No. 06: The Plastic Society
The decision was made. So I thought.
1) Genetic Testing
2) Double Mastectomy (aka Bilateral)
3) No reconstruction
The email was sent bright and early in the morning. The response was fast.
The doctor will schedule your mastectomy; however, you must talk to the plastic surgery department first. We want to make sure that you understand all the options before you make any decisions. Well, I thought I had. And after research and discovering the Knocker Knitters, well, that club of people who knit so creatively, who could resist?
Appointment made, my entourage of Baby Daughter, Husband, and I arrived right on time to the appointed office. Even though it was early, the waiting room was full. I saw the poster, "PLEASE TREAT OUR STAFF WITH RESPECT," but did not fully read it.
What we did read to pass the time was the poster on HIPAA – two large posters with 11-point type. We had the waiting room trying each other's glasses to see if the poster could be read from locations around the room. It did pass the time.
Soon, we were called back to our appointed exam room. The nurse was perky and friendly. As she tossed the hospital gown at me, she then realized she did not have enough chairs to accommodate my posse, so went in search of an extra chair.
Returning with a chair in hand, she proceeded to provide instructions. Take everything off from the waist up and put on the gown—open to the front. Status quo. Nothing new here. Then she added, the Plastic Surgeon has requested before pictures. So she would be returning with a camera to take them. But do not worry, they will be taken from the neck down, indicating with her hand below her chin. She continued, these photos would only be seen by the Plastic Surgeon, the breast surgeon, your regular physician, and possibly a few residents as this is a teaching hospital before being stored in a secured site. No other person will see them.
ME: "So you won't be sending them to the Inquirer?"
The question was answered with a blank stare. "I will go get the camera now." She left.
The change of clothes—or lack thereof, went fast, leaving me time to read the poster. The poster that was plastered on every wall from lobby to waiting room, to hallway to exam room.
PLEASE TREAT OUR STAFF WITH RESPECT
I could read the paragraph underneath. Belligerent and abusive language, and physical abuse of nurses and staff would not be tolerated, and a call to the police will occur. You can be arrested and charges filed.
Hmmm. As one on the Speakers Circuit touting Sales and Marketing, it caught me by surprise. A favorite analogy to sales was this: Imagine yourself sitting in the exam room half-naked (such as I am now). You are antsy. You just want to see the doc, get the clean bill of health, pay the bill, and leave. The doctor enters, medical file in hand. He glances at you, then takes a moment to look at the file in his hand, lifting papers, frowning, then slowly inhales. A long quiet "Hmmmmmm" emerges from his lips. He looks at you, frown unchanged. You went from "OK, I am ready to get dressed and pay the bill" to "Doc, here is a blank check. Make me well." That is an outline for sales; you have a sick client, you diagnose and make them better. Best of all, you have the blank check in your pocket.
I digress. As I read the poster aloud to my posse, I made the comment, "Can you imagine what the wanted poster would look like?"
My daughter replied, "Just think what the lineup would look like."
As laughter erupted with tears streaming down my cheeks, the nurse returned, looked at us, and proceeded to take the photos, no questions asked about the eruption of laughter.
The Plastic Surgery PA entered next. Again with limited chairs, the photo-taking nurse left the room, giving the floor to the new attendee. Now, I am not going to be critical, but when explaining options and procedures, it would be best to have it in a linear format. This person (agreed with by the Baby when we left) was all over the board. She did provide a pamphlet we could take with us and review—which was very helpful. You do have a few options for reconstruction:
(PLEASE NOTE THESE ARE VAGUE AND NOT TO BE USED FOR YOUR OWN DIAGNOSIS)
Option 1: The Saline/Silicone Insert. There are two types—one filled with saline solution, the other silicone. An expander with a metal nipple is inserted into the cavity where the aforementioned breast was. It looks like a flat sippy cup. Each week, you would return to the hospital for an injection of saline water that will expand this cup. It would be located with a magnet that would search out the metal nipple. Once found, a needle is inserted, and the saline would pump up the expander a few mm each week until we reach the desired size requested. (At this point, she looked at me and my husband—again, my mind went to another area). Once the desired size is reached, another operation is scheduled, and the inserts replace the expanders.
Option 2: The Stomach Body Fat Replacement: A few weeks after healing, you return to the operating room, and the plastic surgeon removes fat and muscle from the stomach area and meticulously replaces the area with a mesh screen to hold you together. You are then reopened at the breast site, and the items are sewn into the area. The left side of the stomach items goes to the right breast and vice versa. You will have the drains in both areas to take care of when you are released. Plus, this is another major surgery, so the recovery time is longer. She did have a drawing that a surgeon gave her once that I took a photo of, showing the triangular breast cut. You need to flip the stomach items around so the veins and items can be sewn in.
Reconstruction can actually happen any time—it is just easier to plan and have it started the day of the mastectomy. The breast surgeon, if it is for later, will not stretch your skin as tight to leave room for expansion. And it is a bonus to start immediately. No matter which you choose, you will have surgery on the same area as the mastectomy.
There was more about hospital visits, care—you will have mammograms. And the inserts last approximately 10 years and might be replaced (if medically necessary). And you need to watch for leaks, which is another regular visit to check on them.
I know this is not the complete story; it is just how I heard it. Again, it is an EMOTIONAL vs. MEDICAL decision.
As for me - Plastic surgery consult completed. All options reviewed. The decision remained: Genetic Counseling. Bilateral Mastectomy. No reconstruction surgery.