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23 December 2008 @ 05:12 pm

The surgery I am having done is called Prophylactic Bilateral Mastectomy with First Stage Reconstruction.

In other words: preventative removal of both breasts with immediate start to reconstruction.

I will have two Doctors.  The first will be a Breast Surgeon; his job is to remove as much breast tissue as possible.  Breast tissue is not only in the breast but reaches up to almost your collar bone and around the side to the armpits.   

Once he is done, he will stay and assist the Plastic Surgeon who takes over.  She is going to insert “tissue expanders” under the muscle in the chest wall.  Over the next weeks and months, I will visit the Plastic Surgeon for what is called a ‘fill’ or ‘expansion’.  This is when she puts a needle in the tissue expander and adds saline solution.  This will literally ‘grow’ me a new breast mound.


Kind of like a woman’s belly who is pregnant and her skin expands and makes room for the baby.  It’s a gradual process.  So is this.  In this case not only will the skin be stretched but the muscle as well.  It takes time.

The reason this whole process in necessary, is that during the surgery the DRs will remove my nipple as well as some of the skin around it.  They place the tissue expander under a layer of muscle, there would be not enough room to insert a permanent implant right away.

After the expansion process is complete;  I go in for the second surgery. The exchange surgery.  This is when they will exchange the tissue expanders for permanent implants.  These implants should last 15 yrs or more.  Chances are, I will have to change them at some point.

Then comes the optional final stage.  Once the permanent implants are in and are given time to ‘settle’ I have the option to go in for the third surgery, the finishing touch.  The nipple.  The Plastic Surgeon can re-create the nipple using a skin graft from another part of the body then tattoo it to be the right colour.  


I hope to have the exchange surgery some time in May/June (if all goes well with my healing)


I met with 5 different Doctors before making my choice.  I realize I had the blessing of having TIME on my side.  I did not have a cancer diagnosis and so had time to meet with different Doctors speak with them and go see others for their opinion.

Do we pick them because they are ‘the best’, because they have great bed-side manner?  OR do we NOT pick them because they are arrogant, or have no interpersonal skills whatsoever?   

Is the Plastic surgeon the most important choice – do I meet with them first?  _After all, I will meet with them after surgery and I have to live with what they create for me; the Surgeon is only there for a few hours of my life.  

Is the Surgeon more important – pick them first? _ After all, the whole reason to do this surgery is to reduce my risk as much as possible, remove as much breast tissue as possible; I can always go see a different Plastic Surgeon after the fact for a revision if I do not like the final product.

**(We have to realize that it is impossible to remove ALL breast tissue – so there is always a RISK that breast cancer could develop)**

I don’t think there is a RIGHT WAY you pick your Doctors.  For me, I put more emphasis on picking the Surgeon.  Who I picked came down to who was I most confident in.  Who did I trust?  It was less about pictures and experience (although, all the Drs I met with had plenty of both) it was who did I trust with my surgery.  Who would do a good job?  And most of all what choice was I willing to LIVE with.  That’s the bottom line.  I made my choices based on the reasons I listed above; perhaps you will choose your Doctors differently.  

It came down to trust.  Based on my Dr’s experience (many years); his gentleness and his knowledge and understanding of the BRCA mutations are only some of the reasons why I chose him.  We actually spoke of other non-surgical options the first time we met.  Because I had such trust in him; I had to believe that the Plastic Surgeon he chose to work with must be pretty good (she is).   

When I met with the Plastic Surgeon that my Breast Doctor worked with, I was really nervous.  I wanted her to be good.  She is.  Again, it’s important as well to know that the Plastic Surgeon has experience and knows what they are doing.  I was very fortunate that someone from my family came with me to every appointment I went to.  We were then able to go over things afterwards.  For me again, it was less about what was said.  I have done my research and ‘know’ what they are taking about; I watched how they interacted with their staff, were they respectful, did they order them around..?  I asked the lady at the reception counter about my Plastic Surgeon.  She said she was amazing, has a real passion for breast reconstruction and that I am in ‘very good hands’.  For me, that carries a lot of weight.   Again, these are my choices; this was very important to me. 

Another thing I found helpful to keep in mind is that Doctors will recommend a procedure they like or are familiar with.  I saw 3 different Plastic Surgeons; all very qualified and well respected in their field.  I was recommended 3 completely different reconstruction procedures.  Not ONCE was I told; "I don't do the procedure that would be 'right' for you; you go see Dr.____."  That's not going to happen.  Every one of them has a procedure that would work for me.  I have to pick the one I want.

It is not easy to pick a team.  Bottom line is we have to live with the choice we make.  Make one you are comfortable with.