In the Office of the Plastic Surgeon to the Stars/Following the Lump

Yesterday I went to see the Plastic Surgeon to the Stars. The office was near downtown in an old building with seemingly endless arcades in the lobby. The "lobby" was actually in a cross shape, containing stores and entrances to residences. The office upstairs was deliberately decorated, pleasingly so. Some original art in bright colors, red and blue animal poster in the kid section, everything horizontal with clean lines. But it wasn't fancy. The ivy at the end tables was fake. While I waited, a sleek woman with very short hair was leaving her appointment and getting some face creams from the staff. She was very pleasant, asking staff person A if B was pregnant, because she hadn't wanted to ask B, in case she'd gained weight. The patient looked about 35, like an Audrey Hepburn without the waif eyes, and I wondered if she had gotten a face lift. She had a lacy white knit shirt, dark pants and a long dark coat that hung straight down to mid calf. I had come in with my puffy down coat, plastic bags in my shoes to keep the snow from leaking in, and four layers on top under the coat, and silk longjohns beneath my corduroys. How did she keep warm? I assumed she hadn't taken the subway from one end of town to the other.

My impression of the doctor was that he'd been a nerdy science kid in high school and had grown up to become someone fluent and skilled. He measured my breasts across and in between and up and down--in centimenters, which he pronounced "sontimeters," and I wondered if he spoke French, because that's more the French pronunciation than English. The true French pronunciation, which would sound pretentious, would be "sonh-ti-mehtreh." Very very soft on the r. He did the measuring in a room for kids, and there was a sign on the wall about the patient having to pay for splints and bandages, and I realized he must do a lot of surgery after accidents. There was a brochure or magazine about prosthetics.

In his office he showed me the tissue expanders, which I hadn't seen before. Imagine a large, flat round piece of soap. Then imagine that it comes in a soft plastic skin. Now magically remove the soap and you have a tissue expander, with a little hole in it. Magically again, and painfully, it is put *under* your pectoral muscle, then filled through the hole, at intervals, with water, to expand your tissues. When you're expanded enough, that plastic comes out and a more durable one is inserted, via outpatient surgery. He had me handle the silicone-filled insert, which was soft and more natural, as he pointed out, and the saline one (filled with aqua mouthwash), which didn't feel as if it were as thick and viscous inside. He was pushing for the silicone, but I don't want it. He said I could decide later.

Then he showed me, on his computer, some before and after photos. I thought they looked better than the ones the other plastic surgeon had shown me. I was bothered by the other one's telling me that a reconstruction wouldn't look like a real breast, that it would be high and round. I thought that W's had looked real. So that's why I was in this guy's office. He showed me one picture and said, I could have done that better. He seemed so serious about his sculpting, and talked about what he'd learned about letting the top part of the breast be flat, and ways he had of making the bottom of the new breast rounder. Through stitches inside, here and there, he sasid.

I decided I want him to do the reconstruction. The problem is he doesn't have privileges at Fancy Hospital, which is down the street from his office. He said it wasn't possible (I pretended I was joking when I asked) to wheel me from mastectomy surgery at the hospital into his private surgi-center. But he said I could get the mastectomy and come to him later, after chemo/radiation. I'd been told it's easier to get all done at once--the tissue expander put in while you're still under--but I liked that idea of waiting. He said the breast surgeon could leave on the extra skin instead of cutting it off, but that it didn't matter. I do feel guilty that I'm making a decision that will be slightly more difficult for me but this is what I want. How quickly I went from No-Reconstruction-Hear-Me-Roar to getting a new breast installed by the Best (as I perceive it) in the Business.

Two surgeries! said L. But I like the idea of faster recovery now. I've always been more into immediate gratification than he is. I hope I won't regret this. I also like the idea of living without the new breast for a while, just to check out what it would be like *not* to have reconstruction. I can always decide to just let it alone, au naturel. Which of course it isn't. And I don't want to get a tattoo, like Deena Metzger, in the famous photo. It would hurt too much. Though I'm willing to get a nipple twisted from the new breast later on and to get that tattooed nipple-color. Under anesthesia. Local. My friend J said the hospital lost her nipple sample so they didn't know what color to make hers. She decided on the same color as her husband's nipples but now she says that was too dark, and the nipples show under her clothes.

The lump of anxiety

Had it all day Valentine's and I wasn't looking forward to class, which bothered me, because I usually do look forward to it. The lump makes me feel so desperate and helpless. About an hour before class I had some dark chocolate and some ginger-peach tea. And the lump went away. I will need to do scientific investigation (chocolate alone; tea alone) to see which one it was, if either.