Cancer log 164: I went…

Cancer log 164: I went back for a follow-up consultation with the plastic surgeon today, taking along a doctor friend who kindly offered to come and help me remember all my questions. If you have such available to you, I highly recommend it; extremely helpful and reassuring. And if you don't have a doctor friend, just having someone else to help you remember questions is good. In some ways, I found it emotionally harder to talk about my bodily aesthetics than to talk about my cancer, oddly enough. Our culture is so weird.

To remind you, my left breast is missing the lower inside quadrant, and there's a big puckered scar. It looks fine in clothes; I kind of hate the way it looks when I'm naked, and when I catch a glimpse of it in the mirror, it's like a huge aching reminder of cancer. The reconstruction procedure this plastic surgeon offers is called fat grafting, where you go under anesthesia, they insert needles and suction out some fat, usually from the lower belly (there's some research indicating that those particular fat cells 'take' better than those from other regions, interestingly), and then essentially squirt that into the breast.

You wear a spanx-type garment for a few weeks in the abdominable area, and a light bra; you're restricted from lifting for about a week. And then you repeat the procedure three months later, and then again, three months after that, and possibly one more time, depending on how well it's going. The body tends to absorb some of the fat that's been moved, so it's hard for the surgeon to predict how many procedures it'll take to get to a result you're happy with. And he can't inject it all at once, because it would make a big ball of fat and the inside of the ball wouldn't get blood flow and would just die -- what you're trying to do is add layers of fat that can connect to what's already there and get good blood flow (vascularize), so it works best as a step-by-step procedure.

Like many women, I have more lower belly fat than I would like. I was a little heavier than doctors considered ideal for most of my adult life, and then I had two babies, so there's a noticeable pooch below my belly button. I will be completely honest and say that when I heard that this procedure, covered by insurance, would remove some of my belly fat to fix my breast, my immediate response was woohoo! But on further research, they don't actually take that much out -- quite possibly not enough to make a noticeable difference in belly appearance, depending on how things go. They can't just take out extra, because that would make it a purely cosmetic procedure, not covered by insurance.

Although I support the fat acceptance movement, and think that it is unconscionable that fat people are discriminated against socially, legally, etc., I must also admit that I have been much happier since losing some weight, and would prefer to be thinner still (aiming to be 'normal' weight, not 'underweight'). Is this whole discussion incredibly fraught and those terms both loaded and medically vague? Yes. Am I brainwashed by the patriarchy? Obviously, also yes. But I have been battling the patriarchy on many fronts my entire life, and I think it's okay to say that I'm tired of fighting that particular fight. I could wish I were more relaxed about my body and more enlightened generally, especially considering that I am raising a daughter and some day she may come to me weeping about some body part she hates and wants to surgically alter. But right now, I am feeling incredibly tired and discouraged about what has been done to my body over this past year, and I would like to take some steps to hopefully make myself happier with the body I inhabit, the body I must wash and dress and face on a daily basis.

So I started wondering whether I actually would want abdominoplasty, what's colloquially known as a 'tummy tuck.' It would be a much more intrusive procedure, similar to my two c-sections, in that it would require a hip-to-hip incision, removal of a large amount of fat and some extra skin, and then sewing the flesh together. Every surgery carries some risk, but my body has so far handled surgeries pretty well -- I recovered fast from the c-sections and the elective breast reduction I had several years ago. I don't think I would have considered a tummy tuck if I hadn't been already considering this reconstruction procedure -- it would have felt 'too extreme.' But if I were going under the knife anyway....? I wanted to ask the plastic surgeon about it, at least, and find out what would be involved. After today's discussion, the upshot is that it doesn't make any sense to try to combine the procedures, and that he would do the fat grafting first, over the course of a year, and that if I wanted to explore a tummy tuck at the end of that time, we could talk about it then. I also told him that I was dieting, and hoping to lose about 10-15 pounds, and he said that it was generally better to lose weight first before going through any of these surgeries, because, of course, if we did the fat-grafting procedure, got my breast to looking similar to what it once was, and I then lost a bunch of weight, some of that might come off the breast. And if I lost some weight, that might change my appearance enough that I wouldn't have any desire for a tummy tuck at that point.

So the short version of all of this is that I'm reasonably resolved to do the following: a) work with diet and exercise to try to lose 10-15 pounds between now and July, probably b) start the fat grafting procedure sometime after July, and probably c) continue that through the next year. I'm guessing that at that point, I'll probably be done with procedures for a long, long time, but I'm reserving the right to change my mind.

Big thanks to Jen Larsen for her book, Stranger Here: How Weight-Loss Surgery Transformed My Body and Messed With My Head. I read it a few years ago, when I wasn't thinking about surgery for myself at all, and found it compelling, informative, brutally honest, and poignant. Also thanks to the breastcancer.org discussion boards, specifically the fat-grafting threads, which were extremely informative.

I hope some reading this find it similarly helpful.

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