There is more to plastic surgery than meets the eye just ask award-winning Joburg-based surgeon Dr Brian Monaisa. Monaisa is the founder of Smile Artists Africa, an initiative that raises funds for breast reconstruction surgery for cancer survivors. As one of just 14 black plastic surgeons in South Africa, Monaisa runs Marang Aesthetics Clinic in Krugersdorp, and heads up the plastic surgery department at Chris Hani Baragwanath Academic Hospital. His work, he says, is about restoring hope.

This theme of hope is one that runs throughout Monaisas career, from his days running an HIV clinic at the height of South Africas HIV crisis and working with a large pharmaceutical company to ensure ARV access, to his current portfolio which includes reconstructive hand surgeries for children. There are few things more inspiring than the ability to return function to little children who have been impacted by a disability for so long, and for them to see a new world opening up for them, he says. The same is true for the trauma and cancer patients I work with.

Fear, loss and femininity

Breast cancer ranks in the top five most common cancers for women in South Africa, and is a fear-riddled diagnosis to receive. You fear for your life, and you fear for what will happen to your family if they were to lose you, but you also fear the losses that might come while you are still alive the loss of your breasts and the perceived loss of femininity that accompanies that.

Will I ever have sex again? Will I feel comfortable naked in front of my partner? Am I still a mom to my children if I cant breastfeed them? Monaisa says these are just some of the questions that women grapple with as they come to terms with their diagnosis, and with the possibility of a mastectomy, a life-saving intervention in which the affected breast tissue is removed. It often feels to them like an attack on their femininity and a loss of feminine identity, because breasts are linked to body image, self-esteem and sexuality, he says.

Breast reconstruction, in this sense, can be a reclamation of self and a celebration of life. It can be an act of self-love, and of restoring hope and joy; it can be an act of empowerment, and its a privilege for me to be trusted to walk that road with someone, he says.

Access and affordability still a problem

While strides have been made in cancer diagnosis and treatments, most women still struggle to access reconstructive surgery. The decision to have reconstructive surgery is a personal one, he says, and there are no right or wrong choices; however, many women are stripped of the opportunity to choose, simply because they cannot afford it.

Depending on the type of procedure, it can set a patient back anything from R70 000 to R250 000, and the surgery is not covered by most medical aids. Some women do not have any funds for reconstruction, while others are able to partially fund their surgeries, but not pay the full cost.

This, says Monaisa, is where the Smile Artists Africa initiative comes in: The money raised aims to reduce this burden and help empower female cancer survivors to live life to the fullest.

Art for social good

Monaisa is an avid art collector, and has rallied renowned and rising artists to donate work to be sold in aid of reconstructive breast surgery for cancer survivors who would not otherwise be able to afford it. Im passionate and vocal about my reconstructive work, and a few of my artist friends came to me and asked how they could get involved, and how they could contribute, he explains. Im a problem solver, so I thought about it, and after some deliberation the idea of an art auction came to me.

From humble beginnings the Smile Artists Africa Art Auction has grown into a star-studded extravaganza, and is now one of South Africas most high-profile charity events of the year: Its such a positive opportunity to contribute and to collaborate with so many people from different walks of life, and while it is a glamorous occasion and an exhilarating experience last year we had luxury cars donated for the day and sculptures coming out of the walls we never lose sight of the message. And that message is that ordinary people can join hands to do something amazing, and make a positive impact by doing what they do best.

The funds also go towards raising breast cancer awareness. This is particularly important in the case of triple-negative breast cancer, an aggressive type of breast cancer that is increasingly found in young black women, who have historically been considered a lower risk group. Its not enough to just deal with the aftermath of cancer, Monaisa explains. Were not raising enough awareness, were not screening enough, and by the time we detect the cancer it is often quite advanced; this needs to change!

The decision to go under the knife is a very personal one. While vanity may motivate some, few people are striving for magazine-model perfection. Most women see cosmetic enhancements as a way to address long-standing insecurities and gaining a level of confidence that only comes from being comfortable in ones own body.

Often, the surgery aims to address problem areas that have not been responsive to diet, weight loss or non-surgical treatments, says Dr Brian Monaisa, a plastic surgeon who runs Marang Aesthetics on Gautengs West Rand. Around 95% of the patients he sees in his practice are women, and one of his most popular options is the mommy makeover, which focuses on physical aspects affected by pregnancy and motherhood.

Monaisa says this has emphasised to him something that is often overlooked pregnancy and motherhood, childbearing and childrearing, impacts women in ways that go far beyond their physicality. We always think you get pregnant, have babies, breastfeed and then that is it; after a too-short maternity leave you go back to the way things were. But, he says, that is not the case. Adjusting to motherhood and its demands mean less focus on appearance, less time for self-care, and less time (or inclination) to prioritise diet and a fitness routine. These things add up, and can have a lasting effect on self-esteem, self-worth and confidence.

Common requests include liposuction, tummy tucks and breast rejuvenations. His clients partners are often hesitant; they worry about the safety of undergoing elective surgery and are happy with their wives just the way they are. You will hear husbands tell their wives how much they love them, and how they dont need surgery to be attractive, but after surgery, two things happen, he explains. First, the husband still finds his wife incredibly attractive, but more importantly, she feels very attractive, and this changes everything. This new sense of confidence empowers women and can have a monumental impact on their general wellbeing and quality of life.

Marang Aesthetics also employs a number of scientifically proven non-surgical treatments and therapies, such as body contouring and facial and skin rejuvenation. Vaginal rejuvenations are also popular, especially among the women who have had other surgeries. Women come back to me saying they look great, and want to know what I can do to make them feel even better, he says.

There are a number of non-surgical interventions available to enhance sexual pleasure and boost sexual health, he explains: Our main goal is to empower our clients. We want people to feel good, because we believe that when youre confident and happy, the people around you will be happy too. It has a ripple effect, and that is how we spread joy.

And this, he says, is why cosmetic surgery is not just skin deep. People make fun of plastic surgery as a vanity exercise, but I was approached in a restaurant the other day by someone who wanted to tell me that I bring so much joy into so many homes, and thats the truth of it. I help people find comfort and happiness in their bodies, and that happiness seeps into other aspects of their life too.

More:

Plastic surgery can be an act of self-empowerment - Mail and Guardian