All the kings horses and all the kings men...

...couldn't put Humpty Dumpty back together again.

Yesterday Rob and I met with a reconstructive surgeon. Those of you playing along at home may be thinking, didn't you already do that? The answer is Yes, yes I did. But the first surgeon's office was a pain in the ass to get to. So yesterday we met with a new one, who showed us an informative (and horrifying) slide show on all of my reconstruction options. More on that in a minute. First, let me back up and bring everyone up to speed.

At my last appointment with the surgical oncologist, she said that the tumor had shrunk enough with chemo that a lumpectomy may now be an option. (Originally, not so much, due to its size and location.) And that's still an option we're considering. But here's a nasty little word none of us ever wants to hear... recurrence. The younger you are the first time around, the higher your chances are of it coming back. (I've read statistics of anywhere from 13% all the up to 40%, but there are a lot of variables going into those numbers so I won't bore you with the details. In any case, those are odds I'm not interested in playing.) One way to significantly reduce the risk of local recurrence is to remove all of the tissue via bilateral mastectomy. Hence the reconstructive surgeon. Got it? Good! Back to the slide show!

So we went through the pictorial of all the procedures. This link from the American Cancer Society does a really good job of explaining it all. And is far less graphic than what we saw yesterday, so read away!

There are several different procedures available that involve removing skin and fat (and sometimes muscle) from one part of your body (usually either your stomach or back, but sometimes from your butt) and transplating it to create new boobs. Yea....no thanks!

The other option starts with tissue expanders and ends with implants.

Kinda like this.

The benefit of this option is that both surgery time and recovery time are much faster. This link has a nice step-by-step photo sequence of the process, complete with nipple reconstruction and tattooing.

Tattoing? you might be asking. Oh, yes. You see, reconstructed breasts don't have nipples. It's kind of like buying a new car. Sure, you can get the leather trim package, but that's going to cost extra. And we all know that the difference between ordinary and extraordinary...is that little extra. So after the reconstruction is nice and healed, the finishing touches are put on in a follow up procedure. And the final step involves tattooing to create the illusion of an areola. Bet you were dying to know that. Oh, and the tattoo artist's name? Vinny. I wish I were making that up.

But then there's the pesky issue of radiation. It's unconfirmed at this point whether I'll need radiation following surgery. But because my lymph node biopsy was positive, chances are pretty good that radiation is in my future. So I'll be meeting a radiation oncologist in two weeks.

How does radiation impact reconstruction? you ask. It means that the window of time to fill the tissue expanders get smaller. The reconstructive surgeon typicallys likes to have 2 months to gradually fill the expanders. This can vary dependent upon the desired size of the exanders (how much they need to be filled) and the patient's tolerance for discomfort (kinda like getting your braces adjusted, how frequently can you put up with that). But the radiation oncologist only wants to give you 4 to 6 weeks post-op before she starts zapping you. So you'd better get those expanders filled up!

Then after you've been radiated every day for 5 weeks, your skin is pretty darn fried. So you're going to want to wait a little while before you go slicin' and dicin' to swap out those expanders for the permanent implants.

Sound like a lot of information? Yup, that's how Rob and I were feeling after yesterday's appointment. So this weekend we're going to unwind from all of that with Brent and Andi and some Oktoberfest lager. Then round out our weekend with a visit at Grandma's new apartment. Have a great one!