Reconstruction surgery is an option some chose to do after a mastectomy. I have looked at a number of options and have decided on immediate reconstruction with implants using Alloderm. This process will begin the day of my bi-lateral mastectomy. Once my breast Dr. is finished removing all the tissue, my reconstruction Dr. will come in and begin his work. The entire process could go as long as 6 hours, 3 hours for mastectomy and 3 hours for Reconstruction. My date is March 10th. My surgery time has been moved up. It is now stating at 7:30am. I report to the hospital at 6:00am.
During this process I looked at 2 possible options for reconstruction. One being the DIEP Flap and the other with an implant using Alloderm.
The DIEP flap (deep inferior epigastric perforator) is a tissue flap procedure that uses fat and skin from your tummy to create a new breast mound. You need a very specialized surgeon to perform this. It is very long and complicated surgery approx 10-12 hrs. But essentially what happens is the tissue removed from your belly is moved to your breast area. Then an artery and blood vessels from the donated tissue are connected to artery's and blood vessels in your breast area. (very general description here-consult your Dr. for detail).
So all of you know, my Dr. did say I had enough tissue on my belly to allow for this type of surgery...in another words I have a chubby belly. Hey thanks Doc, just what I want to hear!
I am not opting for this surgery. Why? 1) There are no Dr.'s in my area that do this surgery enough to make me feel comfortable. 2) I don't want to delay and have a 2nd surgery since if this was my option I would have to wait for a few weeks before starting this since I would have to use a Dr. outside this area. 3) The recovery is much harder and longer. 4) The possibly of the tissue not "living" or getting enough blood circulation is a concern. 5) I have used up my "last resort" if things go wrong with my reconstruction. Meaning if I have implants done and something goes wrong, I can still use this option as a back up for future reconstruction. 6) It creates one more surgery opening/scar on me that needs to heal.
I have opted to do implant reconstruction. After my breast Dr. finishes, Dr. Wotowic will begin his work. He will remove my existing implants-surprise people I do have implants-told you that you would learn new stuff about me. He will be using the skin that has been saved from my breast area (think uninflated balloon) and reconstruct my breast on both sides. One question I have for him is, can he save the areola? I will have the nipple removed but the aerola is just pigmented skin. Apparently this can be saved to help in the reconstruction to create a real looking breast. Once I find this out, I'll let you know since I'm sure your all just as curious as I am.
Now this next part I am still unclear. The Dr. has suggested that I am a great candidate for a product called Alloderm. Instead of having an expander placed in my breast and then visiting the Dr. every few weeks to have an injection to expand my breast out to the size I want, I can opt for this procedure. This is a piece of tissue that is placed on the underside of my breast that is like an expander or flap of skin. The tissue material, known as AlloDerm allograft comes from donor banks. All the cells are removed, leaving just a scaffolding matrix. The AlloDerm is recognized by the body and it repopulates with your OWN dermal cells. The procedure has been used for over 5 years now. In breast reconstruction, the AlloDerm is used as a sling to hold the implant. It lowers the health risks of scarring, capsular contracture (hardening), and implant extrusion-the rippling you might see. Cosmetically, the use of AlloDerm eliminates implant shifting and rippling, and allows the surgeon to create a natural "hang" at the bottom, or fold. Also, the filled in AlloDerm serves as a barrier between the implant and the skin, so the restored breast is more natural to the touch-always looking out for the needs of my husband. Since space is created internally, the need for expanders is eliminated in most cases. My concern is the possibly of infectious disease coming from the tissue since it is tissue from a donor i.e cadaver. Everything I have read about it says more then likely not. Precautions are put in place to prevent this. My other question is if my body starts to generate my own cells to create tissue, could these cells ever become cancerous? All questions to ask the good Dr.
So, typically I would go into the Dr.'s office every few weeks after the surgery and they will inject saline into the expander implants and slowly expand my skin to the desired size I would like to be. Once I reach the size I want to be, I either change to saline or silicone implants. With the Alloderm I might be able to bypass this step. Again, I'm not too clear on this and will be asking on my follow up appointment-since it is kinda a big deal.
Why did I pick this implant option? 1) I have the pocket there because of my current implants-less stress to my body. 2) Recovery much faster 3) Can be done at the same time as my mastectomy. 4) Both Dr.'s work with each other on a regular basis and are familiar with each other's procedure's.
5) They are the Dr.'s who will be performing the surgery on me not an intern, not a resident.
This last reason, having the Dr. perform the surgery, seems like a no brainer. The possibility I can run into if I chose to go to a larger facility is that it is not the Dr. that performs the surgery. He might be observing but not the actual one cutting. If I'm doing all this, I want to make sure the Dr. who is familiar with everything is doing the work. So ask and tell your Dr. what you want. I sometimes forget I am the one in control.
I had wondered about my reconstruction Dr. so I made a few calls, talked to a few different people. Everyone's reaction up to this point has been, he is great. Well, let's hope so. I had the chance to talk to a Dr. who was part of my children's ski team. She is a breast Dr. based out of the Palo Alto area. Jocelyn was kind enough to talk to me and answer a number of questions I had about the various procedures even though she herself does not do reconstruction surgery. Everything she mentioned that should be done was being done by my Dr. She also reaffirmed my decision to stay at San Ramon for surgery and going the implant route was a better decision.
So I'm feeling pretty confident on my decisions so far. I only have 3 weeks left before the surgery. I still will find myself if I have too much free time, dwelling on things. I begin to wonder that ache I feel in my arm pit, is that the cancer spreading or I've been having a lot of headaches, does that mean something. This is all mental but there still is that fear knowing that there is cancer in me right now and I don't know what it is doing. I am ready to get this over with but I am terrified about doing the surgery.
There will be drains in place that will have tubes that are connected to collection vessels that are about the size of lemons that will hang from both sides of my body. I will have to drain and measure the fluid every 12 hours-YUCK! I will spend a few nights in the hospital and then head home. The first week supposedly I will be out of it and then 2nd week things improve. I have been told the first week I really will not be able to move my arms. I wonder how will I eat, bath, and worse, take care of my bodily functions. It was enough having my husband help me after child birth but this brings it to a whole new level of needing help. My idea of being sexy and attractive just goes right out the door with this one. I might be able to drive after the 2nd week but I will not be able to much of anything.
I am happy to say, we are going to become owners of a Lazy Boy recliner this weekend. I have read having one makes it more tolerable to sleep at night since you sit in an upright position somewhat. i know the boys will love it after I'm done with it...it's 2nd life will be a gaming chair.
I just am hoping that nothing goes wrong, infection, rejection of tissue, or whatever. I want to get his over with.
Keep me company as I travel thru my journey facing breast cancer again.
Why would anyone want to read about someone else's problem when you have plenty of your own? Maybe one day a loved one, a friend, or you will be diagnosed with breast cancer. My blog might offer insite into cancer resources, thoughts, questions to ask, or guidance in helping you deal with this disease. These are my experiences and suggestions. Every breast cancer is different. If you are touched by breast cancer, be sure to consult your Dr. for direction in treatment.
I equate my blog to the emergency evacuation instruction the flight attendants do before you take off on an airplane. Nobody pays attention to them but when your plane is about to crash you think, "sh*t, why didn't I pay more attention to them? Which color cord do I pull first again?" We have so many things going on in our lives that one more thing to dwell on that doesn't apply to us right now may not be important but when it does, we wish we would have paid attention.
My blog is something you might read a couple times or maybe follow. Hopefully you gain some knowledge about breast cancer, in particular, Invasive Lobular Carcinoma (ILC). It is the 2nd most common type of invasive breast cancer however it only accounts for approx. 10% of all invasive breast cancers. It is the silent breast cancer. It is generally not detected with a mammo but rather an ultrasound. Invasive Lobular Carcinoma (ILC) is what I have been diagnosed with. My suggestion to every woman who is of mammo age insist on an ultrasound with your mammos.
UPDATE 3/2011
I have had my bilaterial mastectomy and I am recovering. ILC is a sneaky cancer as I said above. My various Dr.'s here and at UCSF confirmed the size of my tumor should be between 2.5cm-3.5cm with possibilty but not most likely, 7cm. After my surgery, my tumor was confirmed to be 11cm. My Dr.'s are very knowledgeable and are on top of things. This is simply the truth about ILC. I had mammos every 6 months, ultra sounds, and MRI's. With all of these, it was not picked up until 1/2011. The good news, if you can call it that, only 1 sentinel node out of 2 has micromastic findings and 5 aux. nodes were negative.
Be sure to start my adventure from the blog history on the right. I have tried to bold points to make it easier to extract the important information. If there is anything you get out of this blog, refer to my Dr.'s listed below if you know someone who has been diagnosed with breast cancer in the East Bay. These Dr.'s; Dr. Gottlieb, Dr. Wotowic, and Dr. Sherman are my 3 musketeers....all for 1 and 1 for all!
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