OP report ...I begged for this surgery, they thought I was nutz....

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Op Report

Preoperative Diagnosis:

Right subclavicular chest wall tumor, complications of previous ruptured gel-filled implants.

Postoperative Diagnosis:

Right subclavicular chest wall tumor, complications of previous ruptured gel-filled implants.

Surgical Proceedure:

Excision of subpectoral intrapectoralis minor chest wall tumor.

Indications:

This is a 41 yr old woman who has had a very complicated, longstanding history of complications with implants. She initially had transaxillary subpectoral gel-filled implants placed that were then ruptured, removed through the axillary area and had them replaced by new gel-filled implants. In 1994 I proceeded to remove through an inframmary incicion the second pair of implants and as much of the siliconomas caused by the free gel left behind as possible. Since that time she has had one other operation in an attempt to remove additional siliconomas of both the medial aspect and the lateral aspect of the breasts and axilla as well as the right subclavicular chest wall tumor which I tried to approach both through approach both through the inframmamary approach and the axillary, with no effect.

She has developed re-currence of this tumor which has been enlarging and becoming more and more painful.

She wishes to have it removed at this time, understands the need for a scar over the chest wall that may be unsightly and is still willing to go ahead.

Description of Proceedure:

After satisfactory induction of intravenous access and sedation the patient had assisted in the marking of the palpable tumor of the right infraclavicular area. The skin was then injected with 1 % Xylocaine with 0.25 % marcaine with epinephrine adn after this had taken effect, the incision through the dermal skin and subcutaneous fat was followed by transection of the pectoralis major muscle along the direction of its fibers, obliquely brought down through the muscle onto what appeared to be a very yellow to grayish, firm, rubbery tumor that was very irregular and had multiple little pseudopods that grew up onto the subclavicular area through the subclavius muscle as well as onto the pectoralis minor muscle whose facia had to be removed in order to include the entirety of this tumor. Careful hemostasis was achieved throughout the dissection with careful ligation of any large vessels that impeded the excision of this tumor. The tumor progressed from approximately the mid to lateral clavicular area to the medial third of the clavicular area, always subpectoral and over the rib and pectoralis minor area. This was removed, again profuse irrigation with antibiotic solution was followed by hemostasis and due to the depth and extensiveness of the tumor which was on cut surface, found to be filled with gel silicone. A # 10 blake drain was left in the depth.

The pectoralis muscle was reapproximated loosely with several #3-0 figure -of-eight sutures and then the skin edges reapproximated with buried # 4-0 Monocryl followed by a subcuticular Monocryl closure. Then steri-strips were applied and a bulky compressive elastoplast dressing was applied over her chest area.

She was then transported to the Recovery Room awake and in stable condition.

Note: I had to mark where I could feel the tumor as she could barely feel it, it felt very small on the outside, and of course as you read, there was nothing that showed up on the MRI. I also told the anesthesiologist right before I went under to tell Doc that the tumor was much bigger and much deeper than we anticipate.

During the surgery, Doc was totally in awe of what she found inside of

me. So much, she paused the surgery so that she could show my family what she had just taken out of me. She could not believe it !

AGAIN, I WAS TOLD THAT IT WAS ALL IN MY HEAD THAT THERE WAS NOTHING THERE.....**************Looking for a car that's sporty, fun and fits in your budget? Read reviews on AOL Autos. (http://autos.aol.com/cars-BMW-128-2008/expert-review?ncid=aolaut00050000000017 )