Goldilocks and the three boobs

One of my friends recently asked how I was getting along with my new boob.  To be honest, I haven’t given it that much thought over the last couple of months.  So much has happened in such a short period of time.  When I was diagnosed with breast cancer in June this year I was offered three options: wire-guided lumpectomy, mastectomy or bi-lateral mastectomy.  The long history of early onset, aggressive breast cancer in my family beggars belief so I was initially of the view that bilateral mastectomy was the only way to forward. I simply didn’t want to provide my body with any further opportunities to let me down.  I’d seen that happen to my Mother and my Aunt and they both died before reaching the age of 50 – no age at all.  Although bilateral mastectomy with immediate reconstruction is a long and complex operation, leaving any unnecessary opportunities for the cancer to return was my main concern.

As more information about the tumour came to light through histology, MRI  and focused ultrasound scans the importance of having it removed, recovering quickly and progressing to chemotherapy took centre stage. I was warned that by opting for bilateral mastectomy, I faced a 20 – 25% risk of developing an infection in the left, healthy side since surgery itself presents an infection risk and immediate reconstruction adds extra complications.  I was given the chance to go away and think about the options over an early July weekend.  I thought long and hard.  The possibility that undetected cancer might be lurking in my seemingly healthy breast worried me a good deal. On the other hand, facing a potentially significant delay in my adjuvant treatment due to any unnecessary infection made me very nervous. I also wondered what kind of mess my chest and my mind would be in if an infection occurred and seriously damaged the reconstruction. In the end the hard facts –  my tumour was very aggressive, hormone receptor negative, HER2+ and here – made me opt for mastectomy, not bilateral mastectomy.  I worked on the basis that I needed to deal with the cancer we knew about and any other cancer that might be lurking around would be taken care of with chemotherapy.

But it doesn’t end here, Goldilocks had more choices to make.  As well as deciding which amputation to have – mastectomy is amputation of the breast – I had to decide which reconstruction to have.  Again I was presented with three options: Diep flap, Latimus dorsi flap or silicon.   I’d always thought of silicon breasts as unnatural and awkward and I didn’t like the thought of foreign materials sitting inside my body. I discounted this option almost immediately.  I was advised Latimus dorsi flap was a fairly complex procedure that would involve moving the Latimus dorsi muscle from my back through a tunnel under my arm and around to my chest. This process would produce a more natural result but could leave me with a weakness in my back and visible scars on my back and front.  Similarly, the Diep flap would be a long and complex surgery moving fat and its supporting blood supply from my abdomen up to my chest.  There would be a long scar across my stomach as well as the scar on my chest but I would end up with a flat tummy and a new breast if I chose this procedure.   Decisions, decisions.

In spite of the complexity and the scale of the operation, I told my consultant I wanted Diep flap.  I was prepared to put myself through extreme make-over style surgery.  But my ideas on my ideal new boob were short-lived because my consultant told me there was insufficient fat on my abdomen to make the new breast.  Fec! Mentally I’d prepared myself for this leviathan of a procedure but stupidly I hadn’t  considered that I might need a plan B. Double-fec!  I needed to give the consultant an answer and I only had two remaining choices. Latimus dorsi with a potential weakening of my back or silicon and the necessary weakening of my resolve.   I chose silicon.  The option I most wanted to avoid. The one I thought would leave me looking unnatural and awkward. The option that meant I would have something foreign inside me as a long-term reminder of my run-in with breast cancer.

So my friend’s question “how are you getting along with your new boob?” is a timely one.

My new boob and I get along just fine, in fact I love my new boob!  I love its shape, its size, its position.  I love the fact that I have one very faint scar instead of multiple scars all over my body.  I love that it will never head south, it’s self-supporting and it doesn’t try jumping out of my T-shirt when I go for a run.  The option I least wanted to pursue has turned out to be the perfect option.  I’m so immensely grateful to my oncoplastic surgeon who is as much an artist as she is a doctor. We’ve already agreed to make another date once chemo is through.  I’ll gladly let her take the other breast in exchange for a perfect silicon replacement.  It’s the next part of my mission to kick cancer into touch.

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7 thoughts on “Goldilocks and the three boobs

  1. I am so glad that you are happy with your decision. In my work as a child psychologist, I often remind kids that there’s often “more than one good solution to a problem.” Your original solution didn’t pan out but you found another one that did. Even after losing 27 pounds since early May, I still have the gift of belly fat. I have TRAM surgery scheduled for March 11. After having had 6 surgeries since June 27th (wire guided lumpectomy followed by lumpectomy #2 followed by a right mastectomy and a few plastic surgeries), I am happy for the break.

    Take care!

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    • You’ve been through it on the surgery front 😦 I hope you can enjoy the period before March and keep in touch, I will be sending positive thoughts for you all the way to TRAM and beyond. Take care too.

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      • Thanks so much. Too many surgeries but no chemo. I hope you find yourself on the other side of that experience very soon. I read “Emperor of All Maladies” right before my mastectomy in August. I was amazed and grateful for the advances in breast cancer treatment in the last 10-20 years. I know it would nice to never get sick at all, but like you, I try my best to live in the full spectrum of life.

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    • I couldn’t get past it either. I’ve been looking at it for 19 years (since my son arrived) and I was convinced there was plenty – I wasn’t after Dolly Parton-esque proportions. Chemo seems to have eaten up my excess flab though so it’s not all bad 🙂

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  2. That sounds really good!
    I opted for bilateral mastectomy, for the same reasons, mother and aunt having died of breast cancer (not like yours – the not-too-aggressive, estrogen receptive version). I couldn’t face being messed up elsewhere on my body, so went for silicon. ‘T’aint great! I’ve got a great cleavage, but… elsewhere, badly formed Cornish pasties come to mind.
    I thought it was something I would just have to put up with, but now you’ve made me all discontented! I was robbed! (Actually, I’m not too bothered as I’ve always regarded myself as rather more useful than ornamental.)
    My original cancer was so small, and the surgery so radical, that I didn’t need follow-up radiotherapy or chemo. But I got a nasty surprise this year, 10 years on, when the cancer came back. I thought the mastectomy had removed that possibility. I didn’t realise that the same cancer could turn up as secondaries without another ‘primary’ tumour in the breast. I wish I’d understood that. I would have taken more care of myself and perhaps put off the return for a few more years.
    Perhaps I would have been better off keeping the good breast, so that I would have continued having mammograms, and caught the returning cancer earlier? Just a thought.
    I’m still very jealous of that great boob of yours!

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    • I think I was lucky with my surgeon. She used acellular dermal matrix (pig intestine) to create the bottom part of the pocket for my blob of silicon so it has a natural curve to it. It’s a very new technique so might not have been available when you had your bilateral 😦 Even though I love the new boob, I’m in the practical not pretty camp, have always been a bit of a tom boy! If my hair ever comes back I’m still ginger so never going to be Claudia Schiffer. They told me bilateral reduces the risk it could come back in the breast to 10-15% from something like 30%. (Breast tissue is in places you just don’t imagine – all the way up to your collar bone, out to your armpit and across to your sternum so even with mastectomy it’s impossible to get rid of it all. My initial tumour didn’t show up on mammogram either). Without chemo they said I could guarantee to see it’s ugly face again in breast tissue or elsewhere within a year. It’s the same type as Bernie Nolan’s so has a nasty habit of metastising early on. I really wish they’d explained to you about how devious this disease is. I’m sure they knew about mets as you had your first experience just a few years after I lost my Mum and they knew about it in 1996. She had radio but not chemo first time round, we still wish she’d been offered chemo as there was a chance it might have prevented her mets too. My consultant said they really don’t know who among us will get secondaries and who will stay disease free. Although they use the 5 year marker, breast cancer can come back at anytime – even 20 years later. It’s why I get a little annoyed when you see reports about people being “cured” because we’re never really cured, there’s always the chance it will show up again and there seems to be very limited understanding of metastatic breast cancer or what that means for the women who have it. On the positive side of things, we both know diet and exercise can make a big difference and I think that applies at any stage so we have to fight on all fronts – food and medicine.

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