Chapter 8 meeting the Plastic Surgeon

When my co-workers first find out about my impending surgery some of the old timers told me to talk to Frances. Not only did I work with Frances, but she and her husband were long time members of my church (small town remember?). Frances didn't work at the circulation desk like most of us so I didn't get a chance to talk to her often. She was in charge of the technical services department, which is where the books are cataloged before they are shelved. Since I didn't see her that much during my normal work hours, I decided to come in to work a little early so we could chat.
I asked her about her cancer scare and why she had a double mastectomy and reconstruction, even though her biopsy was negative. Frances told me that her family had a long history of breast cancer. In fact, cancer was so prevalent in her family that many of the female members were in a long-term medical study. She told that she had many questionable mammograms and had gone through more biopsies than she could count so in 1990 after another iffy mammogram and biopsy she decided 'NO MORE'.
Frances was among the early group of women who had preventive bilateral mastectomy. Many people, including members of her own family, told her that she was crazy, but she was tired of living with the fear. At the time, she had two small children and staying alive for them seemed more important than having breasts.
It is important to understand that having a double mastectomy is not a guarantee that a woman will never get breast cancer, because it is impossible to cut away all of the breast tissue. But by having the surgery, that woman's chances drop about 90% of getting the disease. The ultimate irony of the story is that a few months after having the surgery, one of Frances's sisters was diagnosed with breast cancer. Luckily it was caught early and the sister is alive and well today.
Frances discuss the different kinds of reconstruction I told her that Dr. Sullivan recommended that I stay away from implants and go with something called a trans-flap.
"That's what I had." Frances said, and then she told me her story. The procedure was still quite new in the early nineties. Frances was sitting in the waiting room of her surgeon when she picked up a copy of the magazine Red Book and read an article about trans-flap surgery. She showed the article to her doctor. He told her that he didn't know much about the surgery, but would investigate it for her. A few phone calls later he found that there was only one doctor in the area that did that surgery.
She had the trans-flap and was very satisfied with the results. Frances confirmed what Dr. Sullivan told me, a trans-flap operation is the taking of skin, mussel and fat tissue from the stomach of the patient (basically a tummy tuck), then transplanting it in to the hollowed out breast and Voila! A new breast. Sounds easy.
"Don't believe them when they tell you that you that you will never get a tummy bulge again" She says pointing to her stomach. "SEE, THEY LIE!" I thought that her stomach looked pretty flat.
"Who do you have your appointment with?" She asked me.
"Some doctor with a strange Arabic name.
"Asgari?" She asked.
"Yea, that's the guy. Do you know him?" I asked her.
"He was my surgeon! He is the best of the best." That made me feel better. It is always nice to hear a high praise about a doctor from a former patient. Frances told me a little about his background.
"Dr. Asgari is from Iran. He came the United States abound the time that the Shaw fell from power. The doctor is very sophisticated, very European, sooooo continental. Great! Now I am intimidated by a person that I haven't met yet.
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We were now in the last week of school for the girls. The last week of school was all half-days and I felt that it was important for the girls have a good last day. Which is usually a day long party. I really want Sam to have a good send-off because this will be her last day in Elementary School. In Beaville Middle School starts in fifth grade, like, I don't have enough to worry about. In less than three months my ten-year-old will be entering Jr. High….oh, I mean Middle School.
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On June twenty-first and Mark met Dr. Asgari. His office in was located in one of the very ugly building that stands across the street from the hospital. The street used to be called 'Millionaires Row' because of all of the grand houses that were located there. Slowly, one by one the beautiful houses were torn down and ugly modern buildings were erected in their place. Dr. Asgari's office was in the ugly building that almost never had parking. We are forced to park in a residential area about a 1/4 mile away.
The medical buildings were constructed on the same hill as the hospital. Like the hospital, what is the main floor in the front of the building is two floors down if you use the back entrance. So finding a doctor's office for the first time was confusing. I found the halls narrow as I walk down them looking at door after door until I find the right office.
The waiting room was small then again it was a one-person office.
The first thing that I notice was the fresh cut flower arrangement that was located on a table just inside the entrance. As I looked around the waiting room I noticed that Mark and I were alone, there were no other patients waiting. I had never seen an empty doctor's waiting room before. The room was done in yellows and beige's, with a few very nice matching leather couches and some straight backed chairs that had a floral design. There were also matching end tables. There was a clear plastic rack on the wall that held magazines and brochures. All the magazines were current. The room was conformable and practical. My mother (who only decorated in white and beige) would have loved it. I love it. And, because it did not have a television or music I give it and A+. But Mark didn't like it, he thought it looked cold.
We went to the reception window wondering if we are in the wrong office. We were not. The receptionist was somewhere is her twenties. She was beautiful, with blond hair and a great figure. Then again, what else would the receptionist in a plastic surgeon's office look like? I filled out all of the forms and had a nice chat with the receptionist. Her name was Lacy. It didn't take me long to realize that Lacy was actually hired for her brains. I like her instantly, which is a good thing because in the future we would be spending a lot of time together dealing with the insurance company.
Lacy explains that Dr. Asgari does not belong to any HMO. He gave up on them a long time ago. He sets his price and whatever the insurance company won't pay I will be responsible for. She told me that insurance companies are unpredictable so she had no ideal what my insurance will cover. The cost of the operation is-ready for this- $10,000. Yikes.
Understand that I am 1/4 Scottish and playing to stereo types, Scott's are notorious for being cheap. I will spend money on my kids in a heartbeat, yet not a penny on myself. Trying to get a dollar out of me is harder than getting a dollar from Jack Benny. I didn't need the surgery and my husband did not care if I got the reconstruction or not.
Some women have to have the reconstructive surgery. Their marriage wouldn't last with out it. Not mine, my husband loves me and the reconstruction surgery was for me, not him. I didn’t want to spend the money but Mark insists that we at least talk to the doctor.
A woman came from the exam-room while I was talking to Lacy. She waved to Lacy as she walked past us, through the waiting room and out the door. Moments later Dr. Asgari came out of his office and asked us to follow him. He was in his early to mid fifties. His hair was dark with just a touch of gray; his coloring was not light or dark. He could easily be mistaken for Italian or Hispanic, only his distinctive nose indicated his Arabic blood. He was dressed in suit pants, a white shirt, a tie and white doctor's coat.
Dr. Asgari had and average size office which was decorated just like waiting room, but there with a few small sculptures (which I later learn he made, it’s nice to have a plastic surgeon whose hobby is sculpting). On a bookshelf I notice a professional family portrait: beautiful wife, two sons.
Mark and I sat across from the doctor. I'm was feeling very uncomfortable. Unlike Dr. Sullivan who had a reassuring smile, Dr. Asgari was all business to the point of appearing cold. I noticed that he really did have that continental look that Frances told me about, and I found myself being intimidated. The doctor asked Mark and me few questions that told him that we were already interested in the reconstruction surgery. He did not have to try to sell the idea to us. Later when I talked to other women who had seen a plastic surgeon (including Dr. Asgari) and they told me that the doctors had shown them 'before and after' pictures of the results of an reconstructed mastectomy.
Once it was established that I was interested in the surgery, we all went to the examination room. The room was big for an examination room. It was painted the normal exam-room white and it had the standard sink and counters lining the walls. What it did not have was a traditional exam table. Instead it had a kind of exam chair, where the patient kind-of sat and kind of-stood at the same time. I have never seen anything like it before.
Dr. Asgari opened a cabinet and took out a hospital dressing gown for me. He told me to take everything off from the waist up, and then he left the room. I looked at the hospital gown. It was not like any gown that I had ever seen before. Hospital gowns are usually blue or white and made of cheep cotton, or they are green and made of paper. Not this one. It was a yellow gown was a gauze like fabric, it was kind-of see through. I thought why bother wearing it at all? I shrugged and changed in the yellow gown.
Now remember, I am a minister's wife and a assistant librarian, which makes me very modest. So there I was, half-naked sitting/standing wearing a gauze slightly see-thought hospital gown. And I thought I was uncomfortable before! Dr. Asgari came back in to the room; he sat on a stool in front of me and started to examine my breast. It was weird having a doctor that I have just met touching me, but it was even weirder to have this happen with my husband in the room.
I was getting more and more uncomfortable as the exam continued. Dr. Asgari talked more to Mark than he did to me. I think that was because I stopped talking. I tried to crack a few jokes, but the doctor had no sense of humor, so I stayed quiet.
Dr. Asgari explained that the reconstruction surgery would be done at the same time as the mastectomy. First he and Dr. Sullivan would work together with Dr. Sullivan performing the mastectomy, removing the breast tissue, but leaving the skin of the breast. Then Dr. Asgari will take muscle, skin and fat tissue that were removed from my stomach and use it to build a new breast. Then after I heal and complete my chemotherapy will the second surgery be performed. The second surgery involves Dr. Asgari reconstructing a new nipple on my right breast and reducing the left breast to match the right one.
"Could I go smaller?" I asked. I have always been at war with my breast. I have felt that I was a D cup body in a size A cup mind. Dr. Asgari looked at me and said:
"How small do you want to go?" Suddenly I have a choice! I have always wanted a breast reduction and this was my chance. The doctor explained that he would have to go a little smaller. The largest that he could manage was a C cup, and even that depended on how much fat/muscle tissue he could get from my stomach. He told me that he could only use 2/3's of my stomach muscle, apparently this has something to do with blood flow, and in most cases 1/3 of the stomach muscle was useless.
I found myself speechless. Here was a chance of life-time and I was too frightened to think. I looked down at my body, the body that betrayed me, and I realized that this was the only body I've know and I was going through enough changes that I didn't want anymore! I told the doctor that I wanted my breast to be to be as close to the same as possible. A decision that I later regretted. There would be many times between this doctor's visit and the operation that I wanted to call Dr. Asgari's office and say "A set of small C's please", but I was too shy.
Trying to lighten the mood, I told him that he would have no problem finding enough fat in my stomach to fill my breast. He looked at me with a very serious expression on his face and said that he thought that there might not be enough fat for the surgery. I was starting to like this guy.
As the exam was about finished he told me that he needed a few 'before' pictures. I knew this was coming because long ago back in the excessive eighties, I had a roommate who worked for a New York City photographer. This guy's job was to take the 'before' and 'after' pictures for many big named plastic surgeons. Through my roommate I always knew which New York celebrities were going under the knife.
This is the digital age, and I am in New Jersey, so my doctor took his own pictures. He told me to stand against a wall, then he poised my arms, opened my almost hospital gown, than sat back down on the stool and started snapping away. Now remember standing right behind him was Mark. It was just too weird.
There I was, standing half-naked in front of a man that I met thirty minutes ago and he was taking pictures of my naked torso with my husband standing behind him. The whole thing struck me as funny, and I wanted to laugh, but laughing didn't seem appropriate. So, while trying to suppress a laugh, my face looked as if I was scowling. Dr. Asgari took a few more pictures and quickly exited the room. Mark told me that my expressing looked like it is saying:
"You can take the pictures, but now I am going to have to kill you!!!" I guess intimidation works both ways.