Friday, June 13, 2014

Flying to Antarctica

I never sleep well the night before I fly- not for some time before, if the truth be told. I have trouble giving up my illusion of control to the invisible man in the cockpit. It's hard to entrust a stranger with my life.

Once aboard, bag carefully stowed in the overhead locker and seatbelt firmly tightened, I accept that the choice has been made. I'm headed up to the endless acres of rolling white, as much a toy of the gods as Scott of the Antarctic. Perhaps today they'll do what they've threatened for the last 18 months, and kill me for their sport. That would be the ultimate irony.

But the wisdom of Pooh comes back to me. Perhaps they won't. Either way, there's nothing I can do but surrender to the experience. I give in, just as I do before each surgery. I imagine I'm sledding hundreds of miles in a frozen, ethereally beautiful landscape, the numbing snow spreading in infinite dappled contours to every horizon.

It was some small measure of comfort
to travel with Keith Urban on my lap.
And on this occasion, I wonder more pragmatically if I've brought enough warm clothes, because coming from the subtropical Bungy to the chill depths of Victoria might just be a little bit of a climate shock. But it had been notably cheaper to fly with only the Bear's carry-on sail bag; I'd been damned if I was going to succumb to the Jetstar website's siren song and add checked baggage. How much could I possibly need for five days in Melbourne?


A little back-story. I'd realised some time ago that I just couldn't sit comfortably with the idea of a double latissimus dorsi reconstruction. (No pun intended.) Since I saw Dr Mattel, I'd started to hear louder and louder internal voices screaming that I was tempting fate. God knows I've had enough nerve pain from the surgeries I've already been forced to endure on my upper body; why on earth would I screw around more than absolutely necessary with the sensation and function I had left up there?

No, I wasn't happy with Dr Mattel's advice. It had nothing whatsoever to do with the gradual dawning of awareness that his expressionless face, so impossible for me to connect with, had probably been Botoxed to within an inch of its life. What did it matter if my plastic surgeon was trying to cheat time, as long as he was a great technician? What did it matter if he was as empathetic as an Easter Island statue, as long as I ended up with a great rack?

Who am I kidding? I didn't trust him. You don't tell a patient who's had a life-threatening disease that you wish she was bordering on obese, instead of working to be more healthy, just because that would make your job easier. You don't tell a patient that the timing of her operation will have to work around your skiing holiday, for fuck's sake. I'm a slow burner, but in the weeks since my appointment with Dr Mattel, burn I most certainly did.

Cancel my follow-up appointment I also most certainly did. The fact that no human was available to take my call during normal business hours seemed to confirm my decision. I've had second thoughts, I said to the answering machine; no point being rude. I'm sure he's exactly the right surgeon for some females.

Like, say, Barbie.

But I am not a plaything. The time had come to seek a second opinion.


Jools had been telling me for some time that she knew some excellent practitioners south of the border, in that great state which the Bear has always called 'Mexico' (to the complete confusion of our less lateral-thinking friends). 'She's gone to Mexico for a few days,' he'd say down the phone when I went visiting, without a single syllable of clarification; the last time I dropped in on my best friend, certain people expected me to return with sombreros and chilli sauce.

But this time I was going in search of something far more elusive than fancy hats and cooking ingredients. I wanted to come back with hope, because I'd decided sadly that if the lat dorsi was the only option, I'd settle for being flat-chested for the rest of my life. It wasn't an idea that appealed very much to a girl who spent her late adolescence balancing her conversational shortcomings with increasing lengths of exposed cleavage.

Nevertheless, it did sound more like fun than having my back muscles excised, exported to Twin Peaks and told to learn to be Laura Palmer's deceased and numb perky bits, instead of holding me upright. Apparently they're liable to spasm now and then without warning while they're being schooled. Tourette's tits don't really strike me as desirable to anyone, except perhaps the sideshow manager at the circus.

Dr Goodguy was completely amenable to the concept of a second opinion. "It's important that you're sure," he'd said when I suggested by late-night email that I might like to front up to the exchange desk at Boobman Carvery. Not for a moment did he ask me to justify the request- confirming yet again that the sun shines out of his nether regions 24 hours a day. Referral arranged, I headed down to Jools' sculptor-of-choice in Mexico City.

On the chosen day for my first encounter with this purported Rodin of the flesh, I walked seven kilometres through suburban Melbourne to get there. Perhaps this was sheer bloodymindedness. It had flashed across my mind that I could choose to drop my exercise routine back a little, to avoid losing any more abdominal weight, but the angel on my shoulder had replied that the Freeloader's always on the lookout for a job opportunity in my body. Perhaps constant vigilance might be a reasonable position, regardless of my desire for new tits of substance.

Sounds fair. 17 kilos gone and counting. Above all- above even the reincarnation of my soon-to-be-extinct boobies- I want to live.

The first encouraging sign was that I only spent twenty minutes in the waiting room beyond the allocated start time. Hoorah! I passed the time with a Facebook friend who happens to see the same surgeon; she too assured me of his worthiness. The stars were aligning.

And then the heavens parted and let me through. I found myself in the company of Dr Yes.

Yes, it was possible to perform double DIEP flap surgery using this amount of abdominal fat. A C cup, or something approaching it, was entirely possible. And given that a patient's entire silhouette would be altered for the better by this procedure- the tummy tucked, the breasts more pert- women often found that they were in fact content with a somewhat smaller cup size than they'd anticipated.

Yes, if I found I really needed to be a D cup he could insert implants at a later date. Mind you, this would negate one of the advantages of this type of procedure- the durability of the new breasts. DIEP breasts last for ever, grow with the patient if weight is gained, shrink with the patient if weight is lost, age naturally, never need tinkering with. Implants have a shelf life (no pun intended). In ten years or so, they might well need to be replaced, and who wants to be bothered with more surgery every decade?

Yes, this procedure would ideally be performed without particular interference with the muscles. Only in the case of unforeseen complications would he attempt a TRAM flap process instead, and use the rectus abdominus.

Yes, it was poor logic to gain weight in the hope of a larger cup size. For surely the aim is to stay fit and well? And on losing the excess weight again after the surgery, the artificially inflated balloons would simply deflate once more and turn into saggy baggy elephant mammaries.

Yes, I would only need to be away from home for a few weeks; I could fly perhaps a week after leaving hospital, which would be somewhere between the fifth and seventh day post-surgery.

Yes, the price included everything from the time I decided to proceed until the moment I was finally completely happy with my new chest. Adjustments, if there should happen to be some asymmetry. Pseudo-nipples added creatively, some three months after the original surgery. Implants later on, if I wasn't happy with the size.

And all this imparted with kindness, humour, sensitivity and an attention to detail which made me realise exactly how superficial my previous experience had been.



I emerged triumphant into the waiting arms of my fellow breast cancer blogger, Lisa. It's a treasure chest discovered deep in the sewers of cancer, this making of new and close bonds all over the world as you face your Freeloaders side by side. Thank christ for social media. How else would we survive the emotional battering? How would we ever let out our deepest fears? Aside from Dr Yes, this was the other shining star in the Antarctic sky; I took the chance to meet up with some of the women I've previously known only from a profile picture- women with whom I've shared everything from our cancerchondria to our partner problems to our drug-induced sexual disfunction.

These women know more about this new, cancer-compromised 'me' than almost anyone else in the world. To meet them face-to-face was liberating, heady, exhilarating. We chattered like monkeys on crack. We laughed almost to the point of incontinence, as two of the girls swapped wigs in the middle of a restaurant and caused the spunky waiter to lose his carefully cultivated nonchalance. We fell about again as the same two exhorted some random young women, standing smoking on the sidewalk, to stop before they gave themselves breast cancer. One of my bosom buddies ripped off her wig once more to make the point, sending the youngsters scattering in alarm, teetering like drunken stick insects on their stilettos as they fled.

Sure, it was essentially a business trip- but I had fun.


And so I will return to Antarctica in due course, but not before Dr Goodguy removes both my ovaries and the remaining breast. That will give Dr Yes a level playing field, and it will give me a shorter time under anaesthetic. It's a massively long operation, eight to ten hours, thanks not to its invasiveness- it never goes inside the body cavity- but to its complexity. It's fiddly. It's all about finding, preserving, extracting and then rejoining major and minor blood vessels, so the flap continues to thrive in its new location. Flap death is a very real possibility- but as Jools points out, with the amount of intense exercise I've been doing, it's likely that my abdominal blood vessels will be in superb shape and the transplanted flesh will have the very best chance of survival.



And this I know: when the time comes, about three months after the second mastectomy, I'll have plenty of visitors. These days I can fly to Antarctica in almost any direction, and still find enough true friends to keep me warm.