BRA Day

October is Breast Cancer Awareness Month, and with it comes lots of associated events, activities and special days. Yesterday was one of those special days – BREAST RECONSTRUCTION AWARENESS (BRA) day. So in honor of that day, I thought I’d take the time to give an update on a part of this journey I haven’t discussed much – my impending double mastectomy and reconstruction. (Warning note: this might be a little to graphic for some readers, so proceed with caution)

In January I’ll wrap up Chemo, and after 6 weeks of recuperating, I’ll be ready for surgery. Because of my BRCA 1 genetic mutation, current guidance is to have a prophylactic double mastectomy. So, in mid-February, I’ll go under the knife for my first major surgery. Dr. Johnson will do the mastectomy part – she’ll remove all of my breast tissue. She’ll also take one lymph node from Ralph’s side to confirm that my lymph nodes are cancer-free – they’ll do real-time pathology testing during the surgery to validate, if not, she keeps going until she gets to a “clean” lymph node. Dr Johnson will leave some breast skin behind for the plastic surgeon to use, but otherwise the entirety of my breasts will be removed. In order to reduce my risk for recurrence and any future breast cancers, Dr. Johnson will also remove my nipples as the cancer I have starts in the milk ducts, which are directly connected to the nipples. While this poses a potential aesthetic challenge post-surgery, I’m looking at the positives of no nipples – this expands my fashion choices dramatically while also making topless instagram photos a possibility without risk of them being taken down (I’ll probably not take advantage of either of these things, but hey – its always nice to have the option!).

Once Dr Johnson’s part is done, she’ll turn the surgery over to the Plastic Surgeon to start reconstruction. I’m still “interviewing” plastic surgeons, but should have one selected by the end of the month. Choosing a plastic surgeon for reconstruction is really important because:

• The Plastic Surgeon handles all the surgery post-care, so you wind up seeing this doctor a lot
• The Plastic Surgeon is giving you the boobs that you’re hopefully keeping for the rest of your life, so you want them to be really good
• Reconstruction is where there become a LOT of choices for what to do, and a Plastic Surgeon helps to guide and make these decisions with you.

So, here’s a breakdown of the major choices along the reconstruction path I’m taking (my apologies that I won’t be going into detail on the additional paths that I’m saying “no” to)

Choice 1: Reconstruction – First you have to decide on if you want reconstruction at all, and if you want to start the process right away, or wait awhile. I knew from the beginning of this journey that I would want to reconstruct my breasts, and I want to have as few surgeries as possible, so I’ll begin reconstruction in the same surgery as the mastectomy.

Choice 2: Implants or Flap – this is a big one. Once you decide to reconstruct, you need to decide if you want implants or to use your own body tissue/fat/muscle to reconstruct with, usually from your stomach (known as Flap reconstruction). While the Flap path sounds nice – you get breasts that are made of your own body, plus you get some liposuction from the places where they take the fat – its a much harder surgery, with greater risks of complications, and a MUCH longer recovery time. So, I’ve decided to go the implant route – gets me on my feet and back to “normal” much faster!

Choice 3: Pre or Sub Pectoral – So now that I’ve decided to go the implant route, we need to determine where they go (in your chest, duh, but its a little more complicated than that!). Traditionally, implants in reconstruction patients go under the pectoral chest muscles (sub-pectoral) because the skin post-mastectomy is so thin that the implants need a thicker layer of protection. This means the chest muscles need to be stretched out to fit the implants (not a very comfortable process) and after reconstruction is complete, your pec muscles are just beneath the surface of your skin making them look and work a bit differently than they do normally. In recent years, plastic surgeons have found ways to place reconstruction implants on top of the chest muscles (pre-pectoral) and using alloderm (donated human skin) to act as an additional layer between the implant and patients skin. This makes for pec muscles that stay where they originally are (and can keep doing their muscley job) while ensuring the implants are protected sufficiently to not cause “harm” to the body. After talking to a number of people who have gone through reconstruction, I’m 100% headed down the pre-pectoral path.

Choice 4: Round or Teardrop Implants – Once you know that you’re getting implants, and where they are going, you need to decide what type of implants you’re getting. There are two shape types Round and Teardrop. There are pros/cons to both shapes. However, there are ~350 women who after having breast cancer, then were diagnosed with a very rare type of lymphoma. All these women had teardrop implants – which have a different texture than round implants. This is just correlation, and is not statistically significant, but the trend is enough to send me down the path of round implants – because I never ever ever want to have cancer again if I can help it.

Choice 5: Size & profile – One decision that I haven’t yet made yet, is the size and profile of the implants I’ll be getting. I’m for sure going to “size down” from where I’m at today, but will work with my plastic surgeon to pick the size that is right for me. This will happen in January.

Choice 6: Nipples – last but not least, I’ll have to decide if I want something to replace my nipples. Many women get 3D tattoos that look like real nipples. Others get prosthetic stick ons. Others get tattoos that look nothing like nipples (many get flowers). And others do nothing. I have no idea what i’m going to do on this front – time will tell (and I’ve got all the time to decide on this one, as it occurs well after reconstruction is complete).

So that’s the short update on what my reconstruction will look like. Its a 6-8 week recovery for the mastectomy and reconstruction, and will be followed by a full hysterectomy (more on this later), so it will be early summer 2019 before I’m “back in action” but knowing what that path will look like goes a long way in giving me strength and confidence heading into the eye of this storm.

Unfortunately, even though I’m halfway through chemo, there is still a LOT more cancer ass-kicking to happen in 2018 and 2019

Fortunately, at last night’s BRA Day event (hosted by Dr Lemaine, one of the Plastic Surgeons on my short-list) my mom won a gift basket full of compression socks (very important for preventing blood clots post-surgery)  – so it feels like luck/karma is on our side!