Disclaimer: I am not a physician and am simply sharing my story. Please consult your physician for any medical concerns or treatment decisions.
Giving up my boobs was harder than I had imagined. I feel guilty because I used to complain about them all the time. But once I found out that I had cancer and had to decide what kind of surgery I wanted, I just wanted to keep my boobs. I didn’t want any surgery…although of course that wasn’t really an option. So, like most patients, I had to decide between a lumpectomy with radiation, a single mastectomy or double mastectomy.
Decision Time: The lumpectomy, although awesome in theory, was not the right choice for me. I know survival isn’t really any different between a lumpectomy and mastectomy, but recurrence is more common with a lumpectomy than mastectomy. Also, you need to get radiation. Since my tumor was in my left breast and the heart leans left in our bodies, there is always the chance of radiation exposure to the heart. There are studies that show that this can cause heart disease (just look it up in PubMed or you can Google “radiation heart disease” to see the publications). I already had PVCs/PACs before chemo, then during chemo my heart was struggling (ventricular tachycardia and sinus tachycardia), and I had exposure to adriamycin (which can also damage the heart)…so I did not want any more cardiac risk factors. This left me deciding between a single or double mastectomy. I decided on a double (bye bye breasties) with reconstruction since I am relatively young and there is a lot of opportunity over the years to have a recurrence. I also decided with my breast surgeon to do a nipple-sparing mastectomy given that my tumor was far from my nipple in my left (cancer) breast and the right breast was pretty much prophylactic. Double mastectomies are interesting because they are so commonly done, that I think we underestimate them. They almost seem like minor surgery, but this recovery was way worse than my c-section. I wasn’t expecting that since they didn’t have to cut through any muscle, but it was an incredibly painful and long healing process. I hate pain meds too, so I only took Percocet for a couple of nights and then stopped. I used Advil as needed, but the doc made me wait a week before I could start using that. Most of the time, I just dealt with the pain.
Initial Surgery: The surgery itself was on June 14, 2021 (~4.5 weeks after my last chemo infusion) and was relatively uneventful. I went to the hospital and they were running ahead, so I actually went in early (11AM instead of 1PM). I was under anesthesia for about 5-6 hours in total and woke up NAUSEOUS, but not in too much pain. They gave me the nausea patch behind my ear before surgery (more on this later) and some other meds in a drip, but the nausea still didn’t subside until about 8PM. That is also when I started to feel more lucid. Before that I was mostly grunting and my husband said I cursed at him when he tried to talk to me – oops. I totally don’t even remember that. The pain was manageable and the docs kept asking if I wanted Percocet, but I said no initially. Then, in the middle of the night I gave in, took the Percocet and slept. One thing I will say is not to underestimate how hard it will be to move your arms and get out of bed without using your arms – even in the hospital bed. I did it, but wow did it take a minute. So, if you think you need to go to the bathroom, call the nurse early to give yourself some time. Also, keep an eye on the meds. On a bathroom trip I saw that my face was red and my hands were swollen. Eventually, I realized that the antibiotic hanging on the pole was in a class of meds I am allergic to, as was the script for meds they were sending me home with (ugh!).
Post-surgery issues: So, that beloved anti-nausea patch actually made my vision wonky for almost 1.5 weeks. Apparently, the vision side effect is normal per the anesthesiologist and my eye doctor, but the duration of the side effect was super abnormal. Luckily, it did eventually subside and my eyes are back to normal now. About 2 days after surgery, the cancer boob (left side) started to have a puss discharge from the nipple (yep – gross), and the nipple and some of the skin below it were almost black. Apparently, you have skin, then a fat layer and then breast tissue. However, I had lost so much weight during chemo that they said I had no fat layer, which made it a bit tricky to remove all the breast tissue and preserve the skin. In the end, I would rather they get as much breast tissue out as they could, even if I lost some skin. Although, I admit my boob legit looked like some kind of Frankenstein experiment. Ultimately, they had to deflate my boob and I had to apply Nitro BID to the area twice a day for 2 days. Then I applied silvadene cream to the area twice a day. I couldn’t believe it, but some of the skin actually came back to life. The nipple was looking better too – except for the puss. That just kept coming and it was gross. So, on June 30th, 2021, I actually had to go in for another surgery to clean the infection, remove some dead skin (although this was much less and was limited to a small area near my incision line) and remove the tissue expander. I almost broke down and cried when they told me I needed another surgery. I almost told them to just sew up the left side flat and forget this implant mess. My chest was in pain and felt tight all the time. I was miserable. The incision lines hurt and my mobility was so limited. But, I let them go in to remove the expander and clean the infection. I had originally thought I would need 2 surgeries: 1 for the mastectomy and tissue expander placement and 1 for the implant placement. The infection meant that I ultimately needed 4 surgeries. First surgery had the worst recovery and the last surgery had the easiest recovery. If you only end up needing 2 surgeries, the second one really healed up pretty fast. Within a couple days, I was feeling pretty good.
Recovery: So, as mentioned, this is quite a recovery. The first 3-4 weeks after the initial surgery were bad and I was actually kind of depressed about feeling so terrible and not being able to move very well, but then I turned a corner. The thing that helped the most was actually starting physical therapy. It was night and day. When I started, I gained 20 degrees mobility from the first Wednesday session to the next Monday session. I did those at-home exercises like it was my job and it made me feel so much better. I still had a lot of pain around the incision lines for a while and everything always felt tight from the expanders. This seems to be pretty common, unfortunately, but it is manageable
Size vs. Function: My plastic surgeon and I went back and forth on how big to go. Trying to figure this out is really annoying. I looked up so many blogs and forums to try to get to the right cc’s. I was a 34C before surgery and I wanted to be the same after…but cc’s and cup side aren’t the same since cup size can vary a lot. My doc was leaning towards making me bigger than I wanted, so we compromised in the middle (350 cc implant on the left and 320 cc right). I am glad we did because the cc’s I had originally said would have ended up too small, but what he had wanted would have been too big. Keep in mind that after surgery, your boobs look big and high. Then, they settle over the next few months as the swelling goes down, so they look quite a bit smaller. When it comes to boob size, you do you. If you want a mega pair, now is your chance – you definitely earned them with what you are going through. But, keep in mind, they are not real boobs. Someone I know went bigger than their OG boobs and now she is always uncomfortable when she sleeps. She used to like to sleep on her stomach, but now she said it feels like she is sleeping on cantaloupes. She is planning a reduction.
Silicone vs. Saline: I thought I was going to go with saline because I liked the idea that if one of them popped, the only thing leaking was saline. Then, I got the tissue expanders and did not like the feeling of saline. So, I wanted a gummy bear silicone implant. These are supposed to be the texture of a gummy bear so if the outer shell gets a tear, the silicone gel will not leak into your body. Word of warning here – not all gummy implants are created equal. Some are definitely not like gummy bears and are much more liquid-like. I had a serious conversation with my doctor and told him I wanted to know the brand(s) he was planning to use. They usually order a few options, so I researched each one ahead of time. I even watched YouTube videos of implants being cut in half to see if I was comfortable with the level of gumminess (yes, I am that crazy). In the end, I got Sientra Opus HSC+ round moderate implants and I really like the way they look and feel and dance lol. I am the same bra size as before. With that said, one word of warning on silicone – given the heart issues from chemo, I need to get echocardiograms every so often and no one warned me ahead of time that it would be harder to get a clear image with silicone implants. If I would have known this, I may have gotten saline instead.
Above vs. Below the Muscle: Another decision is whether you want the implants to go above or below the muscle. Again, everyone needs to pick what makes sense for them. I had my implants placed above the muscle, which is less common overall, and especially less common in people who are on the thin side. You are much more likely to see rippling, so plastic surgeons don’t like to take that chance. Their job, after all, is focused on making things look as beautiful as possible. But I was 39 and married at the time of my surgery – I didn’t need to impress anyone and the hubby is more of a leg guy anyway. I wanted the best function. Over the muscle means the surgeon doesn’t need to disturb your muscle (faster recovery) and it seems more natural to me – put the fake boob where the real boob used to be. Also, there is less risk your breathing will feel obstructed. I had read so many stories of women saying that implants made them feel like they couldn’t take a deep breath. It freaked me out. Also, I knew the doctor could just do some fat grafting magic to make the ripples go away if they really bothered me. I am now 5 months out from the final surgery and I do have some mild rippling, but when I put on a good (no underwire) bra, it pushes the silicone so that the ripples disappear. I can wear tank tops, bathing suits, etc., with no problem. I’m totally good with it and I wouldn’t change it. I still have the option for fat grafting, but right now, I am not interested in any more surgeries. I cringe just thinking about it.
As mentioned, I am writing this about 5 months out from my last surgery (8 months out from my first surgery) and my boobs feel/look good. I hate that eventually I will need to get these replaced and imagine at some point I will just have them removed for good, but for now, I like having them. There was a time I thought about going flat and I have a lot of respect for anyone who makes that decision, but I am ultimately glad I didn’t do that at this time. For me, I think it would have been a daily reminder that I am a cancer patient. I like being able to look in the mirror and feel almost like myself. With that said, some women may go flat and seeing that reminds them that they are a warrior who beat cancer. In the end, it is a very personal choice and any choice you make for yourself is the right choice.
Don’t be afraid, for I am with you. Don’t be discouraged, for I am your God. I will strengthen you and help you. I will hold you up with my victorious right hand. Isaiah 41:10 NLT
Disclaimer: I am not a physician and am simply sharing my story. Please consult your physician for any medical concerns or treatment decisions.