to this highly specialized area leaving far too many women with little or no option for reconstruction.
This phenomenon has stimulated a tremendous interest in the field of Oncoplastic Surgery, with many breast surgeons seeking additional training in order to offer full and comprehensive management to their patients. Since there are many various clinical practice settings within the United States, sometimes surgeons will work as a team, and in other situations, a single surgeon may have the skills to perform both the cancer surgery and the reconstruction as well.
As mentioned, in some cases the primary surgeon may not take on the additional responsibility of performing the breast reconstruction; however, if the surgeon has an intimate knowledge of the various techniques, the risks, benefits, and timing of each type of reconstruction, this can help the patient take a more active role in planning the overall surgical approach. This allows for integration of all aspects of the surgery. In many cases, immediate breast reconstruction can at least be started at the time of mastectomy with placement of an implant, expander, or flap. This ultimately helps the patient emotionally through the loss of the breast, and in most cases, decreases the number of surgical procedures the patient ultimately needs to undergo.
In this manner, the field of Oncoplastic Surgery will help surgeons learn and apply creative surgical solutions that simultaneously improve oncologic outcome and surgical cosmesis. These techniques are broadly applicable to all patients undergoing breast surgery, and it is most likely that university training programs will soon offer specialty training for surgeons in Oncoplastic Surgery. The American Society of Breast Disease has dedicated significant resources to teach surgeons these unique skills in a unique annual program called the “School of Oncoplastic Surgery.”
Dr. Lebovic is Past President of the ASBD, and founder of the School of Oncoplastic Surgery.
Once inside the bathroom, I had to strip naked and put on the white elasticized stockings and a gown that opened at the back. I placed my underwear, jeans, sweater, socks, and shoes in a paper bag with my name on it. I walked to my gurney with the bag in my hands and gave it to Paul for safekeeping. Reality set in. At that point, I told myself, “You just have to do this. You'll cry about it later. Now, you must stay positive and visualize a positive outcome.” I had to do this to save my life. And, it felt like I was doing it rather well. Grace carried me.
Men to the Rescue
Before the surgery, I asked my female surgeon to request a female operating team. I wanted the sacrifice of my left breast to be a women's ritual. It felt like a private female thing. When I received a telephone call the evening before surgery from a male anesthesiologist, I was upset. While I was not rude to him, the conversation lasted two minutes. I told him not to over medicate me, and I would see him in the morning. The disappointment hit. I felt weighed down because my ritual was not being honored by the “powers that be.”
I reminded myself: “You believe in the divine right order of things, so you really need to let this negative attitude go.” I had to get past my sense of dread. The inner turmoil lasted a few hours, and I finally fell asleep surrendering to the inevitable. When I met the anesthesiologist the next morning in his funny green shower cap, he seemed quite harmless. He was tall, blonde and had bulging muscles on his thin frame. I liked him in spite of myself. He appeared centered and calm like someone who meditated as well as lifted weights. He exuded confidence. I gave him a slight smile, as a truce offering between us. He passed the test of a painless IV insertion.
My female team took another hit when a short, dark-haired, body-builder type man walked over to introduce himself and offer his assistance as my surgical nurse. I was too preoccupied with staying positive to have an emotional reaction to him. I did not have the time or luxury to get tense and upset. I wanted the energy to stay high and positive so the surgery would be flawless. (I believe that our attitude affects outcomes.) My job was to remain centered and calm while I waited to go under my surgeon's knife. The nurse appeared gentle in spite of his strong masculine appearance, and he spoke to me with genuine concern. Instead of females, I attracted two muscular men who were gentle and caring. I began to get the picture. I was in the best of hands regardless of the demise of my ritual. I got what I needed, instead of what I wanted.
I did manage to become slightly agitated when Paul could not find the healing mantra tape I wanted to hear before being wheeled into surgery. I quickly settled on my second choice—Triple Mantra, designed to eliminate negativity and prevent accidents. As I began listening to the trance inducing sounds, my body relaxed. I was able to transcend the voices, smells, and activity in the room. Within five minutes of focusing inward my surgeon showed up. She was all smiles and positive about the surgery. She looked like a little happy pixie, so I am thinking, “How bad could this be?” I reminded her not to take too many lymph nodes because I was going to do something systemic to heal my body. My plan was to treat my body as though the lymph nodes were positive no matter what they actually found. Plus, I had heard horror stories of women suffering without their lymph nodes, and I did not want to become one of them. It was time to go. It all seemed so rushed. I forgot to tell her to keep my breasts small with the two implants she would be inserting. I just wanted to look normal, not buxom.
Soon after she left, the anesthesiologist came over to me and injected medicine for nausea into the IV bag. I didn't have much time to dwell on what was about to happen to me. When I got a farewell kiss from Paul, I thought, “The next time he kisses me I would have a different body.” With my headphones on, the Walkman lying next to my body and listening to the chant, I was wheeled away from the curtained stall. Before we reached the end of the room, I was unconscious.
The Worst Is Yet to Come
As I was preparing for the surgery psychologically, I realized waking up in pain was the thing I dreaded most. I regained consciousness in the recovery room moaning incoherently that the pain medicine was not working. I felt an excruciating burning pain in my chest. I lost consciousness again. I regained some awareness when Paul was next to me holding my hand. The contact helped me slip into reality for a few moments. The next thing I remember he was sitting next to me in a hospital room. Voices were coming from a TV clamped to the wall in front of my bed. I was complaining, “This isn't working; I am still in pain.” He called the nurse. She tried to teach me to push a hand-held button for pain medicine, but my fingers wouldn't work. I still felt an oppressive, painful weight on my chest, and I could not move my arms and hands. I thought, “I just have to get through the next 24 hours.”
Before breast cancer, I was very healthy even though I had asthma. I stayed a long distance away from hospitals and traditional doctors most of the time. But here I was in a prestigious hospital, and the quality of care was a surprise to say the least. Late in the evening of the surgery, my surgeon came to visit me. She had me press the button to call the nurse for something. When no one came to me after about ten minutes, she got angry. She had me moved into another wing, which was not much better in terms of my care.
When I woke up the next morning, I was still in mild pain and could not move my body in the bed. Two implants were placed under my chest wall muscles. The left one became a prosthesis after she removed the tissue of the left breast and the right one a “boob job.” I had no idea how much pain and restriction the surgery would entail. I went into the surgery and reconstruction very naive. I trusted my surgeon’s reconstruction recommendation. She was just going to “pop” two implants under the muscles of my chest wall. It sounded so simple and still makes me smile. If I had known more, I might have thought twice about the procedure. But, I might have caused myself even more stress living with the alternative. All the options were awful. In this case, ignorance got me to do what was best for me. I just had to suck it up and make the best of my decision.
Initially, my efforts to get help in order to control my pain and adjust my body in
