first off, don't forget to give us vacation suggestions in the post below :) i need something to look forward to! especially since i am going to be dealing with boob surgeries for the next year or so. ugh. it's crazy. you have no idea how many different ways there are to get boobs. and i have to decide by friday which way i'm going.
according to all of my doctors there is no clinical/statistical reason to have a double mastectomy. it will not lower my chances of recurrence or raise my chance of survival. that being said, they have all said that if i am going to have major anxiety about the "healthy" one for the rest of my life then i can have them both removed and move on.
let me try to condense the choices. this should be interesting. and if you're not interested in knowing the particulars of my new chest, this will probably not be the post for you ;)
choice a: single mastectomy with a tissue expander/implant. remove the cancerous side and begin reconstruction at the same time. they will take off the cancer and all breast tissue and replace it with a tissue expander. a tissue expander is basically an implant with a valve in it. every couple of weeks (after surgery) i'll go in and they'll add syringes of saline to the expander until i'm happy with the size. this "filling up" process takes awhile- up to 3 months, i think. then, after there has been some more time to "settle", i'll go back in for an outpatient procedure and have the expander swapped out for an implant of the proper size. the initial procedure is about 1-2 hours long. i'd stay in the hospital for about 2 days and then go home to recover for about 4 weeks. after 2-3 weeks my lifting limitations would lesson slightly...
choice b: single mastectomy with DIEP tissue replacement. in this procedure they wouldn't be using a saline implant, they would be using my own tissue. they would remove the cancerous breast first. then they would make a gigantic incision from hip bone to hip bone, and remove "tissue" (fat and muscle i believe) from my mommy pouch and make it into a boob. then they'd put that in. it's a 6-10 hour surgery. it's pretty much a tummy tuck/boob job in one. i'd be in the hospital for about 4-5 days and then go home to recover for about 6 weeks. again, the lifting restriction would lesson about 1/2 way through. *however*, my doctor will not give me a DIEP procedure until he know for sure that i won't be having radiation. which they won't know until i have surgery. so, if i want the DIEP done, then i have to go the tissue expander route first, then instead of the outpatient swap, i'd have the 6-10 hour surgery at that time and all the recovery that goes along with that. i can, if i choose to, wait till next summer to do that so that i can avoid using sick time.
if i choose to have a double mastectomy,
choice a doesn't change much. they just remove both and add the expanders to both, and away we go.
choice b, however becomes even more complicated, because (hold onto your hats folks) i apparently don't have enough fat in my big ol gut to make two boobs- so they'll have to get some from my thighs- adding a bit of a butt lift to the process. a double does add a couple of weeks to each of the recovery times, as well.
my plastic surgeon said to me when we first started talking "so i see you're a size 34 A. is that what you want to remain?" at which point i started laughing hysterically and asked him who in their right mind would say yes to that question??? especially since nursing has made "A" a farce as well. kind of like the weight on my driver's license- it's what i aspire to be on a good day... so, either way i go, i will also be having reconstruction on my healthy side. if i don't have a mastectomy on that side, though, and just reconstruct then there are different options, for that boob, but i don't really know what they are.
so you ask, why would i bother doing the DIEP? i'm not sure exactly... i know that using my own tissue is healthier and more natural looking, and in the long run should age better with my body. i also know that a tummy tuck sounds very nice to me. but i don't like the sound of the surgery and recovery. i feel like if i was single, and didn't have to worry about sick time, and taking care of my responsibilities at work and at home i would definitely do the DIEP. my plastic surgeon (though he did not say it out loud) seemed to prefer it to the implants. my cancer surgeon couldn't decide what she would do if she were in my place. i am totally overwhelmed. and they want to get me on the schedule for some time between june 23-26th so i have to decide by friday about the double vs. single part. as for the DIEP vs implants, i can kind of see how the implants look/feel and go from there (since the radiation thing will be in question until the final pathology reports come back a couple of weeks after my surgery- convenient, hey?).
downfall of the implant: they are apparently cold. like in winter. there's no blood vessels coursing through them, so when you get cold, your boobs get/stay cold for a while. as if i'm not cold enough already!! also, there's a 20-25% chance that i will have to have some sort of corrective procedure on the implants between now and when i die. they're less natural looking, but i think in clothes they're pretty similar.
and don't even get me started on nipple reconstruction and tattooing!! i'll save that for another post down the line. i'm not kidding- i'm in for a year of boob surgery. ugh. i have a support group meeting on thursday, and almost everyone there has had their surgery, so i'm hoping to get lots of good input from them. and feel free to let me know what you think :) or ask questions that i might be able to answer, or might not have thought to ask and need to ask now!