Plastic Surgeon Update

I called my surgeon, Dr. DerHagopian, last night and voiced my concerns about the consult I had yesterday with the first plastic surgeon he recommended to me. Because I have so much faith in and respect for Dr. D., I asked him why he felt so confident in this particular PS's abilities. He explained that he knew yesterday was such an emotional day for me, he wanted to be sure I had a chance to meet with at least ONE plastic surgeon the same day. And because that PS was located right downstairs in the hospital and because Dr. D. works with him all the time and feels he is very experienced with 25 years in practice, he was comfortable pushing to have him see me right on the spot. Of course, Dr. D. was completely understanding of my feelings and said he was happy to recommend other plastic surgeons until I felt most comfortable.

To be fair, I was in a bit of shock yesterday when I met with this particular PS and I may have perceived certain things he said as being somewhat negative. (Dad and Joan were there during part of this consult as well and seem to think they heard what he said a little differently.) Perhaps he was merely trying to "manage" my expectations and keep me a bit realistic about reconstruction following mastectomy, but I know I should still be able to have high expectations because I have seen quite a few pictures of truly wonderful looking breasts after a mastectomy.

I had called my friend, Price, as soon as I got home from that consult because he was instrumental in leading me to my surgical oncologist, Dr. DerHagopian ... and I hoped that I could now land a good lead to a reputable plastic surgeon. Price's colleague and friend, Dr. Jaime Sepulveda, had said at one time he wouldn't have anyone besides Dr. DerHagopian work on his wife if she were in a similar position. So when Price told me Dr. Sepulveda was now recommending Dr. Deirdre Marshall as an EXCELLENT plastic surgeon, I was almost certain she would be the right doctor for me. It was only an added plus when Dr. D. recommended her as well! (My oncologist also approves ... in an e-mail this afternoon she told me I will have an excellent surgical team in these 2 doctors.)

I had a great meeting this morning with Dr. Deirdre Marshall ... in fact, she called me around 9:00 pm last night after Dr. D. had called her at home to schedule a consult. Although she had 2 surgeries scheduled for today (and doesn't normally have office hours on Friday), she was willing to fit me in between her cases. She was so great when I met her today. She answered the whole litany of questions I had thoroughly, she was patient with her time (notwithstanding another surgery she had to perform), and she showed me a multitude of photographs of her work. Dr. Marshall has been in practice for 15 years since residency and she seems to be worth her weight in gold! (Oh, she is also in my insurance network and has her privileges at one of the same hospitals as Dr. D.) She assured me I will have beautiful breasts when everything is said and done. She showed me how she will mark my body for the incisions (that Dr. D. will then make) and that they will eventually be camouflaged nicely by tatooed areolas and new nipples that come after I have had the exchange surgery for implants! (I know this is probably too much information ... but I find what they are able to do to replicate real breasts completely fascinating. Boy, did I miss my calling in medicine!)

I know it seems surprising to many people that I am opting for a bi-lateral or double mastectomy even though I only have one affected breast. My decision has been greatly influenced by the experiences that have been shared by so many members of my online support group. The good majority of women who had to have a mastectomy and chose only to do one side at the time almost ALWAYS regretted not having done a prophylactic mastectomy on their good breast at the same time. Most of the time, they were in so much shock from the initial diagnosis that they couldn't process removing the other. And in almost all cases, these women went on to have a subsequent surgery to ultimately achieve symmetry in their breasts. I suppose because I've had 8 months to live with my diagnosis and process things, this decision is made a little easier. I have also had time to review soooooo many pictures of reconstructed breasts and hear experiences (good and bad) from my support group members that I was able to almost creatively visualize what I would do if it came down to me having to face a mastectomy. Most importantly, I should add that after all that I've been through already, I don't wish to ever go through this again or have any more anxiety about cancer recurring in the other breast. This is aggressive as it gets and I know it's the right thing to do now. If I have one breast or even two that are trying to kill me, they both have to go!

I will have what is called a skin-sparing mastectomy performed by Dr. D. ... this means all the breast tissue will be taken out, including the areolas and nipples (because cancer can travel to these areas as well), leaving my skin behind. Immediately following, Dr. Marshall will place tissue expanders under the muscles behind my current breasts. She uses Becker high profile tissue expanders which are part saline and part silicone (so they have a softer feel than other expanders that some women say feel rock hard). I will wake up from my surgery with anywhere between 220 to 300 cc's of saline already inside the expanders. She says I will look like I have an A cup. Then after I've recovered for 10 days and my drains (yes, drains!) are taken out of the sides of my breasts to drain extra lymphatic fluid and blood, I will get "fills" of saline every week or every other week to stretch the muscle and tissue. She prefers to fill at only 60 cc's per appointment until I reach the size I want. I will be happy to just get back to my current 34C's! I will have these tissue expanders for about 4-6 months, and then I will have an implant exchange surgery. Dr. Marshall explained thoroughly about this procedure and said when it comes time for the implants to go in, she will manipulate the surgical table to sit me up at a 90 degree angle while I'm under anesthesia so that she can see exactly how the implants fall. They will also move me around a bit from side to side to get the proper placement and make them look as natural as possible. If I can achieve results similar to the following examples of reconstructed breasts, I will be very satisfied.

This is before areola tatoos and the surgical tape is in place just to smooth out the mastectomy scar.

This is just 12 days following the implant exchange surgery ... the tatooed areolas were later moved to be more centered and nipples were later followed by the "twist and stitch" method as seen above.

I'm so glad to have a female plastic surgeon in many ways because I could tell from our consult that she would be VERY SENSITIVE to my cosmetic concerns and still do the best she can to make me feel physically comfortable at all phases of my reconstruction process. If I thought I was the bionic woman following my port surgery, I am really going to be built up now! I'm ready to just get this initial part over with so that I don't have too much more time to think and feel anxious. The longer it takes, the more upsetting I think it will become. I'm just looking forward to being on the other side of all this soon.