When your child needs medical treatment, you want him or her to have the very best care available. So it stands to reason that if your child needs an operation, you’ll want to consult with a surgeon who is qualified and experienced in operating on children — an individual who specializes in pediatric surgery.
Pediatric surgeons operate on children whose development ranges from the newborn stage through the teenage years. In addition to completing training and achieving board certification, pediatric surgeons complete two additional years of training exclusively in children’s surgery. They then receive special certification in the sub-specialty pediatric surgery. They provide the best pediatric surgical care for your child with the most advanced surgical techniques and the personalized attention in a warm office environment. They understand that the experience of having your child to undergo important surgical procedure can be most stressful for your family. It is our primary goal to deliver outstanding surgical practice with reassurance and confidence to minimize your concerns.
In addition to general pediatric surgery procedures such as appendectomies, excisions, and hernia surgeries, the following is a sampling of some of the specialized pediatric surgical procedures performed at K and B Surgical Center:
Ear Reconstruction (Microtia)
Microtia is a congenital condition in which the ear does not develop properly. The word microtia means “small ear.” Microtia occurs about once in every 6,000 to 12,000 births, with a higher frequency among Hispanics, Asians, Native Americans, and Andeans.
The cause of microtia is not well understood, particularly the role of environmental and genetic factors. Genetics are thought to be a cause in only 5% of all patients. Multiple theories have been proposed to explain the cause of microtia during fetal development, such as neural crest cells disturbance, vascular disruption, and altitude, but these have not been proven.
It is important to understand that nothing a mother does during pregnancy, such as drinking coffee, alcohol use, or even drug abuse, has been shown to cause microtia. However, when taken in the first trimester of pregnancy, some medications like Thalidomide and Accutane have been linked to the condition.
Microtia usually occurs on only one side (more commonly on the right ear), but approximately 10% of patients have microtia on both sides (Bilateral Microtia).
Microtia is often seen as an isolated condition, but it may also occur with other syndromes including Hemifacial Microsomia, Goldenhar Syndrome, or Treacher Collins Syndrome. Other syndromes with microtia can also affect the kidneys, the heart, the eyes, the craniofacial bones, and the skeletal system. Children with these abnormalities are often cared for by a Craniofacial Team.
Microtia occurs in many different variations, ranging from just a small ear to complete absence of the ear, called anotia meaning “no ear.” In some cases, the ear canal is very small (aural stenosis) or absent (aural atresia). All types of ear surgery for microtia are technically difficult to perform. Most plastic surgeons would agree that ear reconstruction is one of the most challenging operations performed — requiring a combination of technical skill and artistry. The reason for this difficulty is related to the very complex shape that must be created for the ear in order for it to look natural. Our expert in ear reconstruction surgery for Microtia is Dr. Sheryl Lewin.
Nuss Procedure for Pectus Deformity
Congenital chest wall deformities are more common than one may think. It occurs in approximately 1 in every 300 children. The etiology of chest wall deformities is mostly unknown. There is a strong family history seen in many patients, as high as 40%. We always consider potential underlying genetic disorders such as Marfan syndrome. Additional specialist consultations may be important from cardiology, medical genetics, and pulmonology.
The most common pectus deformity is pectus excavatum or commonly known as “sunken chest” or “funnel chest”. The degree of severity varies from patient to patient. In most cases, the deformity is noticed at birth or very young age. The severity can be seen to worsen over the growth of the child, particularly during growth spurt period as an adolescent. The depression of the anterior chest wall involves the sternum (breast bone) and the cartilage portions of the ribs. Most patients do not have obvious symptoms, but many have exercise intolerance, easy fatigue, and chest pains. There is commonly loss of lung capacity and shift of the cardiac position due to the compression of the organs from the chest wall.
Under the direction of Dr. Steve Chen, the Nuss Procedure is the primary surgical solution for pectus excavatum. It is a minimally invasive technique for correction of pectus excavatum by implantation of a pectus bar with thoracoscopic (small telescope in the chest) visualization. The operation utilizes minimal incisions at the sides of the chest and does not require cutting or removal of sternum and ribs. The Nuss Procedure is now over 20 years in practice and provides excellent long-term outcome with safety and effectiveness.
Meet our Pediatric Surgery Team
Steve P. Chen, M.D., F.A.C.S., P.A.A.P.
Dr. Chen is also the Medical Director of the Beverly Hills Pediatric Surgery and the Pectus Surgical Institute. He holds an academic appointment as an Associate Clinical Professor of Surgery and Pediatrics at the David Geffen School of Medicine, University of California, Los Angeles. Prior to establishing his private practice, he served as the Director of the Division of Pediatric Surgery at Cedars-Sinai Medical Center until 2010. Recognized for his contribution to pediatric surgical care at Cedars-Sinai, he was honored as the inaugural holder of the Walter and Shirley Wang Endowed Chair in Pediatric Surgery in 2003. Dr. Chen is a passionate surgical educator who is actively engaged in the teaching of medical students and surgical and pediatric residents. In 2009 he was honored with the Golden Apple Teaching award at Cedars-Sinai. Dr. Chen has dedicated much of his expertise to the area of minimally invasive surgery for children and is recognized throughout the greater Los Angeles medical community for his laparoscopic and thoracoscopic surgical skills.
Dr. Chen received his Bachelor of Arts degree in Biophysics/Medical Physics from the University of California, Berkeley and his Doctor of Medicine degree from the Keck School of Medicine at University of Southern California. He completed three surgical residencies including General Surgery, Surgical Critical Care, and Pediatric Surgery. He has received board certifications in all three areas by the American Board of Surgery. Dr. Chen has lived in the Los Angeles area for more than 21 years. He has a lovely wife and two young sons who are the center of his life.
Dr. Sheryl Lewin, M.D.
Dr. Lewin is a Craniofacial trained Board Certified Plastic Surgeon who has dedicated her career to ear reconstruction. She is a specialist in Microtia surgery using the Medpor technique. Since there is no natural substitute for the thin, bendable cartilage supporting the natural ear, reconstructed ears cannot bend. The framework (Medpor) needs to be able to withstand the forces of scar tissue that would distort a more pliable framework. Dr. Lewin has performed more than 400 surgeries on children with microtia and has made important surgical advances in Medpor ear reconstruction to reduce scarring, improve visual outcomes, and eliminate the need to take skin grafts from other parts of the body.
Dr. Lewin received her undergraduate degree in Architecture from the University of California, Berkeley. During her studies there, Dr. Lewin founded a student volunteer organization called CalCare that helps disadvantaged children in the Berkeley community. Her involvement in that organization led to a turning point in her career path: She decided to switch from architecture and to the field of medicine, where her combination of skills could change the lives of children in a significant way.
Dr. Lewin went on to attend Stanford University School of Medicine, where she was awarded a Medical Research Scholarship to pursue scientific research while completing medical school. Following medical school, she entered a prestigious Plastic Surgery Residency at the University of Southern California, one of very few residency positions at the time to combine both general and plastic surgery training. Dr. Lewin then completed advanced training with a focus on Microtia Reconstruction through a fellowship in Craniofacial and Pediatric Plastic Surgery at Children’s Hospital Los Angeles (CHLA). This fellowship was under the direction of her mentor, Dr. John Reinisch, the founder of Medpor Ear Reconstruction. After working together at CHLA for 3 years, Dr. Lewin and Dr. Reinisch joined the Cedars Sinai Medical Group, where they continued their practice for an additional four years. While at Cedars Sinai, Dr. Lewin held the position of Associate Director of Craniofacial and Pediatric Plastic Surgery, as well as Director of Microtia Reconstruction at CHLA.
Dr. Lewin established her own private practice, Aesthetic Ear Reconstruction, in February of 2012 with the goal of providing patients with the highest quality of care and a comprehensive approach to treating microtia. She currently maintains her affiliation with the Keck School of Medicine at the University of Southern California and Children’s Hospital of Los Angeles as voluntary Clinical Faculty, teaching and mentoring residents.
Dr. Andre Panossian, M.D.
Dr. Panossian is a board-certified plastic surgeon practicing in the greater Los Angeles area. His areas of expertise include pediatric plastic surgery, vascular anomalies, facial paralysis reconstruction, and aesthetic surgery.
Upon graduation from Tufts University School of Medicine, Dr. Panossian completed his residency in plastic surgery at USC. He then pursued a highly competitive fellowship at the Hospital for Sick Children in Toronto where he specialized in facial reanimation and pediatric plastic surgery. After leaving Toronto, Dr. Panossian completed a second fellowship in congenital hand deformities and vascular anomalies at Harvard Medical School.
He is a Fellow of the American College of Surgeons and the American Academy of Pediatrics. Although his training is subspecialized in pediatrics, Dr. Panossian treats adults as well with complex conditions.
Dr. Panossian is an Assistant Professor of Surgery at Keck School of Medicine at USC. He is also the Director of the Facial Paralysis Center and Co-director of the Vascular Anomalies Center at Children’s Hospital Los Angeles.