Plastics

I met my plastic surgeon yesterday.

His office is in the Med Center, but since I was having Herceptin #13 yesterday, he came to Katy to meet me.

I liked him immediately, especially because I was the silent witness to a greeting he had with a former patient who also happened to be in the waiting room.  The minute he walked in the front door, she jumped up to greet and hug him, and at first I thought they were just old friends.  Then, he said, "I hardly even recognized you!  You look SO good!!"  She talked about it being two years since surgery and that she was doing fabulously.  "No wonder you didn't recognize me.  I looked so much different back then, and my hair has come back."  He just said how happy she looked and how great she looked.  It was a warm first impression.

Shortly after that, a nurse called me back to the conference room, and Dr. Boutros came in.  He introduced himself, and asked me to tell him about myself.  "I'm 33.  I'm the mother of 3 boys.  I'm an Aggie."  He stopped me.  "I'm an Aggie!!!  Did you know that already?"  {I didn't, but it pretty much sealed the deal.  I knew I liked him!}  We then went on to share stories of Aggie football games, how he lucked into some great season tickets on the 50 yard line, thanks to an older woman and her broken hip and bad health, but they'd only last 2 more seasons unless he wanted to give a "donation" of $250,000.  He asked where I was from, how I ended up in Houston, and then the conversation moved to cancer.  I told him it came out of nowhere.  "Do you have a family history?"  No.  "Do you smoke?"  Never.  "Interesting.  What has been the hardest part of the journey?"  I explained that the hardest thing has been all of the unknowns and extra challenges that have creeped in during the process.  The surprises have been difficult.  He then went on to cement my like for him by explaining how challenges can often be blessings, that most of his patients now have such a love for life and such a happy outlook, now that cancer is all in hindsight.  He talked about how he hasn't had to overcome anything so challenging in his life, so he doesn't even fully understand it, but he can see the changes in his patients, and it's inspiring.  He then talked about how his office and Dr. Pollack's are both very faith-based.  He believes that God {or whatever you believe in} has a way of using challenges to build you up and make you stronger.  You just have to have the faith to see the miracles.  I got a little teary because didn't I JUST blog about that?  It was another tender mercy.

Then we discussed the issue at hand--surgery.  He asked what I knew about breast reconstruction.  "Only what Dr. Pollack told me yesterday.  Before that, just what friends have talked about with their own breast augmentations."  "Good," he replied.  "You don't have too many preconceived notions."  He talked about how the procedure is done.  It's called DIEP flap surgery.  There is an incision made in the abdomen from hip to hip.  That tissue is used to reconstruct breasts.  The old way to do this type of surgery was to use some of the entire ab muscles to rebuild the breasts, but this resulted in the loss of core strength.  Now, they leave the ab muscles intact, but use the blood vessels to reconnect and reconstruct.  Plus, most patients, especially those who have had children, don't mind having extra tissue removed from their abdomen.  It's not a true "tummy tuck," because there is no liposuction, but it's a small silver lining in the whole thing.  He explained that Dr. Pollack only refers him patients who she thinks are good candidates for this procedure because it's intricate, lengthy, and state-of-the-art.  "If you just want a mastectomy or an augmentation, there's lots of doctors who can do it.  If you want a good reconstruction, it takes a little more experience and skill.  This is my specialty.  I've done a lot of them, and I'm very good at what I do."

The pros of the procedure are the natural look and feel.  "They will last forever, will always look good, and will grow with you.  They'll look good at 40.  They'll look good at 60.  They'll look good at 90--well, as good as they can look!"  I asked about implants and why I was told they would only last 10-15 years when I've had friends who've had their breasts done who haven't been told that.  "Good question! In a regular breast augmentation, the implant is placed behind tissue or muscle.  Even someone with small breasts has a few inches of tissue."  He then got out a Kleenex and placed it over his fist.  "With a mastectomy, all that remains of your breast is skin.  It's a thin layer, and trying to put implants behind that doesn't look natural at all.  They won't look full.  They won't last.  And, scar tissue will build up between the implant and the skin because it's the cement that puts us back together as we heal.  Without any other tissue to hold onto, scar tissue will just build up.  I've seen patients who have so much scar tissue that they get to a point where it's difficult to lift their arm at the shoulder.  With reconstruction, it's natural tissue and they last forever.

"Can I take a look at what we're working with?"  We went into the exam room.  "Oh, you're a GREAT candidate for this surgery!" he said, tugging at all my extra abdominal skin.  "I can tell you carried your babies really low and they really stretched you out.  That's great because I have LOTS of tissue to work with.  You are going to be so happy.  In fact, you'll probably tell me to make them smaller when we come back for touch-ups!"

I like the doctor.  I am confident in his abilities.  I think the pros of reconstruction FAR outweigh the cons.  We are going ahead with this plan.

I'm so grateful to have more information.  I basically know what to expect for the rest of the journey.  I'll have a hard recovery process and MANY more weeks of Herceptin, but it's nice to have the fog removed off the path.  I can see where I'm going.