Wednesday, September 23, 2009

Dr. Alex Keller - Reconstruction

I had my appointment with Dr. Alex Keller. His office is in Great Neck. I didn't have to wait at all which was great since I was on my lunch. He told me all about the DIEP procedure. He has done over 1000 of them. He explained how the vessels are reattached with micro surgical techniques. He measured me all over and then took photos. Topless photos again. Back when I was 20 they would have been pretty good. Not so much now. After that he said I could get dressed. I started getting dressed and he said I could go in the dressing room. I thought that was pretty funny considering he had just done the exam and took pictures.

The surgery takes at least 12 hours. I told him that the other plastic surgeon said may appendectomy scar, which is vertical, may cause a problem with the vessels that are needed. He said that he does a test called a CT angiogram to all his patients prior to the surgery. It produces detailed pictures of the blood vessels needed to perform the DIEP procedure. He said this makes it so he can operate with a "map" of sorts rather than going around blindly. He thought he would be pretty sure what to expect from this test, but there is always the possibility that he could find something he didn't expect once he gets in there. He also advised me that it was very likely I would need a blood transfusion after the surgery. There isn't time for me to give my own. I could get friends or family to donate or I could use the blood bank.

He talked about recovery. I can't lift Julianna for 6 weeks. :( That is a biggie but it is pretty similar with double mastectomy despite the type of reconstruction. I asked how long it would be until I could drive. He said 10 days to two weeks. Not too bad. I asked about showering. He said I could shower as soon as I got home. Very good. I asked how long in the hospital. He said three days. I thought that was great since Sloan said they keep you a week for this procedure. He said it was all comfort care and pain management after the first three days and he thought I could do that at home. He said I would need a visiting nurse to come to my house for a few days.

We discussed the DIEP procedure vs. implants. For implants the surgical time is very brief. However, you need multiple surgeries. They initially put tissue expanders in. Those have to have saline injected into them every few weeks until your tissue is large enough to take the breast implant. After that, there is an exchange surgery. In that surgery they take the tissue expanders out and put the permanent implant in. The problem with the implants is that it doesn't end there. You have to get an MRI every few years to make sure the implant hasn't ruptured. Also, they are not made to last forever and have to be replaced at least every ten years. The other problem is that it is a foreign object in your body. You can get saline or silicone. There are a lot of people who feel that leaking silicone implants are responsible for a lot of medical problems. The surgeons say that hasn't actually been proven, but why take the chance? So, they both have risks. With the DIEP procedure all the risk is up front because it is a long surgery, but after that you are finished. No long term follow up. It is your own tissue and actually the breasts will gain and lose weight as you do. It looks and feels like real tissue because it is. With the implants you have less risk at the time of the surgery but more lifetime risk and more surgeries long term. I prefer to get it all over with at the beginning and get it behind me.

Now we get to the subject of money. I asked him how much it costs. He said $60,000. He said he doesn't take insurance. I almost started crying right there. I don't have $60,000 and all my friends put together don't either. He said not to get upset and that I needed to speak to the woman in his office who handles the financial end of things. He said he has never turned a patient away for financial reasons. I spoke to her and she said she negotiated with my insurance company. They will pay for the whole thing!!!! All I have to pay is $100. I can handle that.

Dr. Keller works with two breast surgeons. One is Dr. Karen Kostroff. She is the Chief of Breast Surgery for the North Shore - Long island Jewish Health System. Impressive. The other is Marie Chen, also located in the same area. When I asked the office staff who they liked better they said they are both good. They said Dr. Chen takes insurance but Dr. Kostroff doesn't. They suggested I go to both and then make a decision. I thought that sounded like a good idea. I have an appointment with Dr. Kostroff today and I am hoping to see Dr. Chen later this week. I have to bring all my films and tests to each of these doctors. It was a little strange to call Dr. Sclafani's office to ask for my films. I told them I was going for a second opinion. I am still not cancelling the surgery date with them until I am locked in somewhere else.

I will post after my appointment with Dr. Kostroff.

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