I have mentioned several times in this blog that after learning I had the BRCA1 gene I wanted to do as much research as possible. I wanted to know about all of the surgery options available, even if I knew some of them probably weren’t a fit for me. I needed to know all my options. One thing I learned is that it can get quite technical. My goal is not just to throw a bunch of terms at you, so I thought it might help to give you a visual with the chart below. Although simplified, this chart helps break down some of the exact information I found in my research. If you are beginning your own research, or want to learn what a mastectomy is and what reconstruction means this is a good place to start.
Because I was doing a prophylactic surgery, that is to say, I decided to have surgery before being diagnosed with cancer; my options for surgeries were different than someone who was already diagnosed. I am not saying that I believe someone who has cancer doesn’t have excellent options, it just means that there are some options available to me that aren’t when you’ve had cancer. One of those options would be staying completely natural on the outside of my breasts.
So after all my research was done, I decided on a procedure called the Direct to Implant or One-Step procedure. After seeing what my mom went through when she had a double mastectomy, I wanted to avoid going through reconstruction with tissue expanders. Now granted, if I had chosen tissue expanders it still would have been a different experience from my mom, but one of my goals going in was a less invasive surgery with a quicker recovery time.
I also didn’t feel like flap surgeries were a great option for me. Because I am petite, I don’t have a lot of extra tissue to replace my breast tissue. Secondly, I didn’t like the idea of messing with another part of my body. Lastly, it meant recovering in several different places on my body instead of just my chest. Obviously, this is just my personal opinion. There are a lot of women that prefer this method because it’s seen as the more natural option. Using tissue from their own body, some say the breasts feel and appear more natural. This decision must be based on your own body type and preferences, and for me, I didn’t feel like it was a good fit.
With the Direct to Implant option, I could stay completely natural on the outside. The procedure would only remove my breast tissue, then immediately place an implant along with another tissue type substance called Allodermal Matrix. This tissue, taken from cadavers, does not contain DNA and will not be rejected by your body. Most surgeons will place the implant in a pocket of the alloderm tissue and place it under your pectoral muscles. Some surgeons will give you the option to lay it in front of the muscle, but this is a relatively new procedure and really depends on your activity level. Consideration for above or below the pectoral should be taken if you do extreme activities such as CrossFit or rock climbing. I did not feel like my activity level was extreme enough for me to make a judgment on the issue, so I just left it up to the surgeon.
The other important decision in this process is what surgeon to use for the procedure chosen. I told my husband that it was like planning a wedding all over again. I had the date, now I needed to find the venue! One amazing organization I found was facingourrisk.org, which is dedicated to all types of hereditary cancers. They have amazing resources including a surgeon directory and patient list. The great thing about the patient list is you can contact someone who has had a particular procedure and ask them questions. To me, this was a huge advantage. The most important advice I can give is to talk to as many people as you can. I also did a Google search for “list of Direct to Implant surgeons” and found another great resource that listed out certified surgeons across the nation.
Contacting the surgeon’s office was the easy part in my opinion. I went to the website of locations I was interested in, made sure to read the information they had available and looked through pictures and watched videos. I then used the “contact me” section and wrote out my situation and told them I was interested in scheduling a consultation for the Direct to Implant surgery. Every office I reached out to called or emailed me the next day. I want to go into more detail of the places I visited in a later blog, but it’s important to remember that you are hiring them. This should be about finding someone you are the most comfortable with. It may not be the most convenient or the surgeon you doctor recommends. It is always good to have a second opinion, if only to be able to compare different surgeons and options. With a decision like this, you don’t want to wonder after the fact.
I really don’t want to over simplify the decision making process. There are pros and cons to every procedure. Before I even talked to a surgeon or found out if I was a viable candidate for Direct to Implant, I did four months of research. I made sure to talk to several women with experience and medical professionals. All of this takes time and patience, and I cannot stress enough the more knowledgeable you are the better off you will be and the conversations with the surgeons will be that much more valuable.
