My Surgery Trilogy Part Two: Surgery Options, Now It’s MY CHOICE!

December 15, 2016- 1st Reconstruction/ December 18, 2017- 2nd Reconstruction

December 18, 2017– One year and 3 days following my first breast reconstruction I headed back under the knife.  As discussed in my previous post (Trilogy Part One), this decision was a combination of Capsular Contracture (residual of 30 rounds of radiation and falling down the stairs days after my first reconstruction, my own discomfort from tightness of my right breast, asymmetry due to the tightness from scar tissue build up, and firmness of the implant all together.  I also began presenting with unexplained symptomology presenting as itching under the implant and around the center of my breasts.  After numerous clear ultrasounds, an MRI, and my circulating tumor cell test (to be explained in a later post), my plastic surgeon presented to me a research study and updated warning from the FDA linking textured implants (which I had) to anaplastic large cell lymphoma (ALCL), a rare type of non- Hodgkin’s lymphoma.  Being that I already had breast cancer that was found in my lymph nodes, this and my symptoms made me a candidate for an implant exchange and re-reconstruction. (I have NOT been diagnosed with ALCL**)

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**SIDE NOTE: I do want to stress from my last post because I have gotten a lot of messages regarding this warning… Currently it is not recommended by the FDA for a surgeon to exchange textured implants just because of this warning and it also does not mean that all implants CAUSE cancer!  As stated by the Mayo Clinic, “The FDA believes that women with breast implants that have textured surfaces have an extremely low but increased risk of developing breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). However, that doesn’t mean that these implants cause BIA-ALCL.”  With the ongoing research that is being completed daily, the FDA is simply recommending at this time that patients with textured implants be monitored regularly and aware of signs and symptoms leading to a ALCL diagnosis *after the surgical incision has been fully healed*.  BIA-ALCL is diagnosed by using a CD30 immunohistochemistry, please ask your doctors more regarding this assessment if this pertains to you!

BIA-ALCL Symptoms include: new breast swelling, lumps, pain or changes in breast shape.  **Often times this type of cancer is found in the scar tissue, not necessarily the breast itself!

Case studies of people who have been found to have this link between this BIA-ALCL and implants are a very small population, however this does NOT give any medical professional the right to NOT disclose this information! As per the Mayo Clinic: “Researchers haven’t yet determined whether the type of implant — saline or silicone — affects the risk of developing BIA-ALCL.”  Statistics aside, it is 100% something that anyone with breast implants should be aware of and consider when discussing reconstructive options with their physician.  I am thankful to report that since this warning has been updated, my hospital has banned the use of textured implants all together! THIS IS WHY WE NEED ONGOING RESEARCH PEOPLE!!!!

Back to my story, so you are probably at this point wondering well what the heck is this girl going back in for different implants!  Well good question, and my answer is simple.  I feel more comfortable in my body with boobs!  Call me vain, call me insecure, the truth of the matter is I am the one that has to wake up every day of my life, look into that mirror and be reminded “I had cancer”.  “My tits were cut off, my nipples incinerated, and my body was filled with poison to keep me alive” and for that I am eternally grateful! However this is my day after day reality.

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April 2016-Post mastectomy 100cc expanders

I actually have vivid memories looking into the mirror for the first time following my mastectomy, I was bald, I  was fragile, and I was flat chested and I just cried.  To me, and this is my opinion of my own body, my boobs made me feel feminine and beautiful.  I loved having boobs!  Those little balls of fat which laid amongst my chest were mine! I was 26 years old and I wanted cleavage and to look like the models strutting their stuff down the runway at the Victoria Secret fashion show.  To me, if I didn’t have boobs how would I wear my 50+ bras that I own after spending thousands (literally) of dollars at VS, or fit in my perfect little black dress with a scoop neck, or heck how would I flaunt what I got on the beach in a bikini!  These are the thoughts of a 20 something year old with cancer, and these are very REAL very TRAGIC thoughts that many young women experience everyday!  You have to love yourself in life in order to be truly happy, and I knew deep in my heart that I would never accept my physical appearance without boobs, therefore I opted on breast reconstruction!

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The truth of the matter is, you think of plastic surgery as the solution or quick and easy fix for any physical challenges a person may face.  What I have learned is that this is sooooo far from the truth and that just goes to show how naive our Barbie Girl culture really is.  The most important thing to remember is that Breast Reconstruction following a mastectomy is completely different than a BOOB JOB!  Cancer breast reconstruction will most likely require multiple surgeries, extended recoveries, and potential complications… and thats just part of the journey that we have to accept! AND IT SUCKS!  As everything in life they says its a process, a long painstaking windy road where nothing EVER seems to go as planned however, it forces you to love the small successes and that is exactly what my most recent surgery has taught me!

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With the knowledge of ALCL now, I was able to make a more educated decision of my 2nd reconstructive process.  I have read up on the condition, did my own research, and I ASKED QUESTIONS to my doctor, which the first time around I have to admit… I didn’t do too much of.

There are kazillions of breast reconstructive options available to people following breast cancer.  What I’ve found is every surgeon does things differently and that doesn’t necessarily mean that one way is right or one way is wrong.  However, it is SO SO SO important to shop around and become aware on the options.  With that knowledge you will be able to make the choice that is right for you!

 

MY SURGICAL JOURNEY

April 2016: Double Mastectomy

Tata to the Tatas: My Double Mastectomy (For previous blog post in real time)

Letter to the Girl Faced with a Mastectomy

My reconstructive journey began immediately in April 2016 when I underwent my double mastectomy.  Following the removal of all my breast tissue (on both sides) and multiple lymph nodes were dissected (on the right), my surgical oncologist switched out with my plastic surgeon and he placed expanders filled to 100cc and supported with alloderm to withstand 30 rounds of pre-planned radiation.

May 2016: Expander Fills

Pump Pump Pump it Up: Expander Fills

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I underwent 4 saline fills of about 75cc per fill prior to starting radiation to stretch my muscle and skin in preparation for implant placement.  I finished my fills at 360cc expander size which to me was a little bigger than my old boobs of size 34B.

December 2016: First Breast Reconstruction

Breast Reconstruction: “My Free Boob Job”-First Insight to Surgical

Breast Reconstruction: My Foobies Revealed Round 1

On the day of my surgery, my plastic surgeon had 3 different sized implants and pretty much tried them out and chose which looks best for my body.  I was pretty adamant for him to place the largest implant possible, and I came out with 470CC Natrelle 410 Highly Cohesive teardrop gummy bear implants. They are known as gummy bears, because if sliced open, there is a very thick viscous silicone that is similar to that of a gummy bear candy and won’t leak like traditional silicone or saline if by chance they were to rupture.

A quote from my initial reconstructive blog post, ” I have days that I look at my chest and I feel really self conscious and upset, but then I have days where I put on a shirt and see a little cleavage and I get really excited.  Basically, my foobies are not real boobs, and I guess thats why I don’t really feel uncomfortable sharing my photos and advocating for mastectomy survivors everywhere.  My scars tell my story, and I am so blessed for all my doctors for taking such amazing care of me!”

Despite my instant dissatisfaction with my new set of foobies, my doctor continued to reassure me to wait 6 months for them to settle and another 6 months for any sort of revisions to let the skin heal and tissue settle.

March-December 2017: Mystery Symptoms

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I began presenting with increased tightness and itching under my implant.  I had multiple scans, physical examinations, and blood tests all of which were inconclusive.  I was diagnosed with capsular contracture as a complication from my 30 rounds of radiation and presented with the updated warning regarding textured implants and ALCL link.  I became a candidate for implant exchange with fun reconstruction of my right (radiated) side to release my contracture.

December 2017- 2nd Reconstruction with Fat grafting

That brings us to where we are today.  Currently I have 2.5 weeks post op and healing right on schedule (minus some nerve damage under my armpit and under parts of my upper arm which will require physical therapy).  I completely switched out my old textured implants for Natrelle Inspira Smooth Round silicone implants filled to 495CC with a higher fuller profile.  After TONS and I mean TONS of research and really finding pics of foobs that I could picture on my own body, I decided the round vs. teardrop shape was much perkier and more of the look I was going for.

How I came about my decision for this 2nd Reconstruction

Funny quick story about advocating for yourself.  When I went in for my pre-op appointment, my surgeon gave me two standard surgical choices.  1. simply switching out the textured implants for smooth and reconstructing my right contracture. 2. Latissimus dorsi flap reconstruction surgery, which involves an incision made into your back near your shoulder blade, then, an oval section of skin, fat, blood vessels, and muscle is slid through a tunnel under the skin under your arm to your chest and formed into a breast shape– this is a great option for people post radiation because it produces healthy non damaged skin onto the chest with a MUCH less chance of contracting and complications.  **I did not have enough belly for a DIEP procedure and I have MULTIPLE medication allergies so I was not a candidate for my foobs to be fully made out of my own body fat, which also HIGHLY decreases risk of complications.

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Self Advocating at its finest!               I even prepared photos of what I wanted to look like for my surgeons reference— and YES his team hung it in the OR!

Oh, back to my story… so I go in and the resident asks me what surgery I decided on 1, or 2. Of which my response was NEITHER.  She looked at me so confused and said, “so you decided on no surgery?” Of which my response was, well I came up with my own surgical plan!”  Talk about self advocating— lets just say she quickly got my surgeon to have a little discussion.

Okay so after researching I 100% needed the textured implants OUT.  I didn’t want an extended time off of work and really dislike the scars from the Lat flap procedure even though it probably would have been a “safer” procedure due to the high amounts of radiation my skin has underwent.  I requested a simple swap of the implants, cleaning out of my right contracture, then with the addition of liposuction, he could line the implant with fat grafting to “trick” my body from seeing the implant as a forge in object therefore decreasing the risk of another contracture!  AND HE AGREED!!!!! (Basically I should really just be a doctor at this point– Dr. Koziel, has a good ring to it!)

So that was my plan: Changing out my implants, releasing my capsular contracture of the Right breast, reconstructing the right side with alloderm (which is why I required a drain) and liposuction for fat grafting.

Stay tuned for Part three of this Reconstructive Trilogy for a peek into recovery and what I think of my NEWEST pair of Foobs.  (PS: I may or may not have had my doctor put my foobs in a jar… 😉

XOXO Meg

Links for references and more information:

Mayo Clinic

Updated FDA Warning Regarding Implants and ALCL

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