FCKuCANCER.

figured i’d give you guys a deep dive into the consult from last week.

there are three options/types of mastectomy procedures:

• no reconstruction
• skin sparing w/immediate reconstruction
• nipple sparing w/immediate reconstruction

no reconstruction. this one is the most straight-forward. /sarcasm. it involves removal of the breast(s), skin, nipple(s) and areola(s). the muscle remains in tact. it’s basically two incisions (one per breast), the breasts are gone, and it looks flat, similar to a man’s chest minus the nipples and areolas. a blank canvas, if you will. this option would technically leave you with nothing, but nipple tattoos are an option that can be extremely realistic. tattooists are amazing these days, and it would also be covered by insurance. full disclosure: i was fully on board with getting patchwork nipple tatts last time around if my nipples couldn’t be saved.

skin sparing. removal of the breast(s), nipple(s) and areola(s). the skin and muscle remain in tact. incisions are typically around the areola. this option is normally done when the cancer is invading into the nipple, or the proximity is way too close to the nipple that it can’t be saved. it’s also done when the breast(s) are large and such that the nipples are pointed to the floor ie. the nipples aren’t really in the right location, medically speaking. so the choice is do you want to be “perky” or do you want your nipples? tattoos are also an option in this case.

nipple sparing. removal of the breast(s). the nipple(s), areola(s), skin and muscle remain in tact. incisions are typically under the breast fold. think where the underwire cups your breast. so basically as hidden as you can. very similar to that of an elective breast augmentation surgery, but larger because all of the breast tissue has to be removed.

let’s talk reconstruction lingo…

pillow. breast.

pillow case. skin.

immediate reconstruction. means you will wake up with something. it won’t be the final reconstruction, but there will be something to temporarily maintain and protect the overall look of the breast(s) with the final reconstruction happening at a later date, typically 4 – 8 weeks after the initial surgery.

pillow options:

• implant based
• own tissue aka flap aka fat from midsection removed and made into breasts

in the before times, when i was young and skinny (and dumb enough not to know how foine i really was), i was all for implant based. then i got older, my metabolism stopped working and i grew my own!!

at this point in my life — i have enough ish in my body that i didn’t invite; an implant option is not a route i am willing to entertain.

ok. what really determines which mastectomy type is on the table for every person?

• cancer location – number one driver of what options are on the table. the breast oncology surgeon analyzes your case and determines which options can be available based on how/where your cancer is located.
• the plastic surgeon & moi – once the options are laid out, it’s up to me and the plastic surgeon to determine cosmetically what’s best for me.

what is the typical recovery period for each type? hmm, well nothing about me is ever typical, and that’s not necessarily a bad thing but here’s what i’ve gathered:

• no reconstruction – this is obviously the easiest. most patients report feeling numb more than anything. little pain, relatively speaking.
• reconstruction – no way to sugarcoat it, there will be pain with these options
  • implant based – approximately 4 weeks
  • own tissue – approximately 8 – 12 weeks (this is a more extensive procedure w/ incisions at both the breast area and midsection)
• none of the options involve “bed rest” you will be mobile, just at a more limited capacity depending on the type selected.

so, to sum things up…there’s a lot to think about.

i still have to meet with a few more doctors, but i felt hopeful after my first appointment because the doctor was more hopeful. she was positive, affirming and i didn’t leave there thinking i was the only person in the world that didn’t think i was lost cause. the added bonus was that she did not immediately say no to a double mastectomy option, and double shocker, she also didn’t remove reconstruction options. both were immediate no’s by all of the surgeons i met with the last go round. i do have a feeling mda will be more conservative. but we’ll see. aaaand, i still gotta get through five more rounds of tchp.

now, you know what i know…

whew child, fin.