Thursday, July 17, 2008

The Day After

The surgery went well yesterday. We arrived at 6 am and discovered we were not the first people there that morning! There were already several people in the waiting room. There must be numerous operations in the naked city!

The doctor was on time; the operation began at 7:30 am; the anesthesiologist was great and I was awake and out of surgery by 9:30. I fell asleep and was in and out of sleep until about 11 am; home by noon. I have to say that I am very pleased with the results so far and think that Dr. Scheinman did an excellent job! The results of this plastic surgery much exceeded my expectations. Except for a little pain and being tired, I'm feeling really good.

I had a great many reservations about plastic surgery going into this. The biggest obstacle for me is having to have a continued relationship with the medical establishment. Don't get me wrong, I like my surgeons and my oncologist a great deal and feel fortunate to have them on my team. But, as we all know, the bureaucracy and inefficiency of our insurance carriers and/or the incompetence or overwork of the hospital billing staffs make part of the experience very exhausting. The whole insurance travesty creates a host of problems for the doctor's offices, as well.

And, because of the implant I will need more MRI's in the future and that will no doubt be expensive and time consuming. My least favorite test is the MRI. Also, if something should go wrong, I will need more surgery and right now I am very tired of surgery and have a genuine concern about how strong my heart will continue to be. But, in talking with other women who have had breast cancer and who did not choose reconstructive surgery, there will always be a continuing presence of doctors and tests in their lives no matter what. There is no hiding any more.

Someone asked me if I was going to continue my blog after this. There are still tales of Tamoxifen and tales of insurance companies and billing departments and nutrition and exercise to be told. And, then there are all my many friends, relatives and neighbors who supported me emotionally, physically and financially throughout this time who still need to be thanked. Because of them, I have continued to live my very charmed life. For that I am truly grateful.

Sunday, July 13, 2008

Reconstructive Surgery Set For July 16, 2008

Early Wednesday morning I'm going to the Ambulatory Surgery wing of Maimonides Hospital Center to have the final phase of the reconstructive surgery. There are two basic types of reconstructive breast surgery being done these days. One type is called tram flap surgery and the other type is called implant surgery. Within each category there are several options available. I chose the implant surgery.

I had what they call a "skin sparing, nipple saving" mastectomy. In order to do this, at the time of the mastectomy I needed to decide whether or not I wanted the reconstructive surgery at all. So, even though I was already overwhelmed by the fact of having a mastectomy and tired of all the previous surgeries and the chemotherapy and the imposition cancer and cancer treatment placed on my life, I was faced with yet another decision. As you may recall, I hate making decisions, but I also don't like anyone telling me what to do. What a dilemma!

According to the doctors, most women who elect the plastic surgery are more positive and able to return to their lives and to work more quickly than those who opt out of reconstructive surgery. As Dr. Borgen http://www.maimonidesmed.org/body.cfm?id=1073 my breast surgeon and Dr. Scheinman, my plastic surgeon also explained, reconstructive surgery begun at the time of the mastectomy is a simpler process for both the patient and the surgeon. It requires fewer surgeries than waiting several months or years before deciding on an implant; and, depending on the cancer, the skin and the nipple can be spared.

During the mastectomy surgery, after the breast surgeon removes the the glands and the ducts and the fatty tissue, the plastic surgeon places a "tissue expander" and expands it slightly with a saline solution. A tissue expander looks like a plastic pita bread with a magnet. In the area of the magnet is a small hole to inject more saline slowly over time, several weeks or several months depending on the desired size and patient's temperament, to expand the tissue of the breast skin. Then, the exchange surgery-exchanging the tissue expander for the implant- can be done as an out patient procedure with less anesthesia.

Because it was difficult for me to make a decision and because I am fortunate to live in a country that allows me the opportunity to even have this option, I chose reconstructive surgery rather than having a simple but elegant scar with a tattoo. I chose implant surgery rather than tram flap because it seemed to me it is less invasive, requires less recovery time and can always be removed if something goes wrong.

For more information about reconstructive surgery options, go to http://www.breastcancer.org/ and put in a search for "reconstructive surgery".