General Surgeon Appointment
Tuesday was a day of appointments! After my morning workout on the stair stepper, it was time to make the drive down to Murray to my first appointment with Dr. Kristopher Katira, the plastic surgeon. Dr. Katira, so far as I could tell seemed energetic, and verbally knowledgeable. I decided, given my limited amount of information to go with him as my plastic surgeon for post-mastectomy reconstruction. Best as I could tell, if two general surgeons were willing to work with him, he must be okay.
During consultation, we talked about my history and questions, including concern regarding internal scarring, keloids and whatnot. We also talked about an issue that we hadn't really weighed which was "nipple conservation" as part of the mastectomy. I believe that Dr. Chung had mentioned the possibility, but with Dr. Katira, we went into some detail. With nipple conservation the nipple of course would become more of an aesthetic part, rather than a functional or feeling part of me. Something to consider.
Another consideration that Dr. Katira mentioned that I should be aware of is that it is very likely that I could get a mastectomy and reconstruction on the cancer-side. Getting a bi-lateral mastectomy covered by insurance may take some lobbying on the part of the surgeon's offices. Utah is one of the more restrictive states when it comes to condoning coverage for prophylactic mastectomy. When he mentioned this, I asked him about the Women's Healthcare and Cancer Rights Act of 1998, and how this federal law came into play with respect to my coverage. He said that the intent of the law is to provide for mastectomy and reconstruction, but that prophylaxis is a slightly trickier argument to make with the insurance companies, although my familial history and my CML would very much help with my case for getting the second side covered.
After examination of my chest (so fun), Dr. Katira said that I could have a one-and-done insertion of an implant that did not need an expander, because of my bra-size (fun). However if I wanted the one-and-done, such an implant would look very full-at-the-top read: like balloons glued onto the chest. This look is adopted by some. It gives a certain aesthetic, that is more likely to look like cleavage, but will be a very unnatural looking otherwise. I wanted a more natural look.
If a natural look was what I was going for, then Dr. Katira said that I would have to go with the chest expanders + internal structure route. Right after the mastectomy, the plastic surgeon - Dr. Katira would go in and insert an expander and an internal structure (much like an internal bra, made of non-cellular material that is meant to be grown-into by the surrounding tissue). The internal structure would provide the anchoring needed to create a more natural looking breast reconstruction. However this reconstruction will require several surgeries and time for expansion. And of course there will be some pretty intense wound care and drainage tubing maintenance that will be involved during the first two to three weeks of healing. I asked Erik right then and there if he would be prepared to play my nurse. And he said yes! <3 :)
The consultation room for plastic surgery is very fancy, it's like a long hallway of rooms. Once you step into the exam room, there is a sliding door on the opposite side of the door that leads into an individualized consultation room, where you'll find sofa chairs, paintings, and carpeting for "atmosphere". Beyond that, you see another door, I was told that it would lead to the doctor's offices. After my consultation, I got to step through that door. It lead to a hallway, through which I strolled, in my billowy circus-tent-like hospital dressing gown to the photography room. Before leaving, one of the medical assistants took pictures of my chest, at 45 degree rotations from facing-left to facing-right. Then it was off in a hurry to the second appointment - with yet another general surgeon.
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