Tuesday, November 18, 2008

A Date for New Boobs!!

Met with my plastic surgeon, Dr. H, today. The result? I will get my Christmas wish for reconstruction, just not in time for Christmas.

Turns out that Dr. H is already booked up into February. He's going away for two weeks over the holidays for family time. Can't begrudge him that.

So, while disappointed, I'm really okay with waiting. It allows me time to do my homework and then make appropriate arrangements for a wide variety of things, including work, child care, house stuff, coordinating doctors, etc.

And, oh yeah. You all might want the date, huh? It's February 6th. I still need to talk to my chair, but I think it'll be okay since I chatted with him about it briefly last week.

February 6, 2009, is about 80 days away.

It's still up in the air as to what kind of flap procedure I will have. To reiterate, I will have an implant on the left side, but a flap procedure on the right since that side has now been radiated twice and the tissue is too damaged for an implant.

The two flap procedures we could do are a TRAM flap and a Lat flap. The TRAM takes tummy fat and uses some of your abdominal muscles. They cut away this tissue and then bring it up, under the skin, to the breast area. This way, they keep all the blood supply intact. (I could go to New Orleans for a free flap procedure, but I really don't want to be that far away from my support system. With a free flap, they cut the tissue completely away from your body, reattach it and the surgeons spend hours reattaching the blood vessels.)

The Lat flap takes muscle from around your shoulder blade area - the latisimus dorsi muscle - and they bring it around under your arm, under the skin and other tissue to the breast area. However, since there isn't a lot of tissue to use, it means that I would also have to have a smallish implant there in order to even things out.

Other considerations:

Both procedures have the net effect of weakening those muscles - whether they be in your abdomen or in your shoulder blade area. The Lat flap would make it difficult for things like swimming or cross country skiing. I think with the abdomen, there's just long-term issues regarding lifting and back issues, but I need to check into that.

Pros and Cons:
With the TRAM flap, there would probably be no need for an additional surgery other than adding nipples and tattooing. There's always a chance, but probably not. In the long term, I could probably much continue with all my activities eventually. Also, since there will be no implant, there is less risk of infection stemming from a foreign object. The wound more than likely has bacteria and an implant would exacerbate risks of infection.

Cons with a TRAM flap are that the recovery time after surgery is longer - probably at least three weeks. There's more discomfort. Fat also has less blood flow than muscle.

With the Lat flap, there is more blood flow to the area, which is generally seen as a good thing but now I can't remember why. There is less recovery time after surgery (2 weeks) and less discomfort.

Cons with a Lat flap is that we'd have to put in a tissue expander - again - and then do another surgery to put in the permanent implant. Then, there's the nipples and tattooing. The tissue expander/implant increases the risk of infection to that area.

I think I'm leaning toward the TRAM flap. Get it all over and done with as it is unlikely that I'd need another surgery. I'd rather have more discomfort at once then have to potentially go under the knife again at some future date - and also go through the whole tissue expander thing again which is uncomfortable.

I'd also be able to do an oophorectomy at the same time.

Decisions decisions. But I've got 80 days beforehand to think about things. The wound, and whether it continues to heal or whatever, may dictate the course of action, too.

80 days and counting!


Doug said...


I'm with YOU! I would choose the TRAM flap too. I am a swimmer, and could not bear the thought of losing that ability. Three or more weeks of pain and discomfort is minuscule in relation to that!


Dee said...

Hi Doug,
Thanks for visiting and commenting - I do think that the TRAM flap will be what I do. But no need to make a decision now.