Plastic surgeon (spoiler alert: decision is near!)

Yesterday was quite a day of appointments. After my appointment with Dr. Skinner in the morning, I had counseling at noon. (That felt great - I had barely sat down when I started dumping on her everything going on in my life!) Then in the afternoon, I met with the plastic surgeon again, which was a very clarifying appointment.

We continue to really like Dr. Langstein. He is down to earth, honest, confident, yet humble. One of our favorite moments was when we were talking about the kind of reconstruction where you tunnel tissue from your belly to your breast (yes, they do!), and he said, "If you ever wanted that, I would defer to my colleague. That's a young man's game. I'm in my mid-fifties - I'm not interested in doing an 8-hour surgery anymore!" Fair enough!

Other favorite moments: when I was asking about how my breasts would age if I had one real breast and one implant, he said, "All women have uneven breasts. I know women who are two different cup sizes. You're in the God business - and you know that we can't do better than God. A natural breast is always going to be the best. And if God's breasts are uneven, then we can't expect to do better than that." Can't argue with that! (You see what I mean about humility?) Later, when I was asking about recovery time, he said something about, "if you owned your own business..." and I said, "God owns my business." And the resident piped up, "Really, he owns ours, too." Cute.

Okay, enough chit-chat - on to the actual substance of the appointment. First question was, had he looked at my radiation records, and did he still believe I was a candidate for implants? He said from the records it seemed that I had not had full mantle radiation - both he and Dr. Skinner described it more like a left-facing L than the T that is usual for mantle radiation. And even at that, the dose was low. He said my skin looked great, and if I hadn't told him I'd had radiation, he wouldn't know. It doesn't look like it had been burned (though believe me - it was! And radiation burns are no fun at all!). So he was confident that my skin would likely do well even with implants. Coming from someone who is known for telling people everything that could go wrong, I believe I can trust this. He said, "I'm just making up numbers here, but say you have a 75-80% chance that the skin will be just fine. Great. If not, we may see that on the operating table. If not there, then we will see within just a few days, in which case I could take you right back in and do the latissimus flap, and you'd still have plenty of time to heal before your wedding." Great! So implant reconstruction does indeed seem like a good option.

Next question: I asked about this other kind of reconstruction a friend of mine had, where they take tissue from the thigh. I said, "I'm not sure you do this kind, but what do you know about it?" He said, "I do that." Huh? He said, "There's another surgeon in town who fancies himself as the only guy in town who does it. That's not true. He's just the only guy that wants to. He is likely to push that procedure because he believes it is a good one. I don't like doing it because it is a tough recovery." Then he said, "I don't think you'd be a good candidate for that anyway. Stand up, let me look at your thighs." I will tell you right now that you need a healthy self esteem to let a doctor tell you where you are fat enough to make a boob. That, or you are quickly humbled by the process. He pinched my inner thigh through my jeans (!) and said, "See? Not enough fat. It's all muscle." He turned to the resident: "See? No fat." ("Soccer thighs," I explained.) He said again, "You don't have enough back fat, belly fat, or thigh fat to make two breasts. Maybe one. But the only place you have enough is" - he hesitated - "your back side," and he pointed to his butt. Baby! Got! Back! (I suddenly have this urge to rewrite the lyrics of Sir Mix-a-lot's famous and controversial hit, adding this perk to his list of reasons he likes big butts and he cannot lie.) But (<--ha), this is a very difficult surgery to recover from, and not really an option I want to consider. Fact is, I'm not fat enough to create a new boob out of my own tissue.

Okay, so then I told him about the different options we have: 1) lumpectomy now, decide later; 2) unilateral now, hope for the best on the right and see how it goes; 3) bilateral now, and be done with it. He said from his perspective, he would take the lumpectomy now option off the table. Any time you add another incision in the breast, it makes his job more difficult - more scar tissue and less skin. Great point! I hadn't thought of that. He also said he wouldn't do the bilateral now. The right side is at lower risk, and I could likely safely save it for the things I've dreamed of. And heck, who knows - maybe after I have a couple kids, I will have enough belly fat to do a tummy tuck and turn it into boobs. :) Especially if I'm not ready for it right now, don't do it. And after I am done with child-bearing, assuming nothing has happened on the right, I can get "fixed up" and evened out, if that is important to me. That option was already where I was leaning going into the appointment, so it was good to hear him say that, especially since he was the one who earlier had told me, "When I'm looking at Hodgkin's survivors, I'm usually looking at a bilateral." Things change. And what a different reaction from when Dr. Skinner suggested doing a lumpectomy now and put off decision, where I immediately felt bad about the possibility! Much better to have a positive reaction.

As for recovery, he indicated that it wouldn't be as bad as I imagined. Assuming all goes well, he thought four weeks would be plenty to recover. He said even two or three, saying, "You'll still have drains, but you can go to work with drains." Um, I think not. I think I'll just go ahead and wait at least until the drains are out! I'll still plan for at least four weeks. He doesn't give a lifting weight-limit - he said it is more about mobility. "As long as you can move your arm to do something, I say you can do it." Especially with just doing the one side, I'll still have use of my right arm from the beginning, which will make recovery easier. He thought I'd be pretty out of it for a week or so, but after two weeks I'd be feeling pretty good.  All good things! The surgery itself won't even take too long - maybe 4-5 hours. His part is only about an hour. "The time we have spent talking together in the office is already more than we will spend together in the operating room," he said.

So it looks like the decision is: single mastectomy with implant reconstruction. He will put an expandable saline implant in and expand it most of the way, and I'll probably have to go in once more a week or two later and get it expanded the rest of the way. Then I'll be good to go through the wedding, and at some point, if I want, I can swap those out for a silicone (gummy bear!) implant, which is a superior product that offers a more natural look. But what I get will be fine for my purposes. (I asked about wearing a swimming suit this summer, and he said, "You're putting a lot of pressure on the plastic surgeon, now!" I assured him I'm talking about a fairly conservative swimming suit, so not to worry! No string bikinis for me!)

So now I have to decide if that is my final answer, and call the doctor to get it on the schedule! Call now, or let it percolate? (By now, it has already percolated quite a while...) If I call now, it is done and I can put it out of my head and focus. If I don't, I may very well flip-flop again. But I feel fairly confident about this decision, and feel the pros outweigh the cons, especially since it has the endorsement of my surgeons. So I should probably call...