My Breast Reconstruction Journey With Photos
Procedure specific satisfaction rating
About 3 years ago I was diagnosed with breast cancer and it was one of the hardest experiences of my life. I had two kids under the age of 6, a husband I loved dearly, and surrounding family that were all devastated about the news. Thankfully and by the grace of God, the cancer was only in my left breast and about 1.5cm in its biggest diameter, and I was told by the breast surgeon and my gynecologist that the prognosis was good. I had the option to do either a lumpectomy or a mastectomy, and after consideration with my doctors, my husband, and myself, I decided to go for the mastectomy, but for a bilateral procedure. Although my recurrence rate was supposedly low, I couldn’t live with the idea that I could have a ticking time bomb if I did the lumpectomy or just a left breast mastectomy. Nor would I want to have to go through all of this again, mentally or physically, if I had a recurrence. The breast surgeon, after my consultation about the double mastectomy, gave me a few names of plastic surgeons she worked with for reconstruction and advised me to make appointments with them to discuss what sort of reconstruction would be best for me and what the process entailed.
The first surgeon’s office was much like any doctor’s office – cold, quiet, and darting eyes of patients anxiously waiting in the waiting room. It was my turn after filling out some paperwork to go into the back of the office to an exam room and meet with the doctor. A nurse took me back to the room and asked me questions about why I was there, who referred me, what my medical history and medications were in a systematic review, etc. She handed me a gown to change into and said the doctor would be right in. About 10 minutes later while I read everything I could on the walls to keep my mind preoccupied, the doctor walked in. He shook my hand, greeted me to the office, mentioned how he worked a lot with my breast surgeon, and asked about my desires for post-mastectomy reconstruction. Ideally, I wanted a relatively quick, low risk, and somewhat natural appearing result to which he smiled and calmly said he could help me achieve. He explained a surgery with implants and another one that sounded more involved that would take my own fat and skin from my belly and make breasts out of it. He then examined me and my belly fat for what felt like 2 minutes and decided I couldn’t do a belly fat transfer (AKA DIEP flap = deep inferior epigastric perforator flap surgery or TRAM flap = transverse rectus abdominus muscle flap). Apparently, I didn’t have enough belly fat to make two breasts out of it, and said that if I opted for a unilateral or single mastectomy that he could do it.
I’m not sure if the doctor was simply giving me options, or wasn’t listening quite closely enough, but I left a little disappointed. I told him I wanted something relatively low risk and quick, and the DIEP flap sounded pretty scary and I wouldn’t be able to do a double mastectomy and get two breasts out of my current belly fat. I politely thanked him for his time and met with the surgical coordinator to only tell them I was still going to discuss things with my husband and had another consult before I made a decision on where and who I was going to choose as my plastic surgeon.
After the first consultation and a discussion with my husband, we both decided it would be a good idea to have my husband there with me to ask any questions that I may not be thinking of because, honestly, doctor after doctor had my mind a bit fuzzy. The second doctor’s consultation went much smoother with what felt like friendlier staff, I was able to meet with the doctor before being in a gown (which made me feel much more comfortable once I was in one), and he explained the same options for surgeries with his opinion then focusing on what I wanted – something relatively quicker and safer that would give satisfying enough results. He also mentioned that with the implant surgery as the best option for what I wanted, he would likely use an implant that was teardrop shaped (after I went through a tissue expander process, which I’ll explain later) so that it would look better/more natural against my chest after the surgery. The doctor explained how he did a lot of surgeries (he was considered a plastic surgeon and an oncoplastic surgeon) with my breast surgeon and spoke very highly of her abilities, which only made me like him (and her) more.
My husband and I decided in the exam room as I was putting my clothes back on that I wanted to go with this second plastic surgeon, and the discussion with the surgical coordinator was relatively simple. The coordinator would pick a date and time with the breast surgeon and the plastic surgeon that would work best for both of them, and I would be contacted in the next several days to finalize the date. With the surgeons and the path ahead somewhat nailed down, I had a chance to finally breathe a little – I was going to get this taken care of and I was going to hopefully feel somewhat back to normal after it was over. I was able to sleep a lot better that night and could already feel some of my anxiety going away.
Two days after my consult with the plastic surgeon, their coordinator called me and we booked a date – the surgery would be about 4 hours at the hospital and I would go home likely the next day (assuming all was going well). I was told to look into buying a surgical support bra, and there was a company that had a bra with hooks or something for holding up the drains so I didn’t get tangled in them ***. A note about the drains: I was warned by the second doctor, not by the first, about having drains that would prevent fluid accumulation after the mastectomy and when I had tissue expander implants in, so at least I wasn’t in major shock after the surgery. I gave notice at work of my leave and had a heartwarming response from the few coworkers who I shared as to why I had to take time off.
I went to the hospital with my husband while my in-laws took over the kids’ duties of taking them to school and their after-school activities, and the silence of the car ride there abruptly stopped when we heard the ring of the phone through the car’s speakers. It was my mother and father calling to wish me good luck and that they would be at the hospital later that day to check on me. Hearing my mom’s voice choked me up a bit, but I pretended to be the tough woman she raised me to be and told her I would be fine (even though I had no clue, other than broad details, what I was about to go through).
The valet at the hospital makes the stress of parking and walking in a bit easier, and the check-in desk pointed me to the direction of the elevators to the surgical suite. My husband and I got to the surgical check-in desk and the friendly, white-haired nurse who probably worked there for 25 years asked me how I was feeling and complimented my hair color before whisking me off to a draped off section of the pre-op area. The next hour or so was a blur with doctors and nurses in and out of the sectioned off pre-op bay I was in, signing papers, being poked with needles, and lying uncomfortably on the hospital bed that probably had thousands of other nervous patients lie on its all-too-thin mattress. I felt like the only breast cancer patient in the waiting area and was honestly happy to know I was getting this taken care of. Two friendly, familiar faces walked in my pre-op bay: the breast surgeon and the plastic surgeon, both of whom were cool as cucumbers familiar with this usual dance routine of pre-op and surgical madness. The breast surgeon marked the cancer-containing breast and the contralateral breast (the unaffected breast) with a pen and the plastic surgeon marked me after that. I was fortunate to be a candidate for a breast surgery that was called “nipple sparing” (also designated as breast conservation by some standards) since my tumor was so small and not near my nipple or areola. This meant I would still have my nipples after the procedure and wouldn’t have to have another surgery after the final silicone implants were put in.
I said my goodbyes to my husband who tried to act as cool as the doctors (failing miserably, but keeping back tears) and I was rolled back to the operating room through big swinging doors. I slid from the rolling bed of torture to the cold operating room table where masked women and an anesthesiologist greeted and instructed me on what I was to do. Plastic boots were fitted on my calves for circulation, and the rest I honestly can’t remember.
A few hours…minutes?...went by and I woke up in the post-op area with a different set of pinging noises and a massive pressure feeling on my chest. My arms hurt, my chest hurt, my abdomen hurt. I was a little nauseated and turned to my left and saw my husband smiling and he took my hand to give me a reassuring squeeze. The rest is again a little blurry and I recall, fuzzily, that we got to my hospital room and met the nurse that was going to check on me and my pain levels until I could (hopefully) go home the next day.
My parents came by and checked on me with flowers and a soft blanket and just the sound of my mother’s voice made me feel a little better. The drains were annoying but I was mindful of them so as not to tug them while I shifted carefuly in the bed. My chest was wrapped in an Ace wrap and I could only see a peek of what was underneath when the surgeons came to check in on me. Both surgeons came by once last time before nightfall and they assured me that everything went well and they had every belief that I would be going home the next day.
Sleeping was next to impossible with constant vital sign checks and beeps of machines with the occasional yelling voice from the hallways, but my husband stuck it out in the chair beside my bed that night while my in-laws stayed with the kids. The next morning the plastic surgeon came to check on my chest, my drains, and my vitals, and agreed that they would release me home if I could get up and walk around a bit without much assistance. Right after the doctor left I stood up and held my IV pole as I crept down the hallways eager to go home. While walking I saw my in-laws and my kids coming toward me with balloons (each child picked out their own that they gave to me, princess and car themed from each respective child). Their site made me teary eyed and gently held them to my hips and said, “be careful of mommy’s bandages, their very fragile”.
About three hours after the doctors gave me the OK to go home my husband was packing my things and the nurse with her assistant took my last set of vitals and handed me a folder with prescriptions and post-op instructions to take home. I was wheeled out of the hospital doors to the valet and slowly and deliberately got into the car – wishing there was easier way to get in without having to use any muscles of my upper body. Despite a little mishap with the drain versus the seat belt, I was buckled in for a ride that felt like hours to go 15 miles back to our house. I swear, my husband hit every single pot hole and bump in the road on purpose and I felt every blow deep in my chest – but Lord knows the man tried to make the ride as comfortable as possible.
At home the usual mess was on the countertop, mail strewn about on the dining room table, and laundry randomly piled in the corner by the stairs. I resisted my urge to get back into my usual frantic cleaning routine, shrugged and smiled at my husband, and helped me upstairs to my bed. I sunk into our king-sized bed made of clouds and cotton and drifted off to sleep for what felt like hours.
I woke up to a stabbing pain in my chest, remembered what I just went through and took a peak under the bandage to see a bruised, lumpy chest with blue and brown stains (from the marker and the iodine prep, respectively). The appearance of my chest had me nauseated, but I held back the urge to vomit because I knew it would be extremely painful to throw up with the chest pain I was already enduring. I had my phone next to me to call my husband for any help and asked him for some water, my pain medication, and assistance in getting out of bed to use the bathroom.
The next several days went by with repetition of pain medication, then switching to Tylenol when the pain meds really weren’t as necessary, draining the tubes from my chest and documenting their output for the surgeon. I met with the plastic surgeon 5 days after the surgery and they decided my drainage was slowing enough that they could be removed. I thought to myself that I should have taken the Tylenol before coming, but it was already too late. The nurse came in and calmly explained how she would remove the drains and despite the pain, I would be happy their out and no longer hanging off me like I was a squid. I bit my lip and about 5 painful minutes later, they were out. I made a follow-up to start the tissue expansion process with the nurse who politely introduced herself and advised we would get to know one another with twice monthly visits for tissue expansion until we reach the 350cc estimated size that the surgeon and I agreed upon.
Tissue expanders are essentially water balloons that are inserted empty, or almost empty, at the time of the mastectomy, and then later replaced with silicone implants. The tissue expanders have a magnetic port that allow the nurse to find where to insert a (seemingly large) needle through my chest to the implant to fill it up with saline. The saline expands the tissue of my chest that was removed with the surgery after my breast tissue was taken out. The expansion, I must note, was pretty painful for the first few days after the injections of saline – it felt like pressure, tightness, and heaviness on my chest – not something anyone is happy to feel. Another odd post-surgery side effect that I felt constantly was a bulging sensation under my arms. I was warned before the surgery that this was a common side effect, and that visually there was no bulge – it was only in my head – but I could definitely feel this to the extent that I would use my arms to “tuck in” something that wasn’t there. After about 6 weeks my “expansion” process was complete, and after positive pathology results showing that all of the cancer was out and both breasts were now clear of cancer, I was ready for my second stage of breast reconstruction.
If the story of my breast reconstruction is already long, you’re right. I was already sick of the visits, the pain, the tightness, etc. but I had to get to the finish line to mentally be done with the healing process. I made my husband promise that we would have a celebratory party for my new breasts and my new lease on life after this entire experience was behind us (spoiler alert - we had a great party with our friends and family 2 months after my second surgery). I was ready for the second stage surgery where my tissue expanders filled with saline would be swapped out for the breast implants that would be much softer and much more natural looking. When you have tissue expanders in, as they start to fill, they look cock-eyed, pointy, and downright weird. They make sleeping hard and because they keep getting larger with the saline injections, you never really get used to them. I booked the second stage reconstructive surgery and I was so ready to get this over with – I luckily was a nipple-sparing mastectomy candidate, so I didn’t have to think about a nipple reconstruction as a third stage to the surgery. All the while, I kept thinking, who would willingly go through plastic surgery more extreme than this electively? To each their own, I guess.
Second Stage of Breast Reconstruction
The surgeon reassured me that removing the expanders and replacing with the implants that were gummy-bear consistency and tear drop shaped would look as natural as possible. The second stage reconstruction had much less risk factors compared to the initial surgery, and because I had both a skin-sparing mastectomy and nipple-sparing, I was a great candidate for a good result. He would also do fat transfer from my pesky armpit fat (the kind of fat that sticks out when you were a tube top between my chest and my armpit) to my chest wall if the contouring required such an adjustment. And before I knew it, it was surgery day. I had a tearful, nervous, and excited conversation with my husband on the way to the surgery center (thank goodness I didn’t have to deal with an overnight stay at the hospital this time), and we joked about our next vacation where I could be in a push-up free tank top or bathing suit.
Just like before, the surgeon came in all smiles and calming words, marked the areas of my breasts and confirmed my desire to be a full B to a full C, and that I was ready to get this over with. The anesthesiologist had an incredible smile and she made me feel instantly comfortable when she asked if I got nauseated after the last procedure – how did she know? I had kissed my husband goodbye (or see you later, as we promised we would say) and I was rolled back into the sterile, cool operating room. Again, I couldn’t remember much even if you paid me and woke up in the recovery area with my husband at my side, a bra and a wrap around my chest, and that nagging, constant, dull pain in my chest.
Weeks went by with follow ups and more time avoiding lifting, working out, and straining myself and I was finally able to ditch the surgical bra and change into something a little more sexy. The entire process was long, occasionally painful, and mentally tiring, but with the help of my family, my excellent surgeons, and the grace of God giving me strength to push through, it was over. The last visit with the plastic surgeon was bittersweet, but I hugged the surgeon (despite him looking like this was unprofessional – I didn’t care, I was happy to be done and happy with my result), hugged the nurse who did the tissue expansion, and said my goodbyes to the office. As far as I was told, I don’t have to worry about implant reconstruction again for about 10 years, possibly more if the MRI’s in the future were clean.
Looking back on the process of breast reconstruction, I know that I had been blessed with common, manageable side effects, positive results aesthetically, and no residual cancer. I’ve heard tons of less positive stories in support groups and pray that maybe there is something in my story that could give another person hope, strength, or at the very least some insight to the process on a surface level. Because I had very early-stage breast cancer and didn't have to go through chemotherapy or radiation therapy or deal with post-operative infection, I was unbelievably fortunate. For any woman who is about to undergo reconstruction or even a mastectomy, my best advice is to be open with your friends and family for support, keep your eye on the prize (being done with all of it), and find whatever strength you have inside and keep the fire burning despite all the challenges, pain, and road blocks you may endure.