Stuck flat and not okay. At all.

Outnumbered, I hear you. Due to my indecision about what kind of recon I wanted, it was almost two years after my diagnosis and surgery before I had recon. Meanwhile, I had to go through more chemo and radiation (which does it's own number on the chest skin). I understand the motivation to feel normal, at least as much as this disease will allow.

The only upside to this with the COVID restrictions is you can quarantine yourself if you don't feel like seeing anyone, and people won't think too badly of you.

I agree that maybe you need a different therapist. You need someone who will get through the terrible loss you've had without trying to paint a rosy picture ("You're alive, after all!). You may come around to that way of thinking with time, but right now you need some one who will help you put one foot in front of the other until you can go back for recon surgery.

My "helpful suggestion" is to start doing research into reconstruction methods AND the surgeons who are the best at each method, especially if this delay has caused you to give up the one you had planned to have. Maybe you have insurance restrictions, so in case you want to go to someone outside your policy, start the process of approval or at least check into what it will entail.

And I can't stress enough what researching the best surgeons means. Within my own family, two surgeries (not cancer) produced very different results because the patients took different approaches to selecting their surgeons. The patient who researched and picked the best surgeon for their problem had a complete recovery. The other patient just went with someone they picked from a list, never checking things like percentage of success. The outcome was a disaster. Now, not every surgery can be 100% guaranteed, but if you start with the most experienced surgeon, at a top notch facility, you will likely have the best outcome you could hope for.

outnumbered,

There are many wonderful therapists out there. If your current tele health psych is not working for you, please find another.

outnumbered - I sympathize, I am another who couldn't do flat and was very motivated to have reconstruction. I did not want a flap surgery if I could avoid it, and was not a candidate for several of the types available. As you can see by my signature line and the number of surgeries, I did not have a straight line to completion, but rather a number of twists and turns - with half flat two different times. I hated the prosthetics, but did find the best one for me for the flat duration was Knitted Knockers - very lightweight and easy to adjust shape and size. They are provided free and I will link the site for you. I echo the need to find a plastic surgeon who understands and is willing to help, and has the skill to work with the situation you have. I ended up changing plastic surgeons and my current one worked miracles for me. She was committed to providing me the best outcome possible and her meticulous nature and sympathetic demeanor was reassuring to me after the problems I had previously encountered. The bottom line was that she cared and understood my distress, didn't dismiss it. I am a big proponent of fat grafting BEFORE any attempt to place an expander or implant. I did not have rads but had damaged skin due to a perfect storm of thin skin, necrosis, abnormally thin pectoral muscles, lack of vascularity, and a very thorough breast surgeon. My skin behaved very much like radiated skin, and I had many of the issues people who have had rads experience. I had three fat grafts to the flat side over several months and it made a world of difference by adding integrity and vascularity to the damaged skin, and I was able to reconstruct. I would advise that you look into starting the fat grafting process while you are waiting for time to pass until you can attempt recon - these are small grafts spaced apart - you want time between them to encourage the fat to take, done as an outpatient. I will also link a thread about this concept, there are several study links in the thread header. Wishing you the best, and feel free to PM me if you would like more detail about any of my experience.

https://www.knittedknockers.org/

https://community.breastcancer.org/forum/70/topics/744891?page=1

Outnumbered, you are in San Antonio--there's a great breast reconstruction center there. Women travel from all over the country to see them. Here's the link: https://prma-enhance.com

Outnumbered, try talking to someone at PRMA about your options. From their site:

The PRMA billing department is staffed with insurance and billing specialists to help ease this process. We have worked successfully for more than 20 years with numerous insurance providers to ensure proper coverage for our patients. We will submit your claims and follow up as necessary--keeping you fully informed along the way--until your claims have been paid. We always provide you with a cost estimate before surgery so you will know your financial responsibility up front. Below you will find answers to some of our most frequently asked insurance questions. For more information or if you have further questions, please give our billing department a call at 210-447-7829.

Financial assistance is available by other entities or third parties in some cases for those in need. Your local American Cancer Society is a great resource for information on organizations in your area that may be able to help. For patients in need living in San Antonio, Thrivewell Cancer Foundation may be an option to help offset some financial responsibilities. For more information visit http://thrivewell.org/patient-assistance/. You can find information on travel and accommodation assistance HERE.

outnumbered - I am also Tricare Prime and have not had any issues finding providers, I’m surprised you have in a metropolitan area. That is very disappointing - providers should all accept the insurance that covers military. You can also appeal to Tricare to have your Prime coverage apply for a Select provider by exception if that provider is performing a surgery that other local Prime providers cannot. That is what I had to do with my original surgery - skin and nipple sparing BMX - because in 2010 there were few surgeons doing that surgery. My surgeon was a Select provider but was authorized this way and I was able to go forward.Have you looked at the list of Tricare providers from the website and tried to work backwards finding a PS that way? I know Moffitt Cancer center here in Tampa, an NCI center, takes Tricare Prime and they also have a Hope Lodge you can stay at for free if traveling from outside the local area. I believe the Center for Restorative Breast Surgery also takes Tricare, have you contacted them? I know that would involve travel to New Orleans, but they have enough experience to specialize in difficult cases also, and they do implant recon as well as flap.

Hi Outnumberedx4,

I had surgery a few weeks ago. Did they give you an idea when they will resume surgery? Sorry you have to wait so long. Is it possible to find another location that will do the surgery? It sounds like they are really unpleasant. Why 12 months? It is usually 6 months after radiation to remove tissue expanders and add implants. Why the hell didn't they put in tissue expanders during surgery? That's sadistic, especially since you were already under the knife

I think it is shameful that we cannot do better by our military and their dependents. They risk their life and mental health for our country, and this is the best we can do. Just bloody shameful!!!

OUtnumbered no suggestions just lots of sympathy. I am so sorry you are stuck in this situation Stay strong, try to find a new therapist who will actually listen. Does the military have the EAP program? If so, you might find a good therapist thru them.

outnumbered - I am so sorry you are going through this or what kinds of options are readily available. When I was considering DIEP, the surgeon told me it did not matter if I did it with reconstruction or 10 years later, but most do it at the time of surgery. I was not a good candidate for DIEP, so went flat. Talking care of your skin while you wait is important, and your surgeons or oncologist might not know very much, mine did not. Taking care of your stress is important. with Covid-19,much harder. Staying active, hydrated, eating "right" helps a lot. There might be on-line low impact yoga, qigong, meditation if classroom not an option. HUGs