When I first saw this patient in June, 2006, she was lying in bed, with a shawl covering her upper chest. I thought she was nursing a baby, until I took a peak. She had an enormous left breast mass that was sucking the life out of her. She was too weak to walk. She had surgery previously and when the tumor recurred, she gave up.

It was obvious that resecting the tumor would be challenging. The veins feeding it were bigger than my thumb. I called in Dr. Mike Enyinnah-a previous resident of mine and now a great surgeon. We had planned to slowly remove the tumor and keep the bleeding under control. But as Helmuth von Moltke the Elder stated “No battle plan survives contact with the enemy”. The bleeding was so fierce that it was audible. Finally, we just took a scalpel and cut off the tumor as fast as possible. Then we compressed the wound and the bleeding stopped! 

After several weeks, the wound was granulating well and we placed a skin graft. The patient came back 6 months later and had gained about 35 pounds. She was so thankful.

The pathology showed cystosarcoma phylloydes which is generally a benign sarcoma tumor of the breast. The patient had radiation therapy after surgery and remains tumor free.

This was an intensely satisfying surgery with a happy ending. Of course, not every surgery ends so happily.