? Lawrence had to miss it for her kids’ school carnival. (One of Lawrence’s favorite stories is about a WCW wrestler who stumbled into this women’s world to have his love handles liposuctioned. They had to give him a compression garment trimmed with lace and roses.)

The day’s first patient is a slim, middle-aged blonde, with a perky haircut and graceful, flowing skirt. It turns out she wears long hemlines because she hates her slightly blockish legs, which Dr. Lawrence will soon liposuction. The patient fingers a well-worn list of questions, mixing inquiries with nervous laughter and protestations of "I can’t believe I’m doing this." But she’s intent about getting the maximum amount of fat sucked out. She’s also serious that she doesn’t want her family knowing about the procedure. Dr. Lawrence is realistic but supportive. She talks about her own recovery from liposuction and makes sure the patient’s got someone to drive carpool. Then Lawrence warns that although it’s amazing what husbands and children don’t notice, it’s hard to hide bandaged legs. Later, Lawrence admits not giving her own kids detailed explanations of why she was home in bed after surgery last year. After all, she winces, her preschool daughter once told the A&P checkout man that her grandmother had surgery "because she had too many wrinkles in her face."

Cosmetic surgery is increasingly losing any stigma. The total number of procedures increased 50 percent over the last two years, with more than a million procedures being performed annually in the U.S. However, Lawrence still strictly adheres to the "plastic surgery etiquette" she learned during residency: She never acknowledges patients first in public. She follows this rule so religiously that when a tummy tuck patient mentions referring a friend Lawrence had just seen for the second time, Dr. Lawrence acts like it’s news. Lawrence has to switch mental gears before meeting with the next patient. Pausing outside the conference room, she takes a breath and studies the chart.

The patient tells a story similar to one Lawrence has heard many times before. When she was 10, this 30-something woman lost her own mother to breast cancer. Now, her 44-year-old sister has found a malignant tumor and has had a swift double mastectomy. Knowing the genetic dice are stacked against her, Lawrence’s patient is considering a voluntary prophylactic bilateral mastectomy. The patient’s eyes water as she describes her dilemma, but she quickly gets down to business. Her husband, who has accompanied her, is an ophthalmologist, and they’ve done their homework.

Lawrence lays out the options. Without reconstructive surgery, the patient could use prosthetic bra inserts; but they tend to pop out whenever you lean over. Lawrence rules out an abdominal tissue transfer because the patient has already had a tummy tuck. That leaves implants, either saline or silicone. The patient is thrilled to learn that Lawrence participates in research trials that allow her to use silicone; the California doctor who treated the patient had sworn silicone was absolutely unavailable. He’d also advised against the double mastectomy, commenting, “One boob is better than no boob.” Lawrence’s patient is visibly relieved to have found a more sympathetic surgeon.

Lawrence participates in research trials that allow her to use silicone gel implants, right, which some patients prefer, as an alternative to saline implants, shown at left. Lawrence identifies easily with her patients. "I’m, quite frankly, scared of breast cancer," she says. "I think it’s epidemic. At age 42, I just have too much to live for. [I might] trade a life of fear and watching for a bilateral mastectomy."

Empathy has made her a determined crusader. Her "list of battles" includes better operating schedules for breast reconstructions, more generous insurance reimbursements and the option of silicone implants. Lawrence has been known to track down managed care executives at home. "When they deny a breast reduction, I call the medical director and say, ‘When I was pregnant I got up to size D and it hurt! How can you say the patient is fine with just anti-inflammatories". . . They always back down," she grins. This determination, she believes, is what got her elected chief of her department at Northside. Dr. Lawrence is called upon frequently to clean up after another doctor’s mistakes, as happens with the third patient she sees. A shy girl in her early 20s, the patient wears little makeup, a new Susan G. Komen cancer walk T-shirt and jeans. She’s a cancer survivor, but another plastic surgeon has badly botched her breast reconstruction. Surveying the scars, Lawrence isn’t afraid to let the patient and the patient’s parents see her frustration. She doesn’t promise miracles but hopes to get a result "as normal as possible."

Revision patients are among Lawrence’s most ardent fans. For example, Gainesville resident Alecia Parks came to Lawrence after complications from five or six breast surgeries had left her disfigured. "I’d had doctors look at my situation and say, ‘This is as good as it’s going to get,’ " says Parks. But Lawrence studied Parks’ photo for days (even carrying it in her purse to a restaurant, much to her husband’s annoyance) until she devised a way to repair the damage. "She’s my hero," gushes Parks.

Her keys to family management, says Lawrence, have been having a supportive spouse, finding a good nanny and leaving herself wide margins. For example, after being labeled a "deadbeat mom" for missing a last-minute, back-to-school open house, Lawrence now takes off all Thursday evenings in September. To be sure she remembers her turn bringing team snacks to her kids’ ball games, she stores juice boxes and Rice Krispies treats in her minivan throughout the entire baseball season. And when she kept finding out about classroom events too late to attend, she volunteered to be the room mom herself. Now she calls parents from her cell phone as she inches along in Johnson Ferry Road traffic.

But what’s another ball when you’re already juggling three or four? Plastic surgery and motherhood have taught Lawrence about balancing extremes. As she likes to say, "It’s all about balance." The trick is finding your equilibrium.