Next Class: Plastic Surgery Tutorial
With Breast Cancer Comics by Dash Shaw
My next stop after Dr. Duggan was Dr. Yoon Chun, a highly-regarded plastic surgeon (referred to by several surgical nurses as ‘an artist') who couldn't be nicer or more lovely or more intensely intelligent and who spent almost two hours with me in her office explaining the various reconstruction surgery options available.
Dr. Chun also drew pictures, most of which I completely understood, and had I not been so absorbed in the decision-making process regarding the creation and construction of my new boobs - saline implants? silicone implants? TRAM flap? DIEP flap? - I probably also would have started thinking about how different my future might have been had Dr. Chun been one of my high school science or math teachers.
Deciding what kind of reconstructive surgery I was going to have was sort of like deciding everything else in my life - I usually start by figuring out what I don't want first and then seeing what I'm left with, so my thought process went something like this:
1. I knew I didn't want "foreign bodies" -- implants, saline or otherwise -- in my body, and I also knew that I didn't want to have my reconstruction done in stages. Opting for implants meant that once the bilateral mastectomy was done the surgeon would put in "tissue expanders" to make room for the actual implants several months down the road. This would mean regular visits to have the tissue expanders expanded and obviously more surgery, and the thought of all that expanding and implanting spread out over several months made my head start to bobble again.
2. I knew I definitely didn't want to opt out of any reconstruction - that is, despite the fact that I had no immediate plans to pole-dance or bra-model or skinny-dip I knew that I definitely wanted some kind of breast reconstruction. This left me with two fairly complicated surgical options (there were a few other surgical options I immediately rejected). Both procedures involved using abdominal skin and "existing tissue" (i.e. fat, something I had plenty of) to construct the new breasts, but they differed in how the blood-supply-to-the-new-breasts problem is solved and whether or not the abdominal muscle is used. (Note: I'm a blogger, not a doctor, so my descriptions of surgical procedures might be lacking in a little medical exactitude.)
3) In the DIEP procedure -- deep inferior epigastric perforator (I looked it up) -- no muscle is removed from the abdominal area because instead of moving the muscle up to the breast area and having the muscle provide the blood supply to the new breasts, the surgeon transports the tissue (fat and skin) and reconnects the blood vessels in their new location The DIEP requires microsurgery, then, and it's a much lengthier procedure and a much more difficult one, which means that fewer surgeons do it at fewer hospitals. But because the abdominal muscle isn't used the recovery time is allegedly much quicker and there is no risk of abdominal hernia because, well, you still have your abdominal muscle in your abdomen.
4) The TRAM flap -- short for transverse rectus abdominis myocutaneous flap - and again, in blogger's terms -- uses abdominal skin and fat to form the new breasts and the abdominal muscle itself for the blood supply. This means that the surgeon moves the abdominal muscles up from where they usually are (the abdomen) to where the new breasts will be so that the new breasts will have a built-in blood supply. Surgeons tell patients-to-be that this is just like a "tummy tuck" since once they're done sucking out the fat and moving your abs around they do their magical tightening and flattening and improving of your contours, and when my surgeon told me this I latched onto the idea and would not let it go. An estimated recovery of 6-8 weeks seemed like a small price to pay for an Extreme Makeover - especially when my Stage 0 diagnosis required no chemo or radiation.
All this decision-making was happening barely a month before the publication of my fourth novel, something I'd been waiting four long years for, and just as I was thinking that all my pre-publication self-promotion that I'd forced myself to do had been a complete waste of time, Dr. Duggan assured me that the surgery could absolutely wait after my book's publication. So I scheduled the TRAM flap procedure - which I now referred to almost exclusively as simply "The Tummy Tuck" - for mid-November, after all my bookstore signings and Jewish Book Fair appearances (that I'd actually had to audition for) were over...