To go flat or not flat, that is the question.

I finally had my appointment with my surgeon to discuss my implant options and it didn't go quite how I expected. Leading up to the appointment I had decided I wanted safer implants put in for the time being as I didn't feel quite ready to go flat yet. I figured I'd get on the waiting list and have surgery in about 6-9 months. I'd come home in the new year, work, save, have the surgery and head off again.

My surgeon went through my options and it wasn't as simple as I'd hoped. One common problem with breast implants is the development of capsular contracture, a condition in which the scar tissue that forms around the implant becomes hard. Scar tissue is the body's natural response to the presence of any foreign body. With breast implants, the body creates a barrier of scar tissue around the implant to wall it off and protect it from the rest of the body. This is called a capsule.

What I didn't realise is that this capsule makes the surgery far more complicated and painful. I thought it was as simple as whipping the old implants out and putting the new ones in... but no. The capsule has to also come out if I want to eliminate all risks of getting ALCL (Anaplastic Large Cell Lymphoma). I could do this but then the new implants would develop a new capsule which would then need to be removed if I decided to go flat at a later date. This was sounding like potentially too much surgery, I'd rather not go through anymore surgery than is absolutely necessary. I could obviously have new implants and leave the old capsule in but my risk of ALCL would still be there; although currently she says there's no evidence. That's the problem - this is all fairly new, so there's not been enough research done for there to be any statistics. It's obvious to me that these textured implants can cause cancer and I just don't want to risk it.

There seems no point with getting new implants without taking the capsule out. There also seems no point in getting new implants and having the capsule removed and then having to have the implants replaced every ten to fifteen years for the rest of my life.

So I asked her about going flat. As well as my implant I also originally had an LD flap reconstruction. To explain - a latissimus dorsi flap procedure is an oval flap of skin, fat, muscle and blood vessels from your upper back that is used to reconstruct the breast. This flap is moved under the skin around to the chest to rebuild the breast. I asked her if any of this could be saved which would then leave me with something. She answered with exactly what I wanted to hear - yes. This was great news. I didn't know anyone that had had this done and no idea what it would look like. If I had some fat on me I could have had some taken from elsewhere and put it with the remaining reconstruction. I'd then have a more realistic breast but unfortunately I don't that extra fat on me. Maybe I should eat lots of donuts and pancakes while I'm in America! The lump would be tiny and possibly not look like a breast at all. My reconstructed nipple is quite big and I can imagine that It could end up looking like a pubescent breast.

So there are my options. She told me I'd already had a lot of surgery and any more unnecessary surgery wouldn't be a good idea. My last two operations didn't go well and I had complications with both. My body doesn't cope well and I don't deal with pain very well either. To top that off I hate morphine and would put up with the pain rather than the horrible nightmarish feeling it gave me. After going through all my options, she told me to go away and think about it and come back in the new year - my next appointment is booked for February 2020.

So in the meantime I will head off and enjoy my time in America. I feel I've come along way in the last few months, which I will explain in my next blog post. I want to be sure I'm mentally ready to go flat, but I'm all too aware that I need to change my current implants sooner rather than later.