Plastic surgery consult

I asked my oncologist for a referral to a plastic surgeon, because now that I am more than halfway through the chemo, I'm starting to think more about the surgery and feel somewhat anxious about it.  She said they have seen good results from a woman who is new to UNC.  I first met with the plastic surgeon's nurse, and the first thing she asked me was, Are you going to have radiation?  I said that hasn't been decided yet and that my surgeon told me I won't know until after the surgery.  She then told me how reconstruction is done when the person doesn't have radiation.  She told me that expanders (that look like deflated implants) are inserted, and then gradually filled with saline each week until they reach the desired size.  They are then replaced with implants. The nurse showed me a few photos. As she was paging through photos on her iPad she said, "Oh no, I better not show you that one."  Hmmmm....maybe this doesn't always turn out well?  Even the photos that looked reasonably okay did not look real, and made me feel uncomfortable.

The doctor then came in and said she had emailed my surgeon to ask him whether I'm having radiation.  I told her he doesn't know because it will be determined after surgery.  She then said that if I am having radiation, then nothing the nurse just told me would apply.  She said she would need to remove a muscle from my back in order to create a flap on the radiated side.  In my mind I was already thinking, there's no way I'm going to deform and weaken my back to have a fake weird breast.  Then she said there's a new procedure that involves fat grafting. She must have noticed the reflexive disgusted look on my face. She asked me to lift up my shirt, and said, "Never mind, you don't have enough fat." (Okay, that is definitely the weirdest compliment I've ever gotten.)  She then told me that this procedure has a 50% failure rate, and that she doesn't like to do it unless the patient understands the risk.  At this point I started shutting down and no longer processing what she was saying.

This whole consult was very disturbing. Mostly because my surgeon had sort of matter of factly said, "You'll meet with the plastic surgeon and decide what shape and size you want," like it was something easy to accomplish. In fact, it is very complicated and involves multiple painful procedures. And in the end, there is no feeling in the reconstructed breasts.  It seems that since insurance companies are required to pay for reconstruction, there is an assumption everyone will want to do it.  If there was a great option, I would be all for it, but none of this sounds good to me.