During Breast Cancer Awareness Month (October), there’s a lot of discussion about finding a cure for breast cancer. We put on pink ribbons, run 5ks and raise money for research. We do this so that the next generation may not have to face the realities of breast cancer; or, in my case, preventing breast cancer. Thanks to what the industry likes to call “The Angelina Jolie Effect,” we’ve seen a spike in testing for gene mutations like BRCA (which increase your likelihood of developing breast cancer) and conversations around preventive mastectomies. But, what we don’t hear much about is the process – – what is it actually like to have a mastectomy and what are the options to women who undergo breast reconstruction? Well, today is National BRA Day (Breast Reconstruction Awareness) and I thought I’d bring some All-in with Allyn realness to how I chose to reconstruct my breasts. I’ll also let you in on some new technological advances that may have given me a little bit of “Boob FOMO.” Let’s begin!
Did this get your attention? Good. Because I’m going to dive right in. If you’ve ever found yourself asking “What EXACTLY is a mastectomy…” you’re not alone. A mastectomy is a generalized term for the removal of one or both breasts, either partially or completely. This is done to remove cancer of the breast or to prevent the growth of a future cancer. If you’re cringing and have conjured thoughts of Medieval torture devices – don’t worry it’s not that intense.
Since it’s October, I’m not a doctor and can get away with this, let’s use a pumpkin reference. A mastectomy would be similar to preparing to carve a pumpkin. First, you create access to the inside of the pumpkin by cutting around the stem (making an incision in the breast fold). Second, you gently remove the material inside (breast tissue, fat, milk ducts etc). Third, you replace the “lid” (closing the incision).
Boom! Mastectomy done. That wasn’t so complicated, now was it? So, what comes next?
Well, breast reconstruction is similar to creating your design on the pumpkin. There are many options and what you choose is a decision based on your health history and personal preferences. There are three main types of reconstruction:
- Implant – A saline or silicone breast implant is placed under or over the pectoral muscle to recreate the natural shape of a breast
- Autologous or Tissue “Flap” – Rebuilding the shape of a breast using skin, fat and muscle from another part of the body (There are several types: DIEP, Latissimus Dorsi Flap, GAP Flap, TUG Flap, Fat Grafting etc.)
- No Reconstruction – The breast is not reconstructed, but instead, the excess skin is removed leaving a flat surface on the chest.Along with their reconstruction method, women must choose whether or not they would like to retain their nipple, which could potentially develop breast cancer even after a mastectomy.
Implant Reconstruction is the most common form of reconstruction and can be performed in two ways:
- Immediate: Directly following a mastectomy in a process called DTI (Direct to implant) or;
- Delayed: A tissue expander is placed under the chest muscle to gently stretch the tissues to later accommodate a breast implant
Immediate Reconstruction is a preferred method for women who would like to have everything done in one procedure. A woman could walk into the hospital with breasts and out of the hospital with breasts. This eliminates potential physical and psychological complications of future surgeries and having to spend several months “without breasts.” However, DTI surgeries carry risks as the immediate stress on the breast tissue may potentially disrupt blood flow and lead to a nasty thing called “skin necrosis.” This is a happy place so we won’t dive into that any deeper here.
I personally underwent delayed reconstruction, which is the most common form of breast reconstruction. The process involves placing what I like to call “empty balloons” (expanders) under the chest muscle. Over a period of a few months, your doctor will slowly “inflate” these balloons by injecting saline into them though a port. This sounds well and good until the doctor starts coming at you with a giant needle to stab into your newly operated breasts.
I may be exaggerating. In any case, it was pretty scary and the process wasn’t painful – – but what came after was…
Most women have relatively uncomplicated experiences with tissue expanders. The “inflated” expanders begin to look more and more like the shape of a real breast, allowing you to mask the fact that you are technically “breastless” for a few months. You are also able to gauge the size you would like your future breasts to be. Well, not me…
My tissue expanders, instead of becoming temporary breast shaped objects, looked more like I was nursing a SpongeBob Square Pants on the left and a Hey Arnold! on the right.
It wasn’t exactly the look that I was going for. It turns out that something had happened to the expanders as they began to inflate. I underwent a minor “revision” surgery to replace the expanders and thankfully, I joined the ranks of the normal shaped “girls” once again. Despite the complication, and temporarily looking like the mother of a Teen Nick character, I am very happy with the cosmetic results I achieved.
Tissue Flap Reconstruction is a broad category that allows women to utilize their own body tissue to recreate the shape of a breast. Many women opt for this procedure to avoid having “foreign materials” in their body and to create a “natural feel” to the breasts. This was an appealing option to me, but unfortunately I did not have enough spare tissue to perform a free flap procedure. Some women avoid this type of reconstruction because it leaves patients with an additional scar at the location where the tissue was harvested. But to many women, avoiding an additional scar is less important than the ability to regain breast sensation, which is now possible for free flap reconstructions utilizing a new surgical procedure called ReSensation™.
When a mastectomy is performed, the nerves that provide sensation to the breast are cut. This can lead to numbness and loss of sensation. I know about this first hand — I would estimate I’ve lost about 30-40% of the sensation on and around my breasts. It can be devastating to women who are often not told that this is a potential side effect. Thankfully, my surgeons informed me that this could happen, but you don’t fully comprehend how it will affect your life until it does. The loss of sensation has honestly been one of the most challenging parts of my recovery. It has affected many aspects of my life – – my sensuality, personal comfort, it creates fantom itching (yes, I quite literally have an itch I can’t scratch!), the ability to know if I’m having a “nip slip” and the list goes on.
Fortunately, for women who choose free flap reconstruction, the surgical technique ReSensation can now be performed along with it. Surgeons have the ability to connect the nerves that were cut to nerves in the patient’s newly restored breast using allograft nerve tissue, allowing them to potentially regenerate over time (sounds intimidating, but it’s pretty incredible!) If you want to learn more about ReSensation, you can visit their site here.
Yeah, it’s pretty amazing and I am excited for the possibilities this has for women who undergo mastectomies in the future. Every woman deserves to be able to feel her breasts or at the very least know when she’s having a Janet Jackson moment. So, let’s have a round of applause for the science that has afforded women like me the opportunity to have a surgery that could save their lives AND maintain feeling in all the right places.
Stay tuned to All-in with Allyn for more about life post mastectomy, pageants, life as an expat and anything else I can throw some snark and a gif at. Thanks for reading!