You're Funny... You're Hired!

Reconstruction Consult #2

After last week's reconstruction consult, I was thinking I would change the pace and get a consult from a male doctor. I thought surely a male doctor would try harder to preserve the size of my natural breasts.  I mean, doesn't it stand to reason that a male who willfully went into the business of breast augmentation and reconstruction is a "boob man"?  I thought so too.

So Wednesday January 23rd I went to the head and neck unit at ECMC to meet one of the male plastic surgeons that Dr. Lindfield recommended.  I was very leary about going to ECMC. I am not proud to admit my ignorance. It has the word 'County' in it, so I always assumed it was for people who couldn't afford to pay or had no health insurance.  It has the word 'County' in it, so I assumed it was dirty, run down, and poorly run.  When I first arrived for my appointment, my fears appeared to be confirmed. I checked in and had to use the ladies room. The only bathroom on that floor was a single seater and a woman lugging a wheeled cart full of clothes got in right before me and did not come out the entire time I was waiting in the waiting area. At that point, even if she did come out, I am not sure I would go in. The nurse who accompanied me to the room stopped at a scale in the hallway to get my weight (yay-my favorite part! Yes, that is sarcasm).  What made it so much better is that instead of standing next to me and writing my weight down, she kept walking to see if the exam room at the end of the hallway was available, and instead yelled down the hall for my weight. PRIDE = GONE.  Oh well, at least I can disappear into this exam room before anyone knows who just yelled their unusually high weight down the hall.

I waited in the exam room for quite a while for the doctor. This time I was alone because I was beginning to feel bad about all the work that my entertainment entourage was missing.  I am lucky enough to work for an awesome employer that has been more than flexible with me, but hubby and Dad's girlfriend are not so lucky. Hubby works for corporate america and Dad's girlfriend has other committments to take care of every day. At this point in the process, I felt that I was relatively certain what needed to be done and that I could make my own decisions.  Judging by my experience at ECMC thus far, I was going to be scheduling a 3rd consult with someone else anyway, so it was good that they didn't miss any work to sit in this boring, locked down exam room with me for 2 hours. By the way, I really still had to go to the bathroom....

Finally about an hour and a half after my appointment time the doctor came in. My first impression was "Hey, did you go to Timon? Didn't I use to drink with you in high school?"  I immediately felt at ease with this doctor and was excited to hear what he had to say.

Example of breast reconstruction with implants

This doctor communicated in a way I am used to - with a white board.  He came in with 3 different colored Expo markers and immediately went to work explaining the process of breast reconstruction with implants.  He explained that the whole process will take about 9 or 10 months, not counting nipple reconstruction if I want it (that still cracks me up.... ). He explained to me that if at any time during that 9 to 10 months if I develop capsular contracture, he will have to remove the expander, let it heal and shrink, and start over again.  If it is only a month or so in, this is no big deal, but if it is 10 months in, this could be a huge deal. I would only have 1 boob!  The doctor also noted that at this point, I had lost 15 pounds since January 7th.  If I continued to lose a lot of weight, I would need to have surgery again. I had thought that if I got implants now, they would always be the same size and the same perkiness. This doctor told me that this is not true... if I were to lose a lot of weight, the breast skin will sag just like natural breast tissue, but the implant will remain firm causing what he called "rock in a sock" syndrome. Yuck! At that point, he showed me an expander, a silicone implant, and a saline implant. When the time came, I could choose between silicone or saline. Silicone was much more realistic. It was soft and firm, like gel. The problems with silicone is that if there were to burst, it would not be apparent for many weeks or months because they leak slowly.  The government claims that the silicone is safe if it were to burst, but I still don't buy it.  The government says Twinkies are safe. Saline implants look like water balloons.  Natural breasts bounce. Saline breasts ripple. Enough said.

Then the doctor went to the whiteboard and explained the process of autologous reconstruction using the DIEP flap procedure. This was a colorful masterpiece on the white board. Unlike the TRAM flap that Dr Lindfield told us about (read that post), the DIEP flap doesn't take any abdominal muscle, allowing the recovery time to be much faster.  Unlike using implants, all the new breast tissue would be my own, so I would never need to worry about rupture, capsular contracture, or 'rock in a sock' syndrome because it is all my own tissue. If I lose weight, they would get smaller (oh darn), if I gain weight, they would get bigger. And it would age like a natural breast. Nothing more awkward than a grandma with silicone DD's. Once the DIEP flap procedure is completed, all I need to do is heal on my own and then come back for nipple reconstruction.  There is no annual maintenance.  However the initial healing is hard.  Not only does the chest need to heal, but the stomach needs to heal as well.  Where the implant hospital stay is a day, the DIEP hospital stay is 5 days.  The doctor also says that it may be longer before I return to work than it would be with implants. I have a computer job so I am pretty confident that I can work from home pretty shortly after getting out of the hospital. The DIEP flap procedure also carries risk of infection, like the implant reconstruction, but if there is any infection it can be treated with antibiotics, not another surgery. Then finally, with the DIEP flap, the breast size is only limited by how much stomach tissue I have to spare. Hence, I know that I will be just fine!

The whole time the doctor was doing his whiteboard diagrams he was making fun analogies and he was wearing a really cool tie. I asked him if he could show me some pictures of his past work. He said he had tons of pictures but he couldn't show me because he never asked any of his patients for permission to show them. (So at least I know this doctor has more integrity than my past boyfriends).  I told him that I willingly volunteer to be a model.... as long as he does a good job. ("And that's how she got into the internet porn industry....") 

After speaking with this doctor, I was leaning much more towards an autologous reconstruction using the DIEP flap procedure rather reconstruction with implants. I asked the doctor how soon I could get scheduled for the DIEP procedure, but he gave me the red light right there. He had noticed that I came to this appointment alone and didn't want me scheduling anything without talking to my husband and family.  Obviously I need the mastectomy and we all decided that I want reconstruction, so I was upset that he wouldn't let me make my own decisions.  He said I had come in wanting one procedure and within 1 hour did a 180 and now wanted to schedule a different procedure and I didn't consult with anyone. I could see his point, but I still didn't like being forced to delay.  The doctor told me to come back with my entertainment entourage and he would go through the entire dog and pony, including white board diagrams, with them so that everyone is on the same page. I, of course, was mad that I had to wait a whole week before I could even try to schedule. What could I do. No hurry, it's just cancer.