Baby Steps to Reconstruction

 

This quote accurately describes my healing and reconstruction process. I take one baby step at a time. Individually they feel small and insignificant, but over time they add up to a lot! 

It also makes me chuckle because it reminds me of the movie "What About Bob." He reads doctor Leo Marvin's book about taking baby steps to healing but Bob takes it literally and takes baby steps everywhere he goes as he narrates, "Baby steps to the elevator, baby steps to the elevator...I'm in the elevator." 

December 15th 

I went to see my cancer surgeon today. I was super anxious because I REALLY wanted to get my drains out! I understood why they needed to be there originally, but was ready to not have them poking out of my stomach and to finagle them while I did regular activities like showering and going to the bathroom...And believe it our not, they were pretty uncomfortable as well! (Insert your own sarcastic tone) :)

I knew that I had about 2 feet of tubing running through me on each side so I was nervous for the pain. However, getting the drains removed was rather painless. Kaden watched as she did it and he said she basically just cut the stitch that was holding it in, told me to take a deep breath, and she just pulled it out. Kaden said he could see the tubing as it came out up and around my breasts and down through the hole in my stomach. The whole process took about 30 seconds per side. 

She went over the pathology report with me and said that there was only benign tissue in the left breast (which we were expecting since that was the breast I removed prophylactically) and in the right breast there was only 1/3 of an inch of malignant tissue. We had very wide and very clear margins! Nothing went outside the duct and the 3 lymph nodes we took were clear as expected. She said that we caught this SUPER early. So early they typed it "Stage 0." She called it baby cancer, which might sound like an insult for everything that I had to go through, but I will take it! The smaller the better! 

December 16th

Today I went with Kaden to his oncology appointment. Amidst all of the cancer treatment for me, Kaden also had his regular CT scan and we were going into the Dr to discuss his results. The nurse took his vitals and took him back to the room. While we were waiting for the Dr to come in, the nurse came into our room with the blood pressure machine and said, "The Dr wants to do your appointment too, since you are already here." So she took my vitals as well and then added my chart to Kaden's outside the door. 

I was supposed to have an appointment with the oncologist in the next couple of weeks, but I guess he figured he would just do it together; kind of a "two for one." Honestly, this is why we LOVE our oncologist. Most doctors only look at the patient and take a "get in and get out" approach, but our Dr knows each one of his patients individually and remembers us and each of our stories. It was very thoughtful of him to just add me to his patient load for that day. Probably full well knowing we would talk about my cancer anyway. :) I commented to Kaden that it was so nice of him to do that and then sarcastically added, "Although, I liked this place better when we were coming just for you." We laughed and chatted until the Dr came in. 

We talked about Kaden's scans first. His CT scans were clear and there is nothing to be worried about for now! YAY! Kaden asked about the likelihood of his cancer returning. The Dr explained that its hard to know because there is not a lot of studies done on appendix cancer since it is so rare. They have to extrapolate numbers from colorectal cancer because it is the closest cancer to appendix cancer. He said that the likelihood of things returning in the first 3 years is highest. Once you get to the 3 year mark there is a significant decrease in numbers. After that, the next significant drop is at the 5 year mark. We are 1.5 years out with nothing concerning so things are looking very optimistic! The Dr said, "The hope is we just sail right through to the 3 year mark, then 5 year, and then in 10 years meet up to high five and say that he beat it." 

Then we moved on to me. He basically told me the same thing that the cancer surgeon did. Stage 0 and no further treatment needed.  There is no cancer in my body! I joked that I am the new poster child for getting your mammograms and he laughed and agreed! He said, "We never would have caught this without early screening." We will continue to monitor me every 6 months since I do have a small amount of breast tissue left, but that I greatly reduced the risk of ever dealing with breast cancer again. Wahoo!

December 22nd

I had my appointment with the plastic surgeon today. 

A little bit of backstory for those that might not understand the reconstruction process. 

At the time of my mastectomy surgery, the plastic surgeon placed plastic "expanders" in just under my skin. Over the next 2 months these are filled with air to stretch my skin and create a pocket for the implants to go. They are a very hard thick plastic and are not super comfortable. (They have to be thick in case you have to have radiation.) If you are having radiation they fill them with saline, but since I don't have to do that they will fill them with air. This helps it to not feel as uncomfortable and heavy in my body, but they are still really not comfortable!

This is what they look like: 

The round port on the front is where they stick the needle through to inject the filler. 

The tabs on the sides are where they suture it to my muscle. 

I had my expanders placed "Pre-pectorally" or "over the muscle" instead of placed "under the muscle." 

I will do my best to explain what this means, but know that I am pretty new to this too so it may not be the exact wording that the Dr would use. 

A little while ago, it was standard practice to place the expanders and the implant "under the muscle." This basically meant that they went in and pulled your muscle away from your chest wall and put them in under your pectoral muscle. This was done because when you have a mastectomy, they remove all of the breast tissue and you are left with a thin layer of skin. When the implants were placed over the muscle with only a thin layer of skin covering it, you would get undesired cosmetic effects. You could clearly see the implant outline and you would get what they called "'rippling" of the skin, which in effect is sagging rippling skin around the implant. By placing the implant under the muscle you put more things in between the implant and the skin so it wouldn't show through the skin as much. You also had the added benefit of the muscle keeping the implant in place so it didn't move around or shift from the correct position. 

The negative to this is that by pulling the pectoral muscle off the chest wall, it made the process more painful and the recovery longer. When placed under the muscle you also get what they call "animation." Due to the implant being between your chest wall and the pectoral muscle, when you did things that used your pectoral muscle your breasts would move with the muscle contractions. For example, if you picked up your kids, or say, a bag of groceries, your breasts would be pushed up towards your neck (or animated) by your pectoral muscles. Once you put the kid or the groceries down, your breasts would move back into place. Not a huge deal, but some women are pretty self conscious about this.

This is what under the muscle looks like: 

In the last 3-4 years the practice has changed from sub muscle (under the muscle) placement to pre-pectoral placement. (Over the muscle) This way they do not have to pull the muscle away from the chest wall. They use a mesh or a dermal matrix product that is sewn into your breast like a bra cup. They place the expander/implant between your muscle and the outer layer of skin. This helps to cover the expander/implant. The recovery is less painful and faster. To help prevent "rippling" they now use a technique called "fat grafting" where they take some fat from other parts of your body like your stomach, bum, or thighs, and fill in spots in between the skin and implant. 

Usually, at this point in the explanation, I have people say, "Do you need fat donations? I am happy to donate!" To which my response is, "Umm, no, I have plenty of donor sites on my own body thank you very much!" Ha ha! The extra benefit of doing this over the muscle is that I will not have the "animation" that goes along with under the muscle. 

This is what it looks like: (The red is the pectoral muscle, blue is the expander/implant, and the white is the dermal matrix product that is sewn into the breast.)

Today was my first fill. The port has metal on it so the plastic surgeon has a tool that uses a magnet to find it. Once they locate it, they mark where it is, and stick a needle in through the skin and into the port.  They use a large syringe with a tube connected to pump air into it. (You can see this in the first expander picture.) They fill it little by little. The PA is the one who does the fills for me. She put a little air in and surprisingly it felt better than the flat expander.

It is hard to describe what the expander feels like. The best way I can describe it is if you picture a kids water wing floatie.

When it is deflated it can be folded and can have hard/sharp edges. When you inflate it, it becomes smooth and softer but still a bit harder of a plastic. 

The PA asked me if I was ready for my first fill today and I timidly said, "I think so?"

I told her how I was still a bit tender and was worried about the needle going into my skin and that it would hurt as it was inflating.  She assured me that it really wasn't that bad and that I was probably more worried about it then it actually felt in real life. She also said that it would feel better once it had some air in it. 

She found the port, inserted the needle, and proceeded to fill me up. It was actually pretty quick. It felt just like you think it would--like something was inflating under my skin, but no pain. After my fill I actually felt pretty good. I wasn't in any pain and my expanders felt a lot better under my skin. It helped to smooth out some rough edges that were poking me. 

I will have these fills until I reach my desired size. The PA thinks it will be 3-4 more fills over the next couple of months. 

I think that the slow pace is the hardest part of the process. I am the kind of person that likes to get things done as soon as possible. I tell myself that we are going slow so we can get it right the first time. I am also trying to remind myself that this is a marathon not a sprint. I know in the end I will get the result that I want so even though this is a slow process, like the quote at the top says, "Little by little a little becomes a lot."