Meeting a Plastic Surgeon
13 Dec 2014
It’s been almost two months since treatment finished and thankfully I’m feeling rather well! The rotten fatigue seems to have gone as has the puffed out feeling and more importantly the awful diarrhoea thank goodness! The hair is still pretty naff, it feels like it may never grow (still not been cut on the top despite finishing chemo 11 months ago), although I’m now even more grateful to chemo as its relatively straight (how mental is that) and at least it has colour even though I’m now more “blonde” than “ginger”- I appear to have been left with a “blonde brain” so it now meets with my reduced mental abilities (to all my blonde friends - that’s a joke honest). I’m now just left with rubbish nails and a scabby nose that feels like it’s been punched but given what I’ve been through I think I can live with that.
So this week I have been to see the plastic surgeon to discuss reconstruction. This process can start 9-12 months after radiotherapy depending on how damaged the skin is following all the zapping. For me the process started a couple of months ago when I went along to a group ran by my North Tyneside General Hospital. At the group, women who have had reconstruction in the past are kind enough to show you the results of their various surgeries.
I was pretty excited to go along to this group but if I’m honest I came away feeling quite upset. Having thought about it calmly afterwards I think I can put it down to this – I hate the way I look now and am awfully good at avoiding mirrors, I have made a conscious effort to tell myself that the mastectomy was a temporary measure and told myself that Id eventually get my boob back. However after going along to the group I realised that actually I wasn’t going to get it back. I was going to get a boob back but it wasn’t like the one I lost and that one wasn’t going to be temporary – that was something I’d have to live with.
Now before I go any further I must say that I take my hat off to these ladies who are kind enough to “whip em out” to show complete strangers, they were brilliant to do it and it’s something Id actually consider doing myself in the future. I think what put me off was the position of the scars – to put it bluntly I simply didn’t want scars like that and went home to tell Simon I wasn’t going to have the reconstruction.
The following day I was due to see the Breast Reconstruction Nurse so I spent the whole night stressing about that as basically I was about to go and tell her I wasn’t happy with what the surgeon was planning and that they could stick their reconstruction! All very irrational I know but quite frankly this whole episode stinks so I do allow myself to be this daft at times!
Needless to say I burst into tears pretty much as soon as I sat down in my appointment the next day! However all was not lost as the Nurse explained to me another option…..more on that later but perhaps now is a good time to try to explain how reconstruction works.
If you imagine what you are left with following a mastectomy – it’s basically flat and for me the scar runs smack bang across the chest. In order to make a new boob a surgeon needs to obtain some extra skin which they usually take from the tummy or the back and whilst they are taking the skin they take the muscle underneath to make the shape of the new boob. They can also use silicone implants too but because I have had radiotherapy I’d probably not be advised to have this as the damaged skin is likely to reject the implant.
So if you imagine that the surgeon reopens the mastectomy scar and sews in a chunk of skin from elsewhere you are left with a scar on top and a scar underneath. This was what I simply didn’t want even though the results are actually very good from what I have seen.
However I was then told about the other option. This is to insert a tissue expander. The tissue expander is a type of implant that has a port attached to it – the port is used to inject saline fluid into the implant on a weekly basis and the idea is that the implant expands gradually causing the skin to stretch.
Once it has been fully expanded it needs to stay in place for a minimum of 4 months and after this the surgeon would reopen the mastectomy scar and perform the same operation previously mentioned but they would need to remove less skin and the scar would be straight across the new boob with a circle of transplanted skin at the front which would later be used to make a nipple!
Quite clever really isn’t it and having looked at pictures of the two options, I preferred how the new boob looked using the tissue expander method. So I went away feeling a lot happier. Ive attached a picture taken from a booklet I was given so you can see the difference in the 2 options. The one I am going for is on the left!
So following the appointment with the Breast Reconstruction Nurse I had an appointment with the plastic surgeon on 5th November but had just started a new job so I managed to postpone it to last week. I was a little apprehensive about this appointment as Id kind of set my heart on the tissue expander route but I put my sensible head on and went prepared to listen to the surgeon’s advice.
I’ve heard fantastic reports on my surgeon Ms Serra, she is apparently an absolute perfectionist who takes amazing care of her patients and is someone you tend not to argue with – that will do me and as long as she lets me leave hospital as soon as possible I reckon we will get on just fine!
So last week Simon and I went along to meet her and we were both suitably impressed – she is a lovely young Italian woman with a fantastically strong accent but we both came away understanding everything that had been said to us.
Ms Serra took my full history then asked to examine me to work out where she was going to take the skin and muscle from – so I whipped out my tummy and she shook her head………not enough fat there! Next she checked my back out…….same story…….not enough fat. She then tried my thighs and unbelievably there wasn’t enough there either! So the tummy tuck and thigh liposuction appears to be out – gutted lol.
She then explained she would need to use an implant as she can’t find enough fat on me to make my new boob which she would normally recommend but to reduce the risks of my body rejecting the implant she will cover the implant with muscle taken from the donor site. So I am looking at an implant with what is called a diep flap (the flap of skin and muscle they will take from my back most likely but possibly my tummy).
Now an obvious question here is “why not eat a load of pies and cakes and grow a bigger tummy” – well apparently the problem with this is if you did put on weight for the operation you would most likely lose it later on and because your new boob is made out of tummy fat the boob would shrink just as your tummy would when you lose weight! It’s all very complicated isn’t it!
We then talked about the possibility of me having a tissue expander first. Having checked my skin the surgeon said my skin was actually in quite good condition despite the radiotherapy. She couldn’t say for certain how successfully the skin would stretch as it has been damaged by the radiotherapy but she says it’s definitely worth a try. The downside is that it’s another operation on top of the big one that will actually make me a permanent new boob.
Following the tissue expander operation, after 3-4 weeks I’ll need to start going to the hospital every week to have the expander injected with 50-100ml of saline and this takes 6 weeks. I’m told this won’t hurt but will probably be uncomfortable which makes sense. Once the expander is full it has to sit there for a minimum of 4 months and only then can the main operation be carried out although the expander can stay in for up to 18 months but Id rather not wait that long.
So it’s another operation, a clart on going to hospital every week to get topped up and a delay of at least 6 months before the big operation but hopefully the cosmetic results will make it all worthwhile and for that I’m willing to put myself through it all (check out my new found patience).
So I’m now booked in to have the tissue expander put in on January 27th. It’s only an hours operation and again I’ll have drains to carry around which will come out after a few days and I should be allowed home after 2 nights but possibly 1 (yes please) if I’m willing to go home with the drains which I am!
So in a freaky kind of way I’m now really excited even though I’m facing major surgery again but this is the start of the big rebuild so it’s all good! Ideally I need the expander to do a fantastic job which will in turn mean the surgeon can take a small patch from my tummy but given her reaction I’m not too hopeful for a free tummy tuck but the other good news is that later on when my new boob has settled down I’m eligible for surgery on the good boob to make it match! Silver lining and all that!
So that's me off on what is looking like a long journey into the world of reconstructive surgery! It will be here before I know it what with Christmas creeping up on us – and how different a Christmas it will be. Looking back at how I was this time last year is pretty nasty and after last year I’m seriously looking forward to managing a Christmas dinner, having a few more glasses of fizzy vino than I did last year and being able to face chocolate! Happy Christmas everyone and here is hoping 2015 is a much healthier year!
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