Options and Prayers

My parents left for France today. It's sort of weird, but sort of a relief, just because I've got a shit ton of emotions pouring out of me right now, and as I've mentioned before, for some reason, my parents make all of this more difficult to deal with. When I think about it logically, I realize it's because I think this might actually be harder for them than it is for me, and they are not handling it well. And their not handling it well makes it really difficult for me to handle it well. It's sort of hard for me to imagine that they might return to a one-breasted daughter, but in all fairness, I was supposed to be starting radiation right now, not having a mastectomy, and they did wait until they were sure I was not terminal before going forward with their plans. So there you go.

Anyway, I am going up to University Hospital for a consultation tomorrow. I scheduled this a long time ago, right after I discovered I had positive margins from surgery #2, before I met with Dr. J and Dr. M, and seriously thought a second re-excision was a viable option for me. I even posted on the breastcancer.org forum, asking anyone who had had two re-excisions for their thoughts, and got absolutely no response. So this is not something that actually happens in real life. What was that movie in the '90s? With Winona Ryder? Something like Reality Sucks? Or maybe Reality Bites? Yes, I think that's it.

Regardless, I'm actually happy to have this appointment because I am seriously considering the possibility of having my mastectomy with reconstruction at UH. Based on my intense Googling and ferocious blog reading with on vacation, I've pretty much decided that I absolutely do not want an implant. Traditional reconstruction options after a mastectomy are done with an implant - either a saline implant or a silicone implant. This involves a painful process wherein a tissue expander is placed under your pectoralis muscle at the time of mastectomy and, over several months, injected with solution to stretch your chest. Later, another surgery is required for the 'permanent' implant, which is only 'permanent' for, like, 10 years, assuming it doesn't leak, in which case you need to have it replaced right away. It is this a painful process requiring several surgeries, as well as ongoing care of the implant. While I understand this works for many, it is not for me. It just isn't.

This leaves me contemplating the following options:

1. Single mastectomy without reconstruction. The advantages to this are that it would be a relatively easy recovery, and I would probably be able to teach in the fall. The disadvantages are that I would feel like a uniboob FREAK, and unbalanced (both literally and figuratively). It's just hard for me to imagine not being able to get up in the morning and go about my business without feeling like I need to first don my prosthetic boob. I already can't function without putting in contacts in the morning. I have 20/900 vision and a small nose, so glasses with one-inch thick lenses and I don't get along very well, so it's daunting to think about adding a strap-on to my morning ritual. Maybe this is trivial and maybe I will change how I feel about this eventually, but this is what I'm feeling right now. 
2. Double mastectomy without reconstruction. The advantages to this are that I would be more balanced and probably more at ease. Despite the fact that there is no scientific or medical reason to think that I have breast cancer lurking in my right breast, I cannot help but feel this is the case. Even though I think it might be weird to be completely breastless, I think in some ways this might be easier for me than having a single breast. On a practical level, it would certainly be easier. On the other hand, I don't know how I feel about amputating a healthy breast, and the pain that goes along with it. I've written about this here. Emotionally, parting with two breasts seems like double the trauma as parting with just one. Also, none of the doctors I have met with have counseled me to have a double mastectomy, so I am not sure how it would work if I decided that was the route I wanted to go.
3. Single mastectomy with flap reconstruction. Flap reconstruction uses fat from your own body to create a new breast. There are different forms of flap reconstruction; from what I gather, the fat can come from a number of different places. The most 'current' form of reconstruction is DIEP flap reconstruction (do not click on the link if you are squeamish about this sort of thing), which uses fat from your abdomen to create a new breast. The advantages to this are that you do not have an implant, your new breast is 'natural,' and you get to have fat removed from another part of your body. (Who doesn't want this?) The obvious disadvantage is that this is a complex surgery with a pretty horrendous recovery, and the outcome depends on the skill of surgeon. I mean, duh, that's always the case, but with this surgery, it's really, really important to have a good surgeon who is experienced in doing this surgery. It is a lot more complex than traditional reconstruction with an implant, and also involves several steps.  

After much reflection, #3 is my definite top choice. I have been praying this will be an option for me. I know that UH does this procedure, but I am not sure if I can have it done locally. As much as I love Dr. L, if the plastic surgeon she works with can't do this, I need to consider the possibility of doing it elsewhere. Unfortunately, it obviously involves a rather lengthy hospital stay, so having it done at UH, or an even more distant location, would present logistical challenges, but I feel like it would be worth it in the long-term. The other question mark is that I do not have a lot of abdominal fat. It is ironic; for my whole life, I've been blessed with a really flat abdominal region. As I've grown older, I've lamented that I'm starting to get somewhat of a gut, but now, I really, really wish I had a bigger one. (I actually TRIED to gain weight over vacation just so it would increase my chances of being a candidate for this surgery.) The thing is that I am not a super thin person; I am pretty average. It's just that I tend to accumulate fat in my thighs and butt rather than my abdomen. However, apparently these are also candidates for fat donations, especially the buttocks, so I feel like I really need to consider all of my options in terms of where I could possibly have this surgery done, no matter how inconvenient it might be. I don't have huge breasts, and like I said, I'm not a skinny person. I know that I have a B-cup's worth of fat somewhere in my body; I just need a surgeon who will understand how much I DO NOT want an implant, and work with me. I pray I can find one. 

So here are my prayers for tonight: 

Blessings

• I'm thankful to have the opportunity for an appointment at a place that offers cutting-edge care.
• I'm thankful my husband is going to accompany me to the appointment, because driving stresses me out, especially in places with which I'm not super familiar.
• I'm thankful my friend and colleague (about whom I wrote in my last post) is going to watch my daughter early tomorrow morning, and then take her and pick her up from theater camp, so she doesn't have to miss it. 
• I'm thankful the university daycare has drop-in space for my son so that I can have a conversation with the surgeon without a three-year-old in the room, and also have my husband with me. It's like having your cake and eating it, too. :) 

Hopes

• I hope the appointment is informative, and worth our time. I hope I leave knowing much more than I do now.
• I pray with all my heart the surgeon will tell me that I am a candidate for flap reconstruction. 

And now, I am off to take an Ambien. I took one last night, and got six solid hours of sleep, and ohmygosh, it was divine. I am already feeling so much better today than I was a few days ago. I am hoping with all my heart for continued improvement.