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Mastectomy and reconstruction

Oct 15, 2008 - 2 comments
Tags:

painful lump

,

mastectomy

,

reconstruction

,

LD Flap

,

FNA

,

CORE BIOPSY

,

mammogram

,

invasive lobular

,

Lattisimus Dorsi

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Lattisimus dorsi Flap

,

Sentinel Lymph Node

,

Lymph node biopsy



I always described myself as being lucky but if someone had said to me, on the 18th of June 2008, that the next few months would prove to me just how lucky I am, I will have been outraged.  No one gets news like I have just had and still consider themselves lucky.  

But, the next few months did indeed prove to me that I am probably one of the luckiest people alive…

My Breast Cancer Diary

Friday, 8/2/2008

I see a locum doctor at my GP Surgery about the lump in my left breast.  He tells me the lump is nothing to worry about.  The lump feels like breast tissue and is comparable to the right breast. Despite complaining that the lump feels tender (like low grade toothache) he writes in my notes that the lump is “not tender”.  He stops short of patting me on the head and going “there, there” and sending me on my way.

Wednesday, 21/5/08

I see my own doctor about the lump.  He reassures me that it is probably nothing but since every lump has to be investigated he will refer me to a consultant for investigation.  

Thursday, 22/5/08

After speaking to my husband, I asked for a private referral to the Bath Clinic where I can be seen on the 29th but since we are on a mini second honeymoon in Budapest I opt for an appointment the following week.

Wednesday, 4/6/08

The tenderness of the lump leads the consultant to think the lump may be a cyst.  A fine needle aspiration (FNA) to draw fluid out of the mass, proves unsuccessful. The lump is solid, and I later find out, and feels gritty.  The bit of tissue he retrieves via the FNA is sent for analysis.  

He explains that a triple assessment of the mass is likely to show it to be benign, but as it is standard procedure, he arranges for a mammogram and an ultrasound-guided biopsy to be done.

Because of the FNA I have to wait a week before the core biopsy can be done.  My appointment is made for Friday the 13th!  “I hope you are not superstitious” the secretary joked.  “No”, I said, “if anything, I consider it a lucky day.

Friday, 13/6/08

Mammogram done and the clinician does the ultrasound examination and the core biopsy.  She tells me there appears to be a lump within the lump.  The whole thing measures 3.1cm x 1.6 cm.  She does the core biopsy and I am sent on my way

Wednesday, 18/6/08

The consultant delivers the verdict;  I have a grade 2 lobular cancer.  The size and position of the lump requires a mastectomy.  The prognosis is good as the lump is contained; lobular cancers are very slow growing; and, there is no reason why I should not make a full recovery.

He runs through an overview of the surgical options with me:
1. a lumpectomy is not an option – the breast, and nipple, have to be removed
2. I can have the mastectomy and the reconstruction can be done a few months later, if I choose to have one at all; or
3. the reconstruction can be done immediately following the mastectomy.

There are various reconstruction techniques but as this is not his primary field, he will have to refer me to his colleague  whose primary surgical field is breast reconstruction.

Monday, 23 June

The breast surgeon explains the nature of the cancer to me again – this time I am better equipped to take it all on board and I have my husband with me for support.

We discuss the surgical options available to me, next steps to be taken and we discuss the procedure of reconstruction in some considerable detail.

Lobular Cancers:
Difficult to spot; they don’t show up on mammograms because they do not leave tell tale chalky deposits.  It is conceivable that it has been there for a number of years and that it simply was not seen on a mammogram 2 ½ years previously.

My surgical options:
1. He will do a skin sparing mastectomy

2. The reconstruction he recommends is to take an island of skin, muscle and fat from my back (my stomach is not an option because I had previous surgery there), and, leaving the blood vessels in tact, he will swing this around, under my arm to the front where he will use it to create a new breast.  This technique, called a Lattisimus dorsi Flap, or LD Flap, had a good blood supply and failure rate is rare – he has never had a failure.  

There is not enough tissue on my back for a whole new breast so the volume will be increased with a small implant, which can be adjusted with saline to get the correct volume over time.  

Although this is extensive surgery, recovery rates are good and it is not deemed a particularly painful operation.  Loss of power in the shoulder is not expected to be noticeable.  The most significant side effect is tiredness. Recovery time for this surgery is expected to be between 6 – 12 weeks.  

3. If I required Radiotherapy, which will damage the reconstruction, he will not do the full reconstruction.  Instead a tissue expander will be used as a stand-in until he can do the reconstruction, upon completion of the radiotherapy.  “There is only one breast on each side of your back” he tells me, “and it has to have the best possible chance of success.”

Next steps:
An MRI scan of my right breast will be done because I am at an increased risk of lobular cancers – in around 10% of woman it is found on both sides, not because it spread, but that is the way it forms.

A sentinel lymph node biopsy will be done to find out if the cancer has spread to the lymph nodes.  If the sentinel lymph node is clear, I am unlikely to require Radiotherapy.

The mastectomy and the reconstruction (hopefully!) will be performed within a month

Nipple reconstruction, should I choose to proceed with it, will be done two months after the reconstruction.

Nipple tattooing, if I have the reconstruction, will be done two months after the nipple reconstruction.  

Tuesday, 1/7/08

MRI Scan and in the afternoon the pre-Assessment clinic – MRSA screening, Chest X-ray.  All clear and good.

Thursday, 10/7/08

Sentinel Lymph Node Biopsy today.  

Early morning at the nuclear medicine department at the Royal United Hospital for a radioactive injection and scan.

Afternoon, at the Bath Clinic; general anaesthetic and dye injection to identify and remove up to 4 lymph nodes.

Two lymph nodes are removed.

Friday, 11/7/08

MRI results:  No problems!  My right breast is good!

Tuesday, 15/7/08

Lymph node results – All Clear – I am getting my reconstruction!

Friday, 18/7/08

Admitted at Bath Clinic.  Surgery scheduled for early tomorrow morning.

The Surgeon comes to do his drawings on me, explains everything again and reassures me that I am in good hands.  I’ve not doubted that at any stage of this journey but it is good to hear his confidence.

I ask him for a sleeping pill to get me to sleep.

Saturday, 19/7/08

Getting dressed for surgery, thrombosis stockings – I am expected to be on the table for about 6 hours – and gown.  

I cry on the way to theatre, I cannot help myself.  The anaesthetist tells me not to worry; I am in the best possible hands.  I respond that I am not worried, I am sad.  

He does his magic and I go to sleep.

When I wake my first reaction is to look down at my breast.  It looks normal except that there is plain skin where my nipple used to be.  

A fine circular cutline shows where the nipple used to be.  This cut is covered with a transparent silicone dressing.  The surgeon said my breast will not be dressed, and being able to see it like this is better than I could have hoped for in my wildest dreams.  It is OK!

Back in my room, the nurse helps me to put on my post-surgery bra and I go back to sleep.

Sunday, 20/7/08

Breast fine, shoulder painful and my arm and fingers still very swollen.  This because they had my arm stretched out for most of the 7 hours I was being operated on.  I am encouraged to move my arm, but not higher than shoulder height.  

I am fed up with being in bed!  

Late afternoon:
The catheter is removed and my nurse brings a pillowslip so I can carry my drains, all three of them, when I get up.

Finally my bladder fills up and she helps me to the toilet.  

Later still, a physiotherapist arrives to take me for an assisted first walk down the corridor.  

Monday, 21/7/08

Swelling in my fingers is almost completely gone – after lots of gentle movements and finger wiggling the day before.  Moving about has helped a lot too.

The pain in my shoulder is subsiding.  Medication deals well with all the other aches and pains.  My back is surprisingly trouble free, considering I am sleeping on it!  The worst is the cut in my armpit but even that is manageable.

The drip in my hand is removed and I go onto oral antibiotics.  Much better.  Three drains to go and counting!

Tuesday, 22/7/08

Nothing wildly exciting.  Loads of walking – I am starting to get cabin fever – and I even managed a shower and hairwash; I am pleased I had my hair cut before the surgery – it’s a doddle to get sorted.

The first of my drains are removed.  Two to go…

Wednesday, 23/7/08

Drain number two is removed.  Richard is pleased with my progress.  The nurse changes the dressings on my back and under my arm and she waxes lyrical about how good it looks.  Must be good then!

If all goes well, I am going home tomorrow.  

Thursday, 24/7/08

Last drain removed.  I am going home.

Saturday, 26/7/08

Post surgery results consultation.  All good and he is happy with my progress and the movement in my arm.

The actual size of the cancerous part of the lump turned out to be much smaller than anticipated:  1.8cm.  They found some evidence of lymphovascular invasion but no evidence that the cancer has spread to the lymph nodes.  No need for me to have Radiotherapy!

Exercise to my arm is still restricted to no higher than shoulder height.

The results of the receptor type are still outstanding.  If the receptor is Oestrogen, I won’t need chemo.  Things are looking very good.

Saturday, 11/8/08

Consultation.

The cancer receptor is Oestrogen.  No Chemo!  I will be on Tamoxifem for the next 5 years – menopause here we come…

The consultant continues to be happy with my progress and his handiwork.  He is astounded that I have been back to the gym (just cycling and walking).  

We discuss nipple reconstruction – something I was not sure I wanted, I am strangely fascinated with my “little bum with a target on” which is what my breast looks like.  This part of my surgery can be done early October, should I wish to go ahead.

My request to go back to work is frowned upon.  He finally agrees that I can return on a part-time basis but only if I promise to “listen to my body” and not to overdo it.

Thursday, 28/8/08 am

It’s 4 weeks since my discharge from hospital and I seeing the Occupational health people at work today to “stage my return to work”.

Since I am under no pressure from my boss or colleagues to return, Occ Health Nurse and I agree that I will be in charge of my own return; starting with 2 days, 3 days, etc.  reducing and stretching my working day as I feel comfortable.

Thursday, 28/8/08 PM

Ultrasound on my right breast.  I am horrified to discover that the MRI scan picked up three lumps and biopsies have to be done.  That’s not “no problem” – I am gutted.  

This cannot be happening. I am not sure I have the strength for a second round with cancer…

Tuesday, 2/9/08

An auspicious day – I am back at work:  only 2 days this week but it feels brilliant to be useful again.

The biopsy results of my right breast comes back – all lumps benign, just simple firbroadenomas.  Life is good…!

Thursday, 9/10/08

Nipple day – Day Surgery.  

My target area is sliced and diced to form a nipple.  No local required; as expected, the area is totally without sensation.  

Friday 10/10/08

Back to the clinic to change the very bloody dressing.

Monday, 13/10/08

Dressing changed again – but it looks like it has finally stopped bleeding.  

I get a carefully worded bollocking from the nurse for being back at work.  Since I am feeling rather ragged I agree to go home and to stay quiet until I have seen the surgeon on Monday.  

Since there is no pain, I thought it would be taking the mick staying at home.  Clearly I was mistaken.  

More to follow + photos when the dressing is removed


Comments
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Avatar_m_tn
by oropallo, Sep 23, 2012
what kind of scarring is in your back from the flaps.
Do you regret doing that part. I also had abd surgery and cannot use the abdoment.
However, I am a swimmer. I swim one hour a day and live. I am 52 and never want to stop swimming.
Would this method effect that. I dont swim competitively. Just for exercise
R

Avatar_m_tn
by oropallo, Sep 23, 2012
Do you have to wear a bra after that type of reconstruction?
R

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