Interview: Mary O’Brien
Mary O’Brien has just made history having been named the first ever female president of the British Association of Aesthetic Plastic Surgeons (BAAPS) in its 41-year history.
A breath of fresh air, O’Brien is full of energy, enthusiasm and gratitude for what she describes as “the privilege” of being a plastic surgeon and does not seem at all phased by the fact she has taken the helm in the midst of coronavirus.
“I see this as a big responsibility and I’m just hugely grateful for the opportunity”, she says. “One of the things that wasn’t on the job description two years ago was taking over leadership of an aesthetics association at the time of a global pandemic, but my aspiration for BAAPS is that we come out of this period as a shining example of what patient care is about.
“We need to make sure that the reality of surgery and care isn’t lost in this new virtual world we find ourselves in. I want to make sure that the patient is at the centre of all the decisions that are made and that we support our plastic surgeons to be able to continue to provide very high quality care.”
O’Brien’s appointment marks a new chapter for the respected but previously maledominated organisation.
Despite the fact that 90-92% of people who have had cosmetic surgery in the last 15 years1 have been women, BAAPS has always been led by men, a trend reflected across all surgical specialities.
According to UCAS, 58% of people accepted onto medicine and dentistry training are women, but only 11.1% become consultants in the UK.2 This means that, while plenty of women are training in medicine, the number going on to become surgeons is still low.
However, change is afoot. Figures from the Royal College of Surgeons2 show that the number of female consultants rose from 3% to 12.9% between 1991 and 2019. This means women are now represented in all 10 surgical specialties and at all levels within a surgical career. And as specialities go, plastic surgery is quite progressive, with the second-highest female representation of 21% (the first is paediatrics).
BAAPS is always exploring ways to promote plastic surgery as a specialty and make the training pathway supportive of female trainees, and O’Brien’s appointment solidifies this. However, although she has done much work to inspire other women into plastic surgery, O’Brien doesn’t believe gender should be the primary focus. “It’s not necessarily about trying to get more of one gender or the other into the field”, she comments. “It’s about supporting those people who genuinely want to pursue this fantastic career and making sure that the infrastructure is there for them to be able to fulfil those goals.
“It’s a difficult career pathway and, in the past, it has been challenging to combine that with having a family, so I think that the pathway needs to be more supportive of whoever finds themselves in that child caring role, whether that’s women or men.
“It’s an arduous training programme and you need to be very committed to it. You need the support of your family and you need to be able to – as far as you can – compartmentalise your life and accept that sometimes you have to make home or family sacrifices.”
Being the daughter of two doctors herself, O’Brien was well aware of the drive and dedication required to pursue a career in medicine and, in particular, what it took to become a surgeon. “My mother was an anaesthetist and my father was a surgeon”, she says. “They worked together both in the operating theatre and at home as a fantastic team. I have had the opportunity to work with some truly inspirational surgeons throughout my career, but the surgeon who inspired me most was my father.”
Initially, O’Brien wanted to go into general practice or paediatrics, but a trip to East Grinstead hospital, which has a famous history in plastic surgery, sparked her interest in the field. She recalls, “During the Second World War the team there, led by pioneering plastic surgeons, provided treatment to RAF pilots and air crew who had sustained severe burns. My imagination was captured by their emphasis not just on the physical, but the psychological and social rehabilitation of patients.”
She later went on to train in Birmingham at the time of the Iraq War. Part of her work involved looking after soldiers who had sustained burns and significant limb injuries caused by blasts and shrapnel. O’Brien now specialises in reconstructive hand surgery and works full time in the NHS treating a vast range of hand-related issues, from the relatively trivial to the life-threatening, including major hand and industrial injuries and road traffic accidents. The pandemic has also kept her busy of late.
“Lockdown resulted in many people sustaining DIY injuries from a range of power tools [such as] chainsaws, drills, hedge trimmers and lawn mowers”, she says. “Injuries from these tools can be devastating – most are banned in my household.”
In the driver's seat
Part of O’Brien’s new role as president is to chair council meetings and coordinate the association’s activities, of which there are many. BAAPS has always been one of the most proactive and vocal industry associations, making its voice and views of patient safety heard in the national media. Building on these relationships with journalists to try to counteract the negative and skewed press aesthetics sometimes receives is high on O’Brien’s agenda.
“I think there’s a lot of distortion and misrepresentation when it comes to selling newspapers and I would like to be able to engage”, she says.
“I have two teenagers and I do worry about the perception of plastic surgery that comes across in some of the media. There is a real lack of understanding about what plastic surgery is and it would be very helpful to work with journalists so that it’s not just the sensationalist headlines that people see.”
O’Brien believes that education is key to debunking misconceptions. She has already been actively involved in BAAPS training programmes which are not just aimed at inspiring more young people to become surgeons, but at getting them to understand the broader picture of a career in plastic surgery, so that they can see beyond breast implants and lip fillers.
“I have collaborated with various careerseducation events so that teenagers don’t just have that one-sided perception of what plastic surgery is, which is often very skewed”, she says. “Plastic surgery is the most fascinating career. It’s such a privilege to be a doctor.”
As the figurehead of the association, O’Brien, who also holds a Medical Law and Ethics degree, will continue to spearhead its mission to promote safety and tighter regulation within the sector.
One of her main concerns is the “trivialisation” and “glamourisation” of both surgical and non-surgical aesthetic procedures. She says, “We live in a society that increasingly connects via a virtual world and Instagram posts don’t always represent reality. Aesthetic surgery in itself aims to address a specific issue and with it, promote psychological and physical wellbeing. This can only be achieved with appropriate patient selection and a clear understanding of realistic expectations of surgery and postoperative rehabilitation.”
To tackle increasing concerns around mental health BAAPS has revamped its code of practice to put mental health at the forefront, and has also been giving members more guidance on how to support their patients mentally. It has also developed a psychological assessment course to guide surgeons through these sensitive conversations, which will be available later this year.
“So much of what we do is about not just physical wellbeing but also psychological wellbeing and I think, particularly at the moment in this climate, psychology plays a huge part in the decisions that patients will make”, says O’Brien. “Over the summer we’ve been developing a new psychology course for surgeons, which I think is extremely important and I’m very much looking forward to being a delegate on it myself.”
A voice of reason
One of O’Brien’s other projects is a podcast series with herself as host, to open up conversations and raise awareness around plastic surgery, which will be called Knife to Life.
“It hasn’t been released yet so it’s a work in progress”, she explains. “Some lovely people who are key in the field very kindly agreed to have a chat with me and just open up those conversations.
“The first person I had the opportunity to speak to was Ruth Waters, who will be taking over as president of the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) in 2021. We will be working very closely together and it was so refreshing to talk to a colleague and hear about the person behind the mask.
I found it very inspirational listening to these colleagues who I feel very fortunate and privileged to know.”
1. Data from BAAPS annual audit- https://baaps.org.uk/baaps_annual_audit_results_.aspx
2. https://www.rcseng.ac.uk/careers-in-surgery/ women-in-surgery/statistics/