By Henry Hsia, MD
It had been two weeks now. Her implant was gone and she was looking at me from where she sat on the exam table. Even though she had known it could happen, had signed the consent form indicating I’d told her that this could happen, I could tell from the look she was giving me that she never expected it would actually happen.
I knew better, but I admit I hadn’t expected it would happen either, especially to her and now. Several months had passed since the implant was placed. She didn’t smoke, never had radiation for her breast cancer, and had done everything I asked. She’d been doing well and at her last routine visit a month ago I’d congratulated her on making it through the reconstruction gauntlet. Back then, she had sat on that exam table looking at me with a smile of relief and gratitude.
But that was then. Some time after that visit I got the call she had redness and some drainage. During the ensuing flurry of evaluation and discussion, I had her focus on making sure the infection didn’t get worse and threaten her health. And with that in mind, we decided the implant couldn’t be salvaged and had to come out. The explantation had gone smoothly and she completed her antibiotics. She was doing well, except….
“So what’s next?” That’s what her look now seemed to ask me. At her initial consultation, she’d been adamantly not interested in autologous reconstruction. She didn’t want the added scars, the possible donor site morbidity, etc. And the last few weeks hadn’t changed her mind about that. But she also wasn’t willing to accept a bra prosthesis as a long-term solution. She wanted to try the implant again. I didn’t think that was a good idea without better tissue coverage. We were at an impasse.
In the end pressed for time, I punted the question to a future visit, telling her we had to wait a few months anyway. I’m sure it wasn’t the most satisfying answer for her and the lack of a clear plan left me in a frustrated mood. I was still feeling that sour mood when a few days later I found myself at the Plastic Surgery Research Council meeting in New York City.
"Having the opportunity to speak face-to-face with the surgeon and pick his brain about the flap made me feel a lot less sour about missing time with my family"
Even though I’ve always enjoyed going to these and other plastic surgery meetings, it’s been getting harder and harder each year to go, what with the squeeze of ever increasing expectations for clinical productivity and family commitments. As I wandered among the scientific sessions, my phone was a constant distraction as it buzzed with photos of my young daughters that my loving wife was sending from their weekend trip away along with text messages like “Check out what you’re missing!”
Then, looking up from my wife’s latest salvo of guilt-laden cuteness, I saw a poster entitled “The Lateral Intercostal Artery Perforator (LICAP) Flap for Outpatient Total Breast Reconstruction”. Forgetting my family (for just a moment), I immediately thought of my patient and went up and started chatting with the authors who were standing there. This flap wasn’t something I’d thought of during my patient’s visit earlier that week, and it was wonderfully fortuitous and timely to come across this particular poster. Having the opportunity to speak face-to-face with the surgeon and pick his brain about the flap made me feel a lot less sour about missing time with my family.
We had a great discussion and I left the poster looking forward to seeing my patient again. Even though I couldn’t be sure, at least I had a feasible option to offer that I thought she just might be willing to accept. Whatever frustrations and qualms I had about coming to the meeting had melted away. I stood there among the poster presentations and all the exciting and innovating work around me and felt a reinvigorated sense of optimism. Now this is why I go to meetings like the PSRC!
I took a selfie among the posters and shot it back to my bemused wife with the message “Hey, check out what YOU are missing!”