While advancing patient outcomes lies at the center of physicians' careers, the everyday administrative burdens and tight routines of many physicians can make it difficult to constantly push the envelope toward innovation.
But for Alex Mesbahi, MD, a plastic surgeon in McLean, Va., and his surgical partner David Weintritt, MD, a breast surgeon, a less traditional and "grassroots" collaboration has ushered in a new wave of possibilities for patients undergoing mastectomies.
The pair has worked side by side during mastectomies to identify functional nerves and provide pathways for them to regenerate, giving patients the best possible chance of regaining sensation in the breast after the procedure. The loss of sensation in the breast after a mastectomy has for years been accepted as a common side effect, but Dr. Weintritt told Becker's it actually represents a "very important component of quality of life."
Dr. Mesbahi said that while these collaborations are common throughout medicine, putting new procedures like this into practice can be challenging in the surgical field.
"It's very easy in surgery to kind of get stuck in your own ways and not be open to change new technologies, new techniques," he said. "Finding someone that kind of shares similar philosophies, and being open to that, is very rewarding."
The inherent newness of any procedure or innovation is always a challenge, and new innovations can be challenging to integrate into the busy, regimented routines of experienced surgeons. But Dr. Mesbahi remains dedicated to educating his colleagues on both the application and long-term benefits of this procedure.
"There's the reluctance to overcome initially, and there's a lot of direct involvement. For breast surgeons that I've worked with that had never done it, who were not familiar with the anatomy, I would stay in during the mastectomies and show them how to do it," he said. "And many of them ended up just picking it up very quickly and became independent. And then there's still some surgeons who, even three years later, aren't really that into doing that part of the dissection. So I stick around and I'll do that for them. But at least they're still open to allowing that for their patients."
A key point in educating other physicians on the procedure has been the concept of protective sensation — the ability for patients to feel pain and pull away from harmful situations —- and its value to patients' long-term well-being and safety.
"Everyone can identify with the importance of a patient being able to protect themselves, and that's where it's a little bit easier to convey to people who are hesitant," Dr. Mesbahi said.
Initiating a new procedure can feel daunting for physicians who may not be in practice settings that are supportive of the time and resources required in the process, leaving the onus on the individual physician to take initiative.
"Ultimately, it starts with the surgeon. If you're fortunate enough to be in a system that does support that, then that certainly makes it easier," Dr. Mesbahi said. "But having the discipline to continue your education and learn new things is really the foundation of all of that."
The future success of this procedure and other new surgical innovations hinge on a number of factors that can feel outside of an individual physicians' control, such as insurance coverage. But physician engagement and education may prove to be powerful tools in creating more widespread access to breast neurotization.
"For younger physicians and, you know, veteran physicians, it's really important for them all to kind of be engaged and help kind of create this understanding that this really should be part of the reconstructive process that's offered to all patients," Dr. Mesbahi said.