I met with a different plastic surgeon. It was a zillion times better.

First off: Went to the plastic surgeon this morning, the chief of plastic surgery. It was such a better experience than last time, I can't even begin to tell you.

Second: I'm fickle. Every day I feel differently. Now I am considering doing both breasts right now. More on that later. I hate feeling differently every day. Dah!

Third: This is a bizarre procedure, no matter how you cut it. (<-- Get it? Cut it? Like a surgeon?)

Now, to elaborate:

Dr. Langstein walked in and introduced himself and got both our names, clearly knew some things about us and our lives ("Oh, I heard there was a fiance!") and one of the first things he did was say, "What questions do you have? How can I help you?" One hundred billion gazillion times better impression than the last dude, in the first 30 seconds. Then it got better: he explained what he would want/need to do in terms of an exam, and said, "Then we'll let you change out of the gown and into your clothes while we have a conversation." Hallelujah! This little bit of dignity really made all the difference, not to mention it was cold in there, so this allowed me actually to be physically comfortable during a difficult conversation, instead of shivering in an ill-fitting gown. So, we were off to a good start.

Other things we liked: he indulged our silly jokes by at least pretending to laugh, if not actually laughing. He said several times things to the effect of, "I'd like this to be question guided - you're clearly smart people, so tell me what you need to know." He said at one point in explaining what he meant by "high risk": "Well, this is plastic surgery. It's not life or death." Very honest that while this is a worthwhile and important field, it is not going to make or break my life. It was humble, and we didn't feel at all like he was trying to sell us something. Rather, he said that one thing he hopes to do in his work is help erase the painful memory of breast cancer, so when people look in the mirror each day, they aren't reminded of that difficult time. A noble goal!

Then, if you can believe it, it got even better. In my spiel telling him what we already knew and what we were thinking, I mentioned both that the previous doctor did not think he could do latissimus reconstruction on both sides at once, and that implants weren't possible due to my previous radiation. Dr. Langstein said, "Oh, I could do both sides at once. That's not a problem." He also said I may actually be a candidate for implants after all, which makes everything so much easier. He said he would have to look carefully at my radiation records ("That'll be my homework," he said), but he expected since it was a lower dose, and more focused than it would have been if I'd had breast radiation (as opposed to something designed to hit deeper in my chest), it might not be a problem. And if it was, we would be able to see this fairly early on - maybe even on the operating table, because they could see that the skin would lack elasticity, but for sure within a couple weeks we would see signs of it not working. So if that happened, latissimus would still be an option; I could just go back and fix it if my skin wasn't doing what it needed to do. So, while he said he doesn't usually recommend different options because it is such a personal decision, he would prioritize implants over latissimus, mostly for simplicity at the moment and in recovery. Much less trauma for the body. But if that doesn't work, he can do latissimus no problem.

There are various pros and cons for each option, of course. Pros of latissimus: I would not need expanders, which I've heard are very painful. They would use all my own skin (more on donor skin in a minute), and there would be more of organic me in there. The immediate con is that it is a tougher recovering, and it leaves me with several significant scars. There is the weirdness I mentioned before about the back muscle having to figure out how to be a boob now, and the quirks that go with that. The muscle atrophies and the breast changes shape - although maybe that wouldn't be so pronounced with me because I would also have an implant in there. (There's not enough back fat to make me the same size I am now with just my own tissue - I'm either too busty or too skinny. Who would have imagined THAT would be a problem in my life??). And this seems dumb to consider, but with such a surgery on my back, the sensation on my back would be all wacky (ultra sensitive, or no feeling at all), and having your back rubbed is one of life's sweetest little pleasures. My parents used to put me to bed like that, rubbing my back while they sang a lullaby. I would hate to lose that sweet sensation, especially since I will soon be marrying a live-in back rubber!

Implants' major pro is their simplicity, and their technology is always improving and the surgeon is able to get a pretty good shape with them. My recovery time would be less, too. Silly, but: I would have perpetually perky boobs, even into old age. Cons are that they might not "take" for me (this was the "high risk" conversation, but high risk for plastic surgery is not the same as high risk for, say, pregnancy, or heart disease, or heck, breast cancer!). I would probably need expanders, and then possibly another, outpatient surgery to have the saline expanders swapped out for more permanent implants, probably after the wedding sometime. Implants, whether saline or silicone, are long term but not permanent. I would have to get an MRI every few years to make sure they are not leaking. There's no external signal that they might be leaking - no "maintenance needed" light like on my Honda, no, "time to go to the Boobie-Lube" guideline. (<--credit to Michael for that one... we giggled quite a long time about that.) He said generally they last about 10 years before they start leaking, though he's seen them last 30, and if/when that happens, I go in for a half hour surgery and have the leaky boob implant replaced. Sort of tedious, but again, I will have implants either way, so it seems trips to the Booby-Lube are my fate if I want reconstruction.

The other option that a lot of women use is tissue from their stomach. In case you wondered: I do not have enough tummy for two boobs. Maybe one, but that would be pushing it. (I said to Michael, "I think he just called me skinny!") How many boobs do you have in your tummy? You should find out - this makes great party conversation. (Again I say: this procedure is BIZARRE. I said this to the doc, and he said, "I know! And yet, people do it!") The other thing about anything with my tummy is it might affect child-bearing. He said they generally don't recommend any sort of abdominal surgery for women wanting to bear children. So that's out.

Another word about implants, since that seems to be the better option overall, if it is indeed possible. They will expand me as much as possible at the time of surgery (just stop and picture that for a minute, and for a laugh, imagine it with brightly colored balloons, maybe even animal balloons). They do this with saline (sorry, no animal balloons in real life) filled bags (actually, he did use the word balloon), and you can add more saline into them to expand more over time, presumably through a port. With one kind of saline implants they can then leave them in there, no more surgery required. With the other kind, they don't have to expand me as far, but then do a surgery to replace the saline with silicone, otherwise known as - get this - gummy bear material!! Cue song: "Gummi bears! Bouncing here and there and everywhere!" Cannot get over this. Michael asked if they come in different flavors. (Nope, no strawberry boobs.) I'm trying not to make this decision based on a funny name... but come on!!

I dare you to watch that without laughing. This could be my new theme song.

I'm so distracted by this, even now, that I can't remember what I was writing. Where were we? Oh yeah, my gummi bear boobs. I mentioned donor cadaver skin before. Yeah, sounds gross. It's this amazing technology where they use the dermis from cadavers to sort of supplement my own skin, since they will have to cut away some of my skin (the nipple and areola) for the mastectomy. (Nipple-sparing surgery is sometimes a possibility, but it is a little risky, and with radiated skin, he wasn't comfortable with it for me. It's just too delicate, and without enough blood supply, the nipple can die and... well I'll just leave it at that.) So they use this cadaver dermis to patch it up, I guess, and over time, my own skin grows over it. Weird, right?! I don't have to use that, but I admit it sounds freaky-cool. I'm sure my dear fiance is doing more research about it right now - he was pretty intrigued by the prospect.

Okay, so after all of the jokes and giggles, the fact is: I have some big decisions to make, and fast, cuz I want this cancer out of me. With this new possibility of implants, and reconstruction on both sides at once, I am suddenly entertaining the idea of doing bilateral mastectomies. My parents weighed in on this with some pretty compelling arguments, and Dr. Langstein also said when he's dealing with Hodgkin's survivors, he's usually expecting to do a bilateral - although again he said he would need to check out my radiation records and see what I actually had done before he could say anything definitively. There are many pros to having both done at once, not the least of which is not having to worry about breast cancer anymore. And the one major con, of course, is giving up my dream of breast-feeding, which I want to do emotionally and for the health of my children. Can I let that go? I don't know. Lots of thinking to do, in not a lot of time. And so we continue.