May 20th was a day I had been anxiously anticipating—second only to May 8th, when I got the news that there were no additional tumors and there was no lymph node involvement. Relief, but also a new chapter unfolding.
Before diving in, let’s be real—transparency is my thing, in both my personal and professional life. So, here's a little background: In 2023, after a significant weight loss, I opted for elective plastic surgery. A different circumstance, but it meant I had some prior experience working with a plastic surgeon (PS). However, this time, I was meeting a new face—Dr. Cantwell.
That prior experience turned out to be invaluable. I knew what questions to ask, and I was familiar with some of the terminology. But this consultation felt different—it carried the weight of something bigger.
This time, there was no dramatic opening statement like, “Hello, I am Dr. Cantwell, and the good news is that you are not going to die.” (Thank goodness! š¤£) Instead, his introduction was calm and inviting, but we quickly got down to business.
The first thing he asked? “When was the last time you smoked?”
Fair question. After smoking cigarettes for 22 years and using a nicotine vape for the past nine months, trust me—you remember your quit date. “May 9th,” I told him—the day after meeting with Dr. Olimpiadi, who had stressed the importance of quitting for surgery. And I had quit.
Cantwell explained that he prefers his patients to be nicotine-free for at least four weeks before surgery. Cue anxiety—my original surgery date was June 9th, just past the four-week mark, but it had since been moved up a week. I asked if that was going to be an issue, and he reassured me: “As long as you haven’t had nicotine since May 9th and don’t have any between now and surgery, I’m confident you’ll be fine. But, yes, it’s cutting it close.”
So, nicotine-free and committed. Ask my husband or kids, and they might tell you I’ve been a bit of a grinch. Fair. But going 3+ weeks without nicotine when you are a naturally overstimulated human being? That’s a first for me, and I’m proud. š
Then came the deep dive—Cantwell walked Nick and I through everything. Photos, information, explanations—he was thorough, bringing 17 years of expertise to the table.
We discussed:
- Unilateral (one) mastectomy with reconstruction
- Bilateral (two) mastectomy with reconstruction (which had been my initial preference)
- Unilateral or bilateral mastectomy without reconstruction
And then… the reconstruction options: tissue expanders vs. direct-to-implant.
A refresher for those who might not remember from Pt 6, Lesson 3:
- Tissue Expanders: Temporary implants used to gradually stretch the skin in preparation for permanent reconstruction. Saline is added every few weeks until the desired size is reached, then replaced with an implant.
- Direct-to-Implant: Implants placed immediately during the mastectomy, skipping the expansion process entirely.
His reasoning made sense:
- No lymph node involvement
- No gene mutations
- A single tumor, about 2 cm in size
Removing both breasts, in his view, wasn’t necessary. If I were to get cancer in my right breast later, he said, it would be for entirely unrelated reasons—a separate fluke.
Naturally, my next question: Would he be able to achieve symmetry between my two breasts? Because let’s be honest—no one wants one perky and one saggy boob, right?
Cue the awkward moment—off came the gown. Standing there, topless in front of my male doctor and my husband? Definitely a little strange. But, duty called.
Cantwell examined me and felt confident he could achieve symmetry. And if adjustments were needed, he’d handle them on surgery day.
So, with everything laid out, it was decision time. My game plan for June 2nd:
✅ Unilateral mastectomy—remove all the tissue
✅ Nipple preservation
✅ Expander placement—insert expander and fill with saline to a safe and comfortable level during surgery
A clear direction. A plan in motion. The next chapter begins.
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