Breast Reconstruction: Step 1 (of many...)

On Monday Brian and I met with the Plastic Surgeon who will be performing and perfecting my new boob surgery.    Her name is Teresa Buescher, she is at KU, board certified and specializes in breast recontruction surgery.  I had the pleasure of listening to her speak at Gilda's Club in October about the different types of reconstruction surgeries she performs and a panel of women were present each who had chosen a different type of surgery. 

Breast Reconstruction surgery is typically done in stages, as mine will be.  I opted not to have tissue expanders placed at the time of my mastectomy, because, well, honestly it wasn't greatly suggested to me by my surgeon.  He felt the most important thing to do was heal and get through chemo and worry about reconstruction later.  I would have to agree, though I know no different at this point, having been without boobs for almost 9 months.  As it turns out, using such a large chunk of my FMLA for my mastectomy and chemo, I wouldn't have quite had enough time to be off and have my job protected had I done it the other way. 

I love Dr Buescher, and Brian was very pleased with her.  We talked about kids, my job, dogs (she has 8!) and the options available to me.  The route I have chosen to take is not any better/worse than what anyone else you know has/had done.  It's what works for us.  That was the wonderful thing about talking to her.  Whatever works for my life.
 We talked pros and cons. 
I have a job that involves lifting and pulling.
 I have a totally dependent child I need to be able to pick up and carry around.  Forever. 
So, like I said above, it may not be the route your mom, sister, bestie, or cousin's neighbor's aunt's Mom followed, it's MINE.  And no, it's not like getting implants placed for breast enhancement, so many of the typical rules for recovery don't apply here.  I encourage you to share your stories of reconstruction with me, after all, alot of what I know I learned from survivors willing to share with me. And I greatly appreciate their honesty and candor about what they did/would have done different. 
 BUT,  (always a but...) if you think about opening the hole in your face and saying to me something along the lines of how what's-her-stick didn't have to be off that long, or have a drain, or had this/that/the other for restrictions, or anything that remotely feels negative, STOP.  Especially if you've never been through it.

I found during chemo that more than one person said to me "My friend/mom/aunt/neighbor/ what's-her-stick didn't take ANY time off during her chemo....."  Well, I did.  And I felt guilty enough about that as it was, even though you may never have been able to tell, as I just nodded and smiled.   It took, takes work to stop feeling guilty still.   Probably always will.  I don't like to let people down. And I don't like to rely on others.  And though I know the people who said those words to me didn't mean it in a nasty way, the perception on my part of what they said when I already felt crappy, only made it worse.  I won't let someone else make me feel that way. 
So, what I'm getting at is simply this; this is MY choice, MY life, MY story. 
Why share it then you ask?  Because maybe you've been in my shoes and spent too much time nodding and smiling at the things people said to you that only make you feel worse about yourself, and this helps you realize you don't have to anymore. 
 OR maybe you are that person who thought sharing the story you heard would help.  It doesn't, it sounds and feels judgemental, even when it's not meant to be. 
And chances are, if you are following my blog, you love me and care about me, like to read what I write and just want to know what route I've chosen, so you can support me. 
Or your a stalker, and I'm ok with that too. 

Anywho....on to surgery!   I have chosen to have tissue expanders placed in preparation for a DIEP Flap procedure.  DIEP stands for Deep Inferior Epigastric Perforators-or the blood vessels in the lower abdomen.  Flap being skin and fat attached to those vessels. 
The first step being the tissue expanders will be placed on January 25th, 2013. The expanders are a sack with a port on it placed under the Pectoralis muscle.  This surgery takes a few hours, and will keep me in the hospital for a few days and maybe have a drain afterward.  I have a small seroma on my right side from my mastectomy which has never gone away-or a small pocket of serous fluid.  This may be what causes me to need a drain post-op, but Dr Buescher feels is not too significant, and doesn't need to be drained prior to having my expanders placed.
 Below is a good picture of what the process looks like from expander to implant.  She will place the expanders with a small amount of saline initially-only about 50cc's.  Then starting at 2 weeks post-op I will make weekly or bi-weekly visits to the office for them to locate the port and fill the expander with 50cc's of saline at each visit.  The expanders do exactly what the name is-expand the tissue and muscle which I  have lying flat against my chest right now.   Recovery time is 2 weeks of no lifting anything greater than 10-15 lbs, and raising nothing above my head.  Then possibly one more week, depending on how I'm doing at the two week point with arm movement and pain control.  

 

 

 





We will fill the expanders until I am happy with the size, then we hold fills for one month allowing maximum stretching of the muscle and skin.  The fills are quick 20 minute in office procedures with little pain afterward, but no restrictions.  This can take 3-6 months to achieve the size I want, but I can keep the expanders in for as long as 2 years.  Though about 8 months is as long as Dr Buescher likes.  But again, we are on MY schedule.   Below is a more accuarate pic of the what the expander looks like, and the card I get to carry while they are in.  They port has metal in it to help in locating it for fills, but also can set off metal detectors.  So, to hopefully prevent from being felt up by any TSA Agents should my boobs set off the metal dectectors at the airport, I will be sure and keep this card handy....

 



 

 

Remember these are in preparation for the DIEP Flap procedure.  Many women do the expanders, then trade out for implants once desired size is achieved.  I am looking at the DIEP Flap, which will take my abdominal fat and tissue and put it in where my new 'breast pockets'  or 'skin envelopes' have been formed.  The DIEP does NOT cut into the abdominal muscles, so I won't have the concern for lifting or carrying Ethan or doing my job, or hernias.  All in all, it's a tummy tuck/boob job combo.  This procedure is quite more intense than the implant exchange-a 12-15 hour surgery and 6 week recovery.  But it is completely autogolous-or means using all my own body parts. If you google it, the pics are kinda freaky, don't say I didn't tell you.  Dr Buescher specializes in this surgery, which makes me very comfortable with my choice.

 As of right now, I am a candidate for the DIEP, but that could change if I lose weight and in turn tissue off my abdomen.  And since it would be late next spring or summer, I may not be a candidate for this particular type of surgery, and instead do an implant exchange.  That is why we are starting with the expanders for now, and will just take it day by day, or fill by fill, boob by boob til I'm happy and ready. 

I'm excited to start this process, as it kind of feels like a new beginning, and end to my year of cancer.

And I'm ready to have boobs again. 

 

And how appropriate to be starting in January....

 

If the world doesn't end on 12/12/12.