Echocardiogram

This is My Echocardiogram - Required Before My Bilateral Skin-Sparing Mastectomy

(figured you were tired of seeing the MRI of my boobs)

Finding a Surgical Team - YOU HAVE CHOICES!

I will never forget my reaction to our appointments with my initial mastectomy and breast reconstruction surgical team. We met in the morning with the plastic surgeon who explained the process of reconstruction and showed us photos of his patients after surgery. Then, we met the general surgeon (the surgeon who diagnosed my breast cancer) that afternoon for another round of questions and answers.

In every single photo presented, the scars were shocking. Given today's technology, I couldn't believe that the end result of a mastectomy was so disfiguring. During our appointment with the general surgeon, my last questions for him was, "Why does the scar have to be SO big?" He responded by shrugging his shoulders.

That evening, my husband and I turned on a movie to try and relax. It didn't take long before I started to cry and I couldn't stop. My husband tried to console me as I wept uncontrollably, to no avail. Finally, I went to bed and cried myself to sleep. Luckily the next day was a Saturday, for shortly after I awakened, I started crying again. I cried non-stop for three hours. I finally stopped when I thought to myself, "I can't do this!"

At that instant I felt as though I stepped out of a trance at the snap of two fingers. I went to the Internet and searched the words: "mastectomy minimal scar". From that search, I learned that there is another procedure, called the skin sparing "keyhole" mastectomy that has been shown to have the same survival rate as the type of mastectomy presented as my only option the day before. I spent the afternoon Net researching this technique until I found a local surgeon covered by my insurance. I made an appointment with him first thing the following Monday.

I left my appointment with the 2nd surgeon happy to see that a skin-sparing mastectomy does not leave large scars. But, I was not impressed with the photos of this doctor's work - they looked like bad boob-jobs. So, I continued looking.

That same week, I met with a third plastic surgeon recommended by the first Oncologist. (When the Oncologist said, "This doctor is a perfectionist." as she shook her head, I thought to myself, "Why are you shaking your head? A perfectionist is exactly what I want!") During that appointment, I was happy to learn that the general surgeon recommended also performs the skin sparring "keyhole" procedure; and now that I have seen photos of the plastic surgeon's work, I feel very comfortable with how I will look after reconstruction is completed. I am delighted that instead of the disfiguring mastectomy initially presented as my only option, I'm having the skin sparring procedure that hides the scar around the areola. The scar is so well hidden that my husband is calling it my "mandatory boob-job".

The moral of this story: If you are presented an option that you know will have a negative affect on you for the rest of your life. Do your due diligence! The surgery presented to me as my only option was taught thirty years ago. According to my Internet research, most doctors are still doing the old technique simply because that is what they were taught. I don't know in what year you are reading this (written in 2010), but years from now, I'm hopeful that there will continue to be advances in surgical techniques. So, DO YOUR HOMEWORK before going under the knife!

The other piece of advice I can give you is to interview the plastic surgeon FIRST. This will allow you to see photos (the end result of the general surgeon's work) before you even make your appointment with that doctor.

Surgery - A Bilateral Skin-Sparing Mastectomy

My bilateral mastectomy and first step of the reconstruction process (placement of the expanders) took place 18 days after my last round of chemotherapy. I knew this would be an aggressive schedule when I requested it, but I was determined to finish all of the treatment as soon as possible. My goal from the very beginning was to deal with the cancer, get it over, and go back to enjoying the rest of my life as quickly as possible. Since it takes two weeks to get past the various agonizing reactions to chemo (what I call “chemo-hell”) it wasn’t until a week prior to surgery that my mind started to really focus on the surgery, which is when anxiety and fear started to hit.

Luckily, a week prior to my June 8th surgery, I received a visual imagery CD from my insurance company. This was one of the best gifts I’ve ever received, for once I started listening to it – it worked wonders to calm my nerves. My husband saved the three tracks onto a MP3 player so I could easily listen to it prior to falling asleep. I listened to the visual imagery recording eight times prior to surgery and each time I listened, I became more at ease with a feeling of inner peacefulness.

The day before surgery I completed most of the items on my “To-Do” list. My schedule for that day was thrown off a bit when, late in the afternoon I received a call from my Oncologist’s office saying the lab had not performed two of the tests required for surgery. I had to drive back to their office for more blood and urine samples, which was a bit unnerving. But, the lab assured us the results would be back by morning. (Something like this to rattle the nerves seems to always pop up at the last minute.)

I have to say, my most difficult task that day was writing a letter to my mother. Just in case something went terribly wrong, I had to give her an explanation as to why I have not told her of my battle with breast cancer; the sentimental reasons I had given her specific items in my will; and why she had to move on and enjoy the rest of her life. I was crying so hard at times, I couldn't even see the computer screen.

The morning of surgery I felt like a Samurai Soldier preparing for battle. I was calm, strong, and confident the surgery would go well. I listened to the visual imagery recording during our drive to the hospital, eyes closed - reclined in my car seat, almost in a trance (which did wonders to keep my nerves calm). Upon our arrival, everything went smoothly. Shortly after signing in, I was escorted to a changing room, told to remove all my clothing and put on a hospital gown with the opening in back. Upon completing those instructions and placing the clothes and shoes I had worn in a plastic bag, the bag was placed in a locker labeled with my name and I was taken to a pre-op waiting area that held six beds.

I laid in one of the beds in pre-op with my husband and two very close friends by my side. My husband was obviously extremely nervous, so it was great that our friends were there to joke around and calm his nerves. (They were also there to stay with him during the five-hour surgery.) We enjoyed our time together as others were wheeled into surgery, and each bed was quickly replaced. All of the hospital staff was very friendly and focused on the task at hand. A doctor who had the task of "sentinel mapping" (injecting a blue dye to identify the sentinel lymph node) quickly completed the process of sticking me four times with a device designed for that purpose. That was relatively quick and painless.

When my plastic surgeon arrived I was wheeled into a private room where she drew reference marks on my breasts and chest area. She would use these markings to position the expanders under the chest wall muscles after the surgeon finished removing my inner breast tissue from both breasts. Shortly afterward the anesthesiologist walked into the room - a very up-beat, high energy lady who assured us she would be "right there" with me throughout the surgery. We asked that she not use morphine - her response was that they stopped using morphine sometime ago. My husband stressed that I'm a very tiny person (at that point I weighed 105 pounds) and she assured him I would not be too heavily sedated.

Once my surgeon arrived and was standing by my bed, she held my hand with re-assurance. She said she had been envisioning the surgery and everything was going to be fine. I responded by saying I knew I was in the best of hands. I asked permission to listen to the visual imagery recording during surgery – the request was granted. The only other questions I had pertained to the pathology report. I wanted to know how long it would take to receive the report and would it tell us if cancer cells had penetrated the blood vessels running through the right breast. She responded that it would take around a week, and yes, the pathology report would answer that question. I said I was ready, and off we went.

As the nurses wheeled me to the operating room, I laid back, closed my eyes, and started envisioning what I had learned from the visual imagery CD. I envisioned people close to me as my “guardian angels”, hovering over me to protect me and keep me safe. Once we entered O.R. I looked up at the surgeons and could see from their eyes they were smiling. My bed was positioned; the anesthesiologist asked me to start counting; I counted from 100 to 96; and that is all I know of what happened in the operating room.

Pain Management

I had no idea how much time had past once I awakened in post-op. I remember my husband telling me no cancer cells (dead or alive) were found in my sentinel lymph nodes, and I remember a feeling of heavy discomfort in my chest. I was on oxygen (requested by my anesthesiologist); my body was wired with an “onQ” device that was automatically administering an anesthetic directly into each breast (prescribed and put in place by my plastic surgeon). It took around an hour before they finally wheeled me to my room, which was luckily a private room.

Once we were in the room, another pain medication, "Dilated" was connected to my IV and I was told to press a button to receive a 0.2 milligram dosage. Eight minutes would have to pass before it would release the next dose, otherwise I would hear two peeps instead of one to let me know that no medication was released. And, at my request, I was given two Darvocet pain pills by my nurse. (During my last appointment with my plastic surgeon, she had instructed me to ask for the pain pills the nurses would give me every six hours only if I asked for them.) So, once I was in my room, with these three forms of pain control, I was in a good place in regards to pain.

My hat is off to the Little Company of Mary hospital in Torrance CA, for their entire staff is very caring and attentive to pain management. The day after surgery, it was nice to receive visits from the anesthesiologist and the nurse who attended to me during surgery, along with a number of other caring people associated with the hospital. The first question asked by each nurse attending to me was, “What level of pain are you experiencing?” Since my mindset was to stay ahead of the “unbearable/excruciating” pain described by others who have undergone this surgery, anytime pain relief was available to me, I took it. So, I was pressing that button regularly and asking for the oral pain pills every six hours. And each time I was asked about my level of pain, I responded, “around a 3” (which felt more like an aching pressure than a pain).

The Dilated pain medication I was receiving through my IV was taken away around 1:00pm the day after surgery (I had administered a total of 2.6 milligrams). I was released from the hospital the second day after surgery and continued to feel very little discomfort, until several days later when the "onQ' pump that was administering 0.5% Bupivacaine directly to each breast emptied. To learn more about this device so you can request it of your plastic surgeon, go to:
www.AskYourSurgeon.com

When the OnQ Pump emptied, I experienced a constant agonizing pain that felt like I had been stung by a thousand miniature bees. It took three weeks for the “bee-stinging” pain to start subsiding. Once that pain became more bearable, I was more aware of the pain caused by the drainage tubes. So, I was delighted when they were finally removed in the fourth week. Pain from removal of the sentinel lymph nodes and pain in my center chest-plate area took front and center stage next.

I went back to work the fourth week after my mastectomies, which was very hard. For, I had to cut back on the pain meds in order to stay focused. By that time, I'd had enough of the pain. It wasn't until the sixth week that the pain subsided to the point I could stop taking the heavy pain meds (primarily Endocet 5-325 mg) when I was not at work. But, I was still in pain. I experienced a significant amount of “dagger-like” pain during the sixth week that I was told was due to nerve endings healing. It seemed like the pain would never end, but finally it did. What was left was the constant discomfort from the expanders.

Why a Bilateral Mastectomy?

It was interesting the number of women who came into my room filling various roles with the hospital who inquired about my decision to have both breasts removed. Their questions were very subtle, but I could sense they did not understand why I had made that decision. The answer is a no-brainer in my mind. First and foremost, after going through chemotherapy, I can’t image anyone willing to risk going through that awful experience a second time. During my research I read numerous stories of women having cancer in the second breast a few years after the first. Considering the density of my breasts and problems with fibroid cysts that I’ve experience over the years in both breasts, I absolutely was not willing to take the risk, nor did I want the constant worry over my left breast being at high risk of developing cancer years later. (I’ve learned in my research that very dense breasts are at very high risks of developing breast cancer, as well as breasts with a history of fibroid cysts.)

Purely from a cosmetic viewpoint: I still remember, as a small child seeing my grandmother without her bra. Believe me, it wasn't pretty! Grandma must have been a bra-burner, for they were hanging down well below her waist. Anyway, just a few months before I was told I had breast cancer, I looked in the mirror after stepping out of the shower and noticed my breasts were starting to go South, and I thought to myself, "Wonder how long before I look like Grandma?"

After being diagnosed with breast cancer, all three plastic surgeons I consulted gave the same explanation of the breast reconstruction process. They said they could not make the reconstructed breast look just like the natural breast. One gave the analogy that one breast would be like an apple and the other would be like an orange. She would not be able to create a matched pair. (No pun intended.) And when I visualized the natural breast continuing to sag with age (like grandma's) while the reconstructed breast stayed nice and perky, that definitely was not going to look natural, nor pretty. The bottom line: I came into this world with a matched set, and I'm going out with a matched set. It was an easy decision for me to make.

If you are facing this decision, I suggest you read:
http://www.latimes.com/news/science/la-sci-breast-cancer-20100901,0,3642470.story

Recovery from My Bilateral Mastectomy

My recovery from surgery (looking beyond the pain) went great. I’d never experienced a major surgery before, so I had no idea what to expect. But, from my husband’s past experiences, he expected to be waiting on me hand-and-foot while I was bedridden for a week, and that was not the case. I became very self-reliant the day after I returned from the hospital. I was up and about like “no big deal”. My range of motion was limited, and I was weak (more from the chemotherapy than surgery), but I was able to get myself in and out of bed, go up and down stairs, and do anything inside the home I wanted to do. My only physical limitation was that I could not reach for things for the first couple weeks, and did not have the arm strength to drive until week five after surgery (which drove me crazy not having my independence).

Everyone - especially my husband couldn’t believe how quickly I bounced back from my mastectomies. I have no idea what it’s like for most women at that point in the recovery process. But, according to everyone who saw me (including my oncologists and his staff who saw me three days after the surgery) I looked “unbelievably great”. I attribute my speedy recovery to several things:
  1. Scheduling surgery following my biorhythms
  2. Maximizing my intake of greens two weeks prior to surgery
  3. Taking supplements recommended by:
      http://www.lef.org/
  4. Practicing guided imagery

Recovery from My Second Surgery – Expanders Replaced with Silicone Implants

Recovery from the second surgery (that took place August 31st 2010) was also pretty remarkable. Replacement of the expanders with silicone implants was scheduled to be a two-hour operation. Due to extensive scar tissue formed in the left breast that had to be removed, the surgery took five hours. Two hours later I was released from the hospital.

The next day I went to my dentist with dental pain. When I told her assistant I’d experienced a five-hour surgery the previous day, she was shocked. Again, I believe the steps I’d taken in preparation for both surgeries listed above attributed to how quickly I recovered.

The pain from the second surgery was nothing compared to the mastectomies. In fact, I was taking pain meds prescribed for the second surgery more to deal with dental pain than the pain in my breasts. X-rays of my tooth did not identify the cause of pain. My dentist believes I have a fractured tooth requiring a root canal, post, and crown. But, a close friend pleaded with me to not undergo any major dental surgery so soon after my breast reconstruction surgery.

My friend’s advice was good advice, for during my follow-up appointment with my plastic surgeon, she agreed I should hold off on having oral surgery because it would increase my risk of infection. Plus, we don’t know for certain that it’s not an abscessed tooth. So, currently (four days after my second surgery) I’m taking pain meds to control dental pain and have very little discomfort from the breast surgery.

I’m so very happy to have the expanders out! They were SO uncomfortable. I’m sure it’s hard to imagine the steps involved in the reconstruction process. If you are interested in the details, this lady is doing a very good job of documenting her experience:
http://www.youtube.com/watch?v=OcvkiTbgwEo
Luckily, I did not experience the problem she is having with her sutures.

The third step of my reconstruction process, nipple reconstruction is scheduled to take place in the first week of December.