Lovely Dr. L

So, after a lot of reflection, I decided to go ahead with revision surgery. It is tentatively planned for December 4th, although I keep playing phone tag with Dr. T's scheduler re. the specifics. Usually when I make a decision like this, I feel good, and don't look back. I'm not a look back type of person.

The only thing is that ever since I made the decision, my stress levels have risen astronomically. I feel unsettled, not right. I don't think it is anything more than the fact that I can simply not face another surgery. I just can't. I thought once I committed I would rally and get geared up for it, but instead, I'm just filled with a horrid feeling of dread and doubt and enough is enough. My insomnia is creeping back, and I feel like crying a lot. My gut tells me this is wrong. I'm sure there are other things going on, too, and this isn't entirely about the surgery, but still. It's definitely not helping.

I regret being so hungover at my last appointment with Dr. T because I feel like I didn't ask the right questions or express the right concerns, and he is not the same on e-mail. I wish I could rewind and have a do-over of my appointment, without taking away the fun of book club the night before, that is ;-). But regardless, I also feel like Dr. T cannot be completely objective when he talks to me about what next. In a way I feel like we can't just have an honest conversation about pros and cons because he's trying so hard to not come across as pushy. Maybe we just know each other too well at this point. It's hard to say. We talk to each other so easily about everything else, but the topic of revision surgery seems to be a sticking point.

My husband is just about as tired of surgery as I am and thinks I should leave well enough alone. At the same time, he is sort of resigned to an 'I want what you want' attitude. I also think he's afraid to suggest that more surgery would be a good idea because that would be like saying the way I am now is not good enough for him, and that can get husbands into a lot of trouble.

So, what should you do when you don't know what to do? Get another opinion. See? I've actually learned something from all of this. So I called and got myself an appointment with Dr. L, because I felt like I was going sort of crazy, and she is my go-to person when I'm going crazy. Fortunately, in some of our e-mail exchanges, she had mentioned that she would love to see the result from the reconstruction, so I had a reason to make an appointment other than 'I need counseling.' It did cross my mind that she might come into the room and be like 'WTF are you doing here?!' but she didn't. In fact, she came in and said, 'Hi cutie! It's so good to see you!' and gave me a hug.

Dr. L thought the reconstruction looked great and that even my nipple looked great. Apparently the humiliated, flattened nipple is as good as it gets for nipple-sparing mastectomies, which is good to know. Like I said before, I'm just grateful to have any nipple at all, but somehow Dr. T led me to believe this was a bad outcome, so it's comforting to know it's normal, and that I never should have expected anything better. Then Dr. L asked me if I would do it again, which was an interesting question. We had a rather profound discussion about breasts and breast reconstruction and the weirdness of all of it. I told her that if I were to go back in time for a do-over, I'd absolutely do it again. It was the right choice this time. But if I have to deal with this again in the future? I don't think so. I told her that I had already questioned Dr. T about what I could do if I ever needed my right breast replaced, and he had told me that you can always use fat off your back. I told her that at a certain point, you have to ask yourself when is enough enough? All this self-mutilation for a feelingless lump of flesh that really serves no purpose? It's... weird.

Dr. L totally got it - all the complex feelings that go into and come out of all of this that are so hard to explain. She said she was curious about my feelings because 'my twin' was coming in this afternoon, and surprisingly had no interest in reconstruction right now. She asked if I would be willing to do peer-to-peer mentoring for any of her patients who were interested in reconstruction, particularly DIEP reconstruction, and I said absolutely. She said they were just starting a new program to connect patients with each other to help women understand the reality of mastectomy and reconstruction - to get the honest truth about what it is like.

Finally, we got to talking about revision surgery. She unequivocally said not to do it. Not yet, anyway. It's not just that I need time to heal and be normal, it's that I might not even need it, if being larger on one side is my chief complaint. She said that in her experience, it can take up to a year for the swelling from the surgery to go down, and she has seen cases where women had one breast reduced, then a year later it was too small, and they had to have more fat put back in. Her suggestion was to wait a minimum of six months and see how I feel next year.

It seems like a no-brainer, when you think of it like that. And when you think of it like that, you also realize that you are making decisions based around insurance and money, and that these might be the wrong decisions, if time is the only thing that can truly answer your question. Then your heart fills with love for this lovely woman who spent half an hour talking you through your complex emotions and giving you good, solid advice over an issue in which she has no vested interest at all.

It's totally clear to me now: I really don't want to do this. Not now, anyway. I need more time, and that's okay. In the large scheme of things, if waiting costs me an extra few thousand dollars, then so be it. I am hoping this isn't just because I think Dr. L is a goddess, and I would jump off a cliff if she told me to. I'm chalking it up to the nature of modern medicine, which is something like those 'choose your own adventure' books I used to read as a kid: patients are charged with forming their own opinions, then shopping around to find a medical professional who agrees with said opinion. After all, if something in my gut hadn't felt off, I never would have made an appointment with Dr. L in the first place. And quite honestly, I was pretty surprised by her strong anti-surgery stance. I mean hello, she is a surgeon.

So, I am going to call the surgery off and spend December healing more and enjoying the holiday season. I just need to call or e-mail Dr. T and let him know. I'm thinking about waiting until the night before, though. You know, just to get even.

Just kidding.