Back in action

By PSN staff

For the first time since September 2019 and the onset of the COVID-19 pandemic in March 2020, ASPS returned to an in-person meeting in October – and thanks to a hybrid format that encouraged and facilitated virtual engagement for those who couldn’t attend in person, Plastic Surgery The Meeting 2021 in Atlanta proved to be another record-breaking event for the Society.

“It was great to be back in-person again,” says ASPS immediate-past President Joseph Losee, MD. “It was a successful and positive experience from every angle and I’m completely happy with the way it turned out.”

Plastic Surgery The Meeting 2021, sponsored by Allergan Aesthetics, an AbbVie company; Mentor Worldwide LLC; 3M Health Care; MTF Biologics; Stryker; and Galderma boasted the largest number of registrants to date at 3,691 – 2,420 of whom attended in person, and 1,271 tuning in virtually. With more than 100 live sessions, 50 on-demand presentations and 75 hours of CME provided – not to mention more than 300 on-demand abstracts available – the educational component of the Society’s annual meeting more than lived up to the high standards set in years past.

“With the hybrid and on-demand format, it was possible to see almost every educational session,” says ASPS/PSF Vice President of Education Scott Hollenbeck, MD, who added that the in-person ingredient is an invaluable part of the annual meeting’s magic. “I had almost forgotten how meaningful it is to see friends and colleagues in person and exchange stories about career and life experiences. These interactions, which often occur in the hallways and at the social events, are of great value and create a sense of community within our specialty. It was really nice to have that back again.”

Patients of Courage

This year’s Opening Ceremonies, sponsored by CareCredit, poked a bit of fun at the Zoom meetings so many members became accustomed to over the past 20 months. The extended video skit featured connectivity issues, kids and spouses vying for attention in the background, exaggerated outdoor noise, Dr. Hollenbeck having to insist that he is “not a cat,” and other Society leaders playing up the various technical glitches that defined the past year and a half. After lamenting that he was sick of virtual meetings, and that he wished “we could meet in person,” Dr. Losee emerged on stage in a shirt, tie and sport jacket – along with torn-up board shorts and flip flops.

“What are you wearing?” The PSF immediate-past President Gayle Gordillo, MD, asked him. “This isn’t a Zoom call.”

The lighthearted beginning to Opening Ceremonies drew strong laughs from the attendees, but as usual, the Patients of Courage: Triumph Over Adversity Awards program proved to be a highlight. Since 2003, ASPS has honored more than 50 reconstructive plastic surgery patients through the program, which commemorates the bravery and charitable actions of three courageous patients whose lives have been changed or saved through reconstructive surgery.

Jada Monet Idokogi was diagnosed with juvenile polymyositis at age 14, which resulted in her suffering from severe calcinosis cutis that affected her abdomen, back, arms and thighs. She underwent extensive excision of all areas of calcinosis through an extensive process that required more than 10 surgical procedures. Jada earned a Bachelor of Science in mathematics at the University of Maryland while undergoing experimental, high-dose cyclophosphamide chemotherapy as an inpatient. During her recovery, Jada moved to Houston to pursue her graduate degree, earning a PhD in biostatistics in 2020. Throughout her treatment, Jada remained positive in the face of numerous challenges posed by both the disease and multiple surgical procedures. Now 29, Jada is an inspiring example of perseverance through both her academic achievements and defying the poor survival odds she initially received from her doctors.

Jen Rozenbaum was diagnosed with breast cancer in 2017 at age 41. Her treatment included bilateral mastectomies, staged expander-implant reconstruction and chemotherapy. Following her diagnosis, Jen dedicated herself to providing information and emotional support to women both newly diagnosed and those undergoing cancer treatment. As a professional portrait and boudoir photographer, she turned to photography during her chemotherapy treatments as a tool for healing emotionally and began photographing women who had undergone breast cancer surgery. Now with more than 30,000 Instagram followers, Jen shares images of women after mastectomy and reconstruction to normalize breast cancer bodies and provide an accurate portrayal of recovery. She launched her podcast “Shamelessly Feminine” in 2018 while recovering from breast reconstruction, then published a book in 2020 to share her breast cancer journey. Her photography remains a pivotal platform to help heal and empower those touched by breast cancer.

“When Ron Israeli, MD, mentioned nominating me, I was so humbled,” Jen tells PSN. “Taking photos and making videos throughout my journey gave my disease purpose. It allowed me to stay positive and believe that I’m helping others.”

Marc Buoniconti, son of the late NFL Hall of Fame linebacker Nick Buoniconti, suffered a severe spinal cord injury in 1985 while making a tackle for the Division I Citadel Bulldogs college football team. The injury left the young athlete paralyzed, rendering him a quadriplegic. However, Marc used the injury as a point of inspiration, and his family and Barth Green, MD, co-founded The Miami Project to Cure Paralysis, which has produced some of the nation’s most notable medical research and multiple breakthroughs in the management and treatment of spinal cord injury. As he struggled to wean himself from a ventilator after his injury, Marc committed his energy to raising funds for The Miami Project. He eventually returned full-time to the University of Miami, making the Dean’s List and graduating in 1993 with a degree in psychology.

Now 54, Marc serves as president for The Miami Project. He undertook a vigorous campaign, championing the message that paralysis “does not have to be forever.” Marc, who underwent reconstructive surgery in 2020 for his first pressure ulcer, says his mission is to help people walk again and get everyone out of wheelchairs. To reach that goal, his family formed The Buoniconti Fund, which has raised more than $500 million in support of The Miami Project’s research programs.

“Marc truly believes that paralysis is not forever, and that through research a cure will be discovered,” says ASPS member Devinder Singh, MD. “Plastic surgeons are commonly called into action for complex wounds, and that’s precisely what was keeping Marc in the hospital for four months,” he adds. “When I was consulted for a large perineal/ischial ulcer, I recommended a muscle flap transfer, which was very successful and helped him heal. Having Marc get out of the hospital was great, but letting him return to his important mission was even better.”

Each of the patients were recognized by their nominating surgeons: Jason R. Bailey, MD, who treated Jada; Dr. Israeli, who treated Jen Rozenbaum; and Michael Plastini MD, who along with Dr. Singh treated Marc Buoniconti.

New inductees to Maliniac Circle

The 2021 inductees into the Maliniac Circle, a philanthropic designation reserved for plastic surgeons who give back to the specialty through $100,000 deferred-gift commitments or contributions of $50,000 or more via cash or appreciated securities, were also recognized during Opening Ceremonies. The newest Maliniac Circle members are:

• John Gatti, MD, and Margaret Gatti, Esq.

• Gayle Gordillo, MD

• Dan Hatef, MD, and Lynsi Hatef

• John Osborn, MD, and Katie Osborn, MD

• Geoffrey Sisk, MD, and Lauren Sisk

ASPS President’s Panel

The ASPS President’s Panel, “Our Role in the Future of Breast Surgery: Do We Have One?” was sparked by a recent meeting of a state plastic surgery society that had an ACS endorsement.

“They were going to engage in a successful model of single-surgeon oncoplastic surgery and train general surgeons how to do mastectomy and other breast surgeries,” Dr. Losee noted during the panel. “The American Society of Breast Surgeons (ASBS) accredits oncoplastic surgeons, general surgeons, (after) five mastopexies – general surgeons are being credentialed in hospitals to do breast augmentation, implant reconstruction, mastectomies and reductions.”

In response, Dr. Losee helped assemble a group that included ASPS and its sister societies to send the ACS a white paper on the issue. The PSF past President Linda Phillips, MD, an ACS Board of Regents member and UTMB-Galveston Division of Plastic Surgery chief, told the group that she’s been active in bringing the issue to the ACS board.

“I’m taking on specialty engagement and I’ll get together with other specialties,” she said. “There’s practice creep in other areas, and we can build upon this synergy to make sure we’re protecting the safety of our patients.”

ASPS past President Jeffrey Janis, MD, another member of the panel, remarked that there was proposed panel at an ACS meeting two years ago that was to be called, “No Plastic Surgeon, No Problem.”

“The fact the title got so far down the line is a great reason why we’re here now,” he said, adding that the title was ultimately changed.

When asked by Dr. Losee whether ASPS members should be on these teaching panels, Dr. Janis said plastic surgeons shouldn’t isolate themselves – but they need to ram home the importance of board certification.

“It’s in our DNA to collaborate with others,” Dr. Janis said. “We’re the last true general surgeons, and we help other specialties achieve better outcomes because we’re part of the care team. But we’re also not in the business of training our replacements, so where does one line end and the other begin? For many courses, you don’t know who’s in the audience and what their intent is when you give them the skills that they’re asking for – then they leave the ‘weekend course’ and go do what you’ve trained them for. We need to emphasize the skill set of a properly board-certified and trained plastic surgeon and their value to the multidisciplinary team.”

The panel also tackled the question of plastic surgeons missing out on being part of breast care because of a stronger interest in aesthetic procedures or work that provides better compensation. Dr. Janis cited recent data that suggested that while many zip codes throughout the United States don’t have plastic surgeons – leading breast surgeons to handle more procedures – there are cases where zip codes rich with plastic surgeons are also losing out.

“In one area, the division chief there lamented that even though plastic surgeons are right around the corner, many weren’t interested in doing this work,” he said.

So how can plastic surgeons who want to perform breast surgery redirect patient flow?

“We have to stand up locally,” Dr. Phillips said. The person in charge of an ACS course that questioned the need for plastic surgeons joined her institution’s faculty, and when she pursued privileges there, the request was rejected, leaving Dr. Phillips and another plastic surgeon in charge of all those cases – including call. “That means we’re always there, we’re making sure there’s coverage, so there’s not a single instance when we’re not there.”

The PSF past President Michael Neumeister, MD, chair of the Department of Surgery and the plastic surgery RRC at SIU Springfield, said that a build from division to department has many benefits for plastic surgery programs – budgeting not the least of them – but short of that, academic plastic surgeons should try to get a seat at the table however possible.

“This is going to be a slow process,” he acknowledged. “You need to show up at the multidisciplinary discussions about the patients. You need to be there talking about the cancer and treatment with radiology, and medical oncology and such, and show that you’re part of that team.”

Lisa Wu, MD, professor of surgery at the Hospital of the University of Pennsylvania, as well as vice chair of clinical operations and microsurgery Fellowship director, was asked whether expanding scope of practice to become “the complete breast surgeon” made sense in this environment.

“Ultimately, what’s best for patients?” she asked, noting that she forged her own breast surgery training module over approximately 10 years. “In 2017, I did a non-accredited breast surgery oncologic Fellowship at my own institution with the idea of becoming a person who did it all. Can a plastic surgeon be a breast surgical oncologist? Yes: You can train in general surgery, do a plastic surgery Fellowship and join a hospital system that allows you to do oncologic breast surgery without a breast Fellowship. You can do an integrated plastic surgery Fellowship and a breast Fellowship, and practice surgical breast oncology.

“More important, should a plastic surgeon do it?” she added. “I truly believe this is the best thing for the patient – you have the benefit of thinking and seeing through breast oncologic eyes as well as aesthetic eyes.”

Dr. Janis said there’s little time to waste on deciding whether to forge a new path.

“We’re already seeing that we’re losing the mastopexies, reductions and augmentations through the symmetrizing procedures,” he said. “We’re not at the table. This is scope creep and we’re at a crossroads now: Are we going to put our flag in the ground and stake our claim, to say that we’re qualified to do this and more – or are we going to stick our head in the sand (and lament our losses)?”

The PSF President’s Panel

The PSF President’s Panel, “What Has The PSF Done For Me?” celebrated the Foundation’s reach and depth as experienced by the four panelists invited by Dr. Gordillo, who embraced the dual role of moderator and respondent. She was joined by The PSF past President Paul Cederna, MD, University of Michigan professor of biomedical engineering and plastic surgery section chief; The PSF past President Andrea Pusic, MD, MHS, Brigham and Women’s Hospital plastic and reconstructive surgery chief and Patient-Reported Outcomes, Value and Experience Center director; and Indiana University Department of Surgery Assistant Professor Mithun Sinha, PhD.

Dr. Gordillo referenced the movie “It’s a Wonderful Life” and the “what if?” scenario of George Bailey having never existed to illustrate the effectiveness of The PSF grants. As a young

faculty member, Dr. Gordillo wanted to cure hemangiomas and needed funding to conduct research, but she had no “track record” upon which to impress funding decision-makers.

“I got my first grant from The PSF, and that was hugely important,” she said. “It’s a badge of credibility; it says you can compete for funding nationally. That grant, which I got in the middle of my post-op Fellowship, helped me get my NIH grant. (Even a small grant) gives you credibility – that your specialty society thought you have potential.”

Dr. Gordillo used that and other small grants to gather enough preliminary data to receive a National Institutes of Health grant of $30,000 – and the subsequent research that resulted wouldn’t have been possible without the Foundation’s support.

Dr. Cederna noted that ASPS members are tasked, among other things, with giving back what’s lost through trauma or other conditions.

“We strive to do the impossible,” he said. “The PSF knows about firsts; it’s been investing in young scientists’ new ideas and novel concepts for years. Pilot grants are given every day, and they are for new ideas and innovations. That larger extramural funding is critical for the success of these larger project – and it can’t happen without that pilot data that The PSF helps provide.”

As a researcher who’s taken on several different roles and tasks as a plastic surgeon, Dr. Cederna’s current research mainly involves working with amputees to provide them with useful and viable artificial limbs via regenerative nerve peripheral interfaces – an important focus, as 180,000 people face new amputations each year, he said.

Dr. Pusic, who created the BREAST-Q, co-developed the Q-PROM and has been hugely influential in the development of several other patient-reported outcomes measures, told the audience that treating patients’ conditions is a major part of plastic surgery, but that they often need more.

“Early-on, everything we did was with the goal of saving lives; a lot has changed, particularly in plastic surgery,” she noted. “We’ve changed how we think about outcomes. If the goal is quality of life, only patients can tell us that.”

Dr. Pusic said she was one year into practice when she wanted to study differences in breast reduction techniques, as perceived by patients.

“There were no measures available,” she recalled. “We wrote a The PSF grant for a PRO study, and they funded it. That was the beginning of a much longer story and a bigger journey.”

Although the outcomes measure story “is still being written,” the fact of the matter is that the plotline stems from The PSF and a paradigm shift in the way researchers think about and measure outcomes in plastic surgery.

Lecture highlights

Plastic Surgery The Meeting included several lecture highlights, notably an in-depth dive on healthcare and the future of plastic surgery in the post-COVID world by Robert Pearl, MD, a Stanford University professor, bestselling author and former CEO of The Permanente Medical Group. William Magee Jr., DDS, MD, also delivered a lecture on love and leadership. Dr. Magee, who founded Operation Smile in 1982 with his wife, Kathleen, during the annual meeting became the first recipient of the newly created Noordhoff Award for his continued efforts in humanitarian work.

Foad Nahai, MD, Atlanta, discussed the many hats he’s worn over his years in the specialty – but none so important as that as mentor, he said during the Trustees Talk, “Where Would I Be Without My Mentors?” Dr. Nahai, past Maurice J. Jurkiewicz chair and professor of surgery at Emory University; editor-in-chief of Aesthetic Surgery Journal; and past president of the American Association for Accreditation of Ambulatory Surgical Facilities, American Society For Aesthetic Plastic Surgery and International Society of Plastic Surgeons; said he doubted that many plastic surgeons exist “who during our training and career haven’t benefited from the guidance of one or more mentors.”

Dr. Nahai said the mentoring he received spans three continents and began with his parents, Marcelle and Rouhoullah Nahai. University of Bristol (England) Department of Medicine Chair Alan Earnest Alfred Read, MD, had the greatest influence on Dr. Nahai’s career, and he added that without Dr. Read, “I probably wouldn’t be on this podium today.” Dr. Read had encouraged Dr. Nahai’s relocation from Bristol to Baltimore, among other assistance, and though Baltimore didn’t work out to his satisfaction, Dr. Nahai kept working and eventually landed in Atlanta.

“I ended up at Grady Memorial Hospital,” where on the first day he met John Bostwick, MD, and future PSF President Stephen Mathes, MD. “That day I decided: ‘This is going to be home; I’m going to be a plastic surgeon.’ ” Today he continues to practice in Atlanta with his son, Farzad.

Over the course of that career, Dr. Nahai has trained 100 residents at Emory University and 45 at other institutions.

“When one teaches, two learns,” he said. “Where would I be without my mentors? I certainly wouldn’t be where I am today.”

Arun Gosain, MD, past president of ASMS and The PSF, delivered this year’s Kazanjian Lecture, “Caring for Children With Facial Anomalies – Inspiring the Next Generation to Follow in our Footsteps.” Presented biannually in honor of Varaztad Kazanjian, MD, an oral surgeon who rose to prominence during World War I and is widely considered the father of craniofacial plastic surgery, Kazanjian Lecture speakers are chosen by ASMS leadership for their enduring and/or innovative contributions to the craniomaxillofacial subspecialty of plastic surgery.

“What factors can be cultivated that will cultivate and retain interest in craniofacial pediatric plastic surgery among young people?” he asked, before assessing surgeon and patient needs and factors such as economic gain and service to humanity. Identifying a lack of interest in craniofacial surgery, Dr. Gosain asked what could be done to reverse that.

“At an individual level, start with mentorship,” he said, followed by building diversity in trainees as well as clinical innovation. From an institutional standpoint, plastic surgeons can highlight that pediatric craniofacial surgery is critical to the hospital’s mission, and nationally/internationally, a better focus could be brought to advocacy and the improvement of global health opportunities. “We need to maintain the continuity between the training period with our own mentors and with the mentees who’ve sought us out, and develop reciprocal mentorship relationships as those careers evolve.”

The 2021 Maliniac Lecture was delivered by Bryan Mendelson, Melbourne, Australia, a past president of International Society of Aesthetic Plastic Surgery who’s certified by both the American Board of Surgery and American Board of Plastic Surgery, and renowned for his advancements in surgical anatomy of the face. Dr. Mendelson’s address was relayed via video.

The ASPS Maliniac Lecture, named for the Warsaw-born founder of ASPS, Jacques Maliniac, MD, is delivered each year by a plastic surgeon based outside the United States and who’s contributed significantly to the specialty. Dr. Mendelson said his lecture, “Identity, Anatomy and Self-Esteem” was based in part on Dr. Maliniac’s influences, which were gathered by training in pre-war Paris and Berlin. The 1931 book by Jacques Joseph, MD, Rhinoplasty and Facial Plastic Surgery, influenced Dr. Maliniac, in particular that “a person whose looks caused social or economic disadvantage was as severely afflicted as a person who suffered from a debilitating disease.”

Dr. Mendelson highlighted small blepharoplasty procedures and the changes that resulted, emphasizing how small changes can have a disproportionate and positive benefit.

“A small change in facial proportion changes our perception, not just of someone’s looks but of the person’s personality,” he said.

Dr. Mendelson also recounted the story of a young man who lost considerable weight and wanted facial aesthetic procedures but arrived at clinic stooped over and wearing a hoodie. He almost didn’t operate on the man because of the way he appeared – the man had lost 100 kg on diet and exercise alone – and as a child with Tourette syndrome, he was mercilessly tormented. Dr. Mendelson said he performed the surgery, after which the patient and his parents were profoundly thankful and emotional.

“But I thought, ‘My God, to think that I wasn’t going to operate on him because I judged him like everybody else does: by the way he presented,’ ” Dr. Mendelson recalled. “Today, he’s a social worker in the United Kingdom. Any one of you here could’ve done that; we’re in a very privileged position… it’s what you do for your patients that determines their quality of life – and nothing can replace that.

“I hope this session that Dr. Maliniac so kindly provided for all of us will open up your minds and appreciation for the opportunities the specialty of plastic surgery offers us,” he added.

Looking ahead to 2022

During the Closing Ceremonies, Plastic Surgery The Meeting bid adieu to Dr. Losee and Dr. Gordillo, making way for the formal introductions of 2022 ASPS President J. Peter Rubin, MD, MBA, and 2022 The PSF President Bernard T. Lee, MD, MBA, MPH. The new presidents are eager to assume the leadership roles and continue steering the organization to new heights in the year ahead. Next year’s annual meeting will take place in Boston.