Saturday, May 21, 2011


I've now had my initial meeting with both the breast surgeon and the plastic surgeon to consult about the mastectomy and reconstruction.

As advised, I met with the plastic surgeon first.  His office had by far the most fashionable "gowns" to wear.  They were blue toga looking things with a gold clasp at the shoulder, quite comfortable as well.  The nurse then took my blood pressure and oxygen and we had a Q&A session.  I didn't really know what questions to ask her verus the surgon, so I just saved most of them.  She asked me about my autoimmune disorder.  I explained that it is just something that came on a few months ago - the end of January, and we had a biopsy and determined it was unknown autoimmune condition affecting my lungs.  She then dropped the first bomb on me - apparently I may not be able to have silicone implants as an option if I have an autoimmune disorder.  This raised a few questions that she didn't have the answers for.  I had come into this thinking it was most likely I would want silicone.

Then we had a photo shoot!  She explained that they used the pictures to compare before and after and that if they had my permission and (IF?) he liked the outcome he may want to put them on the webpage.She had me remove my robe and stand in front of the blue wall. She took pictures from various angles and then had me put my robe back on and wait for the surgeon - (I wonder if they would let me have digital copy of the pictures...)

The plastic surgeon then came in and examined me, and we discussed what my expectations were, that I wanted nipple sparing with immediate reconstruction with expanders.  He said based on my breast shape that I would be good candidate for nipple sparing.  He did indicate though because of the thinness of my skin, it would be unlikely that I could get much larger than I am now (and said unfortunately that isn't something I can fix with icecream...bummer)  We discussed where the incision would be - I asked about having the only incision surounding my nipple and he ruled that out because it would be too difficult for him to get the alloderm and the expander in.  I asked about having the incision under the breast (in the crease underneath) and he said that he would strongly advise against that in my case with the distance from there to the bloodsupply..  So that is a bummer as well!!  He invisioned an incision out a little on each side and under my nipple..

So I asked him for more clarification on the silicone/autoimmune disorder issue, and he said that basically that after the FDA had disallowed them and then let them use them again, they had placed more constraints on their use, and so in my case he feels that if I am well informed and have the support of my rheumatogolist I may still be able to get them... so we'll see.  He was also concerned about the autoimmune disorder and the medication I'm on being problematic for reconstructive surgery.  So he said I need to be in optimal health and have my condition well controlled.   This was all stuff I hadn't considered.  I left the appointment feeling some level of distress.  After all I don't know anything about this condition!  I know I'm feeling okay now.. but the rheumatologist said this could take anywhere from 6 months to 2 years to resolve entirely - I can't wait 2 years!!!!  I'll be almost 32 by then. 

The next morning I met with the breast surgeon.  They had me wear a short pink CAPE with a snap neck closure.  Then the surgeon came in and she asked what prompted this visit - I explained I had been thinking about it since the fall and was going to indicate this at the high risk clinic but when I told the coordinator, she said there was no point and recommended I just move forward with the consultation outside of the clinic. (to avoid an extra appointment).  This satisfied her.  After ANOTHER exam - we discussed her thoughts on things.  I explained what the plastic surgeon had said.  It was apparently she was familiary with him and his work and she was comfortable with nipple sparing if he was.  She also indicated that recent research has shown little difference in the risk between nipple sparing and non.  I expressed my concern about needing to wait because of the autoimmune disorder, and she was on the same page as me - basically if the rheumatologist thought this would be taken care of in a few months then we should wait, but if this is long term or will potentially go on indefinitely, then she thinks it's in my best interest to act sooner than later.  Based on the early onset history, she agrees that waiting 2 years may be too long, and if we needed to work around the condition/medication we could figure something out in conjunction with the recommendations of the rheumatologist.  She also mentioned that she would recommend a sentinal node biopsy that would be done at the time of surgery and probably require additional incision in my armpit.  There can sometimes be cancer hanging out in the lymph nodes when it's not present in the breast.  Apparently they take up to 3 lymph nodes in this procedure and biopsy them there in the operating room, then if they happen to find cancer in them they'll take them all out.  I'm going to research this more, but it seems like something we should do!

So I was very happy after I met with her - she was reassuring, and she said she would talk to "Mark".. she's apparently on first name basis with the plastic surgeon.  They would discuss what their concerns would be with my autoimmune disorder, and then she would call the rheumatologist to discuss.   She also thought it wouldn't be a problem to schedule the surgery for the second half of September sometime.  She and "Mark" both have Tuesday as their surgery day so it shouldn't be a challenge for them to coordinate being there at the same time.  (So I guess it will be a Tuesday).  Looking like the 27th, since my parents will be out of town until the 22nd...

So my current plan of action is to have my follow up appointment as scheduled with my rheumatologist in July, as well as have my screening MRI.  then see where we're at and if we're all on board to move forward with scheduling the surgery.

With all that said - after my thorough exam and mammogram on Monday, exam on Thursday, and exam on Friday - my boobs hurt.

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