Consults, Weaning, and the Next Few Months

Shortly after learning the results of my genetic test... Chris and I consulted with both our oncologist and plastic surgeon.  Both will be performing a portion of my upcoming surgery.  Dr. Abraham will do the double mastectomy, and Dr. Baur will come in to do Phase 1 of the reconstruction.

From what I can tell from Dr. A (the oncologist), the mastectomy portion of the surgery is certainly painful to recover from, but not considered "high-risk."  She seemed very upbeat about my chances of doing well in and after surgery.  I was surprised, however, by my consult with Dr. B (the reconstructive surgeon.)  I like him very much, and he is considered to be the best breast surgeon available... but he seemed very intent on keeping me grounded in reality.  "Reconstruction is NOT like an augmentation," he repeated numerous times.  "Making a natural-looking reconstructed breast 'from scratch' is nothing like simply getting implants."

For starters, I will have to have my pectoral muscles gradually stretched and expanded over the course of 3 months after surgery, using balloon-like tissue expanders to create a space beneath my pectoral muscles where an implant can later be inserted.  This is because without any breast tissue present under the skin (all of which will have been removed), the implant would not look natural and so it must be placed under the pectoral muscle instead.  The doctor will also insert a piece of allograft muscle tissue (aka: donor tissue from a sterilized cadaver) on either side, connecting them to my existing pectoral muscles to give more space to work with for the initial reconstruction.  Infection rates for a breast reconstruction are 1 in 20, quite high compared to other types of surgeries.  The reason for this is that foreign bodies are being introduced into my system and there is the chance that my body will reject them, or that they could carry bacteria, etc.  Obviously, one of our major prayers is that I DO NOT get an infection after surgery.  An infection would mean they have to go in and remove everything and clear up the infection before moving forward with reconstruction. Yuck!  We don't want that.

Another factor that increases the risk for infection is if the patient happens to be lactating at the time of surgery.  That would be a biiig problem because the milk could spill out and contaminate the surgical field.  So... Elsa and I had to speed up our weaning plan.  What I had planned to accomplish over the course of two weeks (dropping one breast-feeding every four days) was shortened to one week.  We were already down to only two breast-feedings a day (morning and night) but from there we had to quit cold turkey, to allow the maximum amount of time between me lactating and the surgery.  And let me just tell you... I had no idea how bad it was going to get.  The next five days were the equivalent of stopping a freight train in its tracks and watching the cars just continue to rush forward and pile on top of one another... car after car after car.  I was walking around with two land mines strapped to my chest... and Lord help the poor soul at the airport who happened to elbow me while standing in the security line.  I was in so much pain.

I am so thankful to be on the other end of that now.  We're all glad, in fact.  Chris was having a pretty hard time watching me lay on our bed clutching ice packs and crying.

Aaaaanyway, after surgery, I'll have two sets of drains that will help drain off fluid from my chest.  I'll have the drains in for a few weeks after surgery.  And I will go in to see the doctor every week to have the tissue expanders expanded gradually.  After three months, the doctor can replace them with a more natural looking implant.  It's quite an ordeal from what I can gather.  I won't be able to pick up Elsa for quite a while (definitely not while the drains are in) and will have to steer clear of any upper-body strain.  Also the expanders don't always stretch things out in the most symmetrical manner.  I've been doing some online research and it seems those muscles have a mind of their own!  I'm mentally preparing for one boob to end up oval shaped and the other to be in my armpit.  (Ok... so it may not be that bad.  But Dr. B made sure not to make any promises as to symmetry, because there's no telling how the muscles will settle, nor how the scar tissue will complicate matters.)  So you can see why I left his office feeling as though my proverbial "bubble" had been burst.

I'm comforting myself by assuming that he tells everybody the worst case scenario, so that they'll be that much more delighted when they get great results.  I know a number of women who've had mastectomies/reconstructions and are very happy with their results.

So that's the latest update!  Elsa has weaned like a champion and will take formula any time, as long as it's nice and warm.  I'm finally dried up and comfortable again.  I go in for a pre-operative mammogram on April 10th, just to make sure I'm "all clear" before surgery.  And the big day itself is May 2nd.  I'll get to wear the tissue expanders all summer, fun fun.  And hopefully in late August/early September we'll be able to progress to Phase 2 of the reconstruction and change out the expanders for implants.

Prayers are appreciated.  Especially prayers for an infection-free and quick recovery so I can get back to holding my baby girl as soon as possible!