November 26, 2015
Written by Shannon O’Brien (class of 2015-2016)
I woke up this morning with mixed emotions. I was nervous, but also really excited. The idea that I was going to be able to observe my first surgery had finally hit me and I was really looking forward to it. When I arrived at the hospital my nerves had peaked but I remembered what we had talked about at our meeting. I told myself to be confident and comfortable. I went up to the fifth floor and entered the main door, I glanced at the board on my way to the office and saw the charge nurse standing in front of the office. I asked her if I get the key for the scrubs in the office and she asked who I was. At this time I realized that my badge was flipped over and she couldn’t see my name and picture. I turned over my badge and introduced myself as one of Dr. Harken’s students from the OREX program. She told me I could go into the office and ask one of the people in there for the card to get scrubs. I entered the office and introduced myself. One of the women in the office gave me the card and told me to exit the way I came in and to go through the door and into the changing area.
I got my scrubs and went to change. After changing into my scrubs I found a spot for my stuff on the shoe rack and exited the locker room. I put on my hair cover and shoe covers and made my way to the OR board. I looked at all the names of the surgeries that were occurring and the one that caught my eye was a breast reduction. I saw the charge nurse again and she told me that that would be a good one for me to go in on because they were going to be starting in the next few minutes, I thanked her and made my way to OR 7. When I looked through the window to the OR I saw that the patient had already been sedated and intubated. The surgeon was scrubbing in at the sink next to the OR so I waited for him to finish so I could grab a mask without getting in his way. He introduced himself, Dr. Allen, and asked who I was. I explained and he told me it would be great if I joined them. I grabbed my mask, put it on, and entered the OR behind Dr. Allen. He introduced me to everyone in the OR and then he started talking to the nurse to make sure everything was in order to get started.
I was given a stool to stand on so that I could see well. This was amazing, I never expected to be this close but it was incredible. Dr. Allen explained that the patient was a woman in her early 60’s who was having this procedure done to help alleviate some of the back pain and discomfort she was experiencing from the size of her breasts. He explained that the patient was HIV positive and that extra precautions would need to be in place to ensure everyone’s safety. I was given a face shield because I was standing so close to the table. I started to wonder how the surgeon feels about operating with the risk of having a patient with HIV. The first thing Dr. Allen did was inject epinephrine mixed with saline into multiple areas of the patient’s breast to reduce bleeding. Dr. Allen explained that the patient areola were relatively small so he would not need to reduce them to match the change in breast size. He discussed that often the areola have to be reduced during a breast reduction so that they match the new reduced size of the breast.
Dr. Allen began making his incisions, he explained the need to isolate and maintain the pedicle, where the nerve and blood supply are, so that proper healing can occur and nerve sensation is not compromised. He began de-epithelializing the breast by slowly cutting and removing the skin. Dr. Allen explained that the patient has desired to be a C cup by the end of surgery, but explained that that might not happen because removing that much tissue might be damaging. The patient had been an E cup and was likely to end up with breasts about the size of a D cup. Dr. Allen explained that breast surgery is unique, because unlike other surgeries, the breast does not contain the same anatomical and vascular land marks.
Dr. Allen removed the tissue from the first breast and weighed it, he mentioned that he expected to remove slightly more from the other breast because it was a little larger to begin with. When Dr. Allen finished with the first breast (right), the nurse practitioner, Beazley, began stapling the breast closed. After finishing with the staples he made his way along the staple line with sutures, removing the staples as he went. Dr. Allen continued on the left breast with one of the residents assisting him. When he finished he applied the staples and the resident did the suturing. Dr. Allen then went to the phone and did his charting while the nurse practitioner and resident continued to suture. The surgery was 4.5 hours long with at least 2 of those hours being just suturing, I could imagine that their hands must have been pretty tired after that. I left the OR and thanked Dr. Allen for allowing me to watch.
Reflecting on the surgery I thought about the fact that I was really glad that the first case I got to observe was a plastic surgery case. What I like about plastic surgery is the fact that the results are so apparent. You are able to see perfectly clear what was done and the end result the patient will see. I was unable to see anymore surgeries that day because all the others were in progress when I got out of my surgery, but it was an amazing day and I am really looking forward to my next OREX experience.