Yes, that is correct. I’m inviting you along to my breast reconstruction consult. Why? Because I want you to learn what I learned. This was not an easy day leading up to my DIEP flap plastic surgery consult in early October of 2014. I prepared months in advance. It was important for me to find a microsurgeon who was going to know what my expectations were from pre-surgical planning, understanding the surgery, aesthetic outcomes, and how I would be after having this intricate surgery to replace my breasts lost to breast cancer.
The Morning of my Breast Reconstruction Consult
I traveled for my breast reconstruction, so my husband and I stayed in a hotel. We were both fairly quiet the morning of my consult. He watched me prepare physically for the consult; hair, make up, nice outfit. I suppose it was my way of putting forth the message to my plastic surgeon, “I’m here, ready, and on top of things”, even though inside I was a bundle of nerves. We both knew this was a decisive day for us moving forward with possibly more surgery, more travel, asking family and friends to help out, and emotional healing. We went through this five months previously for my double mastectomy.
Picture me putting on my breast prosthesis knowing this would be the first time another man besides my husband saw my flat chest when I had to disrobe at the surgeon’s office. I was uncomfortable as hell about that and likely why my stomach was in turmoil. The ride was quiet to his office. I signed in and we both sat in silence as we looked through materials the office staff gave us while waiting to be called back.
Enter the Exam Room
We saw the nurse first. She was kind, patient, took down some information and handed me my robe. My palms and armpits began to sweat. My once clean body was melting in nerves. The nurse stepped out and I changed from the waist up and climbed up on the exam table. My clumsy breast prosthesis lay on the chair at the side with my shirt I chose just for this occasion.
In just a few moments, in walked Dr. Chrysopoulo. He greeted us with his British, “hallo” and then turned to my husband and said, “Nice glasses”. His first comment to me was, “Don’t sit there. Come sit over in this chair.” My husband looked at him and asked as only an engineer can, “Then why do you have the exam table?” Dr. C complacently said, “We’re a doctor’s office. I have to have one.”
Thus, begins my Experience with Shared Decision Making in Breast Reconstruction
He pulled his chair in front of me. Although my husband was next to me, I suddenly felt like Dr. C and I were the only ones in the room. He looked at me and said, “You’ve been through a lot, haven’t you?”
Why is this question, this moment, important in a shared decision-making consult? Because their business model includes finding out about the patient before she enters the exam room. Their patient liaison spent several phone calls with me listening to my fears, tears, and excitement when I finally got my appointment. The nurses knew what ups and downs I had been through because they called ahead of my consult. They knew what it took getting to this point and having the courage to sit in front of Dr. C to find out about this surgery. I was no longer just a patient. Now I became a partner in my decision to have breast reconstruction.
The Opening of the Gown at my Breast Reconstruction Consult
He asked me politely and calmly when it was time to take a look at the canvas he would be working on. He said, “May I have a look?” Gently easing me into the moment I dreaded. He began by going to work with measurements, calling out numbers to his nurse as she recorded them on the computer. This was a total distraction for me because it became technical then. I was fascinated with this process.
We discussed desired breast size, what my expectations were and what he thought he could realistically accomplish. It seemed very attainable to me. My husband and I began asking him about the details of the surgery, or I guess I was doing most of the asking. The entire time this felt like a conversation, a collaborative plan, and what was going to be best for my future health and surgical outcomes. I wasn’t interrupted with grandiose results Dr. C had accomplished over the years. This was 100% focused on me! My fears and nerves were calmed fairly quickly into this consult.
When Everyone Feels they are Listened to at the Consult
He turned to my husband who had been quiet most of the consult mentally taking notes, observing, and ready to face Dr. C’s final question. My surgeon looked at my husband and asked, “Do you have any questions.” Mr. quiet man engineer sat up in his chair, leaned forward, looked Dr. C in the eye and said, “They pay me to ask questions at my work.”
Yikes!!! Here we go, I thought. The meeting of the brilliant minds, surgeon and engineer! I got a few butterflies again. He asked Dr. C a tough question. “What if you get in there and you can’t find a good perforator for a blood source to transfer with the flap?”
Dr. C looked at him and said, “I’ll do what I can do until I find one, and we pray to God that happens”. He added he had been in the OR for twelve hours for one woman and finally found one, and as memory serves me, it was in her arm. Don’t quote me on that but the point is, he was a committed, successful, honest, surgeon. That is the only answer my husband needed. When we left the facility that day, my husband said the famous line that sealed the deal for us. He held my hand as we walked to the car with smiles on our faces and he said, “That guy is golden!”
Why I Advocate for Shared Decision Making in Breast Reconstruction
I know for certain not everyone has the same experience I did in this shared decision-making consult. But what can you take away from this as you make plans for your own breast reconstruction? If most or all of these points didn’t happen, perhaps it’s time for a second or third opinion.
- Feel like you are being listened to as a person.
- Go to your consult prepared and ask all the questions you have written down. Have they been answered to your satisfaction?
- Bring someone with you who also feels a part of the shared decision-making consult.
- Be sure risks, complications, aesthetic outcomes, and how you will be supported after surgery if you travel are all addressed.
- Leave the consult as if you are a partner in the decision and not someone who leaves there feeling like they are being told what to do.
- When you leave the consult, feel as if you have just established a relationship of trust with your plastic surgeon.
I will continue to educate women and men about what it means to have a shared decision-making consult for breast reconstruction. Your voice deserves to be heard! What was the best part of your shared-decision making consult? I’d love to hear from you.
This is a wonderful post, so honest and so helpful. You were so very lucky to have found Dr. C. I often wish I had found a plastic surgeon who was able to do this procedure when I was going through my reconstruction. I had the expanders and although I’m fine w/the result, I think I would have been much more comfortable with the Diep Flap which would have used my own tissue vs an implant. I recommend your site to many women who ask me about options, Terri. You’re such a valuable and committed resource, Terri, thank you for your advocacy. xo
Hi Claudia. Thank you so much so much for the kind words. I truly appreciate your referrals. It certainly means a lot to me coming from another survivor. Kindly ~ Terri
Such a great honest and valuable narrative of a scary time. I’m glad you journaled then. I followed your path only a month later and met you post DIEP. Wish it had been sooner but things happen in God’s time and still call you my DIEPC sister. Your story with your husband finding compassion in your Dr and consult brought me to tears. It matters that we connect really connect in medicine. I remember those scary days reading your journey still helps even 4 plus years later. So glad to have those scary days behind me still.
Caroline, DIEPC Sisters always! I love that. Thanks so much for your heartfelt comment. I value you being on the Journey! Onward and upward. ~ Terri