I had my first appointment in Ann Arbor today. It was with my plastic surgeon (PS). I was told I'd have 20 minutes with him, so I expected a relatively short appointment. It was not that way at all, and I'm so grateful.
First of all, this doctors' office, in spite of how busy it is and how many doctors practice there, runs incredibly smoothly. Right on time, so efficient, so kind, so wonderful.
The first person who came to see me was a nurse who said if I have any procedure done through the office, she'll be my personal contact the whole time. She gave me her card with her cell phone number on it.
Then my PS' nurse came in. She was also incredibly kind. Until she asked me to take off my top and bra and put the gown on with the open part facing front. LOL I know it's a necessity; it's still just awkward to me. She asked my permission to look at and handle my breasts. Oh, the fun. Not. I don't imagine I'll ever get used to that or comfortable with it. Not for me, but I don't get a choice. Anyway... She explained to me most of the procedural stuff and differences between different types of reconstruction. The two I'm considering are DIEP flap or expanders to implants.
Then my Aunt Kim, who works in the same office but for a different doctor, came in. It was great to see her and it eased a little of the anxiety I was having about the appointment.
My aunt left and then the doctor came in. He went over some of the procedural stuff too, checked out my breasts, asked me some questions to gauge where my head is at and what I'm thinking in regards to reconstruction and different types, and then went over a lot of the risks and benefits of the two procedures I'm considering. He spent almost an hour with me. I didn't have a ton of questions, as I thought I would, because he was so good in his explanations to me.
So, I can take as long as I want to make my decision. But I'm going to make it before my appointment with the oncological gynecologist in June. If I'm having an oophorectomy or hysterectomy, which I am strongly leaning toward and think the gyn will recommend, I believe I'll be having that surgery first. So I told my PS that I will know more about timing in early June.
The two options I'm considering are:
DIEP flap: in a nutshell, the PS would use my belly/abdominal fat to build new breasts under the skin the general surgeon leaves behind. Because of the size I am now and the size of my belly, I would definitely end up with a smaller breast size (which I desperately want). This surgery is 8-10 hours, sometimes longer since I'm having both done. The time in the hospital is 3-5 days. The recovery is about 6 weeks. You risk infection, necrosis of the skin (the breast skin dying), the blood vessels not working after being reconnected (meaning you might have to be rushed back into surgery), blood clots in the breast. You may need follow up surgeries (mostly outpatient) to tweak things (size, unevenness), fix things ("dog ears", among other fun). But those are all things that are threats early and once you get through that time, there really isn't any risk in the years ahead. It's your own fat, your own body, not a foreign substance. It's something you'll never have to have replaced and that won't be damanged like an implant could.
Expanders to implants: once the mastectomy is done, the PS would put expanders in my chest. After a short recovery time, you go to the PS once a week for "fills". The PS fills the expanders with silicone weekly, until you get to the size you want to be. Once you are there, you go in for another surgery to have the expanders removed and the implants put in. With the original surgery, you're only in the hospital overnight. Recovery is just a few weeks. But then it's the same with the follow up surgery. And there are risks of the implants leaking or moving. Implants don't last forever; I'd have to get them replaced a time or two in the future. But I could choose my exact size ahead of time. There isn't as much chance of necrosis.
It's a lot to think about. And before I started typing this out, I wasn't sure which way I wanted to go. But if I'm being honest with myself, I'm still leaning toward the DIEP flap. My fears? Being under anesthesia for the length of the initial surgery and that the surgery won't work (blood flow or dead skin issues). I don't like the idea of the long recovery, but I know that my employer will be flexible and I am hopeful that I can schedule this somewhat conveniently with my kids' school schedules.
I just don't know. I do know that I need to take time to figure it out and I also need to work on my overall physical health (lose weight). So it's time to get moving and thinking. Good thing that running is so good for thinking and clearing your head.
Next on the agenda is Friday's appointment with the general surgeon who will be doing my mastectomy. My PS says she's really nice; I am hoping so.
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