A focus on the present for the future of plastic surgery around the world

By Paul Snyder

Andrea Pusic, MD, MHS, didn’t follow a traditional path into plastic surgery. In fact, The PSF past president’s journey to the specialty began where few others have: in the Canadian Arctic where she worked as a primary care doctor.

“It was essentially a fly-in medical service where we looked after Inuit patients north of Churchill, Manitoba, and on Baffin Island,” she recalls. “It was anything but a standard practice, but during that time I started to realize how much I enjoyed caring for patients and doing procedures.”

One of the procedures that Inuit women in the area needed were Caesarean sections, so Dr. Pusic traveled to South Africa for further obstetrical training. At the time, South Africa was still in the throes of social unrest, so she also had immediate exposure to treating patients who had suffered severe burns.

“The burns were horrific, but I found burn surgery to be very rewarding,” she says. “Back in the Canadian Arctic, I was also handling a lot of hand and facial trauma cases and complex lacerations. It all started to come together for me that this was plastic surgery – and that this was what I loved.”

Dr. Pusic returned to training with a growing desire to pursue plastic surgery but says the competition in her native country of Canada to secure a plastic surgery residency spot was intense. So she began a general surgery residency at Dalhousie University in Halifax, Nova Scotia, where she worked alongside some of plastic surgery’s foremost practitioners, including Don Lalonde, MD, MSc, the first Canadian plastic surgeon to be elected chair of the American Board of Plastic Surgery. He’s also past president of the Canadian Society of Plastic Surgeons.

“I remember doing a fibula flap with Dr. Lalonde and I thought it was the coolest thing I’d ever seen,” Dr. Pusic says. “I enjoyed the big cases, the small cases – it solidified that this is what I wanted to do.”

Dr. Lalonde says he was immediately struck by Dr. Pusic’s work ethic.

“It’s a five-hour drive from Halifax to New Brunswick, and she did that to do a rotation with us,” Dr. Lalonde remembers. “She was an intellectually curious surgeon and a brilliant woman. Even then, you could see her leadership potential – it didn’t matter what kind of person you are or what you did, she had an innate ability to bring out the best in you.”

Dr. Pusic pursued a master’s degree in epidemiology and biostatistics at Johns Hopkins University where she found more plastic surgery mentors in Paul Manson, MD, and The PSF past President Carolyn Kerrigan, MD, MHCDS, who provided an early touchpoint in fortifying Dr. Pusic’s career-long interest in patient-reported outcomes (PROs).

“I was at McGill University in Montreal as a professor, and I had a resident working on a research project who was good friends with Andrea,” Dr. Kerrigan recalls. “My resident said, ‘I think our project could be even better if we had Andrea’s opinion as well.’ So we collected data in Quebec and Andrea provided data from Baltimore for this project that examined the outcomes of breast cancer reconstructive procedures. I was so impressed by her curiosity, her scientific rigor and her writing ability that I told her I wanted to stay in touch and continue to collaborate where we can.”

After her time at Johns Hopkins, a plastic surgery residency opportunity became available at McGill, and while Dr. Pusic says she wanted the spot badly, she was nervous about her chances given that she was pregnant with her first son when she interviewed for the position.

“I still remember thinking, ‘There’s no way in the world they’ll accept me, because by the time I start, I’ll have a child,’ but Dr. Kerrigan was part of the interview committee and she has five children of her own,” Dr. Pusic says. “They were very welcoming, and I knew it was the right program for me.”

Pushing research further

For as much as reconstructive procedures attracted Dr. Pusic to the specialty, she says that research – specifically focusing on PROs – fueled further motivation for her, and ultimately, plastic surgery at large. That research took root during her first few years in plastic surgery practice at the University of British Columbia in Vancouver, British Columbia.

“Once that idea of ‘We really need to know whether we’re succeeding or not from a patient perspective’ took hold, that became a new passion,” she says. “But none of my work on PROs would’ve happened without the support of The PSF. At the time, it was an idea that was still kind of ‘out there,’ but The Foundation got behind it.”

Since that time, the PRO measures developed by Dr. Pusic and her team, including the BREAST-Q, FACE-Q and CLEFT-Q, have become gold-standard outcomes measures used in research and clinical care around the world.

“Andrea is magical in the way she can put together a research team,” Dr. Kerrigan notes.

Reflecting her commitment to patient safety, Dr. Pusic’s next big focus was to lead the development of the National Breast Implant Registry (NBIR), a cornerstone of The PSF’s registry portfolio. Dr. Pusic launched the NBIR in 2018 as she began her presidential term with The PSF.

“Establishing the NBIR was a huge amount of work, but The PSF never wavered in its belief that this was critical to patient safety – and the FDA was a great partner every step of the way,” she notes. “It required a lot of determination on our end to keep its development on track, which is why I was so pleased when we recently hit the 50,000-patient mark. This milestone is clear evidence that the NBIR has surpassed an important inflection point and will continue to increase patient safety and product innovation going forward.”

Her involvement with ASPS and The PSF on various committees and in fortifying research put her on track of The Foundation leadership, though she notes that attaining the presidency wasn’t an early goal.

“My motivation was always to contribute and make an impact in what I was doing,” she says. “When I was a member of the Clinical Trials Committee, for example, the members of that committee had great ideas and my focus was making sure those ideas were put into action.”

The benefit of that approach was not only getting NBIR off the ground, but also having a wide-ranging knowledge of the research work in The PSF portfolio and the organization’s continued commitment to patient safety, all of which benefited the specialty when the FDA held public hearings on the safety of breast implants in 2019.

“I consider it extremely fortuitous that Andrea was the president of The PSF during my year as the Society’s president,” says ASPS past President Alan Matarasso, MD. “She’s thoughtful, sincere, fair and non-judgmental. On top of that, she’s insightful, hard-working and has demonstrated her ability time and again to advance the agenda of plastic surgery for the welfare of our patients. It was truly a pleasure and honor to work with her.”

At home and abroad

Since the days of her formative experiences with plastic surgery in the Canadian Arctic and South Africa, and even now as the chief of plastic and reconstructive surgery at Brigham and Women’s Hospital in Boston, Dr. Pusic remained committed to helping patients in the developing world. Through various organizations, she’s not only traveled to treat burn patients but also to teach breast reconstruction and other procedures in India, Bangladesh and several African countries.

This commitment to helping patients – and furthering the development of plastic surgeons in those countries – found a new organizational structure during her The PSF presidential term through the creation of Surgeons in Humanitarian Alliance or Reconstruction, Research and Education (SHARE), which in 2020 began teaching its first class of Global Fellows in sub-Saharan Africa. The program seeks to enhance collaboration to improve care and surgical capacity in regions with limited numbers of plastic surgeons but high incidences of conditions requiring plastic surgery treatment.

Although the COVID-19 pandemic threatened to derail the project right as the initial flights to Africa were being booked in early 2020, SHARE leadership looked at the situation and turned it into a positive.

“It forced us out of our standard way of thinking,” Dr. Pusic says. “We realized we could actually do more teaching and mentorship virtually. It’s been incredible to see these young surgeons who are either residents or in early practice who are thrilled to be part of the SHARE program and able access ASPS educational materials as well as mentorship and virtual teaching from our members. Even though we’re not physically together, there is a great connection and commitment between SHARE mentors and Fellows. It feels like we travel to Africa and back in the space of a few hours on a Zoom call.”

The commitment not only to improving research for the benefit of patients but also steering future generations of plastic surgeons prompted The PSF immediate-past President Gayle Gordillo, MD, to bestow The PSF Distinguished Career Researcher Award upon Dr. Pusic at Plastic Surgery The Meeting 2021 in Atlanta.

“Andrea’s been a pioneer in PROs research in plastic surgery and a thought leader in the registry space for the specialty – developing collaborative relationships with the FDA, breast implant manufacturers and other international plastic surgery organizations,” Dr. Gordillo says. “It’s hard to describe how impactful her work is. I can recall being at a plastic surgery meeting in Japan a few years ago and the young plastic surgeons there just flocked to her. They were so eager to speak to her – she truly is a superstar. I was kind of an outsider looking in, but it really brought home for me the global impact of her work.”

Dr. Gordillo adds that she also felt compelled to bestow the honor on Dr. Pusic as an example of a true female leader for other women in the specialty. Providing that example to other female plastic surgeons is something Dr. Pusic says she felt was important since taking her place in plastic surgery residency as a brand new mother. Her husband, Martin Pusic, MD, whom she met during her time in the Canadian Arctic, is a pediatric emergency medicine physician, so she knows well the constraints that careers in medicine can put on family time. When asked what advice she might have for young women facing the prospect of continuing a career in plastic surgery and raising a family, she answers by saying that she remembers the anxiety.

“I think a lot of young women who go into plastic surgery want to do everything really well, and when you’re faced with having a child, the question becomes: How do I do that and still do everything else?” she says. “I don’t know what the right answer is, but I went for a run yesterday with my 25-yearold son, and he spontaneously started talking about our family and said that he thought we were great parents. I said, ‘That means a lot, because I feel like we weren’t around as much as other parents. I was at work a lot and when I was home, sometimes we were really tired.’ But his comment was, ‘You and Dad modeled it for us. We learned a lot by watching you and seeing what you prioritized. You prioritized us, but you also prioritized doing things to help others and making contributions.’

“Kids are watching,” she continues. “I think the important thing is to be as present as you can for them and just do your best. I would always try to give them my full attention for the time that I was home – and it was easier to do this before we all had phones and email and constant distractions. If I walked in the door and there was only an hour until bedtime, maybe it might mean sitting together and watching cartoons for that hour. Just be there when you can. And you can.”