So what do plastic surgeons do all day?

5 a.m. These days I get up a half-hour earlier than usual to walk our dog Winston, a 7-month-old Bernedoodle that is getting bigger by the day. 5:30 a.m. Like almost every morning since high school, when I was a competitive swimmer, and even in residency, when I’d get up at 4:30 a.m., I start my day with a one-hour workout. Since March 15, 2020, when I last visited a gym, I work out at home. I live with my fiancé Nicholas (plus Winston and our cat, named Scrabble) in Milton, Ont. a fast-growing town next to Mississauga in the Halton Region of the Greater Toronto Area. We’ve got a variety of gym equipment throughout our house, including more than 1,000 pounds of strength equipment. Read: So what do radiologists do all day? 6:30 a.m. Time to take a quick shower, get dressed and eat breakfast, usually Chex cereal and yogurt. I don’t sit around or watch TV. I don’t have time for it. I tend to be efficient out of necessity! 7 a.m. I’m usually out the door with the latté Nick makes for me after my workout. Depending on the day and my schedule that week, I make the five-minute drive to either the Milton District Hospital or my clinic nearby. I joined the hospital’s surgical team in 2020 after completing both a plastic surgery oncology fellowship and a microsurgical breast reconstruction and melanoma fellowship at the University of Calgary. There were limited breast reconstruction surgeries at the Milton hospital before I arrived—but our volumes have increase since I arrived. Before then, women requiring breast reconstruction in the Halton Healthcare region, which comprises, Milton, Oakville and Georgetown, had to go to the Oakville Trafalgar Memorial Hospital or, on occasion, have an Oakville surgeon come to Milton. Oakville Trafalgar is a much larger facility with four plastic surgeons, two of whom also specialize in breast reconstruction. I’m currently working with one of them—Dr. Lauren Willoughby—to hopefully one day develop a centralized referral program. There are lots of surgical reconstruction options for women who undergo a single or double mastectomy. The most common is implants, which is relatively straightforward and take about an hour. Contouring procedures that make the mastectomy area more comfortable for women also take about an hour. One of the most difficult options is a DIEP tissue flap. A major surgery performed under general anesthesia, it involves taking flaps of skin, fat and blood vessels from the abdomen to rebuild breasts following a mastectomy. It takes six to eight hours to do a single breast. About 30% of my practice is breast reconstruction. I frequently work with general surgeons in Milton like Dr. Dalal Aziz. Often, she will do a mastectomy and I will follow up with the agreed-to option. If both breasts are being removed, I come in and operate at the same time as Dr. Aziz. Breast reconstruction is complicated and emotionally charged. There’s never an easy consultation. Doing breast reconstruction surgery allows me the opportunity to enter a woman’s life at a very stressful time and try to be the bright spot in their journey. It makes such a meaningful difference in their lives. That’s why it’s the part of my practice I like the most. I do a lot of other things as well, of course. A notable one is doing melanoma sentinel node biopsies and excisions in Milton, which saves skin cancer patients in the Halton Healthcare network from having to travel elsewhere to get this vital diagnostic procedure. 12 noon I do three office days a week, from 8:30 a.m. to 5 p.m., at the clinic I share with two urologists outside the hospital. I typically plan a 30-minute lunch into my schedule, but I usually don’t have time. When I do, I eat maybe an apple, cheese and a snack bar. And of course a diet Coke! I think many physicians share the same struggle! 1 p.m. I see 20 to 30 outpatients and referrals at my clinic a day, most of them involving breast reconstructions, skin cancers and hand syndromes like carpal tunnel and trigger finger. Fridays I operate all day. I also do a half-day of invasive skin cancers (‘lumps and bumps’) and hand surgeries. My long day is Monday when I see burns, tendon injuries, hand and face fractures, dog bites and other trauma at the fracture clinic at the hospital. You never know how many patients and fractures you’ll see. I treat the injuries I can and add the ones I can’t to the hospital’s emergency board. I’ll come back in later that day or another day or weeknight to do them. I wasn’t always sure about a career in medicine, but I did have a long line of family influences. My maternal grandmother, Dr. Doris Cavanaugh-Gray, became the first female cardiologist and second-ever female doctor at Vancouver’s St. Paul’s Hospital when she joined there in 1959. Her grandfather, Dr. John Gray, was also a general surgeon at St. Paul’s. Both of my parents were physicians who retired last year after long careers. My dad, Dr. Tim Nicholas, was a family doctor in my hometown of Aurora, just north of Toronto. My mom, Dr. Cynthia Nicolas, was an ob/gyn in nearby Richmond Hill. I thought I wanted to be an orthopedic surgeon when I graduated from the Schulich School of Medicine at Western University in London, Ont. But one day while I was following one on an observership I met Dr. Bing Gan, a plastic surgeon who opened my eyes to the intricacies of plastic surgery and inspired my love for the field. I think it was that need to acquire and apply those skills with creativity that really attracted me to plastic surgery in general and breast reconstruction in particular. It’s a very problem-oriented speciality that requires creative work and meticulous attention to detail. 5 p.m. Since my days are never the same I get home anywhere between 3:30 and 7 p.m. I walk Winston when I get home, then enjoy the always great suppers that Nick, a teacher, makes for us. Then we walk Winston again—this time together with some training added in. Having a large-breed dog is a big responsibility, and walking and training him while he’s young takes up a lot of our time. If you ever think about getting a puppy, think twice! 8 p.m. Nick and I co-exist after supper: him reading or marking his students’ assignments, me checking lab results or doing dictations or billing. When that’s over we watch some TV together. 10 p.m. Time for bed— provided I’m not on call and wearing a pager to cover seven hospitals for 24 hours, which can be exhausting.—as told to Mark Cardwell.

So what do plastic surgeons do all day?

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