over the muscle | 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.

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:

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.
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:

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.
The recommended MRI every 2 years for these implants has been lifted by the FDA.
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.
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.