• A Discussion on Breast Reconstruction


    In general, I think the public understands the concept of a mastectomy pretty well. The reconstruction process, however, is something of a mystery. Everyone knows it’s an option, but they don’t really know what that option means or when it occurs. I certainly didn’t understand before it happened to me.

    So allow me to educate you.

    Strap in, y’all. This is a long one.

    In January of this year I had what is called a skin sparing mastectomy. I’m not sure, but I think the reconstruction process is different for other types of mastectomies where preserving the skin isn’t an option. I can’t speak to those, but there would have to be considering there are different types of mastectomies. This post is only addressing the approach my surgeon is taking.

    The mastectomy I had is pictured on the left.

    The mastectomy I had is pictured on the left.

    The mastectomy I had removed the cancer and all the breast tissue but left the skin behind. My surgeons started the reconstruction process during my mastectomy. They placed a tissue expander in the pocket left over when all my breast tissue was removed.

    The tissue expander.

    The tissue expander.

    After radiation ended in April the tissue expander was filled to capacity (450 cc’s) and my skin allowed to heal around it.

    That’s the first few steps of the reconstruction process.

    The tissue expander is not permanent. It only does what the name suggests – it expands tissue, preparing it to accept a more permanent implant.

    This week I met with my plastic surgeon to start discussing a timeline for my second (and hopefully final) surgery.

    As of right now I have one normal (albeit kid-damaged) breast on the left and one very hard and perky nippleless Barbie boob on the right. The plastic surgeon’s job is to make them match as best he can. He cautioned me that my breasts will never match exactly but he can get them close.

    The right breast, the one that’s undergone the skin sparing mastectomy, is what he called relatively easy. He’ll open the existing incision, a scar about the length of my hand that runs horizontally across the center of my breast, take out the tissue expander and insert a more natural looking implant.

    The left breast, the normal one, will undergo a lift. This requires a little more work. Here’s a rough diagram the surgeon drew for me. Essentially my nipple will be moved up and the remaining tissue will be brought together at the bottom.

    Hand drawn breast lift diagram.

    Hand drawn breast lift diagram.

    Some questions I asked the surgeon:

    When is surgery?

    The earliest I could have surgery would be November of this year. That’s when I’d be physically ready for surgery. Mentally? I’m thinking ‘never’ sounds pretty good. We met in the middle with February. That way I can enjoy the holidays and my birthday before I’m forced into down time.

    Speaking of down time, how much?

    He said I’ll have surgical drains in both sides this time, so I’ll need to take about two weeks off of work (yes, I’m trying to go back to work, but that’s a post for another day). Then it’ll be about six weeks until I can resume my normal levels of physical activity. My surgeon is a runner, too, so he understands my need to move to maintain my sanity. He said during that six weeks I’m allowed to walk all I want, but no running or jarring activities.

    I had a minor mental tantrum over this.

    I don’t want downtime. I don’t want to slow down. What I want is to stay in the land of the living where cancer isn’t normal. I want to keep moving forward. I had to take a deep breath and remember that this might be another scary step, but it is moving forward.

    How long will I be in the hospital?

    This is an outpatient surgery. The only reason to keep me in the hospital is if they’re having trouble controlling the pain. Otherwise I can go home the same day.

    Will I lose sensation in my left breast and nipple if I have a lift?

    He said, “Maybe.” He also said that the sensation might change, it might become hypersensitive, but I will probably still have sensation.

    Out of everything that’s going to be done, this part gives me the most pause. I have gone back and forth thinking about what to do with my left breast. I only have one nipple left and I kinda like it just how it is. My right breast and under my arm is numb because all the nerve endings were cut during my mastectomy. The thought of losing sensation in my left breast and remaining nipple is almost enough to make me forego the lift on the left side all together.

    Will I need a replacement implant some day?

    It might be 10 years or 25 years, but, yes, I’ll likely have to have the implant replaced someday. The implants are a medical device and so they have a limited life span. How long that life span is largely depends on how my body reacts to the implant, so I’ll just have to wait and see.

    I’ve heard of nipple reconstruction. Tell me more about that.

    My surgeon said this is an option if I’d like to pursue it. His favorite method, called ‘Nipple Sharing’, can take place about three months after the reconstruction surgery. The Nipple Sharing method takes a piece of my remaining nipple as a template and grafting it onto the other side. This is done in the office under local anesthesia. I’m going to have to think about this one. My knee jerk reaction is ‘um, pass’, but I don’t know what I’ll feel like in a year.

    I’ve heard other women say, “Hey, at least I got a free boob job out of breast cancer.” Maybe that’s how they’re dealing with it. I can’t find it within me to be glib about any of this.

    I never wanted this. I never wanted cosmetic surgery of any kind. I didn’t hate my body or want to change it before breast cancer and I don’t hate it now. So in case anyone is wondering, no, I’m not looking forward to this. I’m tired of being hurt in the name of medicine.

    Just sitting in the exam room wrapped in my medically issued robe and talking about surgery sent me back to waking up from my mastectomy. Waking up and looking inside my shirt for the first time was one of the hardest moments of my life. To see a bandage where my nipple used to be, to see a deflated and bruised balloon where my breast used to be. The sense of unreal horror upon waking to find my body irrevocably altered.

    And worse, I’m told that as I was coming out of the anesthesia I looked inside my hospital gown multiple times then forgot I’d looked. I only remember looking for the ‘first time’ once, but buried somewhere in my brain is the memory of living that moment over and over.

    Of all the steps in treatment I feared surgery the most. Is it any surprise that fear has carried forward to today?

    My surgeon described the process of making my breasts match. He said they sit me up during surgery to see how my breasts fall because it’s hard to picture what they look like when I’m lying flat on the table.

    This freaked me the fuck out. Things being done to me while I’m asleep. . . It’s the stuff of horror movies.

    My surgeon must have seen my panic because he reassured me that my face would be covered the whole time. I’m not sure that information helped, but it was kind of him to try.

    If I decide not to do a lift on the left side my breasts will be asymmetrical. There was a time when this was the thing that bothered me the most. Now the thing that bothers me the most is the potential loss of sensation my left nipple.

    Funny thing about the fear. It doesn’t ever seem to go away. It only changes direction.



    Questions are always welcome. I tried to address everything, but if I missed something feel free to leave a comment or send me an email at gettingthewordswrong (at) gmail (dot) com!

One Responseso far.

  1. gloria Adamson says:

    You are amazing with your words. You should write a book. It would help so many women. You make us all think, laugh and cry.

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