University of California San Francisco

Dr. Merisa L. Piper

Piper_MSS Spotlightcollage

Interview with Dr. Merisa Piper by medical student Eizabeth Danial. Dr. Piper is a plastic and reconstructive surgeon who specializes in breast reconstruction and general reconstruction. Her research focuses on improving outcomes after breast reconstruction, particularly after microsurgery and oncoplastic surgery, which combines tumor removal with reconstruction. Dr. Piper completed a combined general surgery and plastic surgery residency at UCSF, a fellowship in microsurgery at the University of Pennsylvania, and is now an Assistant Professor of Surgery at UCSF.

What is one thing you know now that you wish you had known during training?

As a medical student, you're told by your mentors that going into medicine is a lifetime commitment, and it's much more than just a job. But I think that realization is hard to truly know or understand until you become an attending. Once a patient is your patient, they’re always your patient. There’s never a time when you’re not responsible. The level of commitment that medicine requires is so much deeper than what I think you could understand until you are fully committed, and that weight is heavy. Work and life separation does not really exist, but rather it’s about integration. And figuring out how to integrate them is challenging.

Tell me about how you chose surgery and the thought that went into making that decision.

I always knew I wanted to do medicine. Since age 5 I used to pretend that I was a doctor, and I would love to take care of anyone who was injured. Initially, I thought I was going to be a pediatric oncologist. That is, until I saw my first liver transplant [with my Aunt Nancy Ascher] when I was 12 years old, and I was hooked. After that there was no looking back. I was scrubbed into this transplant and was like, “Oh my God, this is the coolest thing in the world.” At that point, I knew surgery was for me. Originally, I thought I was going to do transplant. But, when I was a third-year medical student on my transplant rotation, I realized transplant wasn’t the right career move for me. That rotation was also when I saw my first flap. I found the same exhilaration from this type of surgery and thought of it as a different type of transplant. Same as my initial conviction to pursue surgery, after I saw that first flap, I knew that microsurgery was for me.

Who do you admire?

Growing up, my parents worked full-time jobs and worked a lot. They were always a source of inspiration because no matter how much they worked, one or both showed up to every sports event, performance, girl scout meeting, etc. No matter what they always put their kids first. And they still do.

I met my husband my first year in college, and he has been my number one supporter, as well as voice of reason. He truly is self-less and understands what it means to be in medicine despite not being in medicine himself.

From a professional standpoint, there was a mentor I had in medical school who took me under his wing. He really fostered my interest in plastic surgery and supported and guided me. To this day, he still follows what I'm doing, and I run into him occasionally at meetings. I am incredibly grateful for what he did for me as a third-year medical student.

Finally, of course, my Aunt Nancy [Ascher] and Uncle John. They introduced me to surgery at a very young age and nurtured my love for surgery. They have always been there to provide advice as well as honest feedback. They are the epitome of dedication to their profession and their patients.

How do you recommend finding a mentor who is a good fit?

My mom used to tell me growing up, “You’ve got to kiss a lot of frogs before you find a prince.” This can be applied to finding a mentor. You will meet a lot of different people in medicine. You will find that there are people who resonate with you, who you admire and respect, and who also give you the attention you are seeking. But you won’t meet them without seeking them out. I have a lot of different mentors who are in a variety of different fields. Some of them are in plastic surgery, but many of them are not. They are people who have been present and available over the years, who I respect, and who were available when I needed guidance.

Mentorship is key. We all must figure out a lot of things on our own, and struggle through things, and make mistakes. Do not expect things to go as efficiently or as perfectly as they should. But, having a good mentor, can help make that a little bit smoother.

What is the best piece of advice you have received?

Probably it’s that you shouldn’t go to bed angry. Life is complicated and stressors tend to compound. I don't like to ever go to sleep upset. Try to work things out before that.

From a surgical perspective, when I had my initial complications as a new attending and was talking with Dr. Roberts he said to me, “The only way to not have complications is to not operate.” I keep reminding myself of that. As a surgeon, you need to recognize what has happened, learn from it, and move on.

How do you cope with those moments where things don’t go well or when there are complications?

Usually when I have a bad complication or even just experienced something challenging, talking to others helps me. Although it can be painful, or even embarrassing, being able to talk through those moments is therapeutic and even cathartic. However, I don't think I will ever forget my complications. I compartmentalize them, but they never really go away. Surgery is incredibly humbling, and I think that you know every complication just humbles you that much more. Having an outlet is also so important. For me that outlet is my family and exercise.

Were there any special considerations you had being a woman and pursuing a career in surgery?

My husband and I met when we were young. We got married when I was a fourth-year medical student, and we always knew we wanted kids. At the same time, I always knew I wanted to do surgery, and my husband knew that too. But I didn’t want to put having children on hold until I was done with residency. So, we had two children during residency, and sometimes that meant life was a lot harder. The way that we have made it work is that my husband does a lot with the kids and is always available for them. We also rely heavily on my parents. The combination of having a very, very supportive partner and family present is critical.

Being a woman in plastic surgery, there are definite differences and challenges. Plastic surgery is becoming more gender balanced, but that change has occurred over the past 5-7 years. Now it's almost 50/50 in residency. But when I was a resident, it was probably like 30/70. Despite this change in residency, there is still a lack of academic female plastic surgeons. In particular, there are few female microsurgeons in academia and positions of leadership because of the grueling nature of the operations and the acuity of the peri-operative management. My career poses a constant challenge for my family, because ultimately, if there is an issue with my kids, I cannot always deal with it. If I am at work, I cannot just stop an operation or have someone else take over.

But I have also observed benefits to being a woman in this field. Patients treat female surgeons differently, particularly in breast reconstruction, because I think there is an immediate intimacy between us. There are conversations women may be more comfortable having with a female surgeon than with a male surgeon. I did not appreciate the vulnerability and level of trust that the patient puts in you until I started practicing

What are hobbies outside of the hospital that you enjoy doing?

My number one favorite thing is spending time with my family. I admit on a daily basis that I am absolutely obsessed with my kids. I also love exercising. Sports have been a huge part of my life since I was a kid. Now I do more running, hiking, Peloton, and, occasionally, dance-offs.

I also love to bake and do any kind of puzzle, like jigsaws or crosswords. I love traveling. My husband and I used to travel a ton before we had kids. Even now, with the kids, we still try to do one international trip a year. It's not really vacation anymore….but it is still something that we really love to do.

What is a question you wished more people had asked you?

Well, I don’t feel like I have enough years under my belt to really answer this. But I do want to have the opportunity to talk with more female residents about the real issues with having kids. We talk about it very superficially. There are a lot of challenges that come with having children, raising a family, and being a surgeon beyond compression socks, breast pumps, and belly bands. I would like to be there for the women in our program, whether that be for advice or just to listen.

Is there any advice you have for anybody thinking about starting a family during training?

Do not put your life outside of the hospital on hold, because life doesn't get any easier. It just gets different. So, I encourage all our residents to have kids during residency. Having a supportive partner, family, friends, or other resources are necessary, but you can do it.

The commitment to raising a child can feel overwhelming, terrifying, and way harder than you ever thought possible. But it’s also the most rewarding, love-inspiring, and life-changing circumstance you could experience.

What are you most proud of? Personally and/or professionally.

Personally, by far my family. No matter what is going on in the world, they fill me with joy. Even if they're being little boogers, I'm just obsessed with them.

Professionally, I have built a practice that I really love. My practice is 100% reconstructive microsurgery for patients with cancer. It is the kind of practice I dreamed I would have as a resident. And now, I’m actually doing it. It is way harder than I could have ever, ever anticipated. But it is also amazing. And that's beautiful.

Do you have a favorite quote or mantra that you live by?

I don't know if I have a favorite quote or mantra. In general, I try to be grateful every day for what I have. No matter all the frustrations, when it all comes down to it, I have a pretty amazing life. So I try to recognize on a daily basis all that I have, and how grateful I am.