In the continuing series on what I wonder to the question “Why plastic surgeon? Why plastic surgery?” – for a particular condition, I say “Pour quoi pas?”, WHY NOT? I have the pleasure of sharing yet another interesting set of conditions which I have treated. We are in an era where EBM (evidence-based medicine) rules supreme and other EBMs, namely eminence-based medicine or experience-based medicine is generally given a cold shoulder and has a bad name. However, most do believe that EBM in whatever form can be useful to discuss and make some sense of. Today, I am going to discuss the “KKK syndrome” which every medical student in Tamil Nadu would have heard in his lifetime. To me it is almost synonymous with the OPDs we do in medicine in medical colleges as house surgeons. Much talked about and ridiculed but never taken seriously.

KKK Syndrome – Kai Kaal Kodaichal Syndrome – கை கால் கொடைச்சல் Syndrome

On a serious note, aches and pains in the neck, hands and feet pose a real challenge to the GPs. They refer them to various specialists for further care. A small minority have a substantial and “diagnosable” cause and the specialist treats them. A vast majority continue to endure it, taking lifelong analgesics, anti-depressants and generally suffer. A plastic surgical encounter by accident changes their plight. On encountering such a case, the possibility of carpal tunnel syndrome is evaluated. This could be the cause of the misery being labelled as KKK syndrome and left to their suffering fate. The picture of median nerve during surgery shows the state of the median nerve at the wrist. The nerve gets compressed in the wrist and could be the cause of the symptoms of KKK syndrome. The pictures show the actual appearance of the median nerve during surgery. In the minimal compressive state as seen in the first picture, there is just redness of the nerve and the rest of the nerve displays the typical appearance of the nerve - pearly white in colour. Next stage of severity causes swelling of the nerve and finally the nerve could become haemorrhagic and fibrosed, pic 3.

KKK Syndrome – Kai Kaal Kodaichal Syndrome – கை கால் கொடைச்சல் Syndrome

Another possible cause of unexplained neck pain, hand pain and general feeling of tiredness and misery are, to our surprise, the massive size of the breasts some of these women have - breast hypertrophy. This is where the bra doesn’t fit the breast but the bra is filled with the breast. Lack of knowledge on how to buy a correct bra and unavailability of different sizes of bras do add to the issue but the main cause is the general and the utter massive size of the breasts. This happens in teens and prior to childbirth. Post-childbirth, this becomes a major problem with lactating and post-lactating breasts attaining huge proportions sometimes. Symptoms are however vague like what we experience in KKK syndrome. Thankfully all these symptoms disappear completely and permanently after breast reduction surgery.

KKK Syndrome – Kai Kaal Kodaichal Syndrome – கை கால் கொடைச்சல் Syndrome

As I said, experience is what the patient experiences and shares with us doctors. I feel very proud to share the comment by one of the several patients after successful breast reduction surgery.

I quote a patient who has written to me after breast surgery.

“For years I had suffered from acidity, fullness and bloating. I couldn’t eat spicy food, or drink coffee. Anything would cause acidity. I had heavy breasts that hung low to my navel. I had constant neck and shoulder pain and a bloated stomach every day. I would have to lift my breast to burp many a times. After my breast reduction surgery, I feel like my stomach can finally breathe. Today is the thirteenth day after my surgery, I had palak paneer and two rotis without any issues. These are foods I used to avoid and only nibble on for fear of indigestion. As far as I am concerned, my reduction surgery, far from being a cosmetic procedure has been a medical one. It has solved many nagging, recurrent issues that have been plaguing me for most of my life.”

Similarly, the huge abdominal apron can be the cause of yet another set of symptoms, this time related to the back and the legs. Evaluation of back pain and lower extremity symptoms should include the possibility of the massive overhanging abdomen and lax abdominal wall as possible causes of these non-specific but miserable symptoms these unfortunate patients have to endure.

In the comment above on the breast, I was witness to a totally bizarre and unimaginable set of symptoms related to the GI system, which I have never heard ever before.

I am very grateful to share my experience as a plastic surgeon in dealing with some of the patients who could have been loitering around labelled “KKK syndrome”.

I also would like our family doctors and GPs to keep us as possible partners in the management of hand, neck and back pain. Kauvery has an excellent research facility and I would urge our GP friends to take this up as a project to get insights into the often-labelled KKK syndrome. We may be the first to get an answer.

So next time you think “Why a plastic surgeon, why plastic surgery?”, say loudly, “WHY NOT!!!”

Prof. V. B. Narayana Murthy

Prof. V. B. Narayana Murthy
Sushrutha Professorship Plastic Surgery
Senior Consultant Plastic Surgery
Kauvery Hospital Chennai


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