Multi-D: Plastic Surgery

Hi, I’m Christina Huang! Welcome to Multi-D, where I interview colleagues in different specialties. We’ll explore common specialty misconceptions, and ask - what do you wish other specialties knew about yours?

Our first guest is Liz Malphrus, who specializes in plastic surgery!

The dreaded interview opener...tell me about yourself!:
I'm Liz Malphrus! I'm a chief plastic surgery resident at Penn in Philadelphia. I'm interested in medical education and women's health, and next year I'll be joining a private practice right here in Philly, where I'll be focusing on aesthetic breast and body surgery. 

What are the best parts and the worst parts about plastic surgery?
Best parts: the opportunity to make people feel better about themselves through surgery. The creativity and design aspects of our common operations. Being really good at an aspect of surgery that other specialties do all the time, but don't think that much about.
Worst parts: since we're "the closers," we are always the last team in the room in multi-specialty cases, so we are often waiting around the hospital for our turn! We also inherit a lot of surgical complications and problems from other specialties, which can be frustrating. 

From the perspective of these different training levels: what is the most significant issue or challenge facing plastic surgery?

1. Medical student: it's extremely competitive to get a residency spot, and at this point, many people have to take an extra year (or years!) for research in order to strengthen their applications.
2. Resident: deciding between an incredibly diverse array of sub-specializations and job types: you could do a fellowship in hand, craniofacial, microsurgery, aesthetics, or gender, and you could find a job in academia, "privademics," private equity, group or solo private practice...it's a lot to sort out!!
3. Attending: declining reimbursement rates (this affects everybody but I think plastic surgery has to fight especially hard to be recognized as an essential component of our healthcare system), reliance on other specialties for referrals, proliferation of underqualified practitioners of various types offering plastic surgery procedures (think: gastroenterologists doing lipo, plastic surgery tourism, Home Depot-sourced fillers, etc)‍

If you had to choose another specialty right now, what would it be? ‍

Oh no, don't make me do it!!! If you absolutely insist, I guess I'd pick urology. That was my first interest as a med student and it's a really interesting field with great people.

What is a common misconception about plastic surgery?
Most people have NO idea what plastic surgery is actually like. They think Botched, or worse yet Nip/Tuck, when in reality plastic surgery is a field that undertakes extremely complex operations to fix devastating injuries or put people back together after a tumor resection. Many hand surgeons are plastic surgeons. We fix cleft lips and other craniofacial anomalies. We do free flaps which are essentially transplants from one part of your body to another! It's so much more interesting and complicated than what people think. 

What do you wish other physicians knew about plastic surgery?
Overall, we have great relationships with other specialties but occasionally people will fall into the trap of thinking of us as "closing techs" rather than as a specialty in our own right. There is a LOT that goes into successful reconstruction, and it's best to get us involved in advance to help plan and optimize the patient for surgery, rather than waiting to call us in the OR when you realize you can't get something closed. 

Does plastic surgery interact with radiation oncology? What would you say plastic surgery as a field's impression of radiation oncology is? What did you wish radoncs knew about plastic surgery?

Liz: We do! We actually have a ton of patients in common, mostly cancer patients. While Christina and I are friends I would say that in general plastic surgery as a field is frustrated with radiation oncology because radiation can cause major issues for healing and reconstruction, and often limits our options. And radiation is forever! Though we of course realize how important radonc is in the treatment of cancer, I'd say we view radonc as a necessary evil (sorry Christina!). I wish radoncs could see how different radiated tissue is from non-radiated tissue in surgery...it's like trying to rearrange a rock!

Christina: Having done a plastics rotation, I can definitely say that my attending had zero good things to say about radiation therapy, haha! No apologies needed; radiation definitely can cause fibrosis in the long term and can change the cosmesis and healing of reconstruction. With advances in the field, like hypofractionation (condensing radiation into fewer treatments) and partial breast irradiation, we actually do see improvements in cosmesis and are continuing to study cosmetic outcomes in patients long term. I see a world where plastic surgeons regularly participate in breast tumor boards. For example, if there’s a plan for an oncologic reduction and we have to give the patient a tumor bed boost (extra radiation to where the tumor was) because of their higher risk features, then we could maybe do some preplanning/strategize how to localize the original tumor bed. It can be difficult to boost a tumor bed if you can’t find it after tissue rearrangement.

What advice would you give to students who are considering plastic surgery?
Try to spend some time shadowing with different kinds of plastic surgeons! It's an incredibly broad field and often not an area that med students see as a routine part of their clinical rotations. You'll have to work a little harder to find these opportunities, but it's worth it to make sure you have a good understanding of what our specialty is like.

What are some books, podcasts, or other resources you’d recommend for those interested in learning more about plastic surgery?
WELL since you asked I actually have some resources of my own that I think would be a great gateway for students interested in plastic surgery! My instagram @dr.malphrus covers and occasionally pokes fun at life as a plastic surgery resident, and I also regularly answer questions and give advice for students applying in plastics. I also have a newsletter called Cut & Tell where I share my experiences as a plastic surgeon in training. You should also listen to the DIEP End podcast, which is hosted by my colleagues at Penn and includes interviews with plastic surgeons in different subspecialties!

Are there any projects that you’re working on that you want people to know about?
Same as above ;)

Favorite book/movie/tv show??
OMG this is the hardest question!! I'm going to cheat and say my top 3 favorite TV shows (in no particular order): 30 Rock, VEEP, Peep Show

Your socials:

Instagram: @dr.malphrus

Tik tok: @dr.malphrus

Christina: Amazing! Your Instagram videos are so fun and educational. I love seeing the different subspecialties within plastic surgery. I think it’s important that people understand that plastic surgery is not all glitz and glam but that you also do all sorts of creative surgeries and handle some very complex wounds. I’m honestly a little frustrated on your behalf that you’re often seen as the “closers” and can’t imagine the complicated cases that your specialty probably inherits simply because no one knows what else to do. Correct me if I’m wrong, but I bet most surgeons feel pretty protective of their surgeries (and ability to “do it on their own”) and probably don’t get plastic surgery on board early enough. People have a lot of preconceived notions about plastic surgery in general, and it’s thanks to medical education-focused folks like you that we can learn about what your field actually does! TLDR; don’t assume something about a specialty and just pick up the phone and ask your colleague! 

If you’re interested in being featured on Multi-D, please email Christina at Chrhuang.md@gmail.com.