To Reconstruct or Not?

At 9am yesterday, I went to my finalizing appointment with my cancer surgeon. Prior to that appointment, at 8am, I met with the reconstruction surgeon who would be working in tandem with her. This doctor gave a Keynote presentation on his iPad which showed us the different options available -- then based on my frame and size, which one would be available to me.

It was a surreal appointment. I was like dear-in-headlight a good portion of the time. With each example he had visuals of results. These are former patients with former issues -- basically some of the situations that went wrong and he fixed from other surgeon's surgeries. So the fact that he could fix these made me feel confident about him as a surgeon. For instance, some people had a reconstructed breast that was completely uneven with the other so he got these symmetrical.

His presentation seemed to focus on everything that could go wrong. He said he likes to prepare patients about those possibilities -- infection, bleeding, subsequent surgeries -- so that patients are aware and can make an informed decision. BUT he also emphasized that his goal is not to deter patients -- just inform -- in case something did not go right. In my case, he said there was a 92% chance of having none of the complications he mentioned. He said getting a new pair of breasts is like shopping for a car. It's not a permanent life solution he continued. He said I might need to get a tune-up or new car down the road at some point if I live another 40 years. He said these don't last forever. AND the initial upfront surgeries are something to consider.

The surgeon educated us on three types of surgeries: a flap, an implant, or no breast enhancement at all.

• A flap is removing excess fat from the back, the belly, or other location and then using this to reconstruct the breasts.
• An implant is basically a gel-like substance that is inserted on top of the pectoralis muscle.
• No breast enhancement means nothing inserted.

With the flap, he could use a layer of my latissimus dorsi -- but this recovery is long. He could also use my current stomach -- but he said with my active lifestyle it would limit my core muscles in activities like playing with my son or running. And while I have some belly extra, I don't have enough for reconstruction.

With an implant, the surgeon works in multiple stages. Approximately up to 4 surgeries. The first surgery is the day of breast removal. He would stick in a device called an expander behind my pectoralis muscle, then sew me up. For about a period of 4-6 months he would inject a substance into the expander (looks like a deflated balloon shaped like a disc) with the goal of gradually stretching out my pectoralis muscle). At the second surgery, roughly at 4-6 months, he would then remove the expander and swap it for a gel like implant. Cadaver skin (yup, skin from dead people who donated) would form part of the outside area to lift this implant. Then follow-up surgeries would tweak the original surgery. He said this would roughly be a 9 month -12 month total segment of my life. Complications include infections, bleeding, necrosis (the top layer of my original skin which is kept; if it doesn't survive the lack of blood supply which it originally got from the mammary ducts, then it dies and turns black so then they would have to remove).

With the implant, there is also the weight to the size to consider. If you go with saline, it's roughly 400 grams for a 400cc implant. This is close to a pound (roughly 450grams is a pound; Add another 15% for silicon). So a pair of 400cc implants, (400 per side for a total of 800 grams), is close to 2 extra pounds. This doesn't sound a lot in the body grand scheme of things, but try doing an hour exercise video with a pound in each hand and the body tires-- especially the upper body. I can see why back and shoulders seem to be the complaint. I can see sleeping on my back with a pound on each chest as heavy over an eight hour night. Defintely something to think about.  

With no breast, someone still has to close off the surgery that removes the original breast. It could be the cancer doctor, it could be the reconstruction surgeon.

In all cases there is no nipple. So then there is the option of creating a nipple then tattooing the color unto that area.

I told them to go ahead and collaborate their schedules (the cancer surgeon and the reconstruction surgeon) -- which is either 2 or 3 weeks away from now. With this, they still have to collaborate with the hospital which is why I don't know the specific date yet. I should find out today.

I'm ok now with having to go in and remove the breasts due to the cancer. I've accepted this part and know it's part of my reality and just want to get it over with. The reconstruction part for me is still not as clear. Part of me just wants to just not have to go through anything else -- just remove the breast and I can live with no breasts. But if I change my mind, which is fine, I have one extra surgery. Different people I talk to tell me I'm young and I'm going to want to have breasts. I don't know.

So, to get my mind off this, we went to the happiest place on earth -- Disneyland. And all I could do was stare at other people's breasts in search of flat breasts. I only saw one during the whole day -- and it was on Jesse, the character from Disney-Pixar's Toy Story.

Sigh or gasp?
I don't know yet.

Additional resources:
http://breastcancer.about.com/lw/Health-Medicine/Conditions-and-diseases/When-to-Have-Breast-Cancer-Reconstruction.htm

American Cancer Society
http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-overview-treating-surgery

http://www.cancer.org/cancer/breastcancer/moreinformation/breastreconstructionaftermastectomy/breast-reconstruction-after-mastectomy

Johns Hopkins
http://www.hopkinsmedicine.org/avon_foundation_breast_center/treatments_services/reconstructive_breast_surgery/

Cancer.org re When radiation happens
http://www.breastcancer.org/treatment/radiation/when_appropriate

The oncologist
http://theoncologist.alphamedpress.org/content/7/6/539.full

How heavy are implants?

http://www.realself.com/question/400-cc-breast-implants-weigh