I'm learning about plastic surgery and you may not want to.

The More You Know(TM) apparently Melons remain the preferred fruit for imitating breasts.

In the last post I mentioned that reconstruction was an option for any possible surgery. I spoke to the plastic surgeon about this, and again, any mistakes in the retelling here are my own. 

From the first hot second of this I said to Stephen that I didn't want reconstruction. He seemed more reserved here and I think he thought I was jumping to conclusions. And he was right, being my general sense of reason. 

My surgeon's scheduler got me in with a plastics person she really likes and trusts, and I wanted to at least know my options before I said yes or no. My appointment with him was a bit premature, perhaps, because it was well before I had enough information to really know what type of surgery I would have. Every type of surgery was on the table. So we had a lot to talk about, which was cool because then I learned a lot of terms to come home and read the literature on too.

In essence, there are lots of options, all depending on the surgery.

Option 1: No reconstruction. Option for any and all surgery options, whether it's lumpectomy or mastectomy (single or double). He takes the day off. (kidding, I'm sure he has other things to do). With a lumpectomy, this could mean I'm a bit lopsided, but ladies, you'll all know that no one has perfectly symmetrical breasts. This was before we realized Parus minor had a lump of unknown origin as well, though; a second lumpectomy, if needed, would not balance them out, unfortunately. My surgeon mentioned having done several bilateral lumpectomies and never once has it been that simple. Alas.

With no reconstruction after mastectomy, prostheses are an option. I have no idea how I feel about these, how they feel, what they look like, or really much except that the hospital has some great resources around this option.

Option 2: Lumpectomy (aka breast-conserving surgery or BCS) with reconstruction. Make the girls match up. This can be building one back up or shrinking one down to meet the other. Because radiation can cause tissue shrinkage, he prefers to do this after all treatment is done to get a better outcome. 

Option 3: Mastectomy with reconstruction. Exactly what it sounds like. This could spare the nipple, but that would be up to the surgeon doing the recon. Nipple-sparing surgery is only an option with recon.

That much is all reasonably obvious but recon itself is the part that was interesting.

There are two main types of recon we discussed. 

Implants

The first is what most people think of: implants. Pros of implants is that it's a comparatively quick and easy surgery. There are several cons.

• it's usually done in two stages, so it's automatically an extra surgery. It can be done in one, but this surgeon prefers to use an expander and then place the implant for better results. 
• it requires an overnight in the hospital.
• they can leak and cause infection, leading to emergency surgery.
• as a result, people with implants should undergo regular monitoring (on top of all the other monitoring I'll already now have)
• they have a shelf life, and it's shorter than how long I expect to live...so I'd be signing up for another surgery.
• it's not uncommon for the body to dislike them. There's something called capsular contraction where scar tissue forms around them. While this isn't necessarily awful, it can become extremely painful (about 15% of cases I believe) and a corrective surgery may be needed. 
• implants can be extremely detrimental for recovery/use of the chest muscles. Given my extracurriculars, this seemed less than ideal.

Using Autologous Tissue

The second route is one using autologous tissue (auto meaning self, and logous from homolog, or same structure). That's a fancy way to say they give you a tummy tuck and what they take out of your belly they put in your boobs.

Autologous tissue is great because it's your own tissue. No need for replacements, no capsular contraction, no restriction of motion because of placement. It should be a one-and-done surgery, done the day of the initial surgery (unless I need radiation). Many people will mention the perk of a tummy tuck. The cons here though...

• I don't have enough belly fat to reconstruct much so if I do a single mastectomy, I'd likely need to do a reduction on the other side if I wanted to be even.
• it's a 10-12 hour surgery.
• the surgery is intense and requires being split open across the belly and up top.
• the surgery is intense and requires a full week in the hospital, including a night in the ICU.
• there is a small risk of hernia with this surgery. 
• about 10% of these surgeries have complications where blood flow to the transplanted tissue fails. That requires more surgery, and in total up to about 5% total of these surgeries fail and the patient is left without a reconstruction. 

Amazingly, the surgeon is convinced that the recovery time is the same for all of these: the first few weeks for autologous will be the worst of them, but by 6 weeks, I should feel like myself again. Of course, I suspect that he means doing activities normal people do, not flinging themselves around in the air on straps. I honestly can't get a good sense for how much longer these surgeries would set back full recovery for me and my circus hobbies, but to be fair, I doubt that's something they have had to answer. I am reasonably confident THAT won't be 6 weeks, but more on that another day.

On one hand, it's incredible to me that we can even do all of this. And that insurance covers it: in the US, if your insurance covers mastectomy, it has to cover reconstruction too. On the other hand, it all just seems a bit barbaric. I have a lot of thoughts and feelings about all of this. No decisions can be made until biopsy #2 comes back, I'm not committing to anything, so a lot of this is just organizing thoughts.