At a Glance:
Title: Assistant Professor
Fellowship: Microsurgery, University of Pennsylvania
Residency: Plastic Surgery, New York University
Medical Degree: Virginia Commonwealth University
John Timothy (J.T.) Stranix, MD, is a plastic surgeon with a specialty in microsurgery. This allows him to perform a number of procedures, including autologous breast reconstruction, which are not widely available elsewhere in Central Virginia.
What is it about the practice of plastic surgery that motivates you?
First and foremost, it is the opportunity to help people. As a reconstructive surgeon, you get to have a very positive conversation with patients who are in a really tough situation, whether it be the result of cancer, trauma or surgery. Having the opportunity to help them overcome a challenge, regain form and function and get on with their lives is a privilege.
I’m also drawn to the range of issues I am called on to solve. At a time when most surgical specialties home in on a specific area of the body, I operate head to toe. In doing so, I get to work with members of every surgical field, which I find very rewarding. Every one of them has a different perspective, and I feel I learn a great deal from them.
What are some examples of your partnering with other specialties?
There are a number of them. I work very closely with orthopedic surgeons, especially in cases of complicated orthopedic trauma where there is a lot of exposed bone. Similarly, I work hand in hand with head and neck surgeons, helping to restore form and function after large resections or complications from radiation.
I also collaborate with nonsurgical subspecialties to perform gender-confirming surgery. Right now, we are focusing on top surgery, which means partnering with endocrinologists and the mental health team. Ultimately I am looking to develop a relationship with a reconstructive urologist so that we can offer bottom surgery.
I also work closely with surgical oncologists after mastectomies and radiation oncologists in cases where radiation causes a deformity of the breast after lumpectomy.
You do a large number of breast cancer reconstructions. What are some of the more recent developments in the field?
These days, there are many good reconstructive options for women, and they are getting better all the time. I perform both implant-based and autologous reconstruction, which uses the patient’s own tissue. With implants, the standard practice had been to place a tissue expander underneath the pectoralis muscle, expanding it gradually over a few weeks’ time before inserting a permanent silicone implant. We have started using expanders in front of the pectoralis with an internal sling made of a special scaffold that is incorporated into the tissue. This is more comfortable for patients and can lead to nicer aesthetic outcomes.
There have also been great improvements in autologous reconstruction. The operation has been greatly streamlined, and patients can leave the hospital after two to three days, sparing them the repeated office visits required for tissue expander inflation. This more concentrated schedule is especially beneficial for patients who live a distance from UVA.
My fellowship in microsurgery prepared me for doing autologous reconstruction, where we take tissue from the abdomen or thighs, but it also opens up new possibilities for treating trauma patients in cases where the surrounding tissue is insufficient to make a repair. Right now, we are the only hospital in Central Virginia with expertise in microsurgery.
What other promising applications of plastic surgery are you pursuing?
Lymphedema is one area that we are looking at. Currently, there are no universal solutions for treating lymphedema, which occurs when the lymph system is interrupted — for instance, when lymph nodes are removed to treat cancer. The result is progressive swelling in an extremity as fluids build up. This is not only uncomfortable, but also predisposes the patient to infection.
To address this problem, we have begun to transplant lymph nodes to restore the flow as well perform lymphovenous bypass, another procedure made possible by microsurgery. We dissect out intact lymph channels and connect them to a small vein, bypassing the blockage. This is an evolving field, but the data so far is positive. UVA is one of the few centers in the country offering this procedure.
Are there other developments at UVA that you are excited about?
This fall, we plan to open a new breast center on Pantops Mountain in Charlottesville, offering comprehensive breast care to women. This state-of-the-art facility will bring together medical oncology, surgical oncology, radiation oncology and plastic surgery under one beautiful new roof, in addition to imaging, physical therapy and other ancillary services. By housing these services together, we are creating an environment conducive not only to streamlined patient care, but also to more productive collaboration among specialists, which, in turn, should lead to even better and more efficient care.
As a plastic surgeon, what are your goals for your patients?
Ultimately, I want to deliver the best possible care to my patients in a safe, efficient, cost-effective and reproducible manner that ultimately gives them the best possible outcome as they would define it. This means getting to know them as people. One of the things I like about my job is getting to know my patients as individuals and finding out where they are coming from.
Knowing that individualized care is so important, I have tried to learn a variety of techniques so I can choose the one that best meets a patient’s needs. One of the tenets of plastic surgery is that there is no one way to [perform a reconstruction], which is one of the reasons I applied to different programs for my residency and fellowship. I am always constantly trying to figure out new and different ways of performing procedures so that I can offer more to patients.
Part of knowing your patients is working closely with their referring physicians. How do you keep them in the loop?
As a reconstructive plastic surgeon, my practice depends on referrals from other physicians. I very much appreciate and value that. When physicians refer patients to me, I make sure to share my preoperative plan with them, let them know how the operation went and follow-up by copying them on my notes or sending them a letter.
Medicine requires a team approach, especially when you get into the complex problems that I often treat. Coordinating care with the referring physician is an essential part of building that team.
You majored in chemistry at UVA and met your wife in physics class. What’s it like to return to Charlottesville?
We had always felt that if we could have picked a place to live, we would have picked Charlottesville. It is a great town that fits our personalities. It has a vibrant arts and social scene, but you can very quickly get out into the country and go fly fishing and hiking, skiing or to the beach. We are both thrilled to be here and look forward to raising our two daughters in Charlottesville.
I also feel at home in an academic medical center like UVA. I had always wanted to do academic surgery because I wanted the challenge of reconstructing complex defects, and I wanted to teach. All of a sudden an opportunity at UVA opened up, and I was fortunate enough to get the job.
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