Okay… I know, I am a sharer. Perhaps, even labeled as an over-sharer. And you know the great thing about sharing? It can help other people to not feel so alone, so unsure or to help when they are searching for answers. So today, I am going to share with you: Boobs on the Brehm. I wish I could use emojis here because I would have had allllll types of laughing-so-hard-I-am-crying faces.
Yesterday, the girls turned 6 weeks old. Their favorite thing is feeling supported by a sports bra. They just started sleeping through the night. And they are starting to feel like they belong in our family. Oh, and in case there was ever any question, much like eyebrows, the girls are sisters, not identical twins.
Yes. My boobs are currently my babies. Because they’ve been through A LOT this year. A. Lot.
Are you just beginning your journey with breast cancer? Are you terrified that your breasts are going to be marred for life? That you will look like you were an extra in a 1992 Horror Flick? Are you thinking that there’s no way you’ll ever feel normal again?
WELP. Today, I share this journey with you in hopes that a)if you are going through breast cancer and are going to have a mastectomy, you can see that there is light… hope… and it can all be good OR b)if you have never gone through any of this, you know that women who have are still feminine and normal {whatever that means}. BUT that it truly is a process to get there.
Also, a small note before I begin. I was 33 at diagnosis. My breasts and I had been through a lot together. We’d nursed three premies. We were finally comfortable with each other. They weren’t big or voluptuous but they were mine and I was content with them. That being said, I had no hesitation with getting rid of them. This is not everyone’s reality and that is absolutely understandable.
Here is an outline of my process:
- Chemotherapy – 6 rounds, 1 every three weeks. Taxotere, Carboplatin, and two antibodies, Perjeta and Herceptin. I would actually do Herceptin for one full year. Last round of Chemo was January 29, 2016.
- Bilateral nipple-sparing mastectomy and lymph node removal. February 25, 2016.
- Expanders placed during surgery.
- Fill expanders to “full” 480 cc over the time period between Mastectomy and start of Radiation
- Radiation. 28 rounds. 1 per day. April 2016-June 2016.
- Phase 2 Breast Reconstruction {6 months following last radiation treatment} December 1, 2016.
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So… let’s start at the very beginning with just a bit of the background in case you are just hopping in on my story. In October 2016, I started my first of 6 rounds of chemotherapy for Stage 2a Triple Positive Breast Cancer. I was 33 years old at diagnosis. I had an angiolymphatic invasion which just means that, along with a large amount of DCIS {stage 0 breast cancer} in my right breast, I also had cancer in the lymphatic areas of my breast tissue. I had a 2 cm mass which I discovered on my own while putting on a sports bra and that same week had checked by my GP. Within a week from my initial finding, I was in for my first biopsy following a LOT of microcalcifications which were seen both on a mammogram and via breast ultrasound. And within 3 weeks, I was diagnosed with breast cancer {There’s a lot more in there but we’ll go with that for now}.
I was told immediately that due to the DCIS and cancer to breast ratio, I would need to at least have my entire right breast removed via mastectomy {read: I had itty bitty titties so a mass needn’t have been all too large to obliterate the boob}. With the help of my doctors, friends, and family, I elected to have a bilateral {double} nipple-sparing {they would keep my nipple in tact} mastectomy following chemotherapy and preceding radiation {more on that…}.
I don’t need to show you my very original gals because they are essentially the same as they were post-chemo. But, I am about to share photos of my breasts so if you’re not ready for that, now you know. But still… if you’re not, leave now. Cool? Cool.
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Here are my breasts post-chemotherapy. Yes. They are tiny. Yes. I nursed three babies. No. I never had boobs.
I’m not going to cover alllll the chemo info. This post is a boob post. So, continuing on to the mastectomy process…
In my sentinel node biopsy prior to chemo beginning, in addition to the 2 cm mass, I had two positive lymph nodes. My surgical Oncologist {and rock star woman} Dr. Thayer {Nebraska Medicine} removed all the breast tissue and muscle during the mastectomy as well as 13 lymph nodes {the whole “first section” of lymph nodes in my right arm}. The mastectomy pathology showed that my mass had shrunk from 2 cm to about .002 mm and there was no evidence of cancer in any of the lymph nodes they removed. This means, at that point, I was .99 percent cancer-free! Hoooooray!! This showed that the chemotherapy had been effective.
During the surgery, tissue expanders were placed in the space where my breast tissue and muscle had previously existed. The expander looks similar to an implant but it actually has a port in it. During the mastectomy procedure, my Plastic Surgeon, Dr. Johnson {Village Pointe Aesthetics} filled the expander with 400 cc of air to keep the space expanded until my first liquid fill. This is ingenious as it is a way to stretch the space a bit and make for less liquid fills for the patient in the long run. I also had 4 drains in place post-surgery for about three weeks. Also, the mastectomy was very painful. In fact, for me, the mastectomy was the hardest part and the most painful stretch of my timeline I laid out above. Part of that could be because the effects of chemo were still very much with me when I went through the surgery. Each person tolerates each phase differently. I didn’t anticipate being in so much pain for so long.
And then there are the airbags. I liken the feeling of air in my breast cavity to a pumpkin patch jumping pillow. And the creases you see in the picture below are not scars but rather the deflating of air over the weeks following the surgery. This shows why air is not a permanent place-holder, I suppose.
About a month following my mastectomy, I went into Dr Johnson’s PA, Stacey, for my first fill. Side note: Stacey is my bff. She just doesn’t know this yet. But seriously, she’s seriously incredible at her job and one of the most likable gals you’ll ever meet. Back to the fill. It was the weirdest thing EVER. Seriously. Bizzaro. You can even see in the photo below that my jaw dropped. The process is actually to stick a needle into the port and pull the air out, leaving the breast cavity shriveled and just the skin remaining without anything to inflate it. The bottom breast had already been filled with fluid in the picture below and the top was being deflated. Isn’t that wild?! And the place where the needle is entering is just antiseptic rubbed on the area… not a nip. I swear.
I had, if memory serves, 4 fills of liquid over 3ish weeks to get my breasts to 480 cc of fluid in the expanders. I think it would have even been a bit quicker but I had a nipple infection that caused my right nipple to turn black like a newborn’s umbilical stub. That part of the nipple did not make it in the long haul. May it rest in peace.
The expansion process, for me, was not terrible… for some it is extremely painful… although I didn’t realize how tight the skin had been pulled and just how round the mounds were until I had them removed. They were honestly as hard as softballs. Not one bit of exaggeration.
I had the expanders in place from February of 2016 to December of 2016. My Surgical Oncologist {Thayer. Bomb diggity}, Radiation Oncologist {Dr. Wahl aka Doogie Houser aka Dr. Awesome, Nebraska Medicine } and Plastic Surgeon {Johnson. Dr. Magnificent.} all agreed that I would not have Phase 2 reconstruction until 6 months post-finishing radiation. This would allow the skin to heal and toughen. I completed rads on June 1. Phase 2 Reconstruction {taking out the expanders and inserting the implant} was scheduled for December 1, 2016.
Oh, and if you’re wondering why don’t they just put implants in immediately? It would seem that the medical community does not like to radiate through implants {or maybe it isn’t possible?}. And yet, radiated skin is very difficult to expand or stretch. So… if you’re following that… The mastectomy was happening prior to the radiation and the radiation was happening prior to the implants so a placeholder is necessary… ENTER expanders.
Here are the expanders inside the breasts after 6 months of placement. This is about 8 months after my final fill and right before phase 2 reconstruction.
Because I had a nipple-sparing mastectomy … SIDE NOTE: the doctors suggested that I was a great candidate for what is called a “nipple-sparing mastectomy” and that the outcomes in the current research show that recurrence rate in nipple-sparing patients versus full mastectomy patients are are essentially the same. They like to do this when possible now for the emotional healing of the patient. In all honesty, I was really against the idea initially of keeping any piece of my toxic breasts, but after talking to 6 oncologists/surgeons, I decided to go with their recommendation and do a nipple-sparing procedure. Even with nipple-sparing, the pathology still tests margins when they send the surgical pathology in. If there had been any cancer risk post-pathology, they would have had me come back in to remove the nipples. Whether or not someone keeps their nipples is a completely personal decision UNLESS the pathology says it’s a must, of course… but because I had a nipple-sparing, my scar lines are below my breasts and also, one in my armpit from the lymph node removal. The pictures below show the scars prior to my Reconstruction. They used them as the same entry under the breasts in the second surgery.
I realllllllly love Dr. Johnson of Village Pointe Aesthetics. He is smart. Thorough. Kind. And very funny. He and Dr. Hollins are both awesome and I feel like EVERY person who has gone through the entire process with them still likes the dudes so that’s sayin’ somethin’. He was pretty lucky with me, I like to think, because my expectations were super low given my history as the President of the Itty Bitty East/West Breast Club. You know, where your nipples act like they hate each other and face out? Oh. You don’t know? Well that’s awkward. So the only things I asked him is that I get a little bit of closeness of the breasts because I’d never ever had cleavage, to my memory.
He directed me toward the Natrelle Silicone Tear Drop Gummy Bear implant as it seems to have the best outcomes against capsular contracture {a condition in which scar tissue can form and harden and do wonky things to the implant} and also looks the most natural. I actually wanted the round fake looking implants but I went with what he suggested because I decided he likely knew boobs better than me;). Mastectomy patients apparently do better with Silicone because the saline implants show rippling more easily. As for sizing, Dr. Johnson really figured that piece out for me. The the implant has to fill the space on a patient{especially when you’ve done nipple-sparing because they aren’t going to cut a bunch of skin off} and utilize the cavity to maintain the integrity of the area {from what I understand, of course. I am not a doctor.}. And for anyone who has ever looked into breast augmentation, 620 cc may sound HUGE but imagine that is truly all that is in there… because there is nothing else as a cushion in the space. Also, I am fairly broad so in order to get the gals to touch, they needed a little more oomph.
Phase 2 reconstruction took place on December 1, 2016 at the Village Pointe Aesthetics surgical center. The entire Phase 2 surgery took about 2 hours. And I was home the same day. My mastectomy took 9ish hours and I was laid up for weeks. The reconstruction surgery was sooooooooo much easier. I had two drains for about 10 days and then they pulled them. I was off pain meds in about 5 days.
For the first six weeks {at least} I wore a surgical bra or sports bra 24.7. Also, I took some Advil due to achiness. It took me about 5 weeks to start sleeping normally and through the night again. I was also on a weight and activity restriction for the first 6 weeks as the breasts settled a bit.
I think the four week out product was pretty impressive. I mean, seriously… remember my shriveled up breast cavity up above?! Dr. Johnson is some sort of Zulu Medicine Man, I swear. In the picture below, looking at the screen, the left breast is the radiated side. This is important to note because radiated skin heals differently. Dr. Johnson placed the radiated side a bit lower than the other because the radiated side will scar differently over time and actually gradually pull up while the non-radiated side will naturally drop, because gravity. Also, the left side {looking at the screen} is a bit darker due to radiation. The skin will always be different on that side in both texture and appearance. You can see some of my scarring below the breast, above my sports bra line. Also, per Dr. Johnson, I’ve been wearing a product called Scar-Away over the incisions for the last 3 weeks. Always consult your Doctor before using anything, of course. And yes, I am moley.
And below is a pic of the gals 6 weeks post-phase 2 reconstruction! There will still be a lot of settling to come. Four-six months out we will assess the process and decide if any “tweaks” are needed but honestly, I am sooooo happy to be done with surgeries. And the boobs are SO soft and cushy. And while there are some aches and pains, it’s truly so much better than I thought it would be.
A few interesting things I should note:
- I have very little sensation or feeling in my breasts now. This was a result of the mastectomy.
- My nipples are pretty much always “nipped” soooooo don’t take it personally if you see me and they are totally erect. Instead, just imagine that I am always cold.
- The breasts seem to not warm up. The rest of my body can get warm and they seem to stay one temperature.
- They really don’t do much moving. It’s pretty amazing. The implants are both firm and soft.
- They feel dramatically lighter immediately after surgery. When I awoke after my mastectomy, the expanders gave the feeling of having a toddler sitting on my chest.
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Okay. Whew.
I really really questioned sharing all this info but my whole purpose is to share my whole story and to help others going through the process. I know that breasts are tricky that way… because they are BOOBS, they are private, intimate…which is why I covered my nipples for website use of the pics. Also, I am preparing for major spam comments from people name “TrickyDicky2456” and the like… yay!
Also, I want you to know that I really considered saving this information for a more personal space like a book and then I decided that any woman going through her own journey should be able to see how it could possibly go for her… to maybe feel more prepared or better about the process. If I can make someone feel a little better, I will feel totally okay about flashing my bosom to the entire internet. It’s for a cure, people.
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For now, I am giving my breasts a rest. I will officially start training for my first half marathon next week and am excited to get back to lifting some weight and running with bounce:). I hope that anyone reading this that hasn’t been through the process understands what a true process it is for people going through but also, you can see that the way that medical technology allows women to have breasts if they want is pretty incredible.
Not every woman goes through every step I did. Some go through more. Some less. Some don’t have surgery, just chemo. Or just rads. Some have a lumpectomy. Others do full bilateral mastectomy with something called a DIEP Flap reconstruction which uses skin and fat from other parts of the body to create a breast, rather than an implant. Others opt for no reconstruction or just wearing a prosthetic bra. And also, some women have 7-8 surgeries of tweaking to get everything in check. Every single person’s breast cancer is different. And so, treatment and protocols differ. Always keep this in mind when talking with people who are going through the process.
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Again, only time will prove if I have any additional maintenance in my future but for now, I am just happy to be me. To have such an INCREDIBLE care provider team. To GET to be so healthy. And grateful. With a little bit of cleavage;).
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