Saturday, February 1, 2014

Surgical Plans

Back from the plastic surgeon with an update.

First, I don't remember the last time someone stared at my boobies for so long.  He pinch, pulled, poked, and drew lines with his fingers.  And I tried not to laugh when I had to stand in front of the plastic surgeon, him having one hand on my stomach, and one hand on my breast, with his head to side, eyes shut and concentrating.... It was like he was trying to crack a safe.

Anyway, down to business. We discussed a number of options and came up with a plan. I will be doing what's called a TRAM flap reconstruction, which means they are going to use skin, fat and muscle from my abdomen to recreate a breast. Unlike a traditional implant, this will feel real, be shaped more like my other, and it won't need to be replaced in 10-15 years. Plus, it will kind of also be like a tummy tuck at the same time. The down side is, I will have a scar from hip to hip, and I won't be able to use my abdominal muscles in a traditional way. They cut the muscles in the abdomen to be used in my breast, in the hopes that we can retain blood flow to that breast. But it will forever be gone and unusable from my abdomen. He said that the surgery will cause a hernia, which they will have to fix during surgery as well.

The whole process will be broken into three surgeries. The first surgery will be the mastectomy, sparing as much skin as possible. Then I will have radiation for five weeks. Then, I will have another surgery about six-twelve weeks later to prepare the muscles in my abdomen. Ten days after that, I will have the TRAM flap surgery. It's a very intensive surgery, and he said it will take 2-3 weeks before I will even be able to stand up straight.

The other option is not any easier or better. If I were to go the implant route, I would have what's called an extender placed behind my chest muscle.  They can't just put an implant under the skin, because there's nothing to support it, and the breast muscle will be removed with mastectomy, so it has to go under the main muscle against the ribs.  The extender is like a plastic sack with a valve. Every month they fill with more and more fluid over the course of six months or so, until my chest muscle is stretched out enough to put a saline implant. The process is very painful, and the end result would not look anything like my other breast. Plus, the implants are only good for 10-15 years, so it would need to be replaced by another surgery down the line.  

The goal is to look, feel, and be as natural as possible.  And my ultimate plan is to tattoo a design all over the breast with something Natalie is going to draw. I'd like it to look something like this.... TMI alert with the photo below.  

This is not me, but an image I took off the internet

It was a lot of information to take in at once. And there are a lot of major choices. But I feel I'm making the best choice for me, and I'm very comfortable with the surgeon.

I met with the breast surgeon this morning, and it started out weird. She walked in and said, "So what are you going to do?", and I said in a slightly confused way, "I guess I'm going to have a Mastectomy". She replied, "I guess you decided since YOU'RE the patient". I said, "I don't know what the heck is going on. What are my options?"  I guess we had some confusion, as she thought I had already met with the Oncologist, Plastic Surgeon and Radiation Oncologist.

It got a little better after that. She explained that she wants to see where we stand after chemo, so I will do an MRI in a couple weeks. They usually don't consider doing surgery for a month or more after chemo because of the risk of infection, so we have a little time. She will do the mastectomy on one side only (by my choice), then do radiation.

As far as reconstruction goes, they say there are better "pretty" results if radiation is done before reconstruction. They suggest reconstruction happens in about a year. There is an option to do both the mastectomy and reconstruction before radiation, but I'll have to discuss that in more detail with the plastic surgeon when I meet him on Thursday. And apparently, there are a number of reconstruction options.

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