Outlook Good

Reading over my last few posts I realized that I was really upset two posts ago ("Spoke too soon?") and improving in the previous post ("32C") but that I hadn't yet written to tell you how I'm feeling now, five days after that last doctor's appointment. Gradually over the last five days I've started to feel really happy with the results of my implant surgery. The steri-strips (a white tape the doc puts over the incision) are completely gone now and I can clearly see what I'm dealing with. It's not bad. It's actually pretty good. Firstly, the mastectomy scar still looks surprisingly really good even after being re-opened. Secondly, the differences in the two breasts really aren't as dramatic as I made them out to be. Basically, I think what happened is that when I came home from surgery and took my first look at the results, I jumped the gun in getting so excited about how perfect they looked. In the back of my mind I knew there was a good deal of swelling contributing to the two breasts looking so similar, but I wanted to be positive and happy and excited. As the swelling went down though, reality set in. They are never going to look like a proper pair. (But hey, my original boobs were actually pretty dissimilar to begin with!) Now I'm feeling really happy with them and am back to my old feelings of "I don't think I want a lift" and "I definitely don't want to mess around with nipple reconstruction." However, I know that they may continue to change a bit as they settle and so, again, I am keeping an open mind and just seeing how I feel, and how they look, over the course of the next few months.


Everything else is great. I'm missing the gym, of course. I still have 2-1/2 weeks of no gym and it's driving me insane! I've started reviewing the work I had left off with when I left school towards the end of the semester. I have until sometime in May to complete those two courses. And I'm getting ready to return to work next week. Next week I also have a dietetic internship interview, so wish me luck!

32C

Friday, D and I went to my first follow-up appointment since my implant surgery. I had been feeling pretty down all week because I was a little disappointed with the results of my surgery and felt like I was probably going to be needing a third surgery. By the time the day of the appointment came around I was starting to feel better and since seeing the doctor I feel fine now. Basically, the plastic surgeon explained that he didn't do the lift as planned because once he put the small implant in my right breast it was actually lifted up a lot, and very much in line with the left breast, and doing a lift would not have been much more of an improvement. Knowing that, he decided to not cut up and scar up my right breast anymore. He also pointed out that the two implants may settle slightly so if we do a lift at all we would probably get a better result from doing it after first waiting a bit. I'll be following up with him regularly but in about 3 months we'll see how the two breasts are sitting and will decide whether a lift will be beneficial, at that time. He also still wants me to consider getting the nipple reconstruction. He pointed out that even though it doesn't bother me to have a scar in the place of a nipple on my left breast, doing the nipple reconstruction may make the two breasts look similar enough to distract from the differences that I currently see and had been bothering me. That's fine with me. I'm willing to remain open-minded and wait the three months to see how I feel.

The same day I went to Victoria's Secret to treat myself to a fancy new bra. I have one more week before I am allowed to wear normal underwire bras again. A sales girl measured me and told me I am now a 32C. I was really surprised to hear that because I feel like I still have pretty small boobs and look just like myself, but I guess it's all about the fullness up top, which I definitely have more of now. She asked me what I was looking for and I explained that after two surgeries for breast cancer I just wanted to treat myself to something nice but no longer need all the padding most of their bras come filled with. She told me she too was a cancer survivor, a different kind, and led me to some really nice padding-free bras. I found this absolutely gorgeous,classy, lacy number and of course...they didn't have my size. Later the same day I tried the huge Victoria's Secret at 34th street but again, no luck. While I was there I told a second sales girl my story and she told me four different people in her family had had breast cancer and one wasn't doing so well. We're everywhere.

With two surgeries now behind me and D starting a new job Monday, we decided to head to the North Fork yesterday for a much deserved break. We had been there over Columbus Day weekend and had absolutely loved it. We'd been dying to go back. We spent the day tasting good wines and eating great food (and stocking up on our favorite Pinot Noir Mustard). Back at the B&B we layed in bed watching TV on the laptop. It was such a perfect relaxing day.

Tomorrow it's my mission to find that damn bra in my size! (It's on backorder online.)

Spoke too soon?

Today is Monday, three days post implant surgery. A lot of the swelling has gone down and I've removed the top part of the dressing (as instructed by my doctor). When I first came home from the surgery my new boobs looked pretty similar: high, round & similarly shaped. Today, the right one looks more like it used to: it's sitting a bit lower on my chest than the left boob and it is sort of swaying out to the right side of my chest. My doctor tried to get away without doing the lift because he knew I was really unhappy about it and about having another scar; however, if this is any indication of what the final result is going to be, this just won't do. The two boobs still look really different as of right now. The goal is to get them looking as similar as possible. I'm worried that I'm going to have to get the lift anyway and that this is going to mean a third surgery. Looking at the steri-strips currently covering my stitches I'm also beginning to realize that just because my mastectomy scar didn't bother me the first time around, doesn't mean it's still not going to bother me now. What if it just looks worse now that it's been cut open a second time? So then, if I have an ugly lift scar and an ugly mastectomy scar, do I consider the fake nipple & areola tattoo? A fake nipple & areola would cover up most of the mastectomy scar. But I'm sure they come with their own issues too. I've heard of fake nipples dropping so much that they are hardly there anymore and of areola tattoos fading. All of this is just driving home the point that there is no good way out of this and that these boobs may be a work in progress for a long time. I'm in such a bad mood right now that some Chardonnay may be in order! (Don't worry I haven't taken any pain killers today.) Tomorrow, D and I are going to go try to find me a new bra. I'm still walking around in my zip-up sports bra even though the doctor said I could wear a regular bra as long as it doesn't have underwire, so maybe that will make me feel better.

P.Y.T. (Perky Young Thing)

So, yesterday went far better than we had expected. D’s brother drove us to the hospital and we got to the registration desk at 6 o’ clock on the dot. I was sent with other patients to get changed and checked-in. My doctor came by and went over the plans with me and then marked me all up. I was so nervous that when a nurse came by to go over my medical history, I just started crying. She gave me a big hug and made me feel a lot better. Once she was done, D, his brother & my mom were all allowed back to see me. The OR nurse came by, as did the anesthesiologist, to ask more questions. Before we knew it we were walking me into surgery. I said my goodbyes and the nurse walked me the rest of the way to the OR. On the way we met up with my anesthesiologist, who was joking around with another guy who seemed to look like the friend-of-a-friend anesthesiologist who took my case last time. I couldn't tell for sure though and I didn't ask.


In the OR room I was freezing cold, which made it hard to find a vein for the IV. They used a combination of blankets, some kind of thermal plastic film and a heater blowing warm air on me, which only made me feel a little more comfortable but at least helped the doctor find my vein and get me set up with my anesthetics and anti-nausea drugs. My plastic surgeon made me feel really comfortable and safe. Before I knew what had happened I was coming to. I couldn't see anything but I could clearly hear my anesthesiologist saying "Diane, it's time to wake up for school!" (which is exactly what he warned me he would say). At this point, I think they were wheeling me to recovery. Or maybe he said that while they were taking out my ET tube and then wheeled me over. I was so foggy and just starting to wake up at that time that I really can't be sure.


As I started to regain consciousness in the recovery room, I remember feeling like I couldn't breathe all that well through my nasal tube, plus the smell of the plastic & oxygen were sickening, so I took big gulps of air through my mouth. The more oxygen I got in me the more I seemed to wake up. My vision was blurry but I made eye contact with a nurse so they could see I was already waking up. D, his brother & my mom all came by almost immediately. They were told to just say "hi" real quick because I needed my sleep, and I agreed. I felt so groggy still. They gave me some good news: my doctor didn't have to do the lift (mastopexy) on the right side (the part I was nervous about). He only put in the implant and that was enough to gain the symmetry we were looking for. Everyone went back to wait for me in the waiting room and I started getting better and better pretty quickly. Soon I was sitting up in bed, then they gave me cranberry juice and saltines, and finally I was moved over into a chair. Before I knew it I could shake my head "no" without feeling tipsy and they were bringing me my clothes and kicking me out. Around the time that they were feeding me snacks and getting me ready to move to the chair, I saw a man who I swore this time was the anesthiologist-friend from my last surgery. I confirmed his name with my nurse and she called him over. We had a nice talk and I got to thank him for taking my case last time. I told him my husband and I owed him big time. I got a wheelchair escort out to the waiting room where my mom said no one had warned them I was coming out, so she had to call the boys, who had gone for a walk, to go pick up the car from the parking lot.


After waiting awhile for the car we were finally on our way. Mom went back to work and the boys drove me home. Back at home D got us some mid-east and Egyptian food for lunch and I took my drugs. Later, in the bathroom, I took off my surgical bra (a weird white velcro-closure sports bra that they send you home in) for my first look at the results. The first thing I was happy to see was that I was not going to have an ugly scar on my right breast too. Since he only did the implant, and no lift, my doctor made a small cut along the lower curve of my areola, so the scar will blend right into that area. I now have two round perky boobs. The right one is huge compared to the left but I think it's due to swelling. As my doctor had warned us, the left breast has already been traumatized so I wasn't going to feel any pain there. For the right boob, however, this is all new stuff, so it's all painful and tender and swollen. Hopefully once the swelling goes down they'll look pretty much the same size. While perky and round, the boobs seem to be pretty close to my old size. They kind of look like how my old boobs used to look like in a push-up bra, the only difference is now they are permanently pushed up...and who can really complain about that? Last night I was able to sleep comfortably on my left side for the first time in a long time (Of course, now it hurts to lay on the right side. Beggars can't be choosy, I guess.).


Today, D went to our regular yoga class (I can't workout for a month) while I slept in a little bit before cleaning up the apartment and having a small snack so I could take my drugs (antibiotics and percocet). D came back and made us breakfast. Since the doctor told D yesterday that there was no reason for me to spend the whole two weeks on the couch, we decided to go out. We picked up our dry cleaning and headed to Barnes & Noble to research travel destinations for our next big trip. We had a sushi lunch at our favorite spot and now we're back home just relaxing, especially since I took my drugs at the start of lunch and by the end of lunch they had me feeling all tired and woozy. Tomorrow I get to shower and Monday I get to pull off the top layer of my dressing. I'll keep you all posted. Thanks for all the well wishes and for checking in on me!

Breast Reconstruction is NOT Breast Augmentation

Let's get something straight. Having breast reconstruction surgery is not the same as getting a boob job. "Who would think that?!" you might ask, appalled. But plenty of seemingly well-meaning people have said some pretty crazy things to me about my soon to be new boobs. I think people want to say something positive and so the first thing they think is "well, you get a free boob job in the process!" or "well, you'll have perky boobs for the rest of your life!;" however, for many of us going through reconstruction, it certainly doesn't feel that way. Don't get me wrong, I've read some comments from people who were never happy with their breasts or their body and are actually happier with their new boobs or with the tummy tuck they got through TRAM flap surgery (transverse rectus abdominus myocutaneous; a procedure in which the new breast is made from abdominal tissue). On the other hand, several women I've spoken with, who have already had reconstruction, are very unhappy to have had to go through this process and are very unhappy with the boobs they now have.

Let's think about this. A breast augmentation, or "boob job," involves adding an implant to an existing breast, without altering the function of the breast and while minimizing scarring as much as possible. You can take out your implants later, if you change your mind, and still have your breasts there. As long as your breasts were functioning before, and as long and you suffered no complications from the surgery, you can still breastfeed. You still have sensation. You still have an areola and a nipple.

Mastectomy plus breast reconstruction involves removing the breast tissue, plus skin and the areola/nipple area (in some cases the skin, nipple and/or areola are able to be spared). Your milk ducts and lobules are gone. Your nipple and areola are gone. The skin loses sensation and becomes numb to the touch, so you can't feel anything over most of the breast area. Typically, and in my case, a tissue expander is placed and the remaining skin is stretched to make room for an implant. The implant will create the shape of a breast, AKA a "breast mound," so that you can wear normal clothes & bathing suits without worry, but is not actually a breast. You can't breastfeed from the affected side anymore. If you lose or gain weight, the "breast mound" will not grow or shrink with you (same during pregnancy). I like to think of it as a permanent/semi-permanent (sometimes implants need to be removed or replaced) subcutaneous prosthesis. It sits there, under your mastectomy-scarred stretched skin, taking the shape of a boob so that no one will notice as long as you're dressed. If you want, you can have your plastic surgeon fashion a new nipple out of the skin on the "mound" and you can have an areola tattooed around it (and the "nipple" colored in). You can also opt to have both the areola and nipple tattooed on. Apparently there are some great tattoo artists out there who can make some realistic-looking 3D nipples and areolas. Unfortunately, you never really get your nipple and areola back.

In my case, since I only had a mastectomy on one side, there is also the issue of altering the right breast to match the implanted boob on the left. This is the point where you should be thinking "Hang on, after all that you now have to cut into, and mess around with, your only remaining, healthy, intact breast as well?! That's crazy!" Yes, yes it is. An implant is round (unless you're talking the new-fangled teardrop shaped implants, which surgeons apparently are still figuring out exactly how to work with). This means that implanting the left side alone would leave me with one very round perky boob sitting high up on my chest and one normal, sloping breast sitting significantly lower. In order to make the two sides match I will need to have a slight breast lift (mastopexy) and a very small implant on the right side (to match the "curvature in the upper pole" that an implant gives, as my surgeon likes to say). Did I mention that since a breast lift involves removal of breast skin that I will also need my areola slightly reduced in size or else it will look tremendous sitting in the middle of my newly lifted breast? Did I remind you that this procedure leaves me with a bonus scar? You might be thinking "If it's so bad and if you're so unhappy about it, why do it?" Because it is the lesser of two evils. I am a very active person. I want to continue to be able to throw on my workout clothes, a bikini, a dress or a snug-fitting top and not worry about how my lopsided boobs look in them. I want to avoid having to wear a prosthesis. I want to be able to continue living my life as I always have.

That's what this is about. It's not about getting a boob job as a sweet concession prize for breast cancer. It's about preferring to just keep your own breasts, as they were given to you, but since that is not an option, doing whatever you can to continue to look as close to your old self as possible and to continue to live daily life as you had before.

There, I got that off my chest......literally!