Pushing the Envelope of Reconstructive Surgery with Dr. Anita Mohan

We dive into the fascinating world of plastic and reconstructive surgery with Dr. Anita Mohan, a clinical assistant professor at Stanford University's Department of Surgery. Join host Rachel Baker as they traverse Dr. Mohan's journey from her initial training in England through her PhD and MBA to her current role at Stanford and the VA.

Dr. Mohan, who specializes in breast reconstruction, shares insights into gender-affirming top surgeries and the unique challenges they present. She also discusses her dedication to improving clinical outcomes for patients, particularly those who have undergone significant weight loss or suffer from lymphedema.

Tune in to learn about Dr. Mohan's advice for aspiring surgeons and her vision for the future of plastic surgery.

Rachel Baker: [00:00:00] Welcome to ScrubCast, where we take a closer look at the research happening at Stanford University's Department of Surgery. I'm your host, Rachel Baker. Today, we're speaking with Dr. Anita Mohan. Welcome to the show.

Dr. Anita Mohan: Thank you for having me, Rachel.

Rachel Baker: Thank you for joining us. Dr. Mohan, you are a clinical assistant professor in our Division of Plastic and Reconstructive Surgery.

Why did you choose plastics?

Dr. Anita Mohan: That is a very good question. It was more of an evolution. So I had originally trained in England and we didn't have much exposure to plastic surgery, which is something that I think many medical students even here in the States experience. And during my course of my early surgical residency, I had that opportunity.

It was a specialty that has a lot of cross collaboration. A lot of creativity, lateral thinking and [00:01:00] problem solving. And there was also an artistic as well as a technical component to it all combined. And so those are the qualities that sort of drew me towards plastic surgery compared to some of the other surgical specialties.

Rachel Baker: Makes sense. You have quite a bit of alphabet soup after your name. Um, you did your PhD from the university of Cambridge. You have an MBA from the University of Minnesota, um, and you also completed Stanford's Biodesign program. So, should I expect a patent, uh, with your name on it coming soon, or is it just a lifelong love of learning?

Dr. Anita Mohan: It's a lifelong love of learning. I actually am aspiring to do the Biodesign Fellowship now that I'm on faculty, but I had the opportunity to do their Innovation Program that ran over those two semesters during my Microsurgery Fellowship. Okay. Something that I was really interested in. Um, [00:02:00] that translational work in terms of taking things from bench to bedside, bringing things to patients, working with engineers and other specialties to maybe see different perspectives of things to deal with clinical problems.

I really enjoyed that. So I took time out of residency training. I then took time out to do a PhD and during that time in my PhD, I just got to do a lot of collaborating, a lot of sort of allowing my mind to explore different avenues. And during my residency in the US, I continued that. And the MBA was complimentary to that as well, because it's about with things like new product innovation and design.

And we always think that things are very simple. Our world is very complicated and everything is overlapping and interacting. And so it was all to give me foundations. It's. It's like the PhD where you spend all these years doing your thesis on a topic, but by the time you finish your thesis [00:03:00] and think, fantastic, you just actually have more questions you want to answer.

And then you think, Oh my goodness, when am I going to have time to do that? And then similarly with the MBA, I think it gave an excellent foundation, not only for that. Interest of mine, but also, you know, um, for clinical, um, management, but yeah, that's an area. I hope maybe in the future. We will see now that I'm here on staff here at Stanford.

Fantastic. We love inefficient.

Rachel Baker: Um, so one of the things I thought was really cool. that you do is gender affirming surgery, top surgery, both masculinization for trans men and breast augmentation for trans women. How do these procedures differ from similar ones on cis women? I've seen our plastic surgeons do mastectomies and things, but I imagine there's some added complexity there.

Dr. Anita Mohan: Yes. I think it's just the foundations. And so there is just differences in proportion and the anatomy, [00:04:00] and then seeing where we are from our foundation to where the goal is. And so there's just some subtleties and differences we have to take into consideration. And those are things that we talk about individually based on the patient's anatomy.

You know, there are some Techniques that we utilize in cis, uh, women, both for augmentation and managing tuberous breast deformity, where they have restriction in some of the breast proportions. And so taking those elements and principles, I apply that with gender firming top surgery for the augmentation and sometimes having that conversation and examining a patient and tailoring things.

For the gender affirming mastectomies, again, it's very patient specific. I use different techniques based on the patient's desires and goals, as well as their anatomy. And one thing that we offer is also neurotization to reconnect the nerves. To the nipple and to the skin to [00:05:00] try and preserve as much sensation as well to the tissue on the chest as well as just nerve preservation while doing the mastectomy.

And you know, some of our breast surgeons here I've, I have talked to while I was doing my fellowship also keep that principle in mind. Nerve preservation, even in the mastectomy, and that's some of my research that I had done in the past. So it's lovely to be able to tie in work that I have done in the past to my clinical practice as a, attending.

Rachel Baker: Absolutely. I saw that on your PhD and I was so interested because I know that one of the biggest complications we have during breast surgery is loss of sensation. So can you talk a little bit more about neurotization? How does that work exactly? I mean, I know nerves are really, really small and they grow really slowly and they're just like total drama queens.

Dr. Anita Mohan: Yes, much like the small vessels we connect in microsurgery. And then you talk about lymphedema and lymphatic vessels are even smaller. [00:06:00] So, uh, that's why we call it super microsurgeries. And sometimes they can be very dramatic, but we dissect out the nerves using the same principles we do for microsurgery.

Something we are very familiar with. We can sometimes find two to three nerves on the lateral chest wall that we preserve and we can dissect out to length. And then we can connect that directly to the undersurface of the skin and the nipple in the mastectomy. And, uh, depending on the technique I use, it's those same sort of principles.

So it's allowing that growth back. Nerves do grow back slowly, but generally in the mastectomies, that distance is going to be too far, but it's to try and have any way to preserve that sensation because that numbness, even for the breast cancer patients, is something that people don't often realize. I often mention it's not just the nipple that won't be sensate if we do a nipple graft, the whole chest might have numbness and they're often surprised, but I think that's really important to [00:07:00] let them be aware of.

Another point is by identifying those nerves and not just cutting them, we can prevent things like. pain that some patients get. And we used to see that commonly after mastectomy, patients may get neuromas, um, on the lateral chest wall and that mastectomy pain. So we're identifying the nerves and managing them and giving them something to do.

So it can help with that type of neuroma type symptoms as well.

Rachel Baker: Fabulous. I love it. I can't feel three of my toes after an ankle reconstruction. I can't even imagine what it would be like not to be able to feel part of my chest. That just seems very scary, so I'm Loving the work that you're doing. Uh, you actually have a joint appointment at the VA, but you're, you're British.

Um, so what was the motive there for wanting to, you know, serve in the, the Veterans Hospital?

Dr. Anita Mohan: That was the fortunate opportunity I was presented. The surgeon who was there, had been there for [00:08:00] 30 years, has been dedicating his life and creating a wonderful service to the population of veterans here in Palo Alto.

So it's a little bit daunting having to follow in those footsteps. But myself and a colleague who just joined in October, he is subsequently retired and transitioning to retire. We're taking over that role. It's a wonderful broad base of sort of bread-and-butter plastic surgery and some reconstructive elements as well.

A lot of skin cancer and it's kept my practice very broad actually for my first few years.

Rachel Baker: Absolutely. I was going to say it's an overwhelmingly male population. So I can't imagine you're doing a lot of breast reconstruction over there.

Dr. Anita Mohan: It's interesting because I do actually have a lot of female veterans and patients and it's increasing.

So I think that's exactly right. The services available for women veterans have been limited and I'm offering, and I've spent the [00:09:00] last year trying to get certain things available to be able to do. Sort of do breast reconstruction and revision procedures and offering those things at the VA So I have actually a fair number of women veteran patients as well Which they are delighted about as well in order to have their needs and being able to be addressed as well

Rachel Baker: Wonderful.

Well, so on each episode of scrub cast we ask each of our guests the same two questions and the first one is who is a surgeon you admire and why?

Dr. Anita Mohan: That is too difficult. That is too difficult a question. I've had a lot of different mentors in the past, and there's been so many surgeons that I have admired internationally through my training, met through my mentors and taking sort of elements of what I admire about them.

Their dedication, their just hard work, their [00:10:00] humility, their skills, their personality, their warmth. How they've been a good teacher and things like that. And I just draw those elements and think going through training, how do I want to be when I grow up? And could I aspire to be even a certain percentage of how they are?

And so there's, there's been so many over the years I've been in residency training for a really long time prior to finishing as you might've seen on my CV. And there's been. Too many wonderful people to name only one.

Rachel Baker: I understand. Well, so what is the best advice you have received in 10 words or less?

Dr. Anita Mohan: That's also difficult because I go off on a tangent, so I think stay in the course, stay focused, stay humble and persevere and read. I think this, now this, I'm in my second year of practice here at Stanford, really sort of diving into for the [00:11:00] problem solving. Um, I've, I thought I was reading before, but I am approaching it very differently now to try and solve different problems.

And that's been Really, uh, exciting and interesting. I probably had the most growth with that, and it's been the most exciting.

Rachel Baker: It's really interesting. I, I think a lot of surgeons have trouble finding time to read.

Dr. Anita Mohan: I still find difficult, a difficult time to read. Um, but there's so much information out there and especially in plastic surgery, you think you're coming up with maybe something new, but you often you're not.

And that someone's done it and you're trying, you're trying to figure out the tips and tricks for certain things. I'm trying to find ways to also push the envelope to do better, uh, for our patients. And so that's something I think in residency, you're kind of just reading up until the basics to get it done, but then evolving to [00:12:00] be like, how can I push the boundaries to do better, enhance patient recovery for early.

Uh, less morbidity, less invasive, that's that part of it, which has been really interesting now. And I wish I had more time to read, but that is something I know that always echoes like a little voice at the back of my mind.

Rachel Baker: Fantastic. I love that. Well, it's been such a pleasure chatting with you, but before we go, I want to ask one more question.

What is next for Dr. Mohan?

Dr. Anita Mohan: Apart from signing all my Epic notes? Um, I think, uh, now that I have, um, I'm done with boards, it's a focus. My focus is, uh, building my research interests. So I have an interest in clinical outcomes, work. Working the massive like weight loss, uh, patients and patient reported outcomes as well as more [00:13:00] translational work in lymphedema is something that I really want to grow and build.

But just like During my PhD, a lot of it comes with first, you have to do a lot of reading and background scoping work and working with other specialties for that cross collaboration. I think that's where things advance the best. And so that's kind of the areas that I'm trying to work, work on now.

Rachel Baker:  Fantastic. Well, thank you again so much for coming on the show. It was a pleasure. Good luck with your next steps.

Dr. Anita Mohan: Thank you so much.

Rachel Baker: And that brings us to the end of another episode. If you like Scrubcast, we hope you'll tell your friends and subscribe wherever you get your podcasts. Scrubcast is a production of Stanford University's Department of Surgery.

Today's episode was produced by Rachel Baker. The music is by Midnight Rounds and our chair is Dr. Mary [00:14:00] Hawn.