Tuesday, March 13

Today Brad joined me to meet the plastic surgeon and learn all we could about reconstruction options post mastectomy.  I have been doing my homework. Brad on the other hand has just heard the tidbits I have relayed to him and  even when I tried to talk about it he casually commented that I should reconstruct but wouldn't really explain his thoughts.

This appointment was the one filled with the most emotion, at least to this point. It's difficult to describe what exactly I was feeling during that hour and a half visit. Fear-so much is still unknown (gene results, stage of the disease, treatment plan).  Anxiety-hoping I make the right decision for me. Humility-as naked photos of my bust and belly were taken for the surgeon's purposes to attempt to match my original shape and size. And lastly, sadness that I was having to face this and put my family through it as well.

The surgeon was wonderful!  Very personable and thorough. He started by explaining the expander/implant option.  A plastic form is placed at the time of the mastectomy with a port for injecting saline in small amounts over the course of time to expand the skin on the chest to ready it for implants. This can actually be left in instead of the implants if it is comfortable and has an effect the patient is happy with. If not then it is taken out after several weeks and either a saline or silicone implant is placed.  First know that almost all implants will need replaced or will have other complications requiring more surgeries at some point. He made that extremely clear. Also the end result is not as cosmetically pleasing especially over time.  The saline, should it rupture, "goes flat" fairly quickly. The silicone is designed to rupture and ooze, not drain. Therefore it's suggested that periodic MRI be obtained to check them. Many women don't know they have an issue until they have symptoms. The silicone are more natural in appearance and shape. Either may be rejected by the body but it's not common.

In my research I found that if the patient needs radiation it is suggested to wait on starting reconstruction with expanders. My doctor said it can be started immediately because there is a risk of it not working when rads are involved weather you delay or do it immediately. As you can imagine the skin has at least some degree of damage and usually is not as pliable, plus the circulation to the tissue may be affected. He said should I start the process and it not work we can start all over or take them out and be done. The other issue is that if I would need chemo things would get tricky because steps of reconstruction have to be scheduled around how well my immune system is handling chemo. Keep in mind I won't know for sure if I need none, either, or both until my final pathology comes back after surgery. Therefore it makes the decision making process quite difficult.  If I choose immediate reconstruction that happens as soon as the general surgeon leaves my side so I have to know before even scheduling surgery.

The next option was the flap procedure. This is very overwhelming and there are many options. This surgeon offers taking tissue from the tummy or the back-fat and muscle that has blood vessels that would feed and heal the new tissue. If I need one side I lose one tummy muscle, if I need both sides two muscles. This would increase the risk of abdominal hernia in the future, but I would get a tummy tuck out of the deal. Most info I read said these procedures, known as various types of flaps, give the best cosmetic effect, look and feel more natural, and look better for longer periods of time. Also, they are your own tissue and not a foreign body. It's not common that the body reject an implant but it can happen. As appealing as this all sounds it is NOT for me. Brad couldn't agree with me quickly enough. The risks of infection or surgical complication are much greater. The surgical time is increased by hours and the healing time is much longer. Because of all the lifting I do at work I wouldn't want to weaken what tummy muscles I have left, and although fat, my tummy doesn't look too bad. Ending with a huge abdominal incision wasn't appealing to me at all. It didn't help that one look at the photos of patients going through the process was almost more than I could handle!

At just over an hour into the visit I was feeling like mush. Had to put my feet up again and regroup. GRRR!  I never used to have that issue but as I've gotten older it is hard for me to deal with health issues with me or my family without experiencing what is called a vagal response. You nurses understand that. I got it together and we moved on.

Big question- if not completely decided on reconstruction can my surgeon attempt the tissue sparing technique so that I could reconstruct later? The answer was yes.And even without that I can reconstruct later. If I would decide not to reconstruct then that extra skin could be removed at a later time. He really feels that it's OK to start with expanders immediately even if I need radiation. I am very hesitant. Too me there is the potential to have to juggle too much should I need rads or chemo. Also, it's dealing with increased pain at the same time as possibly dealing with other therapies. If my area were small I could be swayed to start immediately. However knowing the size of the area I have no idea if they can even do the skin sparing technique. He said that if the surgeon has any question at all he takes all that he can. Then of course it is important to remember  that how I feel right now can certainly change. Depression and feelings regarding poor body image etc are fairly common in women experiencing this, especially later.  I have spoken to so many and those who have chosen not to reconstruct at all have been happy with their decision. They are a variety of ages.

Near the end of the conversation we discussed the right side. He asked how I felt about it. Of course I'd love to keep it if I knew it would be fine.  Yet there would be a great piece of mind just taking both and knowing that then my chances of recurrence would be very slim. I didn't ask his opinion, he volunteered it. He said if I were his family member he would take both now and have it over, plus  if I would reconstruct that makes it much easier to match both sides. The gene testing may make my decision for me. However if I don't carry the gene I would need to have a frank discussion regarding the right side with the surgeon doing the mastectomy. GRRRR, why can't something be black and white???

We left and Brad headed to work briefly and I cried some on the way home. Hmmm, that's becoming routine. When he got home he gave me a big hug and said after all the info he wanted me to know he is fine with whatever I decide, that it's my decision and all he cares is that we have many more years together-that it's what is on the inside that counts. Of course I cried again!  That took off some degree of pressure as prior to the appointment he was pretty clear his opinion was I should reconstruct. I think visually seeing all the photos of options and stages of the process helped him understand this isn't as easy as TV makes it sound. Not to mention, although the whole process puts you in awe that modern medicine can accomplish amazing things, the end result is not the same and comes with significant risks. So now to sit and think for a bit and try to have an answer before I see the general surgeon on Thurs.  I am trying to just put it into God's hands and hope He whispers an answer because this decision is quite difficult for me. I'm feeling that I can't really go wrong by waiting on reconstruction and finding out more info and considering it longer. However I can go wrong by making a decision when I am so torn. I can always do it later! Thinking...thinking... thinking