Marissa Tenenbaum, MD, is an assistant professor in the Division of Plastic and Reconstructive Surgery. Her specialties include cosmetic surgery of face, breasts and body, breast reconstruction, breast surgery, plastic and reconstructive surgery, facial plastic and reconstructive surgery.
Dr. Tenenbaum sees patients at West County Plastic Surgeons, Medical Building One, Barnes-Jewish West County Hospital, 1040 Mason Road, Suite 124 and Center for Advanced Medicine, 4921 Parkview Place, 6th floor, Suite G.
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What happened in the course of schooling to influence you to choose your specialty?
As a medical student here, I interacted with the plastic surgery division during my rotations. Susan Mackinnon, MD, chief of the Division of Plastic and Reconstructive Surgery, was very passionate about the specialty. I had a lot of misconceptions about what plastic surgeons do, and was amazed at the different areas they treated – from reconstructive to cosmetic procedures for patients of all ages.
When I was a 4th year medical student, an adorable six-year-old girl with prominent ears came to us as a patient. Her parents explained that she was fun-loving and outgoing until she started kindergarten and the kids teased her about her ears. Because they saw such a drastic change in her personality, they decided to have her ears fixed. When we removed her dressings the morning after surgery, her mom started crying because she was so happy. I was able to see first-hand how plastic surgery touches people and affects their lives.
I perform a lot of breast reconstruction surgery in my practice. There’s a connection to depression for some women who choose not to have reconstruction compared to those who have it. It’s not usually life-saving surgery, but it could be called life-changing, because it makes a woman feel better about herself.
You did your fellowship training in California, how does a West Coast cosmetic surgery practice differ from one in the Midwest?
I did my cosmetic surgery fellowship training in Los Angeles with Grant Stevens, MD, also a Washington University medical school graduate. His practice is very high volume and all cosmetic. It was different from what I experienced at Barnes-Jewish Hospital as a resident, because we did very little cosmetic surgery here. I learned a lot from him, it was a great opportunity.
Beauty standards are very different for women in California -- it’s warmer, so they wear less clothing. It’s big business, because there are a lot of plastic surgeons and a lot of non-plastic surgeons trying to do plastic surgery. It would be a very interesting place to try to maintain your standards and take care of patients.
What brought you to Washington University?
I came from medical school, and couldn’t leave! When I left for my fellowship in Beverly Hills, I already knew I was coming back here.
Which aspect of your practice is most interesting?
What I like best about my practice is the variety. I love esthetic (cosmetic) surgery, because it requires finesse and technical precision -- there is no room for error. People see the reality shows where women use cosmetic surgery as part of their beauty regime and think “Oh, they’re shallow and just have too much money to spend.” But the truth is, most of my patients are actually very normal women (and some men). There is something that bothers them and they want to know if there is anything that can be done about it. So if they are a good candidate, and go ahead with the procedure, they feel so much better about themselves. They are very grateful and I enjoy that aspect, but I wouldn’t want cosmetic surgery to be 100% of my practice.
I like doing breast reconstruction and facial reconstruction as a result of disease, illness or accident. When I’m involved in breast reconstruction after cancer, I’ll work with the breast surgeon, oncologist and radiation oncologist. I love being a part of the team -- it’s something I don’t have with cosmetic surgery.
What new developments in your field are you excited about?
Plastic surgery has always been very technology driven. We tend to be the innovators – trying new methods and figuring out what works. While we aren’t there yet, future developments will involve regenerative medicine. Instead of reconstructing a breast with a foreign implant or tissue transferred from the belly or thigh, we will actually use regenerated breast tissue. It sounds like science fiction, but I definitely think at some point we will be there and it will be exciting to watch.
Are fat transplants effective and safe?
It’s a controversial procedure, but there are some doctors who use it for esthetic reasons – taking the fat from liposuction and transferring it to the breast. While our physicians don’t use it for cosmetic procedures here, we do use it for certain scenarios of breast reconstruction. Fat transplants need to be studied further to determine how safe they are when cancer is involved. Because fat has adult stem cells (and that is what makes fat so great), there is some evidence to suggest if a tumor is already present, fat could potentially speed up the growth of that tumor. As of now, we don’t have a definitive answer.
When would a fat transfer be used?
We usually use fat transfer as a contouring procedure to soften edges during breast reconstruction. Typically we’ll reconstruct with a patient’s own tissue, or implants or a combination of both. At the end of the procedure, there might be areas we want to smooth with fat.
Also, sometimes fat is used in women who have had a partial mastectomy or lumpectomy. If they are unhappy with the asymmetry, fat can help fill in concavities.
Where are you from?
I’m from Minneapolis, Minnesota. It’s a great city. Most Minnesotans don’t let the cold winters hold them back. People cross country ski to work, they ice skate or snow mobile in their free time. As kids, we were bundled up at school recess and sent outside to sled ride and play in the snow. But now I’m a wimp -- when I go back home, I freeze.
Is there a particular award or achievement that is most gratifying?
I’m a busy, successful cosmetic and reconstructive surgeon with three children. The achievement that I’m most proud of is finding the balance between my career and family. It’s the most challenging part of my life, but it’s also the most rewarding. I’m able to come into work and take care of my patients, but my kids know I’m always there for them.
What is the best advice you’ve received?
When I was in medical school, Susan Mackinnon, MD, gave me advice on starting a family. She told me, “Don’t wait until you think other people think it’s OK for you to have children. Have your family when you feel ready, because it’s never a good time. You will do your best to make it work.” It was true, there’s never been a time when I’ve said, “Gosh, I wish I had waited to have my kids until now, because now is so easy!” Her advice stuck with me. Taking care of patients is my passion. But my family is what’s going to be there for me in the long run. I don’t ever want to give up one for the other.
What challenges, if any, did you have in establishing your practice?
It was a challenge, because when people think of Washington University, they think it’s the place to be if you are really sick. It’s never been on the radar for cosmetic surgery, because patients want something more discreet with the anonymity of a private office.
As I mentioned earlier, when I was a resident training here, there really was little cosmetic surgery experience available for the residents. I did my cosmetic fellowship and was recruited back here to get the cosmetic surgery program going, along with Terry Myckatyn, MD.
In the beginning it was hard because plastic surgery, especially cosmetic surgery, is all about your reputation. And reputation is usually word-of-mouth that takes time to grow and mature with you.
Dr. Mykatyn and I had a vision for the office, website and branding campaign for West County Plastic Physicians of Washington University. Because I’m not a business person, it was a very different endeavor. It was fun, but a little bit crazy, because we were getting to do something doctors don’t normally get to do. They don’t teach you a single thing about business in medical school.
It’s been great, our practice has really grown and I feel very blessed to be where I am today. There is not a lot I would change.
If you weren’t a doctor, what do you think you’d be doing?
I’ve had different business ideas – like running an organic, fresh and healthy food preparation business for working families. Because that is something I would like to have for myself. I also enjoy yoga, so maybe I would be a yoga instructor. Of course, I love my kids, so it would be great to be a stay-at-home mom.
But the truth is, I love my job so much, I can’t imagine doing anything else. I want to do this.
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