Rejected as Patient

i am very sorry to tell you that at this point, i cannot in good conscience accept you as a patient.....i think that somehow through all of this, you have lost the first and most important concept that you are at high risk for developing a life threatening disease and so the first and i think only important issue is that you have all the breast tissue at risk removed.....as for the next step o f reconstruction, nothing is guaranteed...your e-mails to my plastic surgeon seem to be most concerned about visual physical outcome....i know that we are actually quite excellent with our reconstructive results but if feel comfortable with a non university based team on your side, then please continue your future care with them....it been very nice to meet you and see you....i think you will do well with another group and i do wish you well....

it is reasonable but i feel at this point it outweighs the true goal and mission i have for my patients.....cosmetic outcome is important but never guaranteed....our issue here is to cure you to the utmost possibility for you never having to face breast cancer.....discussing pictures and other such expectations takes away from our mission at cornell.........i am so sorry that we are not in a position to help you in your goals, but i know you have communicated with others and i sense that they may be better able to help you...

dr. s.

Surgeon's Limitations

Hello Tamarin

I am starting to become a bit concerned that your expectations of the outcome are a bit unrealistic. At baseline we are dealing with a mastectomy deformity, and for that reason the results of this procedure are not predictable like they are with cosmetic surgery. While it is our lofty goal to have the breasts look better, this may be the case in someone who has never had cosmetic surgery in order to make the breasts nearly perfect. I want you to be very clear and comfortable with the fact that the breasts will likely not look better. If I can get them to look close to what they look like now, I will be overjoyed. I am dealing with a significant challenge to your blood supply and im still at the level of worrying that the nipple and skin flaps will not necrose, while you are focusing on sub centimeter differences between nipple height.

I am very concerned also in the attempt to extrapolate from other patients post-operative photos what you will look like post-operatively. Truly it is a futile endeavor, unrealistic and uninformative. Each mastectomy defect is different, and this is sometimes true on either side of the same person. The one photo i sent you was to exemplify the shape of the implants, not to suggest that you will have a similar outcome to that patient.

On a final note, one of the most difficult challenges is to minimize tension on the mastectomy flap to improve blood supply. To this end, we are limited in how much we can upsize the implants at the time of the mastectomy, and I doubt we will be able to make the implants tight in the pocket.

I encourage you to really think these issues through prior to your surgery. I will be happy to continue the discussion with you on Monday.

Dr. T