Breast Reconstruction

There's a lot of different ways about going about reconstruction that may give someone something that looks like the breast, on the other side or the breasts that they recall having before or not. And typically, there's sort of two main options. There's options, where you use implants of saline or silicone although it's mostly so saline it's changed over time and heck you know five years in the future and there might be something completely different to reconstruct some someone. Or, you might use their own tissue taken from another area of the body and a really popular area is often the belly, but it can come ---- the tissue can come from other places. You can even do your own tissue plus an implant if there's not enough tissue and the other area of the body to make the size -- breast reconstruction that someone wants. There’s also some additional things that can happen right -- where you could reduce the size of the other process or you could do some additional reconstruction to reconstruct a nipple, or a nipple areolar complex. But all of that typically tends to go into the reconstruction heading.

Reconstruction is happening to give someone a sense of symmetry or to give them the curves that they that they want to have right. But it's not necessarily about controlling cancer. That being said, sometimes the decisions about reconstruction have to happen pretty early. So that we can make decisions about other cancer procedures like radiation. etc. And so, sometimes it gets talked about pretty early, even when, you know, a patient is just not really ready to make additional set of steps. And so trying to figure out cleanly what pieces of the decision making, have to be made for cancer reasons versus reconstruction can be important.

Mastectomy is where the piece about reconstruction starts to come in and, as you talk to patients who are being -- who --- who become aware that, for whatever reason mastectomy is going to be the surgery that they have to have. That starts to open up questions about reconstruction and some -- some patients will be very clear that they're not interested in reconstruction they're not interested in anything that requires more time, more pain, more hassle you know it's just not on the table for them. It is important for those women -- those patients to know that – that it is still possible potentially to do reconstruction is on the line if -- if, at some point they want them, although the exact type of surgery that might be offered or how good the reconstruction is might vary if there's delay in the reconstruction. For other patients who are getting mastectomies they may want reconstruction. And then there will usually be a discussion about can we offer that reconstruction immediately, meaning you go to the OR to have the breasts removed and you come out with some piece of reconstruction, whether it's because expanders which are sort of a pre-step for implants are being put in or because they move your own tissue around to reconstruct and make a breast mound right after they take off the breast. And those end up being pretty complicated decisions, sometimes what –what someone would really like to have happen can't happen because of the kind of cancer treatments that are needed to make things safe from a cancer standpoint.

Medically speaking usually, the cancer surgeon’s primary goal is to control the cancer. The plastic surgeons, they want you to look as nice as possible. Patients you know typically want both. Sometimes hard to – hard to put both of them together in a way that makes everyone happy.

Deciding to do reconstruction was not an easy decision for me. It was something I gave a lot of thought. I didn't want it to be for vanity’s sake that I was getting it done. And I knew I was going to put myself through a lot more to get it done, and that it felt elective almost at that point. On the other hand, it felt like I was still young enough that it was going to be worth it in the long run, just with things like wearing a swimsuit and just buying clothes and maybe feeling a little bit more normal. So, I decided to do it.

I felt rushed into that decision, believe it or not, because after the chemo, and even though I had that February month, I think that's the point where I felt like I had enough and I just was tired. And I kind of felt pushed into this decision, and I-, and I grappled with it a lot. But then I got to a point where I was like, it's too late.

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It was probably just, not even two weeks, before the surgery, and I told the surgeon, I'm like, "Mm, why don't we just do both"? She's like, "Well, you know, it's not." She explained to me the statistics of, you know, it doesn't jump from one breast to the next. And, you know, you don't want to have to do that if you don't really have to. And, you know, I was kind of  okay with her opinion and her explanation. But then I just felt like it was, I should have changed my mind. But then, again, I don't know what I know now, and I've actually experienced it.

Well, one of the reasons I chose to do reconstruction was I didn't think I could handle having nothing there because I already battle depression. I didn't want to look at my body and remind myself how awful I looked. And my husband wanted that too. He enjoys seeing my body. So. That was a no brainer for me, easy decision. Yep, let's do it. And it actually makes me feel better about myself. I don't think I would feel very, very good about myself if I didn't. For me, that's important. I know for a lot of people, it doesn't matter to them, but to me it does.

You know, this isn't about perky boobs. I mean, I use that as a bright spot to look forward to, and I shared that with a lot of people. You know, I'm going to have perky boobs. This is awesome. I've nursed two babies. I no longer had perky books, so, you know, that was kind of my bright spot and something to look forward to. But in those last days leading up to the mastectomy, I was like, “yikes.” Perky boobs do not replace what you had before. It just doesn't. And I would also like to add that people that say that you get a free boob job when you have reconstruction, I know what they're saying. But there was nothing free about this boob job I got. I paid a very high price for it in more ways than one. So, I hate that when people say that, “Well, you got a free boob job.” And you hear that a lot and it wasn't free.

I very briefly toyed with the idea of having reconstruction. But the thought of having something underneath my, underneath my muscle, inserted in my body just freaked me out. I knew it wasn't for me, not something I could abide by. And lucky, I had a care team that accepted that.

So, I decided to have the breast removed. Now, some ladies want to have reconstruction or just radiation or whatever. Not me, I said, “Remove it. I am no longer in wet T-shirt contests. I don't need it.”

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Okay, so now you're wearing a bra, and one side doesn't fit right. Well, there's a group out there called  ‘Knitted Knockers’. And honestly, it's the best thing you ever seen. And it is just a really unique thing that fits in the other side of your bra, so that you can look almost normal. Who cares? Nobody's supposed to be in your bra anyway, except you. So, but these are things, because you're scared. Well, what do I do? Should I have both of them removed? That's got to be your decision, not anybody else's. If you have a loved one, that's who you talk to about your decisions. But eventually, you make them yourself because you're a woman.

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I had heard so many stories about people who said, “Well, why not take them both?” and stuff. And I thought, that's like having one broken leg, so let's break the other one so they match. And I figured this way, I could still wear a bra and look halfway decent in a dress. And then the other side would have to be like something false. But I did not want reconstruction. I had heard from some, but I don't know how true it is, because I didn't do it. They said it was so hot and heavy during the summer. And I thought, no. I'll just go this way. And it works pretty good.

So, they did an excision along with the unilateral mastectomy. That's probably one of the things that I wish that I had done differently for many reasons. After the surgery, everything was just, the symmetry was all off, and, you know, there's ways to kind of fix that so that no one else knows, but I have to see me. And that made me uneasy every day. And every day of trying to figure out, okay. What can I wear to disguise the disproportion? Or, you know, I didn't think that it would bother me, but it did. It just, besides it just looking weird, it was uncomfortable.

So, then I finished chemo in 2016, and I had my double mastectomy. And I had expanders placed at that time. And I took six weeks off from work. I was recovering from chemo as much as I was from the surgery. I was exhausted and started having the fills, which were not horrible. I've read online that they are very painful, and I think my plastic surgeon was very gentle with me. It wasn't a hardship at all. I never really, hardly felt anything. I will say having saline and expanders, they're hard as rocks. It's incredible. I had no idea. I'd go back to work, and I'd be like, “Feel this, feel this” to the gals. It's like touching a wall. It was really bizarre. So, then I had my exchange surgery in February of 2017. And here I am today.

So what's exchange surgery?

Exchange is where they take the expanders out. The expanders are like a balloon that they slowly fill with saline over a period, mine took about four months to do that. And then he takes the expanders out and he puts them in. I chose silicone implants, which are squishier. And so that's what the exchange surgery is. He replaced the saline expanders with nice silicone implants. And then it’s taken quite a while to heal and for them to kind of settle into a shape.

Then that started the I had what they called reconstructive surgery. And I thought that meant that I would come out of there with my new boobs, but that is not what that means. And, you know, I look back on it and I think, they explained that to me, but it still just somehow didn't make its way through. So, I had the implants. I guess they're implants, where they would fill them up periodically to stretch the tissue to get ready for the final implants. And I guess those fill-ups started about two weeks after my surgery. I went in for just my week checkup. And then after that, they started doing the fill-ups. And that somehow turned out to be a very emotional thing for me. I think, I know why, but I'm not. I'm sure this has been explained before, but, you know, they would just, they would use a numbing agent where the portal was, and then they would inject the saline. And somehow or another on one of the times that he put the numbing agent around the portal, he hit a nerve, and I came off the table. And that was the beginning of my downward spiral for the anxiety that I would have over these, these fill-ups.

And then it's taken quite a while to heal and for them to kind of settle into a shape. And I think he did a really nice job. I'm really happy with it. And I was not able to save my nipples. Some women can save their nipples. I could have saved one, but I didn't want to have one boob with a nipple and one without. They can do reconstruction with nipples too, and I chose not to do that. And I initially was going to do a 3D nipple tattoo, which are amazing. I went online and looked. You can't even tell. They are just phenomenal. And I've seen them live and in person since then. One thing about women with reconstructed breasts, we show everybody everything. And so I ended up decorating mine more with flowers and vines. I didn't do a 3D nipple. But I like what I did. I'm really happy with the overall look. There is a certain, certain detachment. They're mine but not mine. One reason I think why women who have had reconstruction are not as shy to show their breasts as we would have been prior to this experience. It's just kind of a disconnect. Like I said, they're mine but not mine.  I don't think I would do anything different than what I did. I still had to care for my kids. I still had to work. I still had to do all that. And there are other options for reconstruction, and they are, I think, harder to recover from. I’m pretty happy with the choices I made.

And we had a young lady who is 40 who was going to have double mastectomies come. And she, I said, “You want to go see what they look like?” And she said, “Yes.” We went to the bathroom. She said, “Could I touch them?” I said, “Of course you can.” She said, “Oh they don't feel like bowling balls.” I said, “No, they don't.” These are my implants. And she said, “They move and they're soft.” And I said, “Yeah, they are.” The only complaint I have about them is they're a little cold.   Silica gel is not a really good conductor of heat, so sometimes they're a little cold. But   so, show and tell is important. If you're looking at mastectomy scars, but you want to think, but you, you want to see what could be, you need to look at somebody else's who's done this. It's important.