Plastic.

January 12th was a big day. I met my plastic surgeon, Dr. Sinow, who will be doing my reconstruction. My first impression of him was a good one and after sitting in his office for over two hours, I felt completely at ease with both him and my decision.

We spent a short amount of time discussing personal topics such as law school, my relationship status, why I wanted to go through with the surgery, etc. He informed me that a large portion of the surgeries he performs are for mastectomy patients and that given my genetic mutation he would advocate that I make the decision I have made. The rest of the appointment was spent talking about my options for reconstruction and the process itself.

The reconstruction may be done in one of three ways: implants, TRAM flap, or back flap. I do not have any fat or excess tissue in my lower abdomen therefore I am not a candidate for the TRAM flap reconstruction and doctors typically won't perform a back flap reconstruction unless the patient has gone through radiation and it tends to be more of a last resort. So, it was quickly established that I will be undergoing implant reconstruction. He went through great care to explain, very thoroughly, the process of the reconstruction, what I should expect, and any potential risks. I've come to realize that this is going to be an extremely long process but I suppose that what I will endure in the coming months will be nothing compared to what I would have to endure if I were to get sick in the future.

Obviously the first step will be to undergo the mastectomy. I have not yet chosen my surgeon for that surgery, as the first one I saw did not leave me feeling comfortable. My plastic surgeon suggested a different surgeon and I will be meeting her at the beginning of February. Once I have the mastectomy I will heal for two weeks. Some people do opt for immediate reconstruction while in the operating room for their mastectomy, however the risk of tissue death and infection is anywhere from 30-50% and would delay the healing process. Dr. Sinow said that I am a great candidate for immediate reconstruction due to my health and weight, however, I do not want to take on that high of a risk. So, once I heal from the initial surgery, the reconstruction will be begin. My first surgery will be to insert small, saline-filled tissue expanders, under the chest muscle. The expanders will be injected with saline fluid every few weeks for about three months. This is to create a breast mound and create more tissue to work with once the permanent implants are inserted. After the three months pass, I will then undergo surgery to have my permanent implants put in. I have yet to decide between saline, silicone, or silicone gel. Each have their benefits and each have their downsides. I'm leaning toward silicone, but fortunately I have time to research my options and make an informed decision. After I heal, another two weeks or so, I will undergo a final surgery to make any necessary adjustments and to have the finishing touches added to my new ladies.

Most of my concerns have been superficial, that I would not be able to wear bikinis like I do now, or low cut tops, or that my scars would show in a wedding dress, however that won't be the case. Dr. Sinow assured me that I will be able to do all of those things without a problem. Because I am a smaller woman, the incisions and the subsequent scars will be small and limited to the breast itself, not extending across my chest at all. Big positive! Another positive is that by breaking the reconstruction up into several surgeries, the recovery time is much shorter. Dr. Sinow told me that I will be able to run after each surgery by week two, which is very important to me.

I've been trying my damnedest to find the silver lining in this whole process; aside from the obvious health benefits. Many people have asked questions regarding "why" I would do something so radical at such a young age, honestly, I see no other option. Sure, I will never be the same physically, but I am secure enough with myself to know that I am more than a pair of breasts. I feel very confident in my doctor and his ability to give me the best results possible. I've seen photos and aside from prominent scarring, most reconstructions very closely resemble real breasts. I have also been asked several times about dating. It is not a secret that after 4 1/2 years, I am now single. People have asked, what if a man can't understand why you aren't "normal". The way I see it is that, if I am dating someone, not only will I be very upfront about my body when the time is right, but that if a man cannot accept that part of me and embrace it, not only is he not a man, he is also not deserving. I am going forward with this surgery to make sure that I am around for a very long time. I do not want to live in fear and I do not want my loved ones to live in fear. If I did get sick in the future, not only would I not want to go through that, but I would be heartbroken having to put my family through that. What about law school? Well, a majority of the process will occur during my summer break, so long as everything goes as planned. I have an amazing job opportunity with a retired judge who will be helping me by providing me with a job that will be easy on me while I am recovering. A portion of the process will interfere with the Fall 2012 semester, however I am very fortunate to have amazing friends and family who have offered to help me carry books, drive me to school, etc.

So what's next? I am scheduled to have a breast MRI at UCSD medical center this month. This is to make sure that I am healthy prior to surgery. When you undergo a prophylactic mastectomy, so long as the breast is healthy, they are able to leave a little more tissue than they would on a cancerous breast. After that, I will be meeting a new general surgeon for a second opinion. I've heard nothing but wonderful things about her and I hope that she will take my case. Then I will be meeting with my plastic surgeon again to make final decisions regarding the reconstruction process. Once that is done, the surgeons will coordinate their schedules and we will set a date!

Thank you again for all of the loving messages, phone calls, and support. I would not be able to do this without all of you. This has been an extremely taxing decision to make but with each day that passes, I realize that this will only bring positive results. Sure, it's going to hurt, but I can handle that. What I cannot handle is living with cancer on my mind. I want to deal with this on my own terms, not breast cancer's terms.