Interview – The best Czech plastic surgeon

Interview – The best Czech plastic surgeon

Pomahač: Every Patient is Exceptional

HomeWhat's NewInterview – The best Czech plastic surgeon
Bohdan Pomahač is a world-leading plastic surgeon. He and his team performed the very first face transplant in the USA at Brigham and Women’s Hospital in Boston in May 2011. In 2019 he carried out the first transplant on an African-American patient. In past months he has been slowed down by the coronavirus, but now is once again preparing to break into that mysterious world of reconstructive surgery.
How have you been spending these strange times? The USA, or more precisely parts of it, have been hit quite hard.
I would say that the course of the entire epidemic has been surreal from the beginning. Over the past 30 years, I’ve never spent so much time at home with my family, which is a good thing to come out of the situation. Of course, the impact on society and patients has been terrible. Boston has been affected quite significantly, even though our health system has never been overburdened thanks to measures that were put in place at the start. Another positive thing will probably be the use of telemedicine, which patients genuinely like. Coming to Boston for what is often really just a few-minute visit to the doctor, who they still have to wait to see, can genuinely take half a day. Patients who can consult their doctor from home are happier. Obviously, it is not possible to see all patients in this way, but I would guess that 30% of visits could become virtual in the future.

Has the pandemic revealed any positives and negatives in the American health system?
The biggest fear was probably a lack of beds. The American health system has to be effective to the point that major hospitals are regularly 95% full. Free capacity is minimal and smaller hospitals that didn’t work in that way have not been able to survive financially. There were therefore fears that, if the epidemic spread to such an extent as in Italy, we wouldn’t have anywhere to send our patients. A kind of “field hospital” was even set up in a conference centre, but in the end it was mostly used for homeless patients. A positive thing about the American system is the fact that money was immediately invested into finding and producing vaccinations and cures for the coronavirus, something which probably isn’t possible anywhere else in the world.

How has your hospital been functioning, and has your department been working normally, or have you been limited in any way?
In late March 2020 I was still performing reconstructive surgery, but starting from April, all operations were suspended, except for urgent ones. In plastic surgery there are not many of those. After few months things where gradually starting up again – but cautiously, because everyone was afraid of further waves of the coronavirus.

How do you look at the pandemic and how do you perceive it? Have you had or do you have any fears?
Probably like everyone else I am worried about how life will return to normal and what the new normal will bring. Video conferences have shown us that people don’t have to travel everywhere. Airlines and hotels will have to rethink the strategies of their services. What is leisure time going to be like? I wouldn’t like to lose what we had and one day tell my grandchildren about how we used to be able to go to sports matches and concerts in person and not virtually.

Do you feel that it will significantly affect and change the world and our lives in the long term?
It’s possible. A cure for the coronavirus will be found, but various behavioural and procedural changes will remain, similar to travelling after 9/11. The terrorists basically achieved nothing apart from making travelling more difficult and less fun because of longer queues and slow check-ins at airports. I fear that the situation will be similar here and now. Social distancing, limited numbers of people at group events, and so on.

What have you been working on recently? Are you still performing face and hand transplants, and similar operations?
Yes, we are. We have a schedule for face, hand, abdominal wall and uterus transplants. Aside from that, there is a lot of research concerning tissue preservation, etc. In practice, I have an extensive mix of clinical problems which I enjoy solving.

What other exceptional operations have you recently performed? And how may do you have under your belt?
I consider every patient to be exceptional, and I try to do the best I can for all of them. There are only a few genuinely rare operations, because there are very few patients who are suitable candidates. We performed the last face transplant in 2019. The first black patient in the USA to receive one. Because there are so few of these operations, you can always find something about them that is a first (laughs). In the long run, we have to properly examine the results and make sure that we are really doing things that are beneficial for our patients. The history of transplants is full of such processes, moratoriums, and so on. Our job is not to push forwards blindly. We have to evaluate the results before expanding indications and operations.

You have previously said that complicated transplants are not without consequences. Transplanted skin seems to age more quickly than the rest of the body, causing problems. Are you working on this, and have you found any solutions?
Our branch, which is already a part of specialised plastic surgery, is too young and limited for us to be able to resolve discovered problems instantly. We are in the development stage, where new knowledge is found and described, leading to further research. Small problems will take more time to resolve, but larger problems will take much more effort. At present, we know that patients are going through a process of graft rejection, which can be variously fast or slow. In some cases, this manifests itself in changes to the skin, which can resemble quicker ageing. We don’t yet know how long transplanted faces can survive, but it is important to realise that their lifespan will be limited. To compare, transplanted hearts and lungs have a half-life of only 5 years. If faces can survive for an average of 10 years, it will still be a success.

Are you expecting any further breakthroughs in your field in the near future? If so, what?
I would very much like to see a form of treatment that leads to tolerance. To a condition where transplanted tissue is not rejected. Where the body doesn’t consider the tissue to be foreign. In several human studies, this has already been achieved with kidneys and carefully selected patients, but it is still unclear whether this will ever work in the organs of other patients. Throughout its life, the human body is exposed to so many environmental stimuli that lead to complex immune responses and the formation of memory immune cells and response systems. After transplants, for example, in laboratory animals such as mice, we are able to control their immune system and the environment that they are exposed to, which means that many hypotheses and experiments work. In people, however, it is exponentially harder to repeat results. But if it worked, we would be able to transplant a smaller part of the face, and practically any kind of tissue that we are unable to replace.
Another breakthrough would be tissue engineering (making tissue outside the human body), but I fear that we are still very far from laboratory experiments in this case.

How often are you comming to the Czech Republic? And how often do you visit the country under normal circumstances?
I have the honour to be a member of the International Council for Science and Research, directly under our prime minister. Thanks to this position, I am able to come to Prague for a few days twice a year. Sometimes I get the chance to visit for a little longer when I’m on holiday.

Where do you go when you return to the Czech Republic? Where do you stay and where is your favourite place? I suppose it is somewhere in North Moravia.
I like Moravia, but to tell the truth, I mostly stay in Prague because of short visits, which are more frequent. If they have time, my family and friends come to visit me there. It is sometimes unbelievable how Bohemia is thriving and improving. For those who live there, it is like watching grass grow. But for me, visiting once in a while, there is always a huge difference.

What places would you recommend, for example, to American tourists when the borders open? What are your favourite places in the country and why?
I like a lot of places in the Czech Republic. Certainly Prague and the historical town of Český Krumlov. These kind of places are already on the radar of every tourist. But I would add places in South Moravia in the south-eastern tip of the country. The beautiful town of Mikulov and the Lednice-Valtice area – especially for fans of good wine. Lovers of the countryside will appreciate the beautifully undulating landscape of Bohemian Paradise (Český ráj) to the north-east of Prague, or the Bohemian Forest (Šumava) mountain range to the south-west. The town of Ostrava is also becoming interesting, especially Landek park with its mining museum, or the former steel complex in the Lower Area of Vítkovice.

Have you and your family ever considered a permanent return to the Czech Republic?
So far, I haven’t received any offers which I could consider. But you can’t rule anything out!

Who is Bohdan Pomahač?

Born in Ostrava in 1971, he studied at the Faculty of Medicine and Dentistry at Palacký University in Olomouc. During his studies, he went on an exchange trip to Harvard Medical School in Boston. In 1996, he left for the USA, where he has worked at Brigham and Women’s Hospital since 2001. He has directed the division of plastic surgery, trauma and burn surgery for 16 years. In April 2009, his team performed a partial face transplant on a patient who had suffered severe injuries after falling onto an electrified railway track. In May 2011, he performed the first full face transplant in the USA on a patient whose face had been destroyed by an electric shock. He has also transplanted a face onto a soldier who was injured in a car accident, and a woman who was blinded and disfigured by a friend’s chimpanzee. Last year he performed the first face transplant on an African-American patient.