Thursday, March 19, 2009

Plastic surgeon appointment report

We met with the plastic surgeon today. Overall, it was a positive appointment, we accomplished a lot, and the doctor answered many of our questions. The big question (when is the surgery?) wasn't answered definitively, but we're pretty confident it will be on Wednesday the 25th. We just don't know the time yet.

The biggest surprise was finding out that the complete reconstruction won't happen until *after* any chemotherapy or radiation is completed. This makes sense to us after the doctor explained some of the reasons. For example, if Sherrie's on chemo, her white count will be down, and it wouldn't be as safe to inject the expander or perform the implant surgery. If she has radiation, the skin and breast tissue will change, and so reconstruction would be premature.

The doctor explained Sherrie's options, which basically are an expander/implant, or removing skin/fat/muscle from another part of her body (the stomach area) to reconstruct the breast. The latter isn't really an option for Sherrie because she's had previous abdominal surgery (the C-section when Jared was born), and she doesn't have enough abdominal material to complete the reconstruction (i.e., not enough fat). So the expander/implant is the only viable option. This is a good thing, because the recovery time for expander/implant surgery is quicker.

After any chemo/radiation, the doctor will slowly (over the period of a few weeks) fill the expander with saline until the skin stretches enough to accept the implant. Notably, the expander has to be about 50 percent bigger than the implant so that things will work out okay. The surgery to place the implant is fairly simple, and occurs on an outpatient basis.

Sherrie also has to decide between a silicone and saline implant. Before you get too excited about silicone, you need to realize that (a) the most recent and largest studies of the effects of silicone implants show no statistically significant difference between the long-term health of a control group and women who have had silicone implants, and (b) the new silicone implants do not leak like the old ones did. As the doctor explained, they are like a "giant gummy bear." So if the covering breaks, the silicone stays in place and doesn't migrate to other body tissue like the old silicone implants did. Saline implants are harder and show "ripples" under the skin; silicone implants are softer. Sherrie doesn't have to choose which until the time comes to place the implant. Also, if you are wondering, silicone implants are approved for breast cancer patients.

The doctor pointed out that after the surgery, Sherrie will actually be *concave* in the breast region. Apparently, many women say they don't want an implant after the surgery, but after they see the "hole" in their chest, they change their mind.

We liked the doctor; she seems very knowledgeable, competent, and "no-nonsense" as Sherrie said. She will be performing the surgery on her day off, which is a nice thing to do.

When we get a surgery time for Wednesday, I'll post it here.

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