Frannie Slagter has been cancer-free for three years, and this is her breast reconstruction story, including her struggle with a necrotic breast.
“I kinda knew some of the other options, and I looked at a what a LAP flap was, but you trust what your doctors and medical professionals are telling you,” she said.
The plastic surgeon made a convincing game plan for her type of breast reconstruction, a latissimus dorsi flap, and said she had done many of this type. She explained that it was a simpler procedure than others, with less risk. The surgeon mentioned that she had done many, but Frannie now says the important question really should have been, “How many do you perform each week?” Frannie browsed through the before and after stories of her surgeon’s patients, but looking back on it, she doesn’t think any of them had had radiation before reconstruction, as she did.
“This makes a difference, which she really didn’t tell me,” Frannie says. “They kind of tell you, but the first question that the doctor should ask is ‘Did you have radiation?’ For me, in hindsight, the more complex surgery would have had a better outcome, and I would have been a year ahead of where I am now.”
Frannie shares her most important piece of advice to women who are considering breast reconstruction.
Frannie continues, “From the way she made it sound, I thought it would be easy. Of course you want to go with the simplest procedure, and you think there will be nothing to it. I agreed to the surgery, and they put in expanders.”
The plastic surgeon chose to perform the procedure as an outpatient surgery. Frannie believes that having the procedure as an outpatient surgery was probably a mistake. It was a difficult first couple days, and having professional care might have helped with some of the complications that followed.
Her skin was tight after radiation therapy, especially the right side which was extremely tight and contracted. A week after the surgery, her surgeon began to fill the expanders with saline. “I would cry and cuss the whole way home from the doctor’s office,” Frannie says.
The right side, where she had radiation therapy, was the worst. She suffered extreme pain from front to back for days. Unfortunately, within three days of the initial surgery, her breast became necrotic (this means the tissue was dying) and turned black.
“It was barbaric,” she said. “It’s horrible, especially if you have radiation. I can see a women who didn’t have radiation and maybe just wants something simple. That might be a good option for her, but if you’ve had radiation, the risk of complications is just way to high, and the result, you’re not going to be as happy with it, I think.”
Not only did Frannie suffer from a necrotic breast, the wound from the surgery would not heal. She dealt with an open wound on her breast for four months and had to go through hyperbaric oxygen therapy and wound care. Her physician suggested a muscle flap as a solution for her problems. As an occupational therapist, Frannie needed to use her core muscles regularly, as they gave her the ability to lift. Taking from her core muscles was not something she was prepared to do.
She felt stuck and was also afraid that no physician would ever want to finish another physician’s work. All she wanted was to look normal again.
“It was never even on my radar that it could fail. I mean, she said she had a 99.99 percent success rate,” Frannie explained. “So I’m playing my odds. I should be OK. It was never on my radar what complications could occur.”
As the months passed, her skin never stretched, and the wound never healed no matter what they tried. Eventually the time came when she had enough.
“At this point, I just want this healed, and I want to move on. I didn’t even care if I had boobs at that point,” she says. “It was so traumatic. Just get it healed, and then I’ll move on. It is really, really scary walking around with an open wound on your chest.”
Frannie was worried of the possibility of an infection. As a health care professional she knew that an infection could spread and was especially concerned because of the close proximity to her heart.
“I told my husband this is scarier than the cancer,” she said. “I know how fast you could go septic and die.”
The surgeon took Frannie back to surgery. She let some saline out and sewed her up, but there was still an open wound that would not heal. Frannie continued with the hyperbarics and the wound care. She started to see black again in the wound, which turned out to be the implant. Her wound went clear down to the implant in her chest.
That was at Christmas. The next appointment with the plastic surgeon was on December 26, the day she left for a family vacation. Her car was packed, and everyone was waiting as she went into the office. She was finally ready to give up, after 6 long months, and insisted her surgeon take out the expanders. The surgeon did so, right there in the office, and sewed her up. The plastic surgeon agreed that it might be better for Frannie to look into other options, such as a breast center, something Frannie had mentioned she was looking into.
“At the end of it, I was worse off,” Frannie says. ‘I had one size D and one size nothing. It looked way worse, and every time I looked in the mirror I would get mad–mad at myself, mad at my results.”
A Work of Art
“I was a nervous wreck, I was just battered,” Frannie said.
Family and friends in the medical profession encouraged Frannie to get a second opinion and ask to look at a lot of pictures. Frannie contacted a center that she had been researching online. The Center for Restorative Breast Surgery in New Orleans is renowned facility where the latest breast reconstruction procedures are used. Allegedly, that’s where Angelina Jolie had her breast reconstruction done.
The Center offers newer, innovative procedures. One of these is the Apex Flap, where fat is removed from the abdominal area and used to recreate the breast. It seemed more suited to Frannie’s situation.
“I wanted the best of the best. This was all they do. They were so wonderful to work with that it just took off from there,” Frannie says, “They preserve muscle, and they don’t use expanders. No implants.”
The expense worried her, because she was going out of network from her insurance.The cost of the surgery was somewhere around $100,000. Frannie likened it to a transplant. The actual cost was probably even higher.
“They said, ‘Give us an opportunity to work with you. Too many women hear that number and hang up and never call back. Let’s see what we can do,’” she said.
She filled out the paperwork online, and within 48 hours they contacted her. Frannie felt relief. They asked every question that should be asked to learn her medical history and about her cancer journey. Their process was extremely thorough. The questionnaire consisted of all the logical questions a physician needed to ask a new patient. Her other plastic surgeon never asked all those questions. They discussed what the best procedure would be for her situation and made a plan.
“They got it. You could tell they just got it,” she said, “This was going to be better. You could just tell.”
The center explained that she was lucky, because her insurance would cover some of the cost. They talked about what she could comfortably afford and assured her in their earliest discussions that they would try to work with her to make it an affordable option. They did what they said.
All the pre-surgery, pre-op scripts, pictures, etc., were done via phone and internet. Frannie traveled to New Orleans for the first surgery, which was nine hours long. Her abdomen felt tight afterwards, because the physicians actually liposuctioned from fat from her belly to fill her breasts. Thankfully, this time the medical staff kept her in the hospital for three days, allowing her time to heal well.
Frannie jokes that all the weight she gained over the past three years was put to good use, when the surgeon removed it from her abdomen and placed it in her breasts.
Her treatment plan involved a three step procedure. During the second step, the physician repaired the severe scars left by her first attempt at breast reconstruction, made everything “look pretty”, and threw in a little liposuction for her thighs–an added bonus! The third step was a nipple tattoo by renowned tattoo artist Vinnie Myers, who comes to the center for a week out of every month to do nipple tattoos.
“They look very real,” she says of them today.
All in all, Frannie paid the breast center about $20,000, divvied up between hospital stays and surgeons. Frannie explains that a figure was decided up front in those first discussions, but then the center worked to retrieve what they could additionally from insurance. She felt so much less stressed than during her first attempt at reconstruction. The breast center took care of all the details except booking the flights to New Orleans. The whole experience exceeded her expectations.
“They really know what the hell they’re doing,” she says. “Some doctors just look at form and not function. A good reconstructive surgeon looks at it like art, beauty, and function.”
Today Frannie feels happily on her way down the road to recovering her confidence and positive body image. Her breasts are not the breasts they were before the double mastectomy, but the results are the best possible, and that means a lot in her healing. What was once a necrotic breast is now a work of art. She feels as if her body is as close to normal as she can physically get at this point and believes it is time to tell others about her journey.
“All I want is for someone to learn from my misery,” she said, “Explore all the options, and ask questions. It’s worth it.”
For more information on The Center for Restorative Breast Surgery in New Orleans, Louisiana call 504-899-2800 or go to www.breastcenter.com
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