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April 7, 2011

I have new boobs, and they are perky. The perky part has a lot to do with the fact that reconstructed nipples don’t react the way real ones do. They’re stuck in the high beam position.

They are remarkable boobs. I know this because my friends remark on them. Mostly, they say nice things that all deconstruct into “Nice tits” but this morning a friend asked about my surgeon.

“You went all the way to Houston?”

I get that a lot. Evidently, there is some kind of Dallas-Houston rivalry and people from Dallas can’t imagine why I would go to Houston for medical care. “There are doctors here who specialize in breast reconstruction,” they tell me.

I’d almost think that most people have no idea about the complexity of breast reconstruction surgery. It’s a relatively simple procedure, so here’s a summary to make it easy to understand: the doctor places the magic implants on on the patient’s chest where she used to have boobs and then waves a magic wand and voila! Hooters!

Kids understand this concept very well. Did you know that you can take two or three giant cardboard boxes, spray paint them silver, attach some dryer vent tubes for arms and legs, attach everything together with silver duct tape, draw in eyes with some paint pens and voila! Robot!

If you want the robot to really work, you can add in battery-powered LED lights on the instrument panel on its chest.

Of course it doesn’t really work that way. It’s much more complicated. We know this about the robot, but we don’t know it about breast reconstruction; most people don’t think much about it.

Breast reconstruction is, quite literally, making something from nothing. There are two methods: implant-based reconstruction and autologous tissue reconstruction. Most patients have implant-based reconstruction: the doctors insert tissue expanders into the muscle of the chest wall, the slowly expand the space and the skin and muscle slowly stretches, and then the doctor changes out the tissue expanders for saline or silicon-based implants. After it heals, they create nipples, usually by reshaping skin. After the nipple heals,  they tattoo in an areola and voila! A boob! For most patients, it works out. For me it didn’t. The implant in my right breast failed several months ago, which was more disgusting and painful than I would have anticipated.

Most patients have implant-based reconstruction because it is a much simpler procedure than the other kind, and in surgery, simple = good. It’s also not recommended by my doctors for patients like me who have had extensive radiation therapy. That’s when they do the other kind, autologous tissue transfer.

Autologous tissue transfer means “using flesh from somewhere else on your body to make a new breast.” Most of the time they use muscle and skin from your back, but sometimes they use fat, skin, and sometimes muscle from your belly. I’ve had both kinds: my left breast is made of fat and skin from my abdomen and my right breast is made of fat, skin, and muscle from my back, plus an implant.

It’s not easy surgery.

Some people say that breast reconstruction is harder than cancer treatment, and I can see why they say that, although in my case it wasn’t. My treatment was more aggressive than a typical case of breast cancer, if there is such a thing as a typical case of breast cancer, which may or may not have contributed to my implant failure; it’s hard to determine causality.

Moving human flesh around isn’t like transplanting trees. It takes hours, as the doctors individually reconnect blood vessels. In my case, my doctor had to invent a procedure since the main blood vessel they usually use for the kind of surgery I had was, in the words of my doctor, “crispy bacon” from radiation therapy.

Sure, there are doctors in Dallas who specialize in breast reconstruction surgery.

It’s the difference between “specializing in” and “being the best person in the world at.” It’s hard for me not to be an asshole about how lucky I am that my doctor took me on. I do have lovely new knockers, and it’s because my reconstructive surgeon is a genius.

He also has a great sense of humor.

I wonder what he’ll say if I ask him to install a long life battery and LED lights in my new nipples so that they “really work.”

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  1. Daniel permalink

    All i remember from reading this was perky boobs and bacon…

  2. Mary Knapp permalink

    Daddy and I are both laughing out loud, and if you can make two people laugh about their daughter’s ordeal, you’ve hit it out of the park.

  3. peter schaar permalink

    Great post, as most of yours are. I do need to remind you, though, that you are only allowed the battery and LED’s if they are blinking.

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