Breast Reconstruction: So what is actually happening right now?

Can I see some ID? I had to bring these on my trip last week just in case my tissue expanders showed up during airport screening. Nothing to see here...

Can I see some ID? I had to bring these on my trip last week just in case my tissue expanders showed up during airport screening. Nothing to see here...

The most commonly misunderstood piece of my whole journey has definitely been breast reconstruction. Everyone can clearly understand cutting out the cancer. What happens next is very mysterious. Kudos to those of you who feel comfortable asking just what exactly is going on with me now. When everyone else’s heads swivel around to hear my answer, it’s helped me to recognize how little people know about this process and how helpful it might be if I detailed it here. Stick with me though, it’s not a short process to explain.

First things first, so far I have had three surgeries. The first two were lumpectomies, designed to remove the cancerous cells and a cushion of clean cells around them. Unfortunately, after both of those surgeries, the cushion of clean cells, better known as clean margins,  just did not materialize. Each time the cancer was moving into a new space. This helped us to determine that my cancer cells were more involved than we thought. Because of the kinds of cells they were, it also helped us recognize that even if we did achieve the clean margins on a third try, the cancerous cells could possibly still be lurking just on the other side, posing a hidden threat. Therefore, we elected to remove the entire breast - a mastectomy.

When I decided to remove one entire breast, I knew I was removing both. There was NO WAY I was doing this twice. I wanted to quiet my mind and feel confident that my chance of recurrence was as low as possible. The next decision I had to make was whether I wanted to rebuild my breasts or not.

Let me pause here for a second. Some people find this discussion a little too sassy - I mean we’re talking about breasts?! Yes. We are. And in my case, they aren’t sassy, they are assassins. One of them tried to kill me and I feel pretty certain the other was in on it. That’s why it’s ok to ask me anything and everything. You aren’t talking about some sassy subject, you’re talking about my survival. A LOT of people have been asking these questions and frankly, I welcome the opportunity to tell you that the human body is incredible. To me, it’s all science now.

Ok, so when it came to deciding if I wanted to rebuild, I wasn’t sure. It was described as and has proven to be a challenging process. At the end of the day, I decided to move forward with breast reconstruction because it was just right for me. I could have easily gone the other way so I completely understand the women who decide not to proceed with reconstruction, at times during this process I have even wished I was them. It’s a very personal decision and I am thankful I had the opportunity to make it.

Breast reconstruction started in the same surgery as the mastectomy. Mastectomy is surgery to remove all breast tissue from a breast. In my case, they took everything because the cancer was in the ducts so the nipple had to go too. The surgeons work in tandem. My breast surgeon started removing the tissue and when she moved to the second side, the plastic surgeon came in and started reconstruction.

While there are many options for how they do this, in my case, implant reconstruction was most appropriate. To make the final product look as natural as possible, they put the implant under the muscle in my chest. That sounds strange but remember, there is no breast tissue left to cushion things. To make that work, they need to stretch the muscle. In surgery, they placed what’s called a torture device, no, sorry, it’s actually called a tissue expander, under the muscle. The tissue expander looks like a deflated, cloudy breast implant but it’s more textured to the touch. It has a magnetic port on it that’s maybe an inch by an inch in size. The surgeon added a very small amount of saline to my tissue expander while I was in surgery so it wasn’t totally deflated.

Tools of the trade - first the wipe, then the port finder and the marker.

Tools of the trade - first the wipe, then the port finder and the marker.

Over the next few months, I visited the plastic surgeon’s office every few weeks and he added more and more saline to the tissue expander. The visits were painless because I was completely numb across my chest, in fact I am still numb in a lot of areas. It’s about a 5 minute appointment. First, the doctor uses the plastic thing in the photo to find the magnetic port under my skin. He marks the spot using the marker. Then there is a teensy little needle that goes into the port - again, I am numb so I have no idea when it goes into my skin or muscle. The needle is hooked up to a syringe full of saline and the doctor slowly pushes the saline into the expander. You can see it inflate. To me, it just feels like my chest is getting a little tight. Basically, you repeat this cycle until you achieve the size you are most comfortable.

It seems like they're adding a lot of saline but you have to remember, there is nothing there. This isn't like a typical breast implant process.

It seems like they're adding a lot of saline but you have to remember, there is nothing there. This isn't like a typical breast implant process.

After most appointments I was a little sore, like I had done a very rigorous chest workout, but it was tolerable. After the last visit, I was reallllyyyy hurting. I was psyched when I felt I was done around that same time.

Once you hit your desired size, you wait. That’s what I have been doing the last few months. They give you a few months to let your body adjust and settle into things. During this time, my numbness has worn off in some places leaving the interesting, and at times painful, pricks of nerves coming back to life. Losing the numbness in places also tells me when I have overdone it because I get sore. Oops.

Now, this Friday, I will have my exchange surgery. They will open me up via the same incisions (a 3-4 inch line across the middle of each breast), remove the tissue expanders and replace them with my final breast implant. I have seriously mixed feelings about this.

On the one hand, I cannot wait to get the torturous tissue expanders out. They hurt. They are very hard, they have no give, they press on your muscles and nerves and just annoy me in general, particularly when I am trying to get comfortable in bed. The implant will be softer, more natural and more comfortable for me, according to everyone I have talked with who has gone through this.

On the other hand, I am so anxious! This part of my body has been through so much, my brain tells me to protect it and not let anyone near it. My scars are healing and starting to fade. As my nerves come alive and some sense of feeling returns to this area, I can see the progress I have made but know much of it will be lost when they cut into me again. It’s a mind warp.

All of these things are still better than cancer though. It will be a huge win to check off another step in the process. Another step toward feeling like me again. A step toward feeling like a normal person in terms of energy and strength. They say it takes a year to feel like you again and it’s only been five months. I am tremendously lucky and I have to remember that.

So do you feel like you understand now? Survivor sisters, did I miss anything? Thanks to all of my loved ones who had the guts to ask and to all of my other friends who piped up to say they had been wondering the same thing. I appreciate your interest in my journey and would be lost without your love and support. Please keep me in your thoughts for a smooth day on Friday.