To Phase 2 or Not to Phase 2

In my first meeting with my plastic surgeon he asked me why I was leaning towards DIEP reconstruction versus implants. Among my many reasons (which I plan to write more about soon) was this: “I really only want one surgery”. He smiled and basically said (I’m paraphrasing here) “Yeah, that’s not gonna happen”.

Implants have a life span, they need to be swapped out after 10 or 15 years. And the expander to implant route, which is still the most common path, involves the initial mastectomy + expander surgery, months of doctors appointments to get fills, and then another surgery to exchange expanders for implants. That all seemed like way too much of a time commitment.

I had this fantasy of having it all done in one big surgery. I go into the operating room with boobs, I wake up with boobs, and they’re mine for ever and ever. The end.

I knew my doc was just being honest with me when he said that it pretty much never happens that way. Almost everyone has some sort of “Phase 2” revision. But although I hardly let myself speak that fantasy aloud after that first appointment, it remained in the back of my mind. The thing I was hoping for with all my hope. That I would be one of the lucky few who had great results after Phase 1 with no revisions necessary.

Somewhere between weeks 6 and 8 of recovery it dawned on me that I was not the unicorn with perfect results. The hard spots in my boob which I kept telling myself were just swelling didn’t go away. They’re uncomfortable…like little tender bruises…and feel really weird to touch. There are two spots in righty and one in lefty that are very noticeable. The largest spot is so prominent that I can see it’s outline under my skin like an oblong rock nestled there at the periphery of my boob.

I had my 2 month post-op follow up with my plastic surgeon last week and he confirmed my fear about the lumps – fat necrosis. Small sections of the fat that was moved from my belly to my chest died due to poor blood flow and/or trauma. When the cells die they release their fatty insides which creates a lump called an oil cyst. Charming, right? Yeah…not so much.

My doc’s recommendation? Remove the necrotic areas during phase 2 surgery. Do a little lipo on my upper belly and to my hips and use that fat to fill in the holes left from removing the dead tissue. The bonus of that being that he’d also be able to correct the minor asymmetry in both my hips and boobs that I was left with after Phase 1. He made it sound like such a walk in the park. A short 2-3 hour surgery, in the operating room on a Friday, back to work on Monday. No lifting restrictions. Easy peasy.

Maybe for him. But not for me. I HATE the thought of going under anesthesia again for pretty much just cosmetic reasons. It seems selfish and vain to have another operation that I don’t NEED. But at the same time, the necrosis is physically uncomfortable. And I’m emotionally uncomfortable with feeling the lumps in my boobs. I don’t want to touch them, and I don’t want my spouse to touch them. They are just epic reminder that there’s something wrong with me and that these aren’t really my boobs.

Beyond just the fear of another surgery, there’s the fear that Phase 2 could make things worse! What if the fat grafting doesn’t take and I’m left with misshapen boobs with divots and dents where the necrosis was? What if the grafted fat ends up necrotic too and I’m back in this exact same scenario 6 months from now? I know it’s much more likely than not that Phase 2 would lead to improvement. But it’s just such a big unknown…and I don’t want to end up one of those people considering a Phase 3 or 4 to correct problems that cropped up during revisions.

If it weren’t for the necrosis, I’d be much more comfortable with the idea of forgoing Phase 2. The minor asymmetry is something I can totally live with. But I don’t want to live with these bumps and lumps that stop be from being able to fully embrace my reconstructed boobs.

But I have a plan. We’ve tentatively booked Phase 2 for early November. That’s 4.5 months away. So I’m going to do everything I possibly can between now and then to eliminate the need for more surgery. Basically, I’m going to massage the hell out of my necrotic spots in hopes that they break up and go away on their own or at least shrink to the point that they are no longer bothersome. If by the time October rolls around I’ve made significant progress, I’ll call off the surgery. If not…I suppose its under the knife for me.

Wish me luck!


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