Sunday, September 30, 2012

I've had a post rolling around in my head since Thursday afternoon.  Clara developed a fever Thursday night.  I took care of her all day Friday, trying to spare Cathy from the germs.  Saturday she looked a lot better and enjoyed going to the second half of Jonah's double header (I got to experience the full 5 hours myself).  Then she woke up last night all chokey and wheezy.  Lo and behold, we think it's croup.  So, she was a little fussy and low key today for her 1st birthday party with both sets of grandparents and Addie and Michael.  We uninvited Corby, Emily, and Asa because we didn't want to take a chance with Asa and croup.  We're hoping that this passes quickly and we don't have any of the same kinds of croup scares we had with Aaron.  She's sleeping comfortably now and the boys are getting tucked in so I can steal a few minutes to write.

Cathy felt very comfortable with the plastic surgeon, Dr. Butterfield, at Thursday's appointment.  She is very personable, knowledgeable, intelligent, and it is easy to see that she is an artist.  The information we gathered at the appointment left us with plans A and B, contingent upon the need for radiation, of course with subplans for each plan.  Dr. Butterfield preferred (as did we) to be optimistic and work through plan A, which is what we do if no radiation is needed.  

Plan A.1 is to have reconstruction at the same time as the mastectomy with expander implants.  The expanders would be filled periodically over the course of 4-6 months to grow the muscle and skin, then they would be replaced by permanent implants.  Permanent implants generally last 10-20 years, but can last much longer, before they will need to be replaced or maintained.  The upsides of this surgery are that there is only one surgery site and one recovery site.  The downsides are that there is a greater possibility of infection and healing issues than the other options and that there is more scarring.

Plan A.2 is to have reconstruction at the same time as the mastectomy using latissimus dorsi flaps and small implants.  The LD flaps are flaps of muscle and skin that are cut and pulled from just under the scapulas on Cathy's back and brought around to the front to create new breasts.  The upsides of this surgery are that there is less possibility of infection and healing issues because there is a blood supply brought around with the flaps.  Also, there is less scarring.  The downsides are that there will be two surgery sites and Cathy would experience some numbness in her back at the point where the flaps were taken in addition to some permanent muscular weakness in her upper back.

Plan A.3 is to wait 4-6 months after the mastectomy and choose either of the above reconstruction types.  The upsides of this are that infection and healing issues are nil because Cathy's immune system will have returned to near normal.  The downsides are that it is a longer time, more surgeries, and more scarring.

At this point Cathy is inclined to go with Plan A.2.  Plan A.2 presents a reconstruction that tends to be more successful in terms of healing and healthy, as well as a more aesthetically pleasing result.  She is concerned about having two surgery sites and about the numbness, but feels that the lower rate of infection or healing issues far outweighs the other consideration.  She is concerned about infection and healing issues with plan A.1 and doesn't want to wait for more surgeries with plan A.3, knowing that she has an oophorectomy coming up sometime in the future.

Plan B, and all subplans within plan B begin with a right mastectomy, radiation, and then a left mastectomy and either plan .1 or .2.  We're hoping that we don't even really need to think about plan B.

This has been a long post and I have more to write.  Join me in about 30 minutes for part 2.

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