The Fourth Consultation – I could now teach a master class

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!” while I went with “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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2 responses to “The Fourth Consultation – I could now teach a master class

  1. I have saline and love them. Like you I went small ish. No need to be known as tits magee
    PS a title i can up with but would will to you…. wait for it….
    A tale of two titties
    Im just that good

  2. I went over the muscle. My doctor recommended it. He said under the muscle leaves a sloped look at the top of the breast. I haven’t inspected boobs as you have. Maybe you could get your experts lined up and compare the unders and overs.

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