Where were we? Thursday I took off for the weekend and drove up to Murphys (small town about halfway between San Francisco and Yosemite) to share a vacation house with some friends for the weekend. I basically did nothing - eat, nap, read, hang out and chat with friends. Very low key, and very much what I needed to do.
I came home yesterday afternoon and basically dove straight into paperwork. I'm trying (and kind of succeeding) to winnow down the big piles of bills that we've been ignoring, and also got started on the paperwork for the short sale on my old condo.
This morning was more of the same, punctuated by work meetings, getting caught up on email, and my first consultation with a plastic surgeon. Bob had class this morning, so Cait came with me.
The doc walked me through the options. There are basically four kinds of surgery (and a bunch of smaller variations within them).
The first one, which is the least appealing to me, is the expanders/implants version. They cut everything off, put a balloon behind the chest wall and over the course of a few weeks add fluid via a port until the balloon has expanded to the size you want. Then you have surgery and have the expander replaced with an implant. It's pretty straight forward, but it also pulls a lot of muscles out of place. Also, implants need to be replaced about every 10 years. Also, implants are cold, which was a surprise when I first heard it, but it makes sense. If you've got these bags of saline kind of hanging out in the breeze, they are not going to be the same temperature as the rest of your body.
Then there are several variations of "flap" surgeries. These are the ones where you're doing more (or all) of the rebuilding out of body tissue, and the big concern is that whatever you move has to have the right kind of blood supply, or the tissue will die.
The first kind is pretty standard for women who are reconstructing one breast - they take tissue from the abdomen along with one of the ab muscles and shift the whole thing up - the muscle provides the blood supply and some structure. Works great for women with one breast to reconstruct, but not for two. Abs are kind of important for sitting up and stuff. So that's out.
The next kind is a bit of a hybrid - they pull your latissimus dorsi muscle and skin (the one that makes ridiculous bodybuilders look like they have wings?) around to the front, and then seal in an implant under it. Smaller women can do this without implants, but a person of my size would look really out of proportion without some extra bulk under it. Advantages - no expanders, the surgery is one and done. But you still need to replace implants every decade or so, and it's not good for people who like to golf (not me) or swim (sometimes me) because that muscle is pretty important for activities like that. But, for day to day living there are a bunch of other muscles that can be built up with weight training and it wouldn't limit most of the activities I enjoy, although it would change my pilates routine significantly. Here's some links on it (NSFWish - medical boobs)
http://emedicine.medscape.com/article/1274087-overview and http://www.mayoclinic.com/health/medical/IM00280
The last one is called a DIEP flap. In this one they pull skin and fat from the abdomen, and pull some of the blood supply from the abdominal muscles without actually cutting them. This is the most intense of the surgeries, if we do it I'll be on the table for about 15 hours, and I will essentially be getting a tummy tuck in the bargain. Some links on this one - http://en.wikipedia.org/wiki/DIEP_flap
and https://www.youtube.com/watch?v=tYEt1Pw6FNU
This is the one I want. It disturbs my musculature the least, requires no implants or expanders, and can be done in one surgery, although it's likely with ANY of these that I'll want to do minor tweaks over time. I'm a good candidate because I've got quite a bit of extra tissue for them to harvest. I'm not a perfect candidate because of my scars from the lap band surgeries - those scars mean that some areas might not have enough bloodflow to survive the graft. But, those scars are pretty small - I've got one 1.5 inch incision that's pretty obvious right at my waistline, and three very very faint ones scattered across my abdomen.
So the doc took a bunch of pictures of me and is going to consult with his partner who he does all of these surgeries with and decide if they think I'm a good candidate for the DIEP. If I am, we'll go for it. If not, I'll do the Lat flap. If I do the DIEP flap and it fails for some reason, the Lat flap is still a viable option.
No matter what happens, I'm not going to be the size I am now - the result will be a reduction in size, but I'm very much OK with that, and what's left will be a heckuva lot perkier than what I have now. I am concerned with overall body shape, but we can tweak my bottom half a bit with lipo (and there's a sentence I never imagined typing) and keep my overall shape the same. This isn't going to make me thin, by any stretch of the imagination. I'll still be quite heavy, but I'd like to be heavy and in proportion.
So now I wait for the doc to consult with his buddy and decide if I'm a good candidate for DIEP. While I'm waiting, tomorrow will be the last day on the taxol/LCL trial for me. I have to be at Stanford at 8am for bloodwork, and I expect to be there until the late afternoon doing the wrap up bloodwork. MRI on Wednesday.
I came home yesterday afternoon and basically dove straight into paperwork. I'm trying (and kind of succeeding) to winnow down the big piles of bills that we've been ignoring, and also got started on the paperwork for the short sale on my old condo.
This morning was more of the same, punctuated by work meetings, getting caught up on email, and my first consultation with a plastic surgeon. Bob had class this morning, so Cait came with me.
The doc walked me through the options. There are basically four kinds of surgery (and a bunch of smaller variations within them).
The first one, which is the least appealing to me, is the expanders/implants version. They cut everything off, put a balloon behind the chest wall and over the course of a few weeks add fluid via a port until the balloon has expanded to the size you want. Then you have surgery and have the expander replaced with an implant. It's pretty straight forward, but it also pulls a lot of muscles out of place. Also, implants need to be replaced about every 10 years. Also, implants are cold, which was a surprise when I first heard it, but it makes sense. If you've got these bags of saline kind of hanging out in the breeze, they are not going to be the same temperature as the rest of your body.
Then there are several variations of "flap" surgeries. These are the ones where you're doing more (or all) of the rebuilding out of body tissue, and the big concern is that whatever you move has to have the right kind of blood supply, or the tissue will die.
The first kind is pretty standard for women who are reconstructing one breast - they take tissue from the abdomen along with one of the ab muscles and shift the whole thing up - the muscle provides the blood supply and some structure. Works great for women with one breast to reconstruct, but not for two. Abs are kind of important for sitting up and stuff. So that's out.
The next kind is a bit of a hybrid - they pull your latissimus dorsi muscle and skin (the one that makes ridiculous bodybuilders look like they have wings?) around to the front, and then seal in an implant under it. Smaller women can do this without implants, but a person of my size would look really out of proportion without some extra bulk under it. Advantages - no expanders, the surgery is one and done. But you still need to replace implants every decade or so, and it's not good for people who like to golf (not me) or swim (sometimes me) because that muscle is pretty important for activities like that. But, for day to day living there are a bunch of other muscles that can be built up with weight training and it wouldn't limit most of the activities I enjoy, although it would change my pilates routine significantly. Here's some links on it (NSFWish - medical boobs)
http://emedicine.medscape.com/article/1274087-overview and http://www.mayoclinic.com/health/medical/IM00280
The last one is called a DIEP flap. In this one they pull skin and fat from the abdomen, and pull some of the blood supply from the abdominal muscles without actually cutting them. This is the most intense of the surgeries, if we do it I'll be on the table for about 15 hours, and I will essentially be getting a tummy tuck in the bargain. Some links on this one - http://en.wikipedia.org/wiki/DIEP_flap
and https://www.youtube.com/watch?v=tYEt1Pw6FNU
This is the one I want. It disturbs my musculature the least, requires no implants or expanders, and can be done in one surgery, although it's likely with ANY of these that I'll want to do minor tweaks over time. I'm a good candidate because I've got quite a bit of extra tissue for them to harvest. I'm not a perfect candidate because of my scars from the lap band surgeries - those scars mean that some areas might not have enough bloodflow to survive the graft. But, those scars are pretty small - I've got one 1.5 inch incision that's pretty obvious right at my waistline, and three very very faint ones scattered across my abdomen.
So the doc took a bunch of pictures of me and is going to consult with his partner who he does all of these surgeries with and decide if they think I'm a good candidate for the DIEP. If I am, we'll go for it. If not, I'll do the Lat flap. If I do the DIEP flap and it fails for some reason, the Lat flap is still a viable option.
No matter what happens, I'm not going to be the size I am now - the result will be a reduction in size, but I'm very much OK with that, and what's left will be a heckuva lot perkier than what I have now. I am concerned with overall body shape, but we can tweak my bottom half a bit with lipo (and there's a sentence I never imagined typing) and keep my overall shape the same. This isn't going to make me thin, by any stretch of the imagination. I'll still be quite heavy, but I'd like to be heavy and in proportion.
So now I wait for the doc to consult with his buddy and decide if I'm a good candidate for DIEP. While I'm waiting, tomorrow will be the last day on the taxol/LCL trial for me. I have to be at Stanford at 8am for bloodwork, and I expect to be there until the late afternoon doing the wrap up bloodwork. MRI on Wednesday.
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