Saturday, January 16, 2010

The Second Unveiling: The Truth & Consequences About Reconstruction


The look on my husband's face and the unintentional, yet critical, queries threw me for a loop. I thought boob jobs did not create so much scarring! Why are you so cut-up?

I was not angry or hurt by his spontaneous utterances. They just echoed the incredulous feelings I had been having since December 11 (the most current "slice 'n dice" day). Its not that I did not have an intellectual appreciation of what was going to happen to me. Unlike the amputation (aka mastectomy) it would seem that I was not as prepared as I thought for what the reconstruction and masteopexy was going to truly look like, post-surgery. Yes, the reconstructive surgeon had showed me his book of before and after pictures. And, yes, I did study them. But studying that surreal "coffee table" book was like looking at a police mug-shot book -- blurs of unfamiliar images that don't look like they belong in your personal universe.

Upon reflection, it seems that I had, and still am, spending so much time researching and analyzing my cancer, optional paths for survival, and adjuvant treatments to forestall the recurrence of my cancer, that when it came to the reconstructive portion of my journey I had done just enough research to assure myself that I was in good hands with the surgeon. Then I placed my ladies (literally and figuratively) in his hands.

To respond (versus emotionally react) to my husband's own visceral reaction and questions to seeing me completely unveiled (sans gauze and surgical steri-srips), I went back and got the hard facts for him. . . .

Reconstructive Surgery

Immediately after the full mastectomy of the left breast, the reconstructive surgeon began the process of a two-stage reconstruction (sometimes referred to as "two-stage delayed" reconstruction). After the surgical oncologist finished her amputation (with no skin or nipple sparring), and while I was still under general anesthesia, the reconstructive surgeon implanted a tissue expander. A tissue expander is like a balloon that is put under the skin and chest muscle. (And, no, there is no sugar-coating the pain and discomfort the expander can cause under the chest muscle.)

Every 6-8 weeks thereafter, through a tiny valve under the skin, the reconstructive surgeon injected (with a 2-inch needle) a salt-water solution to fill the expander. The valve was always located with what I thought of as a mini-divining tool. My reconstructive surgeon fondly called it a stud finder!? When the magnet stood straight up, EUREKA, the valve opening was found! I was expanded 3 times (I was aiming for a B+ cup-size).

After the skin over the breast area had stretched enough, the second slice n' dice was done to remove the expander and put in the permanent implant on the mastectomy side. Initially it was only going to be a 2 cm incision for the removal and replacement, but due to my petite size the reconstructive surgeon had to cut about 3.5 inches along the breast, coming in from the armpit. Luckily, this was all done along the existing mastectomy incision. As a result, however, that area continues -- even after 5 weeks post-op, to have sharp pulls and stabs of pain.

In the Interest of Beauty?????

In the interest of aesthetic symmetry (which in retrospect, I am having difficulty reconciling this goal with the visual scarring and painful sensory onslaught I am currently experiencing), the surviving breast underwent a mastopexy.

This was done utilizing the anchor incision technique. An anchor incision is made around the perimeter of the areola, vertically down from the areola to the breast crease, and horizontally along the breast crease. (Think, a nautical anchor shape.) This technique produces the most scarring, and is actually a highly invasive series of incisions used in many cosmetic breast surgery procedures.
While the technique creates a surgical wound comprised of a circular top section, a vertical mid section and a horizontal crescent shaped bottom section, the placement of these incisions allows the reshaping and re-sculpting of the entire breast mound, which is necessary during a mastopexy procedures.
Apparently an anchor incision it is still one of the most widely used and reliable methods of achieving excellent breast lift results to compliment a mastectomy reconstruction. (Yipee skipee!)

Everything comes with a price-tag. Like any surgical wound, the anchor shaped incision carries certain risks and can cause several potential complications. The large size and prominent placement of the incisions make visible scarring a strong possibility. Hence, husband's reaction. Most women who undergo this technique will have permanent scars which will be noticeable on the breast and/or areola. (They do say that the scars start to loose their punk-red coloring after 1-2 years...good thing I am working on a 10-year survival plan!)

Additionally, the anatomical positioning of the incisions also might cause damage to the sensitive neurological, vascular and glandular tissues of the breast. This type of injury (the medical professions descriptive word, not mine) can cause temporary or permanent sensory perception issues in the nipple or throughout the breast. Interestingly, my issue at this time is the sensory assault, not the long-term potential degeneration -- the burning around the incisions, the stabbing pains through the sternum and the electrical-like shocks that emanate from the chest wall (this latter pain good, means nerves are trying to find their way back "home").

. . . . then there's the 3d unveiling to come. . . .

You can decide if you want to have your nipple and the dark area around the nipple (areola) reconstructed. Nipple and areola reconstructions are optional and usually the final phase of breast reconstruction. I've opted. (In for a penny, in for a why not in for a boobie, in for a nipple!) This is a separate surgery - again done in the interest of the self-propelling concept of symmetrical beauty. It is usually done after the new breast has had time to heal from the second round of reconstruction (about 3 to 4 months).

Tissue used to rebuild the nipple and areola will be taken from my body, either from the newly created breast, opposite nipple (except there's not much there to share), ear, eyelid, groin, upper inner thigh, or buttocks -- where-ever I have it to spare. Six to eight weeks after the nipple is created I will get with the tattoo-artist to match the color of the nipple of the other breast to create an areola facsimile. Truth be told, I have threatened to have a lotus flower done in place of the traditional areola. Husband had a visceral reaction to that statement too! (Hee Hee!)

With that last reaction, I threatened to have the eye of Sauron tattood instead!

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