Updated: Feb 4
In my last post I focused on finding the right plastic surgeon and the importance of advocating for yourself if who you have been placed with both for surgical oncology but also for reconstruction. I referenced the "need for good flaps" and said I would post about that in another post...so here we go. It is amazing how many words you learn in about a week with a breast cancer diagnosis...FLAPS was one of them. Upon my diagnosis I had no clue there were so many types of breast cancer and that each type responded differently to treatment which is why treatment options are not one size fits all (breast cancer). I did not know reconstruction was far more of an art form then an augmentation. Heck I did not even know much about augmentations...I had never had one and did not really give it much thought. I went into this journey so naïve and truly thinking that I would have a double mastectomy and implants and at 41 I would look 25 again (well on my chest anyway). I wish it was that easy...but it was not.
If you recall from my last post, after I went to my consultation with the best plastics guy in the South East, I quickly discovered how invasive and detailed the reconstruction process would be and why having a good surgical oncologist (first to ensure he gets great margins and gets all the cancer out) would be for reconstruction success. Let me start with, I understand that not everyone chooses reconstruction. In fact, it seems to be the new fad in Hollywood to have your implants removed and go back to your au natural B cup. Hey ladies- I am all for that and you need to choose what best makes you feel whole again because trust me- breast cancer will try to take everything from you! But Chrissy T and her friends have no idea what they are talking about when they make bold statements about how she cant wait to zip up a dress or lay on her stomach comfortably (if only that was my biggest issue in 2020). These types of statements are easy to say when removing your implant does not result in you feeling like a 10 year old boy and being left with absolutely nothing with the exception of scars and no nipples to prove why you look like this. Having a double mastectomy is no easy feat nor is deciding to have reconstruction with implants, autologous tissue reconstruction (a long surgery using your own tissue to create a breast mound) or simply deciding not to have reconstruction at all. However, if you leave this blog with nothing else please know this is YOUR choice and something you need to think about. You should not ever feel like you do not have the right to feel and look amazing again and that somehow you should just settle with being cancer free.
Dozens of people will offer advice to you on this journey and many will tell you of their own stories especially those that never had cancer but chose an augmentation. You will even have those that lecture you on "just get the cancer out who cares what you look like." This comment always surprised me. As if my main concern every single day I woke up was not getting rid of this mass that was slowly killing me. It was in these moments I started to realize that the focus was always on the cancer and that reconstruction was almost seen as silly or not needed in most peoples eyes. This type of sentiment normally came from those that NEVER had breast cancer and had no idea what it was like to face never feeling whole again. Even though they would speak lovingly and I know had the best of intentions of just wanting me here and cancer free they did not really understand what it was like to want the cancer out and still feel like a woman. Be ok with it ladies. You can have both and you do not have to feel bad for wanting it all!
Once you decide on a mastectomy (I chose a double for 2 reasons...
1: I was terrified the cancer would come back in the other breast and I was willing to eliminate that at all cost.
2: Symmetry. I did not want a 34D natural breast next to a new implant about the same size.
It is not rocket science to figure out that an implant has a perkiness that natural breasts do not. So the idea of spending money on reconstruction only to look like 25 on one side and 41 on the other and have the worry that eventually the other one may have cancer was not on the top of my list. Now that I knew a double mastectomy was the right decision for me, I was on my search for both the surgical oncologist and the plastic surgeon. In my last post I discuss going about finding the right plastic surgeon and how I found that in Dr. Harper. It was at that consultation he sent me to who he partners with for double mastectomy cases...Dr. Peter Turk at Novant in Charlotte. My meeting with Dr. Turk was easy and wonderful. He discussed the importance of having the double mastectomy and he reviewed my MRI while I waited. It was at that meeting I told him I still may seek another opinion simply because all this was so new and I really did not know what to do. He was 100% for another opinion and said just let him know when and IF I was ready. All it took was that confidence in himself and in his diagnosis to know this was the surgical oncologist I would go with. Unlike the first surgical oncologist that I was first placed with, Dr. Turk was refreshingly confident and he did not waiver or threaten me and actually encouraged me to seek as many additional opinions as I needed. There was no threat to not give me my MRI results like with the previous surgeon if I did not use him nor was there any issue with my "entourage" attending. So the surgery was set and I would be cancer free in 2 weeks.
So why good flaps? And what the heck does that even mean? A good surgical oncologist will remove all the cancer and leave good flaps. His main focus is to have the cancer completely gone and get good or great margins but he is also aware that doing so does not always mean butchering the patient leaving it almost impossible to have a good reconstructive outcome- no matter who your plastic surgeon is. Once the surgical oncologist is done with his part in surgery (which includes removing the cancer, sending to pathology for a frozen sample to indicate good margins and removal of lymph nodes) the plastic surgeon will then come in and do his part of placing expanders. If the surgical oncologist has done an outstanding job he will get all of the cancer and leave "good flaps." This means the skin looks good and he has not cut too much into the surrounding breast skin or chest and had made it easier for a great result. That is exactly what Dr. Turk did. My margins were wonderful...and he left a great canvas for reconstruction to be a success.
Remember: Usually finding the right plastics guy will bring you to the best surgical oncologist. They need good flaps to make their work the best! Do not be afraid to look for your reconstruction guy and ask him who he uses.