I thought it would be fun on here to go through some of the surgical cases that I do in my work as a plastic surgeon. Because I love it. And probably the best and least biased way of doing that is to just review my last 7 surgical cases!
Why 7? No clue. Seemed like a good number!
The mile high view
As a brief reminder or background, I work as a plastic surgeon. Within plastic surgery, I am further trained as a microsurgeon. The majority of my practice focuses on breast reconstruction after cancer. Specifically, autologous breast reconstruction using a patient’s own tissue. And you can learn more about this and other types of microsurgery right here.
However, the majority of the breadth and depth of plastic surgery is represented in my surgical cases.
How I got here
To become a plastic surgeon and microsurgeon, I completed:
- 4 years of undergraduate studies at Emory University
- 4 years of medical school at the University of Rochester
- 6 years of plastic surgery training at NYU (which I am proud to say is the #1 plastic surgery residency in the world)
- 1 year of microsurgery fellowship at NYU
So a lot of time and a lot of work, but it all has been well worth it! And with that, let’s get into it…
My last 7 surgical cases
We are going from most recent to least recent here…
1. Superficial circumflex iliac perforator flap for tongue cancer
This was for a patient of my partner’s, Dr. Michael Nagai, who had a cancer on part of her tongue. He resected the cancer but it left a big defect requiring vascularized tissue for reconstruction.
So, I harvested the patient’s own skin and fat from her right groin based on a vessel from the superficial circumflex iliac system. We then divided these vessels and connected them to vessels in the neck to allow it to live and replace the missing tissue.
2. Bilateral oncoplastic breast reduction
This surgery was for a young patient with a left breast mass that required removal. However, just removing it would leave a contour defect and asymmetry.
So, in conjunction with her breast surgeon, we resected the mass and incorporated it into a breast reduction to lift her breast.
I then performed a breast reduction on the other side to achieve good symmetry.
3. Lower extremity liposuction for lipedema
I am the only surgeon in my area treating lymphedema and its less well studied cousin, lip edema which results in abnormal fat deposition in usually the legs.
This was a patient with lipedema of both legs who I had previously treated the left leg with liposuction for debunking to help her walk again with great outcomes.
So, I performed liposuction debunking of the right leg removing 6 liters of fluid and fat! This necessitated an overnight stay in the hospital for monitoring.
4. Bilateral upper blepharoplasty and breast revision with fat grafting
This was for a woman who had breast cancer and previously underwent a bilateral nipple sparing mastectomy with DIEP flap reconstruction, using the fat from her belly to create her new breasts and getting a tummy tuck in the process!
Now, she was ready for her revision stage with fat grafting to fill in the cleavage areas of the breasts. So, we did liposuction of her sides and injected the fat into the breasts to create an even more refined reconstruction.
She also had excess skin above her eyes that she wanted removed so I performed upper blepharoplasties (“eye jobs”).
Disclaimer: I am skipping a few cases here. Because they are very similar to the above case in that they were revisions after breast reconstruction. And they all involved fat grafting for minor touch ups!
5. Breast reconstruction with DIEP flap
This was a young woman with left breast cancer who required a mastectomy. We discussed various options for reconstruction including using implants or her own tissue.
Given her preferences as well as the better ability to match her normal breast, we elected to use her own abdominal tissue for her breast reconstruction.
This meant harvest the skin and fat from the belly while keeping it attached to a source blood vessel. Then that blood vessel is divided and reconnected to other blood vessels in the chest to give it life. Lastly, that tissue is used to sculpt the patient’s new breast!
6. Fibula flap for mandible reconstruction
This was another of the many surgical cases the I do with my partner Dr. Nagai.
The patient was a gentleman with a previous trauma to his lower jaw or mandible. This resulted in loss of part of the mandible and difficulty eating.
So, we planned to resect the remaining traumatized portion of the mandible and replace it using the patient’s fibula bone from his leg. This is another example of microsurgery. The fibula bone and an attached piece of skin is connected to a blood vessel that we transplant from the leg to the head and neck and reconnect.
Then this bone heals to the remaining jaw, restoring form and function.
7. Forehead flap for nasal defect
A young woman has a portion of her nose bit off by a dog. Unfortunately, the portion was large enough that nearby tissue was insufficient to replace it.
As a result, I had to borrow skin from her forehead to replace the missing nasal skin. This forehead tissue remains attached to a piece of skin near the eye for 2-4 weeks while it lives and heals to the nose.
After that, the bridge of connecting tissue gets divided and the forehead skin permanently replaces the missing nose skin. Another surgery is generally required to fine tune the appearance.
Amazingly, this surgery has been performed since 700 BC!
This is why I love plastic surgery!
I don’t think that is a more rewarding and fulfilling specialty out there. Of course, there is some bias. But I really love what I do and being able to help patients in this manner. It fits me perfectly.
I hope this illustrates why I feel this way.
But, even with this, I still experienced burnout. Even before I finished training. That demonstrates just how powerful the multifactorial forces behind burnout and moral injury are. We get to do some amazing things to help people in profound ways. But yet burnout is rampant with over 60% of physicians reporting symptoms.
In my case, a lack of financial well-being was the culprit (and ultimately the impetus to start this blog!)
So, I encourage you to remember and hold tight the things that you do love about medicine. And remember that financial freedom (and an overall focus on personal well-being) can help alleviate burnout, help you become a better doctor, as well as live life and practice medicine on your own terms!
What do you think? What does your day in clinical or non-clinical medicine look like? Do you enjoy it? Why or why not? Let me know in the comments below!
