After having bilateral mastectomies, pressure to reconstruct comes from unexpected sources; but I wasn't expecting it to come from my doctor.
Bonnie Annis is a breast cancer survivor, diagnosed in 2014 with stage 2b invasive ductal carcinoma with metastasis to the lymph nodes. She is an avid photographer, freelance writer/blogger, wife, mother and grandmother.
When you're diagnosed with breast cancer, it's customary to see your oncologist, radiation oncologist and breast surgeon at periodic intervals throughout the first five years after diagnosis. The visits usually start out being every three months, then stretch to every six months, and, if you're doing well, turn into annual visits. Today was my annual visit to the breast surgeon. Although I haven't reached the five-year mark since my diagnosis, she'd moved placed me on annual visits because I was doing so well.
I waited for almost an hour to see the doctor. She's an excellent doctor and is very busy. I don't mind waiting for her, because I know she gives me her undivided time and attention. When she came into the exam room, she greeted me like she always does and said, "What's up?" I shared my concerns and then she began the exam. She found a place on my chest wall that caught her attention. As she began palpating it, I winced in pain. "That hurts?" she said. I nodded and asked what she thought it might be. She wasn’t sure but wanted to check it out more thoroughly and ordered an ultrasound. After scheduling that test, she turned to me and said, "So, when are you going to have your reconstructive surgery?" I was puzzled. I had never mentioned anything about reconstructive surgery and, in fact, had never even considered it. When I was first diagnosed with breast cancer, all I wanted to do was have the necessary surgery to remove the cancer from my body and move on with my life. I’d never given a single thought to breast reconstruction.
The doctor sat on her stool and waited for my response. I explained I didn't know I was even a candidate for reconstruction since I'd had both breasts removed. "Oh, yes!" she assured me, “You can always have reconstruction, even years after surgery. I highly recommend it and in fact, it's important to your overall health." When I asked her what she meant by that statement, she explained, "When your body is missing the weight of your breasts, your shoulders and spine try to compensate for the loss and begin to protectively curve forward. When that happens, it can cause back problems and spinal misalignment. If you do the reconstructive surgery, you'll be replacing that weight and your body will respond accordingly."
As I listened, I felt this overwhelming emotion rising from the depths of my being. It was as if I was being handed a silver platter with hope sitting right in the middle of it. I didn't understand what I was feeling but I knew I needed to process it. The doctor must have noticed I was dealing with something because she rolled her stool over closer to me and as she put her hand on my knee, I began to weep.
The doctor had given me a booklet describing DIEP flap reconstructive surgery. Basically, what the surgery involves is removing abdominal tissue and using it to build and reform breasts. It's like getting a tummy tuck and boob job all at once. I was told it would be about a 10-hour surgery and required about a month of recovery. I tucked the booklet in my purse so I could read more when I got home. I needed to talk everything over with my husband, and I wasn't sure I was up for that discussion just yet.
Thankfully, the doctor assured me that my insurance would completely cover the surgery should I choose to do it. Even though it would be a delayed reconstruction, by law, the insurance company had to cover the surgery since I'd had bilateral mastectomies performed. That was comforting to know since breast reconstruction surgery was expensive.
The doctor had presented a good case for reconstruction. If it would be beneficial to my health, why wouldn’t I consider it? But I wasn't sure how I felt about the procedure. I wanted to do some research before making my decision. This was not something I could take lightly, and there were many things to consider.
When I got home, I read the booklet. I got online and researched surgical videos, internet medical resources and talked to three breast cancer survivors who'd already been through this surgery. All of the information I found was overwhelming. I went to bed feeling bogged down and confused. Why was the doctor pushing so for me to have the surgery? I just didn’t understand.
In the morning, my husband and I discussed the surgery. I shared information with him on what I'd found regarding the actual procedure, the recovery period and possible complications. After listening carefully to all I shared, he said he would stand behind me in whatever decision I made. I was thankful to hear that because I still was unsure about the best decision.
I took some time to review everything I’d gathered about the DIEP flap surgery and then I began to ask myself some tough questions. This would be another major surgery for me and it didn’t really wasn’t one surgery but two. Not only would I be having breasts reconstructed, but I’d also be having a tummy tuck at the same time. Knowing this, I wasn’t too thrilled about two additional scars across my body and the pain involved with making those scars. It had taken almost three years for me to recover from my initial breast cancer surgery and surgical revision. I didn’t know if my body could handle that much trauma again.
The questions I posed to myself included:
1. Why? Why would I want to do the reconstructive surgery? Would having newly formed breasts made from my own abdominal fat give me more self esteem?
2. What was the real reason for surgery? Would I be doing it to benefit my health as the doctor suggested, or would I be doing it out of vanity? Maybe having the weight of breasts replaced would help my spine, but was it really necessary?
3. What were the possible complications from surgery? Was it worth taking the risk?
4. What would be the out-of-pocket costs? Even after our deductible had been met and the insurance had paid their 80 percent, we’d still be left with our 20 percent and even that amount would be a financial burden.
5. At my age, do I really want to have another surgery?
6. What is the recovery period? Would I need someone with me to help?
7. Why do would I do something I don't really and truly want to do?
8. Aren’t my prostheses satisfactory enough?
After considering the answers to all questions, I made my decision and I feel good about it. I’ve decided not to have the surgery. I'm not going to cave to the pressure of my doctor. I hope she'll be respectful of my decision but even if she isn't, I’m happy with it. It’s my body and my choice.