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Wednesday, April 11, 2012

Plastic Surgeon 1

Six months and 18 days since diagnosis and my hair has grown enough so I am again,a little Mao Tse Tung-esque around the jowls.

I wake to a beautiful breezy morning when I will set off for my first appointment with my plastic surgeon. I've been planning this visit for months. I was originally booked in the week I fell sick and ended up in hospital.

Afterwards I have another session of radiation so I know it's going to be a long day.

Since the Easter long weekend passed, my routine is all out of whack. I haven't had a chance to go to the gym and client and Karen commitments have made it impossible to get my afternoon walk in.

Perhaps it's a good thing because, as you may remember from an earlier post, I do need to cultivate some stomach fat if I am to have the chance of reconstructing poor dead Nicky in the optimal way. At least I think so.

This is what this visit is all about today. I need to know what my options are as far as breast reconstruction goes. I need to plan ahead because, these days, everything revolves around fighting or beating or managing this bloody cancer.

If I think about it too much, it really does get me down.

Lately, I've watched with dismay as days that may have been spent with my family are absorbed, submerged and eaten away by the fall-out of this disease.

Ben is on school holidays and, apart from a blissful three days spent away at our little shack down the Coast, there's been little 'quality' and not much 'quantity' to these precious times when I could be focussing on this boy - reduced to only-child status since his eldest brother turned 18 and regularly decamps to his girlfriend's hacienda.

Of course I feel sad. I know time is fleeting and madness takes its toll and all that. Ben is growing day by day while I am growing away from what was once normal.

As I bustle about, preparing to leave, Al offers to come with me, and Ethel rings too, offering to accompany me, but these eternal visits to one specialist or another are tedious. They involve long drives in the car. They suck precious time and it is best that only one of us is in debit in this department.

Al urges me to go with an open mind and without any preconceived notions about what I want.

I leave in good time for my appointment and set off in my temporary vehicle, the Willpower Mobile - a little Nissan that's emblazoned with Karen's campaign branding. At least there's one good thing about this repetitive commute: I'm getting Karen's face out amongst the traffic.

The drive takes me a good hour as I head to Sunnybank,and only make one wrong turn. Hooray!

At 10.30 sharp, I am sitting in the waiting room of a suite of professional offices that, I have to say, are rather schmick - all dark wood and shiny surfaces. It is clinical but luxuriant.

I don't have to wait too long before I'm ushered in.

Dr Lily Virtek is a pretty, slightly built Chinese lady who speaks, disconcertingly, with quite a strong Aussie accent. In fact, she's gorgeous.

A Plastic and Reconstructive Surgery specialist, I momentarily spare a thought for all the ugly and deformed who might present themselves to this vision of loveliness. How cruel must be the contrast!

After she takes my personal details, I explain to Dr Lily that I have come to see her early as I need clarification on where my body needs to be if I'm to have a reconstruction. I explain that, rightly or wrongly, I am thingy about my size. I don't want to be too fat and, as it is, I'm struggling with the idea of being five kilos heavier than is usual for me.

Please. Allow me this small vanity.

I accept that without surgical intervention I am stuck with my hideous crooked nose (that swells up to Aboriginal proportions after any hay fever attack), my spotted uneven skin, my short torso, and the clutch of wrinkles collecting on my face. I freely admit I'm no oil painting and that's okay.

But I won't be stuck with a fat body. I've never really had one other than through pregnancy so I just don't associate it with being, well, ME! Besides, I've always been a runner: I LOVE the chase of soccer and you can't really sprint unless you're built for it.

I'm just used to being smaller and now I have back fat and a belly that pokes out, and I've packed away the trousers I've been wearing for 20 years because suddenly, I'm not so much wearing my clothes as being upholstered by them.

That's why I'm here. Not just because it would be nice to have a matching set of boobs. I also want to know just how many donuts I need to eat to get myself a decent tit without necessarily ending up with a backside the size of Tasmania.

Dr Lily gets straight down to business the moment my now bigger backside lands on the chair by her desk.

She takes my personal details, then asks me what bra size I am. When I say 14D, she asks me if I want to stay the same size. She smiles softly when I say: "I want it as small as possible. Big breasts are overrated."

Then she asks me to clarify whether I REALLY want to have my remaining lone breast off.

"I can just do a reduction", she suggests but I explain that I don't want to as I'd be uneven and I am somewhat fond of symmetry.

I tell her I'd like it completely removed because of the high chance that my type of cancer could migrate.

She accepts that and, I don't know, but she looks a little sad. Funny isn't it?

Then Lily produces a small silicon cup with a kind of metal lid. She explains that this is an expander which will be inserted under the skin and gradually filled with millilitres of liquid. This is what is called a 'skin expander'.

Once the skin has expanded over a period of weeks, then a silicon insert is introduced.

Where Paris is concerned, the procedure will be quicker because I guess it's simultaneous with the removal of the beat.

Then Dr Lily asks me to take my top off and I stand there half naked as she squeezes Paris, much as one might test an avocado for ripeness.

She gets down on her knees in front of me and feels my stomach. My heart sinks when she shakes her head. It seems the news is not good.

As I put my top back on, Dr Lily tells me I have barely enough stomach fat for a B-Cup and 'even that would be a stretch'.

My heart sinks. I am about to say I'd be happy with a 'A' but I realise that really would be stupid.

You see, the operation I thought I would have is called a TRAM flap or Transverse Rectus Abdominus Musculotaneous flap involving what is essentially a 'tummy tuck'.

It's a major operation requiring 6-8 hours of surgery and you wouldn't go through with it for an A-cup. You just wouldn't. You'd be better off sticking two oranges down your bra and making do. Or two rolled-up football socks. But not ping pong balls.

Dr Lily explains the TRAMs are the 'Rolls Royce' of breast reconstructive surgeries but requires good tissue and good fat - but I'm simply not a contender because, believe it or not, I'm TOO THIN!

What! You have got to be kidding me.

"What about my thighs? My bum? I read you could suck some fat from there."

Lily chuckles. "You don't have any."

"But my stomach pokes out."

"Those are muscles. You must have been pretty fit before you got sick."

This is all well and good. Once upon a time, my head might have swelled to Jeff Fenech proportions at that point. But I need this fat.

"Couldn't I just eat a few more cakes?"

Here's the thing. For this kind of operation, stomach fat can't be 'cultivated'. Because once the fat is in, if I lose weight, I lose it from that breast. If I put on weight, it goes on that breast. Because it's STOMACH FAT you must maintain a size that's so consistent it maintains the breast in that size.

"You're going to go back to your normal size. I'm sure of it," Lily says.

"Can you transfer fat from the good breast?" She raises an eyebrow and smiles, humouring me with an answer.

"That fat could have cancer but yes, theoretically you could."

"My friends have offered to donate their fat?" I try. One last ditch effort. At this, she laughs out loud. Come on! I was really counting on that tummy tuck.

I don't know what to expect at this stage when Lily walks behind me and asks me to put my shoulders back. I feel her small fingers prodding my back.

She tells me that my only option is an operation involving the Lattisimus Dorsi muscle that is located on the back.

She will take this from the left side and apparently, it is kind of shifted onto the chest.

She explains she's done 100s of these and they're extremely successful with patients reporting few long term effects.

The consequences of this operation are only really critical for anyone involved in climbing cliffs or painting or anything involving heavy above-the-head work involving the arms - so if I was Spiderman, I'd be screwed.

I will have difficulty moving heavy objects from high shelves with that arm.

Who cares about that? What about the IMPORTANT stuff...

"Will I be able to raise my flag when I referee?" Yes.

"What about my golf swing?" We discuss this for a while. I don't even play that well but hey, in the unlikely event that I discover I am bloody fantastic at this sport one day, how the hell will this operation affect my backswing?

Basically, it will reduce the strength in my left arm and if I persist, I can work on that to increase its strength.'

"Can I go swimming?" Yes, "but please don't tell me you like the butterfly." So freestyle should be okay but I'll notice a weakness in that arm.

"Can I still work on my upper arms at the gym?" Yes. Even chin ups. Eventually.

And so, as my conversation unfolds, it's all about activity. That's just who I am.

A little later we discuss the potential timing of the operation. It takes a good six weeks to recover from the operation and I won't be able to move my arms much for that time. I won't even be able to walk for two weeks.

My only concern is that I will have reasonable movement by the time referee season starts. Maybe I can even return to playing soccer. Who knows!

The good thing about this operation is that the surgery takes a little less time (4-6 hours). It's not as major as the TRAM.

I guess another good thing is that I won't have another hideous scar on my torso to confront me in the mirror every morning.

Rats! I was really looking forward to, finally, getting the flat stomach we Sri Lankans are doomed never to have (damn my genes!).

Dr Lily then pulls out a folder and shows me some post-operative pictures of women of various sizes. I have to tell you I'm impressed!

I had no idea breasts could be resuscitated so well. Even the nipples stick out - so much so in the initial stages that, Lily says, you could hang your car keys off them.

By now, I think I've accepted that this is my only option. It's either this, or nothing (thank you radiation, you bastard).

From wo to go, the whole process will take up about six months of my life. What to do? It is what it is.

As we close the meeting, I joke to Lily that while I'm under, maybe she could fix a few more things - maybe a brow lift or a nose job.

Of course, I'm joking.

The truth is, if you'd told me 12 months ago that I'd be visiting a plastic surgeon this year, I would have laughed in your face.

The truth is, whatever my shape and size is, now or in the future, I am having to re-learn that thing called 'self acceptance'.

Sure, I'm a bit obsessive about not turning into a fatty but you know what? Give me time and whatever I am, I'll get there.

We are what we are. Whatever is meant to be, just is.

I have asked for a quote for this operation and will let you know in due course, whether I'll need to sell an organ to pay for this procedure.

Before I leave her, I ask Lily if the 'Virtek' of her surname means she married a Croatian maybe. Her maiden name was Lily Chen.

"No, he's Czech," she says.

"Do you have any kids?"

When she says "No" I think 'What a shame'. Because there's surely a one liner there: about the family of Chinese Czech-ers. Ha Ha.

As it is, I say my farewell and drive back to town.

I stop at Garden City and score myself a pretty fab David Lawrence dress at 'a further 25% off'.

I drive to the Mater where, once again, it's 'chat, wait, chat, change, chat, zap, chat, sign, off'.

I have just seven doses left when this tedious business of treatment will be over.

Afterwards, I meet Lee for a coffee because she works just across the road.

In the evening, I go to Trivia where we come third.

It's 10.20 pm. The evening has turned cold and blustery and I wouldn't be surprised if it rains tomorrow.

Today I have taken the first step towards clawing back to that person I loved: the person who was the old me.

I know I'll never look the same again, me with my Mao Tse Tung hair do and my scar.

Already I can feel the tug of that black water, drawing my ship away from that familiar shore where the old Bronwyn is waving, laughing. Living in her gym gear. Manic. Doing. Devouring it all. Imagining, foolish girl, that that was what it would be like. Forever.

How could she know then the terrors of all of this: the losing.

I'm trying hard to keep sight of her, the Bronwyn that was 'whole'.

Because I know that, when all of this is done, she will be overwritten.

And already, I miss her.

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