Things have been pretty uneventful these past couple months, but February begins a busy season of trips to Houston. With my reconstruction surgery scheduled for Feb. 12, we have a bunch of pre-op and post-op appointments which will keep us pretty busy.
Yesterday was the first one. Alan and I drove down there yesterday (Monday) for a pre-op doctor appointment and a regular oncologist visit this morning.
The appointment with Dr. Moulder, my oncologist, was just a checkup. I had been waiting for this appointment to discuss (again) my local oncologist’s recommendation to remove my ovaries or “put them to sleep.” She answered some of the questions we had and confirmed that she did NOT recommend removing my ovaries or putting them to sleep. I’ve been wrestling with this because the logic that my local oncologist gives make sense. But Dr. Moulder doesn’t agree. She says it sounds logical, but there is no data to support it.
She said …
“Outside of a clinical trial, I would be very cautious about removing the ovaries.”
… and …
“We don’t practice medicine based on empirical evidence.”
She also reminded me that forcing me into early menopause brings on a whole bunch of other concerns, like heart disease, osteoporosis, etc. It just isn’t recommended. That’s all I needed to hear.
We also saw Dr. DeSnyder, my breast surgeon. We went over the surgery that is scheduled for next Wednesday and signed consent forms. She will be performing a nipple-sparing, prophylactic mastectomy on my left side. Her part will take about four hours.
Her nurse noticed that we were not set up with pre-op appointments for my plastic surgeon, Dr. Kronowitz. They had said they would be scheduling it, but it hadn’t happened. After a quick phone call, they had us squeezed in to see him — an unexpected, but welcomed, appointment.
Now, I’ve known for months that I would likely have Lat Flap reconstruction. Basically, they will take my back muscle and swing it around to the front, attach it and place an implant underneath it. This is necessary because I have had radiation on that side, and radiation can cause complications with implants. Using your own tissue combined with the implant reduces the risk of complications. There are other options (like DIEP), but I am not a candidate for them.
So, along with the back flap surgery and the reconstruction on the left side comes a six-hour surgery (on top of the four hours that Dr. DeSnyder needs for the mastectomy). I’d also get two drains on each side of my body, plus one in my back. I’d get three days in the hospital and have to stick around Houston until seven days post-op … just in case of complications.
It’s a pretty big surgery. I’ve been mentally preparing for this. I’m as ready as I’ll ever be.
Until today when Dr. Kronowitz threw a possible wrench in our plan. He told us about an option that has never been discussed before. He has being “doing it on his patients more and more” lately and wanted to provide it as a possible option.
If we were to go forward with this, he would either put in an implant or an expander on my left side (as planned), but on my right side (the cancer/radiated side), he would not reconstruct during Wednesday’s surgery. Instead, he would graft fat from my hips and put it around my tissue expander. Then, about six months later, he would switch out the expander for an implant and add more fat — an outpatient procedure. What he has found is that by doing the fat graft prior to the actual switch, the fat provides healing effects that could take place of the job that the back flap does.
- 6-hour surgery vs 10-hour surgery
- Faster recovery from Wednesday’s surgery
- One night in the hospital vs. three nights
- I could go home on Friday or Saturday vs the next Tuesday
- I’d only have drains on my left side (though I’d have them on my right when they do the second surgery to exchange the expanders for implants)
- I wouldn’t lose strength/range-of-motion that comes with losing a back muscle
- I wouldn’t have a big scar on my back
All in all, it would be a less invasive, less complicated procedure. Sounds like a no brainer, but I made a list of the cons as well.
- I’ll definitely have to have a second surgery. That said, there is a pretty high chance I’d have to have that anyway. He said that chances were that he would be putting in an expander vs. an implant on my left side (a call he and Dr. DeSnyder make during surgery).
- There is a higher risk of complications with the implant than if I do the back flap.
Short list, but that last one is a doozie. Complication risk is higher, and complications complicate everything. We have three kids and don’t exactly live near MD Anderson.
So, do I take the lovely Door #1 which has a potential for an easier surgery, easier recovery and the same aesthetic outcome, BUT a higher chance something will go wrong after the surgery – which will put me back at square one?
Or, do I take Door #2 which is a 10-hour surgery, drains galore, longer recovery, loss of muscle in my back and nice scar on my back to go along with all of my other scars — under my arm, on each breast, plus my three port scars?
I had it all planned out, and now I’m lost on what to do.
My deadline is Tuesday. Ugh.