Tall, handsome, brilliant, bow tie, Brooks Brothers, consummate gentleman and master technician. Totally unassuming, modest, generous, and an unquenchable thirst for knowledge.
My first day on the plastic service, I was assigned to assist Brad Cannon, a senior master surgeon. We were performing a breast reduction. As the case proceeded, the breast seemed kind of square to me. I asked, “Why does the breast look square?” Brad explained, “when you pull the flaps down, they all come out square”. At that point the scrub nurse fainted and started to fall. I wheeled around and got my gloved hand under her head before it struck the floor. I lifted her legs and she recovered. We had both broken scrub and had to leave the room to re- scrub. Brad continued the surgery as if nothing happened. “Get me a new scrub” he calmly ordered.
I returned immediately, scrubbed, and gowned to finish the case. It was my first reduction. The breasts looked square.
The original scrub nurse returned just as we were finishing. “What happened dear?” asked Brad. “It must have been the square breasts sir,” she smiled behind her mask with a wink to me.
My second case that day was a breast reduction with James. We called him Jim. He was performing an inverted T reduction. I noticed that the breasts came out nice and round. After the case, I inquired, “I just did one of these with Brad and the breasts came out square. Yours came out round. Why?”
Jim came up and put his arm around my shoulders. He was tall and leaned over conspiratorially in a soft whisper as if this was to be a deep dark secret between us, “IF YOU CUT THEM SQUARE, THEY COME OUT SQUARE. IF YOU CUT THEM ROUND, THEY COME OUT ROUND “. He smiled that James May Jr. smile.
This was perhaps my first and most important lesson in plastic surgery!
REALITY CHECK
No matter how meticulous the technical mastery of the surgery, which is totally under control of the surgeon, there comes the healing phase which has a mind of its own. Every patient heals differently depending on the mysteries of their genetic code.
The best we can do is set up the conditions for optimal healing, (delicate tissue handling, tissue plane dissection, atraumatic suture techniques, drains, dressings, etc.) and the rest is up to nature.
Identifying potential complications early (hematomas, cellulitis, hypertrophic healing, allergic reactions, etc.) and dealing with them before they progress to disasters requires checking the patient the day after surgery now that in-hospital observation and recovery is unaffordable.
We have seen some rare but crazy anomalies and fortunately had the training and experience and luck to deal with them without worsening the condition.
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suite A Stuart,
FL, US 34994
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