Mastectomy 101 Part 2: Breast Reconstruction and Expansion

Of all the procedures I will be having this year, the breast reconstruction process will be the most drawn out. As I have mentioned in previous posts, there a several different types of breast reconstruction. Some use a woman's own tissue, some use implants, and some use both. I'm only going to discuss the type of reconstruction that my surgeon and I decided on for me, but I do want to make others aware that there are many options for breast reconstruction and many factors come into play when deciding which type is best for a specific woman.

After consulting with a plastic surgeon several months ago, it was decided that my best option for reconstruction would be tissue expanders to silicone implants. I have had a lot of people ask me what tissue expanders are. I'm going to rely on YouTube once again to start my explanation off. Again, this is a very short video (2 minutes) and it gives a great explanation of tissue expanders:

Tissue expanders (like the one shown in the video) will be placed, by my plastic surgeon, right after my mastectomy. On the day of surgery, my general surgeon will go in and perform the bilateral mastectomy. Once she is finished removing all of my breast tissue, my plastic surgeon will then come in and place the tissue expander under my pectoralis muscle. A material called Alloderm, which is made from donated human tissue, will be placed under the expander and sewn to the pectoralis muscle to create a sling for the expander. Here is a visual representation of that:

My plastic surgeon will fill the expanders with a small amount of saline on the day of surgery, to start the expansion process. The skin after a mastectomy is so fragile that the expansion process will be done very slowly. The purpose of expansion is to create a pocket for an implant. After a mastectomy, there is no breast tissue to hold the implant in place, so a pocket is needed. Depending on how well my body tolerates the saline fills, I will go into my plastic surgeon's office every 1-2 weeks to have more saline added. Once the expanders are filled to the size they need to be, they must stay in place for 3-4 months. After that 3-4 month period, I will go in for what is called an exchange surgery. My plastic surgeon will take out the expanders and replace them with silicone implants. Alloderm will again be used as a sling for the implant in the same way it was used for the expanders. 

Some of my worries....

I have talked to a lot of women who have had tissue expanders, and have yet to find anyone that doesn't hate them. They are uncomfortable, hard, and tight in your chest. They often make your breasts look deformed. Many women have told me that each time they get a saline fill in their expanders, they are in pain for the following couple of days. Basically, what I'm trying to say is that the expansion process sucks and I am not at all excited for it. I'm worried about the length of time (around 6 months or more) that I will have to deal with the discomfort the expanders cause. I am also worried about the possibility of infection around the expander. Some women develop infection, at which time the expander must be removed until the area heals. Another surgery would then be performed later to place it a second time, and the whole process starts over. Are you starting to see why I described the process as 'drawn out'? 

I guess the only positive thing about expanders is the relief that comes when they are switched out for implants. Some women refer to their implants as 'squishies,' because they are so soft and comfortable compared to the expanders. I know I will be counting down the days to my exchange surgery! On a side note: I will have magnets in my boobs while the expanders are in, so that will be interesting. I've seen women post pictures of soda cans, keys, and other metal objects stuck to their breasts! You have to keep a sense of humor through all of it, right? 

Mastectomy 101 Part 1: Let's Talk About Nipples

Warning: This blog post does contain photos related to different aspects of mastectomies.

Update

 Before I write anything about my mastectomy, I must formally thank all of you that have reached out in love and support after my last blog post. Thank you for the kind words and for sending me your positive thoughts and prayers. You have strengthened me more than you will ever know. This world is really such an amazing place, with so many amazing people, and I'm so lucky to have such a great number of those amazing people in my life. Truly, thank you.

As for how I have been doing....I am continuing to attend Eating Disorders Anonymous meetings and therapy on a weekly basis. I have been very blessed to be meeting with my therapist from my time in inpatient treatment, as well as from the years of outpatient treatment following my discharge. It has been a special experience to be meeting with her on a weekly basis again. These past couple of months have been an uphill battle, but I am getting there    one day at a time. My eating disorder behaviors have been mostly under control, although I have had some slips, but the real battle is with the eating disorder thoughts. It really is shocking how powerful they can become after slipping for even just a short period of time. I know others that have struggled with an eating disorder or any other form of addiction will understand what I mean when I say that even with the behaviors under control, the addiction is still there, constantly trying to pull you back into its grips. The longer I fight, the stronger I become. Where I am today is a world away from where I was when I wrote my last blog post and I am so grateful for all the love and support along the way      from those around me, from my Savior, and from YOU     my blog readers. So, again, thank you.  

My Surgery    

My bilateral mastectomy is now only 20 days away, 20 DAYS! After the whirlwind of finding out my genetic test results and making all those difficult decisions about surgery (oh, you know, and announcing it to the world on this blog) I became somewhat emotionally detached from all of it. It's not that I haven't been thinking about it at all or talking about it, but I hadn't really started to process the reality of what I'm actually facing until recently. I want to use this blog post to process some of these feelings, as well as inform others of what is involved in a mastectomy, and maybe help erase some of the social stigma and shame surrounding this procedure. I know that I was very uninformed before being faced with it myself, and now I feel a strong desire to help others understand the process, and get comfortable with all that it entails. Chances are, you know at least one woman who has had breast cancer or has had to go through the pain of a mastectomy. Being informed will help you to be more of a support to those women. My emotions about my own surgery have been all over the place, so I hope that this post doesn't turn into a jumbled mess of thoughts. Well, I guess I'll just jump right into to it....here we go:

Below is a very short video, with a very basic explanation of the different types of mastectomies. Although it is a simple video, it answers a lot of questions that people have asked me about my surgery, so I hope you will take the time to watch it.

Since I am having a mastectomy as a preventative measure, I will be doing the nipple-sparing mastectomy. As mentioned in the video, the main advantage to this type of mastectomy is a better cosmetic outcome. I am grateful for this option, not just for the cosmetic outcome, but for the fact that when I look down after surgery, I will still see part of myself there. I believe it will lessen the feelings of loss. With that being said, the outer skin and nipple will be the only parts of my breasts that will still be 'me', and those parts will only be 'me' visually. As shown in the video, all of the breast tissue will be completely cut out to the skin, and the nipple will be cored out. As a result, my breasts will be numb for the rest of my life. What will be left behind is a very thin and fragile layer of skin. 

Necrosis

Because the skin will be so fragile, and the blood flow so weak, I will be at risk of necrosis for the first few weeks following surgery. Necrosis is the process of the tissue dying. Some women who have a nipple-sparing mastectomy still end up losing their nipples. The nipples die and turn black. Extra surgery is required at that point to remove the dead tissue. Other parts of the outer skin can become necrotic as well, and would have to be removed. Here is a photo showing nipple necrosis:

Nipple Reconstruction

Some women without nipples choose to do nipple reconstruction, while others just learn to live without nipples. I have already made the decision that if I lose my nipples, I will  be doing nipple reconstruction. The nipple is reconstructed using the patient's own skin, and once it is healed, it will be tattooed the color of a real nipple. This photo shows one way the nipple is reconstructed:

I have also learned in my research that some women choose to get a 3D nipple tattoo, instead of doing the actual reconstruction. Here is an example of that:

This photo is from the White Tiger Tattoo website (http://www.whitetigertattoo.com/medical/3dtattooing.html)

On the advice of a good friend, I have decided to blog about my mastectomy in small parts. It is all a little overwhelming for me right now, and I'm sure all the information could be overwhelming to my readers. I guess the theme of this post is: I really want to keep my nipples. That might sound a little strange and awkward, but the fear of losing them gets stronger and stronger as my surgery nears.To all of you women out there reading this    have you ever thought to be grateful for your nipples? With that question, I also have a favor to ask of you    please take a moment and be grateful for your breasts... for your nipples...for those parts of your body that maybe you don't think measure up to society's standards of beauty. Facing what I am facing has brought on a strong sense of gratitude for the way my breasts are right now, imperfections and all. I have 20 more days with these breasts, and I feel the mourning process has already begun. I regret ever feeling like my breasts weren't good enough, or that there was something about them that needed to be changed. So ladies, please hug your boobies and be grateful for them just the way they are. Hey, and while you are at it, go ahead and check yourself for lumps. Instructions here