So what’s actually going to happen?  How does this work?

The prophylactic bilateral mastectomy is serious business.  The operation can range from four to over 12 hours – depends on what type of mastectomy (skin-sparing, nipple-sparing) and reconstruction (direct, delayed, implant, DIEP, TRAM, other flap, fat transfer) are planned.  It requires at least one night’s stay in the hospital and has a lengthy recovery (multiple-week’s-worth, not just a few days).  During a mastectomy the surgeon removes all of the breast tissue leaving little or none behind.  The breast reconstruction can happen or begin at the same time the breast tissue is removed: the breast surgeon removes the tissue and hands off the scalpel to the plastic surgeon who does his magic.

After consulting with both surgeons, I chose to have a skin-sparing mastectomy and go the two-stage implant route for reconstruction.  Sadly (or not – depends on how you look at it) I do not have enough extra tissue and fat to spare for some new boobies.  I’m still undecided on whether or not I want to keep my own nipples, but more on that later.

This whole procedure scares the crap out of me.  Even though I’m still two months out, I’m already nervous!  There are so many things that need to be considered and so many unknowns.  A few things are still up for discussion with the surgeons.  I have another list going and will be meeting with both of them again to get some more info to help me decide (updated a couple of answers post-appointment).

• Do we need to biopsy the sentinel node to see what’s going on there? Original verdict was no, but to be re-discussed with new surgeon (see Speed Bump). The answer is still no.
• Should I keep my nipples? Eventually decided that I’m going to keep them.
• Do we really need to snip the pec nerves? It is done to create the pocket, but also for optimal projection. If the pec major remains completely intact, this can cause “jumping boob” when you shake hands, reach for things, or even have a conversation, if you talk with your hands.
• When do we do insurance pre-authorization? Breast surgeon does it first about a month before surgery. Plastic surgeon submits after that is granted.
• How long will I be unable to shower, open my own water bottles, high-five, do the nasty, drive, work, etc.? Timetable for Healing is one of the sections in the Breast Reconstruction Guidebook and details the first four weeks post-mastectomy. You are back to most of your normal routine during week four.

Source: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

Aside from worrying about infections and other surgery complications, the thing that bugs me most is long-term limitations on physical activity.  During the procedure, the surgeons snip some of the nerves that are attached to the pectoralis major to create a pocket for the implant.  Because of this, the pec major atrophies and loses some of it’s function.  The pec minor learns to pick up the slack, but doesn’t fill the shoes.  Does this mean that I won’t be able to go rock climbing again?  How about wake boarding?  Eek!  Anyway, another topic to research and discuss.