Plastic Surgeon #1: Dr. Nguyen

I’m at the Aesthetic Plastic Surgery center of UPMC.  The parking situation here is atrocious, but at least it was free.  The waiting room is small, but I am completely shocked by how many people are here!  There are 13 people in this waiting room, men and women.  I can’t help but look around and wonder what type of plastic surgery they’re here for, and I’m staring while trying to figure out if they’ve already had something done.  The receptionist looks like he’s had his forehead done – his whole forehead is so smooth and looks paralyzed.

The receptionist gives me yet another health history form to complete.  Seriously – I cannot stand this!  I take 12 different medications/vitamins – listing them takes forever. Also, UPMC uses an online system called HealthTrak.  All of my medical information is stored in there.  After appts, the doctors notes are uploaded in there.  I can see all of my medical history, appts, test results, everything.  So why do I need to write this shit every single time I come into a drs office – they are all in the same hospital system.  And I have no doubt the doctor and/or nurse will ask me these same questions – what medications do you take? do you have any allergies? what’s your family history of cancer?

I’m also wondering if the surgeon will be able to see my biopsy results.  I haven’t received a call yet, but the doctor said it could be today or tomorrow.  I’m wondering if Dr. Nguyen will have the results in the computer.  They won’t show up on HealthTrak until a doctor reviews them with me, so I can’t just go in there to look.  The wireless access in here doesn’t seem to be working anyway.

I wait for about 45 minutes while two more people come into the waiting room, and all 15 of the people gradually disappear through the door to the exam rooms.  Eventually, I am called in as well.  I’m given a robe (again, no conceivable ways to make these ties work – they never match up!).  On the desk are three sample implants – of course, as soon as the nurse leaves, I get to work feeling them and determining how real they feel.  I hear a doctor knock on the door next to me, go in and introduce himself, but I don’t hear what he says.  I hope he’s not my doctor (there are 8-10 doctors in this practice), because if he’s just getting started next-door, then I’m going to be here a while.

A while turns out to be 30 minutes, and then a resident – Dr. Jindal – comes in to stall for Dr. Nguyen.  He does answer most of my questions, and we talk for about 20 minutes.  He does not have my biopsy results.  He seems pretty knowledgable, although he is not the one who would be doing the surgery, so I’m not sure it matters much.  Dr Nguyen comes in at around 12:15 (my appt was at 10am).  After repeating most of what Dr. Jindal says, he does an exam, takes measurements and pictures, all of which is rather humiliating but I suppose it part of the process.  All-in-all, I’m there for THREE HOURS!

General impression of Dr. Nguyen: seems nice, seems very concerned about aesthetics (making the boobs perky, tight, etc); seems pretty business like.   As I walk out, he becomes warmer, asks me about my job, jokes with me about having a toddler.  I liked him better at that point.

Here are answers to my questions:

What if I wait to have reconstruction a year or so down the line? Is the recovery easier? Still do a diep?
Probably won’t be a huge difference in recovery to do it all at once or wait until later.  Delaying it just allows more time to think about it.  Can still do the DIEP flap later.

Diep with arm flab?
Has never heard of that being done.

Will I look proportional with flat lower tummy but heavy top tummy and hips?
They do their best to smooth everything out.

How many DIEP surgeries have you done?
Probably does 2 a month for the last five years.  98-99% success rate (1-2% flap loss rate – blood doesn’t flow to the new breasts – will be checked with the first 48 hours).

What if my belly flab isn’t functional?
Belly is most common, but there are other options like back and buttock (although those are not preferable because they’re not as soft as abdominal).  They’ll do a CT scan with dye to check abdominal muscles, blood vessels, etc.  It’s usually reliable in showing them if they can do the DIEP or if they’ll have to do the free-TRAM.  They might have to do DIEP on one side and TRAM on another side.

Can I see pictures of DIEP procedures you’ve done?
Yes.  What I notice in the pictures is how natural the breasts look and how symmetrical they are.  He does a good job.

General:
Will try to go through c-section scar to keep incision low.  Move belly button up because they’ll take all fat and skin from below navel.  Will not take rectus muscle unless absolutely necessary, but hasn’t seen that done.  Muscle-sparing TRAM is also ok because they only take a sliver of the rectus muscle.

Recovery
10-12 hours, 4-5 days in hospital, first two days more observation for complications (happens 2-3% of the time that the artery or vein doesn’t cooperate), 4-6 weeks of restrictions lifting/exercise/etc, after 6 weeks should be healed and be driving, etc by then.  Three-four months later (or longer if I want to wait – no time restriction) = nipple reconstruction, tattooing, minor outpatient stuff for symmetry, scar revision, touch-ups.

Next steps – Dr. Ahrednt’s office coordinates the surgery; usually on a Monday.  Call to make appt for CT scan of abdomen.

Ask Dr. Moreland about stopping Methotrexate (can affect wound healing) before surgery – it could make a small difference, although he seems to think it’s not a big deal if I want to stay on it.

After observation, he does not recommend reconstruction to be done at the time of mastectomy because I would need too much breast skin removed in order to go down to a C cup.  Making a larger incision to remove more skin is likely to look bad and require more significant touch-up surgery down the line.  I only have enough flab for a C cup, but it will be a lot of complications.  He recommends doing the mastectomy now and then having the reconstruction after healing because then I will have the best chance at getting the size/shape that I want.

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One comment

  1. Thanks so much for sharing this information. I’m in data collection mode following a BRCA2+ test in April of this year. I plan to have my one remaining ovary/tube removed ASAP and am looking at DIEP flap as an option. Thanks for being so open about this.

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