Saving Skin

Did anyone watch that miniseries on HBO called “John Adams”? There was an episode where his daughter, “Nabby,” had a mastectomy. This was back in the early 1800s. Here’s what a historian James S. Olson wrote about it. Skip down to the paragraph that starts with “The day before surgery…”

http://www.shsu.edu/~pin_www/T@S/2002/NabbyAdamsEssay.html

Yeah, so my mastectomy was nothing like that. I had what they call a skin-sparing double mastectomy. I’m not showing you my boobs, but if you click on the previous link, you'll see some good examples.

Here’s roughly how a skin-sparing mastectomy works.

Your breast surgeon and plastic surgeon, who are in the OR together, figure out exactly where to make a nice, neat little incision. Mine happen to be going diagonally down from my armpits through the center of my nipple. The scars from the incision are roughly four to five inches long. My incisions cut through at about the 10 o’clock angle. I think the doctors choose the incision site based on where the tumor is in the breast. My main tumor (I had two) was at about 10 o’clock.

This was in my right breast.

Even though I didn’t have any cancer in the left side, I opted to have it removed anyway. Because I’m relatively young, the chances of the cancer recurring on the left side were pretty high. So, "cut it off," I said. 

I would have made this decision regardless of what my BRCA gene analysis said, but once I got those results back, it just gave me more reason to have the left breast removed. The test showed that I have a mutation on the BRCA 2 gene, which gives me a higher chance of the cancer recurring than if I didn't have the mutation (it also puts me at a higher risk of getting ovarian cancer, but that's for another post).

I already knew breast cancer ran in my family. My maternal grandmother (a.k.a. Granny, or Betty Trice) had breast cancer twice. She had a mastectomy on one side, went through chemo, and then 10 years later the cancer came back on the other side.

At any rate, you get the idea of why I went ahead and decided to have my left breast removed, even though it didn’t do anything wrong. Which brings me back to my scars. Since they made the incision at 10 o’clock on the right side, they made it nice and symmetrical on the left side.

And here’s where the “skin-sparing” thing comes in to play.  

1.     After she makes the incision, the breast surgeon scoops out all the breast tissue. I imagine this is like scooping out all the seeds and slush from a cantaloupe, only it doesn’t smell as sweet, and the surgeon probably doesn’t throw it down the Disposall.

2.     She scoops as close to the skin (cantaloupe rind) as possible, keeping as much of the breast skin in tact as possible. I’m pretty sure with a radical mastectomy, like Nabby’s, the doctors just lop off the entire boob and keep just enough skin to sew you back up, so you have, basically, your pectoralis major muscle covered with skin.

Thank goodness they have options for reconstruction nowadays. Women who aren’t interested in breast reconstruction can still have a radical mastectomy today. I guess it’s like Nabby’s, only with health insurance, a sterile environment and the anesthesia. Women who don't want reconstructive surgery may go buy a bra with pockets for foam breast forms. Or they may go around flat-chested.

Again, thank goodness for reconstruction. Here’s what that looks like in a nutshell.

3.     In the OR, the breast surgeon gets out of the way and lets the plastic surgeon do his work. Plastic surgeon puts tissue expanders in where my breast tissue used to be. Basically, my skin was like an envelope, and he just slipped empty tissue expanders in there over my pectoralis major muscles. (Technically, the top part of the tissue expander is under my pec muscles. But who cares?)

4.     The tissue expanders are empty silicone bags. They have a port or something on them, about the size of a quarter, which you can easily feel if you rub your hand over it (but please don't, or I will kill you). During my surgery, my plastic surgeon filled up the bags with a little bit of saline, just so I’d wake up and have a little bit of boobage going on. I can’t imagine what a shock it would have been to wake up and have been totally flat.

5.     Over three or four weeks, I healed from the surgery. But I still go back in to the plastic surgeon every few weeks so he can inject more saline into the tissue expanders. He injects a needle connected to a giant syringe filled with saline into the port of the tissue expander. (Super fun photo of this below.)

6.     He’s filling up the expanders so that my breast skin stretches out a little. Yes, the surgeons spared as much skin as possible, but I still don’t have as much skin as I did before the surgery. So he’s stretching the breast skin little by little. He puts about 60 ccs of saline into each tissue expander every time I go in.

7.     Yes, my boobs get bigger and bigger after every injection, which is awesome if you're me or if your name is Mario Medina.

8.     In order to eventually end up with natural-looking boobs, the plastic surgeon will fill the expanders 30% larger than the size that I'd eventually like to be. This is so there’s room for a little “hang.” Not like post-two-kids hang, but maybe like a 16-year-old's boobs hang.

Check out the wallpaper at my plastic surgeon’s office. This is the wallpaper of a gynecologist’s office, not a plastic surgeon's. Someone should tell him.

But tissue expanders suck. Here’s why:

They feel like rocks under my skin. I can feel the rippling of the bag. They make my boobs look like they’re right under my chin. They’re not meant to be permanent.

So, in a few months, I will have another surgery to have the tissue expanders removed and silicone implants implanted.The same type of silicone breast implants that you'd get if you were going in for an augmentation surgery.

Hopefully that helps explain my comments on Facebook/Twitter… especially the one that said, “At roughly $1/syringe, it costs about the same amount to fill my boobs with saline as it does to fill my Jeep with gas #breastcancer.”