A Clear Path

Sometimes when the Hero is most confused, he meets a mentor. This is a person who will provide information to help redirect the Hero, or at least give him tools to make decisions about the next phase of his journey. Yesterday I met with the latest in a long string of mentors on my travels -- the plastic surgeon.

I felt many of the decisions I needed to make were being sidelined because I was missing information only this doctor could provide. One breast or two, reconstruction options and most importantly -- timelines. Yesterday all of these questions were answered.

First off I will have both breasts removed on August 27. My original concern was if I did, I would have to wait years for reconstruction. My plastic surgeon assured me yesterday I was now on his patient list and he will do reconstruction when my body has healed. However, having said that, I won't have new breasts right away. He won't meet with me again until six months after radiation, and it could be several more months following that before reconstruction can be scheduled.

He reviewed the reconstruction options available and we discussed the pros and cons of each. The first option (really a non-option because I will be having radiation) is a straightforward implant. The surgeon places a "balloon" under the chest muscle and stretches the area to insert either a saline or silicon implant. However, there is a relatively high incidence of the breast becoming misshapen over time as the tissue treated by radiation constricts. My doctor says although the surgery and recovery time for this option are both minimal, he would not recommend this for me.

The second option is latissimus dorsi, a surgery which uses the muscle and tissue from the back. The flap and its blood supply are tunnelled under the skin just below the armpit. It is then put into position to make a new breast shape. An implant may also be used to provide additional fullness. My surgeon says he makes an incision in the back which will be covered by the bra or swimsuit strap, so the scarring isn't an issue. The surgery can take six to seven hours and patients are usually hospitalized for two to three days. At home recovery time is relatively quick. And while I won't be swinging a tennis racket the next week, my day-to-day activities shouldn't be too hampered (Rob may have to vacuum for a week or two). This is most likely the surgery I will pursue when the time is right.

The final option uses the skin and muscle from the stomach region. This is a "free flap" surgery where the tissue and blood supply is completely removed and relocated to the breast. The patient gets new breasts and a "tummy tuck". It is, however, the most complicated of the surgeries and can last 12 hours or more. Post-surgery recovery time is five days in hospital and six to eight weeks afterwards as the stomach heals. There is also a failure rate of 1 in 20, in which the blood supply doesn't work and the new breast doesn't "take". This surgery also leaves scarring between the two hipbones. As my surgeon says it is the biggest upfront investment for long-term gain.

The good news is if I do decide on option three, he says I have enough tissue for at least a "B" sized breast and possibly even a "C". I'm not sure how I feel being told I have enough stomach fat to make two "C" size breasts. The other upside is I've again been told not to worry about losing weight or toning the stomach area; they need all the tissue they can get.

The surgeon was quite adamant I should have both breasts removed immediately. Not only for my own peace of mind, but because it will leave symmetrical tissue and scars for him to work with later. I'm just glad to have the meeting behind me and to be able to move ahead with some decisions. It means I'll truly be able to enjoy my weekend with Trudy and her girls without having this hanging over my head.

Trudy and her daughters -- Emily and Grace -- are arriving tonight and staying until Sunday. It will actually be a fairly busy weekend as Sunday is also Kelly's beach day. Her family and friends meet at a nearby park/beach and they go clam digging and have a big picnic. I'm hoping to take Trudy and the girls, but if not I'll head out there after they hit the road.

I think I neglected to mention a couple of cards recently received -- the Colorado group sent one as did my Aunt Trudy. Now I must go vacuum and tidy my house for my company. Can't leave the dust bunnies...they're big enough to scare Emily and Grace....