The University of Chicago Laboratory Schools

From Personal Tragedy to Post Doctoral Triumph

Tokoya Williams, '00

Dr. Tokoya Williams, ’00, wanted to be a cardiac surgeon when she began medical school. But when she was diagnosed with breast cancer during her last year of medical school—leading to chemotherapy, a double mastectomy, and breast reconstruction—she was forced to put that plan on hold.

“As I was progressing through my journey with breast reconstruction, I realized that’s what I wanted to do for a career,” Williams, of Hyde Park, says. “The reconstruction was the one part that made me feel happy again.”

She decided to pursue plastic surgery to help other women with breast reconstruction after cancer, especially Black women like herself who tend to undergo reconstruction at lower rates than white women. Now, about ten years after she first found a lump in her breast, she’s working as a postdoctoral research fellow for one of her own plastic surgeons, Dr. Robert Galiano, at Northwestern Medicine. She’s helping with his research on racial disparities in breast reconstruction.

Patients seeking breast reconstruction have several options, which include using implants or using tissue from elsewhere in their bodies. As part of the decision making process, patients often view photos to get an idea of how each option might look.

Williams noticed, however, while considering which route to take for her own reconstruction, that it was difficult to find images of women of color who’d undergone the procedures.

“I found I really struggled to find representative photos of what different types of reconstruction would look like for me,” Williams says.

Galiano had also noticed a lack of pictures of women of color. He already knew that Black patients underwent reconstruction surgery at lower rates than white patients. One 2017 study out of the University of Pennsylvania found that even when women of color had private health insurance and lived in areas with many plastic surgeons, they still had breast reconstruction rates that were twenty-five percent lower than white women.

Galiano and his students and residents looked into the lack of photos, and found that only 6.7 percent of 2,580 photos of breast reconstruction posted by plastic surgeons on social media and websites were of nonwhite patients, according to a paper published in the peer-reviewed journal Plastic and Reconstructive Surgery late last year.

“It hinders the Black patient’s ability to make a fully informed choice if you can’t see photos that represent what you might look like at the end of this,” Williams says.

Williams and Galiano suspect issues related to scarring may be part of the reason for the lack of photos. For reasons that still aren’t fully understood, Black patients often tend to have more visible scars after surgery than lighter-skinned patients.

“My guess is we, as plastic surgeons, we basically are image-oriented,” Galiano says. “We really only present our best efforts. One thing that makes for a visually appealing result is if the scars are good quality and not prominent, not visible. The problem is women of color, just by virtue of biology, tend to have more conspicuous scarring, at least early on.”

But posting only photos of white women who undergo reconstruction “does our patients a disservice,” he says.

Williams is working on a computer program that patients could watch as they’re considering their options for reconstruction, and looking at how that program might help women of color, in particular. She’s also working with Galiano on how to improve scarring.

“When you feel like you have a mission in life, you work harder and you feel passionate,” Galiano says of Williams. “She’s making the most out of her disease, out of her experiences and her adversities and trying to make it easier for the women who come behind her.”

Williams is also hoping she can help address the disparities partly by becoming a plastic surgeon herself. As of 2014, only about 3.5 percent of plastic surgery residents were Black, according to a study published in the Journal of Surgical Education. “I think if we had more surgeons of color who came from those groups, that would be one way to get rid of that disparity,” Williams says.

Williams, who grew up in Chicago’s south suburban South Holland, knew she wanted to be a doctor from a young age. As a violinist, she appreciated the dexterity required of a surgeon. She graduated from medical school at the University of Illinois Chicago in 2013. After medical school, Williams completed preliminary training in general surgery, research at Stanford University, and a fellowship in burn surgery at Cook County Health. She now hopes to finish her training in the specialty of plastic surgery.  “I feel like I’ve finally arrived in a place where the work I do can be potentially impactful.”