Ta Da

Amputating both my breasts was a very scary decision. Research prior to making the decision mostly set an expectation of total loss of breast sensation, painful complications, numerous surgeries, and, ultimately, a strong likelihood of deformed reconstructed breasts. I was sternly warned to expect nothing and prepare for the worst.

The other day, I was reminded by my boyfriend that my decision to do it anyway, to take that risk, was courageous. I want to share with those making the decision for themselves that such risks can have positive results.

I am now nearly 8 months post mastectomy and 4 months post exchange to implant and everything is going very well.

I had no complications with surgery or healing whatsoever, perhaps because I took extreme precautions and had excellent care throughout. Perhaps because I’m just lucky. My new breasts actually look pretty darn good! They are softening significantly and even have an unexpected bounce. The scars are smooth and nearly completely hidden in my breast fold (underneath where the breast hangs down).  My skin and nipple sensation is slowly returning, though I don’t think I’ll ever have full nerve function again.

I ended up with 310cc Natrelle Inspira smooth round gel implants, otherwise known as a gummy bear implant. On my body frame (5’5″, 135 lbs.) this makes them a 34D bra size, quite a bit bigger than I started with but a nice, balanced, natural look.

Breast implants are typically placed under the pectoral muscle. When you are getting a breast augmentation, that’s cool because you have the added cushion of actual breast tissue over top of the implant. But, with breast reconstruction, there isn’t that added layer of breast and fat so the implants can move quite a bit when placed under that strong pec muscle. My plastic surgeon opted for over the muscle placement to avoid implant movement. This was especially nifty for me because it will allow me to get back on the silks faster (healing is typically expedited when you don’t have to stretch that muscle) and not have obvious implant squashing when I’m using my upper body in dance.

I’ve continued to take supplements for healing (Vitamin C, B complex, Calcium, and Gotu Kola) and also get monthly cold laser therapy (available at my Austin-based chiropractor) to reduce inflammation and expedite cell repair. I was given a scar protocol that includes 3 creams to apply every few days but, honestly, I couldn’t keep up. Scarring is minimum anyway so I gave myself a break.

My doctors were exceptionally talented and I cannot thank them enough for making me whole again. I recognize myself. I can get past this. It was risky, no doubt. Sometimes you have to double down and hope for the best.

If you’re looking for advice, I have little to offer I’m afraid. Everyone is so very different in their anatomy, desires, fears, and expectations. Shop around, educate yourself, and do what you think is best. The choice you make is the best one. Promise.

WARNING: ACTUAL BREAST PHOTOS
I decided to be courageous again and share actual images of my breast metamorphosis. Images are of both my breasts including nipples. Please do not share the images. Please click to view the images only if you are seeking information about mastectomy and breast reconstruction. Please be respectful and know how sensitive this is for me. View images here.

You know? You know.

Nearly everything I own fits far differently or not at all. My friends are having fun shopping in my closet. I’ve given away many of my tiny sundresses, bathing suits, and even my pretty lingerie. My bra drawer took the hardest hit. I’ve got nothing but a sports bra that was too big before my mastectomy.

This week, after I got the A-OK from my plastic surgeon that surgeries are finished and this is the size I can expect to stay, I went bra shopping. Petticoat Fair is known across the country as one of the leading bra fitters so I couldn’t wait to support my local bra slinger in person. They were charming when I went in pre-mastectomy to get info on therapeutic bras. They even work with insurance! These ladies are simply the best around.

My patient and gentle fitter asked a lot of questions so that I got not only what I wanted but also what was allowed per my surgeon’s instruction at this stage of my healing. She measured me and brought in a ton to try on. She stayed to adjust straps and check fit, making sure that every detail was supportive, comfortable, long-lasting, and pretty. I was glad she expected my new bra to be ALL those things equally.

I ended up with an every-day molded cup wireless bra that would be smooth even under tight, thin knit. It doesn’t press anywhere on my breasts or incisions so it won’t be painful or affect healing. I could have probably gotten one in every color since they are so versatile. I also got a sexy, black French lace bralette from the sale bin. These things can be expensive, especially those with fancy lace or trendy design. I was glad I was able to get one fun thing at a discount. (Heads up…French lingerie is still expensive even when it is on sale. Those curves though!)

They keep everything on file, including my wishlist with exact sizes. (Just in case my beau needs gift specifics…)

One of the best moments was when my fitter told me she was herself a 20 year cancer survivor. We shared a little about our experiences and she finished by saying, “you know,” not as a question but as a statement. It felt strange to “know” just what she meant, having just met her. It also felt good. It felt reassuring. She’s still here. I will be too.

Thank you, Cinco, for my Petticoat gift certificate! And, thank you Petticoat for making the downs an up, in all the ways.

New is nice

Today I am having the second and (hopefully final) phase of my breast reconstruction. They’ll be removing the tissue expanders, which I’ve affectionately named the “Iron Maidens,” and replacing them with soft, squishy, much more natural looking cohesive silicone implants over the pectoral muscle. I’ve got to say, I’m ready.

I went to my plastic surgeon yesterday to be marked. I look like a gradient elevation map. In addition to the boob swap, he’ll also be harvesting fat from my legs, hips, and flanks to nestle around the new implants so they look natural (without wrinkles or dents). They call that fat grafting. The liposuction may be the hardest part tomorrow.

Many people have asked me what size I’ll be after tomorrow. It is not something I can answer I’m afraid. That’s the thing about reconstruction vs. augmentation. I don’t get to choose. The existing space only accommodates a small range of sizes. Also, my doctor is hyper-vigilant about this looking good at the end. (So am I!) He’s measured every contour and will determine tomorrow in surgery exactly what looks symmetrical and attractive on my body shape and size.

He doesn’t speak in cup sizes. He measures in liquid CCs which is really tricky to convert to a bra size. Since I can’t get a straight answer on what I’ll look like and because it honestly doesn’t matter as long as it works out and I don’t have to do it again, who gives a shit?! The new ones won’t try to kill me!

I saw the “before” pictures today as well. Those boring old sociopaths weren’t worth all this trouble! I thought I would mourn them. I thought I loved them. But, like other times in my life, I’ve moved on. I don’t even miss them. I’m better off.

So, old boobs, I don’t much care about you. I don’t even think about you much anymore. I’ve got a new thing going. And my new boobs are going to treat me better. Settle on in to those corners of my mind with things I used to adore. Befriend those comfy platform shoes and sweet, hopeless boyfriends. Or just fuck off like those terrible clogs and mean jerks that made me cry. Either way, you’re being replaced and I’m glad.

One step closer…

Airbags to Water Balloons

Monday I went to a surgical follow up. This appointment was full of surprises.

I had anxiously tracked the drains down to 20cc a day for 48 hours and I was prepared for them to remove the irritating things. They did! I couldn’t wait to give my man a proper hug and put my arm around him in bed without getting tangled in my own octopusal appendages.

In addition, I got news we would make the switch from air to saline in the tissue expanders. My thoughtful surgeon warned me not to watch. Apparently, seeing my own deflated breast could be alarming. I agreed. My mom was there for as much commentary as I requested. She diplomatically described it as “fascinating.” She’s a nurse and is capable of enduring nearly any level of gore so her description was all I needed. I stared at the ceiling, did yogic breathing, and chatted about my skin’s aversion to adhesive.

The process didn’t take long and didn’t hurt. My breasts are very nearly numb, especially internally. Dr. P did give me a tiny amount of lidocaine, a numbing injection, on the surface of my breast skin. A needle was inserted into a magnetic port (very much like the chemo port that was in my upper chest) and the air was sucked out. Then, saline replaced the air and I was back to stiff peaks.

This time he increased the volume to 250cc on each side. He said we would increase once more to 300cc each. The size is already plenty for my small frame (5’5″ and 130lbs give or take a pasta dinner) but he recommended over-expanding by a bit so that the final implant easily fits and he can adjust the scars in my breast fold for symmetry and invisibility.

Pressure on my sternum and odd rib muscle soreness was the only side-effect and gentle pain meds took the edge off. In hindsight, I may consider taking one of my left-over Norco pills since I’m a wimp. I did some seated yoga and gentle stretching and within a few days everything feels fine.

These things are solid, folks. They point straight out like Marilyn in Gentlemen Prefer Blondes. Sleeping on my stomach is right out. Hugging is embarrassing and my projection under clothes will take some getting used to for a tiny-chested, sundresser like me. But I’ve always admired women with curves and I have to admit, I may find a silver lining in this process after all.

Also, I’m thrilled that my skin is already beginning to tingle indicating returning nerve function and capillary blood flow. My nipples respond, if you know what I mean. This is great news! I want to hug my breast surgeon!

Since I’m on the mend, I’d like to share my experience on things that helped and things that didn’t.

  • I’m a supplement devotee so when my plastic surgery nurse recommended a helpful vitamin and mineral regimen for healing, I was easily on board. I wasn’t surprised to discover I was already taking most of the recommended nutrients. But, they had a specific formula from Vitamedica so I decided to save my regular supplements and just take these instead for the duration of my surgical prep and healing. Many of the nutrients in the Vitamedica blend such as Biotin and Calcium were important for my hair growth and recovery from chemo so I wasn’t slacking on my usual supplement program.
  • I also got Vitamedica Bromelain to help with swelling. Bromelain is a component of pineapple so I also ate a lot of fresh pineapple right after surgery. I had very little swelling so I think this stuff worked like a charm.
  • Arnica 30X is something I take regularly, especially for the infuriating blood clot I acquired thanks to the placement of the chemo power port. It helps with blood flow and bruising. This was a natural inclusion in my healing and something I recommend for athletes, healing folks, or those of us who are simply clumsy.
  • I bought a very comfy, though expensive ($60) mastectomy bra. I’ve worn it 3 times and now don’t need it. This was a waste of $$. It was useful at first to hold the dressing I had on the incisions and drain tubes but I can’t see another use for it now. I suggest waiting until expanders are completely filled before buying any new bras. In fact, I’ll probably hold until the final implants are in place before spending any more on lingerie. A simple stretchy camisole that I already had worked beautifully with the dressings and now I just don’t wear anything. Remember, these things are bongo drums. They don’t so much as jiggle and support is already built in with the Alloderm scaffolding they used during surgery. I look forward to getting a proper fitting at Petticoat Fair as a celebratory and therapeutic splurge once my body transformation is complete.
  • I did not lay around like I did during chemo. I was walking, gently stretching, and out and about almost immediately. I’m very careful not to lift anything over 10lbs (including Shih Tzu or groceries) or reach for anything beyond my comfort level but otherwise, my life is really getting back to normal. I was off narcotic pain meds within about 7 days and relied on Tramadol and Tylenol, sometimes taking only 2 Tylenol a day. I haven’t driven much because my mom has been such a help but I feel that when she leaves next week I’ll be ready. I was careful not to over-exert myself but I feel my activity level expedited my recovery and improved my mood significantly.
  • I showered once per day using Dial antibacterial shower gel. I didn’t scrub but just let the suds rinse over my incisions. I have had no sign of infection whatsoever.
  • Everyone who touched my drain tubes, breasts, or really any part of me washed their hands with antibacterial hand soap.  We also cleaned phones, laptops, remote controls, and other high-traffic things with rubbing alcohol nearly every day. We used bleach and steam to clean my whole house before surgery and regularly afterward. We were very careful to avoid infection. Mom’s a nurse, remember, so she was militant about hygiene.
  • My legs and core muscles made up for my upper body inabilities that last few weeks. To get out of bed, I used my yoga and silks stomach muscle memory of balance and force to roll to a seated position without using my arms. I did not let people assist me by pulling me. That hurt. Instead, my boyfriend’s arm was used as an unmoving poll I could use to pull myself, sort of like a jungle gym or climbing a ladder. Sometimes I needed a gentle push on the back or butt to get up. I’m grateful I had plenty of core and leg strength before surgery because it was painful to get up and down or even adjust myself using my arms.
  • Anesthesia can interfere with pooping, a topic I don’t like to speak about publicly. But, it is a major part of recovery I’m afraid. To get things moving again from a digestive standpoint, I snacked on dried prunes and apricots, drank plenty of water, and walked daily. We forgot to get the Colace the doctor recommended until a few days after surgery but I would have taken that as well. I also took daily probiotics and drank my usual morning coffee. It took about 5 days but finally everything began getting back to normal and I felt much better. I don’t like to tinker with my regularity with unnatural methods so food and movement was a priority for me.
  • People had recommended a recliner chair and wedge pillows. I didn’t get organized enough before surgery and I ended up not needing those things anyway. I’m glad I didn’t spend too much money. Plenty of pillows sufficed.

Best of luck with your mastectomy surgery. I hope you find your recovery as easy as mine has been. Please post your own recommendations if you have them in the comments. I’d love to hear what has worked for others.

Out with the old

On Thursday, I checked into the hospital for a nipple-sparing double mastectomy. Most people don’t willingly sign up for amputation. I did and it felt strange. On a conscience level, I didn’t feel much fear. I mostly felt ready. Ready to be done with this. Ready to move on. I was ready for this game of tug of war I’ve been playing to be over, ready to put down this planet I’ve been carrying. Let’s be honest though, chopping off one’s breasts, especially breasts I loved, was a mortifying closure to an already traumatic cancer treatment.

Before nipple and skin-sparing techniques, mastectomy was pretty much a full removal of the entire breast leaving the signature – – scar across the chest. Reconstruction was done over months or even years and involved a series of serious surgeries and permanent, visible scarring. Women learned to wear those scars with pride because it meant they survived that which tried to kill them. But, I’ve stopped at nothing to retain my previous sense of physical self so scars weren’t something I was interested in celebrating.

Because of the small size (1cm x 1.5cm) and location of my tumor (no cancer anywhere near my nipple) I was a candidate for surgery that would leave the exterior of my breast as a pocket for implant reconstruction. This type of surgery was a major deciding factor in choosing mastectomy over a more simple lumpectomy with radiation.

Nipple-sparing mastectomy procedure has plenty of risks though, so my doctors made no promises. I went under anesthesia knowing I could wake up with nothing but sutures. My surgery went perfectly! I have very minimal bruising and swelling, low pain, nearly full range of motion, and (most surprisingly) a pretty sexy, albeit temporary, set of new jugs.

My surgery lasted a little over 4 hours and included both my breast surgeon and plastic surgeon working together, even simultaneously. I was marked  with permanent marker the day before by my plastic surgeon (PS) so my breast surgeon would know where the incisions should be made. Once my breast surgeon was finished with one breast, my PS began building the scaffolding made of Alloderm, a human tissue substitute that eventually becomes part of my own tissue, which will help hold up my new implant under my skin.

Then, a tissue expander was secured in place above the pectoral muscle and filled with 200cc of air. The air will be replaced with saline in about 2 weeks. Air is better at first because it allows the skin and Alloderm to heal without the weight of liquid. Occasionally I will have the tissue expander “topped off” with more saline until the desired size is achieved. Then, after that size has been allowed to stretch my healing skin safely, a final silicon implant will be swapped with the expander. The time between now and my final implant I hope will be around 3-4 months, though it could be longer depending on how well I heal.

I stayed overnight in the hospital. My boyfriend stayed with me and we wandered the hallways all night like it was a high school lock-in, except we didn’t have to hide to make out. It was nearly fun!

All of this sounds sort of complicated but from my standpoint, I made out like a bandit. I rid my body of cancer, kept what I know as my breasts, avoided any visible scarring, and will have nice, gravity AND cancer resistant boobs for the rest of my life. For me, it was the right choice.

My new “foobs” feel really weird but they look darn pretty, considering. I have 11cm scars in the folds under my breasts which are healing nicely. The expanders are super hard to the touch but they are good for a laugh and look excellent under clothes. I got a couple wireless, soft bras to accommodate them. It gives new meaning to the term “over the shoulder boulder holder.” While hard, they are round, feminine, and beautiful in my eyes.

I also have two drains that  prevent fluid build up in my new boobs while they heal. The drains will be removed on Monday. Drains are super lame. They dangle around me and have to be emptied a few times a day. Gross! Luckily, my mom is here to help though I’ve also learned how to empty them myself. They are probably the worst part.

Monday morning my surgeon called to tell me that the tumor was completely removed during surgery. Technically, I no longer have breast cancer. That one sentence made chemo, cold caps, surgery, and hard, weird boobs for a while completely, utterly worth it. We did it! Cancer has been officially fucked off.

Feel free to ask questions about my mastectomy surgery. I have lots of details I don’t mind sharing if you’re about to have the same surgery or if you’re just making decisions on your treatment. I hardly ever read anything about surgeries that didn’t involve limitless negative complications so happy to share my smooth-sailing experience.

Dirty Gummy Pillows

When preparing for chemotherapy, I resisted the urge to read forums and get advice from non-professionals. I would be doing chemo no matter what so gathering details about the potentially sick and wrong things it would do to me seemed unnecessarily cruel.

I attempted this same methodology on surgery research and felt quite unprepared for the conversations had with my breast surgeon and as I interviewed plastic surgeons who would be performing reconstruction. I’ve since been devouring info, images, personal experiences, and options. Is it scary? You bet. But, because my decision will impact my life forever, I want to move forward with my eyes wide open.

I am opting for a bilateral nipple-sparing mastectomy and implant reconstruction. In other words, we will remove both breasts but leave the skin and nipple as a pocket for (sorta) immediate reconstruction. It is a more extreme surgery than a lumpectomy with radiation, which I’m also a candidate for, but I have good reasons for my decision.

Why, you ask, would I say “bye, Felicia” to both my breasts when I don’t have to? Great question.

First, a lumpectomy would require 7 weeks of daily radiation therapy post-surgery. That extends my treatment significantly in a pretty un-fun way. Radiation could leave my skin leathery for life and could prevent reconstruction options later on should the cancer return.

Also, leaving breast tissue makes me nervous. Statistically, lumpectomy combined with radiation does provide similarly low chance of cancer recurrence compared with mastectomy. But, I like to use my brain as well as stats. My brain knows that when breast tissue is present, there is a chance the cancer will return and I’ll have to do a whole treatment plan similar to the one I’m doing now all over again. Since I’m so young, the chances do increase it could happen again. I’m not willing to risk that and would instead prefer to have a more radical surgery preventatively, even though the complications from a larger surgery are more likely.

From a cosmetic standpoint, breast symmetry is more likely if I have the same surgery on both breasts. My breasts are small but nearly perfect and I’d like them to stay that way. While I didn’t intend on ever having breast augmentation, I always fantasized about slightly larger, perky breasts, especially as I got a bit older and began to notice gravity’s gentle coaxing. Now I’ll get my chance. You wanted a silver living, here you go.

That being said, I want a very natural look and highest safety rating with my new breasts. This means I will likely be doing a tear-drop shaped*, cohesive silicon implant, also known as a “gummy bear” implant. They don’t leak and have a very natural appearance and feel. They feel like a new, just-opened gummy bear, not one that sat on the counter overnight.

I also believe, because I’m pretty active, that I’ll have the implant placed above the pectoral muscle. This is much less painful during recovery and eliminates the chance the implants will move around when I am dancing in aerial silks or otherwise flinging myself around dance floors and music festivals.

The mastectomy surgery will be performed after I’ve recovered from the last chemo treatment so likely early November 2016. Skin expanders may be placed during that surgery to allow for healing and ensure the final implants look, feel, and behave like champs. Then, they’ll swap out the expanders with soft, snuggly gummy bear implants for us all to enjoy a few months later.

I’ll follow up with more info once final decisions have been made and post pics as I can.

*Updated implant info here.