The Human-Tissue Saleswoman Who Advises Surgeons in the OR

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Photo: ERproductions Ltd/Blend Images/Getty Images

Anonymous
Hospital Sales Representative
Georgia

I sell human-cadaver tissue. And also one that is porcine-derived, which means it comes from a pig. Our tissue can be used for cleft palates. It can be used for burns, for hernia surgery. But its primary use is for breast reconstruction — for breast-cancer patients having mastectomies. It fits in alongside an implant during the reconstructive surgery.

Tissue that’s harvested from cadavers has to meet certain qualifications. The deceased needs to have been an organ donor. And while they were alive, they have to have been healthy, as in they can’t have had diabetes or been obese. All these qualifications are set forth by our company and the national tissue bank.

It’s amazing. I never even knew this existed until I interviewed for this job.

Nowadays, they’re harvesting not just tissue and vital organs, but femur bones, too. Bone can be used for several different things. I’m not as well versed in that because my company doesn’t do bone, but they do have a company that makes powdered bone that they do use for hernia repair. You can put it somewhere within that wound, and it regenerates; it helps support that hernia in the long term.

I have 80 different surgeons that I call on. I go into hospitals; I meet with the operating-room staff; they all get together; and I train them on my products. I also call on my surgeons in their offices. But a typical day for me is spent in the OR with a surgeon who’s using our product. Depending on the case, for breast reconstruction, the surgery typically lasts three to four hours. For a hernia, it can be anywhere from five to ten hours.

Usually, doctors ask us very simple questions in the OR. They’re not asking us surgical questions, like, “How would I fix this hernia?” But these surgeons use millions of different products a day, so they may have a simple question like, “What suture would I want to use with your product? Or what type of needle would I want to use?” A lot of surgeons ask what other surgeons are doing because they want to make sure they’re doing the same thing as well.

There are just so many products out there that they can use. Of course, health care is evolving and changing. Your surgeons want to use the best product that’s out there. But now, you’re also dealing with hospital administrators who need to save money and cut cost. For them, they can say, “Okay, there’s a competing product that’s not as good as your product, but it’s cheaper.” That is what I hear all the time.

Our company processes the tissue and harvests it. The way in which we process our tissue, we remove all of the DNA and all the cells, which is called the “bioburden,” so you’re left with just the extracellular matrix. It’s not everything that’s living necessarily, but you’re basically stripping it down to nothing without damaging the structure of the tissue, so the recipient body thinks it’s its own tissue. It’s basically bringing that tissue back to its pure form.

If the body thinks that tissue is foreign, it will reject it. It will either extrude it out of the body — push it, force it out of the body — or it eats it up and disintegrates it. It will push it outside of your skin. In breast reconstruction, the tissue is used to reinforce the skin flap. It creates an extra layer between the implant and the skin flap to keep the implant in place. It’s basically an internal bra. It provides the patient with a better aesthetic outcome. You can have your breasts reconstructed with your own tissue, but it’s a much more invasive procedure. You’re using your own tissue and skin, which is only as healthy as the patient. If you have someone with diabetes or obesity or cancer, there is a chance of those flaps failing and basically dying. With cadaver tissue covering the bottom half of the implant, it helps cosmetically. It decreases scar tissue. It decreases the chance of extrusion.

When the tissue is implanted, your body says, “Oh, there’s something here.” All your cells start migrating toward that tissue, and if it successfully recognizes it as itself, it starts growing vascular channels for blood circulation. Our tissue actually becomes your own tissue. That process is called “positive regeneration.” In breast reconstruction, when it’s successful, the new tissue “adheres” to the skin flap, for lack of a better word. And you can see that it’s working, because if there’s a follow-up surgery, when the new tissue is cut, it will bleed. You can see little capillaries, you’ll see little blood spots on it.

But if it’s rejecting the tissue, you can see a couple of different things. You start to see scar-tissue formations, which means that the body sees the tissue as a threat, a foreign body. It is starting to encapsulate around it. You can feel it underneath the skin if it’s not incorporating into the recipient tissue. It’s going to ball up. I’ve never seen it with our product, but I have seen it with competitor products. Surgeons will go in during breast-reconstruction surgery to do the exchange from the temporary implant to the permanent implant, and the rejected tissue is floating in the breast. They just take it out. They take it out and put our product in.

What really sets us apart from our competitors is that we’ve been around for the longest time, so we have the most clinical data. We’re able to speak to and sell through the clinical data that’s been done by institutions, by surgeons. We’ve been implanted in over 1.4 million patients. We have very low complication rates. We’ve never had our product taken out of a patient due to the actual product itself failing.

Tissue is measured by square centimeter. Depending on the hospital contract, it can be anywhere from $10 a square centimeter to $30 a square centimeter. The tissue that we have for breast reconstruction is all human-derived, and there is a variety of sizes, anywhere from a two-by-four piece to a contoured larger piece. It can go all the way up to a 16-by-20 piece in a rectangle size. Then our contoured pieces, which are more rounded, we have in several sizes, too.

Our product is expensive because it is clinically tested way beyond most of our competitors. The testing costs a lot of money. Some facilities are saying, “Well, the cheaper version isn’t putting the patient at risk, so we’re going to go with that.” The way health care is changing, it’s definitely going to be different.

I never stop learning. It requires so much time and devotion to understand the disease and the state of breast-cancer treatment, to understand the products and our competitors. The science is on another level. It surpasess working in pharmaceuticals, which is where I got my start, by 10 million. The best thing I can do for my surgeons is to try to be a book of knowledge. I can’t do that unless I’m constantly reading journal articles and clinical data. I never did anything besides Biology 101 in high school. You know, science was never cool in high school and college. When you really do it for your job, it becomes fulfilling. And with all the new information out there, it literally never stops.

I’ve been to our facility — of course, that is part of my training, to go where they harvest the tissue. It’s a very controlled environment. Very sterile. We look behind windows. We can’t touch the product. Some of our pieces are perforated, so there are little holes in them. That’s for better fluid communication. We can see them placing and puncturing those precise holes. There are certain shapes and sizes that can be ordered based on the patient’s needs, too. I’m typically not in those surgeries, to be completely honest.

They’ve invited me to come see the cadavers and observe the harvesting process. I’ve never done it. That is a very private time for a family. That is their loved one. Of course, the people who harvest the tissue respect the body in every way, shape, and form, but I have a hard enough time being in an operating room, watching a cancer survivor have their breasts reconstructed. It’s very humbling. It’s a very emotional thing for me. For the cadaver lab, that’s somebody’s loved one. Watching the harvesting of tissue doesn’t really impact what I do for my job. I certainly wouldn’t learn anything new from being there. My process starts once it’s sent to my company.

The Human-Tissue Saleswoman Who Advises Surgeons in the OR