Seeing a Plastic Surgeon, no, not for that reason!

When I wasn't sure if I'd need a mastectomy or not, I started doing research.

Ugh! What a subject. I wonder now whether most women just do whatever their doctor suggests and doesn't push it further. But I'm in France. I'm doing it all in a foreign language. I want to compare my care with what is done back home, yada, yada, yada...

The vast majority of women who do reconstruction, get expanders put in when they get a mastectomy. These are usually expanded, as the name implies, several times and then they have to go in for surgery again to "swap" the implants for more natural and comfortable implants.

There is also a "direct to implant" procedure but not all women qualify. I read the qualifications and I would have missed it by a mile. Nope. Not an option (I understand many plastic surgeons won't do it because of the complications). The only advantage is that there is no swap surgery, but honestly, the swap surgery is not as involved as the initial mastectomy and one small surgery would not be a deal-breaker for me. 

After some sole searching, especially while I was waiting on my BRCA results, I had to be honest with myself. I wouldn't be happy with implants. The idea of a foreign thing in my body didn't appeal.

There are a few procedures which use a woman's own body tissue. The gold standard is called DIEP. Basically, it's a combo tummy tuck with the tummy fat transferred to the boobs. It's a very long surgery, minimum 8 hours and there's the double recovery, stomach and boobs. Sounded intimidating but I felt I'd do better with this.

Well, my BRCA test was negative so all my homework and research was basically for nothing.

Except... that tummy tuck sounded good. Just the tummy tuck. I went on line and read up on just that. I found a clinic in Poland that is a third the price with a doctor who was trained in the U.K. and patients travel to him. Daniel was having none of it. If I do this, I'm doing this right here in Strasbourg. Price? Well, that can be my birthday, Christmas, Hanukkah, Mother's Day, etc. gift for the next five years!

I asked the pediatrician for a recommendation and he gave me a name. I figured I'd start there.

I had to cancel the first appointment because I was sick for ages. I figure that a plastics guy doesn't pick plastics to get sick from patients. I also didn't need to expose anyone to my germs unnecessarily so I put it off.

Finally I arrived. Nice office, all decorated. Secretary who seems to have been a patient herself a few times...

Door opens and he is what I expected a plastic surgeon to look like. Not super handsome but well-dressed, fit and precisely coiffed.

We start out all stiffly at first, like with any new doctor. I couldn't resist playing with the implants on his desk. I even recognized a few of them. Not here to talk about breasts!

I told him I wanted a tummy tuck. I wasn't sure if he spoke English but I figured that he would know the term, just because he was a plastic surgeon. He just jumped into English from there. Hey, he really speaks it! I had to throw in a few jabs, and he picked them up immediately.

I tried to briefly go through the breast cancer saga and how that lead me to think about the tummy tuck after reading about DIEP. He was interested in my medical team and was impressed. He knows my surgeon and says he's good. I admitted that I only picked him because of my radiologist, which I realize is not the best logic but I really wanted my radiologist doing the wire implants. When I said who my radiologist was, he doesn't know him but said he has a good reputation. He also liked my African gynecologist. "You picked a great team!" 

Exam time! Bra and panties.  I was surprised that he didn't even want to look at the breasts but I told him, good results. Two tumors with clear margins. Very little "damage" and didn't even need fat grafting. He was concentrated on the belly...

OMG he took pictures!! "Don't use these to blackmail me" I said in English.

"Don't give me ideas!" he quipped without hesitation.

He kind of mushed my stomach around while I was lying on the table.

Dressed and back at his desk, he explained it to me.

It was a big operation. TMI alert! He cuts around the belly button, pulls the skin down. Big scar along the hip, right under the bikini line. The pregnancies had split the stomach muscles. That needed to be sewn together, then liposuction, about two liters.

I'm only slightly overweight and well within his parameters to operate. Better if I lose? Always better but not entirely necessary.

The split muscle wasn't necessarily because of the three pregnancies. He said he's seen tons of damage in women who just had one baby and hardly any in ones with a gaggle of kids. I asked and he confirmed that usually the damage was with the first baby "But please don't go home and blame him!" he scolded. 

I would need the liposuction even if I lost weight. That is my weak area. I envy women who gain in their rear. A big butt can be sexy (although too much of a good thing...) Nothing sexy about stomach fat! I just lose my waist. Liposuction would mean that the fat would be gone forever.

I didn't want to talk about boobs but there are a couple of women looking into reconstruction here so I did ask. I also, since boobs are the subject I know, wanted to sort of test him out.

He doesn't do DIEP but he gave me the name of the doctor who does. Only one in Strasbourg. He does TRAM flap. "But isn't that outdated??" I asked. Oops! Really not a great thing to say. "I read that it had been replaced with DIEP..." He kind of made an exasperated face. I mentioned direct-to-implant and he said that he's not thrilled with that but he can do it. We have to put a sort of hammock in there..." "Alloderm?" He looks at me in shock. "You really do know this subject!" Um yeah. My boobs were on the block twice!

Then, of course, I mention that I might be getting my ovaries out. He throws up his hands. "Yes, you're supposed to tell me these things!" No, no, not right away! I went through the whole story. I just needed the time frame. "I won't do them together! I did that once and never again." Fair enough. I don't think I want to get two surgeries like that together anyway. Ick. Grim! No need...

He said to put a three month minimum gap either way, after the hysterectomy or after the tummy tuck. He gave me instructions to go back to my gynecologist and find out what the deal is. I explained that was already the plan. He didn't pressure me at all to hurry.

A sort of corset has to be worn for three weeks afterwards. He showed me a picture. Getting this done in summer was not recommended, because of this reason. Cooler months are better. 

The cost was going to be steep, he warned. The French system won't pay unless it's a very extreme case and I was far from it. My complimentary insurance might, just might, cover a little of the cost of the sewing-muscles-back-together part. I told him that the belly pulls on my back and causes back pain. Naw, that probably won't get me far. True but can't hurt to ask. "Wait till you see the TVA on plastic surgery!" Oh no. 20%!! 

That little visit cost 87€. I do get an extra visit for that but when I was sure and we could set dates. Same clinic where I had everything else done, as long as I do it before it closes next year! The total cost was 6500. I nearly fainted.

The secretary gave me all the papers. As I walked out, I saw another plaque with the same last name. Some sort of therapist. I pointed to it. The first name was "Heather". "She's French?" No, Canadian. Well that explains his English! (not that it helped my husband's English). I laughed. "That's absolutely the worst name to have if living in France!" The secretary laughed. "Oh they all have so much trouble with it!" Yes, the aspirated "H", the "th" which is said like a "t" and the "er" at the end. It comes out something like "Et-er". Yikes! The secretary asked me how it's supposed to sound and I said "Heather, the national flower of Scotland!" Yes, she's Scottish descent. Figures.

MRI victory!!

I was still not over my gynecologist retiring. No filters or not, she was amazingly supportive. I tried her replacement, twice.

Since I'm not a medical person, I can't really shake down their medical knowledge that well. We were talking about mastectomies and Dr. F. said that with a cancer diagnosis, nipple sparing mastectomies can't be done. Now, I'm not planning on any mastectomies OR occurrences but I was curious... Of course I consulted a site on the net and an American doctor responded that yes, NS can be done.

She also missed the two ovarian cysts on my ultrasound, that she had done. I didn't say anything and showed it to Dr. N. who started counting... No. Not good. Gotta look for another gynecologist...

Where does one look? In the Land Without Board Certification, I need the recommendation of a medical person. I wasn't seeing anyone for awhile so I asked my trusty pediatrician, the same I've had for 16 years, for someone.

First he said another gynecologist. I know about her. I know a lot of her patients and they love her. She has a fabulous reputation but I know that she's oversubscribed and probably isn't taking new patients.

Great suggestion but I better get another name. But it was encouraging that he recommended a doctor who is so well regarded. He then mentioned an African woman.

I had heard that my old gynecologist, before Dr. K, was working with her. That Gyn is also retired but she had already started her own practice.

The pediatrician asks his secretary to look her up. Not finding her... My son was with me, having just had an injection. He then pipes up "Try spelling it with a 'D' like this..."

So when did my son become an expert in African name spellings??

"Well, there's a guy at school... Really tall and I know his parents are African."

Sure enough, up it popped!

I went over there and there wasn't anyone at the desk. A tall black woman in a white coat comes out. I said "Bonjour" and asked if she was taking new patients. My history is a little complicated... Sure. Wait, I had to tell her. I used to be with the gynecologist who she worked with and it ended badly.

"Really? What happened?" I told her that I was having symptoms and that Dr. N. (yes, the radiologist, again...) said brightly that I had a progesterone deficiency. I had to go back to the gynecologist because "I'm a radiologist. I can't help you". Well yeah, found something my gyn missed. Ugh.

She stops the story right there. "Dr. X thought that it was all in your head?" Yes! She flipped her hand up "Oh he said that about everybody..."




We made an apt. and I asked her if she had a son at the same high school as my son. Yup. Our sons are friends. Then she adds "My son is very social. He knows everyone!"

I danced out of there a happy camper.

Meanwhile, I mentioned this to a friend who had a funny story. She's African-American and once, at a parents' meeting, a French woman approached her and started spilling out all this personal medical stuff. My girlfriend was intrigued. This is very unusual, culturally speaking, for a Frenchwoman to do. My friend realized that this woman was mistaking her for someone else. Someone else who's a doctor...

My friend had to cut her off. I think you're mistaken, etc. She assured this woman that anything she had shared would be kept in confidence.

The woman looked like she was going to die of embarrassment. She couldn't even look my friend in the eye at other events...

"Poor thing!" I exclaimed. "Poor thing nothing!" my friend retorted. "Serves her right for thinking all niggers look the same!"

The day of my appointment came. I brought all my files in a bag. A big bag. She dumped them on her desk and started going through them.

She asked all the detailed questions. I was able to blurt it all out like a machine. Three births, epidural only on the second, etc.

She held up the MRI. "You can keep that one. I have two" remembering the amusing scene when Dr. N. ordered a copy after I had turned his office upside down. "No, not that. You had this before the surgery. Where are the ones afterward?"

Ones afterward?!? This sounded hopeful. Out spouted the story of the Quest of a Screening MRI. The surgeon, the GP and the two last gynecologists had said no. Dr. N. was ready to order it himself. My sister back in the U.S. was getting them every year, and had not had breast cancer.

"Oh no! But mammograms are useless on you with your dense breast tissue". Yes!!!! "We need to order another one". She picks up the phone and calls Dr. N.'s office. "Dec. 19th?" "No, I'm not there..." Whoa. She wants this MRI and now! January 13th was the date. "Go over there once you're finished here. Get the prescription and confirm this appointment." Noooo problem!

She did the exam and there were some more ovarian cysts. She could see them. She's not thrilled with the laizzez-faire attitude I had so far. "We might MRI these too." Oh let me face the Ovarian Cyst Question when I'm faced with it.

I jumped in the car and drove the two blocks to the hospital where I gave birth and had my operation.

I walked in and Dr. N. showed up at the desk. "I'm getting the MRI. Look!" I said excitedly. He had a blank look. "False positives..." he mumbled.

Sigh. Dr. N, we talked about this, I told him, exasperated. Tell me, if you see something, can you do an ultrasound right away? Yes. Then I'm good. See you on the 13th.




Yes, I was nervous going out the the Building Where My Cancer was Found but excited to check out the new MRI machine. They had majorly redone the office to accommodate the machine. There were now two waiting rooms. I was sent to the back.



Dr. N. called another patient in. He smiled and said hello quickly but I knew I wouldn't see him for awhile. I went into the back room. Undressed, tech arrived. Right side, all needles. Okay. MRI machines are noisy so I could hear the patient before me. Lots of humming and clicking. I could also hear Dr. N's voice through the walls but I couldn't make out the words. Thin walls. He's not that loud.



When I came in, I realized that not taking Xanax was not a good idea. I kind of panicked and had to be pulled out of the machine. I couldn't breathe and trying to breathe made me move too much. They were able to raise the face form, which helped but not entirely. I was still getting over a nasty chest infection but didn't want to delay this.



Please tell me when you're halfway through. No problem. They forgot. The music also stopped so I was stuck hearing the machine.


I was relieved when they pulled me out again. Glad to have it over. Needle out, clothes back on...


I ran into him again in the hallway. He shook my hand and asked me how I was. Using a line I've told him before "It's YOU who will tell me how I am!" "No, no, how were your holidays? How are you doing?"

I stood there silently, staring at him with my best "I'm not in the mood for small talk" face.

I haven't looked at your results yet, he confesses, smiling. Go do that and then we can talk, I told him as I marched down the hall to the waiting room.


He comes into the waiting room and announces that "all is good" and hands my file over to the secretary. "Great, but is that all? No ultrasound needed? Aren't you going to show it to me??"

He stops. "Okay! come back here with me..." turning and grabbing the file back.



Confession; I wanted to see the cool machine that shows the layers but he just showed me the printed up version. But it was all boring and blank, compared to the MRI I had had just over two years earlier. "See, nothing..."

I can't remember how we got off-subject but it happens every time. His nephew got into Harvard. Oh sweet. He's thinking of medicine. Really? Please don't mention your non-medical daughters again. Please, I thought to myself... Maybe this will make up.

"Look, they visited me this summer! And Dr. G. had him and my brother observe surgery!" He shows smiling Asian dad and son in surgical scrubs, looking very happy, on his cell phone. I noticed it wasn't Apple, so that explains why he was lost with mine.

I was actually growling on the inside. This was the same doctor who explained that my husband couldn't be in the operating room if I had needed a C-section because the minimum number can be in the room... Grrrrrr! But I didn't say anything. I hadn't needed a C-section and it was 16 years ago...



"Oh lucky them!" I said, sort of sincerely. I had a question of my own.


While I was in the waiting room, I had pulled up his brother's project, the brother who got to watch the surgery, and screenshotted two pictures. One was of them playing baseball. The other of his family, the day they left for France. Which ones are you?


The guy hitting the bat. Oh good! He pointed out the barracks behind, where they stayed.

The other, he pointed to himself. There's the older brother. Correct. He's 17 and you're 14. This is your little brother? How old is he?

"We're the same age. We're twins."
"Fraternal, right?'
"No. Identical..."

Seriously, there are two of them??


"Wait! I'll show you..." He scrambled through his photos.
"Here, this is us at Christmas!"

OMG there they were. Same hair. Both had their hands laced (a common gesture Dr. N. does) Same smile. Kind of.
"This is me on the left." He didn't need to tell me that. I knew instinctively which one he was. Something very subtly different in the other one, who is an orthopedist in the Paris region.
I swear I giggled like a school girl. It was just so cute. I guess my unique radiologist isn't so unique after all! Maybe it's kind of scary that there are two of them in the world...