Before I move on from all the breast reconstruction posts, something’s happened that ties things up nicely. Or not that nicely, as it happens.
Not as serious as cancer, but serious because it’s because of cancer.
Yesterday was my 3-month follow-up appointment with my plastic surgeon after my phase 2 revision surgery in October. To recap: that op was to reconstruct my nipple and get my breasts to match in shape and volume following my mastectomy and DIEP reconstruction.
At my pre-op appointment in May 2020 the surgeon said they were aiming for twins, not sisters. However, at my post-op review in December they agreed that my breasts seemed more like sisters, but it was too soon after surgery to know the final result and we’d see how they looked after 3 months. So that’s what yesterday’s appointment was specifically about.
It appears they may not have noted that. After talking about my general recovery and the shape of my recon’d breast, they seemed to be wrapping up the appt, so I asked what they thought of the volume.
He said it looked good. “Really?” I said (confused by the change in opinion). He huff-laughed out loud, looked over to his nurse, head half-cocked, as if to say ‘get her!’.
Then the surgeon said: “It’s better than no volume at all”.
My WTF-ness was obvious. So, they clarified: “I’m being facetious” he said. “I know,” I replied, “and it’s not funny”.
Because: really? Haven’t we progressed from the ‘be thankful for what you’ve got’ (or, rather, ‘what I’ve given you’) mentality associated with breast cancer reconstructive surgery? Because that’s what such glib, back-hander remarks are rooted in.
He then changed tack – although not tact – telling me “It looks better than it did before”. Yeah, I would hope so! (and it does – see I can do #thankful).
Then he side-stepped into: your breasts may never match as there’s so much scarring and changes to the tissue, and there’s no point trying until post-menopausal changes have stopped.
Which leads me to another #PlasticSurgeonsSayTheFunniestThings (#Not)
At the beginning of the appointment, they asked about the indent in my natural breast which had me terrified the last time we met. I explained that my oncology breast surgeon thought it was involution (collapse of the lobule brought on by menopause).
“They used to call it getting old”, my plastics smirked. FFS. I’m in menopause because I had chemotherapy, my ovaries removed and am now on hormone therapy because I was diagnosed with breast cancer at 46. Old age? Get lost.
I guess that should have been a heads up about how the appointment was going to go down.
I’ve alluded previously to awkward moments with this surgeon, but I’ve always given them the benefit of the doubt and self-blamed my chemo-brain miscommunication. But I knew that that wasn’t being authentic to me. I’ve cracked on with them because I had a job that I needed them to finish.
It happens when my husband isn’t with me. He was at work yesterday so, before I went to the appt, we decided that if it did get a bit awkz again then we’d know that any further surgery would be with a different surgeon. So, there’s the positive, I guess.
It was disingenuous to offer me the twins analogy pre-op. However, despite that I don’t expect perfection. But I do expect a closer match. And I absolutely expect respect.
At no point yesterday was I asked what I hoped for as a final outcome. What if they’d said: I know you were underwhelmed by the volume last time we met and we agreed to leave it for 3 months to see how things were and discuss what options were available. How do you feel now?
That’s the consultative, patient-centred approach I’d expect from someone who’s held in such high esteem. You would assume specialists who communicate with patients, with cancer patients, could do so without the need to be defensively facetious in a way that lacks empathy, compassion or a sense of what’s appropriate.
Seems not. And I know I’m not the only one.
When you talk to health professionals about how surgeons communicate *air quotes*, they nod and say, “that’s surgeons for you”.
It’s tempting to say they should use their inside voice, but I’m not having that either. I don’t want anyone that I let treat me to have an inside voice saying things are “good enough” (and all the connotations that go with it). The fact that I’ve been seeing someone for the past 3 years who does makes me feel sick. It feels like I’ve been had over.
Don’t get me wrong, the surgical results of my DIEP are great. But for me, and up until yesterday my surgeon too I thought, the recon isn’t finished until there’s a closer match. So I still have unanswered questions. Questions I stopped asking yesterday because I’d mentally subbed them off my team as soon as they uttered their facetious ‘funny’.
And it’s not just about the surgery outcome. As a patient I am more than that.
No matter how good they are at the hard surgical stuff they need to get better at the soft stuff to form the allness of treating a patient. Cos that’s where the real clever is. That’s where the real respect for a patient is. Because that’s where the wholeness of the patient is.
Anyone can use their ‘clever’ to be a smartarse in a relationship where there’s a vulnerability brought about by a power and knowledge imbalance. It’s not big, and it’s not clever.
You expose yourself on so many levels when you reconstruct your body after part of it was cut out because it was cancerous. It can be hard as a cancer patient to handover agency for your body to a specialist. You’re trusting them with your life but also how you will bodily ‘be’ you afterwards. For them to use facetious asides to invoke in you a gratitude for their work (the “better than … ” that they’ve done for you) is next level toxic positivity.
And it’s got no place in my cancer story any more.
Anyway, at least the appointment was only 6 minutes of my life I’ll never get back – it’s better than it being 30! #ThankfulAgain