General Surgeon Appt

I had an appointment with another general surgeon to see if he had more insight into the latest and greatest techniques, ideas, referrals...  I feel like I may have wasted my time and money.  I basically just heard the same things as my first general surgeon appointment.  I should have used that time and money towards another plastic surgeon interview.  That's where the aesthetics come into play, where there may be a little different technique used.


I was thinking though, about my plastic surgeon visit in March.  I was surprised to see that expanders actually are about half of "implant" material and then on top is a loose bag space where they are filled.  (There are probably other types of expanders, but this is the kind I saw.)  So you start with some volume from the "implant" material and slowly fill each visit to expand until the desired size.  I previously thought the expander was just an empty plastic bag of sorts.  There is a metal port at the top of the empty bag part where the physician can push the needle in to fill the bag.  He finds that port with a magnet, since the expander port can't be seen under the breast tissue. 


I believe I remember reading from several people that when they switch the filled expander for the implant, the expander looked fuller than the resulting implant.  Something to remember...

Nipple Areola Tatoos

I can't believe it!  It's crazy how I can be so-almost-sure about thinking I'll probably get a nipple-sparing mastectomy...and now I'm back to where I was originally with "I want to make sure as much tissue is gone as possible". 

Now I'm looking into the details of nipple reconstruction and areola tatooing.  Apparently, some physicians take skin from an area like the inner thigh that is a little darker and will use that tissue for the areola because they think it looks more natural.  I am thinking that I don't want scars ALL OVER my body and I'll opt for the nipple tatoo.

I found a helpful process in pictures on the site tatooednipples.com.  I didn't realize that the tatoo "artist" would place a stencil over your areola region and draw a circle boundary and then begin the tatoo.  They will give you a local anesthetic, or if you don't have feeling in your breast, they won't worry about that.  Apparently the whole process can take as little as 30 minutes a side!

                                      Measuring Areola Diameter

                                

Tattoo in Progress	Areola Tattoo Half Done

I am worried that the nipple tatoo artist won't do a "natural" job.  How do you determine who is the best nipple tatoo artist in the city?  Here is some guidance from tatooednipples.com:

Types of Artists

Finding an areola pigmentation specialist is sometimes daunting for women trying to complete their breast reconstruction after mastectomy. Not all plastic surgeons offer this service; women are often left on their own while trying to find an experienced specialist. This is especially true for those who have delayed this final step in the process.

Part of the hesitation stems from confusion and misperceptions about the Goth culture at tattoo parlors. It is, however, not surprising that some tattoo parlor artists are highly skilled in 3-D techniques and do include areola tattooing in their services.

The burgeoning trend, however, in areola pigmentation is with permanent cosmetics professionals. These artists have been providing paramedical tattooing for decades and now seem to be cornering the market in providing areola tattooing.

Here are the types of artists and settings where areola pigmentation services are provided:

Plastic Surgeons: Some plastic surgeons will provide areola pigmentation as an office procedure. More often, however, they will have a staff member trained in the procedure. Surgeons also may bring in consulting specialists, as needed, or will provide referrals to a permanent cosmetics professional.

Permanent Cosmetics Professionals: Permanent make-up professionals are becoming the main go-to source for areola tattooing. The industry has embraced this need with a focus on education and compassion. Permanent make-up artists have been providing scar camouflage services for decades. It was a natural progression that this industry would provide areola pigmentation. Plastic surgeons often call upon permanent cosmetics professionals to provide areola tattoos, either in their offices or in the artist’s private facility.

Tattoo Parlor Artists: These traditional tattoo artists are highly skilled in all aspects of 3-D techniques. Their skilled artistry is certainly a baseline for areola tattooing. Many are well known for their excellent work and have opened their hearts and shops to women for these services. Misperceptions about the Goth culture in tattoo parlors should not sway you from finding the best artist in your area.

Tattoo Basics

During a permanent tattoo procedure pigment is implanted into the dermal layer of the skin by using tiny needles. The dermal skin layer is the middle layer between the epidermis (top layer) and hypodermis.

During a nipple tattoo here is what to expect:

• Measurements will be taken (while standing) to determine the position and size of the nipple. (A 4-centimeter circle is the average size.)
• The artist will first draw the tattoo shape on your body so that you can visualize and approve the placement and size. Adjustments can easily be made at this point.
• You will then recline on the table while the artist begins his or her work.
• The artist will numb the area with topical anesthetic cream.
• Pigments will be applied into the dermis using an electronic handheld device that directs tiny needles into the skin. Connected to a digital console unit equipped with a microprocessor, the device enhances precision and needle placement and minimizes trauma to the skin.
• If both sides are being done, the artist may switch back and forth as different pigment colors and brushes are used for various elements of the design.
• As the procedure progresses, very small amounts of blood may ooze from the skin. The artist will dab the skin when needed.
• The procedure will take 45 to 60 minutes per side to complete.
• Upon completion, the artist will place gauze bandages over the tattoos.
• The artist will review and provide printed post-procedure care instructions.
• The results will be darker at first, and the color will fade as the skin heals. It is common that a color touch-up is needed several weeks after the initial procedure. Color touch-ups may also be needed every few years.
• (http://tattooednipples.com/tattoo-tutorial/tattoo-basics/)

Nipple is Tissue

For a while I couldn't understand why surgeons wouldn't just remove the areola and nipple, remove the tissue from the breast and then sew the areola and nipple back on.


First of all, the nipple is tissue that is predisposed to cancer, and according to one surgeon I spoke with, a high percentage of breast cancers occur behind the nipple.  That is a convincing reason to remove the nipple and areola all together.


Multiple surgeons have explained that when you remove the areola and try to replace it, it often undergoes necrosis and dies because there is no good blood supply after you sever it by removing it in the first place.  That is why if you want to save your nipple, you have an incision somewhere else to keep the blood supply to that area.

"Pepperonis"

"Pepperonis" is a silly name my good girl friends would use when they would talk about going tanning in the beds..."I burned my pepperonis".  We grew up in the beautiful VA beachy sunshine and yet it was pretty accepted to go tanning under fake light.  Yes, I did it too a few times.  Yes, I have some lovely sun spots from my sunny days.


Anyway, I am amazed that I am now considering the non-nipple sparing mastectomy again.  At first, this was my intention and then I was pretty sure that I was going to keep my nipples.  Now I'm back to wanting to totally reduce my risk as much as possible.  Back and forth...kind of crazy to think I can be so swayed by facts and emotional influence.  I guess I'm lucky to have a little time to consider all of these options with leisure to make sure I am making the right choices for me/us.


Okay, so I was reading a blog about a non-nipple sparing procedure where she had her mastectomy and then weeks later went back in to have her nipples reconstructed.  The plastic surgeon I recently saw said immediately after the mastectomy he would cinch up the areola vacancy like a purse string and form a nipple.


Here is an interesting description of how a nipple would be reconstructed weeks after the mastectomy.  Takes about 30 minutes with local anaesthestetic (so you could watch it you wanted-cool and yikes!).  You wear little plastic cups for a while to allow the nips to heal without rubbing on clothing.  Looks like your nips are constantly cold:)