Before cancer, I would have never in my wildest imagination dreamed I would step foot into a plastic surgeon’s office to have “cosmetic” surgery. I was comfortable with my body as well as its aging process. Words like “breast” and “nipple” and “areola” were whispered in a barely audible tone in my household growing up, but flow so easily from the lips presently. I have to remind myself to be quiet in certain mixed company. When asked how I’m doing, in order to avoid embarrassment (on their part), I’m doing fine.
I didn’t give much thought as to what would happen to the nipple, to be quite honest. I had so many other things to think about with chemo, surgery, radiation, etc., etc, so this seemed like a minor issue. I knew my surgeon was removing the breast when she performed the radical mastectomy. But I didn’t give much thought as to all the different parts she was removing that would later need to be reconstructed. Looking back, I think I imagined the hands of a sculptor designing a breast in one fail swoop that looked like, well, a breast.
It’s not quite that simple.
Honestly, if they had briefed me on how long this whole process would take, I’m not sure I would have signed up. They were wise not to overwhelm me with all the details at the beginning of treatment. One step at a time, or in the words of Dory, “just keep swimming!”
Foiled again. Until this morning I thought today would be my final, final procedure with Dr. Gordley. I’m not sure how I misunderstood this, as my husband was also there when the doctor talked about nipple reconstruction and tattooing. He and I both thought we would be finished in one visit.
Not true.
While it was a bit discouraging to learn I can’t get the areola tattoo for another two months, I am pleased to report that today was indeed my final surgical procedure in this whole reconstruction process. For that I am very thankful! God has been good, and the prayers of the faithful have kept me going.
We had to wait six months after radiation to start the process, so from the time we started treatment until the end of the reconstruction process, it will have been almost two years. 2013 was the year of treatment, and 2014 is the year of reconstruction. To recap, breast reconstruction (for me) involves four steps.
Step One – DIEP Flap Reconstruction: On April 11th my plastic surgeon performed a DIEP flap. This involved removing tissue from the tummy and forming a flap (breast). This was even more extensive than the mastectomy, and as you recall from previous posts, I couldn’t stand straight for several weeks. I was directed not to lift a thing for eight weeks. (Four months later, still a little sore in fact). You can read about that somewhere on my blog, or venture into Dr. Kyle Gordley’s website if you dare to see how it’s done. Tim and I laughed as we recalled Robin Williams recommending the insertion of squeaky toys for the amusement of spouses, but I have declared a “no touch zone” until further notice.
Step Two – Leveling the Playing Field: The first step laid the foundation but it’s just a flap. And it’s brand new. Suffice it to say, there are some noticeable differences between a brand new breast and a 50-year old breast. I imagine having a double mastectomy has its own unique challenges. While I am happy I was able to keep one of my breasts, matching the two is a challenge as well. Unlike the DIEP flap which required five days in the hospital, the second phase is much easier. On July 29th – the second stage of reconstruction was complete. It was an out-patient, day surgery consisting of mastopexy, liposuction and fat grafting. A lift here and a tuck there, and some fat grafting to fill in the gaps. Removal of the spare tire was notable, and he corrected my port site while I was under. Dr. Gordley said he is working on my décolleté. Not that I will be wearing low-cut blouses any time in the near or distant future, but I did learn a fancy new word that day!
Kidding aside, I also learned an interesting fact regarding stem cells. Fat used in grafting contains stem cells. When grafted under the radiated skin, they help repair the damaged skin. They are just learning about the healing properties of fat stem cells, but I noticed a difference. I could move my arm more freely after the second surgery. I’m more flexible and my skin is not as tight. I’m making a mental note to ask my radiation oncologist about this the next time I see her. It’s amazing how our bodies have the ability to correct themselves, if only we knew more about the healing properties God has placed within us.
Step Three: Nipple Reconstruction. This is done in office and doesn’t hurt because the tissue is nerve-free. I had this procedure first thing this morning. No anesthetic, no hospital, and about 30 minutes from start to finish. It’s the first time I’ve been awake during one of these procedures, so that was interesting. It was just me and the doc (Tim is traveling). An operating chair sits in the middle of a large room on the second floor. I noticed for the first time that my surgeon is left-handed. Classical music played during the procedure, and he didn’t say a word unless spoken to. Which wasn’t much, as I didn’t want to break his concentration. As he was suturing me, small talk informed that his mother can sew, but she isn’t the one who taught him.
This has to be the last procedure because you want to ensure the new nipple lines up with the newly lifted 50-year old one. Once the nipple is in place, he can’t move it. Four risks were noted on my consent form: bleeding, scarring, infection, and flattening. Bleeding and infection are usually due to other problems like diabetes. Shouldn’t be a problem. Scarring will be covered with the tattoo. He made it double the size of where we want it to end up to make up for the last risk, which he indicates always happens. I go back in one week to get stitches out.
Frankly, the only downside I see with this surgery is the protective plastic cone I will have to wear for one month as well as the inconvenience of keeping it dry for a whole week. I look a bit Madonna-esque, but not nearly as noticeable as I thought it would be. I admit it is a little weird looking at my newly formed nipple, but it’s interesting what we get used to. I think Step Four will ultimately help with that.
Step Four: Tattooing the Areola. The tattoo is designed to match the color of the other breast. No, this is not done in a tattoo parlor. The surgeon does this as well, and it is all covered by insurance. I thought I was having this done today as well, but we have to wait two months for the nipple to heal. He said that adding the nipple and areola tattoo will make a big difference in the appearance as well as how I feel about the new breast.
Time to go back to work. Life returns to normal, albeit a new “normal.”
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À la prochaine (Until next time) …