A Funeral for My Boobs

RIP Boobs

March 27, 1987-June 26, 2024

My double mastectomy surgery in June 2024 was successful! It also left some lingering "WTH?!" vibes: I was under a nerve block and 3.5 hours of fully intubated general anesthesia, yet still made it 2 hours home to my own bed that same night. There was only .48 TOTAL lbs of breast tissue to remove; how does that not land me with a sweet insurance discount!? And before I get boring with the month and a half leading up to the surgery, let me blow your mind with the $84,000 cadaver grafts that were used to re-enforce my skin.

From May 7th & June 26th, 2024– SO MUCH unfolded in conversation with the medical experts, yet not a single dent was made in the treatment of my cancer. If you've ever been in this position, you know that there is an unexplainable amount of anxiety that comes with this time gap. There are still so many questions that can't be answered and plans that can't be made...There is fear, worry, and stress...without much straightforward reassurance or guidance. I'm so thankful for my faith; leaning into God for the direction that this world could never offer is everything. If I could go back to this time, one thing I would tell myself is to get a hard copy ASAP of Dr. Jenn Simmons' book: The Smart Woman's Guide to Breast Cancer. It was no coincidence that I found Dr. Jenn, but there will be more on my obsession with her later. For now, I HIGHLY recommend this book for so many reasons, and here's an easy link to get your copy: https://amzn.to/43WEVhv...now back to the reality of what life looked like in May & June...

Like I mentioned previously, Ryan and I still tried to maintain a level of normalcy while continuing to work full time. We both have pretty demanding jobs...jobs that require our presence. I work for a privately-owned company that offers remodeling services with a lot of individualized layers to each project. Walking away for any period of time is a big stressor for me. This also required me to set a level of expectation up front so that my customers knew there was a chance I wouldn't be the one to see their project through. Leading up to my maternity leave, I had to create an excel spreadsheet of all my design projects and update it daily before going into labor. This allowed my coworkers to have the necessary details to keep my projects moving forward. I was happy to prepare for maternity leave ONE TIME, as we were excited to start our parenting journey. We had already decided that we were satisfied with our plan to be 'one-and-done' for many reasons. After Kanon was born, I started with 6 weeks off, extended it to 12, and then I jumped right back into work full time. It certainly didn't take long for the work to pile back up, and I welcomed it with zero reservations. I was not, however, expecting to do it again 11 months later in preparation for the funeral of my boobs...

On May 14th, 2024 I met with a plastic surgeon who was a referral from my surgical oncologist. He trained in the United Kingdom, Italy, France, and the United States, and had very diverse clinical, academic and scientific background–sounded perfect! He was a microvascular surgeon, a skill that came highly recommended from what I gathered while researching. I discovered that there were many different reconstruction options as well. I had a pretty good idea of what route I wanted to go, but it was important to me that we still talked through all the potential options. I went into the appointment with the following questions:

(1) Can I go double mastectomy straight to implant? (2) Are you experienced in DIEP or other flap reconstruction and is it a better option for me? (3) What is the recovery time? (4) What is the lifetime of an implant? (5) Will I need fat grafting? (6) Are you Board Certified by ABPS? (7) Is this hospital accredited with a low complication rate for this surgery? (8) If I need fat grafting, where does it come from on my body? (9) If I go to implant, do you suggest Pre-pec or Sub-pec? And Why?

By the end of the appointment I felt heard, comfortable, and my questions were answered. He had no opposition to my plan of doing the double mastectomy straight to implant. He suggested the implants be pre-pec to avoid animation deformity & long-term discomfort while expediting the healing process.

Reconstruction after a mastectomy is very different than a normal breast augmentation. My surgical oncologist first had to remove all of the breast tissue, leaving just the thinnest surface layer of skin in tact for the plastic surgeon to work some magic. This is where the need for the dermal matrix (aka the $84,000 cadaver grafts) came into play as a reinforcement for the skin. It's very important that this all done so carefully because there is a risk of skin/nipple necrosis. At a later date, I would return to him for fat grafting (lipo) from my inner thighs to fill in the implant contours/ripples. In my head, this plan seemed like the quickest way through the surgical part of my treatment without too many downfalls or added risks, and he didn't provide much more opinion on top of that. I was excited that I had it all figured out until...

A week passed and I still didn't have a surgery date. I knew I would have to wait for my Surgical Oncologist and Plastic Surgeon's schedules to align. I didn't expect to get a phone call from the plastic surgeon himself with the deflating news that the schedule wasn't working between them in a safe timeframe for me. This left me spiraling for a few days. I selfishly wished that Mrs. [insert name here], who wanted a boob augmentation for funsies, could be the one to receive a schedule conflict call instead. I already felt like a ticking time bomb with a cancer diagnosis, and now I had to find another plastic surgeon.

By the time I was referred to the second plastic surgeon, an OR date was already being held for June 26th. I felt good knowing there was a date, but I couldn't help but question why she wasn't the first recommendation. I felt shorted...until I met her on May 23rd, '24. She was much more transparent, relatable, and she met my certification and micro-surgeon criteria. I went in thinking it would be an easy conversation because I already had this all figured out *said with hands on hips*...but she felt very strongly AGAINST going right to implant at the mastectomy stage. She was willing to do it...but felt that it came with increased risk of infection and that I would need a lot of fat grafting. She explained that she'd be able to give me a better aesthetic without the implant in the way of the fat grafting process (there is always a very small risk of puncturing an implant). The body absorbs some of the fat during the healing process, too, so the option to input a healthy amount is best. Starting with the tissue expanders at mastectomy gave me a say in size, her the flexibility to better do her work during the 2nd surgery, and decreased my need for a 3rd procedure of additional fat grafting. Her explanation of overall healing time would essentially be the same in the case of my original plan vs. her suggestion.

I was also offered microsurgical nerve repair to restore feeling, which was not discussed with the first plastic surgeon. This was the lightbulb moment when I realized why having a microsurgeon was so strongly suggested...there are other reasons that I'll get to another day. Nerve repair was a pretty amazing option to have; however, I didn't know anyone else who had tried it, so I couldn't ask about personal experiences. Hearing the experiences of other women was very helpful throughout this whole process because I felt like I could make more well-rounded decisions. Additionally, some advice I had heard along the way was to share in the mess, while avoiding a double consciousness going into surgery. I committed to making decisions that I fully believed were right...I left no room for outside influence or doubt. Ultimately, the nerve repair was an easy pass for me– I felt so blessed just to keep my own skin and was okay with never being able to feel my boobs again.

Chances seemed low, but I couldn't completely rule out lymph node involvement (radiation) at this time either. I had heard of different surgeons and radiation oncologists having preference on radiating expanders vs. implants, so it was something we discussed. She was indifferent from a surgical perspective. She felt as though any reconstruction could certainly fail from the radiation, but she had alternatives to rebuild my left side if that's what it came down to. I felt good knowing that she wasn't pushing one or the other with ulterior motives & I trusted her. We also discussed the different next-step scenarios based on best and worst pathology results: If chemo OR radiation were suggested, I'd stay with the expanders until chemo OR radiation were complete and she'd do the exchange-to-implant then. If I needed both chemo AND radiation, I'd complete chemo, do the exchange surgery, then do radiation. I was still holding on to hope that I was going to be the patient who was "cured" with surgery alone...

As the days passed from diagnosis to surgery, I maintained my normal lifestyle; I drank socially (love a Mango Whiteclaw), ate what I wanted (generally healthy foods), continued my skincare routine (we're pretty low-tox), drank all the water, worked out often, etc. There was never any conversation about my diet or lifestyle at all with my medical team...I guessed that it must've been insignificant to my diagnosis...especially because I was applauded for being young and otherwise healthy. I was told that I would be well again within what the medical field offered. The true cause of my breast cancer would never be known, but there was definitely emphasis on my Chek2 gene mutation playing its role in causation, as well as my "significant" family history. I wanted to trust the process. I had a growing list of new friends in the breast cancer world– survivors and thrivers that were doing great. The system seemed to work, and we were just the unlucky ones who were a part of it.

Summer & surgery were approaching. Living in the snowbelt, there is nothing like that first month of truly nice weather. When May hits, the floodgates of outdoor events happen; there is live music, craft beer, dancing, outdoor vending shows, bonfires, picnics, boating, beaches, sporting events, etc. We took Kanon to as much as we possibly could. It's a time of year where the FOMO can really kick in if you're a people-pleasing, social butterfly like myself. I always want to do all of the things! Ryan is the opposite.😉I was especially hyper about my suddenly dwindling pre-op days. It felt like I was rushing into another maternity leave...like I suddenly had to accomplish certain home projects that I'd been thinking about for years. If you'd like the honest version of my insanity, I spent hours using joint compound on a crack across our textured dining room ceiling that literally existed for about 3 years. Why am I like this!? Thank God for Ryan and his reassurance that it was all going to be okay if I didn't accomplish my crazy to-do list or attend certain events. One nagging goal was Kanon's 1st birthday in early July. There was no way we could skip our only kid's first bday party! How could I even do this while recovering in true t-rex form? 6 weeks of major limitations seemed daunting! Then there was round #2 of that stressful Excel spreadsheet at work...so much to get done...so little time.

My dear friend offered to start a Meal Train, which proved to be very helpful. Grace certainly met us in our circumstances in so many big ways leading up to surgery. This was such a testament to God's goodness. I decided to start a list of thanks & praise; I called it my "silver linings" list. While I felt caught somewhere in the middle of needing to be in control and being okay with losing it, I did my best to focus on the silver linings that God was providing me in all of this. It brought me back to a state of calm in the moments where the intrusive & overwhelming thoughts crept in.

Surgery week came in a blink and we had decided to go to Pittsburgh a day in advance of surgery. My sweet cousin gave us her apartment near the hospital for the night. We already knew that surgery day would be a long one with the expectation of going home afterwards. Everything was on time and ran like a well oiled machine. I was very much coherent for the nerve block procedure, but they pushed some happy meds in the midst of it to take the edge off. Sometimes I wonder if anesthesia meds are given sooner for the chatty patients...I never feel like I get to finish my sentence before I zonk out...oh well...I'll try harder next time. 😜 My surgical oncologist was able to successfully do the mastectomy, maintain good blood flow through my spared skin tissue, and perform a sentinel node biopsy. The sentinel node biopsy is done using a blue dye to find the pathways to the 2 closest nodes to the tumor, this is a precautionary step to assure us that the cancer hasn't spread. All the tissue was then sent off to pathology, my plastic surgeon placed the expanders, 3 drains were inserted, and they lifted me out of my 3.5 hour snooze.

I remember seeing my crazy looking alien boobs for the first time–I was so happy to see that things had gone as planned. There is certainly a small amount of worry going into any procedure that the risks might become a reality. I can also imagine how a lot of women might experience sadness, remorse, or disbelief in that "first look", but I can only sum up my feelings as being overwhelmingly relieved. We were shown how to care for the drains, reviewed other home care needs, and discussed contact information should any questions or issues come up. I was able to eat and get changed. Thankfully, I still had my IV; I've never had an issue with anesthesia before, but I was then slammed with a wave of nausea. They were able to push some meds and I rested in the dark for a bit. Post-op is a weird time, guys. You're present, but not. Coherent, yet blacked out...it definitely takes some time to escape the funk. I slept for most of the 2 hour drive home, with the exception of the Chic-fil-A drive-thru. I definitely couldn't pass up some nuggets. My mom was at our house when we got home to help me create a medication chart, get settled in, and witness me eat chicken nuggets like a savage. I set my alarms to stay up on the pain management...and crashed. It was time to start healing while we waited the next 13 days for pathology.

Head over to my Resources Page for my "Mastectomy Must-Haves". While there are many, many other products on the market, these are the only ones I found to be necessary.

Here's a visual of a tissue expander if you'd really like to imagine the extra layer of comfort all the tabs offer (that's how it's sutured to the chest wall). The center area is a metal port that can be located via magnet through the skin for saline fills (expansion). Below that is a picture just a few days post-op, right before a shower.