Dr. Robert Whitfield removed a breast implant using en bloc capsulectomy, a cancer surgery technique that removes tissue with margins intact. Pathology came back clear, but cultures from the implant pocket revealed an unexpected E. coli infection.
She did ask me to remove all the scar tissue, and we always did that anyway when I did a case, so that wasn't really an interesting or novel thing, but she did ask me to do it in an en bloc way. Okay, what is that? What is an en bloc way? Yeah, so that's where all this got interesting because that would be the first time in my career a patient came to me and asked me to do an en bloc capsulectomy. So en bloc is a pathology term. It's just take it out undisturbed with a margin because you're trying to protect basically the patient from tumor spillage. So you do it in cancer surgeries a lot, and I had done reconstruction for breast cancer, head and neck cancer, sarcomas, all sorts of things, and that was always the goal, was not to be inside of a tumor. You want to be out. So with that request, we did her surgery, and everything went well with her surgery. And about a week later, we were reviewing her pathology, which is the results you get to look for any recurrent cancer. And obviously if somebody's had cancer, you want to make sure they don't have a recurrence. And she did not. And then you look at cultures and there's a variety of ways to take them. We can talk about that. But traditional ways, take like a Q-tip and swab the inside of the pocket where the implant is, because you want to know if there was an infection or anything. And you can also send portions of it and have it. So we did that. And when we looked at that, she had an E. coli infection.
