Beware of the MASSIVE BREASTS

Tuesday, started off great with my unnamed colleague and I dodging a 65 year old male with multiple MIs (who declined CABG) for a SCC resection and flap.

No ICU bed 😎

Our second patient, a 15 year old with massive breasts (gigantomastia) coming in for breast reduction.. ASA 1, healthy and well .. starting HB 13.

Discussed with Dr Mokapela, got told ‘watch out, they bleed’ us - got two large bore IV lines, gave cyklokapron and called blood bank to check if there’s a crossmatch. BRB was ordered but not in theatre yet.

the plastics team were 6 surgeons, three on each breast.. our bps were holding and our ringers trickling in.. an hour into surgery and the surgeons remove both masses at the same time…

in less than five minutes after masses were removed, our sats disappeared, bps unreadable and end tidal CO2 started dropping !! And dropping fast …..

PEP infusion started, voluven pushed and adrenaline boluses given, and almost like the universe wanted to taunt and reward us, the blood arrived at that moment us BRB blood that arrived at the moment of panic. Thank god !

Pushed in the units of RBCs and some fluid and some praying and TLC and our patient thankfully was fine !! Hb at waking up - 9.8😎

Lost 3L !!! and had blood everywhere from the floor to the bed to the surgeons shoes to the massive pile of swobs !!

Learning points from our disaster

  1. Breasts BLEED (3L in our case😭) and they bleed fast !!
  2. has Anyone else noticed that swobs are only hung after you’ve brought your patient back from raisin town and not in real time !! I feel this should be something we address with the sisters, we only notice theres 20 soaked swobs after the fluid resus.
  3. Preload, co load and just have lines ready !
  4. Next time I will have an A line, and blood in theater or even in the warmer waiting for me 😭
  5. Never again will I underestimate a breast reduction !!