Reconstruction – Take One

After a summer of care-free fun with my family, the school year was underway. I was ready to tackle what I thought would be my last surgery on my breast cancer journey. With excitement and anticipation I met with my plastic surgeon to set a date.

My plastic surgeon explained the process. My reconstruction surgery would entail swapping out the expanders for the final implants. Then he would do fat grafting and relocate the fat to my breasts. The grafted fat makes the final appearance of the breasts better.

With breast reconstruction, there is no breast tissue. The only tissue over the implants are the muscle, the skin and the grafted fat. Not all the grafted fat will take either. It can be reabsorbed by the body.

That said, he warned me I would still be able to see ripples and the contours of the implants. This occurrence is unique to reconstruction. It doesn’t occur with breast augmentation because of the overlying breast tissue.

My husband asked the pertinent question – how do you graft fat? Great question! The answer – liposuction. Really?! We both wondered why he didn’t just come out and say that to start. We were both somewhat familiar with liposuction. Fat grafting sounded technical and complicated.

My surgeon examined me to decide the source of the fat grafting. I don’t care how fit you are, having a doctor grab at every pocket of fat is not a confidence or self-esteem booster. He assured me my stomach would provide enough fat.

Then he did it. He stuck his finger in my belly button. He pushed hard and to an internal depth I didn’t know possible. Ouch! He nodded his head – you have an umbilical hernia. What?! That’s why my belly button looked a little different after three kids?

He explained it wasn’t an issue, but he would have to avoid the hernia with fat grafting. Otherwise he could inadvertently suction through the hernia. Hindsight is always 20/20. Looking back I wish He had recommended I fix the hernia first, then do reconstruction, but I am getting ahead of myself.

I asked him if the fat grafting would make my stomach look weird. He immediately assured me anything he did would only improve the appearance of my stomach.

If you have read my blog and my other experiences along my breast cancer journey, you know I am the self-proclaimed queen of TMI. So, here I go again. During my pre-surgery visit I asked my plastic surgeon about something that had occurred during expansions. I never thought about this before, and why would I, but we had no control over how my skin stretched during expansions.

I had chosen a nipple sparing mastectomy. Thanks to necrosis, that dream was crushed on one breast, but not the other. However, as I had expansions the side where my nipple was spared stretched, but the stretching favored one side. This meant my nipple didn’t move. Instead it remained off-center toward the center of my chest.

I asked my surgeon if he could fix it. He began pushing and stretching my skin and assured me he could force it over in surgery. He forewarned me it would probably still not be perfectly centered, but he was confident he could manipulate and force it into a better position.

Believe it or not, I was approaching 6 months post-mastectomy. I had a 6-month follow-up with my breast surgeon. My Breast Surgeon performs two types of surgeries – breast and hernia. A weird combination, but exactly what I needed.

Thus I was able to discuss my hernia with her at my 6-month follow-up appointment. She agreed with my plastic surgeon that I had a hernia, but it was minor. She told me we could schedule it once I healed from reconstruction. Again, I wish she had said – let’s fix this first.

I had enough surgeries in the past year to have a preferred day, time & facility. My plastic surgeon accommodated my requests. I preferred Friday, first thing in the morning at a specific hospital. Fridays were easy for my husband to take off from work. The weekend allowed for two additional recovery days without the need for him to take off more work too.

I prefer first thing in the morning to get it over with and to have the minimum amount of time without food. I like to eat. I typically don’t wake up too hungry but let me just say if I don’t eat after a certain point – I get hangry. I could never make it as an anorexic nor would I want to. I like to eat.

The day of surgery I was not nervous. I was optimistic and excited. I was excited by the prospect of being done. Only a hernia repair on the horizon and then no more surgeries. I looked forward to my permanent implants and their more natural feel. I would not miss my rock-hard expanders nor the occasional bump that felt like getting hit in the chest with a brick – no joke.

I met with all the usual suspects pre-surgery – nurses, anesthesiologist, and my plastic surgeon. He drew on my chest pre-surgery with his sharpie. A line down the center of my chest, lines across the top and bottom of my breasts, and he circled every area where he planned to graft fat. Guides for himself later.

Surgery went well. I left the hospital in a surgical bra and a compression band around my waist. Following my mastectomy I had been a little nervous about my recovery from this surgery. Afterall, he reopened the same incisions as the initial mastectomy.

Much to my surprise in the days and weeks that followed I had very little chest pain. I owe that one to nerve damage. The aftermath of the fat grafting was different story.

Let me just be honest – I felt like I lost a violent fight with the liposuction machine.   I looked like I had lost a fight with a liposuction machine – bruises and all.  I will spare you the details with photos, but my stomach was black and blue!  Questions of why anyone would voluntarily subject themselves to this kind of procedure and pain repeated in my mind.

I spent all day reclined with an ice pack on my stomach. I guess I should probably mention again too – I don’t really do pain meds. I prefer lying lifeless on ice to the side effects of pain meds.

As my body healed, I noticed what I wished now I could have avoided – unevenness.  Remember the hernia?  My plastic surgeon avoided that area during fat grafting.  Afterward I could clearly see the areas he avoided. My stomach was flat everywhere except for an extra layer of fat around my belly button. The edges of this area were neither even nor symmetrical. It was misshaped, an indent here a protrusion there.

My pre-reconstruction stomach

My husband even commented – after everything you have been through, the last thing I expect was for your stomach to be messed up. He was referring to my breast cancer and the surgeries, but I have had three babies.  No c-sections. Somehow, I had miraculously retained my abs. Then Breast Reconstruction messed them up. Who would have thought?

My post-reconstruction tummy.  I know I am wet here, but you can clearly see the shadows from the outline of the fat-grafting.

I know I am cancer free and no risk in the future.  It seems petty, but I would be lying if I didn’t admit my new stomach really bummed me out.  My plastic surgeon had assured me anything he did would improve the appearance. After round one of reconstruction, that was not true.

Enough about my stomach and the fat grafting, what about my chest?! Afterall, this was breast reconstruction surgery. Even with the disappointment of my round one recontruction post-fat-grafted stomach, I love my new chest!  My chest is perky and perfect with and without a bra.  With everything I have been through it looks amazing!

My plastic surgeon was able to force my off-centered nipple into a more central location. My expanders had been surprisingly and oddly far apart on my chest. He was also able to relocate both implants to be at least half that distance apart, much more natural in appearance. In fact overall, the results of this surgery were two natural looking breasts.

I cannot believe how my chest looked post-mastectomy compared to post-reconstruction. Day and night! It truly is amazing what is possible with modern medicine. I am so grateful reconstruction is possible. A double mastectomy is essentially an amputation. The grief of this loss is real. I felt it. Yet with breast reconstruction, I feel whole again. What a blessing!