Twins or Sisters?

Wednesday I had my first date with the plastic surgeon, Dr. Atiyah. Being in his office felt bizarre-- there were pamphlets all over the place for Botox and breast augmentation. Never in a million years would I have imagined myself sitting in the office of a plastic surgeon. But, here I was. Remember- nothing is impossible.

He called me into his office quite quickly, and there Mike and I were met by the surgeon and a female colleague of his. Dr. Atiyah was much younger than I imagined-- but nonetheless, he seemed very professional, knowledgable, and down to earth. I immediately felt comfortable with him. He immediately expressed his shock at my age and my diagnosis of breast cancer. He said the youngest person he has ever seen with the disease was 28. He kept repeating: "You are not supposed to have breast cancer. What a shame." After measuring and weighing me, asking me some general questions about my health, and examing my chest area, he went into some details about the procedure of breast reconstruction and what he thought was best for me.

First of all, he discussed my "good" breast and expressed his concerns with it. He said that because I am so young and therefore not at all fitting of the norm for breast cancer, he believes it would not be unreasonable to remove the second breast as well. This would not only give me peace of mind, but would lessen my chances of a new cancer forming in the right breast. He said that this is something I would need to discuss with my oncologist, but he thinks that it would likely be recommended down the road. Not only would this give me both psychological and health benefits, but it would likely be more favorable aesthetically. He said that with one real and one fake breast, my breasts would no longer be twins, but more like sisters. This is because it is nearly impossible to match a fake breast exactly to a real breast. However, if he were to reconstruct 2 new breasts for me, it would be much easier to make them look identical. The drawback would be that I would never again have natural breasts (there seems to be something consoling about having your own "stuff" on your body).

He then went into the procedure, which turns out to be much more complicated than I suspected. Normally, in order to reconstruct the breast, a surgeon would first consider removing fat/ tissue from the stomach or back and constructing breasts using that tissue. Because I am a thin girl and have virtually no excess fat in either of those locations, the only possible avenue for me is an implant, in my case a silicone implant.

Post-mastectomy, recieving silicone implants becomes much more complicated. This is because the skin where the breast once was is now tightly sewn over, resembling a normal chest wall. Because of this, the skin must be stretched in order to make room for the implant. The first step, then, involves a small incision under the arm, through which something like a bag or an empty implant called a "tissue expander" is placed under the pectoral (chest) muscle. A tube and valve are connected to this implant through which the implant is pumped with a small amount of saline. It is then left for a few weeks while the skin has time to slowly stretch in small amounts. Then, more saline is pumped into the tube. It is again left for a few more weeks for the skin to stretch some more. This is repeated over and over again until the skin is stretched little by little and a desirable breast size is reached. This process can take up to a 3-4 months to complete.

If I were to have the right breast removed, I would obviously first need another mastectomy and would then need to leave time for the incision to heal. Then, the reconstruction would take place. In some places it is possible to have a mastectomy and immediate reconstruction all in one sitting, but the resources for this type of procedure are not availble in the area in which I live.
If I were to leave the right breast in tact, the doctor has informed me that in order to best match the two breasts, he would still need to give me a silicone implant in the right breast as well. This way, the fuller, rounder shape breasts resulting from the silicone in the reconstructed breast would be matched in the natural breast (although the result would still not be as accurate as having both breasts reconstructed).

As for the nipples. The nipples are contructed from tissue and the areola is then tattooed on, resulting in a quite natural looking breast. Before this can be done, 1-2 months of healing is required. The healing process and the nipple construction procedure then adds yet another 2-3 months to the entire ordeal. The result ... anywhere from 5-8 months of off and on procedures, some discomfort from the stretching skin AND 2 lovely breasts :-)

I will likely begin the process of breast reconstruction in the spring/summer, but until then
I am left with yet another important and potentially life-altering decison ... sisters or twins? Now, THIS could be a tough one.