For the past 3 months, I have had to try to get used to the idea that I am planning to have my breasts removed as a way to prevent getting breast cancer. Imagine having a piece of your body chopped off...it's odd. Long ago, I considered getting a breast reduction but never did because I was concerned about loss of feeling and if insurance would cover it. My DD breasts are large and heavy and droopy and far from perfect, but they are still a part of me and my womanhood.
After consultations with 2 breast surgeons and 4 plastic surgeons over the past six weeks, I have selected a great team: breast surgeon Dr. Pamela Wright and plastic surgeon Dr. C. Coleman Brown. Along the way, I've had to make some tough decisions:
Do you want to have a mastectomy? Some people with a BRCA gene mutation decide they would prefer to keep their breasts and monitor them every 6 months. I'm not a gambler, and decided the fear of having a "cancer time bomb" inside me was worse than the thought of having my breasts removed. Answer: Yes
Do you want reconstruction? Some women are fine to just use prostheses or go flat. Not me. I think it would be really weird to have no breasts at all after carrying my large ones around for all these years. Answer: Yes
Do you want to rebuild your breasts using your own skin and fat? Or implants? Originally, the thought of using some of my belly fat to create new breasts sounded super appealing to me. (Hey, I get a tummy tuck at the same time!) But the first plastic surgeon I met with said it's a 12 - 14 hour surgery, with lots more possible complications. Plus, they have to saw through a couple of ribs to reattach blood vessels from the harvested tissue to their new location, the tummy result is not as nice as a tummy tuck (since the purpose is to harvest tissue) and the recovery is way harder. I quickly abandoned this idea. Answer: Implants
Do you want to keep your own nipples? For someone like me, whose nipples are "not in the right place," the only way to do this is to have a breast reduction first. A reduction not only makes your breasts smaller, but allows the surgeon to get your nipples in the right location. [See image above.] At first, I thought I'd skip this step to avoid an extra surgery, but then decided that since I have the luxury of time (because I'm cancer-free), and it turns out this is a 2.5 hour outpatient surgery, why not save this piece of myself? You have to delay the mastectomy by 3 months so you can heal, and there's a risk that the nipples may die after the mastectomy since they only have blood supply from the skin. Answer: Yes (Note: We just learned that our insurance has denied coverage for this procedure and my plastic surgeon is trying to appeal it...)
Do you want the implants to go behind the chest muscle or in front? Until 5 - 10 years ago, implants were almost always placed behind the chest muscle to provide them protection and to give more blood supply to the skin. However, this can cause pain during the expander phase (more about this later) and cause odd looking deformities when you move your arms or use your chest muscles. Now they can create a pocket for the implants using purified cadaver skin and therefore place the implants in front of the chest muscle. As a rower, I did not want anything behind my chest muscles. Answer: In front ("pre-pectoral")
What kind of implants do you want? Saline or silicone? Shaped or round? Textured or not? Answer: Silicone (but don't know other details yet)
If you are not able to save your own nipples, what do you want to do? Some women opt to just go without nipples at all. Others have their plastic surgeon create nipples (during a later surgery) out of breast skin and then tattoo areolas around them. Another option is to get 3-D looking tattooed nipples. Answer: Tattooed nipples (if needed)
All these decisions have been quite overwhelming. I'm grateful to be living in the Washington, D.C. area where there are so many top notch doctors, and just trying to take this one step at a time.
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