Davey Bauer's doctors had a problem. Their 34-year-old patient's lungs were so badly infected with a drug-resistant strain of bacteria, they couldn't be swapped for a fresh set in a single move.
While medical specialists at Northwestern Memorial Hospital in Chicago had a machine that could take over the job of the absent organs for a few days while the body cleared any remaining infection, there was no conventional way to fill the huge void their removal would create in the patient's chest.
Fortunately for Bauer, his surgeons came up with a perfect solution: a pair of DD breast implants nestled in where his old lungs once sat.
"Someone who is actively dying and was so sick like David, generally, will have no option of transplant, and they generally just die," chief thoracic surgeon Ankit Bharat told Jen Christensen at CNN.
"We had to come up with a strategy to do something that we've never done before."
A pack-a-day-smoker since his early 20s, Bauer swapped tobacco for vaping in 2014, thinking like many it was the healthier alternative. When he caught influenza in April this year, his lungs were in no state to cope, rapidly giving way to a secondary infection that no antibiotic seemed to be able to clear.
Desperately short of breath, Bauer presented himself at a St Louis hospital, where the seriousness of his condition was quickly realized. He was put on an ECMO (extracorporeal membrane oxygenation) system to take over the lungs' task of balancing his blood's gasses, yet it was clear the clock was ticking.
"Davey's lungs were so heavily infected that they started to liquefy," said Northwestern Medicine pulmonologist Rade Tomic.
"If you looked at his X-ray, there was nothing left – the lungs were completely filled with puss. When we received a call from Davey's medical team in St. Louis, we thought we could help him, but it was also very clear he wouldn't survive the transplant in his current condition. He needed to clear the infection before we could list him for transplant, but the only way to do that was to remove both lungs. This was unchartered territory for us, but our team knew if we couldn't help Davey, no one else could."
Our internal anatomy is like a well-packed suitcase, with each organ physically supporting the positions of its neighbors. Some body systems might deal with the extra room, while others – like the cardiovascular system – rely on the surrounding pressure to function.
Lacking a precedent for prosthetic lungs, the medical team were forced to think outside the thoracic box. They needed something malleable, sterile, and made of a material that was unlikely to react with the body's already challenged immune system.
As it happened, breast implants appeared to ticked all the boxes, with double-Ds being the best fit.
Fortunately, Bauer had a lot going for him. He was relatively young, and as a landscaper, skateboarding enthusiast, and golfer, otherwise fit and healthy. He was also lucky – a day after his old lungs were removed on May 26, the team were offered a donor pair.
On May 28, Bauer had his temporary breast implants removed and a healthy new set of lungs put in their place. After several months of recovery and rehabilitation therapy, life is looking a lot brighter for the double lung transplant recipient, who not only has his health back, but a new gaming handle as well.
"I plan to get a t-shirt made that says 'DD Davey' on it and change all my gaming profiles," said Bauer.
"But in all seriousness, I'm so proud to be the first Northwestern Medicine patient to undergo this innovative procedure, and I hope this medical first paves the way for more critically ill patients to receive lung transplants in the near future."