VALLEY HEALTH: Real plastic

PALMER —At that crucial point in medical school when an aspiring doctor picks his or her specialty, Sue Dean found herself drawn to plastic surgery. For one, she said, plastic surgeons seemed to have a better sense of humor than the rest, and two, she witnessed the effect surgery had on one young cleft palate patient, and was drawn to the positive impact it could have on individuals’ lives.

After residency, she opened her own shop in North Carolina, but found business hurdles in the lower 48 increasingly prohibitive. Finally, in the fall of 2011, she, her husband Gary, and their dogs Ellie and Ruthie loaded into their Volvo wagon and made the drive to Alaska.

Since their arrival, business has not stopped booming.

“In Alaska, there’s a lot of opportunity for reconstructive practices, which is really different than the lower 48,” she said. “When we came up here, physicians were getting really badly beat up — they still are. I lost money every time I went into the operating room. The costs were more than we were reimbursed by the insurance companies.”

Working out of the new Mat-Su Regional Medical Center, Dean found not only a better business model for her practice, but a better use of her skills, as well.

“Every single year, the most common procedure performed in plastic surgery is the removal of cancer,” Dean said. “I don’t think people realize plastic surgeons are down in the trenches, ‘getting their hands dirty.’ I think there’s a misconception that plastic surgery is kind of Beverly Hills, but here in Alaska you’re really allowed to do the job you were trained to do. It’s been really pleasant… We don’t just have to do cosmetics — we do get to be creative.”

Whereas plastic surgeons in the lower 48 find themselves heavily advertising cosmetic procedures just to make ends meet, Dean has found that in Alaska the landscape is entirely different.

Dean said the procedures she most commonly performs are panniculectomies(the tightening of skin in the abdomen after significant weight loss), skin infections and breast reconstruction. CoolSculpting, also known as fat freezing, is the most common non-surgical procedure she performs.

It being Alaska, she also never runs short on clients coming in suffering from outdoors-related injuries, the lion’s share of those involving burns.

Business became so bustling, Dean took on the typically unheard-of tactic of actively recruiting another plastic surgeon right into her backyard.

To hear Dean describe her effort to ultimately bring in hand surgery specialist Dr. Elliott Gagnon, from Northern California, recruiting isn’t nearly a strong enough word.

“I begged the hospital to get another plastic surgeon,” Dean said. “It’s funny, some of my general surgery colleagues asked, ‘what is this?’, and I said, ‘it’s all good, I asked for him to come here.’ They just didn’t want me to lose market share.”

Bringing in Gagnon did ease the pressure, but not nearly so much as Dean had hoped.

Between office visits, surgery right next door in the Mat-Su Regional Medical Center, and frequent home visits, Dean’s workload doesn’t slow.

Still, passing all of the hand work on to Gagnon has allowed Dean to focus on other patients, including breast reconstruction for cancer survivors, a cosmetic procedure with deep and meaningful benefits.

“Plastic surgery gets called surgical psychiatry,” Dean said. “Anytime you’re doing a surgery of any kind changing (the patient’s) body — even if they want the change — all of us have some identification of how our body is… Obviously, breast reconstruction is a new version of that and it probably does help that I’m a woman. There’s a general surgeon next door who does a lot of mastectomies, and so a lot of patients only come one door over, so we already have that comfort level.”

Dean said there’s no empirical data that shows women’s survival breast cancer survival rates are improved by having breast reconstruction surgery, but, she points out, it usually helps, psychologically.

“It probably makes them happier in their fight against the disease,” Dean said. “It’s pretty traumatic to a woman, losing a breast… Psychiatrists have been able to point out a huge benefit. It’s so commonly discussed — breast cancer, sadly, is very common — that they’ll say, ‘my friend had this and I watched her fight through it; here’s what I would do.’ Some folks already have a plan in place.”

Now officially a Sourdough, Dean said she’s adapted pretty well to the uniqueness of Alaska and the Mat-Su Valley.

“I think I’ve been here long enough where I recognize the seasonality,” she said. “If there’s good weather, in the summer, people may not keep their appointments because fishing is good. I know to plan around hunting season now.”