Reconstruction Surgery follow-up

Here I am back again after a long hiatus. So what did I do during these past 11 days. Lots of stuff but nothing noteworthy so I will not write it here.

Today, I went to see my Plastic Surgeon, Dr. W., for more questions on my upcoming reconstruction. I explained that I am a technical, detail-oriented person (as opposed to just generally being a pain in the neck) and I had some questions to ask. She asked me if I got the printout after the last meeting and I said, "no". She said that might help. Then she asked me if I had seen the photos. I again said, "no" and she thought those might help. I am sure she didn't guess that I really wanted to know what she was going to do to my body - in detail.

And so...

I asked my questions (please note that Dr. W's answers are not direct quotes but only reconstructions of my notes and memories of our conversation):

Me: What is the intent of the first surgery? Is it meant to complete the process or just to start it?

Dr. W: The first surgery is to get the fat plopped into place and a shape made that should resemble the breast you are looking for. After about 2 months, when the swelling goes down, a determination can be made as to how good the match is with the other breast and how it is sitting. Is it higher or lower. In about 70% (her number) of the cases, a second surgery to reshape or tweak the breast is desired. I know you had some concerns with insurance so the second surgery is not a must.

Me: Is the reshaping, tweaking surgery outpatient?

Dr. W: Yes.

Me: That fits my concern. I am staying with Kaiser but may lose Cobra which will raise my rates for overnight hospital stays. (More convo on insurance costs not necessary to be recorded here)

Me: Is the nipple also Outpatient surgery?

Dr. W: Yes.

Me: What can I expect in terms of look and size of the new breast? When will you draw the lines on me and know?

Dr. W: When you are in the operating room on the operating table. I will look at the other breast and your structure and decide then.

Me: I have a pain from the Mastectomy in my lower rib area. It feels like bruising and sometimes wakes me up when I roll over on it in my sleep. Will the recostruction help this?

Dr. W: It is hard to say for sure. When I do the reconstruction, I open up the mastectomy scar and clean out any internal scarring and then fill in all of the areas that were emptied by the mastectomy. The new healing may eliminate the pain or you may still have scarring in that area.

Me: What about my belly button? Will it be repositioned?

Dr. W: Yes. It will be in a different place and may look a little diferent but it will be your belly button. In very rare cases, we can't save the belly button but in almost all cases we do.

Me: What part of my stomach will be used? And what happens to the rest?

Dr. W: One side will be cut through the abdominal muscle..

Me: I thought the DIEP does not cut through the abdominal muscle?

Dr. W: I have to cut down into the muscle to separate out the arteries.

Me: But not cut through the muscle like a Free flap? I will still have use of the muscle?

Dr. W: Yes. you will have use of the muscle.

Me: So you cut through the muscle on one side and then what happens on the other side?

Dr. W: I remove the fat and skin from the other side and discard it. In some cases, if the arteries on one side aren't good, I may have to go to the other side and cut through there as well.

Me: What about creams? Is there anything I should use on the skin at the mastectomy site prior to surgery to make it softer or better conditioned?

Dr. W: There is nothing to use prior to surgery. We do have recommendations for after surgery. Also, in terms of general health. Keep exercising and keep your weight down so that you are in good condition and can have a good recovery.

Me: Ok. So about the other breast. Is it best to wait and see how the right side comes out before doing a lift on the other breast?

Dr. W: Yes. I recommend waiting to see how you feel about the match. Loss of sensation, additional scarring and other factors may affect your decision also.

Me: My left breast droops more than before since I had the lumps removed. It is also slightly deformed. I thought that a lift could help that.

Dr. W: With your history, the scarring and potential for sensation loss may not be as important since you have already gone through one operation on that breast. If you are sure that you want to have that breast lifted, I can try to do it at the same time.

Me: (Smiling) I am not sure what I want to do.

Dr. W: Most women aren't so we can wait and see how it looks.

Me: Will that be a couple of months later also?

Dr. W: Usually it takes a couple of months.

Me: Will I be able to speak with my anesthesiologist before the operation. I want to understand what type of anesthesia he/she will use and how it will be monitored.

Dr. W: Hayward is a little behind but they are supposed to have a program set up so that you could meet with an anesthesiologist prior to surgery. I will try to set that up. The only unfortunate thing is that the anesthesiologist you meet with may not be the same one who does your surgery.

Me: (I explained my concern with the detrimental effect of general anesthesia to the brain and the number of surgeries I had already been through).

Dr. K: All of the anesthesia available and the machines are already in the operating room. It is just a matter of choice on the day of the operation. You can speak with the anesthesiologist that day and make those decisions. Or you could speak with one ahead of time if you like but it is not guaranteed to be the same one you will have for surgery.

Me: I would like to try to meet with them ahead of time.

Dr. K: Okay. I will try to set that up.

Somewhere in here she also mentioned that she had never, knock on wood, (her words) lost a patient in the operating room and that she is most concerned that the health of the patient be good to minimize that risk.

After this conversation, I looked at the pictures of the reconstructions she had done. They looked very nice. The only unfortunate thing was that none of them were on radiated patients. I was interested to see what she meant by looking a little different. I asked if there were any photos of radiated patients but she said there weren't.

From this long blog, you can probably guess how complicated this can be. And, imagine, this was my second meeting with her. There were lots more questions in the first meeting.

On the way to the car I glanced through the sheet she had printed out for me. It was instructions and follow-up for DIEP surgery. Some of the instructions:

1. For the first weeks after surgery, you must walk with your abdomen slightly bent to avoid tension on the incisions. NO YOGA.

2. Do not lift anything heavier than 5 lbs for 4 weeks from your surgery date. Sorry Sam and Riley. :(

3. No vacuuming, raking or strenuous household duties for 6 weeks after surgery. (Sounds good until I think of all of the dog hair - ugh)

4. No Yoga for 6 weeks. You may start swimming after 4 weeks.

5. No driving for 2 weeks.

How much fun will I be having? I will be really thankful to those folks bringing me meals and help during that time.

And that concludes the reconstruction follow-up conversation. Now, just need to wait for it to be scheduled, give my 2 units of blood, meet with the anesthesiologist, get my CT scan, have my colonoscopy and whatever else it take to get me there and of course, the ever-continuing Herceptin infusions. Only 11 doctors visits/diagnostic tests/infusions over the next 6 weeks (so far)!