Tag Archives: Prophylactic mastectomy

Just some “fluffing”

WARNING: NSFW / graphic content below.

Well, it has been a month since I posted my last status update, because there really isn’t anything terribly exciting going on. I do have a photo for you to show you some “fluffing” I’ve noticed in my right implant, though.

I saw Dr. M for another follow up visit a couple of days ago and we agreed that the infection is no more. I have been redness-free for over a month, so I seem to be in the clear. My next appointment with him is at the end of March, which will be my pre-op visit, with the surgery to follow on April 10, 2014. During that procedure my PS will attempt to replace the implant via a small incision in my armpit, using the TESSA technique (right). If he observes that too much scar tissue has accumulated in that space, he will have to place a tissue expander instead. We won’t know until he gets in there. It’s a log way away, but it’s not too early to start crossing fingers and banking those positive thoughts. Get on it! 🙂

As of today, it has been over three months since my exchange surgery and two months since the infection claimed my left implant (see: Houston we have a problem). The implant on my right does seem to be “fluffling,” meaning there has been a slight change in the perceived shape and size of the implant. What is actually happening is my body is changing around the implant forcing it into a different configuration, thus making it seem like the implant itself is actually changing. It is a gradual redistribution of the volume from top to bottom of the implant. The completion of this process may take from three months to a year. Here is the difference in just one month: left = November 13; right = December 13.

The waiting game

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WARNING: NSFW / graphic content below.

It has been over ten weeks since my exchange surgery and a month since the infection that lead to removal of my left implant. I originally thought that I may have the next surgery just three months after the deconstruction, however some issues linger.

While I was across the pond, spending time with family after my mother’s passing, I experienced a lot of redness on the left side. I emailed photos to Dr. M and was told that the combination of stress, emotional and physical exhaustion, as well as a possible infection were the very likely cause of the inflammation. He instructed me to finish the antibiotic I proactively picked up on my way to the airport. After a few days, the redness went down and hasn’t resurfaced since. This Wednesday I saw Dr. M for a follow up. He did an ultrasound and discovered a couple of small fluid-filled cavities. I am to finish the antibiotic and keep a very close eye on the area, while the serous fluid is reabsorbed and addressed by my body. If the redness returns, the fluid will be aspirated for a culture and a decision on following treatment. I’m 48 hours drug-free and things are looking good.

In any case, my next surgery is scheduled for April 10, 2014. At this point, it is unknown whether a tissue expander will be needed. Nothing to do now, but sit and wait. This is what things look like now. I am not wearing a prosthesis or going out of my way to camouflage my lack of bosom. I’ve come to the conclusion that other people’s discomfort is their problem.

Team FORCE at the local Race for the Cure

One month post-exchange

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WARNING: NSFW / graphic content below.

It has been a month since my exchange surgery and over eight months since my prophylactic bilateral mastectomy. I went from about 184ccs of breast tissue pre-PBM, to 550ccs of saline in overfilled tissue expanders, to 350ccs of silicone gel in my Mentor round, smooth, high profile implants.

Not much has changed in the last month. I was hoping that the pocket on righty would close up a bit on the bottom, but that has not happened. This means I will most likely have a revision procedure this year to do that surgically. The new girls look fine in clothing, but I am not 100% happy when looking in the mirror. In addition to pocket revision, I am still planning on addressing the nipple asymmetry by removing the tip of the right nipple. I hope to wrap this all up by the end of this calendar year.

My scars are not pretty, but I already know I develop “two year” hypertrophic scars, so I am not surprised. I just started using Kelocote on the incision spots; hopefully this will help speed up their softening.

In other news, I just returned from a two week Europe vacation visiting Venice and my family; I’m excited to be participating in the local 2013 Race for the Cure on October 12th as part of Team FORCE (Facing Our Risk of Cancer Empowered – www.FacingOurRisk.org); and I was also recently featured in another article in the Fall 2013 edition of a local cancer magazine. Here’s my excerpt (changing names, because I want to continue to keep this blog anonymous):

“Mogatos says she never thought much about cancer until about ten years ago, when her 28-year old sister was diagnosed with breast cancer. In the intervening years, she’s had a great deal of time to think about it: she lost her sister to the disease, her mother was diagnosed with ovarian cancer, and another sister is undergoing breast biopsy.

Mogatos began having alternating ultrasounds and mammograms every six months to monitor her own breast health. She also had the BRCA test, which was negative. Once in a while she’d have an MRI, just to make sure everything was OK. Her doctor explained some women with breast cancer in their families choose to have a mastectomy, so she knew that was an option. But she was only in her early 20s, and “I was going along the lines of if it ain’t broke, don’t fix it,” she says.

In March of 2012, the time came to fix it. Mogatos picks up the story: “An ultrasound spotted some issues. Three separate masses were present. They had developed in the six months since the last mammogram. The oncologist recommended an MRI screening. Waiting for test results was hell, but when they eventually arrived, they were good – no cancer.

“In June, I felt something unusual during one of my monthly self-exams. The lump was in one of the three spots where the ultrasound found issues.” Another ultrasound confirmed that two of the three spots had increased in size and were now palpable. Mogatos had biopsies done, and again endured the terrible wait for results. There were some abnormal cells but no frank cancer. She was told to continue her self-exams and keep regular screening appointments. “The inconsistency of the messages I was getting was very hard psychologically,” she says. “I didn’t want to go through this again, having to wait for test results, feeling anxiety, then being relieved, and then ‘oops, maybe we made a mistake.’ I just couldn’t go through that again.” She began considering preventive mastectomy.

She was referred to Dr. M. “When I met him, we really clicked,” Mogatos says. “He brought up things no other surgeon mentioned. I talked to some of his other patients. I felt he’d be a great partner to get me through it.”

When the time came for surgery, she was ready. “I’d researched, I’d read, and I knew what to expect.” She was too lean for the DIEP procedure, so Dr. M placed tissue expanders, and a recent surgery replaced those with Cohesive Gel implants. “I’m ready to be done with the reconstruction,” she says. “It’s been sometimes painful, sometimes frustrating, but I’m so happy I did it. When I look at the big picture, the possibility of getting breast cancer and not making it through, like my sister, I have no regrets. It’s totally worth it. I never have to think about breast cancer again.”

Scar and surgery photos

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WARNING: NSFW / graphic content below.

Had another follow up appointment on Friday. Dr. M refreshed the tape that’s holding up my right foob. We are going to keep doing this for a few more weeks in hopes that it will be enough for the scar tissue to form at the bottom of the pocket and close it up, BUT I may need another surgery anyway. We compared the two sides size-wise and found that we may need to swap out my right implant for a larger one. Plus, I still need to do something about this missing nipple, so yes, more OR time in my future.

He removed the strips covering my incisions, so I can now inspect them closely. They look 3049813476 times better than after the PBM. No necrosis in sight! I have a spot that looks a little bit like the start of a stitch abscess, so I will be watching it. Here’s what my scars looked like pre-exchange and what they look like now, 12 days post-op. Different lighting, but you can see that at the bottom that they are no longer angry red and keloid-ish.

I also got a copy of my surgery pictures! It is really cool to see the changes from this angle. From left: 1. 184 g/ccs removed during PBM surgery (1/22/2013), 2. Expanders at exchange (9/3/2013), 3. One out, one to go, 4. Mentor round, smooth, high profile silicones in 350ccs.

So I think this is why my right foob seems smaller than the left one, even though the implant size is the same at 350ccs: I am concave/the hole in my chest is deeper on this side, so the implant sinks into the cavity more. We can’t do anything about it right this moment, though.

Facebook support groups

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I have been preaching for a long time now that finding a support group is really essential and this is the #1 item on my list of Resources. Have you joined one yet?

Where? How?

In addition to local community groups that meet in-person, you can find support groups online, specifically Facebook. They have been created and are managed by and for women who are considering mastectomy, preparing for one, or have already been there done that and are there to support those that haven’t (other topics related to hereditary breast and ovarian cancer are also frequently discussed; this varies by group).

I joined a few of them a couple of months pre-PBM and they were and continue to be invaluable resources for me. Lots of advice, photos, love, support, and just general sisterhood. Here are a few of them:

My “home”: Prophylactic Mastectomy (500+ members)
BRCA Sisterhood (1,800+)
Beyond the Pink Moon (1,500+)
Young Previvors (300+)
Previvors (170+)

Bonus: if you write a relevant blog, join us in the Breast Cancer & Previvor Blogs group.

These are all closed/private groups, which means you cannot see the posted content unless you are a member. If you’d like to join one, find the group (follow my link or search on FB) and click on the Join Group button in the top right corner of the group page. A few of them require the requesting person to friend one of the administrators and complete a questionnaire before they can participate, so keep an eye on your FB inbox (including the “Other” inbox).

Come on down and join us! I’m happy to assist anyone that is interested. Contact me.

“I can’t say it enough to all of you beautiful ladies, but thank you :). When I had my PBM, I did it with the support of very few people. I have struggled more than I thought I ever would and then about 3 weeks after surgery I found this group. I had no idea that there were such wonderful women that have gone and are going through the same struggles as me. I know no matter what happens I have a huge group of the most caring, strong, and wonderful women that have my back and will always be there for me. I am beyond blessed to be part of this group. I never thought at this stage of my life that I would make such wonderful new lifelong friends. So I just want you all to know I appreciate you all xoxoxo” – posted in the Prophylactic Mastectomy group (sharing with author’s permission)

Exchange surgery aftermath

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WARNING: NSFW / graphic content below.

It has been five days since the exchange surgery that swapped out my rock-hard tissue expanders for soft and squishy silicone implants. I must say that as I was told beforehand, this surgery really was a breeze compared to the original prophylactic bilateral mastectomy I underwent in January.

My husband took the day of surgery (Tuesday) off from work, but I was home alone the next day and onward. I spent the majority of that day napping, but was pretty mobile while awake. As I already mentioned (see: From the other side), I didn’t experience very much pain. Took my last Norco right before Wednesday’s follow up appointment, during which my drains were removed. This time around it hurt like a b#%$@! I’d say around an 8. Pain Scale

The second follow up appointment was on Friday. This is the day I started driving. During my appointment I got my handy dandy medical device ID card. I’m flying internationally in two weeks, so I’ll make sure to have it with me, but I hope I never have to use this thing.

Dr. M removed the ACE bandage and bra to examine the girls. He agreed that righty is hanging lower than lefty and used some kinesio-type tape to mold it into the proper position. I was told to continue to wear a tight bra and return on Monday morning.

Hubby was out of town the whole weekend, so I spent it home alone taking it easy. I had to keep reminding myself that even though I feel 100% fine, I’m not. I was wrestling with a pickle jar earlier and finally thought: these pickles are good, but a complication-free recovery is better and had my veggie burger sans pickles. It was still yummy.

The reveal

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WARNING: NSFW / graphic content below.

Saw the PS this afternoon for my exchange surgery follow-up. Some great news and some not so awesome. First, the good news: the hemovac/pancake drains have been removed. Woo hoo!!! Buh buy, I hope I never see you again!

In other news: during this appointment I got to see the girls in their full glory for the first time. They are smaller than what I was expecting, even with my over-compensation when declaring what the perfect size would be. We discussed doing 400-450ccs and over-filled to 550ccs to accommodate this volume. The implants I have are Mentor round, smooth, high profile silicones in 350ccs. I was very adamant that I did not want to be able to rest a drink on my bosom. Well, I definitely got the natural slope I wanted. No “shelving” in sight!

And the not so awesome news: righty sits lower than lefty. When I had the expanders, it was the other way around: lefty sat lower than righty. The PS had to open up the pocket to make things even. I don’t know if too much tissue was separated or if it is just swelling or if that’s the void from the drain tube that will eventually close down a bit. This is pretty obvious when I put on a tank top. I didn’t really get a good look and notice this until I was at home, so haven’t yet discussed it with Dr. M.

Aside from the asymmetry and being smaller than I anticipated, I think they actually look pretty good. I like the shape, the amount of cleavage, and the natural slope.

Squishy time

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Well, the day is almost here. Exchange surgery is less than 12 hours away! I’m so happy to finally be here. All that’s left is a good night’s sleep. I feel like Mario when he finally reaches those stairs at the end of the level. 😀

Following the handy-dandy checklist I put together for my prophylactic mastectomy back in January, I have gotten everything ready. Based on all the feedback from the Ladies that have gone through the exchange surgery before me, I expect this to be a breeze. The exchange surgery will only take about two hours and will be an outpatient procedure. I should be home by about 4pm.

Prep for surgery

I didn’t borrow a recliner this time, so I built myself a pillow-fort-kind-of-thing on the bed. I prepped a basket of essentials to keep by my bedside. It will travel with me between the bed upstairs and the couch, as needed. The hospital bag is packed with a few essentials like the tablet, hand wipes, chapstick, cough drops, lanyard (for those stinkin’ drains), medications, and my awesome My Destiny Foundation tiara.

I have been downing prune juice for the past couple of days to get ahead of the constipation. Also bought some snacks and food items that will be easy to prep while I’m home alone this week. I took the rest of the week off and expect to be doing absolutely nothing.

Later gaters. Write to ya from the other side!

Choosing implants

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Saline versus silicone? Teardrop or round? Will high profile give enough projection? Choosing implants has been a popular topic in the Prophylactic Mastectomy Facebook group this week. While reviewing feedback of some of the other Ladies, I found myself questioning the choices I’ve made. After looking over my little list yet again, I reaffirmed that I have made the best decision for me. Here are the winners and the losers .

Disclaimer: Each person may give different levels of importance to the factors I list below and should discuss their options with their plastic surgeon. It is not my intention to convey that choosing anything different than what I chose is wrong. I am just presenting my logic. Right, wrong, or just plain stupid. 🙂 As always, I welcome your feedback!

Implant type

Factor	Saline	Silicone
Durability
Incision size
Chance of rippling
Natural feel
Sloshing
Leak detection

All the hoopla about the link between silicone implants and connective tissue disease, breast cancer, or reproductive issues is just that .. hoopla and unproven. It still caused the moratorium on use of silicone implants in the US in 1992, though. Because of this, breast implants are the most tested medical device out there. The moratorium was lifted in 2006. See FDA’s Update on the Safety of Silicone Gel-Filled Breast Implants for more details.

In any case, both types of implants are encased in a silicone shell. The one encasing the silicone implant is solid, but the saline one has a port (salines are inserted deflated and filled with fluid; silicones are pre-filled). Also, salines are more prone to ripple, causing folds in the shell. These two vulnerabilities are the causes of higher failure rates of saline implants. Although they come out on the bottom here, problems with silicone implants are more difficult to detect. Regular MRI screenings for “silent ruptures” are recommended for patients with these types of implants.

On the aesthetic side of the equation, the incisions needed for salines are smaller, but they are firmer and have been reported to produce a “sloshing” noise.

Implant shape

Factor	Round	Anatomical
Natural appearance
Natural feel/motion
Higher projection
Complication due to turning

From the various photos I have seen, I am not convinced that there is much difference in the aesthetic outcome, but in my head it makes more sense that anatomical (teardrop) implants have a more natural shape, so I gave them the . While both shapes are filled with cohesive gel, the degree of viscosity varies between the round and teardrop versions. Teardrops may look better, but they are firmer due to the gel being more form-stable (read: solid). This consistency is what gives the implants the “gummy bear” moniker.

Whether saline or silicone, implants come not only in different shapes, but also either smooth or textured surfaces, as well as different projections. Due to the distribution of the gel within the implant shell, the same volume of silicone produces a higher projection in a round implant versus a teardrop one. The higher the projection, the narrower the base. With a 29″ rib cage, I need narrow implants and the round version offers the highest projection: ultra high.

And lastly, the fact that corrective surgery is required if the implant turns is a big one for me. When a round implant turns, you can’t tell, but if a teardrop is loose within its pocket, it is obvious. With the current state of my expanders (one sits higher than the other), I am nervous about this possible issue and want to avoid it.

So there you have it: I chose round silicone implants.

Check out this awesome video showing the difference between regular round silicone implants and their anatomical counterparts.

This is a video of me playing with a round implant that has been ruptured. You can see that this type of implant is also cohesive enough to not leak outside of the shell. It retracts just as the anatomical implant in the above video.

Source of Table 6.1: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.