Consultation with the Plastic Surgeon

Um, maybe you don't want to read this while you're eating.

The plastic surgeon I met today, Dr. Y.,  lives about a mile away from me and frequents the same coffee place I go to on occasion. Considering he took photos of me wearing lovely blue paper underwear today I'm going to switch coffee places for a while!

Today's meeting led to one firm decision, and that is to delay reconstruction (if I choose to do it at all) until after cancer treatment is done, rather than start it immediately during the breast surgery.

This is because there's a chance I'll need radiation due to the proximity of one of the tumors to my chest wall. If the breast surgeon can't get clear margins as a result, then radiation comes into play.

And as I mentioned before, radiation will pretty well eliminate one of the reconstruction options open to me (the implant, which follows a 3-6 month period of tissue expansion. That sounds fun, huh?)

But we won't know about the need for radiation until the surgery. So it makes no sense to plan to start reconstruction immediately.

Dr. Y. presented an overview of the reconstruction options. All of them have their pros and cons. All of them have potential complications and the potential not to look very good. None of them would look just like my real breast or any real breast.

I'd be a good candidate for a TRAM flap, which is when they use - let's just say material -  from the abdomen to reconstruct the breast. It's not a tummy tuck but it does tighten things there (although it also can look not so great).

There's also a latissimus dorsi flap, when they use material from the back to cover and support a breast implant.

And there's the breast implant that is inserted after breast tissue has been expanded, that doesn't require disturbing any other muscle or tissue in the body (again, not an option if radiation is necessary).

I can decide to do reconstruction as soon as 6-12 months following radiation (if I have to go through that), 1 month following the completion of chemo (if I have to go through that) or years from now.

I'm relieved to have the reconstruction decision and process off the table for now. Even if I were a good candidate for immediate reconstruction, I'm not sure I'd be up to committing to it. And since an implant can look better if done immediately, I might have felt pressure to go ahead and do it, to get the best-looking result possible.

Now I know that I'll have some period of time to adjust to wearing a prosthetic and can put all my medical-related focus on getting through cancer treatment, rather than also dealing with the reconstruction process. I can have time to really process my adjustment to my changed body and, without the distraction of cancer, decide at any time in the future whether I want to pursue reconstruction. This feels right to me.

Next step: I have a pre-op appointment with the breast surgeon on March 29 (she's out of the office this week). I'm not sure what all goes on during this appointment, but scheduling the surgery should be on the agenda. I'm ready to just get this going already.