Breast Reconstruction is a complicated thing. Especially when you are small in stature. Especially when your scars misbehave. Especially when your name is Amy.
It is completely different than Breast Augmentation, where one is just getting implants.
The difference with reconstruction is that there is no tissue to work with. Breast tissue is taken during a mastectomy, and what is left is chest muscle and skin.
I have history of having issues with my reconstruction. If you have been reading this blog and my cancer story awhile, you already know this. I started out very happy with reconstruction surgery results right after my mastectomy. But, then things settled and my right implant decided to have some fun and slide down a bit. I had that fixed August 2011 and all was well–for a short while.
Enter keloids. A keloid is an over abundance of scaring. You know the singer Seal? He has a beautiful face, but also is known for the keloids that have formed on his face.
{keloid on someone’s knee. Before treatment and after treatment pics}
I have history of keloids. We have figured out that when I am cut twice in the same spot (like my port scar–once to put it in, once to take it out) I form a keloid.
This happened after my plastic surgeon fixed my slipping right implant. The incision he made was to the right of the implant, toward my armpit area. About an inch of the cut was an area that was already cut once by the previous surgery, and yep, it formed a keloid.
Keloids are treated by steroid shots. If left untreated, they will just continue to form scar tissue. Keloids are stubborn, burn, itch and are not pretty or fun. Speaking of burning, the steroid shots that treat keloids burn like heck, and are not fun either. It takes a lot of courage to walk into a doctors office knowing you are going to get burned. Yowza it hurts!
I had the keloid on my right side treated with steroids. I was hopeful it would help. I’ve had success with steroid shots in the past with my stomach scar from Melanoma (2 time cancer survivor here!) and with my port scar.
But… no such luck. Well, maybe too much luck. It worked so well that it thinned the skin out too much in that area. Over the last 4 months we have been watching it closely, and it has been no fun. The skin is so thin to the right of my implant that it looks like someone punched me in the boob. No joke. Thin skin = blood vessels show through, and it looks permanently black and blue and just simply yuck. It has started giving me pain when I sleep on my side. Doc looked at it and said “if that breaks open we will have a mess on our hands. Time to get it fixed.” Yes…time for more surgery.
Is this too long and detailed for you yet? There is more. Much more. If you are not a details person feel free to stop reading here, and just know that surgery is October 24.
One positive about new implants is that there is a new type of implant that the FDA just approved in the state of Nebraska. It is called Highly Cohesive Breast Implants, but in breast cancer reconstruction world we like to call them “gummy bear” implants.
Before there were only 2 types of implants to choose from:
~Saline =liquid.
~Silicone = gel (this is what I currently have)
And now, there are Highly Cohesive Breast Implant. They are still silicone but when you cut through them it remains a solid, like cutting through a gummy bear.
I will specifically be having
Natrelle 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants.
Pros for gummys:
~The results are beautiful and more natural shaped…like a teardrop type shape compared to just round.
~They are slightly textured on the outside which helps keep them in place, and we all know I want that..no more slipping!
~They won’t leak like saline and silicone tend to do.
~They have been really well received specifically by breast cancer survivors.
~They don’t ripple like saline and silicone do, especially important when working with the thin skin and no tissue of breast cancer survivors.
~They feel very natural.
Highly Cohesive Vs Regular Silicone
Cons:
You are limited in size depending on how wide you measure from armpit to armpit.
I only measure 10 1/2 inches across from armpit to armpit, so my visions of a bit more cleavage was not going to happen…or so I thought.
I have visited my Plastic Surgeon a few times talking out my complicated case.
Here is what makes me a very hard case:
~I keloid
~I have no breast tissue to work with.
~I am very small, no fat in the area.
~I tend to form ripples due to how little fat I have in the area.
~To the sides of my implants toward the armpits there is almost a hollow area, it literally is skin and bone. I can feel and see my ribs right there. A typical round implant does not fill that area in at all.
~Above my implants I have tissue. You actually grow breast tissue all the way up to your collar bone. They cut out my breast tissue up to a certain point, and again, since I have no fat it is obvious where they stopped cutting and where the tissue starts. Once my implants settled, it looks like collar bone, then tissue, then no tissue then round implant. Not natural.
These issues caused my Dr. to stare at me from across his big desk and look deep in thought. It was almost a humorous moment. There were headless photos of my naked chest spread out all over said desk, taken in 3-4 month increments over the past 3 years, and he is just tapping his pen with an occasional “hmm” deep in thought. I did not like looking at the photos. I especially did not like how great the reconstruction looked 3 years ago, before I had a runaway implant and before keloids. It was either a laugh or cry moment. I tried to laugh, but my heart was crying and I tried not to look down at those photos on his desk. He finally told me his plan.
He would go in, cut out the thinned skin, add some Alloderm (cadaver tissue that has all the dna removed from it–blech) under the skin in my cleavage area to address rippling. He would take fat from my belly (free lipo baby!) and fill in the “dented” area to the side of my implants by my armpits where you can see my ribs. He felt the new tear drop shape of the new implants would take care of and fill the area above the implants where tissue meets no tissue.
He told me my implants would be the same size I have now or maybe smaller.
Smaller?! That made me sad.
If I’m going to go through another surgery I was at least hoping for a bit more cleavage and va-va-voom!
So you would think the story stops here…it doesn’t.
I saw Dr. on a Friday. I was called by him personally on Monday morning.
“Amy, I’ve been thinking about you and your implants all weekend.”
(a sentence you would only want to hear from your doctor or maybe husband)
He had come up with a whole new plan.
Here it is:
~2 surgeries instead of one. One for expanders. Second to replace expanders with implants.
~Adding expanders –Why? He is worried that after getting rid of the area where the skin thinned out so much, he would not have enough left to do a satisfactory surgery. It gives him much more control as a surgeon to do his art and gives me a bit of control in figuring out what size I would want.
~by using expanders, we can fit a larger implant in, which should fill in both the upper rib area by my armpits where I am skin and bone AND where non-tissue meets tissue above my implants. No free lipo with this plan, but also no new scars in stomach area which could keloid.
~by using expanders we can fit a larger implant. That was worth saying twice. {grin} We will still be using the Natrelle 410 Highly Cohesive Anatomically Shaped Silicone-Filled Breast Implants.
What this means:
~surgery October 24 to add expanders. (would you believe I scheduled surgery around our yearly trip to the pumpkin patch? We go the 19th, and I don’t want to miss out!)
~trips to Omaha (one hour drive) weekly to get expanders expanded.
~being slightly entertained by seeing my breasts grow every week
~4-6 weeks of expansion, depending on how quickly I expand and how big we want to go.
How I feel:
~relieved to have a plan Dr. feels good about
~taken care of by him as he thought about me and came up with the best plan
~apprehensive about 2 surgeries.
~apprehensive about the experience of expanders. I remember a fellow survivor explaining that they are hard as a tortoise shell and uncomfortable. The minute you get comfortable, it is time for more expansion.
~hopeful to have a good, va-va-voom outcome
~tough because I know I can handle it all
~scared because I have not had to go through surgery in so long. I feel out of practice! Bravery seems to come easier when I’m in survival mode. Not that I want to be in survival mode!
If you are still reading you deserve a medal. Truly.
Thank you for caring about me and my…ehem..breasts.
