Just the Facts: In sixteen days I will have outpatient surgery to complete this phase (the major part) of my breast reconstruction plastic surgery. This is a follow-up to the immediate reconstruction which began on April 6, after my complete double mastectomies. The upcoming surgery is known as “exchange surgery” in which the doctor removes the hard, saline-filled tissue expanders and replaces them with breast implants. The implants will be much more natural feeling. After a few weeks’ recovery, I should look and feel much better, and at that point most of the reconstruction will be complete.
Details: Breast reconstruction began for me right after the mastectomies. Literally, my surgeon finished his work, and then my plastic surgeon began the reconstructive surgery. That’s one reason I was in surgery nearly 6 hours back on April 6.
At that time, my plastic surgeon placed rigid plastic tissue expanders on my chest wall. They resemble dome-shaped baggies, and each one has a metal port. At the time of that surgery, he was able to add some saline to the expanders. I believe that was 100ccs in each side. It gave the effect of still having (small) breasts, which was wonderful, mentally! It was truly a blessing to never have to experience flatchestedness. More saline injections were needed to make me look like a grown woman, though.
After a few weeks, my plastic surgeon began the process of inflating the expanders with additional saline injections through metal ports. This was a very cool thing to observe. Remember, a sense of humor is absolutely REQUIRED here! Each week I returned to his office to be injected with anywhere from 30-50ccs of saline in each expander. This gradually stretched my skin, forming a somewhat normal looking bustline for me. Although we didn’t have much choice, Tracy and I were able to offer some input on how much saline was ultimately added, thereby choosing my final “size”. There was only so much room for discussion, since I literally have thin skin, according to the doctor. (Thin skin comes with lower body fat.) I could only go “so big” since bigger would have stretched my skin too thin, making the edges of the implants visible once the final surgery was done. Given that my build is fairly athletic these days (and I expect to keep it that way), I am content with the size we have achieved. It is acceptable, although I won’t stop traffic or anything.
I have had a love/hate relationship with the tissue expanders. I’m so glad just to have a feminine shape! But since the time I woke up from the initial surgery, they have been uncomfortable. They make it difficult to sleep, to move normally, and to give hugs. At one point, the pressure on my ribs from the expanders was so great I was in heavy pain and felt nauseous. On the other hand, the expanders have been a constant source of humor for our family. Everyone knows to (physically) avoid them in order to avoid injury to themselves! We have also laughed at the way they have morphed through this process. Seeing them grow was funny on its own, not to mention the tricks I can perform with the metal (magnetic) port just under the skin on each “breast”. But over time (due to my rigorous exercise, according to my doctor) the ports have shifted, which has made the overall breast shape distorted. Also, I have noted that for whatever reason, the expanders just look different every day. Maybe it has something to do with the barometric pressure or something! But each day I wake up and take a look to see what in the world I’m working with that day. It has been over three months since my last saline injection, and I’m finally finished with this waiting period, which was designed to ensure that my skin had adequately stretched, making a nice “pocket” for the future implants. As interesting as this has been, I will not miss the expanders at all when they are gone!
Some decisions about exactly which implants I will receive still remain, and will be made by the plastic surgeon during the surgery. My general size has been already determined, based on the total amount of saline that was injected. The doctor explained that there would probably be two options at surgery. He would order a set of implants in two different types: the High Profile and the Moderate Plus profile. The difference has to do with diameter and projection. Each type has more of one or the other. Personally, I’d like to maximize both. When my children were in preschool they learned a helpful adage, which perfectly applies in this scenario: “you get what you get and you don’t mind a bit”. I will be content with whichever I get, but If I could choose, I think I’d prefer a larger diameter. This would create a more normal looking cleavage (hopefully). After dealing with two mounds separated by a mile for the last 5+ months, I am really hoping to once again have breasts that exist in the same zip code.
The final decision making will be done by my plastic surgeon and his team in surgery that day. Apparently, they will try both types out, sit me up, take a look and vote. I can’t tell you how weird that makes me feel. But they do this all the time. I trust that the nurses, the doctor and the representative of the manufacturer of the implants want me to look as good as possible, and will choose the most natural looking implants. Nevertheless, I still cringe at the thought of the whole “trying on” affair while under general anesthesia!
The surgery itself will closely resemble the original breast surgery. I currently have two large horizontal scars from armpit to mid chest on each side. The plastic surgeon will open these again, so at least there will be no new scars. I had hoped that the incisions would be smaller this time, as the bigger the incision, the bigger potential for discomfort afterwards. (But you get what you get . . .) After the doctor experiments and chooses my new implants, he will then complete some additional reconstruction, focused primarily on my left side. For whatever reason, the initial work on that side did not turn out as well as hoped. This time, we are looking for more symmetry and balance. This is going to require additional use of Alloderm, a special type of grafting tissue. The Alloderm was used extensively in the initial surgery to form the bottom “sling” part of the future breast area. This time, it will be used to rebuild part of my chest wall and reposition my left “breast”. Unfortunately, use of the delicate Alloderm requires a drain or drains in the days or weeks that follow surgery, so that fluid doesn’t build up and ruin the special tissue. So, I can look forward to going home with a drain after this surgery, but one drain beats four (what I had last time). Hopefully I’ll be able to have the drain removed soon after. I will once again have numerous internal and external stitches, basically mimicking what I had from the prior surgery. I’ll probably just have a small bandage covering the whole thing.
My recovery should be easier than after the mastectomy, but very similar. The doctor said to expect to feel beat up again. I guess that means sleeping in my bed will not be happening for a while. Tracy and I are going shopping for a recliner for me this week, which should make sleeping and resting a bit more comfortable. I won’t be able to perform my normal exercise routine for at least a month. After a week or two, or around the time the drain is removed, I should be able to gradually build back starting with light weights.
What will be different is that this time I’m also dealing with a body under the effects of Tamoxifen. I love its ability to starve cancer cells of their needed estrogen, but Tamoxifen is making me feel like an old woman in many ways. I’m tired. I’m grumpy a lot. I like to sleep more than most anything else and I want my way. (Wait, maybe that’s nothing new?
) Bottom line, I’m not really sure what to expect. I think it will be much like last time, but who knows. At least we are in the home stretch of the whole ordeal this time. That’s a huge mental boost!
What’s coming up: A hospital pre-op visit with an anesthesiologist on August 18, an appointment with my oncologist on August 25, then surgery on August 31. School starts August 25, so I’ll have 5 days for some last minute prep and mini-nesting.
Prayer Requests: I am truly thankful for this plastic surgery. As much as I complain about the intricate details, I appreciate the fact that all this can happen. Please thank God for the gift of breast reconstruction. Please also ask Him for wisdom and skill for the doctor and the hospital personnel who will help me. Also please pray for no complications from surgery, and for quick healing and drain removal!