So on Wednesday I met with the plastic surgeon at UCSF, Dr. Foster (and his resident, a nice young woman whose name I’ve already totally spaced). My ultimate takeaway from the meeting was positive, though yes, there were more details that rocked me and which I am currently trying to absorb (more on that in a minute). I liked Dr. Foster, he seemed steady and warm and explained things really well and respectfully. I have accepted that my cancer care is pretty much going to all be through UCSF and I am generally happy about that, despite the commuting hassles that will invariably ensue. I do feel good about the high quality of the institution, and the qualifications of the team are nothing but stellar. My interactions with staff and all my experiences at UCSF have all been about as positive as they can be, considering.

Anyway, we agreed to and reiterated the “save the nipples” plan of 3 separate surgeries that Dr. Ewing had proposed to me before. They drew me pictures and explained the anatomical and procedural details of where and why and how they cut and sewed where they do and what I might expect in terms of scarring, and showed me photos of what other people have looked like afterwards. (The photos were actually more reassuring than I thought they might be.) We talked about recovery from each surgery and about the timeline as a whole, which turns out might be shorter than I originally thought (Dr. Foster seemed to think that it would only be about 3 months between the first two surgeries rather than 6 months, which makes the whole timeline shorter—and I’m glad about that.)

Now, let me back up and go more into the details, because writing them down helps me absorb and process. And I have to keep absorbing and processing, keep moving these things through to make room for the next batch which I’m sure will be coming soon. Gotta pace myself...

So one of the more disturbing clarifications that seems to be emerging is the way in which my previous radiation treatments are or might be possibly continuing to effect this whole treatment process. Dr. Foster brought up the possibility that there might be changes in my skin and underlying muscle and flesh that could cause issues with healing (e.g. more fragile skin, slower wound healing, more liquid produced post-surgery that will need additional drainage, possibly a greater risk of capsular contracture or lymphedema, etc). Hearing this was disturbing for a couple of reasons. First, it exacerbates the unhappy “gotcha” feeling that I already had going on after finding out that the previous treatments were likely a contributor to this current cancer, and therefore also were a major contributor to my decision to go the more extreme double mastectomy treatment route instead of “mere” lumpectomy. (F*cking radiation: the glow-in-the-dark gift that keeps on giving.) Second, it becomes yet another chaos factor, by which I mean it’s another thing that is essentially an uncontrollable unknown—I won’t know if there will be complications in healing or what they might be until they do or don’t happen, but I have to hold on to the possibility that they could erupt at any time (even apparently decades afterwards, as experience has recently shown.) Chaos is uncomfortable and emotionally fatiguing to live with in the best of times, and this is not the best of times.

Another bit of disturbing info that came out during this consult was the clarification that silicone implants, while much safer and better understood now then they used to be, are not designed to last long term. So if I go that route (which is what I was leaning towards, because I don’t love the idea of having to take “donor” tissue from my stomach, back or butt to make new boobs out of), I am also likely looking at another couple of surgeries every 15-20 years during my (hopefully long) lifetime in order to replace the implants with new ones. (Reconstruction: also apparently the gift that keeps on giving.)

One final bit of disturbing info was finding out that the process of expander insertion (this is when they put in temporary “stretcher” implants and slowly inflate them with saline over a course of weeks and months until I have reached the desired size and shape) involves detaching my pectoral muscles and putting the implants *under* the muscle. For whatever reason, it just didn’t occur to me that there would be muscle manipulation (and therefore add to potential recovery and physical therapy issues afterwards). The process also involves supporting the implants with a sort of hammock of something called “alloderm”, which is something made of stripped and sterilized sheets of human dermis. That’s right, ladies and gentlemen: alloderm comes from cadaver tissue donations. So I’ll also be dealing with the reality that I have bits of dead people sewn inside me along with artificial silicone implants. confused_rev emoticon On the one hand, yay science; the fact that this is even possible is pretty amazing. On the other hand...that’s kind of creepy. Actually, really creepy, if I think about it long enough. Bad enough to have to adjust to the idea of being some sort of bionic cyborg being once this process is through; but also to be frankensteined? (Bet you didn't ever consider that a verb, did you? Well now you can.) Weeeeeiiiird.

Anyway, the next step in the treatment plan here is scheduling the first surgery (the reduction and lumpectomy + lymph node biopsy), which hopefully will still be the first week of November if we can swing it, schedule-wise. Both Dr. Foster and Dr. Ewing seemed to think that would be no problem, but I have to talk to the actual admin in charge of such things before I will know for sure. (I’m anxiously awaiting a call from UCSF to nail down an actual date.) Hopefully it will entail only one overnight in the hospital and then about a two week recovery time until I can start returning to basic activities like driving and picking up weighty things, then another “take it easy” couple of weeks after that. Then theoretically if all goes well and there are no additional complications or additional treatments (e.g. chemo) that would require waiting, I could have the next surgery with the full mastectomy and stretcher implants as early as February (but which I will likely want to put off until March if I can because of other pre-existing plans.)

So now for the feels. How does all this feel? Thanks for asking. I go up and down, but frankly, it’s been really sad, surreal and difficult to hold. I’ve been walking around since this last doctor visit with a heavy sense of dread and anxiety, which causes me to mope around and burst into tears from time to time. Processing by talking to people and writing this stuff on Facebook helps, but really it just takes time to integrate (and grieve) everything that’s coming at me.

I think the thing that’s bothering me most here is the discombobulation that comes from having to continually adjust my expectations or assumptions about what will come at me and what additional things I’ll have to screw my courage to the sticking point and deal with. It’s been like this long slow avalanche down into despair—I keep hoping it’s stopped and I’m done, but then just as I’m wiping my brow and catching my breath I get hit with a few more rocks and pebbles, and then a few more, and then a few more, and then I slide a few more feet downslope and have to recover and clamber back up again only to get knocked down by a few more unexpected rocks. Just when I think I’m regaining emotional equilibrium...bam, another thing to integrate and accept comes along. Ouch, and also argh! It’s not that each new bit of information or detail about treatment is in and of itself so scary or bad, it’s that the constant barrage of things to accept and deal with becomes its own kind of torture, like the death of a thousand cuts.

So far I’m still keeping on keeping on and I think I’m doing pretty well with all this, but dayum! This is hard work (and tough to verbalize, though I’m trying). And it’s just going to keep going and get harder over the next 6-8 months before it finally dies down somewhat. Anticipating and bracing myself for what is to come without fully knowing what it will really be like is hard too. I don’t want to fear all the things but I can’t deny them completely...I have to remain open to the possibility of things going negatively or problematically, but not dwell on it. I have to keep my eyes on the prize, which is living. It won’t be the same living as it used to be, but it’ll be mine, and in the end it’ll be fine however it is, because I will make it so.