So Many Choices

  I remember sitting in the genetic counselor’s office at Huntsman Cancer Institute, back in 2005, and waiting for the surgeon, Dr. Saundra Buys, to arrive.  The counselor and surgeon were going to explain my surgical options and help me decide on the best option.  I’m pretty sure I was overwhelmed with the topic at the time, as most of it is a blur.  However, what I do remember most clearly was the surgeon telling me I could essentially have what I call a “free” tummy tuck if I chose one certain procedure called the DIEP.  At the time, I was carrying a lot of post baby weight and thought it would be a great option for me!  Flat tummy, new boobs and cancer free!  Could it get any better?  I was 28...I wanted to live without fear.  I didn’t care how I got there, I just wanted it done.  But then I remember the conversation turning to nipple sparing options, implants or tissue, and I think I started to become glazed over with too much information, and too many details.  Too many decisions meant it became too complicated for me, which means they lost me at the word nipple.  I loved Dr. Buys, still do.  She is so warm and caring and she really wanted me to take my time and think about the whole package.  Well, after all that, surgery never happened that year as I became pregnant and knew that with growing my family, there was never going to be a “right time” for me anytime soon.

  Fast forward to January 2014.  I, once again, began the process of researching surgical options as I was going to head home for the summer from the UAE and have surgery.  I scoured the Internet for advice, I contacted Huntsman again, I asked questions, and most importantly, I came across a wonderful group of Pink Lovelies, a closed Facebook group called Beyond the Pink Moon, who have become my sounding board and educated me beyond belief.  I was dead set on a nipple sparing, immediate reconstruction with direct to implant as an option (which Huntsman didn't do).  There was no convincing me another way.  It seemed the easiest and best option for me given my time constraints of overseas travel.  I even went as far as contacting a recommended surgeon’s office in a State other than my own, Dr.Chrysopoulo, to discuss timing and options.  Well, that never happened either.  Again, it wasn’t the “right time” as we were being relocated from the UAE to Singapore that summer.  With too much on my plate and not enough time, I gave up my decision to have surgery that summer.

  Now, 2015, I have once again, started the process.  THIS TIME WILL BE IT!  After having my first “abnormal” mammogram in November of 2014, I made it my mission to never be afraid again.  In the back of my mind, something was calling me to stick with Dr. Chrysopoulo’s office as I just had a good gut feeling about them.  They were friendly and quick to respond to every thing.  However, I needed to do my due diligence, so I started talking to my Pink Lovelies on Beyond the Pink Moon as well as to a doctor here in Singapore, Dr. Steven Tucker.  I gathered referrals to everyone’s favorite surgical teams in the USA and started contacting offices.  I had no idea that living overseas and planning a surgery like this would be so hard…lodging, child care, flights, timing, schedules…there’s never an easy or “right time.”  Most surprising, was in this day in age of technological advances and screen time, there are a lot of doctors who will not budge from the good old face-to-face consultation.

Several of my recommendations steered me towards the Los Angeles area.  As I started contacting the offices, I was being asked to fill out forms detailing my entire life, or so it seemed, without even addressing whether or not they would “see me” virtually and if they took insurance.  Once my paperwork and case had been deemed suitable for the practice, it was the next step which they would not budge…in-office consultations only.  NO ONE I was referred to would see me virtually.  No photo submissions, no Skype, no nothing other than in person.  No one, except for Dr. C clear over in Texas.  I believe there’s a reason things happen.  Dr. C was originally the doctor I was going to use in 2014, and now all of my research and referrals had led me back to him.  It was meant to be.

By FDA [Public domain], via Wikimedia Commons

So, I began a more thorough paperwork process with Dr. C’s office in January, which eventually led me to a Skype interview of sorts with Dr. C in February.  I went into the interview knowing that the DIEP procedure was something Dr. C wanted to talk to me about, but I also knew I had a terrible fear of hospitals, pain, incisions, pain, recovery, pain.  I just knew it wasn’t the procedure for me.  I wanted the direct to implant with AlloDerm…I didn’t have time for expanders either.  My frame of mind is beating the ticking time bomb…not how I’ll look after, not about perfection, not about the size of breasts I’ll have when it’s all over.  I just want them gone.  Again, you think back to the “tummy tuck” with a DIEP, and as great as that would be as an added “benefit” (as some say) to a horrible surgery, I just couldn’t do it.  I had also come in contact with several of Dr. C’s patients, now my virtual friends, all of whom were very open with me about their procedures, recovery times and overall satisfaction, which helped me decide what’s best for me.

  I knew, without a doubt, within the first 10 minutes of our Skype conversation, that Dr. C was the one.  I kept turning to my husband with a big smile on my face, as I felt comfortable.  Someone was listening to me and answering all my questions while calming my fears.  Questions, oh the questions!  I love to research; I research too much perhaps, and I begin to freak myself out.  Dr. C. was very upfront about his reasons for performing or not performing various surgical options on me, he told us his statistics with both types of surgeries (DIEP and direct to implant with AlloDerm), the type of implants he uses and why, we discussed possible complications and outcomes that I may or may not be happy with, where scars would be, the dreaded drains, hospital time, recovery times, follow up possibilities, etc.  You name it, we discussed it.  But even after all that, I was still set on my decision, and we agreed on the direct to implant option.

  However, I was discussing a surgery that I knew wouldn’t happen until June…it was only February.  So, naturally, I counted the months in between and all the “what ifs” came flooding in my mind as Dr. C was talking.  And then it came out…”Dr. C, what if I get cancer between now and then.”   I don’t think anyone thought I was going to ask that question…my husband nor Dr. C, but it’s a very real one I live with every day.  I’m beating a clock…or at least I’m trying.  Rather than brushing it off and saying it won’t happen, Dr. C acknowledged my fear, discussed what some possible next steps could be at that moment and I felt better having asked it.  Through all of this, I’ve learned one thing…there are NO dumb questions when you’re trying to save your life. 

  That day, I knew I finally had a doctor and that the surgery would be happening.  It was official.  My paperwork was drawn up and sent off to insurance, hoping for an approval.  I cannot express how amazing the staff is at PRMA.  I have been trying to plan everything from overseas which leads to so many questions, and they've been there, by my side, no matter how many questions I have.  While I feel like I'm bugging them, I truly feel like they are happy to help and understand my anxieties.  No question has been too small.