Those first two weeks after I was diagnosed with breast cancer, I went to a flurry of appointments.  There were quite a few diagnostic and follow up procedures, in addition to appointments with my surgeon, my new oncologist, and two different plastic surgeons.  At the time, I’m sure I would have downplayed the importance of choosing a plastic surgeon.  Perhaps my surgeon knew that, and that’s why she insisted that I meet with at least two before I settled on one.

I am certain that I made the right decision when I chose my surgeon.  I imagine if you’re searching out a plastic surgeon for botox or a tummy tuck, you’re either prepared to feel a little vain, or it’s just not something that you even worry about. But if you’re like most breast cancer patients, it can be a little awkward to go into a doctor’s office asking lots of questions about how great you’ll look after he does his job.  I mean, you just want to survive the cancer, right? It shouldn’t matter if you come out on the other side with a great rack.

This is just one place I think my surgeon was great.  He made it very clear from the beginning that he does lots reconstructive surgeries (a must!) and wanted to be sure that I thought I looked good, period, not just good enough  for having had breast cancer.  He showed me pictures of women who had made all different choices– you might be surprised all the choices someone in this position actually has.  Bilateral mastectomy, or single with a lift on the healthy side to maintain symmetry?  Nipple sparing, nipple reconstruction, 3d tattoo? Stay the same size or go bigger?  He was at the same time realistic and optimistic about my outcome.  Not only did he want me to be happy with how I looked, but he wanted to be sure that  he  was happy– that I looked natural and not like some over-done Hollywood B-lister.  Since there is no fat or breast tissue left after a mastectomy, implants alone can end up looking pretty fake, so he uses fat grafting to fill in around the implant.  This means that during the surgery I had liposuction (not enough to really make a difference, though, don’t get excited) and he injected that fat around the implant, giving a much more natural look. He was also very thoughtful about the incisions, making sure that my scars won’t be visible should I wear even a pretty skimpy bikini top.

Being able to talk easily and honestly is so important, this is a doctor who I saw several times a month.  He not only made sure that he answered my questions, but always remembered the name of my husband or what ever friend came along with me, and called them by name when asking if they had any questions. We talked about lots, and as we neared the end of my expansion, I remember him asking if I’d tried on some of my dresses to see if I liked the way they looked, or if we needed to expand a little more.  He managed to find a way to let me tell him what I wanted without forcing me to outright ask for bigger boobs.  And after the final surgery, he honestly wanted to know what I thought, to be sure I happy with the size and symmetry.

Sure, these aren’t the life and death decisions that the oncologist makes.  But when you’re considering a doctor with whom you have to be painfully honest in some painfully vulnerable situations, and who is in control of how you feel about yourself every time you look into the mirror, it’s worth taking the time to make a good decision.

So I’m taking a small liberty here, no one asked about cording, but it feels like it’s worth mentioning along with my comments on lymphedema.  To determine the spread of breast cancer, breast surgeons remove one or more lymph nodes.  They act as filters, so they are likely the first place cancer cells would be trapped if they’d escaped the breast.  Unfortunately, taking them out to check for cancer, while important, can cause not so great side effects.  Lymphedema– the swelling of fingers and arms in breast cancer– occurs when the remaining lymph nodes can’t keep up and fluid builds up.  That’s why some women wear a compression sleeve after a mastectomy. Because some of the lymph nodes are removed, the lymphatic vessels that service those nodes can harden from disuse and cause problems as well. (They look like tendons that appeared out of nowhere, frequently under the arm and down the arm to the wrist, but can also run from under the arm and down through the chest.)

Before I had my mastectomy, I had an hour or so consult with a physical therapist.  (As an aside, I would insist on having this kind of appointment a week or so before surgery– invaluable.) Michelle is a lymphedema specialist, and she made sure I understand exactly what I should and should not do after surgery.  More than that, she made sure I knew what to expect and what would signal a problem with lymphedema.  She emphasized that it would be far easier to deal with lymphedema early, before it became a significant issue.  Though I have yet to meet her, I also have several friends who see a massage therapist at the Teal Center at the hospital who focuses her massage on the axilla (that’s a fancy word for armpit– I’m flashing back to Fancy Nancy!) to help encourage lymph drainage.

Thankfully, I only had a few small, superficial nodes removed at surgery, so I am not likely to struggle with lymphedema. I did experience some minor cording, and Michelle used massage and stretching to break the cord, which you could hear pop as she broke them down.  Creepy.  On the advice of a friend, I scheduled my appointments with her just before I went for an expansion with the plastic surgeon, and I think the relaxing of that area really helped lessen the pain of the expansion.

Lymphedema and cording are real issues, though as current standard practice does not dictate that a surgeon remove all  nodes, they are not as prevalent now as they once were.  Still, the take home message is that there are physical therapists who are specifically trained to combat these problems.  Michelle did a great job, and she was really nice, too.  A little PT would be so much better than dealing with swelling and the pain from cording.