Pepperney 1

Surgery Observation

I had the opportunity to watch plastic surgery this week. The one particular surgery I saw

was a breast implant reconstructive surgery on a patient with stage two breast cancer. The patient

went through both chemo and radiation, and had both breasts removed. The patient had breast

cancer in only the left breast, but chose to have a total mastectomy as a precaution. Since the

breasts were removed, she chose to undergo reconstructive surgery in order to look like she once

did. The surgeons removed the spacers that the patient had in place in order to stretch out the

tissue to place the breast implants. After removing the tissue expanders the surgeons placed an

antibiotic solution into the tissue to ensure there was no infection from the spacers. They placed

the solution, and then suctioned it out. The surgeons tried two different implants to see what size

worked best. After deciding on the right size, the surgeons sutured the breast tissue and placed

gauze around them. Before taking the patient down to surgery the surgeon placed a bra around

the breasts to ensure that everything was in place.

Before surgery, food was restricted 8 hours before the scheduled time, and water was

restricted 2 hours before the procedure. Prior to this surgery the patient had a total mastectomy,

and had spacers placed in the breast tissue to allow for the implants to go in. The patient had to

be educated on the surgical procedure, and the possible risks that accompany it. The patient also

had many decisions that led her to choose a reconstructive surgery. She needed to be educated

about each of those decisions as well. This was a same day surgery so after recovering from

anesthesia the patient returned home after ensuring she had someone to drive her.

The room was quite and calm, and ran like a well oiled machine. The team consisted of a

surgeon, a surgical physician assistant, a scrub tech, a circulating nurse, two nurse anesthetists,
 Pepperney 2

and a student nurse anesthetist. The communication during the surgery was open and allowed for

all members to talk. Thankfully it was a very smooth surgery and nothing emergent was needed.

The surgeon and surgical PA operated as they removed the tissue spacers, cleaned the tissue with

antibiotic solution, and placed the implant. The scrub tech set up the sterile field prior to the

surgery, and assisted the surgeon and the PA with instruments and whatever else they needed.

The circulating nurse documented the procedure, called a timeout before starting to ensure

everyone was on the same page, and ran out of the operating room to get supplies the surgeon

needed. The circulating nurse along with the CRNA’s, went down to get the patient from preop

and bring her to the OR, and then after the surgery bring her to recovery. The CRNA’s

administered Versed in preop to allow the patient to relax. Upon getting to the operating room

they assisted her onto the table and helped to get her into position. They pushed medications

through her IV and medication through inhalation to make the patient unconscious in order for

her to undergo surgery. The CRNA’s watched the patient’s vital signs throughout the whole

procedure, and slowly weaned the patient off the anesthesia when the surgery was finished.

Before the surgery the nurse prepped the board in the operating room, making sure it had

the correct patient, procedure, allergies, and any medications given. The nurse also helped the

scrub tech as she was setting up her sterile field, and got any medications that were needed. SHe

then went down to the waiting area for same day surgery to visit the patient. She asked the

patient about allergies, and if she knew what procedure was going to take place. After asking her

questions, the nurse asked if the patient had any questions about the surgery or anything else, and

the patient did not. As an advocate, the nurse called a time out before the surgery to ensure the

right patient, procedure, and to make sure everyone was on the right page. From a nursing

perspective she was a true advocate. She anticipated the needs of the surgeon and went to get the
 Pepperney 3

larger size breast implants because the smaller ones were not working. She walked the patient

through the procedure on the way to the operating room, and provided her with even more

warmed blankets. After the surgery was complete the PACU did not have any beds to take the

patient. The nurse kept calling the unit to ensure placement, and she stayed with the patient the

whole time she was in the operating room waiting. Overall, I am really happy I got this

experience. It is nice to see other aspects of nursing, and to see things that I normally would not.