OldDogNewTits












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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Alright, let’s address the title of this entry right off the bat.

My husband is coming to the second round visits for two reasons: (1) He cares about my welfare. (Yes, I am making an assumption here but I think on most days it’s actually true) and (2) He is the co-signer on all of my financial accounts. This statement makes it sound like we have sizeable accounts in Switzerland or the Grand Caymans.  We do not.  We do, however, have one at the local branch around the corner.  There – I am important.  They always have ice cold water available for me at no charge that I may drink in as many two-ounce dunce cap-shaped cups as I desire.  And I’m pretty sure if I asked that they would give me a Saf-T-pop.  For free.

My mom came to this visit (she couldn’t make it to Doctor 5’s second visit) because she is curious about everything and wants to be sure I’m making a good decision here.  She cares.  A lot.  And if that makes me a dork then it’s really just one more thing to add to the list.  Which grows.  Every day.  Especially now since I’m a … blogger.

Anyway, you know the drill. Woke up. Kids off to school.  Got myself ready to go and waited for my ‘committee’ to arrive so I could leave for the appointment.  My husband came back home first, then my brother came over (no, he wasn’t part of the original plan) and then my mom.  No one was in a hurry to get there and get this thing done except me.  My brother and my husband actually started to talk football.  I resisted the urge to kill them both and managed to send my brother on his way and herd my spouse and mother into the car with me. And off we went.

This morning, we paid a second visit to Doctor 4. He’s the doctor that suggested a mini-lift and saline implants (270 to 330cc).  The implants he uses (Allergan) are texturized and come with an impressive 10-year insurance policy.  My friend, Vanessa, came with me last time.  Remember?

We weren’t in the waiting room long before my name was called.  I immediately introduced my husband and my mom and explained their presence and was met with smiles and complete understanding.  (Exhale.)  The three of us were escorted to an examination room by the doctor’s assistant.  She was just as helpful and friendly as she was last time and put me and my entourage immediately at ease.

We chatted with her only a few minutes before the doctor came in.  (I still like him so much.)  He began explaining everything we talked about at my first appointment to my husband and mother to get them up to speed.  I could see that they both felt comfortable with him.

Having just been to Doctor 5 again, the comparison was fresh in my mind.  One of my first questions was about the texturized shells used with the saline implants. If you remember, Doctor 4 swears by them as they are said to adapt better within the chest wall and prevent scar tissue from forming around them. Doctor 5 said he feels they don’t always drop into place as well as the smooth shells following surgery.  And I shared Doctor 5’s comment at this appointment.

Doctor 4 said he hasn’t had any issues with the texturized implants and said they always drop perfectly into place.  He stood by their ability to maintain a pocket for themselves where they are inserted rather than becoming embedded in scar tissue.  He added that prevention of scar tissue means prevention of breast hardening which can occur over the years with the smooth outer shells.  Never wanting to be a guinea pig for science or progress, I asked how long these texturized shells have been available, expecting to hear somewhere in the neighborhood of five years. “Twenty-five years” was the answer.

So I’m guessing they’re tried and true then.

We talked a lot about his specific recommendations for me and asked a few questions here and there.   My husband asked his same ‘What about any complications that arise during this elective surgery? Are they covered by insurance?” question. Similar to our other second round doctor, Doctor 4 said that the number one complication risk is infection but it is extremely rare. He said he personally guarantees all of his work as well as the products he uses during surgery.  He said an infection can be treated, with the implant even removed if necessary, immediately and in the office.  His assurance and surgical history served to satisfy all of us, especially when added to the fact that the implants carried an additional insurance policy of their own.

My mom had some questions about his recommendations.  (1) Would the mini-lift do the trick for me? (My mom was the one who first made the lift diagnosis for me years ago. What? I said we were close.)  (2) What effect would the implants have on my mammograms?  And the doctor answered them with her the same way he did with me.  (1) Yes, because of where I measured, a mini-lift should achieve the result I need without subjecting me to all of the additional incisions and thus scarring involved with a full lift.  (2) With additional views taken during my mammograms, the technician should be able to achieve as full a view of my breast tissue as a patient without implants.

When everyone’s questions had been answered, I asked to see the ‘Great Big Book of Boobs’  again.  And there I sat with my husband, my mom and a complete stranger flipping through page after page of saggy-to-braggy breasts. I figured my spouse had suffered through two boob appointments so I’d at least score him the book. But I hadn’t really considered the fact that he’d be looking through it with his mother-in-law.  Looking back, it seemed more like a Farrelly Brothers movie than real life.  Although I think I did hear him comment about someone’s “cans” while flipping through the book at some point. So maybe it wasn’t a total loss …

And now I really need some time to digest.  And mull.  And ponder. And contemplate, meditate, formulate, deliberate.

Great. Now I’m thinking of that stupid INXS song.

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Okay, we’ve got five consultation appointments down (hard to believe!) and an incredible amount of information to digest.  But only two doctors can advance to the second round.  (Kinda feel like you’re watching America’s Got Talent?)

So, here’s where you come in.  I want you to help me pick these two doctors … so I’m providing you with a Cliff’s Notes version of ODNT to help you decide.  (Didn’t you just love Cliff’s Notes … and didn’t you hate the teachers who knew how to circumnavigate them when creating their tests?  And did you know that the original creator of these books was actually some dude from Nebraska in the 50s named Cliff?  He lifted the idea from his buddy, Cole, from Canada who had already started publishing Cole’s Notes up there. Yes, I am serious.  And no, I didn’t know that off the top of my head.  Duh, Google!)

Anyway, please take a look at your cheat sheet below … but remember … I’m the teacher now.  And what does that mean?  It means there’s a lot of shit in my five carefully scripted reports that cannot be found in these excessively condensed notes.  Shit that could sway you in any direction.  So, my recommendation …. and my request … is that you review the doctor visits and help me cull these five down to two.  (Maybe I can get an 800# for voting like American Idol.)

I’ll likely start the voting tomorrow so please get thinking for me.  Oh, and don’t forget to play the Boob ABC game (from 10/10/11).  We’re halfway there. Thanks, all!

  • Doctor #1 – Full lift and (maybe) implants later; Prefers saline; Not too big; Two procedures
  • Doctor #2 – Mini-lift and implants; Prefers silicone; Big to get your $ worth; One procedure
  • Doctor #3 – Full lift and fat injections from abdomen w/some stomach contouring; Medium-sized; One procedure
  • Doctor #4 – Mini-lift and implants; Prefers saline; Not too big – 270-330ccs; One procedure; Insurance offered on implants
  • Doctor #5 – Full  lift and implants; Prefers silicone; Not too big  – 280-300ccs; One procedure
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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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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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