But it won't be fun getting there!
Doug and I met with my plastic surgeon yesterday. Dr. Kays comes highly recommended. He's been practicing for around 17 years, has performed more breast augmentations and reconstructions in the Wilmington area than all of the surgeons at Duke and Chapel Hill combined, stays current on the research, sits on advisory boards, and employs the latest/greatest technology. He was responsible for pushing for more immediate reconstruction for breast cancer patients here in Wilmington. In the past, reconstruction wasn't offered until 5 years post-op! He's also responsible for coming up with a change to Alloderm (I'll explain that stuff later) that allows for better drainage post-op. And while all of that is appealing, his "bedside manner" is the reason I like him the most. He's not judgmental, and he has no preconceived ideas about how I SHOULD look once this is done. Much of the decision making is in my hands. The kind of reconstruction, the pace of the process and the overall size and look are up to me (even nipple placement, in the end).
I've decided on implants for reconstruction. Here's the process as I understand it:
After Dr. Weinberg finishes the bilateral mastectomy, Dr Kays will come in and place an extender. The top of it will be placed beneath my pectoral muscles (I'll insert pictures soon). The bottom of the extender will be covered with Alloderm. Alloderm is CADAVER skin. Hearing this freaked me out a bit. Granted, it's acellularized and sterilized. Still, that sounds gross! The Alloderm is meant to stimulate collagen growth and provide comfort by preventing internal abrasions (stops the extender from rubbing on the skin). My inner voice kept repeating "Cadaver. Cadaver. CADAVER!" I know this kind of thing is done often, but the thought of Cadaver skin really weighed on me in that moment. Doug later offered another perspective; someone, somewhere was a donor and they made this procedure (and other ones) possible for me and for so many others. I really appreciate my husband's ability to get me out of the crazy corners in my head. And, I am so grateful to organ donors for making this procedure possible.
After the initial jolt to my reality brought on by the thought of cadaver skin becoming part of my body, I was advised about the drains. This part will surely take some adjustment. A lot of adjustment. Ok, really, I don't know how I am going to handle this part!
After surgery, they will install 4 drains, 2 on each side. Initially, I pictured "drains" as small tubes coming out of me that would be a nuisance, but not much more. The drains work on negative pressure. We'll (maybe Doug and I will share this job with other family members) have to suction fluid from the drains (Ewww, gross!) a few times a day. This goes on for about a month, until the drains are removed. And, these drains are not the small tubes I was thinking. They are longer. Apparently, when I shower, I'll need to sit on a shower chair and place the drains in MY LAP. And I'll need help showering at first. Here's where I took a deep breath and fought off tears. I imagined looking like some dirty, octopus-like person, full of scars and fairly helpless. I hope to find that the reality is a lot less scary than the images I was conjuring. My brother, Jason, comforted me with the idea that all of this will happen in stages, and that'll I'll adjust to each challenge as I face it. I hope he's right.
The rest of the discussion at Dr. Kays office held further surprises. I knew that I'd return every couple of weeks for saline injections into a port beneath my skin, to slowly fill up the extender and stretch the skin so it can one day accommodate the implants. I didn't realize that nipple reconstruction was a separate surgical procedure and that areola are later tattooed on. So now, I am facing 4 surgeries (sentinel node biopsy tomorrow, bilateral mastectomy, the surgery to replace the extender with the actual implants, and nipple reconstruction) and tattoos. I'm told the process will take about a year (longer or less based on whether or not I have chemo and the pace at which I choose to fill the extenders). Yesterday was a hard day, emotionally. The thought of cadaver skin, ridiculous drains, an added surgery, tattoos and the length of time between the mastectomy and the final phases of reconstruction are taking a small toll on that confident outlook. But I'm already feeling better today. suppose this journey will be filled with many surprises and challenges. There will be bad days, but I am determined that the good ones will outnumber the bad.
As a side note & for those of you into the latest in technology:
1. Dr. Kays uses Natrelle 410 Shaped Gel implants. They are silicon gel implants that have the highest cohesivity on the market. Unlike the days of old where silicon leaks from implants were a serious concern, these are solid. And, they are sloped just like a natural breast.
2. He uses some technology called Spy Elite. I need to do more research on it, but apparently it shows through the skin so he can see blood profusion to the wound site after surgery, keeping a gauge on the healing process.
3. Dr. Kays recently recommended a change to the design of Alloderm. He wanted it to have holes to help with drainage. After some process and work with a research and development team, this product is in trials. Dr. Kays was given 4, and I may be one of the patients he uses them on. Guess we'll see....
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