BRCA Surgeries: Off to see the Wizard(s)

We’re off to see the wizard…

8/27/2012 9:00 AM. In a couple of hours I see the plastic surgeon. Five weeks after my last surgical foray it is apparent my old friend and troublemaker, left boob, is settling into a less than desirable place. Compared to the initial reconstruction back in January, the cosmetics are much improved. How much is good enough? Where does one stop with the business of plastic surgery in this age of perfection?

Last week I saw my breast surgeon for the first time since bilateral mastectomy in January. He’s a delightful fellow with a boatload of surgical experience in treating breast cancer. While cosmetic problems are not his specialty he did at least ask about the obvious asymmetry. It was clear he did not want to focus on how the new ta-ta’s looked. He spent more time marveling over the fact that when my ovaries and tubes were removed they were able to use my new bellybutton and the previous abdominal incision to do their laparoscopic magic.

My guess is the plastic surgeon will recommend Surgery #7 in October for those who are counting. Probably more oh-so-painful fat grafting. Who knows what else. And it means waiting another couple of months for things to settle if I want nipple reconstruction. Sigh. While I’m grateful for good insurance and a loving spouse who is fine with whatever I decide, it does not make this BRCA management business any easier.

So, it is off to see the wizard and discuss the options. Again.

8/27/2012 2:00 PM

The two docs on my plastic surgery tag team that did my initial reconstruction weighed in on how I’m doing and gave me a range of options for what comes next. It was a pleasant surprise to see them both during this visit.

First up was Dr. Sunshine. Warm, friendly and always upbeat, she wore a royal blue dress and black pumps. Sunshine exploded into the room and gave me a big hug. She wanted to know how I was doing after all this surgery. I could tell from the way she framed the question she was just as interested in my emotional well being as my physical state. We chatted like old friends.

Next came Dr. Engineer. This brilliant woman started her career in engineering and returned to school to become a doctor. I spent ten years working cheek and jowl with engineers and I can see she is at heart, one of that clan. Reserved, precise and analytical, her skill set compliments the effusive Dr. Sunshine. The engineer is all business with her lab coat, sensible shoes and greying hair. We had a focused discussion about options, timing, risks and benefits.

Neither doctor tried to sell me on anything and I appreciate this. As with all these BRCA surgeries, it is my job as the patient to make the tough decisions. It all boils down to how I feel about the way my body looks and functions.

What I learned today is it that five weeks post-fat grafting is too soon to tell what percentage of the graft will remain. The body typically reabsorbs about half of the new fat. The fact that I still have a good-sized concave spot where nice jiggly girl flesh should be is a good indication that another round of fat grafting would make that spot look a whole lot better. In addition, the contour would improve with repositioning the breast mound. In other words, they’d keep lefty from hanging out in my armpit by moving it closer to the midline of my chest.

So, my choices are as follows:

A: Do nothing and be done with it.

B: Forgo anymore revisions to the breasts and get some new nipples in late October after everything is back to normal.

C: Have a revision surgery in late October and wait a couple of months. If all goes well, get new nipples just before the end of the year. I’ve hit the cap on my out-of-pocket for insurance in 2012. If I wait until next year those nips will cost a whole lot more.

Money is only one of many considerations here. More importantly I have to weigh the pain and inconvenience of yet another revision surgery. More liposuction (damn that hurts) and another two weeks locked up in Spanx is not a pleasant thought, but when I think about the boobs I have to exist with for the rest of my life, it is a minor pain in the ass. Or a minor pain in the thighs or wherever Sunshine and the Engineer decide to steal fat from.

What did I pick? I chose to schedule a revision for October and reserve the right to change my mind. I might just call it good and get some new nips. This way I have time to continue pondering the choice as this banged up body heals. It is one of the simpler decisions I’ve had to make in the last year but it’s still is not easy. Ask anyone who’s hiked the BRCA surgery trail. There’s no right or wrong, better or worse. It’s all very personal. I wonder where I put my ruby slippers?

BRCA Surgeries: Stage II Post Op at 4 Weeks

Miles and Jack in Sideways.

Good Stuff:

Bruises nearly gone everywhere. Pain level merely an occasional annoyance. Routine activities like wrangling cats for claw clipping almost normal. More energy. Able to slither into favorite pair of skinny jeans this morning although swelling is still there throughout the midsection.


Spitting a stitch is the expression for those naughty sutures that poke through the skin instead of dissolving inside like they are supposed to do. This was highly irritating (literally and figuratively) with my last surgery. Now I’m a freaking expert at rooting these out and snipping the little buggers. Scars are a mixed bag with improvements in some areas and one section that only Dr. Frankenstein could love. Left boob appears to be settling back into the armpit area. Boo hiss. Both breasts definitely smaller, which is okay with me, but I had hoped they’d be perkier. I keep in mind that that the left boob will always play the radiation wild card and will do whatever it wants no matter what the surgeon does.

Other Stuff:

In one of my favorite wine movies, Sideways, Jack squawks at his depressed friend Miles that he does not want to hear anymore of his “naghead downer bullshit.” Now that the worst of this is over I tell myself to quit feeling sorry for myself and to cease procrastinating. I have not written anything other than this blog for many months. I trotted out my new novel, another murder mystery, and read through all of it this morning. Instead of the tattered mess I believed was there, parts of it were really quite good. I am my own worst critic and need to quell that naghead downer bullshit refrain that often runs through my head. Time for me to get back to work.