Monday, August 20, 2007

Still Under Construction

I’ve been trying to think of a delicate way to say this, but I’m not having much luck. So I’m just going to say it. I drove into Philadelphia this afternoon for nipples. Yep. You read that right. I saw my plastic surgeon and he somehow fashioned nipples for me. It was a very strange experience.

I think I’ve mentioned this before, but Dr. Serletti is one of the best breast reconstruction surgeons in the country, one of several handfuls who do the particular surgery I had in December. He’s the head of his department at the University of Pennsylvania – a teaching hospital, which means very rarely do I ever get to see just him and a nurse.

When I had my surgery there would be flocks of student plastic surgeons coming in my room to essentially feel me up and make sure I had good blood flow to my breasts. Modesty is not something a person can afford in a teaching hospital. Besides, when I reminded myself it was actually my displaced tummy they were poking and prodding it wasn’t so humiliating.

Today, however, was just the doctor, the nurse and a fellow surgeon. Apparently my doctor was showing the other doctor how HE does nipples and I’m a great candidate because I have two different examples for him to work with. The left breast had been removed by a radical modified mastectomy a year and a half before reconstruction, while the right breast was a skin sparing mastectomy done at the time of reconstruction. This probably doesn’t mean a whole lot to most of you, but trust me. There’s a fairly significant difference.

I’ve decided the ability to draw with a felt tip pen is a prerequisite to being a plastic surgeon. It seems like every time I go in there he’s leaving little drawings on me. Today I had to stand there with my ridiculous gown around my waist while he drew X’s on my chest, stood back to eyeball his artwork, and then drew tiny spokes out of the X’s, all the while Dr. McSomething-or-other looked on approvingly.

After that it was up on the table where he shot my feeling-less boobs with lidocaine “just in case”. That was a breeze because I couldn’t feel the needles. Just the way I like it. Then he draped a pad over my chest that had a three inch-hole for him to work through.

So I’m laying there, trying to figure out where I should look because I’ve got three people standing over me and if I’m not looking at one of them then I’m staring into the bright light, when the doctor makes his first incision. That was freaky because, while I may not have any feeling in that area, I could feel the pressure and the “pop” when he made it through the skin. Even now I’m shuddering just thinking about it.

I’m not complaining, though. The way they usually do nipple reconstruction any more is to pull up some of the fat and fashion it with the tissue and skin. In six weeks or so I’ll go back and get everything tattooed. But the way they USED to do it was a skin graft from either the inside of the upper thigh or… or… oh, I can’t say it. It’s much too painful to even voice out loud. Just think of the MOST delicate area of the female anatomy and you get the picture. If they still did it that way I would be using Todd’s idea of gum drops because there’s no way. NO WAY!

Dr. Serletti is as professional as they come. He’s very nice, but he’s all business. In a bizarre chain of conversations, however, he started talking about Caddy Shack as the funniest movie of all time. In fact he hikes up to a cabin in the Adirondacks with a friend of his and they take a VHS of that movie every time. It was shocking to learn he has a sense of humor.

I don’t think I can impress upon you enough how strange it is to be laying on a table with three people hovering over you: one of them sewing a nipple; one of them snipping the sutures and blotting the blood; and one of them watching the happenings with clinical interest; all the while talking about movies and books and generally chatting about things you would otherwise discuss over coffee.

After everything was plumped up and sewn into place, the doctors left and the nurse dressed me so I still have no idea what they look like. It will be another four days before I get to see the handy work. I have no doubt things will look a bit weird, but probably no weirder than they’ve looked for the last two years.

I go back in three weeks and at that time we’ll discuss the tattooing and also more revisions to the left breast. Because it was a delayed reconstruction Dr. Serletti had to use an approximately 3” by 6” scrap of belly skin to make the breast mound and the incisions are a bit jagged. So instead of a round breast I have sort of a trapezoid. At least I’m unique! But he’ll smooth those edges out to make things look a bit more normal.

Foolishly I always thought – if I ever really thought about it – that reconstruction was a surgery and then you were done. Boy was I wrong! Which makes me all the more glad that we put off Hawaii until next year. I should be completely finished with all this by then.

This morning I started back into my “healthy” mode, drinking a lot of water, walking two+ miles on the treadmill, counting my points, etc. But, as I’ve said before, any type of medical procedure induces a craving for something of the java variety – hot, cold, whatever. The best I could do was a cold bottle of Starbuck’s Mocha Frappuccino for the ride home. I should have known I’d need at least two, but I only bought one.

Probably better that I only bought one since they’re more points than I should have had. **sigh** Thankfully, tomorrow is another day…

Labels: reconstruction, weight management

Mused by Jenster :: 9:01 PM :: 26 People musing:

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