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.
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.
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