Breast Reconstruction Consult DIEP flap Surgery: The Power of Two
You may bring someone with you to your breast reconstruction consult for your DIEP flap surgery but it is the power of two, you and your plastic surgeon, who are the two key players at this all important appointment. This topic is worthy of a two part blog. Part 1 will touch on the potential emotional and psychological aspects of the visit and part 2 will discuss the actually physical and technical part of the visit. I have learned a lot reflecting on the experience of my first visit with my plastic surgeon. I have gained yet a different perspective from speaking with other women about their experience and what this involved for them. What I do know is this; the appointment needs to be a home run for both you and your plastic surgeon. You need and want to know everything you can about this very long and intricate surgery. Your plastic surgeon has to size you up both physically and psychologically in the appointment and know you are, in fact, ready. It is indeed, the power of two.
Part 1 ~ The Emotional and Psychological Aspects of your Breast Reconstruction Consult
The Patient:
Imagine you are walking into the office of a complete stranger, your reconstructive plastic surgeon. You may still have your breasts going into this consult or you may not. Let’s say you still have your breasts. You are BRCA positive and you have decided to remove your breasts to greatly decrease your chances of getting cancer by having what is known as a prophylactic bilateral mastectomy with DIEP flap. Perhaps you have cancer and still have your breasts because you are considering a mastectomy with immediate reconstruction. Either way, you are about to ask a complete stranger you are meeting for the first time to remove body parts, body parts defining your very femininity; body parts that may have played a key part in sexual intimacy between you and your partner or nourished your children.
A young woman who would still like to nurse but knows the possibility will forever be altered by a mastectomy and reconstruction discusses this with her plastic surgeon. There are certainly devices to use now to simulate nursing but it’s not the same as the nerve sensation, the let down of the milk, and knowing the nourishment from your own body is feeding your child. These are all trade-offs you have considered and will be talking to your plastic reconstructive surgeon about.
You are about to bare your breasts to this stranger in hopes they can rebuild some semblance of what you once had. Will they be able to reconstruct your breasts to the same size? What about loss of sensation? Will their attempt to reconnect nerves help with a bit of what Mother Nature gave you, the ability to sense a touch? Will it be in your best medical interest to save your nipples or will they have to be removed and eventually rebuilt or tattooed back on? How are you going to look in clothing or a swimsuit when you have healed? Scars, where will they be and will they be visible?
Let’s say you no longer have your breasts and you are discussing a delayed DIEP flap. Now I can write about this from a personal standpoint, and I am going to get personal. Perhaps I find this important to reveal now or perhaps it took me this long to write about it and make known my own feelings about my initial consult and what I went through psychologically and emotionally. Either way, I hope to make a connection with the reader about what the day was like for me and what they might expect.
The morning of my initial consult, the morning I knew I was going to meet my plastic reconstructive surgeon for the first time; I spent quite a bit of time primping before the appointment. I generally like to feel feminine and take extra time to spruce up for date night with my hubby but I did it for different reasons on my consult day. I even bought a new outfit to wear to the appointment because psychologically I needed to. Make up, jewelry and even a new pair of fancy underwear. Stem to stern I wanted to feel as feminine as possible because once the medical gown came off I was going to be standing there as an amputee in front of a complete stranger. But why did I go to these lengths?
There were circumstances surrounding my case but I woke up from surgery without breasts and lived with this for seven months. My once strong self-confidence and sense of feeling pretty was diminished in those seven months after my double mastectomy. Not being able to find clothing making me feel feminine and sexy was chipping away at my sense of womanliness and it was palpable to me each time I was asked to go to a social event with friends. I was self-conscious in my prosthesis. I wasn’t a good trooper or a good sport in trying to adjust to my “boobs in a box” as I referred to them.
I wanted my plastic surgeon to see me as the woman I once was and wanted to be again. I wanted him to know why I came to his office that day. I wanted my missing body parts back and it was important I could forget cancer and move on with my life by having this DIEP flap breast reconstruction. When I had to disrobe in front of him for the first time, my armpits were sweaty and my heart was racing a bit faster than normal. The only other people who had seen this “mess” was my husband and anyone who had been present in the operating room the day my breasts were removed during my mastectomy. I don’t care how pretty and feminine the panties I bought were, I didn’t feel pretty and feminine standing there with my bare chest with hideous folds of skin left from my bilateral nipple sparring mastectomy. But, I was there to discuss how he was going to change this. I wanted him to sense my style, my sense of femininity and what I so desperately wanted back.
You stand there before your plastic surgeon with this heavy emotional and psychological baggage you brought to this appointment. You disrobe and bare yourself, with or without breasts, in hopes their artistry, skill and compassion will understand and change this. Heavy stuff indeed!
The Plastic Surgeon
Woman or man, you have had years of training, far more years than a plastic surgeon, to be able to perform microsurgery and DIEP flap breast reconstruction. You decided early on to dedicate your practice to reconstructing what cancer took away. You’ve developed a clinical side to your personality through your years of skill and records of successful breast reconstructions to be able to churn out one answer after another to patients who walk into your office to comfort them with the plethora of questions thrown at you during their initial appointment.
You work with your nurse during the visit to carefully measure, assess, and visualize what will be after surgery. You gather health history to make sure patient safety is optimized both during surgery and after for optimal healing. You listen. You discuss risks of the surgery; wound healing, fat necrosis, follow-up appointments, drain management, length of hospital stay, care of incisions, insurance questions and what the next phase of surgery might look like and when it will take place. The list goes on.
You might be thinking in your head, “I have to be at the top of my game when I turn the door knob to meet this patient for the first time. What will our chemistry be like? Will I make an easy connection to this patient or will they walk away still questioning their decision to even see me?”
You’ve rehearsed, studied and have in your professional cache a plethora of greetings, reactions, body language and skill to make this appointment one of compassion, charisma, connections and humble self-confidence to put this patient at ease about cutting them from hip bone to hip bone to remove tissue, fat and blood vessels to create for them a new breast mound that will feel as close to the breasts they had before. There are those tough cases keeping you up at night. There are those cases leading you to further research of your own either with your professional cohorts or evidence based studies so you can do the best you can for this patient.
You have to have the eye of an artist; be able to visualize shape, symmetry, softness, size while hoping there is a road map of blood vessels lying underneath the outside, human body standing before you. You assess the blood vessels by asking about prior surgery, or perhaps place a small Doppler over the tummy of your patient in office to verify they are present and viable. But you know once you begin to disconnect and reconnect those blood vessels to a new source in this patient’s body there might be challenges as you spend upwards of ten hours in the operating room rebuilding her breasts.
Now let’s humanize this experience. Suppose you are a Mommy or Daddy, a wife or a husband besides being a micro-surgeon. You have a sick child at home or are experiencing a family crisis the morning you meet a new patient. Perhaps it was something a bit more benign like being late, through no fault of your own, because of traffic, or a patient requiring extra time. Perhaps you are hungry because you skipped lunch to make this appointment with your new patient. Maybe you are battling an insurance claim for another patient. What if there are staff issues at your office? You are, after all, human.
Now you are getting ready to turn the knob of the door to meet a patient you have never seen before. You both need to connect in the brief time you are in the exam room because not only are you about to rearrange their body but they are about to decide if they are going to put complete trust in your ability to do so. You know you have to leave all those personal hiccups on the other side of the door and treat your patient as if they are the only ones that matter to you during their initial visit.
The Power of Two
I wanted to give you a glimpse of the unbelievable human emotion taking place for both patient and plastic surgeon during this visit. This is only a small part of the psychological aspect of the initial visit with your reconstructive micro-surgeon who will be performing your DIEP flap surgery. In order for it to be successful it requires a high level of emotional intelligence from both players. Does it always happen? Reality tells me, no, but it’s not surprising given what takes place in this short but intense first meeting. From my own personal experience with my plastic surgeon, I am happy to say it was a good day for both of us. When we left his office after my initial consult. My husband looked at me as we walked through the parking lot and said, “That guy is golden!” I knew I hit a home run. Even though my husband was there watching and observing intently he let me do most of the interaction with my plastic surgeon. He knew and respected: