Reconstructive Surgeons
Over the past three months, I've met with three reconstructive surgeons for consultations about my breast reconstruction following mastectomy. All three talked with me about the two reconstruction options: synthetic implants and natural tissue flaps (where your own tissue from the belly, gluts, or back is used to recreate breasts). I decided early on that I wanted implants; flap reconstruction is a better option for women who are overweight, it has a much longer recovery time, and it leaves significant scars at the donor site (plus, to be honest, it kind of gives me the willies just thinking about it). Reconstruction using implants can either be done at the time of the mastectomy, or temporary implants called tissue expanders can be placed at the time of the mastectomy. The expander has a valve that allows it to be gradually filled with saline over a period of two to three months, allowing the surrounding skin to adjust, then, when the desired size is reached, the permanent implants are placed in an outpatient procedure.
Dr. Grunwald is Division Chief of Plastic and Reconstructive Surgery at St. John's. She was recommended to me by my boss Charlie, who serves on a board with her husband It turns out that she has operated a lot with both Dr. Funk and Dr. Giuliano, and she also went to medical school with Dr. Hurvitz. I liked her immediately - she was smart, warm, and a very good communicator. She agreed that flap reconstruction probably wasn't a good option for me and recommended implants with expanders. She spent over an hour talking me through the procedure and recovery, and she showed me a lot of before and after photos so that I could get a sense of how it will look.
Dr. Grunwald's one big drawback is financial - she doesn't take insurance. Although her fees are reasonable and we can afford them, I felt that it would be prudent to meet with one or two other surgeons who do accept insurance.
Dr. Randy Sherman - November 24, 2014
Dr. Sherman is on staff at Cedars-Sinai and was recommended by Dr. Giuliano (and Dr. Grunwald did her fellowship with him). My expectations before meeting him weren't too high but I actually did like him very much. His approach to the consultation and communication style was very similar to Dr. Grunwald's - very poised and professional, but also warm and caring. However, his recommendation was different from hers - he recommended direct placement of the implants rather than the two-step process using expanders. One interesting thing that he said was that replacement of the implants is usually not necessary - in most cases, women choose to replace their implants for cosmetic reasons.
Dr. Suzanne Trott - December 11, 2014
Dr. Trott was recommended by Dr. Funk as a good alternative to Dr. Grunwald who accepts insurance. She has a private practice in Beverly Hills. She wasn't as smooth a communicator as Dr. Grunwald and Dr. Sherman, but the more I talked with her, the more comfortable I felt. Of the three, she did the best job in explaining her recommendation (the same as Dr. Grunwald's - expanders then implants) - she felt that using expanders would give my skin the best chance to heal and grow, so that I can ultimately return to the same size breasts that I currently have. Ultimately, I decided that I liked her very much, I want to use a doctor who was recommended by Dr. Funk, and I want to use a doctor who accepts my insurance - so Dr. Trott is my pick.
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I think that all three doctors, in their different ways, were clearly trying to manage my expectations about how this is going to turn out from a cosmetic standpoint. It seems that most women headed into a reconstruction with implants after a mastectomy expect - or at least hope - that they will get "perfect" breasts. They all said that most women end up going bigger than their natural breasts were, and they also expect to get their ideal shape. However, this surgery is very different from a typical boob job, because most of the breast tissue that normally would cover the implants is gone (and Dr. Trott said that with Dr. Funk, even less tissue is left than with some other surgeons, because Dr. Funk is so good at mastectomies). Dr. Trott explained that she would use Alloderm to replace some of the breast tissue. (Alloderm is a collagen matrix made of cadaver skin that has had all the cells taken out of it,
leaving just the collagen behind. This makes
it easy for the recipient's body to incorporate its own blood vessels and tissue into
the Alloderm.) Still, the implants will be much more obvious than they are in a normal breast augmentation. More than that, Dr. Sherman explained it best when he said that women scrutinize their reconstructed breasts in a way that they never would have done with their natural breasts, and therefore are much more likely to find fault with them.
All three of the doctors said something to the effect that I don't seem like the type to get crazy about my boobs, and it's true - I'm not. All I want is for my new breasts to look as much like my current breasts as possible (or, if I'm being perfectly honest, as much like my pre-breastfeeding breasts as possible). I think I have a good understanding of the limitations of the surgery. However, I've also seen some pretty great-looking reconstructions (both in photographs and in real life at my support group), so I'm optimistic that I'm going to be happy with the outcome.
Anna - it is amazing that you had the where-with-all to document your treatment like this. I wish I had done the same for other women who are diagnosed and don't know where to turn for real life accounts. I was going through my diagnosis/surgery/treatment about the same time as you at Cedars and my plastic surgeon was Dr. Sherman. I hope your surgery and recovery went well. I am 2 years out of bilateral mastectomy and just had breast reconstruction revision surgery. Too soon to tell for sure but I think I will be pleased with the results.
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