WEBVTT 1 00:00:00.291 --> 00:00:01.785 My name is Matthew Joy. 2 00:00:01.785 --> 00:00:04.046 I'm currently a resident physician 3 00:00:04.046 --> 00:00:05.745 in training at the Virginia Tech 4 00:00:05.745 --> 00:00:08.026 Carilion School of Medicine in Roanoke, Virginia. 5 00:00:08.026 --> 00:00:11.334 I'm training in plastic and reconstructive surgery. 6 00:00:11.334 --> 00:00:14.302 At our hospital, we do mostly reconstructive surgery. 7 00:00:14.302 --> 00:00:16.669 Probably 75, 80 percent of our practice. 8 00:00:16.669 --> 00:00:18.801 So that could be anything from a skin cancer 9 00:00:18.801 --> 00:00:20.689 that needs to be removed and reconstructed 10 00:00:20.689 --> 00:00:24.179 to a congenital defect like a cleft lip or cleft palate 11 00:00:24.179 --> 00:00:26.190 that needs to be reconstructed. 12 00:00:26.190 --> 00:00:28.587 We do a lot of breast cancer reconstruction 13 00:00:28.587 --> 00:00:29.665 with our group. 14 00:00:29.665 --> 00:00:32.770 But then we also have a cosmetic surgery center 15 00:00:32.770 --> 00:00:36.729 line:15% where our staff works throughout the week. 16 00:00:36.729 --> 00:00:37.828 line:15% A couple of days a week, sometimes we'll 17 00:00:37.828 --> 00:00:40.490 line:15% have cases there doing cosmetic surgery. 18 00:00:40.490 --> 00:00:42.287 line:15% And then we see our patients in clinic 19 00:00:42.287 --> 00:00:44.426 both for consult and follow up. 20 00:00:44.426 --> 00:00:47.808 And then we take consults from the emergency room. 21 00:00:47.808 --> 00:00:49.451 For stuff that's coming in throughout the day 22 00:00:49.451 --> 00:00:51.382 and sometimes at night as well. 23 00:00:51.382 --> 00:00:53.500 We will see the patient generally in the clinic 24 00:00:53.500 --> 00:00:55.153 once they've had their diagnosis 25 00:00:55.153 --> 00:00:58.225 and they've usually already met with the cancer surgeon. 26 00:00:58.225 --> 00:00:59.440 At that point and they've decided that they're 27 00:00:59.440 --> 00:01:01.351 interested in getting reconstruction. 28 00:01:01.351 --> 00:01:03.109 We talk with the patient about those options, 29 00:01:03.109 --> 00:01:04.551 the different surgeries that we can offer 30 00:01:04.551 --> 00:01:05.790 line:15% them to reconstruct the breast 31 00:01:05.790 --> 00:01:07.389 line:15% after they've had either a mastectomy 32 00:01:07.389 --> 00:01:09.820 line:15% or a lumpectomy for their cancer. 33 00:01:09.820 --> 00:01:13.458 line:15% And then we usually coordinate that surgery 34 00:01:13.458 --> 00:01:14.358 line:15% with the breast surgeon. 35 00:01:14.358 --> 00:01:16.739 And usually the first surgery happens at the same time 36 00:01:16.739 --> 00:01:19.442 the patient has either the mastectomy or the lumpectomy 37 00:01:19.442 --> 00:01:20.883 and then we do the reconstruction, 38 00:01:20.883 --> 00:01:22.359 or at least the first part of it immediately 39 00:01:22.359 --> 00:01:25.054 at that same time during the same operation. 40 00:01:25.054 --> 00:01:26.966 So they have a mastectomy, and we usually 41 00:01:26.966 --> 00:01:29.197 will do a breast implant is the most common 42 00:01:29.197 --> 00:01:30.965 version of breast reconstruction. 43 00:01:30.965 --> 00:01:32.066 And we use a temporary implant 44 00:01:32.066 --> 00:01:34.070 first to reconstruct the breast. 45 00:01:34.070 --> 00:01:37.123 line:15% And to allow the skin to heal. 46 00:01:37.123 --> 00:01:40.693 line:15% And we can actually expand the skin 47 00:01:40.693 --> 00:01:42.997 line:15% to recreate a more normal breast shape 48 00:01:42.997 --> 00:01:45.151 line:15% after the patient has had a mastectomy. 49 00:01:45.151 --> 00:01:47.560 That process takes several weeks, 50 00:01:47.560 --> 00:01:48.986 maybe even a couple months. 51 00:01:48.986 --> 00:01:50.276 And after they've healed up from that, 52 00:01:50.276 --> 00:01:51.660 and the expansion is complete, 53 00:01:51.660 --> 00:01:53.251 then we take the patient back to the operating room 54 00:01:53.251 --> 00:01:55.333 for another smaller procedure where we remove 55 00:01:55.333 --> 00:01:58.680 the expander device and place a permanent implant. 56 00:01:58.680 --> 00:02:01.049 And then we can do ancillary procedures after that. 57 00:02:01.049 --> 00:02:04.298 So on a busy day, usually means I'm waking up 58 00:02:04.298 --> 00:02:05.658 around probably five o'clock, 4:30, 59 00:02:05.658 --> 00:02:07.818 five o'clock in the morning to get to the hospital 60 00:02:07.818 --> 00:02:09.530 by 5:30, six o'clock in the morning 61 00:02:09.530 --> 00:02:11.363 line:15% to round on my patients. 62 00:02:11.363 --> 00:02:13.340 line:15% I usually see anywhere from a couple 63 00:02:13.340 --> 00:02:15.722 line:15% to a half dozen patients in the morning. 64 00:02:15.722 --> 00:02:17.942 line:15% These are patients that have had operations 65 00:02:17.942 --> 00:02:19.438 line:15% recently that are still in the hospital. 66 00:02:19.438 --> 00:02:22.267 See how they're doing, write notes and orders 67 00:02:22.267 --> 00:02:23.415 for them in the morning and then 68 00:02:23.415 --> 00:02:24.984 head to the operating room to work 69 00:02:24.984 --> 00:02:27.010 with one of my attendings for the day. 70 00:02:27.010 --> 00:02:29.777 Anywhere from two to five or six operations 71 00:02:29.777 --> 00:02:31.744 for the day, depending on the length of those. 72 00:02:31.744 --> 00:02:34.205 And usually finishing up operating 73 00:02:34.205 --> 00:02:36.729 some time around five or six o'clock at night. 74 00:02:36.729 --> 00:02:38.489 Sometimes earlier, sometimes later. 75 00:02:38.489 --> 00:02:40.300 And then maybe checking on a couple 76 00:02:40.300 --> 00:02:42.836 of those patients afterwards. 77 00:02:42.836 --> 00:02:45.919 And then headed home for the evening.