Plastic and Reconstructive Surgery Recognition Women in Surgery

The Microsurgeon’s Toolbox

Plastic surgeon Joani Christensen wearing white coat in hospital

Plastic and reconstructive surgery is fueled by innovation. Surgeons in this specialty treat a wide range of head-to-toe conditions, often applying creative solutions to unique surgical problems. From cosmetic procedures to surgery for lymphedema, breast reconstruction and limb preservation, these surgeons blend world-class surgical skills with artistry to achieve the best results for patients with complex conditions. It is this creativity that inspired Joani Christensen, MD, to become a plastic and reconstructive surgeon.

An assistant professor of surgery in the Division of Plastic and Reconstructive Surgery at Washington University School of Medicine in St. Louis, Christensen specializes in microsurgical techniques for reconstructive and lymphatic surgery. Reconstruction aims to restore the body’s form and function after cancer, injury, defect or disease. Performing reconstructive procedures requires expertise in microsurgery, a type of surgery that uses operative microscopes and precision tools to operate on small structures, such as blood vessels and nerves.

Since joining the Department of Surgery in 2021, Christensen has contributed to the growth of clinical programs in lymphedema surgery, breast reconstruction and microvascular oncologic reconstruction.

“Washington University is a world leader in head-to-toe plastic surgery, oncologic reconstruction and general reconstructive surgery. The addition of Dr. Christensen, a fellowship-trained microvascular surgeon, to our faculty, means a growing number of patients with lymphedema and oncologic defects have access to the best in clinical care,” says Division Chief of Plastic and Reconstructive Surgery Justin Sacks, MD, MBA, who is the Sydney M. Shoenberg, Jr. and Robert H. Shoenberg Endowed Chair in Plastic and Reconstructive Surgery.

Christensen earned her medical degree from Johns Hopkins University School of Medicine, then completed an integrated residency in the Harvard Plastic Surgery Training Program and a microvascular reconstruction fellowship at MD Anderson Cancer Center in Houston, Texas.

Christensen knew from an early age that she wanted to pursue a career in surgery. She wanted to help people, and the visible ways that surgery could improve a person’s wellbeing appealed to her. There were several formative moments during Christensen’s training that inspired her to specialize in microvascular plastic and reconstructive surgery.

During a rotation on the plastic surgery service in medical school, she saw surgeons perform a breast reduction surgery. Many women with larger breasts develop problems with back and neck pain, and some elect to have surgery to reduce the size of their breasts, which can improve those symptoms. The procedure involves removing breast fat, tissue and skin, and reshaping the remaining breast to achieve the patient’s desired size and shape. When she saw how the surgeons could create a new breast that met the patient’s aesthetic goals, Christensen knew that plastic and reconstructive surgery was right for her.

From that early inspiration, Christensen went on to learn the latest microvascular techniques during fellowship training. Christensen describes a plastic surgeon’s skills and techniques as a toolbox.

“Plastic surgery is about flexibility and applying the skills in our toolbox to problems affecting any area of the body,” says Christensen. “We tackle a lot of issues that patients might present with by going back to the principles. How do wounds heal? How does a tissue survive? We analyze the problem, define the defect, determine what must be replaced or corrected, and use our tools to fix head-to-toe problems for our patients.”

When Christensen encounters a unique surgical problem, she finds the best solution by choosing the right tool from her toolbox. Christensen recalls a particular case from her fellowship that emphasized the importance of selecting the right tool for the job.

After someone with a spinal cord tumor had major surgery to remove the tumor, they needed new tissue to cover the large area that had been affected. Christensen used her microsurgical expertise to transfer a graft from another part of the body. She then connected blood vessels from under the arm to the graft, like plugging in an extension cord, to allow blood to flow and tissue to heal. Ultimately, the combination of oncologic and reconstructive techniques left the patient cancer-free and able to return to a normal, happy life.

“There are many ways to solve a problem,” Christensen says. “Our role is to apply our skills to find the right solution for that particular patient. That’s what makes our work so rewarding.”

Christensen also studied novel procedures, including hand and face transplantation. These procedures, while rare, are becoming more possible due to advances in translational research.

Research and innovation in the Division of Plastic and Reconstructive Surgery aims to create new solutions for more patients. The development of tissue matrices using bioengineered materials, led by researchers in the Plastic Surgery Research Laboratories, could reduce the need for grafts from other parts of a patient’s body, making the tools in Christensen’s toolbox that much more useful. Christensen notes that these innovations at Washington University are creating new possibilities for the types of procedures plastic and reconstructive surgeons will be able to offer in the future.

“At Washington University, we have a team of leaders in every area of plastic surgery,” Christensen says. “In all clinical programs, from nerve and microvascular surgery to craniofacial and lower extremity reconstruction, and everything in between, there are renowned specialists here providing the best in patient care.”