Thursday, August 21, 2014

Getting Things Off My Chest...

Yes... I love to bring humor into otherwise stinky situations. It's not that breast cancer or leukemia or bone marrow transplants are awesome or funny - they suck; however, once the cards are dealt, you just have to roll with it, dance a little, and laugh a lot! So yes, you should expect lots of good mastectomy puns coming your way in the coming weeks and months!

With that being said, I do want to get something off my chest (not literally... yet).
 A mastectomy is not a free boob job.

It was one of the first things I said when I realized that double mastectomy could be in my future, "Hey! At least I get the boobs I always wanted!" That's because there was a time, not so long ago, when I thought that a mastectomy was a surgery when the surgeon cut you open, 'pulled out your boobs', gave you some implants, and you could go about living your life as it was - maybe just more endowed.  HOWEVER, as Donny and I scoured websites for information, watched Youtube videos, discussed the procedures with friends, and chatted with my physicians, we learned that nothing could be further from the truth.
Now as I mentioned in the previous post, there are different types of mastectomies and it is important to keep this point in mind. What I'm about to dive into, is specifically tailored around a bilateral, total mastectomy - the type I will undergo in only 18 days. However, all mastectomies suck. Period.

Once my physicians scheduled my surgery, I began describing what my mastectomy entailed to colleagues and friends - that is when I realized that I wasn't the only one who was a bit in the dark. Thus, I am providing a mastectomy crash course.

*WARNING: The below info, pictures, and videos are not for sissies. Proceed with caution.*

In a nutshell, here's what my mastectomy will look like (if all goes according to plan): 

  • A total bilateral mastectomy with reconstruction is about a 5 hour procedure.
  • The breast surgical team will start off the surgery. When they're done, the plastics team takes over.
  • The Breast Team
    • My breast surgeon is going to make a marquise type cut above and below the nipple. That skin and all breast and fatty tissue will be removed. My breast surgeon will also scrape the inside of the remaining skin to try to ensure that as much cancer-causing cells are removed.This means the remaining 'flap' of skin is going to be very, very thin.

    • It is important to note that my breast surgeon pays careful attention to the tissue as she is removing it, since she likely would be able to spot an invasive cancer. The plan is to leave all of my lymph nodes in place; however, this could change if an invasive cancer is spotted during surgery. This is because invasive cancers typically spread to the lymph nodes before moving around the body. Removing the lymph nodes not only serves to potentially remove cancers but also allows the physicians to determine if additional treatment is necessary (i.e. chemo, etc).
    • To summarize everything I just said, watch from about 1:40 to 3:00...

  • The Plastics Team
    • Once the breast team is done, the plastics team takes over. 
    • In about 1 in 20 cases, the plastics team is unable to begin the reconstruction process (i.e. if the skin appears to be losing blood flow, etc). If this were to happen, they would just close me up and I would come back for another surgery in about two weeks.
    • Some good news! My plastic surgeon was particularly impressed with my skin, despite my prior radiation, and estimates that there is about a 1 in 40 chance that we won't be able to start the reconstruction process.
    • If all goes well, my plastic surgeon will initiate the reconstruction process and place my drains. The drains are rubbery tubes that allow the lymph and serous fluid to leave my body easily and collect in little bulbs. I will have these in for anywhere from 4 days to 3 weeks. Fortunately, my plastic surgeon is not anticipating that they will be in long since I am on the smaller side. Woohoo! 
    • What does the reconstruction process entail? 
      • In my case, I will be getting tissue expanders. Basically, a fair amount of skin gets cut out so unlike breast augmentation (aka a boob job) where implants are inserted, the plastic surgeon has to stretch the skin over time before putting the implants in. 
      • Tissue expanders are like really thick but empty water balloons. At first, there will barely be enough room in my chest for the expanders. After about 4 to 6 weeks, whenever the skin starts to relax a bit, my plastic surgeon will start filling the expanders with saline. 
      • We won't know for a while if I will have to see him once a week or once a month to get saline injections. Filling the expanders involves a quick outpatient visit to the plastic surgeon in which he will stick a needle in the little ports underneath my skin and inject saline. 


      • Once we get to a point where I'm happy (likely months from the initial surgery), we schedule another surgery. I'm told this surgery is 'easy'. My plastic surgeon will just cut along the scar and switch out my expanders for implants. 
      • In regards to picking the type of implant, this is not a decision that needs to be made now. Regardless of the type of implant chosen though, all implants need to be replaced every so often. Thus, I will continue to undergo breast surgery for the foreseeable future. Since we're not worried about the type of implant at this point, I will revisit this down the road.
So many implants...
      • Also, since this is not a nipple sparing mastectomy, I will also visit the world of nipple reconstruction at a later point.  
  • Pathology will receive everything that is pulled out, likely while my plastics team is still hard at work. Over the following 2 weeks, they will analyze the sample and provide my oncology team with a final diagnosis. Hopefully, they will not find any new DCIS and/or cancer.

Inpatient Stay
  • Once the surgery is complete, I will likely be in the recovery room for 1-3 hours. After that, I will make my way to my hospital room. At this point, the physicians are anticipating that I will spend 1-2 nights inpatient. 
  • During the inpatient stay, I will do a lot of resting, receive some narcotics, and learn how to empty my drains - a job that will likely be delegated to Donny since my range of motion will be non-existent.

Recovery with Drains
  • As mentioned above, the drains will stay in for anywhere from 4 days to 3 weeks. During that time, my primary job is to move my lungs but not my arms.
  • The incisions themselves are not extraordinarily painful, I am told. However, for petite people, the skin stretching coupled with drain tubes and expanders can cause an enormous amount of 'pressure.' My physicians have assured me that I will feel "pressure, not pain" which could sound promising. HOWEVER, I was a leukemia patient that learned that 'pressure' from bone marrow aspirations (when the MDs pulled bone marrow out of my hip), was very painful - maybe a different type of pain but pain none the less.Thus, I'm a little skeptical.
  • While the drains are in, Donny and I will need to empty them 2-3 times each day. Fortunately, my plastic surgeon removes them as soon as the drainage dips below 30 ml/daily from each drain.
  • Immediately after surgery, my chest is going to look pretty gross. After removing a lot of skin and scraping the remaining skin until it is very thin, my chest will kind of look like a topo map due to the drains and unfilled expanders.
  • Since it is kind of hard to understand this without a visual and because this girl is awesome, I recommend watching the below video, if you would like a better idea.

Recovery post Drains
  • Since there will not be a lot of room in my chest, removal of the drains is expected to provide a huge relief. However, I won't be back to my normal self once the drains come out. Full on healing and recovery won't start for a while longer. 
  • I have had to promise my plastic surgeon that I will do nothing for a couple of weeks and you don't mess with this guy.
My fabulous plastic surgeon.
  •  I am not permitted to lift my arms other than to feed myself until he gives me the all clear. Thus, cooking, washing my hair, high-fiving, and even walking are off the list for a while. As you may have guessed, picking up the kiddos and driving is absolutely forbidden for a while longer. 
  • Eventually, I will start up physical therapy to regain my range of motion but for a while, I just have to let everything heal correctly. 
  • To give you an idea of how lousy my range of motion will end up. Here are some of the 'exercises' I will be doing post mastectomy...

Beyond the physical
  • It would be ridiculous to describe a mastectomy and only address the physical component because there is a HUGE psychological component. Any time an individual's body changes drastically, his/her perception of self is bound to be altered in some way - whether good or bad or maybe it goes back and forth between the two. Therefore, in the coming months, I will undoubtedly be sharing my thoughts on the psychological effects of this process. 

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