Why Plastic Surgeons Should Consider A Patient’s Mindset

Steven Martinez:
Welcome to the Plastic Surgery Podcast, part of the MEDQOR Podcast Network. I’m Steven Martinez, managing editor of Plastic Surgery Practice. And today, I’m joined by my colleague, Keri Stephens, she’s the chief editor of our sister publication, 24×7 Magazine and the co-chief editor of PSP. Last year, I wrote an article for PSP about negative experience she had with a plastic surgeon who performed her breast reconstruction surgery in late 2020. I’m talking to her today about her story and we would like to examine what it’s like from the patient’s point of view when a plastic surgery is less than elective and hopefully show what it’s like when there’s a disconnect between a patient and a plastic surgeon. Keri, thank you for joining me today.

Keri Stephens:
Thank you.

Steven Martinez:
And telling your story.

Keri Stephens:
Yeah, definitely. I’m excited to share it.

Steven Martinez:
So first off, I was wondering if you wouldn’t mind talking about the diagnosis that led to your decision to get a double mastectomy and breast reconstruction.

Keri Stephens:
In July of 2020, I tested positive for a mutation called CHEK2 and it’s tied very strongly to breast cancer. And I actually have a strong family history of breast cancer, which is why I was tested for the gene. And as soon as my doctor read my diagnosis, and I was 37 at the time, said, “Yeah, she’s going to have a double mastectomy.” It wasn’t really even a question, it was like, ‘This is what you need.'” And, obviously, it was really a hard pill to swallow. It wasn’t even on my radar before that. I didn’t even really worry about my family history because my aunt who had had breast cancer in her 40s tested negative for BRCA, and that’s the main gene that people associate with breast cancer.

Keri Stephens:
So, to me, I was like, “Oh no, we’re good. We don’t have that in my family.” But luckily my OB persisted and had me tested. And with the gene, I had a really bad variant of it, which means my chances were much higher than a typical person with a CHEK2 mutation so it was not really if, but when, I would have breast cancer and they also knew that it would tend to be metastatic, so pretty aggressive with this genetic mutation. So for me, it was like, “Yes, get them off.” I was done having my children, I breastfed both of them and it was like, “Okay, let’s just do this,” even though it was something I definitely did not want.

Steven Martinez:
How did it feel to hear that news? I mean, that’s like you said, it was out of nowhere.

Keri Stephens:
It was awful, honestly. I mean, it was one of those things where, bringing myself back to that position, it feels honestly surreal. It feels like there was before that news and after that news and it’s not even been two years since I found out, but it almost feels like I can separate my life in those ways. It changed everything. I think, too, because I have two young children and I have a daughter who’s about to turn eight. And my first thought was, “What if she has this genetic mutation?” I mean, what if she has this? I mean, there’s a good chance, and I think that was just so terrifying. It was just crazy, but honestly I did feel very empowered by my decision and I knew that that was the right move. And there was never really a question of if I was going to do this, but it was just wow, this sucks, honestly.

Steven Martinez:
How were you referred to the plastic surgeon who was going to perform your breast reconstruction?

Keri Stephens:
So my breast surgeon, my OB was actually, she was friends with the breast surgeon that performed the mastectomy and she immediately referred me to her. And then when I went to visit her, she immediately put me in touch with her plastic surgeon. The thing that I didn’t realize before I started this journey was that a lot of plastic surgeons don’t do breast reconstruction because that’s a insurance based procedure and they don’t want to touch the insurance company. So she said “This is the doctor that I use. He’s great aesthetically.” And he was, he was great aesthetically, but it wasn’t like she gave me a list of plastic surgeons. It was “Okay, this is who I work with.” And what I also didn’t realize was as soon as my mastectomy was performed, I was actually just the plastic surgery patient. They didn’t even care about the breast surgeon at all, but they performed the procedure together.

Steven Martinez:
How long did the surgery take place or how long did it take?

Keri Stephens:
I think it took a few hours. I’m not entirely sure. It was crazy though, because it happened in the height of COVID. So I had to leave the hospital a few hours later and I remember that was crazy. I was not prepared for that at all, but it was a few hours and they did a nerve blocker for my pain. So they felt, I guess, fine with sending me home, but I didn’t really want to go home. I wanted to stay in the hospital because I had little drains coming out of me. It was a wild process but it was pretty quick and they inserted expanders in me. So I know that a lot of people do direct to implants, but I was not a candidate for that they said. So they basically had to stretch my skin out and do expanders to make room for the breast implants that they would do a couple months later.

Steven Martinez:
So before the surgery, this is when your tale starts to go a little bit south, but how did your first meeting with your plastic surgeon go?

Keri Stephens:
Oh, it was a mess. I mean, I think I probably am to blame for that a bit. I was in such a bad head space from all of this. Again, I mean, it wasn’t elective. I mean, it wasn’t like something like, “Ooh, I’m going to go get new breasts.” It was just not like that. And I mean, yes, they probably sagged a lot more than before I had kids, but again, it wasn’t something I was thinking about. So when I went in, he was just focusing on the aesthetics, which I do understand from his perspective was the purpose of this, because I did get reconstruction and I know going flat is an option for women. Actually, no one even talked about that with me but that’s beside the point. But it was bad. He basically said, “So what do you from this?”

Keri Stephens:
And I said, “I don’t care. I just want to be alive.” And he is like, “No, you do care or you wouldn’t be here. Then why are you getting reconstruction?” And I felt like it was a bit insensitive to what I was going through and as a plastic surgeon who takes insurance, I know that he was used to working with breast reconstruction patients, but I do think it’s just such a different process. And it’s just such a different perspective that I came into the process with that I wish he had been more empathetic of that. And I didn’t feel that sense of empathy with him.

Steven Martinez:
Well, when he challenged you on that point, when he said that, “No, you do care”, how did that make you feel in the moment? You’re talking about how you were in this different head space because you’d just received that news and you were about to go through something that there was a lot of unknowns about.

Keri Stephens:
Yeah, I was a mess. I left the appointment, just hysterically crying to my husband, my mom, my friends like “I hate this guy. He’s the worst.” And, I mean, he wasn’t, it’s just, I think I was in such a bad space mentally and emotionally and I was unprepared for all of it, that his lack of empathy just really rubbed me the wrong way. And I actually wanted to find a new surgeon, but again, it’s so many of them don’t take insurance. And my breast surgeon recommended him. And I remember going to her to an appointment with her afterwards and she asked what I thought about the doctor. And I was like, “Oh my gosh, he was terrible.” She’s like “Really? Wow. Okay. Why?” And I think she was even taken aback because, I mean, from anesthetics point, he did a great job.

Keri Stephens:
He is very skilled surgeon. So I would never say anything about that. But she’s like, “Well, you could try to look for someone else”, but at this point my surgery was already scheduled and I truly just wanted my breasts off me because, at that point, I wasn’t even sure I didn’t have cancer. Because this was all decided before I did a mammogram, and my first mammogram came back, felt like bad. It was suspicious. And I had to get more testing to make sure that I didn’t have breast cancer because that could have affected lymph. Basically they said, “You won’t be treated much differently than if you had breast cancer, but if you do, you’ll have to get lymph nodes taken out and stuff like that and possibly chemo.” I was just so overwhelmed by the whole process that the thought of trying to find another plastic surgeon was just not even, I was like, “I’m just going to go with him.” I knew he was very good at what he did and I was just going to take my ego out of it, but it was not the best experience.

Steven Martinez:
Why do you think he was confrontational? I mean, obviously you can’t get into his head, but do you think there was some sort of strategy that he was trying to employ by being firm with you?

Keri Stephens:
I think he wanted me to realize that I did care about the aesthetics and maybe, at that point, that wasn’t top of mind for me, but later I would care and, I mean, he’s right. I do care now. When it’s all behind me, but at the time, I mean, it was just so overwhelming that it’s like, that was the last thing I was thinking of. I was just afraid I had cancer. I was afraid I was going to die. I was afraid the reconstruction part, it just wasn’t what I was thinking about at the time.

Steven Martinez:
Can you talk a little bit about this idea, you mentioned it when we did our interview for the article that breast reconstruction patients often encounter this idea that it’s a free boob job and maybe why that’s an offensive concept?

Keri Stephens:
Well, I think breast reconstruction, to be frank, the afters are not prettier than the befores. I will be honest. I mean, I have scars everywhere and it’s fine. To me, my scars show what I’ve been through and they talk about being alive for my children, for myself. But, again, it’s not a free boob job. I mean, I have no feeling in my chest, which people don’t really think about why that would be a problem, but it is. I mean, I was at the beach last week and I get sun on my chest, I don’t feel it. If something burned me, I wouldn’t feel it. It’s like that from a safety standpoint, can be pretty dangerous. So when I think of a boob job, and I mean, that’s looking better than the before, but for me, the after is not so pretty, but it’s my story.

Keri Stephens:
So I think to a breast reconstruction patient saying it’s a boob job is just extremely offensive and we’ve all heard it. And I’m part of groups online for mastectomy patients and we’ve all talked about this and it’s like, how do you really annoy someone, say that? And the pain of a mastectomy, people can’t understand until they’ve been through it. It’s severe pain. I mean, it’s an amputation. And just remembering that, and I think for plastic surgeons, what I would love to tell them is that you just need to approach it differently and from a more empathetic standpoint, because chances are these women don’t want to be getting this process done. It’s not something they wanted, ever. And for me, luckily my mastectomy was prophylactic, but for a breast cancer patient who knows too, that they have chemo radiation ahead of them, it could spread. It’s just a completely different process and a completely different mindset that these women are going into the process with.

Steven Martinez:
So I want to talk about another, I guess, confrontation you had with him when you were deciding about the size of your implants before the surgery.

Keri Stephens:
He definitely encouraged me to go bigger and I said, “I’m good. I’m good. I don’t want them bigger.” I had two kids and they changed shape after that. And I didn’t want big boobs. I didn’t. I just wanted something that I felt natural in my clothes. And the last thing I wanted was to look weird. So I just wanted to be myself. I wanted to feel just normal in my clothes because that’s how I felt. But it was interesting. I did feel a push to him. I think he was surprised because with the expanders, what was interesting is, each week they would expand my skin. And you could try on boobs and as weird as it sounds, almost like a push up bra. And each week I would go in, or every two weeks to get expanded. And I think he thought I would go bigger than I did.

Keri Stephens:
I just didn’t want to go bigger. I felt like this is what I’m happy with, these look natural and what he did say, most women wish they had gone on bigger. I am so glad I didn’t go bigger. So I stand behind the size I went.

Steven Martinez:
You were happy with your decision.

Keri Stephens:
Yeah. I do know a lot of women though. So one woman I met in my mastectomy group, she and I actually became friends from this situation. She had my mutation as well. She went from a double A, to a double D. So, I’m like, “Okay, wow.” And I think she likes them, but again, I mean that’s not what I wanted. I did not want to look like Dolly Parton, as I said. The whole process was so awkward anyway, because everyone knew I was undergoing it and it’s like, everyone that knows me and knows my story knows that my breasts are fake. So I didn’t want to draw even more attention to that.

Steven Martinez:
Yeah, that makes sense. It’s not a secret.

Keri Stephens:
No. And, I mean, it’s a personal thing. I’ve been really open with my story because I’ve, one, to use it to help others and to encourage women, especially, and men, to get genetic testing and to really be looking into their family history. But it’s my body and it’s a personal part of my body. So it’s something that I want to draw the least amount of attention to as possible.

Steven Martinez:
So your surgery, it was successful, even though you maybe wanted to stay at the hospital a little bit longer and they were pushing you out the door, but post-surgery you mentioned that you had an issue with pain, that it was not subsiding. Can you tell me about how you sought care for that?

Keri Stephens:
Yeah, so I consider myself to have a strong pain tolerance. I ran track in college. I’m athletic. I feel like I can be in pain at times, but this pain I was in after that, it started a few months or, sorry, a few weeks after my surgery and I was driving actually, I was finally able to drive, and I just felt this horrible shooting pain. And it was unlike anything I’ve ever felt in my life. It felt like, because with the mastectomy, they’re cutting through nerves and all of that, and it was almost like zapping. My nerves, I guess, were regenerating and all that. And it was just truly pain I could never explain. And I told my doctor, the plastic surgeon, and made a comment that I was in really, really bad pain.

Keri Stephens:
He said, “Well, yeah, you just had a mastectomy. It’s going to be painful.” And I felt like that was a bit dismissive. So I did what any 21st century woman would do. I went on Facebook and asked my group, like, “Are y’all experiencing this, is this normal?” And they responded, “Are you on Gabapentin?” And I said, “No, I don’t know what that is.” You need this. So the next time I got my expanders expanded, I went in and brought my husband and just made a comment about how much pain I was in with my expanders, all that. And the doctor’s like, “Oh, you need have a Gabapentin.”. I’m like, “Okay, yeah.” I did apparently. And I mean, it was just so frustrating because I was in so much pain for weeks. I didn’t need to be in that kind of pain. I remember trying to walk around my neighborhood for Halloween with my kids and I was literally, I made it a few feet and was doubled over in pain before this. And it was just truly, to this day, I will say there was no other pain like it I’ve ever experienced.

Keri Stephens:
And it was just so frustrating because it didn’t have to be like that if I had just been on the medicine I needed, at times I don’t think it would’ve been like that. So anytime I talk to someone getting a double mastectomy, I encourage them to get on Gabapentin ASAP.

Steven Martinez:
So, I mean, after he was initially dismissive telling you “Of course you’re in pain, you just had major surgery”, you said you brought your husband. Was that partly strategy on your part, you thought maybe if you brought in this second opinion, he might react differently?

Keri Stephens:
Absolutely. And, again, I think this goes back to something I’m really passionate about. I think a lot of times women’s pain is dismissed, it’s something we’ve heard a lot, but it really is true. And I think women, especially, I mean, everyone needs to be their own advocate, but especially women because our pain is dismissed so often we have to be extra advocating for ourselves. And I wish I did. At the time though I didn’t know about Gabapentin before, when I was telling him how much pain I was in, but yeah I did do that as a strategy. I was like “I’m going to see what happens when my husband comes.” So it was interesting.

Steven Martinez:
So throughout this, you’ve been mentioning how you found a community online through Facebook. How do you feel about that idea that you had to go out and seek your own support rather than it being a part of the treatment process?

Keri Stephens:
I think it’s terrible. I mean, I think there should be much more support. I wish moving forward doctors, plastic surgeons, of course as doctors, could basically help women and men going through anything like that, support groups, because I know with my dad, he has prostate cancer and when he was diagnosed, he got a cancer mentor, basically through the cancer centers of America. They found someone for him that was going through the same stage, same age, that could talk him through his cancer journey. And I know that was helpful for him. And I think if they could do that with mastectomy patients and probably put it with prophylactic mastectomy versus people with cancer already, because that’s a very different journey. And I think that, again, I never want to try to put myself in this position of actually having cancer because I didn’t. But I think finding people that can mentor them through the process would be so beneficial because it’s just so unknown.

Keri Stephens:
And, again, I mean, I know a lot people because, with genetic mutations, maybe they had a sister that had gone through this, that had also had a prophylactic mastectomy or something or had cancer and then had the mastectomy, but I don’t have any sisters. And my mutation actually comes from my dad’s side of the family. So his sister, my aunt had one, but in my mutation, in men, is prostate cancer, which my dad has. And so it’s because I didn’t have anyone to walk me through this journey I felt alone in a lot of ways. And thankfully I was able to find a community of other women that have been through this, on Facebook, but it was really isolating.

Steven Martinez:
To close, what do you think could be done better for patients in your situation and how do you think a plastic surgeon can approach, or should approach their reconstruction patients?

Keri Stephens:
I think, just with a lot of empathy and understanding that this is not a typical cosmetic surgery procedure where you go in for a BBL, you know what you’re getting, you want to do this, you’re excited about the process because you know you’re going to look better afterwards. I mean, I don’t think I look better afterwards. As my plastic surgeon did a excellent job aesthetically, but I have scars everywhere. It’s not something that I feel beautiful from. I feel, honestly, I call my Frankenstein boobs, but it’s okay because they keep me alive. But I just think plastic surgeons should really come to their reconstruction patients with a sense of, I know this is not what you want, but let’s talk you through the process. And I’m not saying handholding us through it, but understanding that it’s a very different procedure and just talking differently to them and coming from a sense of empathy, because empathy is really important when someone’s going through this because chances are, they’re not excited about it.

Steven Martinez:
Well thanks so much for sharing your story again, Keri. Really appreciate it. If any of our listeners would like to read more of our content, just go to plasticsurgerypractice.com.