Tag Archives: MRI

‘Twas a Week since my Surg’ry


‘Twas a week since my surg’ry
To take out the mass
I still can’t believe
It all happened so fast

We started out chatting
And blogging ’bout boobs
Yet somehow this week
We’re onto chest tubes

We’ve learned about mole rats
The kind with no fur
And we’ve all guessed which boobs
Go with him or with her

We’ve met lots of doctors
Who all aim to please
Some say just a lift
Some say double Ds

If you go with an implant
Then, you’ll need to choose
‘Tween saline and silicone
With both you can’t lose

But you’re not done yet
Now you must decide
If it’s under or over
the muscle inside

The scars, anesthesia,
The risks and the price
It all made my head spin
This roll of the dice

And we found a lump
in my breast on the way
But learned it was nothing
Hip-freakin’-hurray!

Then later an x-ray
Revealed a round mass
Attached to my lung
And we struck an impasse

So a CAT scan, a spec’list,
A loud MRI
Soon gave us to know
that a surg’ry was nigh

So I dealt with my fears
And I packed up my stuff
And I went to the hospital
‘Cause I’d had enough!

Through IVs and catheters
Chills and Code Red
I came out of it all
I’m now home in my bed

My right side’s still achy
It hurts when I cough
So I’ll rest, write & e-shop
Hey, look! That’s half-off!

My friends were amazing
My family divine
But the best thing of all
was to hear “It’s benign.”

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Crazy ramblings from the day before my surgery (LUNG surgery, for anyone not up to speed)


I woke up this morning and shook off my crappy night of dream-riddled sleep. My husband and I attempted to have a calm, normal morning (which is a bit of a farce the last few days) for the kids. But I think they were fine and managed to get ready for school and out the door on time. I took care of a few things I wanted to get done before tomorrow and got ready for my 10am registration appointment with the hospital. I drove there by myself sort of in a daze and realized I probably shouldn’t have pushed everyone away who offered to come with me this morning. Still on autopilot when I finally arrived, I pulled in the skunky old parking garage and began circling for a spot. If I wasn’t anxious enough about the whole situation, the fact that the ceilings seemed to be only five feet high finished me off. I drive a Honda Pilot, not an overly tall vehicle but not a small one either. And in any garage with low ceilings, I have that cringing feeling whenever I drive under a concrete beam that it’s going to nail the roof of my car. Or least take off the luggage rack. This garage was so old that the beams looked to be covered in stalactites, or at least those free-form Biscuit drop biscuits we all ate as kids. Long story short, it was gross. But I trudged on, nailed nothing with my car, parked it and took the elevator to the first floor.

When I got there, I checked in with the receptionist and she told me to take a separate elevator to the fifth floor. Naturally, I walked into the elevator and pressed the ‘6’ button. I stare at the keypad as it started to ascend and realized my mistake in time to avoid extra elevator travel. When I got out on the fifth floor, I checked in with the receptionist and waited for their insurance person to get me registered. After we were done, there was more waiting. Next, I was called by the staff person who was responsible for explaining all of my surgical instructions as well as the terrifying consent forms. She asked where my husband was as he was required for this part. Crap, I had told him not to come. A quick phone call remedied that problem and he was there about fifteen minutes later. I don’t know what I was thinking. I should’ve had him there from the beginning. There’s just so much to go over and remember.

We signed everything mindlessly until we got to the Thorascopy/Thoracotomy Risk form. I found some of the information listed here to be a little frightening and others interesting. Here I share with you some of line items that jumped off the page at me.

10-15% of thorascopies are unpredictably converted to thoracotomies. Come on, 85-90%!

Nerves are always compressed between the ribs during chest surgery and will cause pain or numbness for four to eight weeks post-operatively. Crap. Four to eight WEEKS?

Chest tubes are necessary to drain the air space left in your chest and must remain until all air leaks have stopped, and only then can you be discharged, normally 6-10 days. My husband and I both did a spit take on this one, which was weird because neither of us was actually drinking anything. NORMALLY 6-10 days? When we asked about it, we were told that this “normal” range typically applies to older patients who are not in the good health that I am in. At this stage of the game, they are hoping and expecting that I will be able to have the chest tube removed earlier than this “normal” prediction. Crossing fingers on this one.

The overall risk of death is 1 to 3% when removing lung wedges, lung lobes and other chest masses. Well, yes, that number is very low but, you know, it would have grabbed your attention, too.

We glossed over everything else about possible hemorrhaging, infection, respiratory and pulmonary failure, nerve damage, chronic pain, fluid leakage, renal failure, myocardial infarction, stroke, paralysis and coma like champs. Once we were done, there was more waiting … this time for the anesthesiologist … or maybe it was the nurse anesthetist. I have no idea. Like everyone before her, she asked a million questions about my medical history in an effort to avoid any problems tomorrow. She explained that I will be given anti-nausea medication as soon as I arrive (at 5am!) and they will begin prepping me for surgery. She said the procedure takes about four and a half hours and that, once it was over, they will bring me to ICU and attempt to wake me, at least a little, as soon as I get there. Things like when I leave ICU for a regular room, have the chest tube removed, get to go home, etc. all depend on what type of surgery is performed (which will be decided on the table) as well as how I’m doing afterwards. All signs now indicate that things will be textbook case and I will be fine. I like those signs. They are my friends.

After we finished with the anesthesiology consultation, there was more waiting … this time for my lab work. They asked me what I’ve had done lately. I figured my response of “blood work, chest x-ray, EKG, CAT scan and MRI, all in the last two weeks” would have been enough to dismiss me and enable to go home … but no such luck. The blood work and the chest x-ray both need to have been done in the last seven days. So, off we went to see the nurse who couldn’t have been nicer but provided me with the most painful blood extraction of my lifetime. I know I had previously awarded this title to my MRI tech but this one topped it. The problem seemed to be my “tiny, rolling veins.” We tried … and tried …. and tried … and finally got the vein. But then, she needed to call in an extra nurse to push on the vein because it was draining too slowly and she was afraid she wasn’t going to get enough blood. By the time it was done, I was, too. And I told my husband that I would likely be taking a little anti-anxiety medication later today. (I don’t know why I’ve been fighting it really.) After the blood work, I had only to take a few more chest x-rays. Sure, all of these x-rays are slowly killing us but they sure are a walk in the park compared to the needles.

Now wound up like a top, I walked back to my car with my husband, thrilled to be leaving but as anxious as I’ve been since all of this mess started. And very happy that my wonderful friends were literally waiting for me with a cheese tray at a friend’s house to eat and dish and just chill out for the rest of the afternoon. (Thanks, ladies. It was both delightfully relaxing and delicious.)

It’s now the witching hour. The kids are home and toiling through homework. Dinner is looming and I still have to pack my bag. (Does anyone have any suggestions on what I should pack?) And there are several other little details I want to take care of before tomorrow. And, yet, somehow I feel this post still isn’t the last you’ll hear from me today. Writing not only chronicles everything for me but it also provides the greatest relaxation I’ve found so far. I think it forces me to process everything systematically and sensibly. And I need as much sanity as I can get my hands on right now. Though as the clock ticks and the meds permeate, you can likely expect typos, word misuse and other craziness in my ramblings. Enjoy the rawness.

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Tales from inside the MRI tube


I had my MRI bright and early this morning, a feat in and of itself for my mom and me to get there on time. I didn’t really know what to expect again as I’ve been a ridiculously healthy person all my life. (Thanks to those of you who attempted to prepare me verbally.) There was a little paperwork to fill out beforehand which I did mindlessly for about the dozenth time in the last few months. When I brought it back to the receptionist, I asked about the procedure and couldn’t figure out why she was staring at me as if I showed up at the medical center painted blue and walking a duck on a leash. And then I realized what I said,

When I go in for the MRI, will I be wearing only my wedding gown?

I guess I was more nervous than I thought … and maybe still a little Xanax’ed. I tried to correct myself but then the word ‘bridal’ then came out of my mouth. What the F was wrong with my brain? I finally forced my mouth to spit out the word ‘hospital’ and she smiled and said yes, probably moving her letter openers and other sharp instruments from the counter to underneath her desk as I walked away.

I sat only a few more minutes until they called my name. When I walked past my mom to go to the back with the tech, she reached up and high-fived me. ??? I was, of course, expecting a more stereotypical hug and words of encouragement from this very sentimental woman … but I think the hardwiring in her brain is a little whacked right now, too.

The tech brought me to a dressing room where I changed into my HOSPITAL gown and then moved on with her into the MRI room. I lay on the table with a wedge pillow under my knees while she put an egg crate cushion and then the brains of the whole device on my chest. She gave me a ‘panic ball’ (which looked a hell of a lot like a nasal aspirator) to hold in my left hand in case I felt the need for immediate ejection from the tube. She asked if I wanted my eyes covered to avoid feelings of claustrophobia. I said yes. And she placed the headphones on my ears. Friends told me to bring my iPod but I forgot. And I wouldn’t have been able to use it anyway. Her headphones allowed her to talk with me and play music between her instructions. She asked what I wanted to listen to and my mind went blank. ‘What are my choices?’ I asked, completely spoiled by the XM radio menu in my car. “Anything FM,” she said. I rattled off the only local call letters I could think of and found myself quickly tuned into a New Orleans easy listening station. Lionel Richie. Great.

She left the room and began the LOUDspeaker communication … and starting sucking me into the tube, head first. Unfortunately, I instinctively opened my eyes and realized that I could see the ceiling of the tube, which I was pretty sure was so close that I could touch it with my tongue if I tried. And, no, I didn’t like it. She kept moving me into the tube until I was waist-deep within it. At that point, the movement stopped and she asked if I was okay. I said, “As long as you’re not taking me into this thing any further.” She said she wasn’t, so I exhaled and decided to keep my eyes closed and attempt to relax to the smooth stylings of now-playing REO Speedwagon.

Anyone who tells you that he can sleep in the tube is lying his ass off, by the way. The noise was incredible. It vacillated between loud siren sounds and jackhammers. I closed my eyes and pretended to be in my favorite hotel room in New York City. Those sounds are extremely commonplace there, and I hear them all the time from my bed while on vacation. This ‘happy place’ thinking seemed to work for me. Until I realized I had been holding my breath the whole time and I flinched when I suddenly had to draw in a quick breath to keep from fainting on the table. Which meant we had to do that round of tests again.

There was a lot of “Take a deep breath … and hold it …” until I often felt like I was going to faint during the whole process anyway. I don’t know if these repeated loudspeaker instructions are normal or if they were just required for me because an inflated lung is easier to inspect than a deflated one. I just did what I was told. Over and over and over again. Until they told me that they had to put in an IV to inject me with some substance to help enhance the images again. (Remember the CT scan?)

After a good bit of pain getting the IV in while I was still all covered on the table, the tech told me that the vein she was working with was no good so she’d need to do it again. She then gave me THE singlemost painful needle insertion I’ve ever experienced in my life. I actually apologized for the howl I let out. But at least the f-er was in now. And she said that this injectable dye would not give me the urinating sensation I got with the CT scan injectable. But I did get the mouth-full-of-turpentine, chemical taste again. (I honestly wonder about the damage I’m doing to myself with injectable dyes, multiple x-rays, CT scans which are said to equal 100 x-rays each, MRIs, etc.)

Now with this foreign chemical surging through my veins, they took another whole series of images … and friends like Michael Jackson, Norah Jones and Oasis kept me company. After about an hour, I was able to get up, get dressed and return to my mom, who kept herself busy on her iPad in the waiting area. My results are expected by Monday. Surgery is guaranteed, but there are still a lot of questions surrounding it that I’m hoping things like this MRI will help to answer.

More soon ….

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Meeting the thoracic surgeon today and planning the next steps


It’s now the end of another long day. I had my specialist appointment today. He was very knowledgeable and had a great bedside manner. And he is apparently the best in his field anywhere in this area.

Thankfully, my husband and father came along with me or there’s a good chance I wouldn’t be able to report on a damned thing. For every ‘it has the look of a benign mass’ there was a ‘we can easily collapse the lung and remove a chunk of it or your chest wall to get everything out.’ (Deep breaths.) He does this kind of thing every day. But I don’t.

Following the appointment, my husband carefully scripted the following text that we have now collectively forwarded to more than fifty people:

“We saw the thoracic surgeon today. He looked at the CAT scan, etc. He seemed pretty confident that the mass is benign, again citing shape, location and density. But we won’t know for sure until he is in there. Regardless of what it is, he wants to go in, check it out and remove it. He might be able to do everything thoracoscopically but will be prepared to go in with traditional surgery to remove it if necessary. The next step is an MRI, which will happen either Friday or Monday. We should also have a surgery date by Monday. It will probably happen right after Thanksgiving.”

Since his text, we have scheduled my MRI for the crack of dawn tomorrow morning. Which will be good practice for the 5am arrival time I’ve already been quoted for the upcoming surgery. I am a big baby about sleep. I love it and don’t like ending it so early in the morning. So, the sweats I’m sleeping in tonight added to a ponytail and possible toothbrushing should complete my morning regimen before my mom (who is sleeping here tonight) and I head out tomorrow morning.

I had another little moment of anxiety today when the surgery options were being explained to me. A little dizziness as I’m prone to nervous fainting and some nausea. So I was prescribed a little oral ‘help’ from my doctor and am feeling well enough to write everything down tonight before I fall asleep. (Here’s hoping I sound lucid.) Writing about everything may seem odd at a time like this one but organizing my brain is helpful, even therapeutic, for me. So thanks for listening.

And please continue to keep my friend in your thoughts and prayers. She still really needs all the positivity she can get.

Talk to everyone soon. Oh, and if you’ve ever had an MRI, I’d love details and advice for tomorrow. Thanks, all.

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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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