Dr. S called me last night. He had a consult with Dr. K and said he had some concerns. He said they work very well together and he trusts him, but he's afraid of getting 'burned'. I was confused as to what he was talking about so he explained it to me.
He says he's been burned in the past with women who get the DIEP flap and then have to endure radiation, which destroys the new breasts. He could spend 8 hours of surgery and create two perfect breasts (his work of art!) only to see them ruined by radiation. That leaves unhappy, upset patients.
Dr. K told him that there was a near zero chance that I would need radiation but it's a difficult call since my breasts are so big and we don't know what we might find. They might test the tissue after the mastectomy and find it's loaded with all sorts of invasive cancer. Dr. K doesn't think that will happen, but it is a possibility.
Dr. S said he could always insert tissue expanders following the mastectomy and once the pathology results come back clean (or after I complete radiation, if needed) then he can perform the DIEP flap. That will mean two major surgeries and two recovery periods, which doesn't appeal to me. There's also the chance that insurance will view it as an elective procedure, which means it's all out of pocket for me.
He said it was my choice and he certainly wouldn't have offered to perform the DIEP flap if he didn't think it was possible. He wanted me to know ahead of time that there is a risk that I may need radiation and what it would mean. I appreciate him being upfront about it. I understand that if I end up needing radiation I will have what will appear to be a botched boob job and it will not be the surgeon's fault.
So, we're going ahead with the DIEP flap. I have my fingers crossed that the pathology report shows no advanced cancer so no further treatment is necessary. The scheduling secretary is currently working on lining up the date and I should hear from her in the next couple of days. I'm thinking I'll know something on Tuesday but secretly hoping she'll call tomorrow.