May 2012
I had never met with a plastic surgeon before. I had no idea what to expect.
I assumed Dr M’s office would be similar to Dr D’s, with perhaps the exception of posters about breast implant types, catalogues of nose shapes to flip through in the waiting room, perhaps some pamphlets about various services offered—maybe a visual public service announcement of Botox gone wrong if I was lucky...
Seriously. No clue, but my imagination wanders into the morbid territory of Dr Frankenstein’s lab, so entering a regular old everyday waiting room with a normal coatrack and a stack of popular magazines was a touch... disappointing.
Dr M made up for it, though.
I was sent into the exam room to change into the familiar cotton gown for yet another breast exam. (I was becoming accustomed to getting to second base with someone I’d just met.)
Dr M came in and introduced herself, a sunny whirlwind of businesslike efficiency. She asked all the usual questions, apologized profusely for cold hands with a self-deprecation I identify with, and went on with her exam. We chatted while she felt, measured, photographed, and basically poked, prodded, and pulled things in ways I hadn’t known they could stretch. There was even a tummy-tuck eligibility test: shirtless, I had to grab my stomach flab while bent at the waist, and attempt to stand straight (I couldn’t—no tummy tuck for me, boo).
It was weird.
I’m comfortable with weird.
When she was finished, she sat back on her stool and studied my torso, while I sat on the exam table. “Well,” she said. “Good news. Your body is great for your age and after two kids, but your breasts are in very sad shape. More good news is that you’re here to fix them.”
Seriously?
I gaped and recovered, glancing down at the girls who I fondly referred to as a pair of C flats. (Professional bra fittings land me into a C cup despite the need to fold my deflated pair into the cups, so I’m a C flat. Like the musical note... get it? Heh.)
“Well, I have nursed two kids...” I began, but cut off with her gentle head shake and wordless murmur of the negative. I spoke flatly, “You mean this isn’t...?”
“No,” she said apologetically. “And since you’re not eligible for a tummy tuck, you’re left with the option of implants instead of reusing your own tissues—you have no extra to spare.”
I heartily disagreed, but she had gone to med school and I hadn’t, so... boo. No government-funded tummy tuck. I suppose I would have to settle for perky new government-funded boobs... le sigh.
I dug into my purse. “Before we get too far into a conversation of implants, I have something for you...”
“You brought me a present...?” Dr M said with disbelief.
“Sort of.” I handed her an envelope, which she opened to study the contents.
You see, in my effort to appear unwavering in my determination for this proactive surgery, I had brought along a few visual aids. Specifically nasty photos of the piercing I had had a couple years ago that my body had rejected.
Remember in this post when I’d said I'd had a history of being a medical exception? I was the kid who’s eardrum didn’t heal after the routine myringotomy for chronic ear infections, I was the teen who was hospitalized for a week for mononucleous... and I was the one whose body decided to remove a stainless steel post by slowly passing it through cartilage.
Biochemical mutiny is an ugly thing, trust.
All I could think of was that the photos of my ear mid-rejection plus the seamless, scar-less cartilage I was currently sporting in the previously-pierced area might hand Dr M pertinent information in regards to inserting foreign objects into my opinionated cells. (You know, since she does it for a living and she might want a heads up.)
She had no experience with my body or its overkill reactions, and well, since I had to live with the results of her handiwork, I figured giving her the most information possible only made sense.
Eyebrows raised, she flipped through the photos with delight. “This. Is. Awesome.” She studied my ear, then returned to the pics of bulbous tissue rebelling. “Gross. I love gross things. This is great!”
“Does it tell you anything helpful?”
She grinned, still starring at the photos. “No. Not at all. But you’ve just made my day.”
“Okay...” I was completely confused, until she asked if I’d been sick at all at the time of the piercing, or thereabouts. Sure enough, I’d been diagnosed with strep throat immediately after having it done. She concluded that 100% the rejection was illness-related, and I was clear to have the piercing redone after surgery should I be so inclined.
(Sweet. Just what I’d wanted to hear! Too bad Mr Lannis doesn’t share my jubilation. We’ll just surprise him one day... tee hee.)
So. Onto the surgical options...
Option A: a single scoop-and-replace surgery. Dr D would perform the double mastectomy, and then Dr M would pop some implants in place and I’d be rolling.
The drawback: I couldn’t alter the size of the new girls... whatever sized pocket left by excavating the breast tissue would dictate how large of an implant Dr M could stuff inside.
The benefit: a single surgery derailing our family lives instead of multiple ones, multiple anesthetizations with multiple risks, and multiple recovery times.
Option B: two surgeries. One that would include the double mastectomy by Dr D, then Dr M would insert tissue expanders. The second surgery would be to swap the expanders for implants at a later date—most likely six months after the first surgery.
The drawback: dual surgeries meant dual surgical risks, and dual recoveries, as well as multiple appointments with Dr M to fill the expanders in the months between surgeries. Time occupied, and lots of it.
The benefit: I’d get to be vain and plump up the girls to the size I’d prefer, providing the size fit my frame.
Option C: three surgeries. Actually, this was the worst case scenario. If for any reason there was an issue mid-mastectomy (say, the skin became dusky—a sign of low blood flow and possible tissue death to come), I would emerge from the first surgery flat. As in: no breasts, no nipples, nothing that resembled female chest anatomy—nothing at all.
The second surgery (probably six months later), would be to insert almost-empty tissue expanders, which would then be filled slowly over the course of many months (likely half a year) until they were the desired size, at which point I would undergo the third surgery to swap out the expanders for implants.
Dr M assured me that this was the worst of the worst case scenarios, and even if she and Dr D managed to completely botch the entire procedure, I’d still love the result as it would be lightyears better than the breasts I had now...
Yes, this appointment did wonders for a girl’s body image. ::snort::
Obviously option C was not something I’d actively choose. That left me with the other two: single scoop and replace, or dual surgeries to pick my own size.
Option B seemed too pretentious... undergoing multiple surgeries to alter the size of my breasts just because...? I mean, Mr Lannis didn’t care. At this point we were both pretty thrilled with the idea of upgrading to cancer-free, perky new ones (for free!), regardless of size...
It’s not like money was an object here—the procedure, whether I chose a single or multiple surgical course would be covered in its entirety by Ontario Healthcare—but I couldn’t completely derail our family’s lives twice for the sake of vanity.
It would be one thing if it were a necessity, but... practicality won out. If I was a good candidate (Dr M had some measurements and strategy to discuss with Dr D, as there were particulars that would dictate the ease of option A), I would opt for the single scoop-and-replace surgery.
So what would happen, exactly? It was fairly simple, really...
Dr M explained that Dr D would remove my mammary tissue and basically cauterize the area where it attached to the outside of my pectoral muscles. Then Dr M would pull my pecs off my ribcage and place a teardrop-shaped implant behind them—in order to create a seamless shape, so the implants appear to be a part of my body. It’s not the same placement as for breast augmentation, but in that situation there is mammary tissue to cushion and hide an implant.
If you’re keeping score, the pectorals are a band of muscle across the chest... an implant beneath them would have nothing to hold it up and in place. That’s where a fancy pants product called Alloderm comes into play. A sheet of Alloderm tissue matrix would be sutured in place below the pec to act as the bottom of a pocket for the implant—it would cradle the implant in position, forevermore.
I’ve doodled some horrendous sketches to better illustrate my explanation, relying on the lack-of-artisitic-skill to keep it from falling into the gory-disgusting-ew category. They're colourful because I figured they'd be less likely to trigger squeamish reflexes in people who have that sort of problem. And mostly because I just wanted to draw some rainbow boobs. You're welcome.
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| It's my anti-ick version of the Alloderm pamphlet's illustration. Green for chest muscle, pink for Alloderm. |
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| Cross section view: green for chest muscle, pink for Alloderm, orange for implant. (Yes, I currently only have access to crayons. Shush to the Peanut Gallery.) |
Alloderm.
This would be the product that derailed my brain.
Dr M began to explain how the implant would be cradled by the Alloderm tissue matrix, and I was, erm, distracted. Below is our exchange, paraphrased...
Dr M: Okay, so there’s this product, a tissue matrix that comes in sheets, and I’m going to use it and your pectoral muscles to create a pocket for each implant to sit against your ribcage.
Me: Cool cool.
Dr M: It’s processed cadaver tissue and mwow mwow mowow mowow... [FYI: That’s the phonetic spelling of whatever sound the adults make on Charlie Brown. As soon as Dr M hit “cadaver tissue” my brain stopped processing.]
Me [frozen, watching Dr M’s face as she speaks, unable to hear anything because I’m fixated on the concept of cadaver tissue in my body(!), and struggling desperately not to squee in the middle of this discussion and be considered anything other than completely sound in mind and body and fit for surgery.]
Dr M: Mwow mwow mwow... so that’s what I want to use, and it’ll lie beneath your skin, giving a better, more seamless shape for the implant.
Me: Okay. Cool.
[And then we talked about more details—strategy, timing, coordinating schedules—and I left. At a later date, we discussed the particular conversation outlined above...]
Dr M: So... Alloderm. You’re okay with it?
Me: Totally!
Dr M: Okay, because clients usually have one of two reactions when it’s brought up. They’re either completely grossed out by the idea of processed human tissue, or they think it’s great. You didn't really react at all.
Me: Oh... well... see... you said “processed cadaver tissue” when you first discussed it, and I’ve been trying really hard to look, um, less weird than I really am, so I just didn’t say anything because in actuality, my brain was stuck on “zombie tits!”
Dr M [lights up]: I know. Cool, right?!
Yep. Alloderm.
Yeah, after that first meeting I couldn’t for the life of me remember the name of the zombie tissue because I was imagining a near-future, zombie-infested world where instead of being the cannon fodder of the undead apocalypse (because I’m not fooling myself: I’ll be one of the first to go), I’d been given an edge in the new era thanks to being one of them... Having recognized the cadaver tissue in my living body, I am camouflaged, and left alone... muahaha!
Clearly Dr M was just as excited about this concept as I was, and now you know why I love her.
Partly because she obviously loves mind-bogglingly gross stuff and wanted to share in a squee-worthy moment with someone she’d pegged as finding it cool, and partly because she was clearly a bit jealous that she couldn’t lump some cadaver flesh-mesh into herself as prep for the rising...
Yes, Dr M is awesome with awesomesauce on top.
Onward...
There were more options to discuss. Namely, did I want to keep my nipples? A nipple-sparing mastectomy meant instead of cutting and going through the nipples to remove tissue and place implants, the surgeons would go through an incision at the base of my breast—basically where underwire would rest.
And I asked Dr M about something that was bugging me, specifically about the what ifs of using my own fat cells instead of implants.
It was my understanding that when reconstructing breasts from the patient's own fat cells, those fat cells behave the same as they would in their original placement. That means they would shrink and swell with weight loss or gain, regardless of having been transplanted into my boobs. Which meant that if I were to lose any weight, I could lose it through my new boobs, and likely unevenly. Likewise, if I gained, I could gain through those same fat cells, now on my chest, and unevenly.
Dr M said that was correct. Not always the case, but certainly a possibility.
I’ll take the falsies, yo.
After all this—the exam, the measurements, the photographs, the explanations of possible strategies—Dr M said she wasn’t sure how she and Dr D would tackle this particular case, or whether I was a good candidate for the single surgery option. She’d need to think, and compare notes with Dr D, and get back to me.
So I left her office with a head full of, well, zombie dreams, and went home to wait.
I was called back to the office a couple weeks later at the end of May to hear that, yes, it would appear I’m a good candidate for the single scoop-and-replace surgery. They would attempt a nipple-sparing mastectomy (my first choice) but if the nipples lacked blood flow post tissue removal, there was a possibility I wouldn’t be able to keep them.
I assured my Surgical Super Team that despite having a preference, I wouldn’t be upset if it ended differently—they needed to err on the side of their medical expertise. No cancer bombs were still no cancer bombs, regardless of the removal strategy to rid me of them, and I’d be appreciative.
They loved that.
I signed the paperwork. It was a go.
Now was the wait.
My Surgical Super Team needed to coordinate their opposing operating room schedules for this joint endeavour to take place. I had busy summer ahead, it was proposed that sometime around the end of August 2012 would be a good time.
Then the call came—nope, shuffled. Maybe early September. September passed, then into October. Another call—I was on deck if there was a cancellation, any time, and with possible short notice.
Like, really short. Two weeks maybe, and I heard a possible notice of far less (in the extreme).
In November of 2012 (seven months after meeting Dr M), I got the call saying there was a secured date for surgery if I wanted it. Yes, it took seven months to nail down a surgery date.
Was I upset? No. Frustrated? Sure. Impatient? Of course.
But here’s the thing: I wasn’t sick. I had expected a wait.
I was more concerned about allowing enough time and flexibility for Mr Lannis book time off work to help care for me and our boys, and being able to line up possible support during the couple of days when things were in flux...
Dr M’s assistant was apologetic about the timing—and justifiably so: not many families with young kids would go for it. But it worked out. And it would mean getting this surgery over with.
The date? December 20th, 2012.
Yes, right before Christmas...
[Note: The next installment of this series can be found here.]
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