He Had Me at OUTSTANDING

I had a follow up visit with my reconstructive surgeon last week.

My surgeon is head of the reconstructive surgery department at Sloan Kettering and is thought to be one of the best in his field. 

However, what he excels at in technical skills he lacks in bedside manner. 

He looks a little like Stanley Tucci.  A Stanley Tucci who makes little eye contact, talks quickly and rarely smiles. 

He is informative, abrupt and seemingly unsympathetic.  Interesting qualities in a surgeon who chooses to work at a cancer hospital.  He could easily use his expertise doing boob jobs and face-lifts with patients who need a little less hand holding and support.

At our first meeting last year, he explained the surgical options available for my reconstruction, and he quickly examined me.  Then he sat down at his desk and drew stick/circle figure breasts with slashes and stitches to further illustrate the types of surgeries available to me. And, he ended many statements with, “follow?”  As if he knew he was talking too fast, and he wanted to make sure I was keeping up with him. 

He draws fast, he talks fast, and he’s out the door fast.  Follow?

That first consultation with him was one of my my difficult appointments. My surgeon told me that my reconstructed breast would never look like my unaffected breast.  And, he told me that there was little chance that he could create a breast the same size as my unaffected breast.  To illustrate his point, he drew those awful cartoon pictures of breasts.  Slashes and stitches.

not outstanding

Up until that appointment, I was okay with my mastectomy.  I was at peace with being rid of all the potential micro cells still hiding in my left breast.  But, I was also somehow under the impression that my reconstructive surgeon would reconstruct my breast to match the other breast.  "Not possible," he said. 

Now months later, I understand that there is no way to reconstruct the effects of age and gravity and forty months of nursing with a brand new silicon implant.

Now, a breast reconstruction expert, I know that following a mastectomy, a tissue expander is put in place behind the chest muscle wall to stretch the muscle and create a pocket for the silicon implant.  The expander is inflated every other week to slowly stretch the chest wall. (My son called this "pump up the boob.") 

My surgeon told me that he would make the new breast look as good as he could—but it would not look the same. 

The thought of being asymmetrical for the rest of my life AND looking at his many cartoon breast drawings with slashes and stitches got me down.  And, at that point I was pretty unflappable.  Breast cancer, PET scans, MRI, surgery, drains—I was powering through it all. 

I emailed my yoga friends and asked them what positions I could do to help further stretch the chest muscles.  If I couldn’t have a match in breast shape, I definitely would have a match in breast size. 

I had my mastectomy.  My breast surgeon opened and removed all of my breast tissue, and the reconstructive surgeon put in the tissue expander and closed. 

After all of the chemo and expanding, in my last surgery my reconstructive surgeon took out the expander and put in my silicon implant.  My chest wall was expanded enough to put in a perfect size match.  Thank you, chest opening yoga positions.

So now all these months later, I have my old, 41-year-old breast.  And, I have a brand new reconstructed breast.  My kids lovingly (mockingly?) refer to them as Flopsy and Mopsy. 

I had been planning for months that at my follow up visit, I would thank my surgeon for doing such an amazing job.  Mopsy is a beautifully reconstructed breast.  He was right.  My reconstructed breast does not look like my old breast, but it looks pretty good.

I don’t know if it’s because my results are good, or because I really tried to understand him better, but I have come to respect, and even like my surgeon.

I wanted to thank him, but I also wanted to tell him that the slash and circle drawings at our initial visit were scary (actually, terrifying), and he might consider a different approach when he educates new cancer patients to the reconstruction process. 

He is very good.  He's even great.  I know that he can be better.  I want him to be better.

My husband thought I was crazy.  My husband reminded me that I am a patient and not a patient advocate.  He told me that I am not my surgeon’s mentor.  And, he was also sure that my reconstructive surgeon had heard all of it before and didn’t need or want my constructive criticism. 

So as I sat in the waiting room to see my surgeon, I debated if and how I would share the constructive criticism.

My surgeon dashed in through the door, said a quick hello, made no eye contact, and asked me how the implant was.  I told him I thought it looked and felt pretty good.  He opened my exam gown, examined me and agreed.  In fact, he said the implant looked “outstanding.” 

At this point, we made eye contact. 

Outstanding.  I know that he was complimenting his own outstanding surgical work.  But, outstanding?  He thought my breast, formerly full of cancer, was outstanding. 

I agreed with him.  And, thanked him.  And, I decided not to share my constructive criticism.   I decided I’d let him keep on doing what he does. 

And, I’ll keep on doing what I do--with my outstanding breast.