Frantic Friday, split between the hospital and the office. Delivery of health care services is becoming increasingly polarized between the “acute” care centers and ambulatory facilities. My practice has evolved since its inception, focusing on aesthetic procedures, which are entirely discretionary and scheduled in the office setting. A month ago, a friend informed me that she had been diagnosed with left breast cancer, intended to have bilateral mastectomy and chose me as her reconstructive surgeon. Plastic Surgeons are essential team members in the treatment of breast cancer. It’s not as trivial as recreating the facsimile of a breast but more importantly restoring the locus of control to a patient who has been given a lifethreatening diagnosis.

Breast reconstruction methods can be broadly divided into “autogenous” (own tissue) vs “alloplastic” (tissue expander/implants). The fund of knowledge has expanded, delineating the indications for each, however the patient’s preference, institutional commitment and surgeon expertise all contribute to the success. My patient was succinct in her brief, “I’d like to be similar to where I was beforehand”. Her Surgical Oncologist and I collaborated on a surgical plan, (skin sparing, nipple sparing mastectomy) the intraop Pathology diagnosis was favorable and the availability of a suitable “space holder” (tissue expander), which simulates her preop appearance all converged to facilitate her recovery.

Gratitude. To the technically accomplished Surgical Oncologist who completed his mission, leaving a uniform, tidy flap, which serves as the basis for reconstruction. To the hospital team, who accommodated a Plastic Surgeon whose preferences were largely unknown. To my staff who protected the practice by tirelessly rearranging my day and taking care of patients while I was “MIA”. To scientific inquiry, which has made some progress in elucidating the pathophysiology of breast cancer, so that mastectomy doesn’t have to be “the operation that all women fear”. To the pioneers of breast reconstruction, who truly embraced Tagliacozzi’s vision of Plastic Surgery, “We restore, rebuild, and make whole those parts which nature hath given, but which fortune has taken away. Not so much that it may delight the eye, but that it might buoy up the spirit, and help the mind of the afflicted.” Most importantly, to my patient, who entrusted her reconstruction to me and in so doing, inspires me to do the extraordinary.

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