Breast eyes

Being a medical student can offer a glimpse into the lives of other people that few professions provide. Patients have revealed things to me that they haven't disclosed to their doctors, friends or loved ones, including some stories I'd rather not have been privy too. Sometimes that intimacy, be it emotional or physical, can overwhelm.

This week in theatre, I witnessed a number of breast operations, including mastectomies, lobectomies, cyst removals and enhancement surgery. For the final operation yesterday, however, I got more involved.

A lady had visited her GP regarding a growing lump she had noticed on her right breast. Unfortunately it turned out to be an invasive ductal carcinoma, and further investigation revealed a tumour in her left breast as well. To survive, she would need both her breasts surgically removed: a bilateral mastectomy. This would require more assistance than the previous ops, and it was decided that the registrar and house officer would operate on her left breast, whilst I scrubbed in and assisted the consultant to resect the right.

It wasn’t a particularly technically demanding case, and within forty-five minutes or so we were getting ready to send the resected tissue to the pathology lab. That’s not to say, however, that it wasn’t bloody (and, given that we used diathermy, that the smell of burning flash wasn’t in the air). Breasts are very vascular, and there were many spurting vessels as we made the initial incisions. When we had finished removing and before the surgeons had begun making the flaps and reconstructing the site, there were two big, crimson, almond shaped holes on either side of the chest. It was like staring down at two huge eyes where the breasts should be.

Breast eyes. From Bra Art. Not a particularly appropriate picture, but there aren’t many when you do an online image search for ‘breast eyes’.

Having breast surgery must be pretty traumatic for any woman (and the 300 or so men in the UK each year) diagnosed with breast cancer. From the psychological perspective (the fear of death or major morbidity, body image issues, effects on family and friends, sexual intimacy concerns, etc) as well the physical. And having surgery will almost certainly not be the only reason for visiting the hospital for investigation or treatment: lymph node biopsies, radiotherapy, chemotherapy and hormone therapy may all also be on the horizon. And like most cancers, it's a long term-diagnosis, even if we do all succeed and the patient achieves remission.

Gladly, the results of all this treatment is improving patient care. Since the Breast Cancer Screening Programme was introduced in England in 1988, there have been an increasing number of women diagnosed with the disease, but a steady drop in women dying as a result.

Source: http://www.statistics.gov.uk/cci/nugget.asp?id=575 

And like many common diagnoses, the good news is that future patients are likely to do even better and benefit from even more advances in surgical, medical, pharmacogical and psychological care.