80’S CANCER JAM OF THE DAY:
I’m still searching…searching for the magical sculptor who will mold from my fair, flattened silhouette into an artful bust that will make me grin when I catch a fleeting reflection of myself in a low-cut top. Apparently, my imagination and reality are having trouble lining up.
You might remember that I recently wrote about going on a two hour journey to meet my first plastic surgeon, henceforth known as Picasso. I drove to his office with great anticipation, heightened by the fact that his name is Jean-Pierre. How perfect! An “artiste” with a French flair. Ooh la la! (Yes, I do know that Picasso is a Spaniard, smart aleck).
Picasso’s office was very crowded and bustled with women in various stages of alteration. I waited 15 minutes in the reception area and was then called back to a room. There I waited another 45 minutes. Arrggh! I tried to be patient since I had only called the day before and they were kind enough to see me on short notice.
Finally, Picasso entered. It wasn’t lost on me that he was very attractive. Let’s see: French, a surgeon, good-looking, what else could one want? Oh, of course, he was also an Ironman triathlete. Once my adulation dimmed, Picasso started taking my history in a pleasant but very hurried fashion. He anticipated my answers and wrote them down before I could speak, frequently having to erase as I corrected him. I could tell that he was very aware of the many patients waiting in other rooms.
Picasso: “So you’ve had chemo and now you’re all done and ready to move on to reconstruction.” Scribble, scribble.
Me: “Um, no, actually I have to do radiation.”
Picasso: Erase, erase. “Ok, so you want to get the implants in before you proceed with radiation.” Rescribble.
Me: “Well, no, my radiation oncologist would prefer that I wait to do reconstruction.”
Picasso: Erase. “Oh, I see. That’s fine if that’s what you want to do”.
Me: “Well, you tell me. What do you recommend from your experience?”
Picasso: “I think you should probably do whatever your oncology doctors recommend.”
Me: (thinking to myself) “Major copout.”
So, the bottom line I got from Picasso was this: He prefers to start with breast implant reconstruction, although he admits that there is a 1/3 failure rate after radiation. It’s an easier surgery with a shorter recovery time, and we can always go to Plan B if it fails. Plan B is to use my own tissue to create a breast, which involves up to 15 hours in the operating room and 6 weeks of downtime. He usually recommends waiting 6 months after radiation to begin, but he’s willing to start as soon as February based on some newer research showing that waiting leads to more scar tissue and less pliable skin.
Ratings for Picasso: Friendliness: B+ Office Wait: D Explanation: A- Patience: C
Fast forward to yesterday. I was supposed to start radiation therapy at 11:30 after days of soul searching, lost sleep, consulting the I Ching, you name it. I made my decision at midnight the night before to go forward and finally felt some peace.
Luckily, I had an appointment before radiation with plastic surgeon #2, who we’ll call Renoir. When I entered this office, I was greeted very warmly by a smiling gray-haired lady with a ton of Southern charm. There wasn’t another soul in the waiting room, which I tried not to take as a bad sign. I filled out my paperwork and was taken back to a room immediately.
Once I had changed into a gown, Southern Belle came back and thoroughly explained the implant procedure. She showed me a tissue expander, which would be placed under my pectoral muscle through each mastectomy scar and slowly filled with saline over several months. At that point, it would be exchanged for a permanent silicone implant. She then showed me the different implant styles. At this point, Renoir walked in.
Renoir was a short, dark-haired man in his 50’s with a peculiar smile. He wasn’t nearly as cute as Picasso, but I felt more at ease with him. He listened attentively. No history form, no erasing. I asked about Plan B, the foob made from my own tissue. He came over to me and squeezed my belly, trying to coax out some fat. He furrowed his brow, “Nope. Not enough skin. You won’t be a candidate for an abdominal procedure.” Back to the implant.
Renoir: “So you have to have radiation. Hmmm. Are you sure you want to do that?”
Me: Horrified that I was having to rethink this decision yet again. “What do you mean?”
Renoir: “It really damages the skin badly. Has the doctor told you the benefit from doing it?”
Me: “Well, overall, it’s a 9% increase in 10 year survival.”
Renoir: “9%? Hmmm.”
Me: Panicking now. “But..the statistic I keep going back to is reducing the risk of local recurrence from 35% to <5%. That’s pretty good.”
Renoir: Looking doubtful. “Well, you have to make that decision. I’m just telling you what I’ve seen. It really makes my job a lot harder, from a result standpoint. You can decline radiation, you know.”
Renoir then proceeded to tell me that if I were going to do radiation, it would be a lot easier for him if I got the tissue expanders in before the skin was radiated to prevent healing complications. “Oh shit! Another curveball. I’m supposed to get zapped in an hour” I thought.
Renoir: “Go talk to the radiation doc and let me know what you decide. He may not want anything under the skin during treatment.”
I left with my head spinning and my heart pounding. So much for peace. Now I was facing the prospect of major surgery and doing the radiation with painful foreign objects imbedded in my chest. Or should I do the radiation? Oh God!
Ratings for Renoir: Friendliness: A Office Wait: A+ Explanation: B Patience: A Freaking Me The Hell Out: F-
Long story short: I went to the radiation office and told the super nice lady at the front desk that I had to talk to the doctor before my treatment. I told him what the plastic surgeon had said about doing surgery first, and he agreed, much to my surprise. His only condition was that the expanders would not be allowed to be filled at all until after treatment. This would cause more of my lung to be irradiated due to changing my chest wall angle. No thanks.
I have one more plastic surgery appointment before I make a final decision. Tuesday, I’ll be off to see Monet. I really want to ask him if he thinks putting these expanders in before radiation is crucial to the success of the reconstruction. That’s my bottom line. My gut is leaning toward getting through one treatment at a time and not rushing things.
What do you breast cancer warriors think about the whole dilemma? I’d love to hear your advice.