Surgical reconstruction is one of the most challenging and gratifying areas of surgery. It is a major part of virtually every surgical specialty. Those who know me well, know that reconstruction is one of my passions. I love the patients, the challenge of the defects, the joy of surgical planning, and the meticulous nature of the surgical procedure. I especially love to teach and mentor students, residents, and fellows. This is my opportunity to pass on the philosophy and principles of reconstruction to the next generation of surgeons.

The best way to treat any complication is to prevent its occurrence. Each surgeon has the responsibility to thoughtfully outline the surgical steps and identify the most likely points at which problems could arise. Formulation of a sound and safe surgical plan is honestly one of the steps in reconstruction I enjoy the most. This process must start well before the day of surgery. It includes considering which approach to use, which incisions are best, and which reconstructive options offer the least morbidity with the expectation of attaining the best cosmesis and function. There is often a judgment call as to which option best balances the risks with the best outcome. These “judgment calls” distinguish the excellent surgeon from their peers. Surgical expertise, clinical judgment, natural surgical abilities, and surgical experience dictate the likelihood of a good outcome.

There are no surgeons who escape complications. We all have them. They are often some of the most complex problems we face as surgeons. However, in addition to managing these complex clinical problems, we must learn from them. Each complication is a learning opportunity. Each complication should be thoughtfully and thoroughly analyzed. Each complication should add a layer of expertise and an added level of maturity to the surgeon. The experienced surgeon can identify the most likely etiology, given the circumstances and the information learned during the procedure (such as a suture line on too much tension). We oftentimes find ourselves saying, “Well, that was no surprise.” But could we have done anything differently? A better incision? Better preoperative preparation? Better medical or nutritional optimization? Any additional surgical measures we could have undertaken? Hopefully we learn something from each complication and remember those lessons throughout our career.

My closing thoughts are directed to the young and mid-career surgeon. As I entered into the latter part of my career, I was often asked for advice on how to improve or enhance the professional development of a colleague. My advice was to identify a role model who is a leader in their field, someone you respect, a surgeon who is “at the top on their game.” Contact that colleague and take the opportunity to seek their advice on patients with complex problems, especially cases where the solution is unclear or where the remedy could be approached in several different ways. Once choosing a role model, ask if you can come for a visit. This allows you to see how the surgeon runs their surgical practice and their operating room. This visit offers an opportunity to observe surgical procedures, novel approaches, and advanced techniques. I have never visited another surgeon with a national reputation, from whom I did not learn something: a new technique, a surgical nuance, or a more facile way to perform a surgical maneuver. These short-term experiences form a collegial bond and establish a new friendship. This relationship assumes a prominent role for the rest of your professional career.

Article published online:
09 February 2023

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