TMI Warning – this post contains lots of talk about things like nipple tattoos. Proceed at your own risk 😉
This morning we met with surgeon #2, Dr P. I really liked her and immediately knew that I want her to do my surgery. She reviewed my case and agreed with everything the previous surgeon said, but also gave me the option of lumpectomy with reconstruction and a big reduction on the left side for symmetry. Then I could get the pathology and make a good informed decision to proceed with a mastectomy if needed.
I loved this idea, and it has been driving me crazy that I don’t really know what is in there. It was also a relief that somebody was considering letting me keep my breasts, however different they would look.
Then I went to see a reconstructive plastic surgeon, Dr A. After his nurse got all my vitals, my husband and I sat in a conference room that looked like a living room. Couches, coffee tables scattered with photo albums of….boobs. And implants to play with. The photos were amazing. I actually understand the value of nipple reconstruction or tattooing now and it was a million times better than internet photos.
Dr A went over all the options with me and I have a lot. All of them are statistically equivalent for eliminating cancer but have varying cosmetic results.
OPTION 1 – LUMPECTOMY + RADIATION + REDUCTION
I can have a right lumpectomy (big, like the size of a Ho-Ho) that includes the nipple and oncoplastic reconstruction where he “puts everything back together pretty” and I’m reduced a couple of cup sizes. Then radiation, which reduces a size or two more and changes my skin texture, wrinkling and toughening it. Then I wait at least 6 months for it to stop shrinking. After 6 months, I would have a reduction on the left side to creat symmetry. It’s a really big reduction, but I’ll still have breast tissue in both sides. And a nipple tattoo if I want, LOL.
OPTION 2 – RIGHT MASTECTOMY + RECONSTRUCTION + REDUCTION
I can have a mastectomy on the right side and reconstruct using a silicone implant. Then I can have a reduction on the left side to match the implant. But then over time the left will be affected by age and gravity and I’ll likely want an additional lift surgery down the road. I’ll still have breast tissue in the left side. And don’t forget the tattoo….
OPTION 3 – BILATERAL MASTECTOMY + RECONSTRUCTION
A bilateral means both sides. It’s a cancer mastectomy on the right, then a prophylactic (preventative) mastectomy on the left. Almost all breast tissue is removed and I’ll be reconstructed with silicone implants, Angelina Jolie style. During the mastectomy Dr A will make a pocket for the implants in my chest muscles and put in expandable implants. Every couple weeks I would go in and have saline injected into the expander to stretch the pocket and skin to the correct size. Then I would have another surgery to exchange the expander for a silicone implant. And again, tattoos.
Another option might be direct to implant instead of the expander if I go really small and don’t need radiation.
Whew. At this point the migraine was starting. I told Dr A I just want them the smallest size that still hides my insulin pump and he laughed with me about it. I’m his first patient to design her breasts around her insulin pump.
Then came topless photos (go ahead and laugh) measurements and more forms. All I do is fill out forms.
Dr A also gave me a fantastic book on breast surgery and reconstruction.
His nurse instructed me to not look at anything cancer related and go home have a normal evening and sleep on it. It was good advice.