anonymous
8th August 2019
The Moment of Truth - 3
THE MOMENT OF TRUTH
By DR C.V. MEHENDALE
I have repeated ad nauseum to my students the following
advice: "Alright, you are able to do a certain operation; your hands are
itching to add on more operation to your list; the patient, besides, wants to
have the operation done, especially if it is cosmetic surgery, the patient is
perfectly happy to spend money on the operation, but these, gentlemen, ARE NOT
indications for operation. The real indication for a surgical procedure is that
in the judgement of the surgeon, the operation is worthwhile and the patient
understands the benefits and the shortcomings of what is recommended." If
the shortcomings of the operation are not stated clearly, then the patient will
harbour false hopes leading to later unhappiness. The patient has every right
to say no and to seek another opinion. Who knows, another surgeon may be able
to lead the patient to the mirage he is seeking! The following story may be of
some interest to readers.
I had refused to do reduction mammaplasty in the early days
of my practice. This would have been my first case in private practice. A young
female patient came with a young man for consultation. She said she would like
to have her breast size reduced. It is my usual practice to inquire exactly
what it is that the patient wants—and why. The usual answer is that the breasts
are too heavy, too uncomfortable, bra straps cut into the shoulders, skin in
the groove below the breast often gets sore, walking, running or even bending
are ungainly etc. This young lady said she wanted her breasts reduced because
her fiancé (pointing to the young man) felt that they were too big. She herself
did not think so. Her mother and sister had similar builds.
I examined her. She was a healthy person with rather large
breasts. I pointed out to both the lady and her fiancé that they can be reduced
in size and given a better shape. The method I use leaves the areolae and
nipples with their natural sensation. Even though the milk-producing potential
of the heavy breasts is low, she could still suckle her children. I made it
clear that this was not a small operation; blood transfusion may be required.
Hospitalisation for a week to ten days would be necessary. The operation would
leave quite a long scar. However, if she so wished, a garment with a plunging
neckline or a bikini may be worn without revealing the scar. I told the lady:
"All this information is to help you to decide. I do not want you to
decide in favour of an operation in haste. As matters stand today, I will not
do the operation.” My statement appeared to have shocked her. I continued: "It
seems that you do not want the operation. I would not subject you to it, unless
you yourself want it. Reflect on the information given, then, if you still want
it, come back with the following investigations.” And I listed them.
A week passed; then another, but there was no further news
from the lady. One part of my mind said: "You muffed it! Your first reduction
mammaplasty in private practice, and you bungled it!". Another part of my
mind said: "To say 'no' was correct. Possibly she did not really want the
operation. Moreover, she is a Christian, her fiancé is a Punjabi Hindu. If
things do not go well for them in future, she would regret for the rest of her
life what, in her opinion, was an unnecessary operation. She had not by even
one word, expressed her wish to have the reduction"
She did re-appear almost three weeks after the first
consultation said I had made her do a lot of soul-searching. Now she knew that
she wanted the operation: "It was shyness that stopped me from saying that
I want the operation. I realise now that my fiance asks me to do this or that I
though I do not do all that he asks me to do”. She had a successful
mammaplasty. Later they were married and lived for about in Germany before
shifting to Canada. Their Christmas cards told all was well with them, for
about 5 years after the operation.
The opposite procedure, to increase the size of the breasts
with a prosthesis, is unfortunately very prevalent. It is a simpler operation
of a much smaller magnitude and leaves behind a very short scar. It is a purely
cosmetic operation. Lay people regard any operation on the breast by a plastic
surgeon as a cosmetic procedure. Then the patient has difficulty in getting the
claims for medical expense settled. This happened to a patient of mine who had
massive, nay, gigantic breasts. She used to wear a 'tailormade' bra which was a
marvel of British ingenuity (acquired at a recurring high cost). By doing a
well-deserved reduction mammaplasty I had removed a little over 2.5 kg.,
leaving behind well-proportioned breasts. She was thrilled with the result but
even more thrilled to tell me of her happiest moment-"to enter a shop to buy a
bra off the shelf like any other normal person". Suddenly there was a
change in her voice. This patient, who was getting on in years and was still
unmarried, said: "I wish I had got it done years ago". The intonation
said it all: the shame, the agony and the physical discomfort suffered over a
number of years. Her claim for expenses was refused by her company as they did
not reimburse cosmetic operations. I wrote to the company on my patient's
behalf. I brought the following points to their attention.
* In all
the years she worked with your firm she made not a single claim for medical
expenses.
* It is
true that some of the cosmetic surgical operations could be described as
frivolous, non-essential procedures intended to boost misplaced vanity. This
operation is not in that class. It need not be considered a cosmetic operation
just because I have improved the patient's shape.
* Please
remember I have removed her disability and her deformity which cried out for
surgical relief. If I had removed a mass even one tenth in weight from anywhere
else, you would have paid her medical expenses.
They did!