I was supposed to have pre-admission clinic but lo and behold; there were no patients for me there either!!!! I had mixed feelings. I felt disappointed because it meant I still have no work to do today. But I also felt relieved because pre-admission is one dreary job!
Anyway. One of my consultants was operating today on her elective list (not on call) so there was something to do. We had 3 cases...cewah.. I thought we'd be finished by mid morning. We didn't finish all of them until nearly 4.30pm!
Case #1: bilateral mastectomy and insertion of tissue expanders (duration: 4.5 hours)
So this patient had cancer in her right breast but she wanted both of the breasts out because she had a family history of it (therefore high rate of recurrence).
She wanted immediate reconstruction (versus delayed a few months/years) so this surgery was a joint venture between my consultant (general surgeon) and the plastic surgeons. We first did the mastectomy in an unusual fashion.
The surgeon made a cut around the nipple, then "shaved off" the breast tissue (contents) from the surrounding skin. She then pulled out the entire content of the breast from the hole made at the nipple area. It was done this way to preserve the breast skin so expanders could be fitted it. So you can imagine a breast with a gaping hole at the nipple and its contents empty.
After that the plastic surgeons came in and put in tissue expanders in the empty cavern where the breast tissue was. This will keep the skin overlying what used to be the breast remain stretched so that implants can be put in at a later date.
This is an excellent way to preserve cosmetic aspects of the breast. In ordinary mastectomies, the whole chunk of breast would be removed including the overlying skin. Therefore if someone decided to have a reconstruction, the plastic surgeon would have to take skin from elsewhere (back of thigh, abdomen) to "make" breasts again.
Case #2: Insertion of port-a-cath (duration: 1 hour)
Bosan. But still I'll talk about it. Hahaha. A port-a-cath is a long term catheter that is put inside a big vein; namely the subclavian or superior vena cava (huge vein which ends right at the heart). It helps patients who need long term intravenous (through the vein) medications like chemotherapy, antibiotics, blood transfusions, haemodialysis avoid multiple needle jabs. The catheter remains in the patient's chest and is used whenever needed.
Case #3: Bilateral mastectomy and sentinel node biopsy (duration: 3 hours)
This was another patient with only one-sided cancer but who opted to have both breasts out so that she would be "symmetrical". I don't blame her...she was big-breasted, therefore if she only had one breast, she'd be lopsided and bend to one side hehehe.
This was the regular mastectomy; cut the breast off, the whole breast and nothing but the breast.
To save time, we split into two "teams". The consultant and I worked on one breast and the registrar and the medical student worked on the other breast. We both had our own scrub nurses too. Lumba la konon2 sape siap dulu. Mesti la consultant menang la kan haha. We had fun.
It still took a long time though because:
1. the patients breasts were enormous (1kg each!!! yes, we weigh them after we take them off) so it required extra work to cut it off from the chest wall. And it kept getting in the way of the knife/diathermy. At least now the patient is 2kg lighter!
2. the patient's breast was rich with blood vessels (well, all of ours are but hers more so). So she kept popping arteries. Spurts of blood here and there and everywhere like fountains (not exaggerating here). Aiseh. Tension. In fact one of the spurts hit me in the side of my face. Euwwwwww!!! Kotor gak tudung but saved by the balaclava worn over it. Ada splash mark lagi...lupa nak ambik gambar hehehe! Scout nurse baik..tolong basuhkan muka yang ada dot2 darah.
Interesting but man.. how tiring. I have great respect for surgeons. Operating all day long is exhausting physically and mentally ..what more those who operate day and night or every day.
6 comments:
eh kalau operate breast and reconstruct, is the breast still sensitive to touches? what about those yang besarkan breast and bubuh silicon or whatever they put in there.
anyway rasa betul2 macam doctorlah now that your entry dah ada blood spurting and all. (not that dulu tak macam doctor of course)
Masih sensitive kan? tapi tak bley breastfeed.
Err how does it look like? benda kat dalam breast. A lump of meat saja ke, ada tak terkeluar arteries? how's the shape like? memang err cone-like or takde shape?
What do they do with the bio waste?
yang part darah memancut tu, akak ngeri.
lollies- sensation is in the skin, so if the breast skin is intact there will still be sensation even if the breast contents are removed/implants inserted. i dunno if they have to use skin grafts to re-fashion the breast that the sensation would be the same or not.
k nina- the contents look like a blob of fat. sorta like this:
http://www.pathology.washington.edu/about/education/gallery/jpgs575/spb/img0034.jpg
amazingly the shape of the blobs of fat look exactly the same as it would on the outside.
taklah, the arteries are very small, maybe 1-2mm in diameter. usually they clip it or burn it off so it should spurt or bleed
k aini- hehehe. it was fascinating actually. wpun artery tu kecik tapi darah tu memancut tinggi because the pressure of blood in the artery is high. pas tu pancutan tu pulsating following the pulse rhythm.
* so it should not spurt or bleed
oh ye..biowaste. it's first sent to the laboratory for testing bla bla. then it is rightfully incinerated.
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