Surgeons are often Type A personalities, the ones who sit in the front of the class, who volunteer for everything, who stay scrubbed in the OR all day with appendicitis and do a post-op check before checking themselves into the emergency department (yes, that was me.) As such, surgeons are often dismissive of the subspecialty of breast surgery. The surgeries are not as complex as cardiac bypass surgery or Whipple procedures for pancreatic cancer. In fact, it’s often a rotation for interns. I was a Type A personality. I had no plans to do breast surgery.
Then, a funny thing happened. I had my first son during residency. Planned with military precision, of course, to coincide with the beginning of my designated research years, as I had hoped to squeeze another baby in there somewhere. After his birth, I would breastfeed, because that is what Type A mothers do these days. It’s the best! Of course, I would do the best! However, like many mothers out there, we had an incredibly rocky start. Poor latch with inadequate weight gain. Triple feeding with pumped milk. Cracked nipples leading to mastitis. As a Type A person, I threw myself into research in an effort to solve the problems. Not just the many, many baby books out there, but Medline searches on breastfeeding management. I learned more than I ever had in my surgery textbooks about the breast, the physiology of lactation that is both incredibly simple and enormously complex, and most importantly, miraculous. I was reminded constantly in my reading of the importance of preserving this ability to breastfeed my son, for his and my health, and how challenging that could be.
I would sit in my office, working on surgical infections research, as I pumped and read about normal breasts and infected breasts and cancerous breasts. Antibiotic rotations in ICUs and glucose control became less exciting than being able to offer targeted medical advice to a frustrated friend in Boston, whose refractory mastitis was being met with shrugs from some of her local doctors until we correctly identified MRSA as the source. Maybe it wasn’t saving lives, but it saved her breastfeeding relationship with her child. Who knows, maybe in the end it would be saving lives! I read more about how breastfeeding reduces a woman’s risk for breast cancer, even among those with a genetic mutation called BRCA that usually carries a 50-80% risk. I couldn’t remember seeing that in my textbooks; if it was there, it earned such a tiny mention that to this day, my residents are often surprised to learn this. I encountered a woman in another state who had required bilateral mastectomy before her sons were born. Impressed with the efforts to which she was going to acquire donor breastmilk for her babies (luckily, safely and with screening), I donated 150 oz of stored milk.
My appreciation for the breast and the medical care of the breast grew. I entered my final years of residency torn between breast surgery and pediatric surgery, my original plan. Even on my ped surgery rotation, I managed to insert some of my independently gained breastfeeding knowledge, convincing my attendings that due to the easy digestibility and low reactive potential of breastmilk, breastfed babies should not have to be NPO (nothing by mouth) as long. I learned that breast surgery may be comparatively easy to do, but that it is much harder to do well. My breast surgery attendings taught me techniques to maximize the cosmetic outcome after breast surgery. I taught myself techniques to minimize disruption of the ductal-lobular units, maximizing the normal function of the breasts after breast surgery.
These days, after recently giving birth to my second son, I am back to seeing breast surgery patients. I see nursing moms with lactational abscesses, cringing with sympathy pain, mad on their behalf when they report bad advice which may have contributed to their infections. I see young women with benign disease and carefully explain how my surgical approach will preserve their ability to breastfeed, watching them shrug that off as unimportant, hoping that they appreciate it when motherhood is real and not something in the far off future. I see cancer patients daily. Some reminisce fondly about breastfeeding. Some weep over the loss or change in their breasts, not only because of their appearance but because of how their breasts make them feel womanly. Some joke a little that their breasts’ work is done, and that they don’t need them as much anymore now that the babies are grown. I go back to my office and pump, and think about these women and their breasts and my breasts and how crazy it always is that something that is life-giving can also be life-threatening. I remember the woman with breast cancer, feeding her babies with breastmilk from kind women. I think of my patient who was diagnosed with cancer at the end of her first pregnancy, operating on her with my own big belly while the reassuring beat of the fetal monitor played, and how disappointed she was to breastfeed only a few short weeks from her remaining breast before chemo started. I think of all this as I hold my baby boy at the end of a long day, my Type A tendencies relaxing, and he pops off my breast to give me a milky grin. And I am in awe and respect of our breasts.
Ed. note: A version of this post originally appeared at the Academy of Breastfeeding Medicine - click here to read.