Week 3 - Breast Surgery, An Often Necessary Procedure

What a busy week this has been! In addition to shadowing Dr. Grant on his cases, I also viewed surgeries done by Dr. Tousimis (Casey’s mentor) and Dr. Schwartz (David’s mentor). I have realized that every surgeon has their own techniques, styles, and preferences while operating. The residents, fellows, and medical students rotate with a different surgeon each month so it was interesting to see how the newest set of students interacts with Dr. Grant and the styles they have learned through other surgeons (since they switched on July 1). I have learned that it is essential to talk to as many physicians as possible about preferences and ideas before designing a product that will be used by them as everyone will have a slightly (or even drastically) different opinion about what is best.

A patient who had a breast reduction during my first week of summer immersion came in for her first post-op appointment. I was excited to see how the woman was doing after having her breasts ‘exploded’ to remove tissue and create breasts that were more proportional to her frame. To my amazement, the patient was extremely happy with her procedure and could not say enough good things about how much better she felt. In fact, she said that the pain due to the surgery was not as bad as the back pain that she had been enduring for years due to her enlarged breasts. I honestly expected the patient to be in much more pain since she had an extensive surgery just 10 days prior but it proved to me, once again, how much of an impact surgeons can have on their patient’s lives.

Another patient came to the office because her silicone implants from a surgery 10 years earlier had ruptured. Silicone implants have an average lifetime of 10-20 years and the manufacturer will pay for the second (or even third) set of implants so that the patient only has to pay for the surgical fees. The breast with the ruptured implant had noticeably more ptosis than the contralateral breast. It was determined that the implant had ruptured by palpating the area. The silicone will be removed in a subsequent surgery in which both of the implants are replaced and the breast in slightly lifted (the patient would like to maintain breasts that are normal for her age and body size). She was very satisfied with her first set of implants and had no reservations about replacing them.

My most surprising case of the week was a 61 year old woman who presented with an extremely large cystic-like breast cancer tumor—it was about the size of a basketball. She was very embarrassed by the situation and warned Dr. Grant and I that it was very “gross” before showing us. I had to fight to maintain composure when she removed her gown. I do not understand how someone could allow a tumor to grow so large without seeking medical attention. The woman only weighed about 100 pounds so the breast with the tumor was clearly visible outside of clothing as a deformity and must have been growing for years. Dr. Grant will use a skin graft from the patient’s leg to close the large wound that will be created by excising the tumor. I will be sure to comment on this case more after surgery occurs.