7. Plastic Surgeon Visit

Went up to UC Davis plastic surgery clinic today (4/5/11) to meet with a surgeon to talk about mastectomy options. I was a little keyed up due to the minor car accident earlier in the day....well minor in that no one was hurt, but major because my car is wrecked...AGAIN and I won't have it for 2-3 weeks! Blood pressure was a little high, but that was due to the adrenaline in my body.

Mom and I managed to make it to the clinic on time. After spending over an hour with the doctor, it seems there are a couple of things to decide when it comes to having a mastectomy. Using implants or have an "autologous" procedure that uses my own tissue.

As it stands now I have 3 options, all of which include a sentinel node biopsy:
1) Lumpectomy with Radiation,
2) Mastectomy with no radiation and reconstruction with implants
3) Mastectomy with no radiation and reconstruction with autologous tissue.
If the biopsy shows cancer in the nodes, then radiation and chemo are on the table for discussion in all 3 scenarios.

Here are my thoughts on the various options:

1) Radiation is poison and I am not crazy about that idea. Don't want my tissues burnt to kill cancer cells, don't want my bones and heart and other organs to go through that if there are other options, which there are.  High levels of radiation are just not good for you. I want to avoid this if at all possible.

2) Implants have risks of leakage or rupture which can be problematic. Silicone implants are either not used anymore, or just not by this doctor. He talked about Saline implants, which sounded doable until I found out about this other option...

3) Using my own (autologous) tissue  to build a new breast? Really? I had heard of it but didn't know much about it until today. It is called a DIEP Free Flap procedure and would involve taking stomach tissues (skin, fat and blood vessels) and 'transplanting them' (my words) to make the new breast. There are other forms of 'Flap' procedures, but DIEP does not involve the stomach muscles, as some other 'Flap' procedures do. This DIEP procedure is MAJOR surgery! It is done with microsurgery that takes approximately 6 hours and can be done immediately following mastectomy or can be delayed until a later time for a variety of reasons. It involves being hospitalized for 5-6 days so they can monitor you in ICU for 4 days for observation. All of the tiny blood vessels have to be detached from the stomach and reattached at the breast. A very specialized procedure. Although they do not involve any of the abdominal muscles, it is still a major surgery that will make the stomach sore for up to a couple of months. Recovering to the point of working takes a good couple of weeks, but that may be for people who get to collect disability and don't have flexibility to return to work. I am self-employed and have to work to get paid, so I hope to be able to work from home within a week.

Decisions, Decisions!!

I know someone who did a 'Flap' procedure and has had nothing but complications from it. Though hers was not a DIEP Flap procedure, she discourages people from seeking autologous treatment, the kind that uses your own tissue. I plan to follow up with her to find out what exactly the problems were, because the first time we talked about it, I really didn't understand it. Now I have a better idea of what she went through. I am curious to know what she would have done differently given here experience. I am also seeking referrals from the plastic surgeon that I can contact about their experience.

Time is of the essence and I am at 7 weeks since diagnosis and getting the tumor out within 6 weeks is highly recommended. I don't want to rush to judgement, but I have to make a decision and move on with the best solution for me. There is no 'one size fits all'  answer for this kind of treatment.

As I pondered this decision today, I realized the importance of get something scheduled ASAP since time is marching on. At this point I am thinking of using tissue from my own body. The two surgeons, the one who does the mastectomy and the plastic surgeon who does reconstruction need to coordinate their schedules which has proven to be very difficult!

Late in the day I found out that doing immediate reconstruction, where you actually wake up with a new breast, is not an option until end of MAY! That is too long to wait - it would be over 3 months since diagnosis and I don't want to risk the tumor growing or spreading, so it looks like I will have to do the mastectomy first, have a tissue expander put in that will allow for reconstruction to be done at a later date, approximately 1-2 months after the mastectomy.

A very tough decision to make. Given that time is now working against me, I scheduled the mastectomy for Thursday, April 20th, 2011, knowing that I will have to go back again for the reconstruction. So far, given the information that I have found, I am thinking the DIEP procedure is my best bet. This way the tumor is out and if I choose to have implants done instead, I can still change my mind. But I really like the idea of using my own tissue, not a foreign substance. But then again I just don't know. Just when I think I have it all figured out........