I think I need to fire my plastic surgeon...

Plastic surgery is a tricky beast—because along with it comes expectations. And with expectation often comes disappointment. Sitting here this afternoon, two days after my most recent surgery (the 4th this year), I find myself once again adjusting to the way my body, specifically my breast, looks. The let down is all about expectation.

There wasn't a lot of room for doubt back in October. My plastic surgeon came highly recommended, she had excellent credentials, and heck, she was featured in Oprah Magazine's "Top 40 Under 40." However, as I step further away from that initial place of terror, I’m not sure my plastic surgeon really has time for someone like me. In this flippant factory of making women’s bodies perfect, where do I fit in? Someone who never would have considered plastic surgery (or surgery period) if the universe hadn’t demanded I sacrifice a breast. I don’t take the decision to undergo more surgery lightly. I’d prefer to keep my future free of the “tweaks” and “touch ups” that my PS seems to consider the norm.

I suppose this is one benefit to opting out of reconstruction. Once your breast is gone, you’re done. I still earnestly consider each procedure I ask my body to undergo, and Dr. Chang and I don’t seem to view these decisions with the same gravity. Her time with me is so quick that I barely get to process the information she bestows. And her haste flusters me in a way that makes my mind go blank—my questions lost in the panic of having her walk back out the door. I was never meant to be in a plastic surgeon’s office. There has to have been some sort of karmic mix up.

It was Dr. Chang herself who really started all this nonsense about expectations. I hated the areola she tattooed back in January, and I immediately became much more self conscious about my breasts. (The areola looked like something a 6 year old might draw with a skin-colored crayon.) Dr. Chang promised me that once I was finished with chemotherapy we could fix it. So I went to see her this summer with the expectation that we would just need to fix up the tattoing. Instead, she looked at my breast and pointed out how much it ripples (she suggested maybe it’s because I’ve lost weight) and declared that I need surgery to tighten the skin. She explained that this would simultaneously make my areola a bit smaller and more even. And if I wanted to go ahead and switch to a silicone implant we could easily do that too. Boom. Less than 5 minutes and she was back out the door.

As I called my mom on the way home I realized not only was I facing yet another surgery but I had tons of unanswered questions, a great deal of which revolved around having a silicone implant. No one chooses saline for the aesthetics, so the idea was tempting, especially since I'd be undergoing surgery anyway. I’ve never been fond of the water balloon feel. When I got home, I e-mailed the patient coordinator my long list of questions for Dr. Chang and of course missed both of her follow up phone calls in the forthcoming days. (We leave for Ecuador.) I return home, and immediately continue researching silicone breast implants and figure I can have Dr. Chang go over the information with me during my pre-op appointment (scheduled for 5 days prior to surgery). [On a side note, I learn that while most women prefer silicone implants for obvious reasons, their safety for women, and in particular breast cancer patients, is still under researched and not entirely known.]

When I see Dr. Chang for the second time it becomes apparent that switching to a silicone implant is actually a much more significant surgery with a longer recovery time, DRAINS, and then additional surgery to remake the nipple she just did in January. I’m not prepared for drains or any sort of significant recovery less than 2 weeks before school starts, so all of my questions about silicone become moot. (She’s not convinced it’s what I really want at this point anyway, and wisely suggests I hold off.) So it’s decided I’m going to stick with my current saline implant, but I’m definitely excited about the possibility of removing the ripples and having it look a little better. She pinches my skin to show me what it will look like. I, of course, have done the same thing in the mirror at least a dozen times watching the ripples disappear as the skin tightens. I like it.

But then as a couple more days pass, I start to think about the logistics of this operation. It doesn’t seem possible to tighten the skin that much and preserve the nipple. I’m not interested in an additional surgery following this one. So there I am on Tuesday sitting on the operating table, still not clear on exactly what we are doing. I ask Dr. Chang about preserving the nipple and she basically tells me what I’ve already figured out. In order to significantly tighten the skin, I’d lose the nipple and most the areola, which means later redoing the same surgery I had back in January. What bothers me more she asks, the areola or the ripples? I need to decide. So we are back to the simplest option, making two elipse-like incisions on either side of the nipple in order to fix the areola (really all I wanted to begin with), but this comes with the caveat that we won’t really be effecting the rippling much. I thought that was the whole point of surgery!!!

Somehow, I’m pretty sure that all this confusion and false expectation could have been circumvented with a bit more time and communication back at the beginning of July. Don’t worry, Dr. Chang assures me, this will probably satisfy me for now and at some point I can decide to “do it all.” Switch to silicone, tighten the skin, and redo the nipple/areola for the “perfect” breast. But for the moment, I feel disappointed as I see the same ripples across my salt water breast. Which is silly, because when I went in in July, all I wanted her to fix was the areola. And even with the stitches, I’m pretty sure the areola looks significantly better. It’s all about expectations.