Week 8 - Final week of immersion

I can't believe we just completed our last week here in the city! It was such a phenomenal time and I am so grateful that I had this opportunity. I learned a ton and was able to observe so many cool surgeries and procedures.

My last visit to the OR was the perfect surgery to end with. The patient was receiving a bilateral mastectomy due to cancer in her left breast. To reconstruct the patient's breasts, Dr. Spector performed a deep inferior epigastric perforator (DIEP) flap surgery. This surgery involved removing adipose tissue, skin, and vasculature from the abdomen and inserting it into the breast pocket. Removal of the abdominal flap was interesting to watch because the DIEP artery had to be carefully dissected from the rest of the tissue before the flap could be moved to the breast. During the removal of the flap, the breast surgeon and her team were working on removing the tissue from both breasts. I learned that when doing a bilateral mastectomy and only one breast is cancerous, there are two sets of surgical instruments. The surgeons would say "dirty" or "clean" when referencing which set of instruments they needed.

After all the breast tissue was removed and the flaps were dissected from the abdomen, Dr. Spector and Dr. Cohen, the other lead plastic surgeon, were almost ready to place the flaps into the breast pocket. The next step was to gain access to the internal mammary artery (IMA) and internal mammary vein (IMV) in order to provide a blood supply for the flap. To do this, portions of the rib were cut away and the IMA/IMV were located. Finally, the artery and vein from the flap was anastomosed to the IMA/IMV, the flap was carefully positioned inside the breast pocket, and the patient was sutured closed. After about 10 hours, the surgery was over and I left the OR for the last time. Assuming I don't find myself unexpectedly in an OR anytime soon..

The last 8 weeks have been incredible to say the least.. I am definitely going to miss my adventures here but I am also looking forward to getting back to Ithaca!

Kylie Persson

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