Fast facts (if you don’t have time to read the full post): Today I had an ultrasound to measure my tumors. I am going to write a separate BONUS post today about that experience since today’s first post is about breast reconstruction! Yay double the posts, double the fun! Well, sort of. Are you having fun? Speaking of fun, I have chemo number six on Thursday. I will have Taxol again and another chemotherapy that is platinum-based.

TO THE LONG VERSION!

Last Tuesday I had my first introductory Zoom meeting with a nurse from Plastic Surgery Northwest which is my plastic surgeon based in Spokane. They will be handling my reconstruction surgery! It is one of three appointments I have over the course of the next three weeks focused on the breast reconstruction process. This first meeting was to go over the two options available to patients: implant-based and tissue-based reconstruction. Prior to this meeting, I had met with two different breast cancer thrivers who each had breast reconstruction. Both had done different options. Their stories and experiences had influenced which reconstruction I was leaning towards prior to the meeting and the meeting solidified which reconstruction I want: tissue-based.

When I first was diagnosed with breast cancer, so many folks had made jokes that I would be getting a free boob job out of this experience. I mean, at first I agreed and thought it was funny and then I learned what it entailed and this boob job is not your hot girlfriend’s boob job. This boob job is torture and trauma. I am losing both of my breasts before I get new ones. All of my breast tissue will be completely removed from my body once I finish chemotherapy. I will heal for roughly six weeks and then start 28 rounds of radiation therapy. Once that is over, I have to wait at least a year before I can have reconstruction and endure another not so fun surgery. Totally just killed the mood, didn’t it? 0/10 do not recommend BRCA1 genes or breast cancer as a way to get a “free” boob job. But I digress! So what’s the difference between implant and tissue-based reconstructions?

In a nutshell, implant reconstruction is a two-stage procedure. The initial stage involves the placement of a tissue expander – a silicone balloon filled with saline – beneath the remaining skin and chest wall muscle. Additional saline is gradually added to the tissue expander to stretch the muscle and skin, reaching the desired size. The second stage of implant reconstruction involves the removal of the tissue expander and replacing it with a permanent breast implant.

I am not a strong candidate for this particular surgery because I will be receiving radiation after my mastectomies. Implant-based breast reconstruction is not a good option for patients who have previously been treated with radiation because of poor aesthetic outcomes and a high likelihood of healing problems. For patients who require radiation after mastectomy and placement of the tissue expander, the timeframe to proceed with the additional steps in breast reconstruction may be prolonged. Radiation increases the risks of healing problems and infection in the implant-reconstructed breast. It also increases the risk of capsular contracture, or hardening of the tissues around the implant, from 30% to 60%. Forty percent of women undergo another operation for their implants by seven years after their reconstruction. There is more to this particular type of reconstruction, but since I am not choosing it, I want to focus more on the tissue-based reconstruction.

Tissue-based reconstruction uses my existing tissue to recreate the shape of a breast. There are several names for this kind of technique including “flap reconstruction”,” autologous reconstruction”, or “free-flap reconstruction.” Specific names that you may see are those referring to use of tissue from the abdomen: Transverse Rectus Abdominus Myocutaneous flaps (TRAM), free TRAM, muscle-sparing TRAM, Deep Inferior Epigastric Perforator flaps (DIEP), Transverse Upper Gracilis flaps (TUG) and others. I will be undergoing a DIEP procedure which spares the majority of the abdominal muscles and preserves abdominal wall strength. Yay hardcore core!

So basically, I will be getting a tummy tuck and using the tissues and vessels and muscles from my abdomen to reconstruct the breast mounds. This procedure tightens the abdomen where the tissue is removed and results in a long scar that will go from hipbone to hipbone. How much fat I have will determine my new breast size.

A major plus with this particular technique is that it can help the body heal, even after damage caused by radiation. And similarly to natural breasts, they will change in size over time if I lose or gain significant amounts of weight. They also feel the most realistic of the two options! But it is important to note that I will have ZERO feeling in my new breasts since the mastectomies will remove all tissue and nerves. Basically these new boobies are for aesthetics. The weirdest part of this procedure for me is that I will lose my belly button and they will give me a new one… I still feel weird about that. I am oddly connected with my belly button. I know it is basically a scar hole, but still! Thirty years with the same belly button and now I have to bond with a new one?! What the fuck! What if I don’t like the new hole they make me? Holy shit! See what I did there? Heh.

Some down sides to this procedure are that it is a commitment and pretty intense. Tissue-based breast reconstruction operations are much longer than operations to place implants for breast reconstruction, taking 8-12 hours for the initial reconstructive procedure. I will most likely be in the hospital for three or four days after the operation, learning to take care of my drains in my abdomen and breasts before I can go home. Mind you, this will be taking place in Spokane as well. The recovery time is also quite long, around eight weeks after surgery before I can return to all of my normal activities. I basically cannot move for the first two weeks and will need everything done for me including helping me shower and feed myself. Rip.

Though the initial reconstruction is a significant commitment, there is a very low likelihood of future procedures. I will have warm and soft and squishy breasts. This option is the most natural looking of the two options and it is a result that can endure for decades. I guess that saying “beauty is pain” will be taken to a whole new level with this procedure.

Long story short, losing my breasts is one Everest I have to conquer. Reconstruction is another. In the meantime, I climb the chemo Everest and hope I get to say “yay” and climb back down. I have an incredibly long journey ahead of me, assuming I enter remission and all goes to plan. This process will be years in the making. I want to make it clear that reconstruction is a choice I am making for me and my mental health. I want to have some sense of normalcy some day. I don’t think I will ever get to return to my baseline normal, but I will get to experience my new normal someday I hope. Just fucking sucks in the meantime.

Today’s song lyric of the day is brought to you by Lykke Li.

“Lonely I, I’m so alone now

There’ll be no rest for the wicked
There’s no song for the choir
There’s no hope for the weary
If you let them win without a fight”

– No Rest for the Wicked – Robin Schulz Remix, Lykke Li, Robin Schulz