This is a really belated blog entry. This is how long I take to recover from assisting in OTs on certain days. Haha… I’m definitely not into surgery. By and by I do get the RUSH from all that cutting and fixing stuff together, but I don’t see myself doing this for the long term.

Anyway, was sent to OT to help out with a case… I thought it’d be a fast in fast out case… but… I was sorely wrong…. It turned out to be one of the longest cases I’ve assisted on during this month but it was also the most interesting of all the ops I’ve been present at.

It was a skin sparing SMAC with reconstruction with TRAM flap ie. Take out the breast but sparing the skin, and all the armpit lymph nodes and do a tummy tuck and use the fat from there to make the new breast.

To put it simply, and so that non medical people won’t be put off by all that jargon (if they haven’t already sworn off my blog)…
1. Core out the breast with the cancer like how you remove the fruit from the pumpkin from the top and leave only the skin.
2. Make a small cut at the armpit area and take out all the nodes you can find.
Simultaneously, the plastics:
3. Make an elliptical incision across the tummy in the area encompassing the belly button.
4. Make cuts around the belly button so that it’s separate from the rest of the tummy fat.
5. Find the vertically arranged rectus muscle on the side of the breast you cored out, and cut off the end that connects it to the lowest part of your tummy. (of cuz there’s all that ligation of arteries and division of the Scarpa and sheath)
6. Undermine the edges of elliptical incision (ie. Separate the fat from the muscle wall both above and below the elliptical cut area you made)
7. On the elliptical flap, draw a circle approximately the size of the missing area on the top of the breast.
8. De-epithelialise the area around the circle (ie. Skin the flap), make sure no remnant skin left behind or the recon will result in cysts.
9. Then tunnel this L shaped pathway from the breast to the mediastinum (centre of chest) and vertically down to the flap.
10. Push the TRAM flap, together with it’s stump of muscle up through the L tunnel into the cored out breast.
11. De-epitheliase more of the skin such that any skin under the edges of the opening (where the nipple used to be) would be dermis.
12. Sew yp the edges using yr vicryl 4 and ethilon 5.
13. Break table. Flex the pt’s hips and then pull together and secure the Scarpa’s fascia, then the outer layers…

END RESULT: Breast reconstructed and a TUMMY TUCK at the same time! TADAAA!!!