No Hill For a Climber, Breast Reconstruction Consult

Wouldn’t it just be a wonderful gesture if when the world is crashing down all around us, we could just stop it from spinning long enough for us to hop off for a moment to regroup our thoughts and emotions? It would be quite a generous gift from society too, if all of our bills and debts payments could be forgiven for the duration of a loved ones illness. This might happen if we lived in a perfect world, but a perfect world only exists in the imagination of children and those who are out of touch with reality.

The world is not going to stop for us.

It never has, it never will…

No matter how critically ill you or your loved one might be, the bills keep coming in regardless of your ability to pay them along with your rising medical and prescription medicine expenses. Your utility providers do not give a damn about your family struggles with critically ill health. The bank who has financed your home and automobiles could not give a shit either. These institutions will only let you miss a couple payments before they begin mailing you foreclosure warnings while your pleas for continued leniency falls on deaf ears. Miss a few payments and they will come take your transportation and the roof over your head.

Therefore, no matter that we have a loved who might need us at home, we still must report to work and do the best we can to keep our bills paid during a critical illness. We must do this while also still being able to be lovingly attentive and properly care for our loved ones.

And you had better not take too much time off from work in order to care for your loved ones as your employer too will only show you just as much compassion as policy might dictate.

Fortunately, Loraine’s diagnosis is pretty recent, therefore we have not yet encountered any financial difficulties from her breast cancer. However, we have taken in her brother Howard almost a year ago who is suffering from cancer as a result of also suffering from Hepatitis C. Compounding his problems to another level is he has also developed cirrhosis of the liver. This good man has worked hard all of his life, yet because of his illness, he is now fully disabled. We have a full plate and are doing the best we can to care for him, and now, I find myself with two loved ones in my home suffering from cancer.

If we can’t get the world to stop momentarily, could we at least get it to slow down momentarily while I catch my breath?

Wednesday night, it did not matter that I wanted to, actually needed to remain home. Because of a demanding work schedule I had to go on the road for the night in my semi to deliver construction and industrial supplies for my employer. As I tucked Loraine into bed, told her that I love her, and then kissed her goodnight, I reassured her I would be home in time for her appointment. I slipped downstairs grabbed my road gear and said a prayer that nothing would cause me any delays in getting back to our hub in the morning. I desperately needed to be back in time to be able to clean up and catch a quick power nap before getting Loraine to her 1:00 pm appointment with the plastic surgeon who will be doing her breast reconstruction.

Reconstruction procedures will be started immediately after her breasts have been removed on January 6th.

When you have been married to your soul mate as long as I have been, you find that you are totally in tune to your loved one, even from great distances. While out on the road, about 4:00 am, I got a vibe that Loraine was up and needing me. Say what you want about cell phones being a distraction from relationships, they also keep us connected when apart. I picked up my smart phone and through the magic of technology I was able to see that Loraine was online.  I called her and we chatted for a while before she was able to get back to sleep. We talked about how nervous we both were about the doctors visit later in the day and we also just made a little small talk to distract our minds from the unknown outcome of our consultation with her plastic surgeon.

I left my hub with 535 miles to run and 29,000 pounds of freight to unload myself. No big deal when all goes right, but you never know when your truck might have a flat tire or a mechanical breakdown. You never know when a state Depart of Transportation might pull you over for a random inspection either. My prayers were answered, I returned to my hub with no unnecessary delays Thursday morning.

Loraine and I left our house in Leavenworth at noon, and drove the twenty five miles or so to St Luke’s on the Plaza for her appointment. Not knowing for sure where I was going, I rushed to get there in order to not be late. The Plaza area of Kansas City, Missouri has had a tremendous amount of growth and construction since the last time I had ventured down there and traffic can be off the hook crazy, especially now with all the Christmas shoppers hurrying about their business. Thankfully, we did get there on time, and I must have looked like a total rube when I pulled up for valet parking outside of the valet lane. I backed up to pull in where I should have and managed to run over their valet parking sign in the process. You might not have ever guessed that I am a professional driver…

We did arrive in time for Loraine’s appointment, yet we still had to nervously wait a while before she was called back by the nurse. Once we were back in the examination room, the nurse instructed Loraine to remove her blouse and bra and to don an examination smock, opening in the front, and then she left the room. Loraine and I made a little small talk, coming up with questions to ask the doctor. As much as I thought we were prepared with good questions to ask him,  my mind began drawing blanks. I’m pretty sure Loraine’s did too. There was so much vital information to absorb, too much for a mind that was already fully saturated with fear, hope, dread, and a numbness that comes from overthinking possible outcomes.

Thankfully Dr. Martin is experienced enough to anticipate all of our fears and concerns. We asked a couple questions first, and then he essentially shut us down from asking more. I at first thought this was pretty damn rude, but kept my peace. And I am so glad I did as he gave us a very detailed plan of action for a choice of three possible reconstruction procedures once he had examined Loraine’s breasts by taking measurements from top to bottom, under and across. He informed us that because the tumor had retracted her left nipple in too far, that saving her nipples and areola were not possible. Here are the procedural choices we are looking at:

The plastic surgeon will step in once all of Loraine’s breast tissue has been removed. At this time, he will insert tissue expander’s either directly under her flesh, or under her pectoral muscles of the chest. Placement is going to all be dependent on how thick or thin her remaining breast skin might be, and the blood supply to this tissue. He will not be able to decide the placement until he has seen exactly what he has to work with.

Note: it only makes sense that this is the best time to do this procedure as she will already be opened up for it.

Once he has put the tissue expander’s in place, he will close her back up, and we will be through with any further procedures until Loraine has healed enough, or, not until after six months have passed after the completion of radiation and or chemo treatments should they be necessary.

At the point in time where saline solution can be injected into the tissue expander’s in order to create a pocket for an implant, Loraine has the choice of just having them removed. She can forego reconstruction altogether should she not like the feel of a foreign object in her body. Some women find them to be uncomfortable.

The good thing about having to wait, is it will giver her time to honestly evaluate the pro’s and con’s of breast reconstruction. This will also give us time to do further research regarding reconstruction procedures. Should she decide to forego reconstruction, the tissue expander’s can be removed at the surgeons office under a local anesthesia. Or, he can begin the expansion process over the course of a few office visits before actually placing permanent implants.

Once her new new breast tissue has been expanded sufficiently to accept implants, Loraine will have three choices of procedures:

  • Saline Implants. The pro of saline is that if an implant were to leak, the sterile saline inside would be simply absorbed by her body. If a saline implant leaks, the breast will go flat. The con is, saline implants typically do not look or feel as real as silicone implants.
  • Silicone Implants. Pro’s, silicone implants look and feel more realistic. Yet, are known to cause health issues in women should the silicone ever leak out. Leakage is only detectable by MRI according to Dr. Martin.
  • DIEP.  A DIEP flap is a type of breast reconstruction in which blood vessels called  deep inferior epigastric perforators as well as the skin and fat connected to them, are removed from the lower abdomen  and transferred to the chest to reconstruct a breast after mastectomy without the sacrifice of any of the abdominal muscles. In a nutshell, the surgeon will remove a sizable piece of football shaped flesh and fat from Loraine’s stomach, cut this in half, and then stitch the left and right sides to Loraine’s chest. Once this procedure has healed, she would then return for liposuction of more fat from the sides of her abdomen which would then be injected into her new breasts in order to shape and contour them. The pro’s to this procedure is her own flesh would be utilized and there would be no foreign objects in her body which could possibly leak their contents. The cons is the procedure will be more painful, and will require a three day stay in an intensive care unit (ICU) for three days of around the clock care of the incisions each and every hour. And then there will be the liposuction and fat injection  procedures to follow. Should Loraine have to undergo radiation and chemo treatments, this is a tremendous step to take. I honestly do not want her to suffer this much in addition to the pain and indignities she will already be suffering.

Regardless of the procedure Loraine goes with, the creation of nipples and areola will be the final step, and this might take up to two years to get to.

No matter what my dear wife, my soul mate, my best friend in life decides, I will stand by her in loving support. Should she decide to not undergo reconstruction at all, I will stand by her. Almost thirty four years of love and compassion is far deeper than a pair of breasts could ever be. My main and only concern for this wonderful woman, my bride whom I committed my life to, is that she gets through this with a full cure and that we have many more healthy years together. We will do this together.

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