Decision making can be very nerve wracking. I have gone through it with others and have had many struggles myself over things like: Which flight to book, what laptop to buy, get married/get divorced, start a business/end a business, what nail polish color to choose, have the lamb or the halibut, Pinot Gris or Sauvignon Blanc... I sat down yesterday afternoon with Christine Lee (my Breast Surgeon) and started our conversation by giving her a brief overview of the past 14 months of my life and some of the other 'decisions/situations' I've been faced with (I won't bother recounting the events here... most of you reading this will know some... I gave her a 90 second snapshot of pretty much the whole 9 yards). She sat and nodded as I spoke, her face soft and eyes caring... and then we began to speak of the matter at hand.
We went over the notes from Robert Resta (Geneticist) regarding my results from my BRCA1&2 tests, agreeing that although nothing definitive... a (slight) load off of my siblings and a welcome departure from having to be concerned about my Ovaries (at this time). We also talked about the meeting David & I had with Wandra Miles (Plastic Surgeon). Dr. Lee asked if I was going to continue to meet with other Plastic Surgeons (in hopes of finding a 'good fit' for us) and I told her that I was very comfortable with Dr. Miles and saw no reason to look further; it was only after this that she made it apparent that she trusts and enjoys working with her (even making a joke about 'if there are any problems with your surgery it will be Dr. Miles' fault... not mine' :). I found this a very becoming quality, as she seems to go to lengths to allow me to make my own choices throughout all of this.
I told her that I have decided that I want to schedule surgery for a Bilateral Mastectomy with Immediate Reconstruction, with Dr. Miles placing the expanders on the same day. She said that although she fully understood the pressure I am feeling and the level of anxiety it is causing, that she felt confident that I was making rational decisions for the right reasons and fully agreed with my choice of procedures. I should have the date for my initial surgery within the next couple of days and hope it will be sooner than later. Dr. Lee explained that since I'm having the Immediate Reconstruction it will make scheduling a little more complicated as not only will both of them have to be available on the same day but a larger block of time will be needed for an operating room. Now that I have the wheels in motion and am firm in my heart and mind about the procedures... I hope they call and say it's next week! I'd really like to get started to be closer to getting finished!
I was well prepared with a (long) list of questions as well as a voice recorder and will post notes later on what I learned yesterday. For now... this is the information I received from Dr. Miles a few weeks ago... the information that caused me to go into 'meltdown' when I first read through it. It's still by far my 'favorite read'... but gets a little easier to handle as acceptance settles in...
TIMELINE FOR EXPANSION
1. Surgery Day: Once it is determined that you may have immediate reconstruction, placement of the breast tissue expander is done immediately following your mastectomy. This adds approximately 1 1/2 - 2 hours to your surgery. After surgery you are in the recovery room for about 1 hour before being transferred to your hospital room. It is common to stay 1 - 2 days before going home.
2. Stitch and Drain Removal: You will see Dr. Miles one week after your surgery to have your stitches removed and dressing changed. Sometimes you will have seen your general surgeon before this and she may have changed your dressings. Your drains will be removed by Dr. Miles ( or your surgeon) based on the amount of output. The goal is for your output to be less than 20 - 30 cc from each drain per day before removal.
You will also be seen by your surgeon (or oncologist if necessary) 1 - 2 weeks after surgery to discuss your final pathology and treatment plan if needed *Let's all cross our fingers/toes that we don't have to go there*
*and another Deep Breath*
3. Two Weeks Later: First Expansion!! Providing that your wound is fully healed, we will begin expansion of the tissue expander. This is done by either Dr. Miles or her nurse. Take a Tylenol or Advil 30 minutes before your appointment. This helps with any pressure you may feel afterward. It is not uncommon after these expansions to feel muscle spasms in your back (especially at night) for a couple of days. You may use your muscle relaxer medicine that Dr. Miles prescribes or your pain killers.
4. Weekly Expansions: You may come in once a week to be expanded or you may space these visits as far as you wish. How many weeks this total process takes will be determined by how large you wish your breasts to be. Generally we aim for symmetry with the unaffected breast. Patients having both breasts being reconstructed generally have the choice of size open.
5. Done Expanding. After we reach our determined size, then we wait a minimum of 3 MONTHS to let the skin and muscles settle. You can begin contemplating upon a date for your surgery to exchange your expanders for permanent implants. We will discuss this with you at this time.
6. Surgery To Exchange Implants: Great Day!! This takes about 2 1/2 - 3 hours and is an Outpatient procedure. You can go home on the same day but also have the option to stay overnight. Generally we do not need to put in drains for this surgery.
7. Stitch Removal/Dressing Change: In 6 - 7 days we will remove your stitches and change your dressings. Now we will have to wait while the implant 'settles down' before we can create nipples.
8. Nipple Reconstruction: Three months later. Yes, 3 MONTHS. The breasts change as the implants settle, and belly out and the breasts soften. Now we decide on where the nipples should be. Let's book surgery!
9. Nipple surgery: This takes about 1 1/2 hours and after recovery, you may go home. It may also be done as an office procedure. Dr. Miles will discuss this with you.
10. Stitch Removal: One week later we remove some of the stitches. We remove the remaining stitches one week after this.
11. Tattoo: Usually one or two months later, we will pigment the areolar/nipple complex.
LET'S REVIEW:
1. Mastectomies and insertion of tissue expanders (Inpatient Surgery).
2. Two weeks later, first expansion.
3. Expansions every week until target size reached.
4. 3 Months later, exchange tissue expanders for permanent implants (Outpatient Surgery).
5. 3 Months later, nipple reconstruction surgery (Outpatient Surgery).
6. 1 - 2 Months later, tattoo nipple/areola.
7. 1 Month later, check color match.
8. DONE!! DONE!! DONE !!
TOTAL TIME: Approximately 9 to 12 Months.
... *and another ... DEEP BREATH* ...
The top example on this page (taken from a random Plastic Surgeon's website) is a very 'successful' depiction of the procedures and an explanation of the progression.
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