FCKuCANCER.

ok. i’ve made my decision, met again with the surgeons and here’s my understanding of how things will go. full disclosure this may contradict some things i have previously stated. and that’s ok, because im still learning and have been in discussions with different institutions that do differ in how they do some of these things.

here’s the upcoming procedure list and tl overview…it ain’t for the faint at heart but i’m a g

procedure	length	hospital stay	recovery eta
bilateral mastectomy / lymph node removal / tissue expander placement	4 – 5 hours	1 night	driving: 2 weeks working: 3 – 4 weeks full: 4 – 7 weeks
radiation	tbd, but most likely daily, for 5 weeks	n/a	working: during full: 6 months
reconstruction	tbd	4 nights	driving: tbd working: 4 – 6 weeks full: 4 months
revision / cleanup	tbd	outpatient	tbd

let’s get technical…

bilateral mastectomy.

• left nipple sparing (YAY!) mastectomy
• right prophylactic nipple sparing (YAY!) mastectomy

risks. bleeding, scarring, defect, need for more surgery, swelling, numbness, wound complications, nipple scabs/necrosis

lymph node removal.

• targeted axillary lymph node dissection
• sentinel lymph node biopsy
  • if new biopsies are negative for cancer = radiation, and 8 mos of maintenance immunotherapy (herceptin & perjeta)
  • if new biopsies are positive for cancer = possible decision to remove more/all lymph nodes in area (at time of reconstruction surgery) + more chemo, 14 rounds, every 3 weeks (kadcyla)

risks. lymphedema < 1 – 3%, need for complete dissection, bleeding, scarring, swelling, numbness, wound complications

tissue expander placement.

• tissue expander placement
  • at time of placement expanders will be filled with air. the amount will be determined at that time to minimize damage to blood flow. during subsequent follow-up visits the expanders can be filled with air and eventually saline as i heal to achieve desired size. the expanders will be removed during the reconstruction surgery. think of them as placeholders/shape preserveration
• minimal skin incision to lift nipples

risks. expander sutures detachment causing the expander to rotate (more an issue if i am still going through radiation, but the risk of this happening is minimal with the type of expanders i am getting)

radiation.

risks. tissue expander deflation during radiation. expander sutures detachment causing the expander to rotate (more an issue if i am still going through radiation, but the risk of this happening is minimal with the type of expanders i am getting)

reconstruction.

• if removed lymph nodes tested positive during mastectomy, possible removal of all lymph nodes
• tissue expander removal
• flap surgery – ie breast reconstruction using my own tissue from elsewhere, most likley lower abdomen and/or thighs.

risks. risks are high because this is a biiiig procedure i’ll include those details next year closer to surgery time.

revision / cleanup.

• liposuction and any other minimal incisions for corrections from a cosmetic standpoint

risks. this is determined by what procedures will be performed, so will include closer to surgery time once the decisions have been made.