Healthcare workers discuss the importance of gender-affirming care

Physician Assistant Sabrina Sam, 26, works in a field of surgery that is not common nationwide yet plays a crucial role in enhancing the quality of life and increasing the confidence of transgender women.

Facial feminization surgery (FFS) is a reconstructive procedure that alters what is commonly viewed as masculine facial features to feminine facial features. FFS, which has been around for about 20 years, continues to grow across the country.  

Sam works alongside FFS Dr. James P. Bradley. Sam’s dream job out of college was to be a plastic and reconstructive surgery PA.

“It’s truly a beautiful feeling to have the opportunity to follow all my patients on their life-changing journeys from start to finish,” Sam said.  

Reconstructive procedures help transgender people feel their true selves while also serving as a form of protection in the face of transphobia. Sam said that being a PA and performing FFS is a rewarding experience. She spoke with The NewsHouse about her passion for healthcare and the joys of working in reconstructive surgery. 

The following interview has been edited for brevity and clarity. 

What initially made the medical field your dream career? 

One of the things that made it my dream career was being a kid and seeing my family go to the doctor and just seeing that direct, positive impact a person can have on another person. 

How did you come to the decision that cosmetics was the field you wanted to be a part of?

During my general surgery rotation during PA school, my preceptor told me I’d be first assisting one of the plastic surgeons there. We did a septorhinoplasty, and afterward, my preceptor told me I did a great job, which was a huge confidence booster for me. It was also one of the reasons I was drawn to surgery. What made me interested in plastic surgery, specifically, was seeing how plastic surgery is not only for building the patients’ confidence cosmetically but also for helping the patient medically, such as when you do a septorhinoplasty, which helps with breathing. 

Can you talk a little bit about your medical school experience and positions prior? 

I did an accelerated PA program during college, which was two years of undergrad and two years of PA school. Since the PA program was accelerated, it definitely was a lot of material to learn in a short amount of time. The third year was considered our didactic year, which was full of multiple lessons a day with a couple of tests a week or so. And the fourth year was considered our clinical rotation year, so that’s when you’d go to different hospitals and rotate through other different specialties. We’d reconvene after a month or after each rotation and take a test on that.  

What was it like when you first started your job as a PA?

When I first started working as a PA, it was really nice to have the provider whose position I was taking over available for a few days to help me transition into the position. I think most, if not all, jobs are continuous learning experiences, so I knew there would be a lot to learn, but the key was to take one day at a time, and then over time, many parts of the job just became second nature. 

I was introduced to facial feminization surgery during my interview for this position, and I immediately felt that I wanted to be a part of this care. I understood early on that it’s a field that is still new to people, and I wanted to be a part of spreading awareness and changing the lives of this patient population. 

What is the process like with a patient coming in for facial feminization surgery? What is your main role? 

Typically, we’ll see 8-12 new patients for facial feminization surgery a week. Our first priority is to make our patients feel comfortable. We understand that many of our patients have experienced discrimination and want to make sure that they know we are on their side. Then, we take time to learn about their medical history and get a good understanding of what areas of their face they would like to feminize.

I take the information to Dr. Bradley, who then sees the patient and does a more thorough physical examination. He makes the final decision on which procedures are necessary for the patient, and I provide the patient with all necessary preoperative and post-operative information. Even though I’m considered a physician assistant, I’m technically a “physician extender,” which means that I’m usually working alongside Dr. Bradley during our shifts. This means I’m operating with him in the OR and also seeing patients during office hours with him. 

Is your job what you expected it to be?

The job was everything I expected it to be. I’m happy that I do get to have time in the operating room and also time at office hours, as well as getting to know our patients, so I get to be there for their full journey. And Dr. Bradley is an incredible teacher, so I’m actually surprised at some of the skills that I’ve become very comfortable performing. 

It’s truly a beautiful feeling to have the opportunity to follow all my patients on their life-changing journeys from start to finish.  

Do you receive any backlash for your job?

Unfortunately, during this job, you will meet some people who are unsupportive of the transgender community. To help bring awareness, I’ve taught a few lessons about facial feminization surgery in the hospital, so I provide insight into how much of a positive impact our workers have on the lives of our patients when they treat them as equals. 

What do you expect for the future of facial feminization surgery? Do you see it emerging worldwide? 

I definitely imagine facial feminization surgery becoming more commonly done all over the world. Dr. Bradley has been to various countries where he has taught others how to perform these facial feminization surgery procedures. I also believe it will continue to grow as people become more familiar with the surgery and see the beautiful results that come with it. 

Do you have other goals for your future? What are you looking forward to? 

With the practice that Dr. Bradley and I have grown, it’s difficult to imagine leaving the facial feminization craniofacial reconstructive world. Dr. Bradley performs excellent work on our patients, and we’ve created such a strong team. For my future, I look forward to learning more about medicine and surgery from my job. I’m also excited to make more patients feel safe being themselves.