Met with the plastic surgeon today who was super nice and had already read up on my history and talked to the other surgeons about their plan (always a good sign when they know all about you and take the time to read up on your issues). One of the first things he said was, "it looks like you've already been through hell and back" when starting to talk about my history. He gets it. He said that they are seeing a lot of people who had sternal radiation for lymphoma in their teens now getting breast cancer and since I had full lung radiation for my Ewings Sarcoma I probably have a higher risk than them. So good to really confirm that I am doing the right thing!
Seeing that I am small, most of the reconstruction options aren't a viable option for me since I don't have extra fat to use for flaps etc. And because of my small cup size and radiation, doing a direct implant isn't the best option either unless I want to be smaller than I currently am, which I'm not sure is even possible! So an expander it will be with an alloderm graft as well. My left rib cage has pectus excavatum basically I have a bent up rib cage that is all misshaped. This limits my options as well as I am most likely missing an additional muscle that they use for the surgery, hence the other reason to use the alloderm. The alloderm is a human or pig (gross I know) tissue matrix (the real cells are all sucked out somehow and you dont have rejection issues, your body eventually reabsorbs it and lays down strong tissue on top), this will allow them to place the expander (and eventually implant) under the Pectoralis Major muscle and use the alloderm to hold it in place on the under side. The expander will be placed and filled partially full with saline.
Then after surgery about 2-3 weeks later, I will start having the expanders filled every 1-3 weeks depending on how my skin tolerates the stretching (radiation makes it more fragile so we may have to do it more slowly). Once we get it to where we want to be (hopefully a full B cup), then they will over expand it to be a C cup. They then wait 6 months to a year to let the muscle and skin fully stretch and relax. After everything is ready, then they will go in and switch out the expander for a real implant (silicone or saline). The over fill the expander so that there is room and so that the real implant isn't perched high up on your chest but in a more natural position. The expanders aren't the most comfortable thing and are much harder than an implant will be and won't feel real natural but then when you get the implant its much more normal and real feeling.
For now we are going forward with the nipple sparing procedure. Mainly because he needs the extra skin to be able to fit everything in. If I want to remove the nipples later, they can do that at the time of the implant switch out so I have some time to decide what I want to do, which is kind of nice!
So we are moving forward! One week till surgery day!
I've got a ton of stuff to get done so hoping to deep clean the house, get the kids summer clothes out and make sure things fit, get stuff ready for them to start their new schools, cook meals to freeze, clean out my car, and hopefully make it to a graduation party! Jared is busy on Saturday so hoping to do a lot tomorrow, Sunday and during nap time! I also need to get a couple of my tomato plants staked or caged and do laundry!
I'm anxious for surgery to be done but super nervous. I hate anesthesia... its kind of like my flying fear... I don't like having someone else completely in control of my life. I have the same feeling that I get when I know I have to fly... panicky and scared! But I trust my physicians, they have all reassured me and each of them has said that if anything was looking like something was wrong (bleeding etc) that they would stop it and close me and finish the surgery later so as not to put me into any jeopardy. So they are all watching out for me. I will be talking with anesthesia in depth the morning of my procedure. I had an issue with one surgery where I woke up before the paralytic had worn off and was still intubated, couldn't move or open my eyes but could hear everyone around me and thought I was dead. So I don't want that feeling again and was told that they could reverse the paralytic before they wake me up so I need to ensure that happens!
Everyone has been super supportive. I've found a few others who are getting ready for their surgeries, one is even here in town! And have found a network of other pre-vivors!
This surgery won't define me but it will be a part of me and a big part of my life for the next year until reconstruction is completed. My hope is that once I am complete that I can move on, live my life, and leave behind the fear.
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