I am a medical student in Taiwan. After reading “Subtotal Resection of Gastrocnemius Muscles for Hypertrophic Muscular Calves in Asians,” by Lee et al. (Plast. Reconstr. Surg. 118: 1472, 2006), and looking for some textbooks and papers, I have three questions to ask. I have contacted several professors about them. Since their answers varied, I write this letter to obtain further information.
First, according to my knowledge, the gastrocnemius muscle is composed of fast fibers in high percentage, whereas the soleus muscle is composed of slow fibers.1 The gastrocnemius muscle also contributes to muscle power more than does the soleus muscle in plantar flexion during exercise.1 Muscle power plays an important role in balance and speed.1,2 My question is whether it will cause any problems once the patient becomes pregnant,3 ages,2 or is involved in an emergency.
Second, the article by Lee et al. declared that the patients’ muscle power was regained based on another study that used the Cybex test.4 However, the Cybex test limits the angular velocity of contraction to some preset rate that cannot be exceeded, no matter how forcefully the subject pushes the level arm.5 I am curious about whether it can test if the patient can generate equal muscle power as before.
Third, I have heard the Declaration of Helsinki in medical ethics class, and I would like to know whether this surgery was reviewed by the institutional review board based on the Declaration.
In my personal opinion, I think the definition of beauty should be judged by one’s personality rather than one’s appearance. Beauty is in the eye of beholder that comes from mind, not camouflage. However, in Asian society, soft and slim are always considered hallmarks of beauty. For example, foot binding was once a very popular procedure to make women more feminized in ancient China.
As a young Asian woman, I can easily understand the eagerness of those patients who have undergone the calf reduction operations. Nevertheless, there is still something that I worry about. I do not know if those people can meet the definition of “patients” who look for a cosmetic surgeon to deal with their appearance. I am afraid that if we do not consider the long-term potential risk of surgery thoroughly, they may someday become real “patients.”
Department of Medicine
Tzu Chi University
No. 701, Sec. 3, Jhongyang Road
Hualien City 970, Taiwan
1. Powers, S. K. Exercise Physiology: Theory and Application to Fitness and Performance.
5th Ed. New York: WCB/McGraw-Hill, 2004.
2. Spirduso, W. W., Francis, K. L., and MacRae, P. G. Physical Dimensions of Aging.
Champaign, Ill.: Human Kinetics, 2005.
3. Butler, E. E., Colon, I., Druzin, M. L., et al. Postural equilibrium during pregnancy: Decreased stability with an increased reliance on visual cues. Am. J. Obstet. Gynecol.
195: 1104, 2006.
4. Kim, I. G., Hwang, S. H., Lew, J. M., et al. Endoscope-assisted calf reduction in Orientals. Plast. Reconstr. Surg.
106: 713, 2000.
5. Kottke, F. J., and Lehmann, J. F. Krusen’s Handbook of Physical Medicine and Rehabilitation,
4th Ed. Philadelphia: Saunders, 1990.
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