When life gives you lemons...

     I got to meet with my plastic surgeon today. It was an interesting experience because with the proliferation of plastic surgery, especially in popular media, it was something I knew I had some false preconceptions about. Also, I never really pictured myself as a plastic surgeon's patient. I sat in the waiting area thinking. "I'm really here, about to have a consult with a plastic surgeon about a huge alteration to my body. This is so weird!" My adorable man was able to come with me to the appointment; although he is still in training for his job, the training today was an introduction to the work environment where he has all ready been employed on two other occasions. <snore> "Uh, my wife has breast cancer and is meeting with the plastic surgeon for the first time today. Do you think I could skip the unit orientation?" Yeah. Not a problem.

Aw, isn't he adorable?! He's not very happy that I use the word adorable...

     Anyway, last night I got to sit down with a breast cancer survivor and really ask some personal questions. She was a little concerned that I was thinking I want a bilateral mastectomy. She is about ten years post a (single) mastectomy, and just wanted to make sure I understood what the procedure would mean for me: for my recuperation, for my psyche, for my intimacy with my husband, for my physical health, and for my life, my future. You get the idea. It was fantastic to be able to ask specific questions and see where her journey has taken her ten years later. She was a little younger than I am when she was diagnosed, and still had a one year old in the home. It was tough. If I'm experiencing denial in the whole process of "you've got cancer" it's in accepting that this surgery is considered major surgery, which indicates significant recovery time.

I decided to curl my hair while I still can!

Yup, I'm kind of struggling with that. I'm not the best patient in this regard because I tend to push myself a little too hard, and then pay for it when I'm recuperating. I understand this about myself, and yet I feel helpless to prevent it from happening. I know when it comes down to it I will make this mistake during the healing process, and yet that knowledge will not prevent it from happening.
     Then on my way to my appointment I receive a text from my mom detailing how long her friends' recovery was. It does NOT sound like something I can handle with grace. I feel like "if it takes that long I am going to be ANGRY." My mother also wants to know that I'm not alone, because her friend tells her the day she met with the plastic surgeon is the day it all became real to her - the day it hit her. So, there I am in this office I had never imagined being in, a little psyched out by these concerns.

Contoured implants

Shane, being a rather large 'child' went straight to the sample implants and started playing with them. Okay, I admit, not playing, but curiously examining them. I found a brochure about some of the options, and it was quite informative. I had no idea what implants are available, or why they may or may not use a particular style of implant. The doc will recommend a type to me based off of my body's appearance as I recover.

Round implant

I had looked up the plastic surgeon's website, and spent some time reading about him and his patients' endorsements of him. I anticipated that I would enjoy meeting him. I was not disappointed. He spent most of the appointment asking sincere questions about Shane and I. About Shane's residency hopes, about my educational goals, and other 'getting-to-know-you' type things. It felt like if we had met under other circumstances we could have had a fun double date with him and his wife (I have to assume about his wife, his website mentions her so I know she exists, but he didn't refer to her, of course).

     He examines me, records measurements, discusses the possibility of nipple conservation (something I have very mixed feelings about,) and takes the infamous 'before' pictures. I try to flex my abs because I've worked hard on them! I doubt it will make a difference in the pictures, but I just couldn't help myself! We discuss a little bit about the size of my future implants. (That sentence is so weird. It's like when I say "my cancer.") The doc asks if I want to, ahem, increase my size modestly. I tell him "maybe a little, but I'm talking a little." He asks if I want a specific (common) cup-size. I say maybe the next size down... closer to the size I was before nursing four children. Shane asks him about flap procedures where they remove muscle and tissue from another part of your body to help create a more natural breast. The doc says "She's not a candidate, there's not enough on her body to use for that." I take it as a compliment. Just over a year ago it might have been a different story, but I've been hitting the gym 5-8 times a week for a year, and while I have lost some weight, I've lost awesome clothing sizes! I'm pretty buff (for me) right now. I also think this is another way in which God has prepared me for this trial; at least being physically fit should speed my recovery, which is the next thing I ask the Doctor about.
     I've read and heard some horror stories about recovery. The doc reassures me. He anticipates my recovery should be between two and three weeks. He will place one drainage tube on each side. I can drive when I can manage my pain without narcotics. Shane asks how long the procedure will take. It depends on the surgical schedule that day, but if they can work it out, both the general surgeon and the plastic surgeon may be able to work on me concurrently. Dr. Tittensor can perform the left side mastectomy while he performs the right (prophylactic or preventative) mastectomy. Then he will complete the reconstruction, and the procedure time can run about two and half hours. If it doesn't work out this way, and Dr. T performs bilateral mastectomy (both sides by herself) and then he comes in and does the reconstruction, the procedure will likely be more than five hours. Wow! That's a significant difference. Join me in praying that their schedules work out!

     If you feel awkward about reading about my nipples you can skip this paragraph. They offer "reconstructive" procedures, tattoos, and sometimes they can save your nipple based on how close the cancer is to it. My cancer is close, and not close at the same time. Dr. T. and the plastic surgeon are a little uncertain about whether it might be an option or not. Dr. T. will have to make the determination during the surgery. I'm not sure how I feel about these options. I may wait until a few weeks after the surgery to decide what I want. It feels odd to me, I have such strong opinions on wanting a mastectomy, that the ambivalence I feel regarding this decision leaves me feeling like there's a vacuum in my decision making processes. I can imagine a variety of circumstances, and none of them make me feel more comfortable than the others.

     We discuss size again. The expanders that I will come home from the operation with are little silicone bags with a port that features a magnet. The magnet guides a needle for a syringe which enables them to slowly increase the size of the expander: I will visit the office about every week and a half and they will inject saline into the expander, giving my skin time to s-t-r-e-t-c-h. This continues until I feel comfortable with their size. Then, they know how much saline is in the expanders, and pick the appropriate implant based off of that information. Then I will have an outpatient surgery to replace the expanders with the implants. As an additional note, if the pathology reports from my surgery indicate the cancer was starting to spread I will have chemotherapy with the expanders, prior to receiving the implants. Since chemo wouldn't start until 6-8 weeks post-op, that would mean I would have the expanders for quite some time.
     The good news about all of this is that the mastectomy results in loss of sensation. As in my chest will basically be numb. The expanders don't hurt, but they feel very tight, especially as the skin stretches over them. The injections don't really hurt. The surgery doesn't hurt like the first one. It's all about the positives, right? Along those lines is the reason for the title of this post. One of my best friends posted on Facebook about how sad she was about my cancer, and asked her FB friends for prayers on my behalf. Her brother (whom I have met) responded by saying "When life gives you lemons, trade them for melons..." It totally cracked me up, and I've used it a few times to lighten the mood when discussing my cancer. I especially love how lemons and melons are anagrams, 'cause I'm a nerd. Shane says we're going to put it on a plaque for me. Yeah, that's exactly what I can picture hanging in my office!
     On our way home, the nurse calls from Dr. T's office with the results from my MRI. They're a 'grab bag' of pros and cons. There appears to be a spot of concern that could be a 'satellite' of the cancer. Am I sure I want a mastectomy? Because if I want a lumpectomy they will have to biopsy this second site, and the Dr. will likely try to talk me into a mastectomy. I confirm that I definitely want a mastectomy! The tumor measured 1.17 cm at it's longest on the ultrasound. It measures 1.5 INCHES on the MRI. It's either growing crazy fast, or the increased sensitivity of the MRI revealed it to be much larger than the ultrasound showed. There is NO indication of cancer in my right breast. My lymph nodes look great. Like I said, a total grab bag! I ask about the hormone receptor part of my biopsy's pathology report. Different cancers can be 'fed' by hormones... and stuff... and the type of receptors your cancer has (or doesn't have) determines a lot about your treatment. My results should have been in last week, but as the nurse reviewed my file, she realized the test was never ordered! She ordered it before calling me, and those results should be available in a couple of days. I thanked her because I've been anxiously awaiting those results!

Happy colors, I guess these 'jammies will work.

     After I dropped Shane back off at work I stopped at Kmart. I've read I will need front-closure sports bras, pajamas, and shirts to wear during my recovery since they will be much easier to put on. Amazingly, Kmart has this cute and modest front closure night gown in my size! I figure I'll shop on the internet a bit, and there's a store I've been trying to get to here in town that sells special bras etc. for breast cancer and breast surgery patients that I will check out. Since we haven't budgeted for these kinds of expenditures, I discussed how we will need to file our taxes soon with Shane. We really need to pay down some credit card debt, but maybe a hundred dollars will go a long way in helping me feel semi-normal during my recovery.
     I have so many ideas for additional posts, but I am ready for bed tonight, so y'all will have to be patient until I have time again. Considering the amount of homework I want to get done BEFORE I have a bilateral mastectomy, that might not be for a while! Of course, as I have mentioned before, this blog also helps me in coping with all of this, so I reserve the right to surprise myself. :)