Night at the museum

Last Thursday morning, my friend Emily sent me a link to an article in the Guardian about a craft event she thought I *might* be interested in. Ten minutes later, I had booked a flight the next day to London, with the sole intention of spending the evening at the Royal College of Surgeons. I emailed Perri Lewis, the article's author, to ask if she would meet me. I danced around the room in my dressing gown when she replied to say yes.

Perri described "All Stitched Up" as "an event at the Hunterian museum in London where medical professionals and knitters are being brought together to swap their stitching skills." In essence, it was a workshop in craftsmanship of all kinds, including knitting, weaving, spinning and, the reason I was there, surgical suturing. The Hunterian was utterly absorbing: row upon row of skulls of various types, graphic videos of surgeons at work, cabinets of curiosities winking at me from their formaldehyde.

My night at the museum couldn't have been more timely: up until then, I had been writing about mastectomy and reconstruction using oranges as an educational tool. Along came an event which filled my mind with a wealth of analogous possibilities. I was particularly struck by this: "surgery, derived from the Greek words for 'hand-work', originally described the manual care of injury and disease." Perri introduced me to Akan Emin, the surgeon and research fellow she interviewed in her article, and he made me realise my oncoplastic surgeon is not only a doctor. He is a sculptor with an incredible eye for shape and proportion.

The combination of traditional handicrafts and science that All Stitched Up provided made total sense. I am passionate about translating the medical experience - and mine in particular, of course - into one that is more friendly, accessible and informative for women. I want to explore the ways I could help other women come to terms with what happens to their bodies during and after breast cancer surgery. All Stitched Up confirmed to me that it is doable in creative, surprising and inspiring ways. I can't wait to get started.

Thank you to the Hunterian for giving me permission to take these photographs.

Are you taking the pith?

Mr A has finished the fruit sculptures he promised me, but we had a misunderstanding. I was expecting a sculpture with incisions in the skin of the orange to show how they open the breast up to remove the tissue. However, last night he texted me two photographs of oranges to help explain more clearly how an areola is created during skin-sparing mastectomy and latissimus dorsi reconstruction.


This is the perfect strategy for beginners as far as I'm concerned. Think of the educational possibilities the surgeon and the orange could provide me with! I'm far less squeamish about seeing the peel shaved off an orange vs. the epidermis shaved off somebody's back muscle, although I do hope to get around to watching the latter sooner or later. In the meantime, I have commissioned the artist to make me a skin envelope out of an orange for a future date.


So, how is an areola made again? An ellipse is drawn on the patient's back, near the centre of the LD muscle. The surgeon cuts along the dotted lines, and separates the muscle underneath from all of the skin except that of the ellipse. Mr A says to consider the white tissue as LD muscle and the orange as the ellipse of skin remaining on the back. The circle, marked in the middle, is the future areola. 

Fig. 1.

The LD muscle is then swung under the armpit, ellipse of skin still in place, and brought around to the front of the body to form the basis of the new breast. The skin around the areola-to-be is carefully trimmed: skin has two layers, and in order to maximise the volume in the new breast, the surgeon wants to leave as much behind as he can. But he can't bury the epidermis, because it wouldn't heal. So he shaves the superficial layer of skin around the circle, the top layer called the epidermis, and leaves the dermis, the second layer, behind.

Fig. 2.

The muscle (the white tissue in the picture, remember?) is set in the skin envelope (the breast is ready to be refilled after having had the inside removed). The shaved bit of the ellipse is buried along with the muscle, so that only a circle of skin is left exposed: the new areola. I believe it's at this point that the surgeon reaches for his sewing kit, so stay tuned for your how-to guide on suturing skills: specifically, how to neatly sew an areola.

On medical accuracy

Such is my relationship with Mr A that he is willing to read my blog on a regular basis. He sends me emails pointing out which medical concepts I have fluffed up or misunderstood and then I come back to edit, rewrite or post anew.

This morning I got an email from him because he was troubled about the accuracy of the orange-scoring analogy. Okay, so I might have exaggerated it - I've only got two or three ray-shaped scars on my new breast (it's unclear for reasons I shall expand upon in the future). I suspect Mr A's problem is the photo of the orange I've featured has many more flaps cut into it than my skin had.

Now you might think at this point it is time to give up on the orange analogy. But Mr A is willing to work with me here:

"...orange peel needs to be modified. Idea is fantastic but tiny bit of change and I will try to do this for you tomorrow as I need to go buy an orange :)"

I can't wait to see what he comes up with. Who'd have thought I'd have my surgeon making me fruit sculptures in the name of medical accuracy?