OldDogNewTits












Will insurance cover any complications that arise during elective surgery?

Remember the question my husband keeps asking the doctors … and how the answer we keep hearing is basically … NO?  For this reason, all breast doctors want you to get a mammogram before surgery.  Some doctors (Doctor 1 in our case) even want you to get a full physical workup. By doing so and ruling out any potential health issues beforehand, your risk of problems during surgery drop to almost nothing.

Seemed like a pretty good idea to me. Plus I haven’t had a good workup in years.  “Years” meaning never.  So, I decided to bite the bullet and submit to a complete medical examination and all the joys that go along with it.  It’s always good to know where your health stands anyway, right? I called my regular doctor … which resulted in a general exam (weight, blood pressure, etc.), blood tests and a surprise PAP (and it wasn’t even my birthday) yesterday as well as chest x-rays and an EKG today.

Some, not all, of the results are in.  The blood work is fine.  Always good to hear. Unfortunately, the chest x-ray (the first I’ve ever received) is not.

I have a tumor. On my right lung.  On the pleura (lining) of my right lung.  Which, apparently, if you’re going to have a tumor on your lung is the best place to have it.  About the size of a ping pong ball.  Or a jawbreaker.  Believe it or not, this was debated for a few minutes.

They don’t know what it is. So, I’m going in for a cat scan tomorrow. My husband and my parents know. And two of my good friends.  And now you.

For the record, yes, I am concerned.  More so than with the breast lump we discovered six weeks ago.  And pissed off with myself for being concerned.  I have a good friend in the hospital who is actually having surgery tomorrow to have a mass removed.  If you send out any good vibes tonight, send them to her.  She needs them.  I need a good night’s sleep. And maybe a valium. I’ll be fine.

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{November 12, 2011}   The Ghosts of ODNT Past

As promised, I’ve been thinking a lot about everything. And reviewing my thoughts from the last (almost) three months.  I sat in a coffee shop for hours recently … sifting through every single one of my blog entries to date … searching for clues of where my real feelings lie.  And I don’t even drink coffee!  Chamomile tea and a banana managed to sustain my right to loiter at the bar on my laptop all that time.

Anyway, over the course of my walk through ODNTs past, I came up with the following little jewels …

  • August 22,2011I sort of feel like I want to reclaim some of who and what I was before becoming a mother. Physically, I was a woman with a flat stomach and boobs in the right place.
  • August 26, 2011I am unhappy with my post-breastfeeding body and I am merely looking to restore it to its original form. I am not, repeat NOT, looking to Pamela Anderson-ize myself.
  • August 31,2011They’ve never been huge. But, at one time, they were at least what I would have called “inflated” … as well as situated correctly on my chest.  (And from later in the same entry)  So I started thinking about it. And checking myself out in front of the mirror, lifting things up to where they used to be. To where they’re supposed to be.
  • September 14, 2011She (Doctor 1) said that, particularly on a smaller person like myself, oversized breasts will actually create a look of added weight overall on a woman’s frame.
  • September 22, 2011She (the mammogram technician) said that, while there are arguments stating that under-the-muscle placement does decrease the odds of an implant causing a visual obstruction in a mammogram, there are still no guarantees that a problem couldn’t form behind that implant and thereby be invisible to the technicians. Cancer cells, tumors and other problems can occur anywhere in the breast tissue so no placement is one hundred percent foolproof.
  • October 8, 2011He (Doctor 5) said that the biggest mistake women make is going too big or too wide. He added that women should look to correct and improve the shape of their breasts and not just be worried about their volume. He actually said smaller breasts are “more elegant,” which I’m pretty sure makes me Audrey Hepburn.
  • October 30, 2011Okay. I’m definitely getting a lift. That’s the one thing every doctor … and even my mom … agreed on.

I feel like I’m finally starting to get a little clarity here.  And I’m finally starting to see the answer through the murky fog and haze.  Maybe.

Does anyone else see it, too?

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Doctor report number NINE. I can’t tell you how much I’m pushing myself to write this one. And … believe it or not … for the first time since this project began, I did not take any notes during this appointment.  I planned to take notes. I even brought my little breast doctor notebook with me, confirmed that I had a functioning pen (there are never any guarantees in my world) and opened both of them as I waited for the doctor to come in. Literally poised to begin scribbling.

But I took none and, thus, we are limited to the confines of my memory for details about this big event.  God help us all.

Anyway … as I mentioned a few days ago, I decided rather spontaneously that (along with Doctors 4&5) I wanted to give Doctor 1 a second visit.  ‘Spontaneously’ is sort of true and sort of not true.  Doctor 1 has never left my mind (and, apparently, the mind of a few other readers as well).  I mentioned that I was still thinking about her as we entered round two (10/20/11)  and even made a follow-up appointment with her office at that time that I was forced to cancel due to a family issue. So, a few days ago, I stopped hemming and hawing about the whole thing and called her office. And she was able to see me immediately. My husband was not able to rearrange his schedule this week to come, so my mom came along for the appointment.

We got there a few minutes late and the staff was already waiting for us so we went right in.  Doctor 1 came in, met my mom and we got to talking about everything immediately. I was pleased/delighted/tickled (whatever, you get the point) to learn that she’s been keeping up with the blog and thus knew a lot of what I’d been told along the way.

I explained to her that I had gotten caught up in “blog fever” and was following the direct path dictated by the voting … but that her name had never left the front burners of my brain. I explained that, while I felt very fortunate to be choosing from two great doctors for a mini-lift/implants combination surgery, her recommendation of a full lift and very possibly no implants sounded like a good option for me as well.

Didn’t I start this whole thing saying I felt saggy from years of breastfeeding?  It’s really problem one that I was (and am) looking to solve.  I never wanted to make myself huge.

My mother and I talked to Doctor 1 about everything we’ve learned so far from the other doctors.  For the record, Doctor 1 is a saline as well as an over-the-muscle believer.  I was on the same page with her on the first point but was unsure about the second.  But we weren’t really talking implants at this point.  We were talking full lifts.  And, while she certainly made me feel as though she’s seen much worse cases than mine in this area, we both agreed that it would be the easiest and least complicated way to get me to my goal of physical, pre-breastfeeding restoration.

Further, she’s not a big proponent at all of the whole mini-lift. She says the crescent incision on the top of the nipple does very little to raise things up and often the nipple stretches to fill in the areas where it was and where it is now creating a rather oversized end result.

I think at this point I actually volunteered to take my top off.  It was the best way for Doctor 1 to explain to my mother the technique involved with the full lift.  So, off came my top and out came her breastmarking pen.  (I’m guessing it must have other uses but who knows?)  Inking in the exact placement of the cuts really enabled both of us to see exactly how things would fall (or rather rise) in place. And this literal blueprint allowed me to bring the proposed plan home to my husband so he’d be in the know about everything, too.

Now, we were ready to see some before and after pictures. Doctor 1 took us into her office and shared them from her computer.  (I want to point out that she is the only doctor who personally handles the “aftertalk” of pictures, finances and other questions with her patients. Everyone else had an assistant. I like this personal touch.) Again, she showed us images of several women who opted merely for a full lift over implants, or perhaps went that route after removing implants from a botched job.  And these ladies all looked great.  Very natural. The higher, more consolidated breast tissue actually seemed (visually) to increase the overall volume on some level.  Or so I thought.  And, with a full lift-only surgery, there would be less risk and overall maintenance.  Definitely something to think about.

My mother asked my husband’s ‘What about insurance and complications arising from elective surgery?’ question. Doctor 1 was very frank. She said ultimately that any complications brought on by this surgery would not be covered by insurance. But then she said a few things that enabled me to exhale.  First of all, she said that every patient who undergoes this and similar procedures in her practice must first submit to a complete physical (in addition to the mammogram required by all other doctors) to rule out the potential for any health anomalies or other irregularities that can occur during surgery.  She said that approximately once a year they discover a health issue in a patient that prevents the surgery from moving forward.  Of course, it’s never a big deal because it is caught beforehand.

Once a patient’s health is cleared through the physical, the chance of a complication arising during the surgery is very slim.  She said that she has had only one person come down with an infection since Katrina (the Hurricane – it’s still how we classify things chronologically in New Orleans - it’s like saying ‘B.C.’ around here) and she was able to treat her quickly and easily with oral antibiotics.  She added that, like the other surgeons we interviewed in round two, she fully guarantees her work and would not charge a patient for any repair or revisions that might be necessary.

I left the office feeling very good about the appointment. I was glad my mom had gotten the chance to meet Doctor 1 and ask her questions but sorry that my husband had missed it.  We walked to the car together and I felt my stomach turn at the thought of writing yet another doctor report.

Oh, and I made a mental note to drive very carefully so as to avoid any kind of accident.  Mothers talk a lot about the importance of ‘clean underwear’ in these situations but I don’t ever remember hearing any warnings about the potential embarrassment of strategically inked-up boobs in a crisis.  And, for the record, I’ve showered three times since this appointment and I’m still wearing the markings.  They’re a little faded but I could still totally demonstrate Doctor 1′s proposed full lift technique in a pinch. (Pardon the pun.)

And now, I need to go think about this whole thing.  A lot.  So much so that I sort of expect my brain to start smoking.

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Okay, let’s get back to our ODNT roots here.  We’ve been through five preliminary consultations, two follow-up appointments and one scary emergency mammogram and ultrasound together.  We’ve talked about botched boobs, troublemaking boobs, giNORmous boobs, mystery boobs, saggy boobs, perky boobs, slapping boobs, foreign boobs, holiday boobs, famous boobs, dancing boobs, old boobs, stabbed boobs, insured boobs and uniboobs.

But we’re not done yet.

We still have a big decision to make, don’t we?  I will be calling for a vote down to one doctor in the next few days.  (Don’t vote on this post though please.  The poll will be up soon.)

Anyway, if you think I’ve already made my decision, think again.  One minute I’m looking in the mirror, checking myself out and thinking …

“Okay.  I’m definitely getting a  lift. That’s the one thing every doctor … and even my mom … agreed on.    And I should probably get a little inflation.  Just a little.  I don’t want to be too big.   After all this research and soul searching, I really should do something for myself. Everyone knows that moms don’t stop and do things for themselves enough, right? Come on, Michele. Don’t be such a wuss. 

And then the next minute, I’m all …

“I can’t do this. This is crazy. There are risks. And there are starving people in Africa … and tuition to pay …. and house notes and electric bills and other debts. We’re not rich people.  How can I spend this kind of cash on my boobs?!!?

Yes, yes, I know. I’ve exposed my inner Sybil.  The pendulum of the human psyche.  The fight (sometimes to the death) between the right brain and the left brain.  Sybil presents herself from time to time in all of us when making big decisions. Most people call it vacillating, wavering, overanalyzing.  I just call it a Sybil moment. (If you aren’t familiar with this classic movie, look it up.  Sally Field.  Good stuff.  Long before her current stint on Brothers & Sisters.)

My point? I’m still not sure what to do.  And yes … while ultimately it is my decision to make and I will have the final say … my family, my friends and YOU will also be playing a very important advisory role for me.  You’ve basically come on every one of these appointments with me.  You’ve heard everything these doctors have had to say.  We’ve learned about full lifts, median lifts and mini-lifts together.  And the incisions and scarring associated with all of them. We’ve learned about the pros and cons of saline versus silicone.  And about texturized implant shells.  And we’ve learned about ccs - and how they can SO make a difference. We learned about fat injections as a new augmentation alternative. We’ve learned about an implant’s effect on mammography. And so on … and so on …. and so on …

So, since we’re all experts now, I’m asking that you please take a minute to look back over the appointments.  At a minimum, please review the Doctor 4 and Doctor 5 reports, first  and second round if I may be so bold as to ask.  Both of these doctors are excellent and I would be in good hands either way.

But … which doctor is the best fit for me?

Or … should I leave well enough alone and scrap the whole damned thing?

This is the moment of truth.  Please read over whatever you need to help me decide … and then be on the look out for the next round of voting in a few days. I LOVE you people for riding shotgun with me throughout everything. :)

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My fifth (and potentially last first round) appointment was Thursday morning. My friend, Melissa, had recommended the doctor and came along for the ride. And I want to point out immediately that this place as well as this experience was different from the others.

What better month to bring up this topic.

My friend, Melissa, has been battling breast cancer now for the last few years. And she’s been beating the hell out of it I might add. You know how when you’re watching some Sex and the City, Desperate Housewivesy-type show and one of the characters has cancer, but they manage to deal with it with levity and an amazing sense of calm and grace, you think to yourself ‘This woman does not exist. If it were me, I would not be able to face people every day and talk about it, let alone joke about it.’

Well, I’m here to tell you that this woman does exist and her name is Melissa.

I won’t delve too much into her personal story but, suffice it to say, she was given the sobering news twice. For the first occurrence three years ago, she opted to have a lumpectomy. After this procedure, she (like all patients) was carefully monitored for any signs of recurrence. Which is how they caught the second occurrence about a year and a half later. This time, she (like many women) opted for a much more aggressive treatment. This time, she would take on a double mastectomy so that she could live worry-free of this disease. For good.

So, the two of us spent the afternoon at the very specialized facility where she had her procedures done. And, as I mentioned above, it was a very different experience from my prior appointments. Rather than a small, private waiting room filled with others seeking cosmetic improvements of various natures, this office (really a small hospital) had a large, beautiful waiting area … a two-story, glass-ceilinged atrium that actually looked and felt more like a spa than a clinical space. There were no TVs or other distractions but rather just a setting to promote peace and comfort to all who entered. The center even offered a little refreshment area for its visitors. And on the table in front of me … where there were typically albums of before and after work … was a similar pink scrapbooking album filled not with breast photos but rather with heartwarming letters, family pictures and other amazing testimonials from women whose lives had been changed as a result of the services and treatment they received from the medical staff here.

Honestly, it was very humbling.

We were taken to a private examination room almost immediately, which is where I actually completed all of my paperwork. Melissa and I caught up a little bit while we waited and she confessed that she wore a boob-showcasing outfit to this appointment … in my honor, of course. (Coincidentally, this is the second time this week that a woman has selected her wardrobe based on its boob presentation for me. Is that weird?)

And, after waiting a little while, the doctor came in. Friendly right from the start. He gets points for that. Feeling a bit small for seeking cosmetic augmentation in a place that is largely medically restorative in nature, I nervously explained right off the bat that I was not here necessarily but more recreationally. He liked my use of the word ‘recreationally’ and said he’d be using it in the future. We talked just a few minutes about what I was looking for (you know the drill by now … nothing too big as I am a small person) and he seemed pretty in tune to everything I had to say.

He said that the biggest mistake women make is going too big or too wide.

He added that women should look to correct and improve the shape of their breasts and not just be worried about their volume. He actually said smaller breasts are “more elegant,” which I’m pretty sure makes me Audrey Hepburn. And finally, he emphasized that an implant should be used to enhance your natural breast, not become it.

In discussing my options, he said that he encourages his patients to get everything that they want done in one procedure. When I asked about the full lift and implants being done together, he said it was no problem. Remember Doctors 1, 3 and 4 all stating it should not be done? And they offered two different reasons.

  • Doctor 1 & Doctor 4 said it shouldn’t be done because the anchor incision involved in a full lift would be under too much pressure to heal if there was an implant stuffed beneath the skin. Doctor 5 said that the anchor incision he makes involves only a very superficial layer of skin and therefore healing and thus scarring is not an issue.
  • Doctor 3 said it shouldn’t be done because of complications that can occur with the patient’s blood flow and there is a possibility of losing the nipple. Doctor 5 said that blood flow concerns are only present in repeat implant patients and assured me that, while the risk is never zero with anything, I would not be a candidate for these types of problems.
  • Doctor 2 (in case anyone was wondering) was also pro-2-procedures-in-1-surgery but his only argument was that any accomplished surgeon can achieve the desired results with no problems.

The doctor also assured me that, if anything, he was a bit of a germophobe and he had never had any complications arise as a result of infection. He said he uses something called an implant funnel to insert the implant. He literally likened it to a pastry tube … only instead of sweet buttercreamy goodness, mine would be filled with silicone. Delicious.

When I asked about the texturized implant shells (that we learned about from Doctor 4), he said he feels they do nothing to prevent the possibility of scar tissue and hardening. Additionally, he said the texturized shells don’t slide down into place and settle as well after surgery.

When I asked about implant placement, he said he determines whether the implant should be placed above or below the muscle based on two things:

  1. The patient’s activity level – Triathletes, for example, are encouraged to seek over the muscle placement … as putting the implant beneath the pectoral muscle could become too physically restrictive for them.
  2. The patient’s quantity of tissue – Patients with a limited amount of breast tissue available are encouraged to seek under the muscle placement … as there often simply isn’t enough skin present to stretch and support the addition in the front.

And, incidentally, he added that under the muscle placement typically results in a more natural curvature and slope from the chest wall into the breast thus creating a more natural look overall.

When I asked about the silicone versus saline decision, he said much prefers … are you ready for this? … silicone. (The exact opposite of Doctor 4, remember?) He said he uses it almost exclusively in his practice explaining that silicone is lighter in weight than saline which is more comfortable for the patient. He added that silicone also doesn’t have the same problems with breast hardening or even possible visibility as the patient ages and her skin thins. That said, he highly recommends a new innovation in the implant world called cohesive silicone for various reasons:

  1. Unlike the silicone of old, cohesive silicone adheres only to itself, keeping it together where it should be on the chest wall rather than leaching into other areas of the body.
  2. The recommended MRI every 2 years for these implants has been lifted by the FDA.
  3. The same 3.5 centimeter incision made for the lift can be used to insert the silicone implant, thus any argument to opt for saline over silicone due to less cutting would be null and void.
  4. He’s seen many first generation silicone implants (from the 70s and 80s) come out … practically empty of their contents … with no harm done to the patient.

When I asked about the fat injection method rather than implants, he seemed to steer me away from that direction altogether. He explained that he felt the technique was best used in cancer patients who are seeking to match one post-surgical breast to another healthy one. Melissa and I were both pretty surprised. We expected this technique to be one he lingered on for a while. It was, after all, the method Melissa had chosen … though she did explain to me that, because she had undergone radiation during the course of her first treatment, she was not a candidate for implants. Her breast tissue would likely have rejected them.

When I asked about the effects that implants have on mammography, he said that so many women have implants these days that there are now named techniques for performing the test proficiently on these specialized patients. He also added that any mammogram, implants or not, can miss anomalies in the breast tissue. Apparently, nothing is foolproof. (Sigh.)

Then, he took lots of measurements of just about everything I’ve got above the waist. Which ain’t much. And he seemed very focused on the fact that I have a very narrow base width which basically means I have a narrow chest. 32 to be exact, A/B. (Lord, did I just put my bra size on the internet?) The doctor said that, for me personally, he would recommend somewhere between 280 and 300ccs of “assistance.” Which is just about exactly what Doctor 4 said. (Yay! Consistency!) He also said that he would recommend something between a full lift and a mini-lift. Rather than an anchor incision, I would need something more L-shaped, coming down from the center of the breast and turning outward on both sides. Best of both worlds, I suppose.

Oh, and they took pictures. Lots of ‘em. I was escorted to a special room, a studio if you will, with very high-tech cameras, computers, lighting, etc. There was even a little heater in the area where I was photographed so I wouldn’t get too chilly, being disrobed and all. I kind of felt like a supermodel. A naked supermodel. Which I guess would sort of make me something else, wouldn’t it?

A word of advice to all women out there who may pursue this avenue – Do not wear any identifiable jewelry, clothing or hairstyle in your headless photos. And God help you if you have a tattoo. Trust me. Your pictures WILL be recognizable. I’ve already identified an acquaintance in one of these photos with complete certainty.

With my photo session behind me, I returned to my exam room to find Melissa waiting for me. And while I dressed, she undressed and showed me the handiwork of her operations. And, I must say … Melissa, you are beautiful. Your boobs are far superior to anything I could hope for. Your doctors did an outstanding job and you deserve every ounce of it. Unbelievable. Boobs made from scratch … using only parts of your body. I am speechless.

We left the exam room and walked back out into the posh waiting area again … with me having learned (and I think grown) a lot from my visit … but not before stopping to snap an all-important picture. It’s one of the many t-shirts they sell in the lobby.

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Breast cancer patients are incredible, awe-inspiring. I bow at the feet of these women.

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It was a typical school morning. The kids were griping about their breakfast and then again about their lunch choices. Yes, I love the snot out of them. But, son of Moses, eat the damned food and quit complaining … please! And, just as I managed to get them out of the door and throw myself together, Vanessa was already in the driveway to pick me up. My poor friend had a hairdryer malfunction this morning and still made it over here on time. God Bless her.

I was so not in the boob-groping, question-asking mode but I had to slap myself around and get in the zone again … for the fourth time in the last few weeks … not counting the unexpected mammogram and the ultrasound.

We found the doctor’s office with no trouble and got settled in. The decor was very “man den.” Neither one of us could better categorize the look of the place. It was very nicely appointed and clearly very masculine. There were no television shows or before and after books to keep us occupied so I attacked my fourth packet of dry personal paperwork while Vanessa thumbed through the magazines and kept us entertained. Robert Redford was on the cover of AARP magazine. Pass. Cosmo had a cover story entitled What Guys Hate for You to Wear in Bed. Simultaneously, Vanessa said headgear and I said retainers. Of course, the story was actually about matronly night gowns. We liked our answers better.

I think we were debating the cosmetic benefits versus the health risks of the Latisse eyelash growth treatment when the nurse called my name.

Unlike the other appointments, this one started with the doctor’s assistant (and not the doctor) doing the interview. She was great. She laughed at all of my nervous jokes and didn’t miss a beat. I like that quality in my medical personnel. I also like it in my kids’ teachers, my waiter, my dry cleaner, my masseuse, my grocery bagger, etc. but that’s beside the point.

She asked about my recent breast lump. I mentioned that everything had turned out fine. She asked about pregnancies and whether or not I breastfed. My answer of ‘Like nothing you’ve ever seen’ made her laugh again. Then, she asked me to get on the scale. In front of my friend. Not cool.

After talking to me a bit, she said I sounded like a good candidate for a mini-lift/implant combo but said she couldn’t be sure until my examination with the doctor. She said, due to my small frame and (let’s be honest) my small boobs, the need for a full lift was unlikely. And, just as we were told by doctor #1, she added that a full lift with implants would require two surgeries because the risk of scarring is too great when you combine them into one procedure. The anchor incision cannot heal properly when the breast is stuffed full (creating very taut skin) with an implant. (Remember doctor #1 telling us that exact same thing? And remember doctor #2 saying the opposite? Maybe he’s Dr. Uniboob.)

The upside to the mini-lift? It involves significantly less cutting (and thus potential for scarring) than the full lift’s anchor incision. Another plus is that the mini-lift can be done at the same time as the implant insertion thus requiring only one surgery. That’s huge to me … as I don’t think I have the nerve, patience or funds to go through this shit more than once.

We then discussed the silicone versus saline decision. This office offers both but clearly favors the latter. And they offered several reasons:

(1) Saline implants cost at least $1K less than silicone.

(2) Because they are filled after they are already surgically in place, saline implants can be rolled into very thin tubes and inserted through an extremely small incision, resulting in faster healing and reduced scarring. Silicone implants are inserted in their bulbous entirety, requiring a larger incision that needs more healing and has the potential for a more visible scar.

(3) In the event of a rupture, saline implants are not harmful to the patients in that they are filled with saline which can be absorbed harmlessly into the body. A ruptured silicone implant is harmful to the patient and should have her running to the nearest doctor.

(4) A leak in a saline implant is easily detectable to the eye and thus no annual inspections are required. A leak in a silicone implant is very difficult to detect (even by mammogram) and thus an MRI is strongly recommended every other year to confirm its integrity. And those MRIs would all be at the patient’s expense.

(5) Saline implants can stay put in the patient for as long as she desires with no risk. Silicone implants should be replaced every ten years to reduce the possibility of their deterioration and thus harm to the patient.

(6) The saline implants used by the doctor (made by Allergan) come with an optional insurance policy offering a 10 year warranty on the entire procedure and the implants if there are any problems. After 10 years, the policy still covers the replacement cost of the implants themselves, but the patient would be responsible for any and all doctor’s fees associated with replacing them. Silicone implants offer no such guarantees.

Consequently, their patients opt for saline over silicone 10 to 1.

Elaborating a little on their Allergan product, she explained that the exterior of the saline implant shell is texturized rather than smooth. This new characteristic is said to feel much more natural within the patient and its roughed-up exterior adapts well with the natural tissue thus preventing the hardening of the breast and the development of scar tissue.

I asked about implants and their effects on mammography and got a much more informed answer than I had elsewhere. She explained that a patient with breast implants can have a complete and thorough mammogram but it’s imperative that she inform her technicians prior to the testing. A standard mammogram takes only a small number of images to achieve a full view of the breast tissue. A mammogram for an implant patient requires that extra images be taken to achieve a full view. So, it would seem, problem solved.

This assistant was ridiculously informative and I hadn’t even seen the doctor yet. She stepped out of the room and said she’d be back in a moment with the doctor to perform the examination. Vanessa and I were mentally exhausted but had been so thoroughly informed about everything that I think either of us could have given a lecture on the subject if asked. Our brains were both about to explode … as was Vanessa’s bladder apparently so she darted to the bathroom while I waited for the doctor.

I sat there checking emails and texts on my phone until they all came back in. I was topless within 60 seconds for an audience of three, my personal best to date. The doctor measured everything – chest width, breasts, waist and hips – as he aims to create a balanced figure. He was clearly a perfectionist (as a general physician, a plastics specialist and even a microsurgeon for the hand) which we both agreed was a really great quality in a boob man. There would be symmetry, there would be proportion and there would be art in his execution.

He then talked to us a bit, underlining everything his assistant had told us and asked if we had any other questions. No one had said anything so far about the fat injections (from the abdomen to the breasts) so I introduced the subject and was met with a very clear response:

“The American Society of Plastic Surgeons does not recommend fat injections for cosmetic breast enlargement.”

He explained (emphatically, I might add) that fat injections were only recommended for use in very small quantities (for example, in isolated touch-up areas on the face). At this point in time, he said the procedure is simply too new, too controversial and too investigational. The risk of scarring is increased and mammography becomes very difficult to interpret as foreign tissue is now present in the area. He also added that the technique offered less aesthetically to the patient as they are often required to undergo the procedure repeatedly to maintain their results. Fat deposits relocated to the breast area are frequently re-absorbed into the body, meaning the augmentative effects are lost.

Such a different opinion than doctor #3.

So, back to the implants. This doctor much prefers under the muscle placement. Honestly, it seems most doctors do. He said they feel better and are more naturally camouflaged within the body. He further added that under the muscle placement offers better mammography results as well as significantly less breast hardening. The textured saline shells, used by this office, result in little to none of this problem and massage, while often required with implants, is not needed at all.

He asked about sizes and, with a little guidance, we decided I should be looking at somewhere between 270ccs and 330ccs. That would supposedly put me somewhere between a small C and a full C. (Vanessa reminded me that doctor #2 wanted to put me in a pair of 450ccs. I’m not sure I could have gotten out of bed in the morning.)

And then they brought out ‘The Great Big Book of Breasts’ (okay, they don’t call it that but wouldn’t it be a great name?) which looked a lot like a wedding album. Granted, it would be a very creepy wedding album and potentially X-rated given its sometimes horrifying contents (the befores, of course). And, after looking at yet another catalog featuring page after page after page of boobs staring back at me, I have two comments to make here:

(1) This doctor does beautiful work.

(2) There are a lot of ugly ass boobs out in the world. Seriously, I have seen chests as flat as a man’s, boobs that look like long empty tube socks stretching down below the ribs, nipples as big around as Coke cans … you just can’t even imagine.

Oh, and if you’re thinking that I forgot to ask about Board Certification, think again. I asked both the assistant and the doctor. And, in keeping with the theme of the whole appointment, I got an answer plus a little bit more. First of all, yes – the doctor is, of course, Board Certified in his field. (At that point, we were pretty sure he had a body suit with a big “S” across his chest under his white coat.) And then he taught us a little something extra. He explained that we must not simply ascertain that the doctor is “Board Certified.” We must confirm that the doctor is ‘Board Certified in Plastic Surgery.” Any doctor can be “Board Certified” but it could be for General Surgery and not Plastic Surgery, which is one big ass red flag. And, apparently, there are plenty of general docs out there anxious to get a piece of this cash cow industry who masquerade as specialists by calling themselves ‘Cosmetic Surgeons.’ Load of crap. Remember that.

The bottom line is that we both really liked him. And I’ve now seen four doctors … and gotten four pretty different opinions. I honestly didn’t expect that. And I’m seeing doctor #5 this Thursday.

Seriously … my head hurts.

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{September 22, 2011}   The Mammogram Results

“NORMAL, NORMAL, NORMAL!!!  I’ll bring you a hard copy of the report so you have it for your surgeon when you make your choice.”

This was the text I received today from my friend and, more importantly, my OB/GYN regarding the test results sent to her this morning.

I can’t hide my smile but I’m not going to lie. The first thing I did was cry. I had decided that everything was fine, would be fine, would always be fine … and I believed it. Still, there was this crappy little nagging feeling in the back of my mind that was nervous as hell.

I knew my mom was nervous as the subject came up a lot. She’s had a few of her own scares so she was a good resource to have around and also, you know, my mom. I knew my husband was scared as he’d become a prolific texter … warning me not to overgoogle anything … and then yet somehow quoting statistics and percentages that he could only have discovered through his own excessive online research.

But let’s go back in time a little. When I first heard the news on Tuesday, I knew that my aggressive nature had to kick in and I needed to nip this concern in the bud as soon as possible. Which is why I texted my OB/GYN as I was leaving the doctor’s office. Poor thing does have a life of her own and was probably trying to deliver someone else’s baby as I called both her office phone and her cell phone. And then I texted her.

I managed to reach her quickly and we discussed two places where I could have the tests done. The first place was very highly regarded and would be able to give me my results instantly. Instantly after the first available appointment on September 29, eight days away. I would have no hair or fingernails by then.

My doctor knew that … which is why she called the second place, a reputable one located closer to home for me and already in possession of the results of my last mammogram. Comparing these test results is one of the best ways the technicians can detect changes and, sometimes, problems in their patients. They could see me late the very next day. That was yesterday.

I’m sure you can guess which option we chose.

So, I left my house for my mammogram at the same time I’d normally be picking up my kids. My doctor (remember also a neighbor and good friend) even offered to get my children for me and have them start their homework alongside hers. Sooo sweet, but my husband was able to make himself available to me and the kids for the afternoon. Which I really appreciate.

I walked into the imaging center and signed in. Then, I found a decent magazine. Then, I was called up to go through all of the insurance and registration rigmorale. Then, back to my People magazine. (Did you know that Kim Kardashian wore three different gowns on her wedding day?) Then, they called my name.

As instructed, I went to the back area, women only, and changed into my stylish pink paper vest, which I nearly ripped in half exiting the ‘dressing booth.’ I made a nervous joke about it to the lady sitting in the same small waiting area as me. She just stared at me with a blank look. I thought a nasty thing or two about her in my head … then felt like a jerk when a translator finally came over and gave her the same instructions I received. In Spanish. Well, at least she didn’t hear what I said in my head. Which was in English anyway.

Armed with my now crappy Karma, I was escorted down the hall, first into the room where the mammograms are done. The technician there was very nice and patient with my nervous shell of a self. She maneuvered and manipulated my body to take the images she needed. This was my third mammogram. I had my first at age 35 and my second less than a year ago.  And, for whatever reason, this one hurt the worst.  Some of my friends hypothesized that they need to be that much more thorough when a problem is suspected.  Who knows?

While there … and thinking so much about breasts and lumps and implants lately, I asked the technician her thoughts on the impact that implants can have on the accuracy and efficacy of a mammogram.  And then I explained how my lump had been detected and why I wanted to know.  She said that, while there are arguments stating that under-the-muscle placement does decrease the odds of an implant causing a visual obstruction in a mammogram, there are still no guarantees that a problem couldn’t form behind that implant and thereby be invisible to the technicians.  Cancer cells, tumors and other problems can occur anywhere in the breast tissue so no placement is one hundred percent foolproof.  Then, we finished up the procedure and our informal teaching session and I was returned to the internal, ladies-only waiting area … until I was called again for my ultrasound.

Apparently (and this is not hypothecized), when there is a suspected problem, an ultrasound is also ordered to accompany the mammogram to rule out any issues. I haven’t had an ultrasound in years.  Do you know they actually warm up the ultrasound conductive gel these days? It was a welcome change from the frozen system-shock of years ago.

The ultrasound technician was just as lovely and soft-spoken a person as the mammogram tech.  The lighting was dimmed, decor nice and new age music was on.  I honestly felt a little like I was going to a spa for a massage.  And then, of course, I remembered that I wasn’t.  Still, I lay on the table and tried to relax completely, appreciative that there was no pain or discomfort associated with this test.  The tech commented on the fibercystic tissue in my breast, inherited from my mother.  Then, she moved the wand around over my left breast in search of any problems.  I tried to read her face for any signs of concern.  Just a poker face with a positive demeanor.  I didn’t really know what to make of any of it. She took a few pictures and said she wanted to run them by another tech elsewhere in the facility so she left me in the room, alone with my stupid thoughts, for a few minutes.

I lay there on the table while she was gone and thought about everything I’d learned during the last day as well as during the last month (ODNT is one month old today) … and thought about all the amazing people I’d heard from in the last 24 hours.  I had literally gotten inspirational messages from friends from grade school, high school and college, friends from former jobs, parents of my children’s friends, new friends and even people I’ve never even met. Incredible. I felt completely and suddenly very moved ….and then a little panicked.

I hadn’t really thought this plan through.  I had brought a buddy with me to every consultation appointment so far which, with one small exception, provided only general information to me and never any kinds of bad news.  And yet this time, partly due to the last minute nature of everything, I’d chosen to come alone.  What if she came back into the room with bad news?  How was I going to drive myself home? My imagination ran a little wild for a few minutes until she came back into the room.

No bad news. No real news other than that there was no bad news.  She couldn’t comment too specifically on anything and said they’d send everything over to my doctor who would then be contacting me. And, unfortunately, it was past closing time now.

Still, I left that office feeling pretty good.  For whatever reason, I knew this wasn’t going to be an issue. I have no idea why and I won’t deny that I was still a little nervous up until the point when my personal doctor contacted me with the good news today. Maybe it was all the prayers, good vibes, rain dances and other positive energy the universe sent my way yesterday.

Thanks, everyone. I feel loved. :)

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Remind me never to schedule my breast consultations two days in a row again.

(I wonder if anyone’s ever uttered those fourteen words in that order before.)

It’s really too much breast manipulation, medical jargon and complicated reporting for me (and my shrinking brain) to tolerate in such a short time frame. So, I want to write everything down as quickly as I can before it disappears into a black hole somewhere in my mind after I sort through the junk mail, curse out a telemarketer or something.

Today started off just fine. A nice change from the last two days. After I got everyone out the door and threw myself together in yet another two-piece ensemble (never realized how many dresses I had until they were off limits), Ashley was already outside in the car waiting for me. Again, I would be prompt today since I was not the one driving. We dropped her youngest off at his little school and headed out to meet doctor number three.

We found the office quickly and got to work on my third set of paperwork. I’m always amused at the subtle differences in the forms from office to office. These forms asked me if I was on Facebook.(He better not be planning to tag any damned pictures of me.) I said yes and assumed that maybe I would just be recruited for a fan page of his work somewhere. But who knows?

The waiting room was a nice one, very contemporary in design. And there were abstract paintings here and there of the female form. Seems appropriate, yes? The plasma wall-mount TV was there purely for the purpose of running a tape loop of their best breast augmentation products. My dentist does the same thing. Well, his tape loop emphasizes teeth, of course.

Ashley and I passed the time by flipping through his before and after book. Impressive, as most have been. It didn’t hurt that he seemed to have a lot of particularly gross patients with which to work. (They’re all headless, so I can say whatever I want here!) There was a lot of particularly saggy skin not to mention a whole array of nipple piercings and tattoos (some with their own piercings worked into the design) to help us arrive at our clinical assessment of “gross.”

It wasn’t long before the nurse came out and called my name. She escorted us into the first examination room and seemed surprised that I had a buddy with me. She said she often serves in that role. Do other women usually go by themselves??? (Thanks, Ashley, for coming today.) I took off my shirt and threw on the robe without really even thinking about it, getting infinitely more comfortable with my toplessness lately. (Yeah, that’s probably not a good thing.)

The doctor came in pretty quickly and asked a few questions. I think I had the robe off within two minutes of his arrival. I couldn’t help but notice that his examination included not only my breasts but also my stomach. Immediately, he was able to offer his recommendations to me in a choice of two options:

(A) I could get a lift (the same full lift described at the first doctor appointment) in one surgery and then have implants inserted in a second surgery. Like my first doctor, he strongly urged that these two procedures be performed separately … but for a different reason than the first doctor. He said that, during the combination surgery that includes both procedures, 90% of the blood flow is cut off from the nipple and therefore there is a chance that (look away to the faint of heart) the nipple could die. So, two procedures it is, then. Moving right along …

Or

(B) I could get the same lift and use a grafting technique that injects fat from another area of the body into the breasts to increase their overall mass. He said not everyone is eligible for this procedure and again asked to see my stomach. (Now I get it!) Oh, and yes, I have enough spare fat to move it upstairs. Yay?

I kind of like this new B option.

The upsides? My stomach would be a little smaller and apparently “contoured” following the surgery. Bonus! And there would be no foreign objects in my body.

The downside? It costs more than the lift/implants combo as it involves more actual surgery. The incisions for what I’m going to call the FRP (Fat Relocation Program) are very small and hidden in the bikini area. After time, they and the anchor incision are expected to be barely visible.

And Ashley did point out one significant fact to my now-swimming brain. Yes, option B (the lift/FRP combo) would cost more than option A (the lift/implants combo) … but … there would be no maintenance. With the lift/FRP combo, I would never have to worry about replacements, leaks, explosions or any other ‘natural’ disasters that could ever befall an implant. So there would be no further (unknown) costs associated with this pay-more-now-but-no-more-later option. Definitely food for thought.

Concerning the implants, he said he uses both saline and silicone, the latter of which costs about $1000 more. He said, in his opinion, they are both equally safe and durable but that his patients are typically more satisfied with the authentic feel of silicone. In either situation, problems can occur and replacements are generally required after ten or more years. He added that, with his implant patients, he likes to see them annually to check in on everything. Concerning mammograms, he said there are two schools of thought. Some say the implants obscure a full view of the breast tissue and therefore can be very detrimental in detecting a problem. Others argue that the implant actually pushes up on the overall breast thereby propping it up in its entirety and making it easier to get a full view of everything. So, the score there is still 0-0.

But, despite providing the implant information to me, it really seemed like he was favoring the fat injection method. He made a pretty strong case to Ashley and me about the whole thing. And we saw some ridiculously impressive before and after pictures of mastectomy patients for whom he literally created entire breasts (and sometimes nipples) for these women from their abdominal tissue. They looked incredible. Lovely breasts and a flat stomach was the consistent end result. I can’t think of a category of women who deserve it more.

I have so much to think about. And still a mammogram to attend. What a day …

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I woke up this morning to my alarm slapping me in the face and telling me to get out of bed. My daughter had choir practice and needed to be at school extra early today. Never mind the fact that the rain and my husband, hit hard with a headache again, kept waking me throughout the night. It was time to get up, throw everyone together and out the door so my day could begin.

Yesterday morning couldn’t have been smoother but this morning was a little … bumpy. (Sooo not the ‘explevatory’ word I want to use here.) Nobody was in an especially good mood, with my daughter being the real star of that dark and dramatic show. So, once they were all off and on their way, I was left to get myself, now really not in the best of moods, ready for appointment number two. Remember to wear a two-piece ensemble again, Michele. (If I ever forget and wear a damned dress, I will have to stand there completely naked for the examination. Topless is demeaning enough.)

Fortunately for me, my upbeat friend, Vanessa, was my appointment buddy for today. And, even more fortunately, she offered to drive … enabling us to get there on time today … unlike last week when I was in charge of the driving. I googled the address from the car and we got there without incident. All improvements from last week.

After finishing the elephantine amount of paperwork a second time, Vanessa and I were left to peruse the waiting room and all that it had to offer. The TV in the corner blared ‘The View’ for anyone interested in hearing about Danny DeVito’s latest exploits. The requisite glass cabinet of upscale Obaji skin products was on display on the wall near the exit. There was an additional glass case featuring all of the doctor’s Mardi Gras memorabilia. Clearly, he had been this organization’s king at some point in the past. And his membership was probably paid for by the many sets of beautiful new breasts that may have, ironically, been flashed at his very float for that parade.

Vanessa and I flipped through his ‘Breast Book’ – filled with page after page of impressive before and after shots. True, there were some women who either had no business being befores or were fairly disappointing afters … but most had made significant improvements in their areas of interest. There was even a before and after picture of a man who had reduction surgery. And, yes, we both thought he had made the right decision. All of the pictures were headless, including his, except for one. One beautiful blonde woman with a smile as wide as Texas wanted to be sure she got credit for her efforts. And did she ever look happy!

We were just finishing up the book when the nurse called my name and we went to the examination room. She handed me a gown and told me to put it on facing forward. Oh, and I want to mention that this room had some nude Venus de Milo-y statuettes here and there as well as a plastic resin cross-section of a boob.

Isn’t this exactly what I was looking for last time???

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And, as I was undressing and putting on my gown, Vanessa took her top off … just for me to see a comparison. She promised before, remember? First of all, I want to compliment my friend (who I will point out is six years younger than me!) and say she has great boobs. Everything looked to be very much in the right place to me. Did I have that six years ago? Of course, I didn’t get to look at them long because, about two minutes after she unhooked her bra and pulled down her strapless spandex dress, the doctor walked in without warning … forcing her to throw her sweater around her chest and sit there throughout the entire appointment with her bra in her hand and her dress at her waist. Our little secret.

The doctor wasted no time with me. I kind of expected a man to be different. He got right down to the examination and was fairly physical with my breasts. He immediately said that the first thing he would recommend was a Bilateral Supra Areolar Mastopexy, which is sort of like a mini-lift. It wouldn’t lift as much as the full lift suggested at my first doctor visit but it also wouldn’t leave the anchor scar (line from the nipple to the breast base with a perpendicular c-shaped scar under the breast). The only incision needed would be made around the nipple and the implant could actually be inserted through that opening. Unlike the last doctor, he said the two surgeries could be done at the same time and that, since the only incisions made would be around the nipple (rather than the full lift’s anchor incision), scarring would not be an issue. And he seemed very confident with his answers.

When I asked about implants, he said he uses both kinds but much prefers silicone over saline. (I know. Again, different, right?) He said the silicone implants feel much more real and less invasive to the patient.

When I asked about the recovery period after the surgery, he said there would be some pain but that I could exercise after two weeks. (Woohoo!) He said the breasts are taped down a few weeks during the healing process anyway. (Sounds awesome.)

When he asked me how big I wanted to go, I looked at Vanessa and we came up with the same conservative “Not too big” (me) and “Small C?” (Vanessa). He seemed surprised with our answers and said that you want to go big C or small D to really get your money’s worth and have others notice the difference. I think he mentioned something about my husband at this point. (I really wasn’t wild about this conversation.) And then he asked to take my headless picture for my file. (Please let me know if my pictures hit the internet so I know when to file for free boobs!) Perfectly nice man. Seemed to really know his stuff. Just sort of felt a little like a number. Two lifted boobs, D, silicone, check.

Of course, he did leave us to play with his sample silicone implants – the 330cc, the 420cc and the whopping 450cc – which would translate to me being a full D. With my small frame and my just under 5’4” ‘stature,’ I looked like I was about to topple over. I might just need to take it down a notch.

They say everything happens for a reason. And I mentioned earlier in this post that he was pretty physical with the examination. It wasn’t exactly comfortable, of course. But without that literal manhandling, he would never have found the lump he found today in my left breast. Yes, lump. Which was also what I got in my throat when he told me. Remember that scene in Sex and the City with Samantha? Damn.

(I love you, Vanessa, and am so glad you were there with me today.)

So now, in the middle of this whole thing, I need to go get a mammogram to determine what the hell he found today. I would have had to do it for any of these surgeries anyway, but now I’m just going with a little more urgency … and anxiety. And I have another consultation appointment tomorrow. Sigh.

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et cetera
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