October 19, 2009

I left to catch the 7:06 AM train from Lancaster to Philly for the areola-nipple reconstruction surgery this morning.  Michael drove, hoping to get to UPENN by the time I was finished (the morning traffic is murder—so I was trusting Amtrak to get me there on time) so he could drive me home.  He had made a reservation online, and I forgot to scan the reservation, thus had no ticket when the conductor came by—it’s not like this was the first time I made this trip!  He very kindly sold me a ticket on the train and I settled in with my NYT. 

Halfway there—we made a dead stop right before Exton.  Okay, relax.  That was my self-talk, which worked through the tenth minute.  Then I dug put my cell phone, which, OF COURSE, had no battery charge remaining.  After another five minutes, I got up my nerve to ask the woman across the aisle if I could make a 30 second call to Michael.  I told him we had been stopped for fifteen minutes and had no idea when we would be on our way—a failed power control box in Atlanta was the source of our delay.  Michael called the hospital to say I would be late and we took off about 7 minutes later.  That was my walking time from 30^th street to the Abramson Cancer Center—taxi time.  Forget it, the line for the taxis was 30 people deep—thankfully, I had my brandy new running shoes on.  Seven minutes, yup!

I arrived, having had no time to get nervous.  I won’t go into scalpel details, but I was awake—YIKES.   Dr. Serletti has not heard of the calming effects of playing a CD for distraction sake.  The best part was him leaving the surgical suite to get a med student to assist him, after completely prepping the breasts and belly, and upon his return—the door was locked!  Not joking.  I was alone in the room and couldn’t move and he was telling someone to get the key.  I was a little skeptical as to whether or not these were bad omens.

Everything went well, he is as cool as a cucumber.  He performs 170 DIEP flap reconstructions a year—my trust couldn’t be stronger.  I didn’t love hearing all of the surgical sounds though!  I am now very cozily settled in front of the fire, letting percocet take care of the pain.  I have 5 books checked out of the library and will take a short walk tomorrow.  Again, I am happy to be on this side of a procedure. 

The following piece on getting what you need for your reconstruction is so well-written, that I want to pass it on—no need to re-invent the wheel on this one.  It is from breastreconstruction.org.  (A fabulous site.)  The only thing I want to add is, check out the credentials of any doctor to whom you are referred.  How many lumpectomies or mastectomies do they perform a year?  What is their specific training related to treating women with breast cancer?  How many implants do they deliver to women following mastectomy?  How many TRAM or DIEP flap reconstructions have they performed in their career?

What Do I Ask My Doctor?

You've been diagnosed with breast cancer, and surgery is imminent.  But, where do you begin?  Like many women, you want to prepare a list of questions to bring to your consultations with your breast surgeon and plastic surgeon.  In this section you'll find a great starting point. 

The most important part of your consultation with your plastic surgeon starts before you walk into the office.  You've done your research, you've asked friends and family for advice and you may have an idea of what type of reconstruction you desire.  Although that's a good starting point, it is likely that something essential is missing.  In order to ensure that you will have an informative consultation, you should make a list of your reconstructive goals.  This list will serve as a reference during your initial appointment with your plastic surgeon.  The “best” surgeon is one who will discuss these goals honestly, and establish what is realistic, and what is not.  Every member of your team of doctors, from your breast surgeon to your radiation oncologist, needs to be on board with the aesthetic goals for reconstruction that you establish with your plastic surgeon.  If all of your doctors work together, you can create a “dream team” that can hopefully make your reconstructive goals a reality.

Putting together a list of goals may be easier for some than others.  Try to establish three to four main goals (see example below).  Ask yourself what you want to get out of reconstruction.  Achieving symmetry?  Matching your other breast?  Having breasts that are larger or smaller than they were before cancer?  Your aesthetic goals should include anything that you desire.  Even if your goals seem unrealistic; your surgeon can go over what is achievable and what is not. 

Example: Jane Doe is 33 years old, and has invasive cancer in her right breast. GOALS:

 Remove both breasts, left side prophylactic

 Maintain my full C cup, if not one size bigger

 Keep my nipples

 Get the most natural looking and feeling breasts

Jane presents these goals to her surgeon.  Along with these goals she has a list of questions:

Which type of reconstruction am I the best candidate for?  What are the risks and benefits of this procedure?

Will this procedure meet my reconstructive goals?

How many surgeries are involved with this procedure?

What are the complications that can arise from this type of procedure?  What are the rates of infection and other morbidities?

What are the lifetime maintenance requirements for this procedure?

How many times have you performed this procedure?  How many failures have you had with this procedure?

Can I see before and after photos?

Do you have a former patient that I can talk to over the phone?

What are the next steps - including insurance approvals and preparing for surgery?

In Jane's case, she describes what is most important to her.  Ideally, she would like to have reconstructed breasts that feel natural, and have a substantial size.  Keeping her nipples may not be possible, but if she didn't present that goal to her surgeon, it may have been overlooked.  Wanting a more natural look and feel to her breasts, the surgeon may recommend a flap procedure; however, Jane would need enough of a donor site to support her desire for large breasts.

This is just one example of why it is essential to have a list of goals when you go into your appointments.  You will walk away feeling like you have a connection with a surgeon that takes the time to listen, answer, and thoroughly explain what is and what is not possible.  Knowing that you are on the same page with your doctor will leave you with less anxiety and new found hope as you approach your surgery date. From breastreconstruction.org.