Maggie McKay (Host): If you're considering plastic or reconstructive surgery, you want to be confident in the doctor and facility you choose. So today, we'll learn more about the Beebe Plastic and Reconstructive Program with Plastic and Reconstructive Surgeon, Dr. DaKota Urban.

Welcome to the Beebe Healthcare Podcast. I'm your host, Maggie McKay. Thank you so much for being here today, Dr. Urban.

DaKota Urban, MD: Thanks for having me.

Host: So to start off, can you just introduce yourself? Tell us a little bit about your background.

DaKota Urban, MD: Absolutely. I'm DaKota Urban. I am the plastic and reconstructive surgeon here at Beebe Healthcare. I did my medical school training back in Kansas where I was born and raised, before matching into general surgery first up at Christiana and Wilmington, Delaware, and then had the opportunity to go down to South Florida, and Tampa and do my plastics training. And now, we're back. And I am here at Beebe as a plastic surgeon.

Host: Can you talk a little bit about the Beebe Plastic and Reconstructive Program?

DaKota Urban, MD: Yeah, absolutely. So, it's a new program. So, we're kind of building it as we go, but we kind of have a lot of different hats that we wear and get to help a lot of different patients down in lower Delaware. So, we get to do a lot of breast surgery, whether that's our breast reconstruction with the breast team across the way or patients that need breast reduction or other breast surgery. We also do a lot of cutaneous oncology. We're at the beach with a kind of an aging population. So, we have a lot of skin cancers that need to be taken care of. So, I do a lot of cutaneous oncology, especially on the head and neck. I get to do a lot of our bariatric patients that undergo massive weight loss surgery and have wonderful outcomes, but then they're stuck with this extra skin, so I help them take care of that. So, I do some body contouring. And then, a little bit of everything else with plastic, so I help other teams if they need help with some of their wounds and things like that. So, it's not a boring job, but it seems like every day I'm doing something different. So, it keeps everything fun and fresh.

Host: That's awesome. So, of all the areas you could have gone into, what inspired you to specialize in plastic reconstructive surgery?

DaKota Urban, MD: I thought about that a lot. So whenever I was in general surgery, actually Dr. Dickson-Witmer, one of our breast surgeons down here, was one of my attendings, and taught me in my general surgery training. And when we do some mastectomies, I got the opportunity to stay with the plastic surgeons and do their portion. And they kind of sparked my interest. And a lot of what I do is superficial. I mean, everything we do in medicine is for the benefit of the patient, but in General Surgery, usually working inside the belly and things like that, so you really don't get to see what you're doing. And in Plastic Surgery, whatever I'm doing, you get to see it, so it can have a huge impact on the self-esteem of the patient. It can make people feel whole. And so, you really can change someone's life for the better and really make them feel complete and raise their self-esteem, especially when we do breast reconstruction and kind of take care of them after they have to have their mastectomies to make them feel like they don't have that disease anymore. They feel more whole. So, that really got me interested in Plastics. And then, I got the opportunity to go to Hopkins and Temple around here and get to learn a little bit more about Plastics and really sparked my interest. So, it was really fortunate to train in what I enjoy doing.

Host: So, how do you think your journey has shaped your approach to patient care?

DaKota Urban, MD: I don't come from any real educated background. I'm one of the first doctors in my family. So, I think growing up and going into medicine, I really am patient-oriented, so I really want the patient to feel like they're a part of the care, and that I'm always available to them. So, I think that's kind of one of my big aspects of patient care, is letting them be a part of their decision-making process and getting to be a part of all the things that I'm doing for them so that they feel that it's not just me making decisions for them. And then if there's ever any questions or concerns, making myself readily available to my patients so that they have full understanding or just can answer any questions for them.

Host: So, you talked about some of the reasons people have reconstructive surgery. What are the most common conditions or situations that require plastic reconstructive surgery?

DaKota Urban, MD: So, the two main that I do is probably 80% breast. So breast cancer, unfortunately, we have a lot of patients that are undergoing mastectomies for breast cancer. So, we're either doing what's called autologous, using patients own body tissue, or implant reconstruction, which probably 80-90% is implant-based reconstruction. And then, the other patient population are our patients that unfortunately have like sarcomas or other cancers that need a large soft tissue removal, whether it's on the extremity or something, or a melanoma, where they need a little bit more, they need something to close the defects where it can't just be readily closed. So, I could take tissue from one area and kind of design a flap to get that closed for either surgical oncologist or general surgeon. So, I'd say those are like the two big areas that need reconstruction.

Host: And as far as treatment methods, what's available?

DaKota Urban, MD: With regards to like a reconstruction?

Host: Yeah.

DaKota Urban, MD: So, with breast reconstruction, like I said, you can either do autologous or implant-based reconstruction. So, I always talk to the patient about kind of their goal. And a lot of times if you don't need radiation, implant-based reconstruction is a very good treatment option where they can actually go home the same day. They don't have to spend days in the hospital. They don't have to have a donor site where they were taking tissue from the belly or the back. So, they have a lot quicker recovery. So, those are kind of the two main types of reconstruction, and that's a whole different podcast on its own, just talking about those two.

But then with lower extremity and abdominal wall reconstruction, whenever you have to take out a sarcoma or a melanoma, it's just mainly anatomy. So, it's just moving tissue based on your blood supply, but you have to know kind of the anatomy and how that blood supply works so that you can't just move tissue. You just can't take skin and move it. It doesn't have a good blood supply. So, you kind of have to know the anatomy and then, there's a plethora of different flaps that you can do to try to get these defects closed for people.

Host: Dr. Urban, in your opinion, what are some of the most significant advancements in plastic reconstructive surgery in recent years?

DaKota Urban, MD: I think there's a lot, especially as we get to understand anatomy. I mean, we've come a long way with anatomy and different types of flaps that we can do. I mean, I am down here at Beebe where kind of the very large like academic type of flaps where you're talking about free tissue transfer just isn't really readily available here, but that's kind of big academic hospitals like Penn and Hopkins and those.

But then, our implants are always improving. We have different acellular dermal matrix and things like that that we're using in breast surgery, which there's different products. There's about a thousand different products. It's hard to even understand them all. And then, even in breast reconstruction, we're able to do direct-to-implant. It used to be where you had to put a tissue expander in all the patients and then slowly expand them and then take them back to the operating room and switch those out for implants. But now, we're able to do direct-to-implant. Because of what's called ICG angiography, we're able to actually use a special camera and inject some dye into the IV and you can actually see the blood supply of the whole body in this camera. So, you can see the mastectomy flaps and know that your perfusion is good, and that you're not going to have any stress on the skin flaps if you kind of stretch it over an implant. So, we have a lot of advancements and there's a lot of technology. It's hard to keep up with it all, especially if you're starting to do wounds in burn care, which is a part of Plastics too. I don't do as much of that, but there's a whole different area of just wound and burn care that has so much technology that we're able to help patients.

Host: And how have these new options impacted patients? Like, is the recovery faster or...?

DaKota Urban, MD: Definitely. If you're able to do like a direct-to-implant and breast reconstruction, you save them from having to wait about three weeks to heal from that initial surgery. And then, they have to come back to your office every week to kind of get expanded. So depending on how much you have to expand them, that can be another four to eight weeks of just coming to see you weekly to fill the expander. And then, you have to go to the operating room for another surgery to take out that expander and put in an implant. So if you can do that all in one surgery, you're saving the patient a lot of time and a lot of, extra trip to the operating room. So, I think that definitely benefits the patient overall.

Host: And are there any drawbacks?

DaKota Urban, MD: The drawbacks, like I said, with what's called SPY, you're able to look at the blood supply. So, I think, by being able to look at that, it really takes away the concern that you have a wound breakdown or the mastectomy flaps aren't good. So, that takes away kind of the biggest concern when it comes to breast reconstruction with implants, is that your mastectomy flaps are good, and that it kind of takes away what you can't see with the naked eye. So, I think there's not a whole lot of drawbacks when it comes to being able to go to direct implant. Like I said, if we do SPY and it doesn't look good, then we do the tissue expander, but it allows us to kind of skip a bunch of steps if we are able to do so.

Host: And when should someone go see their doctor to talk about the possibility of reconstructive surgery? What are some of the reasons they'd be referred?

DaKota Urban, MD: So, a lot of it I do see after the breast team or they get their diagnosis of breast cancer,. Most of the time, whenever the breast surgeon sees them for the consultation for discussing mastectomy and things like that, they always refer over to me to kind of discuss reconstruction. Sometimes they might be undergoing neoadjuvant with chemotherapy. But before they go and undergo any surgery, direct-to-implant me to kind of discuss reconstruction.

Like I said, with the sarcoma team, I'm usually working in concert with them, so I'm in the operating room with them. So whenever they see patients and they feel that the defect is going to be way bigger than they're able to handle at the time of surgery, they send the patient to me so that I can be a part of their case and come in and help. And then, the dermatology team sees a patient that has a skin cancer in a cosmetically sensitive place, like the face or the neck, they usually send them over to me so that I can either take care of it and close it in a cosmetic way.

Host: So when a patient comes in to see you, what questions should they be asking and what can they expect from their visit?

DaKota Urban, MD: So, we kind of go over what their diagnosis is and what their kind of knowing what the plan from the other surgeon is. And then, we kind of discuss. I always ask if they've looked into breast reconstruction or if they've looked into any kind of reconstruction. And then if they haven't, we kind of discuss all the different types of reconstruction and then we kind of walk through the recovery, the procedure. And then, there's different handouts we give patients, because it's a lot of information, so we send them so that they have something physical to look at that kind of recapitulates what we talked about. And then, usually, they're not scheduled for their surgery for a few weeks from when I see them. So, I usually bring them back for a pre-op after they've had the time to digest and, if they think of any questions, come and see me. And that way, we can rediscuss everything.

Host: Dr. Urban, could you talk a little bit more about breast reconstruction and the work you do with the Breast Health team?

DaKota Urban, MD: Yeah. I work very close with the breast team. There's three wonderful surgeons part of the Breast Program, and I'm kind of their fourth as their reconstructive surgeon. But for the most part, if a patient's undergoing a mastectomy, I'm usually working with them to try to do their reconstruction at the same time. And then, a lot of times that they've undergone breast-conserving therapy with like a lumpectomy or things like that, then sometimes I see them for any kind of cosmetic deformity or anything that they may have.

And then, when patients undergo, surgery on one side, usually they need a symmetry procedure or something done on the other side. So, I usually kind of wait a little bit until we get a little idea of what the reconstructive side is going to look like. But the Women's Care Act is wonderful. It allows most of the stuff to be covered by insurance. So if they need a symmetry procedure, like a lift or a reduction on the non-cancerous side that we can get that covered for them.

Host: And what areas or locations do you serve? Where's your office located?

DaKota Urban, MD: I am in Rehoboth, Rehoboth Beach. But we basically serve all of lower Delaware, so all of Sussex County.

Host: And are you accepting new patients?

DaKota Urban, MD: I am. So, if you call the office, we're happy to get you in.

Host: Okay. What do you like most about the team at Beebe Healthcare?

DaKota Urban, MD: I think they're extremely open. Everybody's very team-oriented. Everybody's wonderful to work with. I really enjoy being a part of the Beebe Healthcare team. I would say we're here to take care of the Sussex County population in the best way that we can. And I think that we work very cordially together to do that.

Host: What are you most excited about for the future at Beebe Healthcare?

DaKota Urban, MD: Like I said, it's a new program, so we're kind of getting it up and running and getting it started. And it is definitely growing fast, and I'm just excited to kind of see how it continues to expand. I think, eventually, it's going to get to where they're going to need more than just one of me. So, we're definitely getting really busy. I think it's exciting to see that we get to offer these services to patients who before were having to go up either to New Castle County or even into Baltimore, Pennsylvania to get these services. So especially with breast reconstruction, most of these patients weren't able to get their reconstruction down here. They were getting their mastectomies and then happened to drive an hour and a half north just to get their reconstruction at a later date. So, being able to offer this all down here where the patients to not have to travel and do those kind of things, I think is a wonderful opportunity. And like I said, it is growing rapidly and it's exciting to see.

Host: Is there anything else in closing that you'd like to add, that you'd like people to know that we didn't cover?

DaKota Urban, MD: I think we kind of covered everything. But if anybody's interested, one thing we're kind of growing is we're kind of working out the Cosmetic Surgery. So, anybody who's interested in anything cosmetic-wise, it's not a big part of my practice. But it is something that we offer. But I think that if you have any interest in needs of any kind of plastic surgery, we are more than happy to help. And if we can, we'll get you where you need to go. So, I'm extremely excited and I've loved working with the Beebe Healthcare team. And if you're interested, please call us and we'll be happy to see it.

Host: Thank you so much for sharing your expertise and making the time to tell us more about what you do and Beebe Healthcare.

DaKota Urban, MD: Thank you. Appreciate your time.

Host: Again, that's Dr. DaKota Urban. And if you'd like to make an appointment at Beebe Plastic and Reconstructive Surgery, please call 302-291-6250. The office is in the Medical Arts Building on the Rehoboth Health Campus. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thanks for listening. I'm Maggie McKay. This is the Beebe Healthcare podcast brought to you by Beebe Healthcare.