There is only one way to remove a boob, and that's with a rusty spoon. Boob replacement, on the other hand, comes in three flavors.

Option one is an expander, in which the surgeon puts a glorified balloon behind the chest muscle. After it has about six weeks to heal, they numb the skin and inject saline until the expander reaches the desired size. Then the expander is replaced with a silicone gel implant. If only one boob is being restored, the other one often receives a small implant to achieve symmetry in the perkiness department.

All breast implants go behind the chest muscles, otherwise they would slip down and result in a belly button boob. There is only so much existing room behind the muscle, which is why the expander is used. However, since an expander starts out small, their is an initial asymmetry. Plus an additional surgery to switch the expander for the permanent implant.

Option two uses a different muscle, the latissimus dorsi. The medically inclined may have noted that this is a back muscle, and most people prefer their boobs on the front. Well, the surgeons don't let that little detail stop them. The muscle is detached at the bottom, swung around to the front, and used to hold an implant in place. This creates a horizontal scar along the bottom of the muscle's usual position on the back. However, it creates an instaboob of the correct size, and the implant is not a temporary one.

The obvious drawback is that you lose use of that muscle. I am assured that people with this type of reconstruction don't miss the muscle, and that the other back muscles compensate for the missing one. Oh, and there's a large scar on the back. Sadly, the muscle is numbed so there is no accidental or purposeful boob flexing.

Finally, option three is a tram flap. There are four vertical muscles in the abdomen. One of these is rolled up and used to create a boob. Like with option two, the muscle is numbed and there is no ability to perform boob flexing. On the other hand, there is an instaboob without the no longitudinal scar on the back. But that's all moot as I do not qualify for this procedure. All the surgeons agree that I don't have enough belly fat to use, plus things would become messy if I were to get pregnant. That leaves me with only two options.

Option one is much less complicated, so there is faster healing. However, it does require a second, though fairly routine, surgery. Not to mention I'd have uneven boobs for a couple of months. Option two is more complicated and has a longer healing period, but the end result tends to feel more like a real boob since it uses more of the patient's own tissue.

Then there are considerations involving the implant itself. Generally, they last for somewhere between ten to twenty years before requiring replacement. The new silicone gel ones feel more correct that the saline ones, plus the gel is cohesive and will not leak out should the implant burst. Choosing the silicone gel over saline was the one easy decision.

After much consideration and discussions with four different surgeons, I have selected option one. Why start with the more invasive procedure, when I have a good shot at getting the desired results without rearranging extra body parts. Should things not work out well, they can always take out the implant and switch to option two with a different implant. On the other hand, once muscle is detached and numbed, it cannot be restored to its former glory.

Compared to choosing the number of boobs to remove, that was an easy decision. I still haven't made a decision on that front, and I very well may end up talking with yet another doctor. I figure if I talk with enough doctors, eventually they will converge on a number. Of course, with my luck, that number will be something like 1.47, which is as useless as it gets.