Reconstruction

Talking about your breasts is a pretty personal thing, talking about reconstructing your breast after a mastectomy is even more personal.  Not something I would ordinarily talk so openly about, but it has really helped me to approach this experience very methodically and openly.  I warn you in advance that this post is blunt and to the point.

The time has come for me to have my final reconstruction.  My entire life, I have never once considered having plastic surgery, especially breast augmentation, however when given the choice between plastic surgery or no breast....I choose plastic surgery.  Perhaps I am more vain than I thought I was.  Really I think I just want to be able to wear the clothes I like, look good, and not worry about symmetry.

One of the hardest decisions of my life was back in March when I chose to have a mastectomy.  Since then, I have spent a tremendous amount of time learning about reconstruction methods.

The easiest method of reconstruction is to use an implant.  This surgery is relatively quick and usually results in a nice perky breast.  The problem is, real breasts aren't as perky as round implants.  So then the decision needs to be made if you want to have an implant placed in your other breast to help with symmetry.  This adds another surgical site, and since you are adding an implant makes your breasts larger than they originally were (although you can choose how much larger).  The end result is two perky breasts that hopefully have good symmetry.  Although this is the simplest reconstruction method, there are some downsides.  Implants don't last forever, even in straight forward augmentation (boob jobs).  Additionally, reconstruction with implants often is not successful for women who undergo radiation.

Another method of reconstruction is a flap procedure.  Surgeons take fat, muscle, and a blood supply, usually from your abdomen or trapezius, and somehow reposition it to your breast.  Obviously this is a lot more invasive than implants.   Not only is recovery time longer, but since muscle is sacrificed there is a good possibility of reduced strength or muscle imbalances.  Surgeons, however, seem to like this technique  because the blood vessel is pulled from the original location to the breast and no reattachment is necessary.  For me, this was never an option.  I'm simply not willing to sacrifice muscle for reconstruction.

The final method involves fat, skin, and associated blood vessels being taken from the abdomen, butt, or inner thigh and transplanted (actually removed and then reattached) to the chest wall.  The surgeries are called DIEP, S-GAP, or TUG depending on where the tissue comes from.  No muscle or motor nerves are sacrificed with this procedure and a gifted microsurgeon can produce amazing results.  I've heard some women say that their new breast perfectly matches the other side.  The downside of this surgery is that it is an incredibly tedious surgery; often patients are under general anesthesia for up to 10 hours, thus increasing the risk of surgical complications.  After surgery, if all goes well, there are strict precautions for up to 6 weeks.  This procedure also requires a sufficient amount of adipose tissue in either the abdomen, butt, or inner thigh so often is not a viable option for extremely thin women.

To help me make my decision, I have met with three different plastic surgeons as well as consulted via telephone with a microsurgical specialist in New Orleans.  Since I had taken flap procedure off the table, I had two options: implants or S-GAP.  I am a perfect candidate for implants because I am young, healthy, and did not get radiation.  I was told that I was also a candidate for a S-GAP.  Apparently I have enough butt fat to build a small breast.

Based on this information, I have decided to have implant based reconstruction.  I chose this procedure because of the reduced surgical and recovery time.  I have also chosen to have my 'other' breast augmented slightly to help with symmetry.  So the end result should be slightly larger and more perky than I was before.  Although I wasn't really looking to increase my breast size, I do want to have good symmetry, and S-GAP aside, this is my best chance for that.  If for some reason this is not successful, I can always pursue the S-GAP in the future and the 'other' implant can be removed.  There are also new reconstructive techniques emerging all of the time.  Maybe, down the road, there will be a procedure that uses your own tissue without the surgical risks and extended recovery time.  In fact, one of the plastic surgeons mentioned one such new technique.

I did not take this decision lightly, in fact, it probably took me a few months to come to a final decision.   Seriously, my plastic surgeon just found out my final decision this week.

I would advise anyone who has to make this decision to meet with multiple plastic surgeons.  I found that different surgeons feel more comfortable with different techniques.  If one surgeon is not trained in a specific technique, he/she may not mention it as an option.

This week when I met with my plastic surgeon I told him my final wishes.  I said words that I never thought would come out of my mouth such as 'I don't want my breasts all jacked up, try to make them droop more like natural breasts'.  Apparently this is possible.  and 'I want the very smallest implant possible'.  Throughout this process he has been very respectful of my desires and I feel that he truly understands my wishes.  We'll see.......Surgery is August 15th.