Monday, July 30th

Sorry I'm posting these appointments so late. This week has really taken the wind out of my sails! Monday  was the much anticipated trip to the plastic surgeon. Brad and I  really like this guy. He is so laid back but so thorough and particular. He was running an hour and 20 min behind so thank goodness my appointment was at 4pm so Brad didn't miss a half day of work to join me. The doctor spent 40 min with us so it's kinda hard to be upset that he was behind. I feel it's because he covers every base with every patient.

None of the information was really new, mostly just review. The difference was we both had a much clearer head about all of this. I was very open and honest in discussing that reconstruction is the one surgery I do fear. Every other one just seemed that I had an issue, it needed fixed, so my opinion was let's get on with it already. This one is just so much different-it's completely elective and comes with a whole host of risks. I explained my past history of infections even while on antibiotics and the suspicious infections I have had over the last 12 years. The surgeon explained what I already knew. The trends in research now say don't over treat with antibiotics, in fact, back way off. He admitted that he and many of his colleagues have always treated patients with pre-op antibiotics and then continued them for a while after surgery. Statistics show there are no real benefits to this for most patients. He admitted he has to really focus on breaking that old habit. However he did say that with my history and knowing I had an infection after my mastectomies as well as issues with drainage that he would in fact use more liberal antibiotics for me. Just because I have had a history of infections that it doesn't mean I will this time but at the same time it could mean I'm at higher risk. Looking back my infections really haven't been associated with surgeries at all except the fluid from the mastectomy so that is good.  Just knowing he would agree to treat me with antibiotics was a relief. I have often joked that currently it's easier for a patient to get an antidepressant or an narcotic prescribed than it is to get an antibiotic!

As  we discussed before, the process involves scheduling approximately a 5 hour surgery to place the expanders, add some saline during surgery, then allow for healing time. He stressed he does one step at a time to make sure healing is progressing as it should and that there are no issues. He won't do any further fills after surgery until healing is under way and drains are out.  Yes, this surgery means more drains! After several weeks expansion begins with saline fills. Everyone tolerates these differently and progresses at their own rate. Expansion takes anywhere from 2-4 months. After expansion is complete then the surgery to exchange the expanders for the implants takes place. It usually takes about 2 hours. The chest muscle is pulled up and used as is cadaver grafting to help support the implants.

He did assess my incisions and felt there were no issues in regards to my prior infection. My skin is in good condition and  there is plenty there to work with.  We did talk a bit more about the formation of nipples and he showed us specific photos of that process. He absolutely won't do the nipple construction at the same time as the exchange for the implants as he feels it is way too risky and needs to be done after healing is well under way for the breasts. Another sign that he is a perfectionist. If the breasts don't heal just right then by putting nipples on immediately could cause them to end up uneven, off center etc. Also, if the underlying new breast tissue is not healthy with good circulation it could cause the nipple construction to fail. There are some doctors who will do the two together. Brad and I quickly agreed that is not for me anyway.  There is not normal sensation there and for most women there is none. Some women don't even have to wear a bra after reconstruction if they don't want to unless they have nipples that need covered up. Just another very personal choice. I would strictly be going for some contour  and with my infection concerns this could easily be crossed off my list so an easy decision for me!

He really stressed he felt I made a smart decision to have both breasts removed as prophylaxis. In his experience he has seen so many women suffer undue stress each time they have follow ups worrying that the remaining breast has developed a cancer. And of course from a reconstruction standpoint it is much easier to match breasts starting at the ground level. I'm still very happy with that decision! It was the right one for me!

If I had booked today he could have done my first surgery before the end of August. He encouraged us to take all the time needed and to call him when I am ready. He himself really helped put me more at ease, it's just still a very lengthy involved process.

Brad and I talked that although I don't want to be on a time frame we feel I am. I just want all of this behind me. I'm ready to move on to the next chapter of my life cancer free. I deep down would love to have some shape back if I could come to grips with what all it entails. And financially, I just really need to do it before the end of the year. Starting a new year with medical bills is very unappealing but even more so is starting another year with surgeries and recovery time. My hysterectomy and my sinus surgeries were both during the summer. My mastectomies hampered my summer plans this year. I would so love to have a summer to just simply relax and enjoy life without pain and healing time or loss of work. Oh the decisions!!!