Hers was the first mastectomy scar I had ever examined. She was small, sweet, polite, Filipina. Her son was there, attentive, well-groomed, gracious. No, she had not been well since her last visit.
“Pan-positive review of systems” as we say. The symptoms were ominous. Constipation, sweating, backaches, headaches, fatigue, generally feeling bad. She had a new lump in her armpit. It was distressingly large.
I asked her the appropriate questions, characterized the symptoms, and then formulaically gathered the information I knew the surgeons would demand from me: how is the wound healing? Had she noticed fevers, pus from the incision site, swelling? No. None of these things. She wore a hat over her one inch of downy hair. It was one of those hats that was popular in the early 90s, a cream-colored poof.
Then the time came to look at what was done to her by the surgeons. I made her comfortable, a hand on her shoulder helping her lay down. I smiled warmly and it was easy to mean it with her as my patient. I helped her pull her shirt up, soft maroon-colored cotton. I switched to that neutral professional face I’ve honed, the face that is supposed to protect patients from my normally unedited roster of expressions.
And there it was: a pink shiny flat plastic-looking triangle in lieu of a breast. No pus, no redness, no swelling. “Check.” (The surgeons would be happy.) Seven neat stitches still in place. I re-form a smile, “It looks good! Healing well.” But in that poignantly naïve medical student way, I was horrified at how our job is to mutilate other people’s bodies.
Before I could leave to grab a suture removal kit, she had a question. She pointed to the far corner of her mastectomy scar, under her armpit, the lateral end of the incision. I saw it, a little nubbin of something. A little corner that protruded from her flesh just so. A little dog-ear haunting her previously flat side body. “Will this go away?” she asked. “No. No, I’m sorry, it won’t.” And I assured her this is normal after a mastectomy.
But then I did some reading about my assurances. The surgeons could have cut and sewn the tail end of the incision differently, so that the wound would be smooth and flat against the chest, rather than a “dog-ear,” a misplaced corner marking the outer margin of where the breast used to be. Why did they choose to leave a dog-ear on her chest? With all of their skill, their time, their education, why didn’t they do a simple surgical trick so that the end of this scar lay flat across the chest?
Two months later, at another hospital, I saw a different patient with a mastectomy scar. A tall white woman with artfully frosted hair and regal gold rings with diamonds. Her mastectomy scar was like her jewelry—artful, composed. No dog-ear in sight. No nubbin
left behind by a rushed surgeon or resident in training. No corner for a thing that no longer exists. I’m amazed, in fact, at how nice a mastectomy scar can look. Nice. A strange word to associate with mastectomy.
Although I wish it wouldn’t, my mind plays the two mastectomies side by side. Had my first patient had her surgery somewhere else, somewhere fancier, if she’d worn more gold rings instead of none, if she’d been taller, been whiter, had read more web pages or watched more Oprah episodes about breast cancer, would she have known to request the tailoring of her mastectomy scar so that there would be no dog ear? Would she have had a surgeon who would have never considered leaving a dog-ear? Or was it only the vantage of my comparative view that made this dog-ear so troubling?
A few weeks after I met her, I had checked in on my first patient. The armpit lump had been biopsied and it was cancer. She was in the ICU. She later died with the dog-ear still in place.