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Guest Post Series

(Part Three)

The following post is part of a series that details the beginning of my journey becoming a PREVIVOR of hereditary breast and ovarian cancer. I carry a DNA mutation, but I do not believe this was a mistake. I believe that God created me with purpose in each detail of my being. In this, and those that follow in the series, I want to share my experience, and how He used what could have been a devastating situation, into the start of something beautiful, something that changed me forever.

choosing a surgeon 300x300 Guest Post Series:I’m a PREVIVOR | choosing a {plastic} surgeon. I think the most indecisive phase of the process for me was choosing a plastic surgeon.  I prayed, I asked for others’ opinions, and went back and forth quite a bit.  But no matter what anyone else told me, ultimately the decision was up to me, and it’s a pretty permanent decision.

I want to clarify a couple things before I launch into the selection process that I took*.
*It is different for everyone.
When dealing with mastectomy and reconstruction, you have to choose TWO surgeons, not one.  Mastectomy/reconstruction patients need:
A breast surgeon {BS}.
A plastic surgeon {PS}.
I already was working with a BS to get the BRACAnalysis done, so I felt like this was a “done deal,” but I did visit with another BS to make sure I was comfortable with the amount of research and due diligence I did before making a final decision.
I also want to preface all of this by saying, this is not “just” a breast augmentation.  People, including me, use the terms “plastic surgery” and “cosmetic surgery” interchangeably, but they are very different.
Reconstruction is completely different from having a “boob job,” lift, or reduction.
Reconstruction of any part of the body takes a totally different skill set than other “run of the mill” plastic surgery procedures, like augmentations, tummy tucks, nose jobs, or liposuction.
On that note, if you meet someone who has had or is going to have a mastectomy, please don’t talk about how you or someone you know has had an augmentation.  It is not the same.  You don’t have to relate.  It’s okay if you can’t, and sometimes it’s best to just not say anything except, “I’m sorry you’ve had to face this.”
Reconstruction requires the surgeon to make something out of “nothing”.  So, the positive to that is, it drastically shrinks the pool of surgeons from which to choose.  The negative is, it drastically shrinks the pool of surgeons from which to choose.
The specialization also means that it’s important to know what questions to ask, and what to look for in a surgeon.  The internet has some pretty awesome resources for what kinds of things to look for.  You are, of course, always welcomFollowing are a list of things that I recommend:
Note: I am not a doctor, nor an expert.  This is simply a short list of things that I did.  I am not giving legal advice, and anyone else’s decisions regarding this matter are their own to make.
1 // Look for a Board Certified plastic surgeon, instead of a cosmetic surgeon or a surgeon who lists a non-specified board certification.
The American Board of Plastic Surgery makes this pretty easy, and has a simple look-up on their site to check the validity of a surgeon’s Board Certs.  My surgeon is Board Certified.  Many times, by choosing a PS, you’re also choosing a BS, or vice versa, because of hospital privileges, etc.  So, for a BS, besides being Board Certified, nother thing to look for is a Fellow program.  There is a special Fellow program for BS’s.  My BS happened to NOT be a surgical Fellow, but I knew that and weighed that with my other criteria.  I’ll touch on why later on.
2 // Look at their credentials, education, and training — look for top schools.
Is their alma mater the most important thing in the world?  No, but it doesn’t not matter.  If a personal has gone to an esteemed school, it stands to reason that they are likely very good at what they do.  Weigh this along with the other criteria you’re considering.
3 // Make sure they have a lot of experience in the specific surgery YOU are having.  Ask for references.  Ask for before and after images, and ask for after images that were taken at least a year post-op.
Make sure they have done many of the same procedure.  Look at as many before and after pictures as you can, and ask questions about some of the cases.  Ask about complications, ask how they handled the complications.  If a surgeon denies ever having a complication, or dodges questions, RUN AWAY.  Look for cases similar to your own {there are quite a few kinds of breast reconstruction methods–more than you’d think!}.
Ask to speak to one or more former patients.  Most surgeons support this, and many past patients are more than happy to discuss their experience with others.  I found that anyone who had gone through mastectomy in the past were quick to come to the aid of someone else going through it as well.  I spoke to a former patient, and she did have a complication.  She explained how my PS handled it, and along with the technical talk, we bonded over the emotional experience of being BRCA+, young, and going through mastectomy and reconstruction.  If a surgeon refuses, I consider that to be a red flag.
4 // Make sure they are only performing surgeries at accredited surgical centers.
Who will be doing the anesthesia?  Make sure that it is a Board Certified anesthesiologist.  Is the surgical center itself accredited to the procedure you are having?  Go see it first, if possible.
5 // Make sure you actually like them.
Are they listening?  Are you confident in them?  What does your gut tell you?  This was a big thing for me, especially in my dealings with the other BS that I met.  This was one of the things that actually helped me make my decision.
I’m very blessed to have a cousin {Cousin J} who is a surgeon.  She was finishing up her residency at the time I was planning for surgery, so I scheduled appointments with the two PS’s I met with on days when she was in town.  She thinks about surgery and surgeons differently than “the rest of us”–she’s in essence talking to colleagues, so that levels the playing field quite a bit.  {Imagine bringing an auto mechanic with you when going to get your car fixed; the conversation would likely go much differently than if it were just you talking to the repair technician, even if you personally happen to know a lot about cars.}  I made a long list of questions, printed it out, and brought it with me.
My Aunt C {Cousin J’s mom} is a nurse, so I invited her to come with me to visit with the BS’s, as Cousin J couldn’t be in town for all four appointments {one for each BS, one for each PS}.
Honestly, without these two women, I could not have gone through that process without an emotional breakdown.  Aunt C and Cousin J, THANK YOU for taking time for me.  I love you!
// Plastic Surgeon #1: Dr. T //
Dr T. was awesome, and I really struggled with not using him, but the thing is, the PS and BS have to work together, at the same hospital, in tandem, so with the ones I talked with, I had to choose PS 1 and BS 1, or PS 2 and BS 2, I could not choose PS 1 and BS 2.  Make sense?
Anyway, Dr. T was SO friendly, and so so sooooo passionate about what he does.  His “bedside” manner was excellent, and he was thrilled by the challenge each patient brings.  He also had some, uhhhhh, creative ideas.  If you want to know the craziest idea, you’ll just have to email me.  I’m not writing it here, it’s just too personal.
When it comes to staying in touch, this man was all over it.  He emailed me, called me from the airport while waiting for a flight, and his detail and ability to speak things at my level were wonderful.  I could tell he did this because he truly loves it, and breast reconstruction is all he does.  Cousin J loved Dr. T.
The difficult part about this appointment was hearing what I didn’t want to hear.  I was in emotional shock.
I wanted to go smaller.  I had been thinking about a reduction for years, so I thought this would accomplish that, too.  But, Dr T. explained that he could accomplish this slightly; the way my body is built, my rib cage, pectoral muscles, etc., I was built for a certain size, and if we were to go significantly smaller than my natural size, then it would not have the results that he wanted for me to look as close to completely natural as possible.  It would look completely fake, and that’s not what you’re really going for with reconstruction.
Timing.  I was ready to get this OVER AND DONE WITH.  But his timeline for the reconstruction surgeries were much longer than I was hoping.  The time between surgeries would be 6 months, and if I remember correctly, there would be three surgeries, including the initial “big one” when the breast tissue is removed and reconstruction begins.  I was frustrated, and had a meltdown in his office.  And in the car.  And later that day.  Ugh.
Reality.  Since this was the first appointment to talk in depth about the details about the whole process, I think I went into shock.  This wasn’t so much anything Dr. T or anyone else said, but that’s just simply when it hit me, and it hit me hard.  I broke down and cried, but everyone was so, so, so understanding.
Nipple Sparing vs. Nipple Reconstruction.  Dr. T totally supported nipple sparing, but the topic really freaked me out.  Nipples can die, people.
THEY CAN DIE.  AND FALL OFF.
The whole “controversy” with nipple sparing, there is a small amount of breast tissue that is left in the nipple, and technically could develop cancer some day.  Cancer patients are NOT allowed to do nipple sparing, but those who are doing prophy surgery {preventative} can, if they are a good candidate for doing so.  Not everyone is!
Sometimes, patients do not have good blood flow in the skin, which restricts blood flow to the nipple post-surgery, which causes it to die.  When the breast is intact, the blood supply comes from places other than the skin, through the breast tissue.  When the breast tissue is removed, the blood supply is altered.  Then, if reconstruction is being done, the implant or tissue expander can put tension/pressure behind or against the skin, further limiting blood flow.  This is what causes skin death.
The down side to nipple reconstruction {NOT keeping one’s own nipples} is another area of scarring where the skin is taken, and they tend to “flatten” over time, and must be re-tattooed eventually {some of the, um, detail of the nipple is tattooed on to make it appear more natural}.  Also, if the nipples are spared, sensation MAY/MIGHT/COULD eventually return, whereas with the nipple reconstruction, no.
So, why would someone not want to keep their own nipples?  Because they can die.
// Plastic Surgeon #2: Dr. M //
Dr. M was recommended to me by my BS.  I looked at a book of his “work” when I was in her office, before I even met with him.  Cousin J was not as much of a fan.  Not that she didn’t like him, but she just preferred Dr. T’s enthusiasm, specialization, and that he had a backup plan that he verbalized.
I met with him second, I want to say a full week or two after Dr. T, so mentally I was in a much better place to hear what he had to say.  What he was telling me was not as shocking as it was when I met with Dr. T, because I had already heard it, processed it, and was no longer just in a state of emotional shock and fear over how radical and strange everything sounded.  I was calmer.
I ultimately went with Dr. M, not only because I really did like him {true}, but because I wanted to use the BS that I liked.  I did NOT like that other BS, and since I had met with two really good PS’s, the tipping point that led me to choose Dr. M was that he had that one extra “pro” on the list of pros and cons: I got to use the BS I wanted to.
//  //  //  //  //  //  //  //  //  //
After deciding on Dr. M, I had to meet with him again to discuss specifics.  He went over what the surgery would be like, what recovery would be like, and then things got real.  I had to start prepping for surgery.  I had made all of my decisions on the who part of my surgery, I decided when, and then I just had to wait.  I had made all of the decisions by the end of May, and did not have my surgery until August.  It seemed like an eternity, but in all reality it did go by quickly.  It was weird waiting for something like that.
Got questions?  Comments?  Send ‘em my way.
I know this is a lot of info, and a lot to read.  I appreciate whoever out there is reading, because it’s definitely helping me to write about it, remember, and share.
gayle signature1 300x37 Guest Post Series:I’m a PREVIVOR | choosing a {plastic} surgeon.
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