Lydia's song--thanks for the 'amazing' inspiration

By Nicholas Economides, MD, PhD, FACS

October is a month of added significance: not only does it represent true autumn with the change of scenery and the self decorating of the trees, as they shed; it celebrates the campaign against breast cancer, a disease potentially signifying a true fall in someone's life.

I begin the month wearing a beautiful pin, the pink ribbon finely crafted with rubies. Mine is very special, as it commemorates two dear patients and friends, as well as my long-term commitment to breast disease, learned and practiced, struggled and completed, guided by an artificially inflicted memory of my grandmother's demise at age 48. I was not yet born when she died four weeks after her mastectomy.

My first significant challenge to restore the femininity of a woman's chest came early in my career as a plastic surgeon. Patricia had two grotesque scars covering her chest and revealing the outline of her ribs, all from a bilateral mastectomy, necessitated as treatment for her advanced cancer. When I met her, she had just been deserted by her husband, a Delta Airline captain, who literally could not cope with the deformity caused by the amputation. She wanted to renew her body image and to feel like a woman again. She was 38, a mother of twin girls.

After two uneventful and successful surgeries, she was able to wear a "C-cup" bra. In a span of one year, she became an active member of the local Cancer Society, eventually participating in a fundraising fashion show and winning the competition in the category of "Evening Gown." She was accompanied by her fiancée and her 12-year-old twins, who witnessed a truly metamorphosed loved one re-enter life's arena with unprecedented authority.

I became speechless when I was notified that the bone scan resembled a lit Christmas tree from her widespread bone metastasis. I truly had believed that I was part of her permanent "cure." Through her unlimited kindness, she reassured me that I had succeeded in converting her life to "full" again; she directed me to promise that I would remain a medical adviser and a friend to her daughters. She quietly passed away one year after her monumental fashion event.

Fifteen years later I met Lydia. She was happy to know that her lump would be cured with just a lumpectomy. Her oncologist cleared her for reconstruction. Lydia was 43. Her husband was very dedicated and at her side throughout my involvement. It was an issue of asymmetry, causing an imbalance on her shoulders and severe neck pain from the one side, which was excessively large. She asked me about my prior experience in breast surgery. I shared with Lydia and her husband illustrations and information from prior years. They did see Patricia's anonymous photograph, the one in her winning gown. I was subsequently able to rebuild Lydia's one breast and reduce the opposite, thus producing a highly desirable result. She was complete again.

It was six months later that she was told she had metastasis. There was an error in the staging of her cancer, where adjuvant chemotherapy was necessary but omitted. The oncologist's office had closed down without passing the critical information to his successor.

She had lost significant weight and wore a proper wig, still accompanied by her loyal, but now grieving husband. She informed me of her pragmatic understanding, fully aware of her inevitable destiny. She gave me the jeweled pin to remember her, Patricia, and all the unfortunate women who eventually succumbed to the disease. She sang beautifully as she rehearsed the first five words of "Amazing Grace." Her husband, a Methodist Church minister, silently wept.

Patricia's twins were later checked for the familial gene. They were positive. I orchestrated their skin and nipple-sparing preventive mastectomies conducting immediate reconstruction for restorative purposes. They have not missed their natural breasts and at the age of 40 look very much like Patricia, when she was the life of the Cancer Society 28 years ago.

Five years ago I received a call from a chiropractic doctor about a lady with neck and shoulder pain. He described imprints from the straps of the bra and inability to manipulate her neck successfully for pain relief. The patient was Lydia's daughter-in-law. I ended up performing a reduction mammaplasty, an insurance-approved procedure, resulting in a total cure for what is commonly known as "anterior chest wall syndrome," due to breast hypertrophy.

October is definitely a month of reflection for me. I owe to Patricia and Lydia all my zest for knowledge, skill and answers. Their fate was an absolute rarity for patients with breast cancer; their influence on me afforded me the opportunity to help numerous other women with all types of breast disease.

Today there is a myriad of options, sophisticated diagnostics, great results, cures, enhancements, prevention and preservation, through oncoplastic approaches in outpatient settings. Patients do not have to be amputated. Cases with previous breast implants do not have to be explanted. Plastic surgery has become the cornerstone in the treatment of any breast condition, simple or complicated.

Lydia's song resonates correctly: "Amazing" for our achieved accomplishments... and as the word "Grace" follows, the ultimate reflection and the elegance of the pin I proudly wear today.

Editor's note: Dr. Nicholas Economides is a board-certified plastic surgeon who has been practicing for 28 years. He has been with Holzer Clinic since 2002 and practices at the clinic's Gallipolis, Athens and Jackson locations. In addition to his M.D., Dr. Economides has a Ph.D. in academic surgery and has served as the senior plastic surgeon consultant for the Mroz-Baier Breast Care Clinic in Memphis.