Immediate reconstruction – the decision is made

In the end I’ve decided to go for immediate reconstruction. So as soon as the breast surgeon has done the right-side mastectomy and removed the lymph nodes from the right armpit, a plastic surgeon will reconstruct the breast using my own abdominal skin, fat and blood vessels.

These three procedures could take around eight hours in all, or perhaps even longer. The reconstruction involves complex microvascular surgery and is by far the longest part.

Now I don’t know about you but that all sounds pretty scary to me. The thought of such a long operation was one of the things that made deciding whether to have immediate reconstruction so difficult (Decisions you never dreamt you’d have to make). Now that I’ve made the decision, however, I’m completely at ease with it.

When I first found out back in July or August that I’d be having a mastectomy, I thought I’d be happy being what’s known as “flat”. I’m not sure what tipped the balance in the end but I do know that when I was watching TV quite happily last Sunday night, I happened to look down at my chest and just welled up at the thought of there being just a big gap there in a month or so’s time. I did think I could make do with a prosthesis, but it’ll be good knowing that if and when I do get back to cycling and playing tennis and skiing and swimming – and diving into swimming pools on summer holidays – that I won’t be worrying about balance and things falling out.

I’ve already had one lengthy consultation with the consultant plastic surgeon who’ll be doing the reconstruction. The surgeon went over the procedure, the risks involved and the recovery and showed me some photos of reconstructions that she’d done that are similar to what’s planned for me. This particular type of reconstruction has lots of advantages over an implant. The rebuilt breast looks and feels more natural; it changes as you age; it shouldn’t have to be replaced. As with an implant, it will have little, if any, sensation. Unlike with an implant, however, you have a hip-to-hip scar to deal with and a long recovery period. You also often need a second operation six months or so down the line to tidy the scar and do a bit of tweaking to the new breast if needed. That’s also when they do nipple reconstruction, again if needed.

Let’s focus on the nipple, then (I told you this was an education). I wrote in my last post (An “excellent response to treatment”) that the breast cancer has shown an excellent response to the chemo and that this might have positive implications for the reconstruction. In a mastectomy, the nipple is often removed but with me they are going to try and keep it. They initially thought the nipple would have to go because of the location of the tumour but the tumour has shrunk back to such an extent under the chemo that it may be possible to preserve it. They’ll give it a go; after the operation they’ll biopsy tissue taken from behind the nipple and if they find any cancer, there will have to be another procedure to remove the nipple. That would happen around two weeks after the original procedure; then we’d be looking at doing a nipple reconstruction later on.

I am now in the very strange position of not being allowed to lose any more weight before the operation. I’ve lost 4 – 5 kg since coming back from our summer holidays at the beginning of August, due to a combination of eating more healthily, eating less (this one I guess could be down to a combination of worry, the chemo and choice), and more or less stopping drinking alcohol (a lot easier than you’d think!). The surgeons are already considering changing the type of procedure I’m to have from a DIEP flap reconstruction to a stacked DIEP flap reconstruction, the latter being for women who “aren’t eligible for standard DIEP surgery” as they “don’t have a lot of extra belly tissue”. I’m one of those, apparently, although you could have fooled me!

It does make you wonder, though, about the workings of the mind with regard to weight loss and gain. I’ve lost that weight completely effortlessly and being overweight, especially after the menopause, is a risk factor for breast cancer (How did I “get” breast cancer?). I know it’s not that simple, but it has crossed my mind that I really should have been a bit more vigilant and not put that weight on in the first place.

The operation could be on 19 December, but that has yet to be confirmed. If you’re having surgery after chemotherapy, ideally it should take place between three and six weeks after your last round, and better closer to three weeks than six. For me, assuming I have the last session of chemo as planned on 25 November, that’s any time between 16 December and 6 January. The fact that this period includes Christmas and New Year complicates matters as people are on holiday and operating theatres get booked up in the run-up to the break. The issue is finding an available operating facility on a day that suits everyone. Everyone can make 19 December but it’s proving hard to find an operating facility that’s free for a whole day. I hope to find out soon if they’ve found somewhere. The fact that I’ve developed some nerve ending damage in my right foot and toes from the chemo potentially complicates matters (An “excellent response to treatment”). If it continues to get worse, we won’t do the final round of chemo. This means I’ll already have had my final chemo session and the period during which they should do the surgery will be from 2 to 23 December.

You’re in hospital for 5-10 days after this operation, so if it does happen on 19 December in theory I could be back home on Christmas Eve. I have been warned, however, that I could well be spending Christmas in hospital. Better that, though, than waiting until after the New Year.