Breast cancer “reminders”

Quite apart from coping with the emotional side of having had breast cancer, there are plenty of physical reminders to make sure I don’t forget what I’ve been through any time soon.

I was thinking I would list the various side effects I’m experiencing in order of annoyance but that’s hard to do. I have different types and levels of pain or discomfort in different areas and each side effect is annoying in a different way. Here goes.

Peripheral neuropathy. I’m still experiencing pain – numbness, tingling and throbbing – in the balls of my feet and toes as a result of the nerve ending damage caused by the chemotherapy drug paclitaxel. This comes and goes, ie it’s not constant, and while it is improving, on some days – if I’ve done a lot of walking, say, or have worn heels – it can get pretty bad. I can’t remember when it last woke me up at night but it’s usually the first thing I’m aware of physically when I wake up in the morning. This can take up to a year to get better, although in some cases it’s permanent. So I’m guess I’m playing a waiting game.

Post-surgical pain. I still have pain – numbness, tingling (but different from the feelings in my feet) and a burning sensation – in the upper inner part of my right arm and what feels like muscle pain where the reconstructed breast meets my chest and below and behind my armpit. This is much less painful than the peripheral neuropathy but it is annoying, as this pain is more or less constant so I’m aware of it most of the time. I’m pretty sure the muscle pain – or what feels like muscle pain – has got worse in the past few days. It’s at its worst when I wake up, especially if I’ve rolled on to my right side while I’ve been sleeping.

The numbness and tingling is caused by nerve damage that happens during surgery to remove lymph nodes from the armpit area. The effects subside as you heal – within about three months for most people – although they can last or become worse months after the surgery. The numbness and tingling is definitely not as bad as it was but it’s still annoying. Another waiting game.

Breast lymphoedema. I saw the radiation oncologist on Monday and, while the cellulitis (It went downhill from there) has evidently cleared up nicely, she mentioned the dreaded L word – yes, lymphoedema – with regard to the persistent swelling in the breast area. Early treatment is recommended to help prevent hardening of the tissues and reduce the risk of you getting cellulitis (please, not again!). So I’m to have a course of manual lymphatic drainage (up to fifteen sessions over up to six weeks), a very gentle form of massage that allows the lymphatic fluid that’s collecting and causing the swelling to be redirected to – untouched and undamaged  – lymph vessels in the vicinity where the fluid can drain away more easily. Also, later today, I’m to be fitted for a lovely compression bra. I’m assuming this will be an even sturdier version of the post-surgery bras that I’ve really never stopped wearing since my op on 19th December – other than for a few days during radiotherapy when I had cellulitis and a bad skin reaction to the radiotherapy – because there’s always been some sort of swelling or another. Compression treatment for lymphoedema puts pressure on the area where you have swelling, and the pressure helps the lymph to flow through the lymph vessels. It also acts as an extra force for the muscles to work against, which helps the fluid to drain out of the area.

The swelling is not painful in itself, I suspect mainly because I have no feeling in most of the area in question. At rest, however, my inner upper arm rests against part of the swollen area and this aggravates the already tender upper arm.

By the way, breast lymphoedema I can cope with (Fear of lymphoedema); please let it not spread to my arm.

Cording. Now that the cellulitis has cleared up, I can start having physiotherapy again on the cording, this hardening of the lymph vessels to form tight bands under the skin from the chest or under arm down to the elbow and beyond that can happen after breast cancer surgery involving the axillary lymph nodes. The cording is not painful as such but, again, that’s because I have limited sensation in the affected area. I also know to limit my movements so that it doesn’t hurt where I do have feeling. It’s only painful in those areas when I forget and try to stretch further than I am able to. With physio and the arm and shoulder mobility exercises I’m continuing to do every day, the cording should go over the next few months.

Hip-to-hip scar. I was really nervous about the potential consequences of the surgery to get the fat and blood vessels from my abdomen for my reconstruction. While the immediate aftermath was tough, it’s the part that’s giving me the least trouble now in terms of ongoing post-surgical pain and/or discomfort. The scar that runs from one hipbone to the other has healed well really well (there’s just one small area of less than an inch long where it’s a bit messy) and while the surrounding skin can still feel very tight and hard in some places, there’s no pain. Discomfort, yes, but not pain. I’ve been shown how to massage the area above the scar to loosen the skin up and I do abdominal stretching and strengthening excercises at least twice daily. Things should continue to improve.

Lost toenails. Chemo played havoc with my nails, especially my toenails (Note to self – keep your toes covered when trying on shoes). The nails on my two big toes are in the process of growing out and the nails I lost on four other toes are growing back in*.

I think that’s it on the physical side effects front.

And then there are the drugs:

Hormone tablets. I take one tablet of letrozole every day and will do so for the next five years, when I’ll move on to a different hormone therapy, for another five years. I count myself lucky in that I seem to be tolerating letrozole very well; I have no side effects to speak of.

Calcium and Vitamin D supplements. Letrozole can cause osteoporosis; the calcium and Vitamin D supplements I take daily are to counteract the effects of the letrozole in this regard.

Iron tablets. I’m still taking these three times a day for post-operative anaemia. I stop taking them in a few days, three months after my op.

Zoledronic acid. I’m to have my next cycle of the bone hardening drug, zoledronic acid, this coming Monday. Thereafter I’m to have it every six months for as long as I’m on letrozole. This drug – and other drugs of its kind (bisphosphonates) – is used in the treatment of post-menopausal women with early-stage breast cancer as it’s been shown to lower the risk of them developing osteoporosis and of breast cancer spreading to the bones. This treatment is given via an iv drip in the chemo unit at the clinic.

Now none of the lingering side effects I’ve described above is so painful that I have to take painkillers. And I’m otherwise quite well, if still pretty whacked. And it’s still early days and hopefully everything will get better over time. But for the moment these things are annoying and they do cause pain and/or discomfort. They – and the drugs and exercises that I still need to take or do – are obvious reminders of what my body’s been through over the past seven months. I used to think I’d been quite lucky in terms of physical side effects. Reading back through this latest post, now I’m not so sure. I guess it’s all relative and no-one said it would be easy. One thing is certain, though. Regardless of how I deal with the emotional side of things, physically I’m really not going to forget any time soon that I had breast cancer, am I?

*My fingernails are looking great, I’m relieved to report.

It’s not over ’til it’s over

The hospital-based phase of my breast cancer treatment has finished but there’s still lots going on. My final radiotherapy session was a week ago now (Bike 8 – Car 7. Victory is mine) but by tomorrow afternoon I’ll have been back at the centre every day this week except today. Given that I started radiotherapy on 4th February, that means I’ll have been there every weekday – including two days as an in-patient – for precisely a month. No wonder I’m tired. And there’s more to come.

On Monday, I had my post-radiotherapy appointment with the consultant oncologist who organised the radiotherapy treatment. Also on Monday, I had to have new dressings put on those parts of the irradiated area that are worst affected by the radiation. On Tuesday, I had a six-week check-up with the plastic and reconstructive surgeon. On Wednesday, I was back at the radiotherapy department to be checked over and to have fresh dressings applied. I’ll be there again tomorrow for the same.

Let’s start with the “radiotherapy-induced skin reaction”. This is really common in people receiving radiotherapy (Sunburnt backs, patchwork dressings and crop tops (Radiotherapy part 2)) and can involve redness (yes), dryness (yes), itchiness (yes) and skin breakdown, ie cracking or weeping (not quite, although one or two areas are still at risk). The reason they’re keeping a close eye on things is that radiotherapy side effects can continue to develop after treatment ends and indeed can be at their most severe around 7-10 days after your final session. While the radiographers don’t think the skin will break down now (if it did, I’d be at increased risk of infection), they’re continuing to take precautions until the 10 days are up. Better safe than sorry, especially with my record on infections.

On to Monday’s meeting with the oncologist. She examined the irradiated area and said she was “hopeful” the infection that had me in hospital for two days on iv antibiotics was resolved (It went downhill from there). I finished my course of antibiotics later on Monday and there’s been no flare-up, so it’s good news on that front.

There’s still swelling/fluid build-up in the reconstruction and under my arm and the cording  (where the lymph vessels have hardened following the removal of the axillary lymph nodes) there has got worse. The cording now stretches from where the reconstruction meets my chest to past the crook of my arm. The oncologist suggested that a massage treatment called manual lymphatic drainage or MLD might help with the swelling. From what I can tell, this could require sessions three times a week or more for up to three weeks. So much for finishing treatment. Except now, of course, instead of treating the cancer, we’re treating the side effects of cancer treatment. Major difference. The physiotherapy I was having – and loving – for the cording is on hold until the skin reactions from the radiotherapy clear up. The MLD wouldn’t start until then either.

As for the plastic surgeon, there’s good news there in that she didn’t seem overly concerned at the appearance of the reconstruction and surrounds… despite the swelling, redness, inflamed scars and indentations. She did agree it was not the “lovely” – my word, not hers – thing that it was in the aftermath of the operation. However, she said reassuringly that while it might take six months (yes, six months!) for everything to settle down and will likely require a second round of surgery to tidy things up, “I don’t think you’ll have any problems” in the longer term. Phew. My claim to fame is that she took a couple of photos for her collection. She didn’t often get to see her reconstructions like this, she said, ie in their full, immediate post-radiation, scarlet glory! I’m really not used to having this part of my anatomy photographed but I was happy to oblige.

The abdominal scar has healed really well. I got some advice on how best to massage the area above the scar to loosen it off (it’s still quite tight) and on scar care in general. Also, not that I did that that much of it before, but I can start running again. I’ve to wear two bras, though, a regular sports bra and a crop top!

Next week is shaping up to be a lot quieter on the appointments front. Hopefully the radiographers will sign me off at the beginning of the week and then I’ll have nothing until the following week when I’ve got appointments with the two consultant oncologists involved in my care. The oncologist responsible for the radiotherapy – a clinical oncologist – will review how the skin reactions and swelling are looking and perhaps I’ll get an idea of when I can restart physio and perhaps start this new MLD treatment. The oncologist who’s been responsible for all my drug treatment to date – a medical oncologist – will arrange a date for me to come in to the chemo unit for my next cycle of the bone-hardening drug, zoledronic acid (Breast cancer does indeed “come with baggage”). I’m to have this initially every three months and then every six months during the five years I’m on letrozole hormone therapy. I had the first cycle with my final chemo session last November. It’s hard to believe that was only three months ago. It seems like an absolute age.

 

 

 

 

 

 

 

A busy week with welcome news – “no mass identified” and “no further surgery necessary”

It’s turning out to be a busy week. There was some very welcome news on Monday, followed by lots of poking and prodding and pummelling over the rest of that day and the following day, but all to the good. There’s more to come; in fact by Friday afternoon, Wednesday will have been the only day this week I won’t have been at the hospital.

It’s funny, but since the operation on 19 December (mastectomy, axillary lymph node clearance and immediate reconstruction – Saturday’s op – a daunting prospect but a key step on the road to wellness), I’d been focusing so much on my recovery that the cancer had pretty much taken a back seat. However, it was very much back in focus as I headed to the hospital on Monday afternoon to hear from the breast surgeon on how much cancer there was in the removed breast and lymph nodes and whether I’d get to keep my own nipple on the reconstructed breast or whether it would have to be removed in a second operation.

I’d had what’s called a skin and nipple-sparing mastectomy. The breast surgeon had recommended this with the caveat that if any cancer cells were found when the tissue that was removed from directly behind the nipple during the mastectomy was biopsied, there would have to be a second operation to remove the nipple (Immediate reconstruction – the decision is made).

As with the reconstruction (“It’s perfect”), the mastectomy had been a technical success. If it had failed, the nipple would have turned black within six hours of the operation. It didn’t, thankfully. And as it turns out, there was good news on the biopsy front at Monday’s consultation. “No further surgery necessary,” the breast surgeon informed me. Needless to say, I’m both delighted and relieved at this outcome. I had expected to lose the nipple initially, but the fact that the chemo did such a good job (An “excellent response to treatment”) meant that a nipple-sparing mastectomy became an option. To have gone from assuming I’d lose it to thinking that I probably wouldn’t then back again to having to prepare to lose it after all would have been hard. So big smiles all round.

As for the removed breast, no mass was identified. Indeed, there was “no invasive in-breast disease” at all. If you consider that the tumour was initially probably bigger than 5cm across, you get an idea of just how successful the chemo was. As I’ve said before, the fact that the chemo worked so well on something we could see implies it’s had the same effect on any stray cells that may have broken away from the original tumour but can’t be seen while they’re on their way to try and cause havoc elsewhere in the body. And that, really, is the whole point of chemo.

On top of the mastectomy and reconstruction, I’d had a Level III axillary node clearance, which means that all the axillary lymph nodes on the affected side up to a essentially under the collarbone were removed. We knew at least one lymph node was “involved” – as the jargon goes – from the biopsy that was done in July. It turns out there were a “few scattered clusters” of cancer cells in seven out of the 10 nodes that were removed. That is the only fly in the ointment, albeit quite a big one.

Discussing the histopathology report was just one part of Monday’s consultation. The breast surgeon felt under my arm and announced I had developed something known as “axillary web syndrome” or “lymphatic cording“. Cording is a commmon occurence after breast cancer surgery involving the axillary lymph nodes and it’s when scar tissue develops in the lymph vessels from the armpit to as far down as the elbow. It feels like a tight cord – or a taut guitar string – under your skin. It’s harmless but disconcerting and it can be painful (it was). Also, because it’s tight, it restricts your arm and shoulder movement. I told the breast surgeon I was already in the process of arranging an appointment with the physiotherapist; I assumed she’d be able to help. I subsequently got an appointment for the following day, ie Tuesday.

Also, the fluid build-up (known as a seroma) in the underarm/breast area and in the abdominal area above the scar that had started after Christmas (Post-op progress report No 2: A bit of a moan) had got worse, so the breast surgeon sent me down to the radiology department to see if they could drain the fluid off. Having used ultrasound to locate the fluid, they extracted using a needle and syringe almost 400ml of fluid from the underarm and breast area. That’s more than is in a can of Coke, a friend helpfully pointed out. If you think of it that way, you can imagine how much more comfortable I felt afterwards. This might have to be done a few times before things settle down.

They tried very hard to drain the tummy area but try as they might and despite it feeling like there’s a bag of water in there, nothing came out.

Before the physio session on Tuesday, I had an appointment with the plastic surgeon. The reconstruction is looking good again now that the swelling’s gone down. The surgeon replaced some of the dressing on the abdominal scar, gave me some advice on scar care and tried to drain off some of the fluid from the abdomen and some more fluid from the breast. To no avail, on both counts. So she referred me back to the radiology department, where they’ll have another stab (literally!) at the abdomen later today.

At the physio session, the physiotherapist spent a considerable amount of time massaging the cording and loosened things off to such a degree that I had far more mobility in my arm and shoulder than I’d had when I entered her office just an hour earlier. Again, smiles all round.

I see the breast surgeon again tomorrow. As I said, a busy week. Then next Monday, I have an appointment with the oncologist followed by my second physio session. Also sometime soon, I need to meet the consultant who’ll be in charge of the radiotherapy part of my treatment. There’s a lot involved, isn’t there?

 

 

 

 

 

 

The least sexy washing line ever

It occurred to me as I hung up some items of clothing to dry over the radiatior rail that this was possibly the least sexy washing line ever. Check out the photo below… I’m telling you, with breast cancer it really is all glamour.

Starting from the left, we have:

Item 1: the wig liner, to stop your wig sliding round your head.

Item 2: the post-op bra, to support your reconstructed boob. Look at the SIZE of that thing! Andy reckons you could use it to transport bricks.

Item 3: the anti-DVT socks/stockings, to be worn 24/7 for the first week after the op then during the day for another two weeks.

Item 4: the compression knickers, to stop you feeling like your insides are going to fall out through your abdominal scar.

I know what you’re thinking and yes, I know and I do apologise… the bra and pants don’t match.

 

 

Feeling a million times better than this morning, but what a struggle

I’ve just had lunch, and before that the physiotheraptist and I went for a spot-the-Christmas tree walking tour of the corridors of the ward. I walked unaided.

You did what?!, some are you are no doubt thinking. Well, it was in the plan to be up and walking about on Day 3 so things are just going to plan. Really, I’m no hero. However, if you’d seen me a couple of hours earlier, you’d never have thought me capable of such a thing. At that time I was honestly thinking that this part of the “journey” was much worse than anything I endured during chemo. I’m not going to bore you with the details but several taxing events happened this morning (some of which now don’t seem so taxing; it’s always the way) and I was really feeling there was no way I was going to get home this year, never mind possibly this week.

I was feeling so down that I texted my two sons who were about to leave the house to come and visit me to tell them not to come. That’s how bad it was. They’ll come later with their dad.

So what else can I do now that I couldn’t do when I woke up this morning? Most importantly, I can get out of and back into bed on my own (although I’ve only been back in once as I’m spending the day in the chair and keeping myself mobile by moving around the room from time to time). I can lift the water jug and tea pot and pour my own water and tea (so much less calling on the nurses), and I can go to the loo (the catheter came out this morning). And I’ve just leant down from the chair and picked something up of the floor, which would have been unimagineable yesterday. And obviously, I can now walk unaided.

Things are very tight round the abdomen join but I’m trying to stand up a little bit straighter every time I stand up. It is not easy.

Two drains came out yesterday. I still have two in, one in the underarm and one in the abdomen. The fluid drains into little bags and you carry those around with you in a plastic bag when you go walkies. You only forget you’re attached to them once.

So, massive strides today, but this morning was tough. With hindsight I probably took the setbacks harder than I needed to or should have, but it was what it was.

As for this afternoon, I’m off for another walk around the room, a friend is due to visit and then I’ve got a few episodes of Desert Island Discs lined up to listen to. 🙂

“It’s perfect.”

I awoke this morning to the sound of the plastic surgeon saying my name. It was 7am.

We chatted about how I was feeling (fine) and how the night had been (good). She dismissed yesterday’s fainting episode – “it’s really common” – then examined her artwork and declared it “perfect” in terms of the medical procedure having been a success.

The reason it’s checked so often initially is that there can be problems with the blood supply in the first 48 hours. If this happens, you need to go straight back to theatre. In extreme cases, the “flap” they’ve transferred from the tummy and reattached in the chest area can die and the procedure fails.

At seven this morning, I was just 40 hours out of surgery. If it’s looking this good at this stage, says the surgeon, “we shouldn’t have any problems”.

So it’s gone well in a medical sense. Perfect in an aesthetic sense would mean the reconstruction was identical to the original. It’s pretty darn close, I would say. I’m amazed, as are the nurses who do the checking – a couple have said it’s the best they’ve seen.

The lovely boob is one thing. The hip-to-hip scar is another. “You look like someone’s tried to cut you in half,” jokes one of the nurses.

The consultant gets down to business with the on-duty nurse. It seems I have a busy day ahead. I’ve to get out of bed and spend time sitting in the chair. Two of the four drains are to be taken out today and the urinary catheter should come out tonight. The loo is only about eight steps away from the bed but I fear that tonight when I have to go, each step is going to seem like a mile.

I’m envisaging lots of effort, sweat and perhaps some tears today as part of my “remobilisation”. It has to be done. Wish me luck.

The basics

I could write a book about the last 36 hours alone but instead I’ll just give you basics.

I have been out of intensive care since around two o’clock this afternoon. The plastic surgeon came in the morning and declared herself happy with things, saying it had all gone “very smoothly”. There’s a lot of bruising but the reconstruction looks quite amazing. The breast surgeon managed to spare the nipple, at least for the time being. I’ll get the results on whether that can stay or not, on how much cancer was left in the original breast and how much was in the lymph nodes in one to two weeks’ time.

Andy came to visit this morning just as I was about to try and get out of bed for the first time. They let him see me for two minutes then shooed him off to the waiting area so they could get on with things.

It took a massive effort just to get into a sitting position on the edge of the bed. I was sweating buckets within seconds. Standing up was ok, as was shuffling four steps sideways to the chair and sitting down. However, I started to feel dizzy within seconds of sitting down, closed my eyes and started taking deep breaths… then fainted. It was just for a few seconds. I came round to see the outstretched hands of three intensive care nurses who would have made sure I didn’t fall off the chair.

I managed to sit in the chair for the designated ten minutes and then retraced my steps and get back into bed; there was no fainting on the return journey. It wasn’t easy and it wasn’t pretty, but that’s another hurdle passed. Andy said when he came back, I’d changed colour.

I had been warned it would be hard. The plastic surgeon had told me twice “you’ll feel like you’re 105 the first time you get out of bed” but explained it was important to do it on the first day. Tomorrow apparently I’ll be up and walking. Great, but hard to believe at the moment.

I’m still on loads of painkillers but I’m taking all of these by mouth now, except the morphine, which I still self administer via a drip as and when needed. To be honest, I haven’t used it that much today. I did of course use as much as I was allowed for the getting out of bed event.

What else?

Well Andy came back earlier this evening, this time with the boys, which was lovely.

My potassium levels are low so I’ve been given Nutrisip “oral nutritional supplements” to drink. They’re seriously revolting.

The physio’s been round, and has given me lots of exercises to do.

I’m now on two-hourly checks. Luxury! Night, night.

 

Saturday’s op – a daunting prospect but a key step on the road to wellness

I’m finally starting to feel more positive about the operation I’m to have on Saturday. It’s what the past four months or so have been building up to and I’m trying to focus on the fact that it is, as a friend from work put it, a key step on the road to wellness. It’s not easy, though, when I’d so much rather none of this were happening at all.

I know with the mastectomy we’re getting rid of however much is left of the breast tumour after the eight rounds of chemo (An “excellent response to treatment”) I’ve had since 19 August. I’ve accepted the axillary lymph nodes have to come out, although I can’t help worrying that I’ll develop lymphoedema (Fear of lymphoedema) at some point in the future. And I’m completely happy with my decision to have the immediate reconstruction that involves using a flap of tissue and skin from the tummy area to create the shape of a breast.

I have to be at the hospital at 6am on Saturday morning. The operation itself will start at around 9am and, according to the plastic surgeon, it should be over by 3 or 4pm. The op is a pretty daunting prospect, not least because it lasts so long. The longest part is the reconstruction, during which the tissue and its blood vessels are completely detached from the tummy and reconnected using microsurgery to a new blood supply in the chest area. Amazing.

After the op, I’ll be taken to the high dependency unit where I’ll have one-to-one care with the breast wound being checked every 30 minutes for the following 12 hours. I’ll be covered in a heated blanket to keep me warm and so increase the blood flow to the tissue that’s been moved from my tummy to my chest. There will be huge amounts of painkillers involved, not least morphine on demand. I’ll be hooked up to lots of monitoring machines. There will be a few “lines” for drips – for painkillers, antibiotics, fluids, taking blood. I’ll have a urinary catheter in. I’ll have four lots of surgical drains in place to drain blood and fluid from my various wounds. I will also be linked up to a “sequential compression device” that will massage my lower legs to guard against my developing DVT.

It sounds silly, but I’m wondering what I’ll wear on my head during surgery. I guess not the wig. A good friend who used to be an anaesthetist has said to ask for a theatre cap to wear if I don’t want to go “naked”.

I’ve got my compression bras and knickers for post-op wear at the ready. They’ll hold everything in place that needs holding in place after the deeds are done. I think the support is needed for at least a month. The plastic surgeon has warned me that “you feel like everything’s going to fall out” down where the hip-to-hip scar is. It won’t, she added reassuringly, it just feels like it will.

The plastic surgeon will phone my husband once the op’s over to let him know how it all went and how I am. He’ll come and see me that evening. I don’t imagine I’ll be much company :-). But then I don’t imagine he will be either, given how squeamish he is. What he will be being is extremely brave. I’ll ask him to put something on the blog so that anyone who wants an update can get one.

If things go well, it seems I could indeed be discharged on Christmas Eve or even on Christmas Day itself. The drains will have to be out and I’ll need to be able to dress myself and have a shower unaided before I can go home.

Step one on the road back to wellness – the chemo – is over. I can’t quite bring myself to say “bring it on”, but step two here we come.

 

“Are you happy with the size?”

“Are you happy with the size?” Of all the questions I’ve been asked by the various healthcare professionals I’ve seen since I was first diagnosed with breast cancer in the middle of July, this has to be the best. It came from the consultant plastic surgeon who, in less than a week’s time, immediately after I’ve had my mastectomy and the lymph nodes in and around the right armpit removed, is going to reconstruct my right boob out of my own tummy fat.

So, am I happy with the size? Well, yes. I’ve always taken the view that they are what they are so there was no point worrying about whether I’d like them bigger or smaller. I’m quite fond of them as they are. In fact, I like them so damn much, I’d happily keep both forever. But that’s not possible. For obvious reasons, the right one has to go. I’m sure I’ll miss it when it does.

“Don’t even think about touching the good one” was my initial thought when the plastic surgeon put the question to me during my first appointment with her a couple of weeks ago. I didn’t say that, though. I just said something like “yes, I think so”, and left it at that. I was intrigued, though, and asked about it when I met the surgeon again last Tuesday to go over any remaining questions I had about the operation (19 December – it’s official & Immediate reconstruction – the decision is made) and recovery. It seems some women take the opportunity to have the healthy one made bigger or smaller and then the reconstructed one is made to match. Others, like me, just want the healthy breast left alone.

Thinking about it during the drive home, I realised that while the plastic surgeon mentioned the possibility of breast reduction and augmentation, she didn’t make any mention of a lift – or if she did it didn’t click. Now there’s a thought…

 

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.