Case of the week - September 20, 2007
Sep 20th, 2007 by Terry
Breast cancer.
Two words that strike fear and horror into every woman’s heart. When a woman’s breast cancer requires a mastectomy, the effects on her self-image, her sexuality, her ego, and her soul can be devastating.
Mastectomy with immediate reconstruction is an option for women today and offers a viable way back from the disfigurement of a mastectomy. At XYZ Hospital, the two surgeries are done in tandem, with a breast surgeon removing the breast(s) and a plastic surgeon reconstructing it after.
A muscle flap will be transposed from either the abdomen or the back to build up the chest wall, and a temporary tissue expander will be inserted to give the area some stretch in order to accept a future breast implant about 2 months down the road. After the permanent implant is placed, an nipple and areola are created surgically (and artistically) that looks quite authentic; the skin is even later tattooed and the finished “product” looks GREAT and natural.
These women are quite scared to death, and one of the first things that we anesthesia providers can do for them is to provide some chemical sedation through their IV before the surgery. This makes a world of difference to our patients, as most of them have hardly had a good night’s sleep since receiving their diagnosis. The surgery itself takes quite a few hours (about 5 on average), and requires a general anesthetic with an endotracheal tube. There is generally very little blood loss, but it is important to keep these patients pain-free, adequately hydrated, and warm. Their position may be changed a couple of times during the surgery, as access to the flap muscles requires turning the patient from front to back, or front to side, and then return to front again. So positioning of the patient is of utmost importance, taking care to keep the person’s alignment completely neutral, all pressure points padded, and supported.
Mastectomy with reconstruction never ceases to amaze me at the skill and artistry of these surgeons. And the hope and rejuvenation that they help to provide to the thousands of women who receive this diagnosis and choose this route.
I had a patient come in today and FINALLY tell me that she’s been having breast pain with black nipple discharge. After exam showed extensive dimpling, I asked her why she didn’t tell me about it the first time I saw her in July???? She said that she was embarrassed.
How sad!
P.S. Can you put a link up to my main blog The Nurse Practitioner’s Place? Thanks!
That’s a really nice description.
My wife, now a 2x breast cancer survivor, chose to skip the tram-flap the first time, and just wore a prosthesis. Then, a different cancer occurred in the -other- breast, so she opted for inserts on both sides after the second mastectomy. Plastic surgery is a nice field. Watching the surgeon draw on her chest was pretty amusing, even within the tension of the moment.
(And for those who worry about such things, I have her explicit permission to discuss her condition, surgeries, and outcomes in any reasonably medical context.)
Your writing skills are first rate and your insights about the patient experience are terrific. I hope family members are informed of the details in your post because they haven’t slept since the diagnosis either and it would be comforting to know their loved one is being treated with such competence and kindness.
Onehealthpro