April 25, 2025

Thursday I actually returned to work at the office. First time in forever. It was good to resume some normalcy and see my coworkers. I'd be lying if I said I don't like working from home tho. While I do enjoy the social side of working in the office, from a production standpoint I get more done at home. 

Friday I go back to VCU to meet with their plastic surgeon. I'm of the opinion - get all the information while I can. "Collecting Data" I have absolutely no idea what chemo will do to me personally. I know what the laundry list of side effects can be... I just don't know what my own body will do, so no telling what I will be able to comprehend down the road. 

With a 3 hour drive, I left early enough to take into account any potential traffic. I arrived about 45 minutes before my scheduled appointment. Once again, all the staff was very kind. I get to where I need to be and get checked in. Copays, man... woooo..

I get seated in the waiting area, expecting to have plenty of time to play on my phone. (take one guess what I was playing!!) About 5 minutes later they were calling me back. Guess my early arrival got their day off on a good start. 

I'm taken into the exam room, go over the routine questions, get vitals taken, the usual. Brie was very nice and we chatted like we'd been friends for a while. 

The doctor comes in. After introductions, we get down to business. She's a little softspoken but super knowledgeable and blunt. Exactly what I like. Don't sugar coat crap with me. Tell me straight up. 

She explains that the team went over my case the day before, just like I was told at my last visit. I love this! She goes on to explain the basic process of the mastectomy. Again, I'm glad the doctors don't assume people know everything about this process. From there, she explains the way implants used to be added. Good grief! I'm glad they don't do that anymore and I feel bad for any women that went thru that! I'm not going to go into those details.. 

My options for reconstruction: 

No reconstruction - removal of the breast tissue and sew it shut. No more boobs.

Implant stage 1 - adding a tissue expander at the time of mastectomy. This is an elastic bag placed where the breast tissue was previously. It has a tube and valve. The bag is filled with saline over the course of several weeks. This is to allow the skin to gradually stretch to the desired size to allow room for the implant.

Implant stage 2 - removal of the expander and addition of the implant

There's another option for reconstruction.... DIEP Flap (Deep Inferior Epigastric Perforator)

Short version, tummy tuck and boob job all in one. Apparently there's special certifications required to perform this option and, you guessed it, she has those. 

The process basically is this - go into the tummy and remove tissue. Add it to the breast area. Reconnect the blood supply. The perks to this - no foreign material inserted. It's my own self so there's nothing for my body to reject. 

In either of these cases, for me, there will not be a nipple saving option. There are options for tattooing a nipple on so it looks real, so I am told.

Now, there are many other things to consider regarding reconstruction surgery. Implant option requires the expander before the implant. This is a more drawn out process. Also with implants, there's the potential for the lining to break down, which means there would be a need to replace them over time. 

Flap procedure takes a lot longer since they have to reattach blood vessels. The hospital stay is usually longer too. There wouldn't be a need to have more surgery on this down the road either. Recovery time is typically longer with this process too. There would be additional drain tubes added, just like during the mastectomy, but this time they would be in the abdomen too. 

Either option is a viable and good one. For me, at this stage of the game, the flap option is where I'm leaning. I'm not keen on the idea of foreign materials in my body. The rods and pins in my back cause me enough issues. 

We'll see. There's still more researching Kira needs to do. We have time.