The Joy and Privilege of a Surgical Career
I am a Brazilian plastic surgeon currently practicing in the U.S.
On my last year of plastic surgery training in the U.S., one of my mentors said my extra goal for that year should be to leave a legacy at Indiana University. Given my passion for breast reconstruction, I organized a plastic surgery team to donate and participate in the Susan G. Komen walk.
After graduating in 2014, I took a position as assistant professor of plastic surgery at West Virginia University (WVU). I can say that this position changed my life in many positive ways. The Women’s Health and Cancer Rights Act (WHCRA) was signed into a law in October 21, 1998, and states that all insurance plans must provide coverage for reconstruction after mastectomy for breast cancer.
Widespread WHCRA knowledge seemed like a given to me, but I quickly changed my opinion after I started working in West Virginia. I found out that one patient after undergoing a mastectomy was looking for a “way to feel normal again,” but cancelled her appointment with me as soon as she learned I am a plastic surgeon: she was unaware of WHCRA and simply assumed she didn’t have the money to afford plastic surgery.
Unfortunately, this is not an isolated story. Many partial and total mastectomy patients never hear about their reconstructive options: “I was told by my physician that immediate reconstruction was not possible,” “The plastic surgeon where I live doesn’t take my insurance,” or “I never heard about reconstruction.”
You may think that those conversations happened prior to WHCRA, right? Sadly, they happened in 2014 and continue to happen to this day. Moreover, you may ask why? While studies show that breast reconstruction after mastectomy rose between 31–36 percent between 1998 and 2007, other gaps remain: racial/ethnic difference are still present; patients in near-metro and rural areas are less likely to receive reconstruction probably due to lack of plastic surgeons in rural communities, difficulty with traveling, and lower likelihood of providers referring patients for reconstruction.
We as surgeons can either get frustrated about it or do something about it. I decided to light a little candle rather than complain of that dark and in 2015 created the Dine Out for Breast Reconstruction Awareness (BRA) Day event taking place on BRA Day in October.
Through long hours, multiple steps walked, many doors knocked, I was fortunate to have the Morgantown Chamber of Commerce co-sponsoring the event. On my first year, I came $140 short of opening the fund, which I made up with a personal donation. The BRA fund goal was established with a goal of helping patients have access to breast reconstruction and providing education on patient’s options.
Dine Out for BRA Day has become a yearly event and grown with help of the community, patients, and the Cancer Institute at WVU. Since its inception, revenue has more than quintupled. Last year, we went beyond Morgantown with participant restaurants from other areas of the State.
We have been able to help patients with gas money and meals. It is a small help, but we are slowly spreading the word about WHCRA.
I feel that some of West Virginia is very similar to some areas in Brazil. Coming from Brazil, I never imagined that there is poverty and lack of health care access in the U.S.. Working with the Appalachian population, I learned that:
- It takes time to build trust, but once that happens, patients and community want to participate and help. I have patients that travel hours to come to my clinic and patients that took me to their high school pink game to be honored
- We need to be humble and realize patients need help. Do not assume that everyone has a nice home to live. Sometimes we fail to acknowledge that if a patient comes with a wound infection because they do not have access to a warm shower, it is partially our fault for not recognizing their needs
In 2017, I received a Public Awareness grant through the Plastic Surgery Foundation to continue to raise awareness of breast reconstruction options among West Virginian patients.
I feel that is my obligation as a 3rd year Medical Student surgery clerkship associate director, show the next generation of physicians the importance of looking after our patients in many ways. It goes beyond the clinic visit, the operating room and our office door.
Back in Brazil, my first exposure to plastic surgery was with burn patients. The surgeries and the impact on people’s lives was captivating.
A few months after finishing my training, my life took some turns that brought me to the U.S. After moving, I was doing research in plastic surgery at first. Fun as the basic science may have been, I missed the interaction with patient and making use of my hands. I restarted with a general surgery residency.
Repeating my training was demanding, but it made me a better surgeon. The advantages of repeating your training are maturity and a second chance. Maturity keeps you focused in learning and using time wisely. It makes the grueling hours pleasant, as you know that they will mean a lot once you are done.
Second chance is the opportunity of re-do something. How many times in our lives, we wish we had a second chance. I considered being privileged because I could repeat my training, look for the deficiencies, improve what was missing and have the opportunity to sharpen the edges. Being a surgeon is a privilege that we should never take for granted and we should be grateful every day to our patients that put their trust in our hands. There is definitely nothing more precious than that. Therefore, I believe that is my duty to give back by participating in the community, joining the advocacy groups and educating the next generation to come.