Plastic Surgeon #3 and Post-Ops 1 and 2

This is kind of a long post that includes a journal entry from June 6 followed by a more recent update on post-op appointments from today.

I met with Plastic Surgeon Number 3 yesterday. This one, Dr. Michael Robinson, does DIEP flap procedures. A DIEP flap is where they take skin and fat from the lower abdomen and transfer it along with a blood vessel to the chest area to create boobs. It is a 6-10 hour procedure that requires 3 nights in the hospital and a 4-6 week recovery time.

Pros for this procedure include the obvious tummy tuck, but it is also nice because you never have to worry about having your implants replaced, which is recommended every 10 years. Some people go much longer than that (and you can as long as there are no problems), but that is the standard amount of time they are said to be “good” for, whereas the DIEP flap is permanent and would not require any maintenance. It also can’t get cancer because it is fat and not breast tissue.

I did seriously consider this as an option yesterday, but after talking it out with my mom, a couple of friends and the nurse, Michelle, who has been assigned to me through my current plastic surgeon, Dr. Criswell’s office, I have decided not to go through with it. As much as I would love a tummy tuck, the cons, for me, outweigh the pros.

At this stage, with my surgery being next week, I would have to take Dr. Criswell out of the picture entirely. This means that I would still have the mastectomy surgery on June 13th with Dr. Turk, but I would not get the tissue expanders put in until Dr. Robinson could get me into his schedule. And having Dr. Criswell insert the tissue expanders as we have planned now and then switching to Dr. Robinson later on is not an option. Which means that I would wake up from my surgery on the 13th completely flat-chested and remain that way for weeks. It could even be months if I am to need chemo.

After thinking hard about the emotional repercussions of going from size Ds to size… nothing… and having to stuff a bra and basically re-living middle school all over again (I’m just kidding, I never had to stuff my bra) for an unknown period of time, I have decided that, for my own sanity, I would not be able to handle it. Yes, I know people do it all the time. And, yes, I know they make products (prostheses) specifically for this purpose. Call me vain, but I know that I would not be able to look at myself in the mirror and see “me” without my boobs. This whole thing will already be hard enough as it is with the scarring, losing my nipples, time and travel lost at work, and the effects of all of this on my future dating life. And I’m just not willing to put off the mastectomy surgery in order to get Dr. Robinson’s and Dr. Turk’s schedules synced. If you have been keeping up, it was incredibly difficult to get this surgery on the books as it is, so I am sure as shit not going through that again.

And, as much as I would LOVE a flat(ish) stomach, the procedure would, at best, make my pants fit better. They only take the fat from the belly button down, so it would not be anything huge enough to make a difference in my clothing size, and once I start weighing in the recovery time on top of my lifestyle this year, I just can’t (and am not willing to try to) make it work.

Implants are the best decision for me at this time. I really love Dr. Criswell’s vibe and how she and her staff have treated me so far, and if I have to see someone once a year for the rest of my life, she would be the person I choose. I feel like she will take care of me and make sure that I am happy with the way I look. Plus, I can always just GET a tummy tuck later on if I just really want one. (And Dr. Criswell can do that one too.)

I can’t really explain it, but I feel like I just belong with Dr. Criswell. I only had about a month to make this very permanent decision. But I have done my homework quite thoroughly. I have talked to countless women that have been there before me, I’ve met with three plastic surgeons, my own OB told me she wished she’d done a mastectomy for the peace of mind it offers. And now that I am armed with all of the information I need, I feel I can walk into that surgery confident that I am making the right decision for me.

And, even after the disappointment that filled my first post-op appointments today, I still don’t regret my decision to have the double mastectomy.

Today, I thought I would get these drains out because we have almost reached the two week mark, but I was very wrong. I told my mom, somewhat jokingly, before the appointment that I might cry if they didn’t take them out, and as much as I tried to hold it in, I did cry. They are painful and annoying and always in the way. I let myself believe that I wouldn’t be coming home with them, and now I have to continue dealing with them for another week at the very least. Which also means another week of uncomfortable sleep, no driving, no sweating, no raising my arms above my ears, and no lifting anything heavier than 10 pounds. All of which adds a layer of frustration because I am not used to this kind of confinement.

My second post-op appointment went only slightly better than the first. Dr. Turk told me last week that he’d have the results from the invasive cancer they found on whether or not it was hormone-receptive. Today, he told me they found SIX areas of invasive cancer in addition to the large mass of DCIS (non-invasive) they were initially concerned about. And that second mass that showed up on the MRI that I was concerned about was invasive. The areas were very small, the largest being 9mm, and I am lucky we caught it early enough that it hadn’t spread to my lymph nodes.

However, this is frustrating because it puts me in a weird grey area where the need for chemo is not exactly black or white. This is where the hormone receptors (AKA biomarkers) come in.

For those of you who aren’t aware, when cancer is found, part of pathology includes testing the cancer’s receptiveness to hormones, which basically just asks/answers the question of whether or not hormones “feed” it. This does not answer what caused it in the first place.

They test three hormones: Estrogen (ER), Progesterone (PR) and HER2. Dr. Turk had my results for ER and PR today. They were 21% and 22% respectively. And he didn’t have the HER2 result yet. He said they usually prefer these biomarkers to be closer to the 100 mark, so this could be a problem. I have to talk to an oncologist to figure out where to go from here once the HER2 results come in. And my understanding is that the HER2 result will determine whether or not I’ll need chemo.

I asked him why I would need chemo at all since they took out all of the tissue, and he said that since the cancer they found is possibly affected by hormones, there is a 10-15% chance it could pop up in other places in my body. Getting chemo would squash any chances I may have of it turning up later somewhere else. (The HER2 result should tell us for sure.)

So, the short answer is: there is no good reason as to why this cancer popped up. It’s not genetic. And it’s not because I didn’t eat enough blueberries. Sometimes shitty things just happen and there’s no obvious reason why. You can waste your life away wondering why or trying to figure it out, or you can do your best to try to accept that it has happened and go with the flow (and all that that entails). Breakdowns are inevitable and totally acceptable, as long as you pick yourself back up and keep on living.

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