Tag Archives: mammography

My multiple personalities are fighting again


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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The Fifth Consultation – and in Breast Cancer Awareness Month!


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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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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