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I saw two docs this week: Dr. D, my oncologist, and Dr. K, my plastic surgeon.

Oncologist Visit: SCORE!
Plastic Surgeon: Dammit, dammit, dammit.

Dr. D checked a bunch of stuff and the results are pretty good. My white blood cells look normal and my tumor markers are staying down. My estrogen levels have risen about ten points, but he’s comfortable with the level right now (Rising estrogen could be potentially bad since the tumors I had were being fed by estrogen). So I will continue with the current course of hormone- blocking Arimidex. He’s sending me for a baseline bone density test and a chest x-ray, and if those look clear, then I don’t have to go back for 6 months.

The visit with my plastic surgeon went exactly how I didn’t want it to go. >:-/ Before I even changed into the comfy paper shirt, he looked serious. “Why don’t you change so we can talk about your options.” Awesome. Talking about my options could only mean that I was about to get news I didn’t really want. I reluctantly changed and hopped (moped) onto the exam table. He came back in and asked me to stand up. (Oh, I forget to mention, my husband was there too. There is nothing weirder than standing topless in front of another man’s face while your husband looks on!) Dr. K looked at, prodded, and poked at my current upstairs situation. Then he kind of squished my sides, touched my back, and asked to see my belly. He added a little squeeze there and then asked me to sit down. I sat down quickly and sat up very straight (because good posture will help in a situation where you get bad news). He said, “There just isn’t enough skin on your left breast for regular reconstruction. The radiation caused it to shrink too far. But there are some other things we can do.” It was a good thing I was sitting up so tall, because then I had enough room to sink down and feel defeated.

********Can I just be vain for a second? You know what? Cancer sucks and it’s horrible and I hate it. But before cancer I had always privately dreamed of breast augmentation. Then I was diagnosed with cancer and although it has been awful, my secret little victory was a bigger set up top. Finally! Cleavage without wearing a corset! Bathing suit tops that don’t have that waterfall of fluid due to push-up pads! Reconstruction after mastectomy wasn’t going to be perfect and the scars would remain until forever, but at least I would be able to work on that hourglass shape. I have the curvy hips, the small waist, and with proper reconstruction, I would have the busty curves too. Now I know that breast size doesn’t make the woman, and we’re all still the same whether we have breast or not, but I’m serious about my femininity. For me, being feminine starts with your attitude toward yourself and others–and if you look good while doing it, you’ve got the whole package. I need to be thankful for my life, because no matter what I look like, I’m still here to be a wife, mother, and educator. And I am thankful for all of that…I just want to have my cake and womanly curves too.********

Dr. K started to explain the two best option for my troubled breast area. The right side is perfectly fine. I still have a tissue expander in there and I will be able to get normal reconstruction: just an implant and I’m outta there. The left, however, is a shrunken mess and my two options are the dreaded flaps:

Option #1: DIEP—A DIEP flap is a type of breast reconstruction in which blood vessels called deep inferior epigastric perforators (DIEP), and the skin and fat connected to them are removed from the lower abdomen and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the abdominal muscles (I am calling this one the belly flap).

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Option #2: Latissimus Dorsi Flap—An oval section of skin, fat, and latissimus dorsi muscle is detached and slid around through a tunnel under the skin to the breast area. Blood vessels remain attached whenever possible. The tissue is shaped into a natural-looking breast and sewn into place (this one shall be named the back flap).

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There are pros and cons to these procedures (mostly cons)

Belly Flap pros: tummy tuck (that I don’t really need)
Belly Flap cons: slicing open my abdomen, 4 days in the hospital, giant scar on my abdomen (so no to nude photo shoots), the teeny tiny stretch marks that are left over from pregnancy will be transferred to my breast, requires two surgeons, I don’t really have enough belly fat to make anything worthwhile.

Back Flap pros: smaller scar, shorter hospital stay, your latissimus dorsi muscle isn’t all that important. I told Dr. K that I thought it was an important muscle and he said, “not unless you are an extreme athlete”. (Wow, first I get the news that I can’t have the regular surgery and now I find out I’m not an extreme athlete? Such a cruel, cruel world!)
Back Flap cons: scar across my back (meaning I’ll never go back to wearing those backless gowns I’m so fond of), weird sensations–since the blood vessels stay intact, if someone touches your back, you’ll feel it on your front, weird recovery– how do you sleep with ouchy spots on your back and on your front?

So after discussing all of this, I told Dr. K that I needed time to think about it. He agreed, filled my right tissue expander with more fluid, and I left. (Now I can be described as small, hard grapefruit boob/big, soft, oddly-placed, slightly in the armpit boob.) Luckily, I was able to meet with some fabulous cancer people the next day who had been through the whole process or were about to. Getting first-hand advice was really helpful and I feel much calmer about making a tough decision. Those Pink RibbonCowgirls (a local breast cancer support group) really know how to make everything seem not so scary.

Don’t worry though, I’ll be sure to keep you abreast of what’s flappening. ;-)