Breast Reduction

Beep beep beep beep the regular heart beat.

Whoosh, ventilator for every breath.

Acrid smelling blue paper drapes cover her face and head like an


Lay along both sides of the torso cascade over abdomen and legs.

Expose collar bone to navel, personality concealed,

An operative site.


Stretch the areola, sterile marker, outline a cookie cutter circle.

Stretch the skin, malleable sterile ruler, measure check compulsive


Compare lateral to medial, right to left.  Delicately draw the reduction


Purple ink lines mar the mounded silent flesh.


“15 blade.”

Score the top layer of skin, precise pressure known by rote, reveal white


De-epitheli-ize:  skin off the epidermis, pinpricks of blood seep up,

Leave the precious subdermal plexus of veins intact, the nipple’s drainage


Allow blood flow out.  Save the nipple.

Leeches in reserve for post-op use if veins grossly engorged.

Keep the nipple alive.


“10 blade.”

Deep pressure with steel through dermis, lay the flesh open,

Bulging yellow fat, islets of streaky white true breast tissue.

Thick red liquid wells.

“Sponge . . . Forceps . . . Burn.”

Touch cautery to forceps, electric current sizzles, minute puff of smoke.


Use cautery to cut, superheated fat falls apart, suction plume with a

miniature wind.

Ignore the burnt smell.  Pass off excised tissue.

Maintain a rich arterial pedicle for blood supply to the nipple.

Blood flow in.  Save the nipple.

Hemostasis as we go, burn each oozing vessel.

Sculpt shape size trim compare.

Art judgement experience training creativity.


“3-0 monocryl.  We’re closing.”

A small curved needle, fine colourless suture difficult to see without


Forceps hold tissue, needle driver glides the point through.

Petit pas de deux: rotate wrist, draw thread, tie a square knot,

Economy of movement, hands in synchronous motion around each other,

Come together, move apart.

Each meticulous bite reveals more of the soft final shape,

Pleasure to sew gaping tissue, create a new structure.


“4-0 monocryl.”

Finer suture to finish, as thick as a long straight coarse hair.

Run a continuous subcuticular stitch, back and across, tension just right.

The wound a thin line with no visible stitches.


Satisfaction in symmetry.  Archetypical form, pink healthy nipples.

A pound of flesh?  Two pounds less to carry,

No quibble she will be pleased with her new shape, ease on her neck and


Wash away the dried and clotted blood, gently place stark white dressings.

A modern treacle.