deconstruction

I am ready to be deconstructed.

Four and a half years ago, after a mastectomy that removed my right breast, 2 silicon implants were placed in my chest.  The one on the right replaced the breast that was removed.  The smaller one on the left was supposedly put it to make it more "match" the fake right breast.  The left breast needed a lift.

It didn't work out so well, cosmetically.  Actually, the lifted left breast "looks" pretty good, but it doesn't even come close to matching the silicon blob that protrudes from my right chest.  The right implant never "settled", so it sits high on my chest, almost to my collarbone.  I've heard the doctor say that it is "too large".  I think he means large, width-wise, because every time I extend my right arm I feel a pinch in my underarm area.  This is especially annoying when I swim.  

For the last year or more my breasts have become more and more painful.  There is a constant ache around the right implant.  I recently had an MRI to check and see if anything was wrong, but that came back with a diagnosis of "everything looks fine" in there, meaning that the implant was not leaking.  I suspect that it is muscle pain, because the implant is actually under the pectoral muscle, and the muscle feels stretched and strained.  It is especially painful when it is cold outside.

Anyway, I've had enough.  I want the implant(s) out and am ok with being flat chested on one side.  I'm not sure how the left breast will look with the implant out.  Like a deflated balloon?  But a plastic surgeon should be able to do something about that, shouldn't he?

Much as I don't like the idea of someone cutting on me, I want this done.  I can't wait to be free of my silicon chest.  For more than 4 years I've felt like I had a plate of armor weighing down on me.  I don't hug people closely - I always hold them just a little bit a part from me.  I'm protecting myself and I'm embarrassed by this barrier that is in me.  I'm afraid to be touched on or around my chest.  This all makes me sad.  

I'm ready to let it all go.  The silicon, the fear.  I want my body back, even if it is wounded and flawed.

I want to touch and be touched.

My appointment is on Tuesday, and that is when I will schedule the surgery.

[My gosh, I notice in the post below, written more than 3 years ago, I am saying much of what I say today.  Funny that it has taken me 3 years to get to the place where I am ready to go through another surgery.]

a place to put my hurt

First, a confession: I can be quite neurotic – hypersensitive, over-dramatic, lacking in objective perspective, even downright loony.

Perhaps I am still “processing” the whole ordeal of losing my right breast. Or maybe I'm this way all the time, but won't admit to it without an excuse.

I do not want any of the feelings that I write here to reflect on the professionalism and skill of the doctors who have treated me. Even though I have not quite come to terms with my reconstruction surgery – things are, in fact, still changing – I consider my plastic surgeon to be extremely competent, responsive, and perhaps a genius.

I am getting used to my new breasts – even starting to feel that they look good, despite not being perfect matches. The right breast is falling more and I don’t feel so strange looking.

And because I’m more healed, I’m not afraid to expose my breasts anymore. (Yes, I make love with nothing covering them now – yeah!) What is it about the way I do not want others to see my wounds - to see where I hurt? I bet a shrink could make something of that.

Maybe part of my reason for writing here is to have a place to put my hurt.

$39,070.61 for a boob job, and this isn't over yet!

The hospital bill came last week for the Breast Reconstruction Surgery that was done last month. $39,070.61. And this was an outpatient surgery. My gosh. How do women who are not breast cancer patients afford these boob jobs?! Or do they charge more when it is covered by insurance?

My insurance (for which I pay $1200 per month) is covering all but $1405.23. But I’m not sure if this is the end of it. It seems that these bills keep creeping in for months after the affair.

And it seems clear that I will need another surgery. Will my insurance cover that? We can barely even afford the insurance. (Actually, we can’t afford it.)

Yesterday I was visiting with girlfriends and I showed them my breasts. This is the first time that I have uncovered myself to people other than John or doctors. Both Lynda and Deb think that the way I am now is unacceptable. The left (native) breast is fine, lifted and slightly augmented with silicon at the top. The right breast, the silicon implant, is very high and round and much larger than the left side, at least on the top. So that I’m both lopsided and imbalanced. More and more, I’m beginning to think that taking out all implants, and learning to be as I am – a unibreast – is the best solution. But I’m not sure if I’m brave enough. I’m self-conscious enough of my strange looking chest without clothes on, how would it be to look so “different” with clothes on?

Before the surgery, Dr. Lickstein told me that 25% of Breast Reconstructions require further “procedures” to make things right. I guess I’m in that 25%. At the time I thought that meant a little tuck or something in the office. Now I realize that it means another surgery.

another surgery??

I woke up this morning, climbing out of my depression, knowing in my bones and soul a spirit that can face breast cancer and everything that goes with it – including a lopsided chest.

I met with my plastic surgeon, Dr. Lickstein. He seems to think that I am healing well, and I can get back to exercising in a week (yeah!). He also thinks that we should watch the fake boob for a couple of months to see if it will fall some. If not, he suggests another surgery to exchange the implant with another smaller one. This would be a simpler surgery – 45 minutes he says – with little pain. But I would need to go under anesthesia again.

I’m open to the idea.

my new breasts

My, my. I had my first look at my new breasts this morning.

Hmmm.

I had to carefully remove all the gauze and stuff, and I was expecting everything to be bruised and stitched and swollen.

Instead I have these lovely 2 small breasts. Maybe a little battle scarred - but mine.

They are not quite balanced or even, but Dr. L says that it will be a few weeks until everything settles out.

I am impressed with my native breast. It looks like it did when I was 25 years old. Perfect. The other one is not as large as my native breast, and not exactly natural looking. The silicon is definitely much softer and more comfortable than the saline expander.

Even though I would never elect to have this surgery, I can see why people who have the money would do it. I think that Dr. David Lickstein must have some kind of special gift for creating beauty.

I'm still a little tired and I run a fever every afternooon and kind of ache. But I've taken a shower and am dressed. It does feel good to have this over with.

breast reconstruction surgery

The morning before my surgery I weighed myself. 147 pounds. I figured I might lose a few pounds during this venture and I wanted to see how much. This morning I weighed 154 pounds. I only ate a half a cracker yesterday and gained 7 pounds. Go figure. It must be all those bags of water that they kept dripping into my veins.

Other than the nausea and headache that goes with anesthesia, things went well. Incision pain was bad yesterday, but that means that I still have nerves in my nipple (yeah!). And I only took 2 pain pills, then decided that the headache pain was worse than incision pain, and switched to just Tylenol. Now, less than 24 hours after surgery, I’m on nothing.

I’m still wrapped in a surgical bra, but they look about the right size. Actually the left breast (my native breast) looks a little larger, but Dr. L says that could be due to swelling. And they look even. I’ll get a better look tomorrow when I take this gauze bra off and take a shower. The right breast feels a lot better than when the expander was in – softer and somewhat lower.

Thank god this is over with. I don’t want to ever go to surgery again in my lifetime.

surgery jitters and more drugs

The woman before me in exercise class this morning was tall and thin. She used the high step and kept up well with the instructor, so she was easy for me to follow as well. When I looked at her in the mirror, though, I noticed that she had very high (and large and round) breasts. She wore a low top, and at times her breasts looked like they were going to jump out!

My gosh. Why do women do this? And yet here I am, 2 days away from “doing it”! I called my plastic surgeon’s office this afternoon and spoke to Leah again. I won’t end up like this, will I? I mean, I’m almost 60 years old, and breasts like that would make me look like a freak. Leah assured me that Dr. L knew what I was expecting from the reconstruction surgery, and that I would not end up with such exaggerated breasts.

Last minute jitters, I guess. I am nervous about the surgery – more about the anesthesia than everything else, though.

I saw my oncologist today and complained to her about the femara. The hot flashes are so pronounced through the night that I don’t get a lot of sleep, and end up very tired most of the time. Along with my bones and joints aching more, I’m pretty cranky. She suggested an antidepressant – Effixor – says that it will relieve much of the night sweating and help me to sleep better.

I’ve never taken an anti-depressant before. Even though I have my moments of feeling “down”, I’ve never considered myself to be clinically depressed. And I’m hesitant to take yet another drug to cover the side effects of a drug.

Anyway, we’ll see. I’m going to get through this next surgery, with all the pain pills and antibiotics that go with it, before I consider taking another drug.

nothing left to do but trust the doctor

I had the pre-op appointment with my plastic surgeon today. Signed a mountain of papers and asked every question I could think of about what would be done during the reconstruction surgery and what to expect afterwards.

Basically, the expander that was put where my right breast was will be replaced with a silicon implant. The implant looks rather large to me, but Leah, the physician’s assistant, says that they just look large outside of my body.

Then, on the left size an incision will be made around the nipple and then down the lower center of the breast. (Ouch!) A small implant will be placed under the muscle and then the skin will be pulled together at the bottom to “lift” the breast to match the other one.

And the table will be rotated up and down several times so that Dr. Lickstein can balance and even them up. I'll be just like a corpse.

The surgery will take 3 ½ hours – but Dr. L says it won’t seem that long to me. Ha ha.

Anyway, I guess I’m ready. I know that it has to be done, and putting it off and worrying about it isn’t going to help. And I trust my doctor – he is careful, and pays attention to detail. He understands the way the body works and heals, and he takes pride in his work. Most of all, there is something "real" about him. I sense that he cares.

There’s nothing left to do but trust him.

the "test"

Tomorrow I should get the results of the "test” (oncotype DX assay).

It’s funny not having a clue as to how it will come out. The way I see it, I have a 50/50 chance of being in the low risk group and will not need chemotherapy. I read over and over my pathology reports. There are favorable signs – the cancers are estrogen and progesterone responsive, the Ki-67 marker is less than 10%, the S-phase is low. Actually, the only unfavorable sign is the HER2 positive result. And the fact that there were 2 separate cancers in my breast worries me.

But the result of this test will determine the next year of my life, at least. And how I know and trust my body.

I feel like I did before I knew the results of the MRI-guided biopsy that determined whether the “something” that they saw was cancer or not. I was so hoping for it to be nothing because I did not want to lose my breast.

For now, I am thinking positive. Yesterday I had my last injection of “new breast”, and Dr. Lickstein says that I can plan on implant surgery in 3-4 weeks. I’m actually looking forward to surgery! My expander now is every bit as big as my native breast, and I am confident that Dr. L will put me back together well.

And, since John has been laid off, we have decided to make lemonade and go on a 1 month road trip to the Southwest. Just forget everything and go away for awhile. There’s something healing about that for us.

the decor of a plastic surgeon's office

There were new silver chairs in the lobby of Dr. L’s office today. And new curtains.

There was some art on the walls: A black and white beach scene, with large rock-like things in the foreground of the picture that were like the green pod-like things on the table. It appeared to be a cross between a photograph and a painting. In the examining room there was a picture that reminded me of one of my weed photographs. The veins of the leaves were a beautiful blue.

I’m fascinated with the décor of this doctor’s office. It’s a nature theme, but also with subtle silvers and golds. The receptionist said that it was supposed to be “calming”, and it is.

The beauty of nature and that of the human body is clear and obvious, yet somewhat understated. I like that. There were a few black and white photographs of women in the hallway. I wish that there was at least one of a man’s body.

What I don’t like are the cosmetic advertisements that are in the shelving in the lobby. I would like to see abstract sculptures there. I’m annoyed by the cosmetic advertisements in all of the doctor’s offices these days anyway. Reminds me of snake oil.

the basketball on my chest (the "expander")

I just had the 3rd injection of saline into my “expander”. I call it the basketball on my chest. According to Dr. L, there is now 380 cc’s of saline in there. He wants over 400, so that means another injection next week.

It’s not that it “hurts”, but it is quite weird, especially for a couple of days after the injection. I always feel a little shaky after I leave the office. Like my body is just a bit shocked. This week I came home and just laid down. It definitely feels “full” and tight (and big!).

I am starting to get anxious to just get this done, even though it means another surgery. Dr. L says that after the last injection, I will need to wait at least 3-4 weeks so that the stretched tissue can settle down before he can put in the implant. And he says that lifting and matching my native breast will be the challenge for him. I told him that he needed to be like God, and make them beautiful.

And then there is the complication that chemotherapy would bring to this whole schedule. But I’m not thinking about that now …

re-thinking plastic surgery

There is a peculiar intimacy (or chemistry) between a surgeon and patient. Surgery opens up a whole new level of trust that you have to have with your doctor - your body is literally in their hands.

I always watch a surgeon’s hands. I know people who have “brains” in their hands. I do not, but I know people who do. My friend, Nancy, is always doing something with her hands. She will be talking to me and then all of a sudden hand me a wonderfully complex and beautiful paper sculpture that she had been making while we are talking. I am amazed.

So I look for this gift in a surgeon’s hands.

But I also look for “relatedness” and ability to “connect” with others as individuals. I like to think that my surgeon is aware that there is a real person (me!) that is way down under all that anesthesia.

Plastic surgery adds yet another dimension to this patient-surgeon chemistry. Until I ended up in a place where I needed cosmetic surgery, I always pooh-poohed it as a frivolous luxury for the rich. Why mess with what God made? Why want to look forever “young”?

Now, I’m having to re-think all of those attitudes.

Beauty and art enter the realm of science and medicine.

When Dr. Lickstein “reconstructs” me, I want beautiful breasts. Like God made. They don’t have to be perfect. I don’t want large breasts, I never had them before. But I want them to look “real”, whatever that means.

I guess I’m asking for a lot.

ohmygosh (looking at myself)

Ohmygosh – look at me. That’s my reaction at looking at my chest and the site of my mastectomy surgery, and I don’t make the effort to look. On the one side is this beautiful, soft, natural breast. On the other … scars, bulges of skin, a hard round something (the expander). This is my body? This happened to me?

It’s been a good week, though. For the first time, I am beginning to not actively hurt – though there are still places of soreness. Dr. Lickstein gave me the first injection of “new breast” (saline into the expander) and it was no big deal. I had been expecting the worst. He told me not to worry about the seroma and to get on with exercising my arms. And the seroma does seem to be getting better.

It has been a month since my surgery. Tonight I asked John a lot of questions about what happened on that day of surgery. Funny how little I remember.

I went to an exercise class this morning and it was just wonderful. I was able to pretty much keep up with all the ladies and I left feeling flushed with endorphins. I’m going again Monday. I was able to do most of the arm exercises using low weights.

And I made an appointment with the oncologist for next Thursday. Finally I guess I’ll face the facts about my cancer and what I need to do now.

the drain is out!

The drain is out and I have my life back and I have my body back.

Amazing!

I went for a walk this morning with Jubilee and I smelled so much of sulfur that the bugs would not stop swarming me. And then I went to Dr. Lickstein’s office, not knowing if he would take it out or not, since I still have a fair amount of drainage, and he just took it out. Yeah!

Even though I still have some pain and swelling, it seems that my body now is back to its own integrity and has moved into the driver’s seat. I’m now in active HEALING! I no longer have to take the antibiotics, and I’m beginning to think that I have a life again.

Happy New Year!

Dr. L's new office

Dr. Lickstein is my plastic surgeon. He is the doctor with whom I will be dealing the most from here on out. I will see Dr. Rimmer one more time, and I need to make an appointment with the oncologist, Dr. Bertrand. But I will be seeing Dr. Lickstein every week or so for the next few months as he “reconstructs” me.

“David” is his first name. He looks like a David. At first glance, he seems a bit “nerd-y” to me – scholarly. He looks to be about 45 years old. He also seems dependable, up early taking care of details. He does not seem like the kind of doctor who caters to the rich. But I bet that's what the rich people like about him, his scholarly and medical grounding and his apparent disregard for trendiness. He came to me by way of recommendations from women who had used him.

They have a new office, and boy is it swanky. Actually, I love the décor. Modern, with a lot of glass, but like a forest. The flooring is a mix of pebbles and carpet patterned with a hint of fern. There is a water wall in the lobby, and a large arrangement of green pod-like things. It doesn’t look like a doctor’s office, but more like a high end architect or legal office.

I think it is appropriate that a plastic surgeon’s office be somewhat artsy. When I mentioned to Dr. Lickstein this morning that the office was “swanky”, he seemed a bit embarrassed, saying that he was still finding his way around. This office, though, is more in my neighborhood – I can walk to it if I cut across a construction site. And it is Lickstein’s neighborhood too. In our casual conversation this morning, as he was pulling out a drain, I learned what temple he attends and where he lives – both nearby.

It’s interesting to be going to a “high-end” cosmetic surgeon. It’s obvious that this office is made to appeal to rich women who pay upfront for their services. It doesn’t look so much like a “medical” place. This morning (Christmas Eve) he was only seeing a few patients like me who had a medical urgency (like getting the damn drains out). Still there were a couple of glamour girls in the lobby (how can you call such a sophisticated place a “waiting room”? There is a climate controlled refrigerator with water, china, tea, etc.)

Dr. L’s old office had some modern art on the walls of the waiting room, and when I commented on them to Dr. L he said that they belonged to his partner, Dr. Pinsky. I wonder if Dr. P is the inspiration behind this new décor?

surgery date and 2nd thoughts

Today felt very confusing to me. I began to have 2nd thoughts about the type of reconstruction I had chosen. So I began to read some of the literature I have, and I talked to people. In the end, I’m back to where I think I’m ok with the decision to have the mastectomy and go more slowly with the reconstruction decisions.

I’ll wake up without a breast though :-( - but I’m ok with that, I think.

The surgery is scheduled for Monday, December 17th.

Dr. Rimmer is the surgeon,





...and Dr. Lickstein is the plastic surgeon.







I feel that they are both very competent and compassionate doctors.

the plastic surgeon

Despite the fact that I still can’t read the mounds of literature that I’ve been given about breast cancer and reconstruction, I think that I’m getting a little more courageous about this whole ordeal :-).

Today I saw the plastic surgeon, Dr. Lichstein. He’s a sort of nerdy kind of guy, but very likable. He comes with very good recommendations from my breast cancer support group.

There are lots of options for reconstruction - silicon implant, saline implant, taking fat from the belly (and getting a simultaneous tummy tuck, which I could use) – each with its own advantages and disadvantages.

For now, Dr. L says, the most important thing that I do is treat the cancer, that I can gradually make my reconstruction choices.

Since the idea of a 7-hour surgery (and 4-5 days in the hospital) doesn’t appeal to me, I decided to just go with the mastectomy for now. After Dr. Rimmer removes the breast, Dr. L will put in an “expander” – which will gradually be filled with saline to stretch my skin for an implant (saline or silicon or fat from my tummy). After 3-6 months Dr. L will do the implant surgery, lifting the other breast to match the fake one.

They showed me photos. The final products all looked great. The expander stage looks very weird.

They said that I would have to deal with “drains” for 7-10 days after the surgery because the body tries to fill in empty cavities with fluid. But that it wasn’t going to be as bad as it sounds.

The cancer treatment (chemo, radiation, etc.) will not be determined until after a pathologist examines the removed breast and lymph nodes.

God, I can’t believe I wrote all that. It does sound gruesome. Dr. L's office is now coordinating with Dr. Rimmer’s office for a surgery date, which he says could be next week, but will be no later than 3 weeks from now.