Let’s talk about breasts, baby. Let’s talk about you and me. Let’s talk about all the good things and the bad things that may be. Let’s talk about breasts.
There go all my male readers. I can hear them muttering, ‘no thanks.’ Bye, bye.
It was inevitable the topic had to come up eventually as I do have breast cancer. We can’t ignore them forever.
I’ve always had a pretty good relationship with my breasts. I haven’t wanted to make major changes to them or wished they were bigger, smaller or different-shaped. Perhaps that was why I was so disappointed when they decided they wanted to kill me.
Well, just the one wanted to kill me. The one on the right. The smaller, more evil one.
I remember being teased by some boys in high school that I walked around, pushing my chest out all the time. I wasn’t. I was sucking my stomach in, but I guess it had an equal/opposite reaction of stomach in to chest out.
After I was diagnosed with breast cancer, my first visit was to the surgical oncologist who inspected my breasts and sighed, ‘it’s always in the smaller one’.
I was aware that lefty was a bit bigger than righty but her estimation was that lefty was a G cup and righty was a DD cup, so probably a more significant difference than I thought.
‘Even though the tumour is quite big [5cm], I could probably still do a lumpectomy and you could be left with quite a decent-sized breast,’ my surgical oncologist told me. ‘Then we’d do a reduction on your left and you’d probably have C cup breasts. They’d be smaller than they are now …’
‘That’s ok,’ I replied. ‘Sometimes they can be a bit heavy and cause back pain. C cups are fine.’
‘It’s always in the smaller one …’ she repeated.
The treatment plan we devised was that I would have neoadjuvant chemotherapy, surgery, radiotherapy and then reconstruction/reduction. There was a chance that the neoadjuvant chemotherapy could shrink the tumour, leaving us with more breast tissue for a lumpectomy rather than a mastectomy.
Did you know that only one in 10 women in Australia has a breast reconstruction after a mastectomy? Comparatively, about one-third of women in the UK and half of women in the US have breast reconstructions after a mastectomy.
After going through the decision-making process, I can understand why women are reluctant to go through breast reconstruction. There are so many choices that it can feel overwhelming.
Firstly, there’s lumpectomy vs mastectomy, if you have that choice. Uni-lateral vs bilateral mastectomy. There’s skin-sparing surgery vs non skin-sparing. There’s putting a tissue expander in to ‘save the space’ following surgery or building up the breast later after going through all the treatment. There’s implants vs using your own tissue/fat. There’s TRAM flap, DIEP flap and SIEA flap . These are all the options that I had just put in front of me for my surgery. My head was spinning.
I was also getting differing advice from my oncologists. My medical oncologist was quite negative about me considering putting in a tissue expander to save the space because of the chance it could interfere with my radiotherapy treatment. ‘Just get it all out and worry about rebuilding it all up later,’ she said. She mentioned that the tissue expander could ‘throw a shadow’ over my chest during the radiotherapy and I could risk some cells not getting targeted. She encouraged me to speak to my radiation oncologist about this possibility, and my radiation oncologist reassured me that the tissue expander would not interfere with her radiotherapy treatment.
My surgical oncologist gave me a referral to a plastic surgeon. ‘You want one of the young ones,’ she told me. ‘They’re up to speed with all the latest techniques and are far more willing to try things than the old fuddy-duddies who’ve been doing the same thing for years.’
I met with the plastic surgeon to discuss reconstruction options and he was very confident that he could do a TRAM flap reconstruction for me following a skin-sparing mastectomy and radiotherapy. I was keen to keep the breast looking and feeling as natural as possible to match the one on the left, rather than having a hard implant in there that would be a reminder always of my surgery. A TRAM flap reconstruction uses the lower abdominal muscle, and the skin and fat in this area to build a new breast for you. A bonus of the surgery is that you get a bit of a tummy tuck with your fat going from your stomach to your new breast.
It’s not an easy surgery and not without its risks. It can be a very long surgery and the recovery time is much greater than after a mastectomy. You can have a lot of pain because you are cut not only in your breast area, but also across your stomach. I was in no rush to undertake the surgery after my mastectomy (who wants to have more surgery again?) and wanted to give myself time to recover from everything, lose some weight so I was in the best possible condition to get over the surgery, and save up (money and work leave) for what could be a very expensive procedure with a long recovery time.
But I haven’t made it to the reconstruction stage and I probably never will. I had a tissue expander placed under my skin during my mastectomy, which has ‘saved the space’. It was the most painful part of my mastectomy. It was sewn into my chest wall so every time I moved after my surgery, it would pull against my chest. I did spend a couple of those first days at home regretting the tissue expander as it pulled every time I sat down, got up or lay down.
I almost had to have it taken out after I did something really stupid to myself, which I’ll tell you about in another post sometime.
The tissue expander is not as big as lefty so I’m definitely uneven and should probably go to a proper bra shop and get fitted with a proper prosthesis to match up both sides. But I have other priorities at the moment. Having the tissue expander gives me the appearance of cleavage so it’s a less noticeable difference between the two sides if I hadn’t had the expander put in.
It is meant to be a temporary device so it wasn’t built for comfort. It can be hard and painful sometimes. It has had its issues with fluid build-up around it. The seroma following my surgery probably took about 12 months to finally disappear and be reabsorbed into my body. Despite having four drains in following my mastectomy, it took a long time for the fluid to clear out of the mastectomy space. The drains usually stay in place for one to two weeks after surgery. I had one in there for at least three weeks that just continued to fill up with fluid. Eventually, my surgical oncologist said we had to take it out because the risk of infection was too great to keep the wound open for any longer. I got used to having the drains in. I carried them around in a little bag. Sometimes I’d forget about them and look down and see the bag dragging behind me. ‘I think you forgot your friends,’ my friend would tell me again as they dragged along the ground after we had got up and left a café or bar.
When I told my surgical oncologist this and that the drains regularly ‘popped out’ and I ‘popped them back in’, she was pretty unimpressed. It was good luck rather than good management that I did not give myself a major infection. But hey, life is too short to worry about where your drains are!