This last week has been very eventful. On Monday at the residents discussion the talk was on Breast Reductions.
First the discussion was on different types of reductions, mainly different types of incisions and techniques used to reduce the breast size. Then there was a good discussion of how to decide what type of reduction the patient will receive. Specific cases are discussed and the idea of what is realistic and what is not was gone over. Many of the scars after the surgeries are quite noticeable. Images from : www.aboardcertifiedplasticsurgeonresource.com.
Generally, an incision is made around the nipple and the nipple is then removed and a new nipple relocation is added to raise the nipple site to fit with the new smaller breast. Tissue is removed along with skin and then brought in downward to close over and shape the new breast. Scars will remain around the nipple, extended to the crease, and through the crease as seen in the pictures. Later that day, a patient came to office hours to be consulted for a breast reduction. Mistakes were also discussed where the reduction produced breasts that were very asymmetric and occasionally with nipples that were misplaced. Many of these complications arise because the doctor works with an assistant on one side or because of shifts from laying on teh operating bed to getting up. This really brought the talk together because I went from the academic discussion to the patient doctor interactions.
Additionally, I attended the M&M meeting Monday evening were complications for the past month in the plastics department were discussed. No patients died of complications, but additionally surgeries were required. In one case a tissue expander became infected after only a week and after taking intravenous antibiotics the patient opted to have the expander removed.
At office hours I was able to the progress of the patient I spoke about last entry and the V.A.C. has continued to help in wound closure progress. I also helped to remove sutures. The patient had a cut that ran down the side of the face and a second cut on the upper back. A running stitch was used to close the face face wound.
I also attended a butt flap surgery where a patient had gotten a bed ulcer after lying on their back for an extended amount of time. In order to close the wound the muscle above the wound was mobilized and swung down to close over the wound.
I have also spent time working on the Case Report that I am writing up. I have submitted a draft to the Chief Resident that I am working with to get feedback on format and wording.