013: Not Putting on a Shirt... Seriously

Updated: Jun 22, 2021

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Episode Summary:

Optimal reconstructive surgical outcomes are for everyone, and we are the ones to decide and define what reconstruction looks like for us. Kim Bowles with Not Putting on a Shirt joins Tammey to share her story as she chronicles her fight against surgical battery, Kim talks to us about how this strengthened her commitment women’s rights and shares how she used the power of the 1st Amendment to plant the seeds of advocacy for aesthetic flat closure. In this episode, we learn more about aesthetic flat closure as a reconstruction option, obtain tools for self-advocacy, and hear about resources for better clearer communications with your provider.

Topics in this Episode:

  • Intro

  • A Historical Review of Reconstruction

  • Are you wanting breast reconstruction or chest wall reconstruction?

  • Always gonna be someone who judges you and your decisions

  • Restoration, reclamation, reality

  • There is surgery and then there is aesthetic surgery

  • Self-advocate! Is there an echo in here??

  • Not the puppy dog kind. . .

  • Finding a common language for the clearest communication

  • We decide how important our breasts are to us.

  • Don’t accept assumed knowledge

  • I’m still me, damnit!!

  • Question integrity... always!

  • Sexism in medicine?

  • I have autonomy over my plan.

  • What is surgical battery?

  • An artifact of medical history.

  • Make a big deal over it!!

  • A systemic problem...

  • Constitutional rights.

  • How to help yourself and others

  • Sign off

Guest Contact Information and Social Links:

Contact Information and Social Links:


A special thank you to our sponsor, Riverdance Soapworks. Handcrafted products we personally use. Visit www.riverdancesoapworks.com and let them know you heard about them from Tammey.



Tammey Grable-Woodford: Hello, and welcome back to Your Killer Life. I am so excited because we have an amazing guest today. So we're going to start talking about reconstruction, and this is one of the reconstruction options... our topic today... is one of the reconstruction options that I don't think it's enough attention. So we are going to be talking with Kim Bowles of Not Putting on a Shirt - NPOAS. I love it.

So welcome, Kim. Thank you so much for joining me on the podcast.

Kim Bowles: Hi, thanks for having me.

Tammey Grable-Woodford: So tell us a little bit about your story. Tell us about your diagnosis and when you were diagnosed and kind of, um, what, what, uh, what, just tell us about you.

Kim Bowles: Yeah, sure. So I was 35 when I had to colicky baby and a three-year-old dynamo toddler son. And when I was diagnosed, I found a very large lump, and it was Stage 3, HER2 positive breast cancer. So for folks that don't know what that means, that means you get an extra year of infusion therapy. At least.

So I, I went through chemo before surgery. Sorry, it's been a little while since I've talked about the cancer thing, I'm about three years out now, and I'm doing ok. I have no evidence of disease, which is great. Purely a matter of luck, by the way. So yeah, I went through, you know, five months with neoadjuvant chemo.

I was bedridden. My mom moved in with us to take care of the kids while I was incapacitated. And. Uh, then, you know, sur... the surgery decision that we all have to face, I decided to go flat. I decided that I had missed enough of my kids' lives, you know, from chemo. And I just wanted to get back to taking care of my kids and living, uh, living a normal life as best I could.

I think we all crave normalcy after we've been diagnosed.

Tammey Grable-Woodford: Oh my gosh. Yeah, so much so trying and trying to find it is not necessarily the easiest path.

Kim Bowles: No, and there's always a new normal, right. And my goal was just to, just to get back there as soon as I could because it's, it felt like so long, and chemo did ultimately kill the cancer because when I had the mastectomy, there was no cancer, no invasive cancer remaining. So that was really lucky.

Tammey Grable-Woodford: That is great news. And so you had neoadjuvant chemo, and for those that are listening, that's just that's before the mastectomies, and then you were HER2 positive what type of cancer did you have?

Kim Bowles: Ah, just invasive ductal, the standard. Yeah, it was in the nodes. So large tumor in the nodes of Stage 3a and that's why I was so thankful when sur... of the pathology came back from surgery, that it was all the invasive cancer was gone because that actually bumps up your survival numbers quite a bit.

So I'm grateful every day for that. For modern medicine saving my bacon.

Tammey Grable-Woodford: And I just want to point out to those that are watching and listening that I'm 3b you, I should say was 3b was my diagnosis. You 3a and I always like to kind of point to the faces and say, you know, there is health, there is life, there is vitality, there is living and being alive in the diagnosis. And goodness, Kim, you are amazing in all that you are doing. So let's talk a little bit about reconstruction, and I'm talking with a surgeon that I am going to have on to kind of go over the different types. And just like with cancer, I had no idea there were so many types of cancer, and I certainly had no idea there were so many different types of reconstruction options after the fact. And I certainly did not understand until I went through it myself, the, um, complexity of reconstruction.

One of those things, you know, speaking of normal, trying to get back to whatever your normal is at the end of this. There's the DIEP, the TRAM, the implant that even with the implants, there's under the muscle... over the muscle. And then one that does not get talked about enough, and is an actual reconstruction option is a flat closure, but you've been working really hard. And we now have this new thing called aesthetic flat closure.

And can you educate us all a little bit about kind of what was, and what is, and the importance of that terminology and where we are headed with that?

A Historical Review of Reconstruction

Kim Bowles: Oh, absolutely. So 40 years ago, we didn't have breast reconstruction. If you had a mastectomy, that was it. I mean, there was no widely available breast reconstruction whatsoever. You were losing your breasts, and that was it. You had to go flat. There was no other option. As science progressed and surgical techniques progressed, we got implant reconstruction was the first type of breast reconstruction to come on the scene, you know, silicone implants under the skin to produce the breast mound. And then we got a microsurgery. So transplanting tissue from another part of your body and connecting the vasculature so that the tissue would survive and create a breast mound that way from your own tissue.

And there's combinations of that. There's a couple of newer techniques. I don't know if you've heard of the Goldilocks mastectomy, but for women with very large breasts, especially large pendulous press, where there's lots of extra skin, you can at the time of the mastectomy. If you take out the breast tissue, so if you imagine like scooping out, like with an ice cream scoop, you just scoop that up. And what do you have leftover? Will, you still have some fat and some skin there that normally would be discarded, but sometimes, and not all patients are candidates for every procedure, but sometimes you can rearrange that tissue with a skilled surgeon to produce like a smaller breast mound.

So that's a newer option that doesn't require like harvesting from another part of your body and doesn't require an implant. And again, you can combine it, like if you want a larger breast one, you could probably combine that with an implant, maybe at a later date. I'm not sure, but, so there are quite a few options for breast mound reconstruction that happened over the last, you know, 30 years, 40 years.

And as those techniques came on the scene going flat started to be relegated to a second class status because initially, it was, you had no choice and to access breast reconstruction; you had to have a bunch of money. Insurance didn't cover it. So going flat was what, what you were forced to accept if you couldn't afford breast reconstruction. And that started to become the narrative.

Then in 1998, we had federal legislation that required insurance to cover breast reconstruction. And that started to change a little bit. So breast reconstruction rates skyrocketed, I don't, I'm trying to remember the numbers. I know there's escaping me right now, but still, the narrative that going flat was something that no woman would choose if she had another option that was still, like that persisted, and I don't want to disparage breast reconstruction. Breast reconstruction is an important part of healing for so many women. It's a very personal decision. There's a lot of factors that go into it.

For me, the risks and the costs of breast reconstruction, particularly in terms of like the healing period. You know multiple surgeries over a period of one to two years in order to get a breast mound.

It just wasn't that important to me to make that worth it. So I decided to go flat. Now I'm starting to lose my train of thought here, chemo brain. I think we're all familiar with chemo brand. If you're unlucky enough to have to go through chemo.

So breast reconstruction, it's a new thing. It's a new thing in human history. It's new thing in medical history. And we don't realize that you know, most of us that are diagnosed today. We don't remember a time when there wasn't breast reconstruction or at least, you know... Yeah. So that's the history.

And I think over time going flat lost; it's sort of, I don't know if surgeons lost their... their... Oh, God. It's so... it's hard to explain. We just don't have a lot of data on it is the problem right now.

So women going flat started to get sort of, uh, not great quality closures. So I think there was a prevailing attitude amongst a smaller subset of surgeons that they don't need to, you know, do additional work, to try to get a nice flat contour. They can just, you know, sort of throw it together, and then the plastic surgeon can deal with it later.

So a lot of women nowadays are not getting great quality closures that they can live with.

Tammey Grable-Woodford: That's interesting because I know I'm in survivor groups now, and I'm sure you are too out on Facebook and hearing from women and, and, you know, sharing... women sharing photos and being left with dog ears. I'll I'll... probably ask you to talk about that, but being left with dog ears or being left with a clump of tissue.

I've posted my photos, and I forget which episode it is... so I'll make sure and put that in the show notes, but... I posted my post-mastectomy, uh, pictures. And there was nothing that really prepared me for what that would look like. And I feel like, and of course you, I mean, you don't know, right? Like my, my general surgeon and I had multiple consults with everything, but that was my surgeon. I only went through once on the mastectomy side, and he did not leave dog ears. I had a clump of wadded up tissue in the concave chest cavities that were left, which I was hon... I didn't expect that. I mean, why would I know that I would have concave divots in my chest afterward, but he also did spare as much skin as possible knowing, because he and I had that conversation up front, that I would be seeking reconstruction.

And so I did have a good experience with my surgeon who asked me, will you be seeking reconstruction? What type of reconstruction? He helped me get a consult with a plastic surgeon prior to my mastectomy, so he could make the best decisions, his incision lines were beautiful, but it still was traumatizing to me to see, you know, what was soft and feminine and a part of my identity, it's not vanity, my identity. To have that taken away. And to see what I was left with.

And even in that, when it came to reconstruction, a lot of folks don't know there's damage that happens. I had the inframammary fold on one side, no idea what that was until I needed to know, was damaged. Um, but anyway, it is a traumatic experience.

And so, talking with, if you have women who have not had their mastectomies yet, and who are, are weighing, you know, do I want reconstruction or not? What are some of the questions that you would recommend that they ask their general surgeons since that's going to be their entry point? And I always recommend see a plastic beforehand, if you can, so that you, you know, like you just have that information.

And then what are dog ears? And why is that an important thing? And is that addressed as part of the aesthetic flat closure?

Are you wanting breast reconstruction or chest wall reconstruction?

Kim Bowles: Yeah. So your first two questions, your first question was, what should you, what are your considerations when you're considering whether to do breast reconstruction or not? And the second one is, well, let's get to the second one in a minute.

I definitely recommend speaking with a plastic surgeon so that you know all of your options because every woman's medical situation is different.

I'm not a medical professional. So, you know, I can't give medical advice. I can tell you from a patient's perspective, it's the breast reconstruction decision really, beyond the constr... medical constraints or whether you're a candidate for different things or not, or whether you can access a microsurgeon for a flap surgeries, not everyone can access that, you know, especially in rural areas, but beyond the medical constraints, it's a matter of your personal values and priorities.

Is it important to you to maintain what I call, some people call, a breasted appearance? Is it important for you to present an image to the world, and to yourself in the mirror of having breast mounds, is that important to you?

And you'd be surprised like, cause what you've never until you're facing mastectomy, you've never really been confronted with this.

It's never been an option. You've never thought about it. So you need to take the time. As much time as you can. To really think about what's important to you because breast reconstruction is not without risk, and it's not without cost. So you're, you're weighing the risks and costs of pursuing that with the benefit that it might give you.

And I think the most important thing is to seek out women who've been through it. Who've been through the decision-making process and crowdsource. And that's why I think as much as I sort of... facebook is a love it, or hate it kind of a thing, but it's a great place, it's a great platform for finding a group of like-minded women who can sort of tell you how they experienced that process, like how they made the decision, what went into it and what their experience was after the fact.

That's the that's the biggest thing I would recommend. Honestly. Beyond just making sure you see a plastic surgeon who can tell you what your options are medically. Talking to other women talking to other survivors. Um, you can join there's FLAP groups on Facebook. There's a DIEP flap, um, group run by Terri Coutee, which is patient advocate I'm acquaintances with, um, there's, there's a couple of flat groups, um, "Flat and Fabulous," "Fabulously Flat," "Flatties Unite." Uh, there's a whole bunch just search Facebook for flat, and you'll find it. And you'll just get an outpouring of support for that option.

And I've found most women are very supportive of all options. So even if you're in a flat group, you'll, you'll get support as you make your decision.

And the other thing I would say is try to think, you know, think about the future, and you know, what might your regrets be?

I mean, we can't, we can't know the future, and we can't know how we're going to react, but just thinking about what does reconstruction involve and what are the, what's the likely outcome. And after I make that investment, how am I going to feel about it? Years down the line. So it's just different for everyone.

It's, you know, it's so personal, and you're going to get judgment from some people you're going to get some people in your life for who are going to be like...

Tammey Grable-Woodford: Yes.

Always gonna be someone who judges you and your decisions

Kim Bowles: What's wrong with you? Why aren't you getting your boob job? I guarantee you're going to hear this ignorance from some people, or if you decide to get breast reconstruction, why would you put your body through that?

I mean, it doesn't matter what you decide. You're always going to be wrong. Cause you're a woman making decisions about your body.

So, seek out a plastic surgeon. Seek out, other women. Think about the risks and benefits in your specific case. Think about in the future, what are you going to look back and have regrets and screw anybody that doesn't support you?

Tammey Grable-Woodford: I liked that last one a lot. And it's true.

Kim Bowles: People love nothing more than did that pass judgment on a woman's body.

Tammey Grable-Woodford: It's it's absolutely incredible to me. And it really is what's important. And you know, and even when it comes down to two nipple reconstruction, which I battled with, even that like, you know, you're right at no point in your life, are you sitting around thinking, gosh, what is it going to be like if I, you know, until you're faced with it, remove my breasts.

Would I leave them off? Would I...?

You just, no, you don't go through that. And so, with reconstruction and we'll get into that. Cause I'll, I'll share my story in additional episodes. You're right. It is multiple surgeries and other considerations, implants are not forever. They have to be replaced, and there are even oftentimes multiple surgeries to get the result that you want.

Kim Bowles: There are. And I want to say; I want to interject and say, I have a criticism of the way that breast reconstruction is sometimes oftentimes presented by the reconstructive surgeon, the gallery of images that they will show you are not necessarily the average results that you can expect. They're the best possible results.

Tammey Grable-Woodford: Right.

Kim Bowles: That's fine. As long as you understand that, that's what they're showing you. You know, if you're p... if you're expecting a perfect result that you're unlikely to actually achieve, you might be disappointed, you know, and that's not, you don't want that. You want a realistic expectation of what can you expect?

I think most plastic surgeons, you know, will talk about that, but, but they won't show you necessarily pictures of what you can probably expect. So just... keeping in mind a realistic expectation. I mean, we... we all, wouldn't it be great if we had a no-risk surgery that would give us, you know, perfect breast mounds back that didn't have any risks and that's just not the reality.

Restoration, reclamation, reality

Tammey Grable-Woodford: No, if it, you know, you're right. If you, if you could have a reconstruction to restore you to yourself, the way that you beforehand, wow, wouldn't that be something, but that is not the case in, although I'm happy now it has taken me multiple surgeries to get there. And I had a great surgeon who said to me, and I loved how she set the expectation because she said: "our goal is to get you as close to normal or what you would consider your normal with clothes on."

Kim Bowles: Yeah. Yup. Clothes on.

Tammey Grable-Woodford: And that's a really important distinction. And that's when that hit me pretty hard that I was not going to have the boob job boobs at the end of this, and it's quite a process just to get the the results that I have with, you know, and, and I actually think about how lucky I am in a lot of ways because of the surgeons and the team that I had.

And, and not everybody has that same attention to detail or care, I guess, or skill, right? I mean, frankly, it's a skill.

Kim Bowles: Yeah, absolutely. And there's so many factors that go into play, that come into play, excuse me. For.. that determine what your final aesthetic result, some of which you have control over and most of which you have zero control over.

And disparities in quality of care, come into play here also. I mean, women who are in a position of privilege, financial and social privilege, you know, obviously have a much easier time shopping around and going to a specialist.

There is surgery, and then there is aesthetic surgery

That's not the case for most women, most women in this country, who you land on first is who you get and not to disparage surgeons, but aesthetic surgery is not easy. I mean, it's, it's not easy. There's so many things that... so many years of training that go into even just standard plastic surgery training, and then microsurgical training beyond that.

I mean, you're really talking about a sub subspecialty of surgery. So you have to be your own advocate.

Tammey Grable-Woodford: Definitely!

Self-advocate! Is there an echo in here??

Kim Bowles: You know, you have to advocate to the extent that you can, you have to look at what your options are and just not accept no for an answer. And no one's gonna advocate for you except for you. So, you have to take ownership over it, and that can be challenging.

Tammey Grable-Woodford: It can, especially when you're being told that no, that, that looks great. You look good. And you don't agree with that. And, and I think that that creates opportunity for some frustration and possibly second opinions, because if you are not, I guess what I would recommend with women is to really not settle, to not feel like you're forced to settle, if you can, and you have to seek additional, you know, providers and, and opinions then do it.

Kim Bowles: Absolutely. Absolutely, and their, your, your surgeon is not going to set you up for a second opinion. That's you; you do that. And this is another utility of the Facebook support groups. They can recommend surgeons in your area. I have a surgeons directory on my website, but I mean, That's not the only resource you can seek those out from individual women, that, who've had good experiences.

Not the puppy dog kind. . .

Tammey Grable-Woodford: Absolutely. So let's talk about dog ears, because a lot of people, people who are listening, who are caregivers, people who are just starting their journey with breast cancer. I really need a better word than journey... starting their hike.

Kim Bowles: Yeah, hike up the mountain with the mountain lion chasing you.

Tammey Grable-Woodford: Right. That one, I really trying to do better with my language around this. Right?

Kim Bowles: It's a struggle.

Tammey Grable-Woodford: It is, I mean, let's stop, let's stop putting a bow on it. So as we start that process, what is a dog ear? And is that something that is addressed as part of the aesthetic flat closure?

Kim Bowles: Ok, great questions. So if you picture yourself naked with your boobs out, the breast tissue is like around... this is a major oversimplification, but just for visualization purposes, the breast tissue is like, picture it as like a tennis ball, like in the middle of the breast. You don't, what's coming off of your... what's protruding off of your chest is not just around tennis ball.

It's surrounded by stuff that fills in the contour, right? That's the fatty tissue and the skin that's sort of ancillary to the breast tissue. If you just remove the breast tissue, which is what a mastectomy technically is. And then you close the wound. What do you have left?

Do you have a smooth contour?

No, you have lumps and bumps and excess fat. That just is still sitting there. That's a dog ear—the fat and extra stuff under the arm. I'm like reaching over here. You came and see I'm off camera under your arm, where the wraparound tissue that goes from the nipple and then the contour curves around under, towards your back, under your arm. That is the area where a dog ear, you know, this technically a dog ear is a, is a different kind of discontinuity, but what people normally talk about as a dog ear, they're talking about excess underarm tissue. So if the mastectomy is done with no additional contouring work, you will get a lump of fat under your arm that's quite uncomfortable.

So that's why an aesthetic flat closure is so important to ask for by name because you don't just want a mastectomy with no reconstruction. What you want is a comfortable result that you can live with. And that involves smoothing out of the extra tissue, um, so that you have a smooth, comfortable contour that you can, you know, But you can, you can move your arm around you don't, you're not rubbing into anything. You don't have folds and lumps. And you know, it's an aesthetic, there's additional work, additional surgical work, you know, after they removed the breast tissue, additional work required most of the time, particularly if you have larger breasts, additional work required to make a smooth contour, that's comfortable for you.

And that's an aesthetic flat closure.

And until early 2020. We did not have a name for that.

So women would tell their doctors, I want to go flat. I want to be flat like a ten-year-old boy. I want, there was no agreed-upon specific definition of what exactly they are... you're talking about when you say you want to go flat, but now the National Cancer Institute has defined the term "aesthetic flat closure" as basically a chest wall reconstruction—so rebuilding a smooth flat chest wall contour after the breasts are removed. And it's important to ask for it by name so that your surgeon knows exactly what you want.

Tammey Grable-Woodford: That is so important because I will tell you I had no idea what... until I was in breast cancer groups, how painful, how uncomfortable that, that was even left there, because it just seems like, I can't imagine. I mean, as it was finding clothes and adjusting to my new normal, I mean, even with reconstruction going through that process, I can't tell you how many tears I cried just trying to find a shirt that looked good and not having that. And I was large breasted, um, prior to cancer and, um, I still had extra tissue. I didn't have a, it wasn't, it was not the dog ear, but what happened was I had extra space, and so I would lay on my back, and my implants would fall under my armpits because I had extra tissue there.

And my surgeon, um, the second time she went in and cleaned that up and had to basically extend my incision line, which I didn't care. I would...

Finding a common language for the clearest communication

Kim Bowles: Well, that's another thing is the incision line. In order to get a good aesthetic flat closure, a lot of times, you do have to extend the incision line. It's just; you can't avoid it sometimes. And I think most patients don't mind the X longer scar in order to get a smooth contour. But I'm telling you in surgical training, particularly plastic surgery training; it is, it is a foundational principle, it's a religious tenant that you, you get the smallest scar possible because what they're trying to do is restore your original appearance and a scar is a defect in their mind. And I mean, it is a defect, but at the cost of producing a comfortable contour, of course, most patients are ok with that. It's a; it's a miscommunication.

You know what I mean? It's a common miscommunication. So you do have to be clear with your surgeon, particularly if you want to go flat. Extend that damn incision however far you need to get it under the arm. I want a smooth, flat contour.

Tammey Grable-Woodford: And I will tell you the extension, especially the incision from my plastic surgeon because she was so careful in her process, and she's a plastic surgeon. That has faded. So the incisions that I had that she extended are almost not even visible at this point. And of course, everybody's skin is different and everybody, right.

Everybody is different. And so my results are no guarantees to what someone else's results are going to be. But I know that I can say without question, I did not mind having a... seriously, I already had probably nine or 10-inch scar on my chest. Another two inches was like,

Kim Bowles: Yeah, I know. And it's, and this is. Why it is so important to have these specific conversations with your surgeon. You don't want things going unsaid that are gonna lead to an outcome that is not optimal for you. And it's tough to know as a patient we're just thrown into this world, and what are we supposed to be experts on fricking surgical technique? It's ridiculous, but that's, that's where we are right now. And it's on us to make sure that we are clear with our surgeons. Most surgeons are good about this too, but it's, I think we're evolving in our language and in, in our, our level of expectation for aesthetic result is going up a little bit over time.

And I think that's a good thing, but it's, it's all about clear communication and and shared expectations because your surgeon cannot perform a miracle. It's never going to be perfect. But we want to get as close as we can, right? As close as we can reasonably given the cost of additional surgery. So this does not, it's a negotiation and it's really important to be clear.

And that's why this new term aesthetic flat closure to my mind is, is a game-changer because without clear language, how can you possibly have a shared understanding of what you want?

Tammey Grable-Woodford: That is so true. And it's amazing the excitement, you know, again, because I chose the path of reconstruction that I chose and I'm saying path of reconstruction that I chose because I want to make it very clear. Aesthetic flat closure is a path to reconstruction. It is your, one of your choices for reconstruction.

We decide how important our breasts are to us.

Kim Bowles: You're reconstructing your chest wall. You're not reconstructing a breast mound. You're reconstructing your chest wall contour. Like a... almost and not, it's not a male chest contour. It's a; it's a chest contour without breasts. So we all remember growing up when we were ten or nine or eight or whatever... some of us were unlucky enough to develop early, right?

Um, we didn't start out with breasts and that's not to say that breasts aren't important, you know? But we, individually we decide how important our breasts are to us and how important it is to maintain that appearance. It's so individual and we all started out with the breastless contour. And if you have to remove your breasts and you don't want breast reconstruction, you should be able to get that breast-less contour back, at least approaching it.

Tammey Grable-Woodford: Absolutely. And I think that with providers, I've always the way I phrased it is because no providers intentionally not wanting to give you the best possible result.

Kim Bowles: Well...

Tammey Grable-Woodford: I think that what happens is the providers...

Kim Bowles: There's a very few surgeons who will intentionally overwrite your wish to go flat. That happened to me, but almost all of them are ethical. Oh...

Tammey Grable-Woodford: Wow. We're going to come back to that. I'm actually making a note, and we're coming back to that because...

Kim Bowles: This is what really started my activism.

Don't accept assumed knowledge

Tammey Grable-Woodford: That. Ok. We're definitely coming back to that. So what I was going to say is that I think there's a lot of assumed knowledge with a provider and what I mean by that and assumed information. And what I mean by that is they're having the conversations multiple times a day.

And for you, it might be the first time you're having this conversation. So they have a bunch of assumed information in their head because it is routine to them. And unless you ask the specific questions or dig a little deeper or ask for clarification, you're, you're likely not going to get it. Right? So just even me thinking back, if I had just asked the question of, "What will I look like postop?" With my general surgeon, I would have been mentally prepared for what looked like construction, staples. I would have been mentally prepared for not having sensation in my chest. I would have been mentally prepared for what the drains looked like. Right? But I didn't ask that question, and I call it the cancer train, which moves so darn fast...

Kim Bowles: It does.

Tammey Grable-Woodford: When you, Oh my gosh.

When you're diagnosed, it is just you are on that thing, and it is moving unless you say I need to breathe, and I need to pause this for a second because I need to ask some questions and get some information.