A Diet to Die For! Breast Cancer in Canada.

If Barbie were Yiddish, Joan Rivers could be her bubby (pronounced similar to boobie) …

Joan Rivers has had a lot of plastic surgery — I think I heard her say on some show that she’s spent about $150,000.00 on plastic surgery. To me, she still looks old, except now she could be Barbie’s really old relative with smooth skin. Poor Melissa, Joan’s daughter, could also be Barbie or Midge’s great old auntie now, too — I certainly see the similarity between Midge and Melissa’s foreheads, don’t you?

This post is about surgery, including plastic surgery, except it’s about the decision for reconstruction surgery after a radical mastectomy.

The good news is that the Ontario Health Insurance Plan (OHIP) pays for all reconstruction surgery for breast cancer survivors because it’s considered “body image”.

I haven’t been referred to a plastic surgeon yet and Dr. Ewan says it will probably be a year before I’ll be able to get to see one — and that most plastic surgeons typically don’t like to consider surgery after breast cancer for at least a year after a mastectomy [paraphrasing] — so this information may change after I’ve seen a plastic surgeon.

After a mastectomy, there are several options (all paid for by OHIP):

1. Do nothing. This is more common than I ever thought and more common amongst mature women over 60. I read an article about a photographer who had taken photos of women with mastectomies which looks pretty darn cool.
2. Prosthetics (plastic boobs that pop into your bra). One of the nurses at the hospital came in to show us her prosthetic (there were 2 of us in the room that had a radical mastectomy). She popped it out and I was relieved to see that it has a nipple — continuing to look like a girl is important to me. She said that she had her mastectomy over 20 years ago and only now is she considering reconstructive surgery.
3. Implants. These, to me, seem to be the least invasive. My question would be, does the other breast also get a bit of a lift — since I still have one real breast, I think it would look quite odd to have one breast that doesn’t project like the other one. I’m hoping the answer is yes, I would get a smaller implant into the real breast so that both breasts match.
4. TRAM flap. For me, this sounds like I would be out of commission for a long time again. Although getting a tummy tuck as well as a new realistic looking boob sounds fabulous, I’ll guess that recovery time is at least another 6-8 weeks. After the surgeon takes the fat from the abdomen, they make a new breast from it. After which I can decide to have a tattoo for the areola — and the nipple is made out of a piece of the labia. I doubt all of this is done at the same time, which probably adds to the recovery time. Since I’m self-employed, this is not an ideal option for me … even if I would love to have a tummy tuck at 50!

Perhaps it’s a good thing I have to wait at least a year before making any decisions since I’m still numb from the elbow up to the shoulder, across to the collar bone and down past the incision area — it’s bizarre to be itchy and numb simultaneously.

Hopefully none of these options would make me look like old plastic; the way the majority of celebrities are moving towards … how on earth do they expect to have a career in acting if they can’t show any expression … hmmm. That’s another question for another blogger that cares about celebrities.

Look for the Joan Rivers doll & Melissa Rivers doll coming to a store near you …

… and Melissa Etheridge … and Olivia Newton-John … and Sheryl Crow.

When I was first diagnosed with breast cancer, I tried to find as much information as I could about the above celebrities’ various breast cancers, and what treatment options and reconstruction surgery they undertook, if any.

I, of all people know what a private matter this is and certainly don’t begrduge any of them for holding back details … I’m also not a celebrity hound and usually don’t know or don’t care about their private lives … but was hoping that if they spoke publicly about their treatment options and choices, it might help someone like me. Medical terminology can be quite droll and difficult to read at times — this is one of the major reasons that drove me to start this blog, i.e. provide as much information about breast cancer and the Canadian health care system in one place, in easy to read and hopefully understandable language.

Unfortunately, I couldn’t find very much information about the above celebrities’ choices for breast cancer treatment … and most of the celebrities seemed to have had a lumpectomy: which is, if the tumour is small enough, similar to digging out a cyst, and means there is no removal of the breast, except for a tiny bit of tissue. I realize that on petite women and those with small breasts, even a small tiny bit of breast removal can be deforming.

I’m not thrilled to hear Christina Applegate say she is “cancer free”. That’s impossible from my understanding of the disease — I can only guess that because she carried the gene BRCA1 (which stands for BReast + CAncer) [link opens to National Cancer Institute], she decided to have a bilateral mastectomy (removal of both breasts) BEFORE any cancer had the opportunity to invade her body.

Here’s a link to another blog regarding Christina Applegate’s decision to have a bilateral mastectomy and her interview on Oprah Winfrey on CNN.

Since Christina Applegate likely didn’t actually have any tumours, she likely opted for implants. The implants were likely completed at the same time as the bilateral mastectomy … and likely why she was able to bounce back fairly quickly.

Ok, an over-use of the word “likely” … but I’m guessing what she did based on my personal knowledge about breast cancer.

—- Pardon the Detour —-

Another option for breast reconstruction is a Tram Flap [link opens to Wikipedia]. If you have abdominal fat, although more invasive than implants, a Tram Flap seems to be a great option — you not only get a real looking breast, you get a tummy tuck, too! If you are in Ontario, these procedures are covered by OHIP.

Information missing from Wikipedia
Will your Tram Flap (they really should find a sexier name for this!) have a nipple and areola? Yes, if you opt to get a tattoo for the areola. The nipple is recreated from tissue from your labia.

Recovery time from a Tram Flap will be much longer because you are getting multiple surgeries. There’s also a Diep Flap [link opens Wikipedia] -a  Tram Flap is apparently muscle-sparing.

—- End Detour —-

… and this is probably extremely personal but I think should be known: as far as I’m aware, if you carry the BRCA gene, not only does the likelihood of getting breast cancer increase ten-fold, the chance of also getting ovarian cancer increases as well.

My guess is that Ms. Applegate likely also had an Oophorectomy (removal of the ovaries) [link opens to Wikipedia]. If she didn’t get an Oophorectomy, this decision must have been quite difficult.

She didn’t undergo the miserable staples across her chest, radiation or chemotherapy that us regular folk have to contend with. If she did, she wouldn’t be in the public eye for at least a year.

In a way, Christina Applegate really isn’t doing us many favours by speaking out — if she really wants to help, she needs to say more.

I asked my surgeon, Dr. Ewan, about BRCA testing here in Canada and he informed me that the tests cost “hundreds of thousands of dollars”.  Yikes! No wonder the wealthy are disease free.

Please, my friends [bad political joke], stop sending me pictures of Christina’s cleavage unless you know what she had done — I have to admit that I was fairly convinced it was body makeup that gave her cleavage a lovely glow because I know what physical scars are left behind.