Sunday, September 28, 2014

Breast Reconstruction 101

I have been on a learning curve regarding breast cancer and breast reconstruction.  I still don't know much about it all, but I do know a lot more now than I did a few months ago!  

I've learned that there are several options on how to go about breast reconstruction after a mastectomy.   There are pros and cons to each option that you have to research and take into consideration while making the decision.  The three main options are no breast reconstruction, tissue transfer, and breast implants.  Here is a break-down on each option and my thoughts and experiences with each one so far: 

1.  No breast reconstruction...just heal from the mastectomy and you are good to go!  The main cons of this option are aesthetics, being able to fit into your clothes properly, and feeling "normal" again.  There is a part of me that can really appreciate this option.  I'm all for feeling comfortable and care-free.  Still though, I never really considered this option for myself.  I think that at this age and stage of my life I will feel more settled if I can get back to as close to normal as possible.  I know that if I HAD to take this option, I could do it!  One of the important lessons I have learned over the years is that God gives you the grace to do what you need to do in life!  So, I know that if I had to, God would give me that grace!  As a matter of fact, He already has!  Until the reconstruction is completed you are left in that in-between stage which is basically the same condition as not having had breast reconstruction.  I've been living like this for 2 months so far and I am fine with it.  I do have to think twice about the clothes I put on but overall, it's really not that bad!  Nevertheless, I am thankful that I don't have to stay this way!

2. Tissue transfer.  This option was actually my first choice.  What they do is take your own tissue from another part of your body and they use it to form new breasts.  It's kind of like a skin graft but it is the fat and skin tissues that they use.  This requires microsurgery where they reconnect the blood vessels and have to keep the tissue alive in order for it to graft in. The thing is that you have to have enough excess fat somewhere on your body to be able to borrow from.  Usually they use the fat tissue from the belly, back or butt.  In my case, I really don't have any excess fat in any of those areas.  Oh, don't get me wrong, I have excess fat!  It's just not in the right place they need it to be in to be able to use it.  In rare cases they can use the thigh tissue and my doctor was willing to try.  Oh, I thought this was going to be the silver lining around this big dark cloud!  I thought to myself, "Do I dare hope that they can get rid of these saddle bags of mine and actually put them to good use?"  How many times have I jokingly said that I wished my saddlebags could be transferred north?! Honestly, I think I was more excited about NOT having saddle bags than I was about having nice boobs!!  

The pros to this option are of course that you are using your own tissue and not foreign objects to reconstruct the breasts, the result is softer and more natural, and there is not much risk of having complications down the road.  However the cons are that the chances of having complications early on are much higher and the recuperation process is much longer.  If the blood supply isn't successfully reestablished then the tissue will die and you will be back to square one. So it's tricky!  

I read all kinds of testimonies on-line from women who have used these different options.  The problem is that you will always find some people who had great experiences and others who had horrible how do you know what to do?  Well, I was feeling a bit torn about it because I had been in contact with one lady who had such a horrible experience with it and so totally regretted having chosen this option, that it did sober me up a bit from my "no-more-saddle-bags high".  However, I still felt like I wanted to go forward with it.  

So what do you do when you aren't sure what to do and it's a pretty major decision?  Well, what I do is I ask God to intervene!!  AND HE DID!!  I constantly asked the Lord to open and close the doors according to what would be in my best interest.  If I could successfully have the tissue transfer, that would be my first choice.  But, if that was going to wind up being a nightmare like it had been for that other woman, then "PLEASE intervene and close that door or in some way please, God, show me that I should not go through with it."  Nevertheless, I had a green light from my doctor to go forward with the plan and I felt peace about going forward with it.  

Then one day, out of the blue, I received a phone call from my plastic surgeon telling me that, after careful consideration and conferring with other plastic surgeons, she decided that the tissue transfer was NOT in my best interest and that the risk of having life-altering side-effects was too high to warrant the surgery.  Her main concern was that she would have to take out some of the thigh muscle which could then affect the use of my legs in the future.  So GOD CLOSED THE DOOR!!  And I just thanked Him for so GRACIOUSLY INTERVENING on my behalf!!  Ever since the day I got that phone call, I never looked back.

3.  Expanders & Implants.  Most people are familiar with the notion of implants, although when most people think of breast implants they think of women who have had their breasts enlarged with implants.  It is NOT the same thing!  When you have your breasts enlarged you still have all of your natural tissue; they just push it out and up with the implants.  But in the case of a mastectomy they actually take out all of your breast tissue and you are only left with skin and muscle.  If they just stick in an implant, there is nothing to hold it in place.  It would just slide all around underneath the skin.  Not pretty!!  So, what they have to do is open up the pectoral muscles and insert what they call an expander, which is kind of like an empty implant.  Once you heal, they start the expansion process which entails going to the doctor on a regular basis (usually weekly or bi-weekly) and they inject small amounts of saline solution into the expanders each time.  So, little by little, over time, the expanders are getting bigger and stretching the muscle and the skin and forming a pocket inside the muscle.  Once everything is stretched out enough, they take out the expander and put the new implant into the little pocket that was formed and voila, there you have your new boobies!  Well, something like that!

Since the tissue transfer wasn't an option for me anymore, this became the Plan B.  On August 28th I had the double mastectomy and the expanders inserted and now I am just waiting to heal so that I can begin the expansion process.  The cons of the implant option are the possibility of complications down the road.  The implants can leak, they can shift and you can also have something called capsular contractures.  This is the main reason why the tissue transfer was my first option.

If anyone reading this wants to learn more about this whole process I would recommend watching this series of videos on YouTube by a woman who video-blogged her whole 4 year ordeal with breast reconstruction.


Susan Radder said...

I am so inspired by your candidness regarding this entire process!! It is so refreshing & I so admire it! Keeping you in my prayers that God will accomplish great things through this journey and you will know His guidance each step of the way!!! Love you!!!

Karen Silva said...

Thanks so much, Sue!! I appreciate your encouragement because sometimes I do feel the temptation to keep things "private" but then I think..."Why?!" So I take the plunge and just put it all out there! I have to say, even though sometimes it is hard at first, in the end it does feel freeing to be transparent. :)