-: My name is Matthew Joy.
I'm currently a resident physician
in training at the Virginia Tech
Carilion School of Medicine in Roanoke, Virginia.
I'm training in plastic and reconstructive surgery.
At our hospital, we do mostly reconstructive surgery.
Probably 75, 80 percent of our practice.
So that could be anything from a skin cancer
that needs to be removed and reconstructed
to a congenital defect like a cleft lip or cleft palate
that needs to be reconstructed.
We do a lot of breast cancer reconstruction
with our group.
But then we also have a cosmetic surgery center
where our staff works throughout the week.
A couple of days a week, sometimes we'll
have cases there doing cosmetic surgery.
And then we see our patients in clinic
both for consult and follow up.
And then we take consults from the emergency room.
For stuff that's coming in throughout the day
and sometimes at night as well.
We will see the patient generally in the clinic
once they've had their diagnosis
and they've usually already met with the cancer surgeon.
At that point and they've decided that they're
interested in getting reconstruction.
We talk with the patient about those options,
the different surgeries that we can offer
them to reconstruct the breast
after they've had either a mastectomy
or a lumpectomy for their cancer.
And then we usually coordinate that surgery
with the breast surgeon.
And usually the first surgery happens at the same time
the patient has either the mastectomy or the lumpectomy
and then we do the reconstruction,
or at least the first part of it immediately
at that same time during the same operation.
So they have a mastectomy, and we usually
will do a breast implant is the most common
version of breast reconstruction.
And we use a temporary implant
first to reconstruct the breast.
And to allow the skin to heal.
And we can actually expand the skin
to recreate a more normal breast shape
after the patient has had a mastectomy.
That process takes several weeks,
maybe even a couple months.
And after they've healed up from that,
and the expansion is complete,
then we take the patient back to the operating room
for another smaller procedure where we remove
the expander device and place a permanent implant.
And then we can do ancillary procedures after that.
So on a busy day, usually means I'm waking up
around probably five o'clock, 4:30,
five o'clock in the morning to get to the hospital
by 5:30, six o'clock in the morning
to round on my patients.
I usually see anywhere from a couple
to a half dozen patients in the morning.
These are patients that have had operations
recently that are still in the hospital.
See how they're doing, write notes and orders
for them in the morning and then
head to the operating room to work
with one of my attendings for the day.
Anywhere from two to five or six operations
for the day, depending on the length of those.
And usually finishing up operating
some time around five or six o'clock at night.
Sometimes earlier, sometimes later.
And then maybe checking on a couple
of those patients afterwards.
And then headed home for the evening.