Mastectomy - psychology and recovery.

     Argh. I am so behind on my blog! But, hey, aren't you proud of me for taking some time to recover? OK, OK, I admit, I have pushed myself too hard a couple of times. I am trying hard to be a patient patient. Well, hard for me... My recovery has gone quite well. The Doctors are impressed, but not actually surprised since I am fit and young compared to the majority of their patients.
     I'm going to get personal here again, so if you want to skip six paragraphs...

This image from Google is pretty representative
of my scars. Not bad, huh?

     My scars are pretty awesome. On my left, under my breast, my scar measures about three inches. I have two on that side because they spared my nipples. My scar above my nipple, over where the tumor was located, is about two inches. My scar on the right side is barely two inches, and all ready fading into obscurity.
     The pathology from my surgery indicated that my Invasive Ductal Carcinoma (IDC) was surrounded by Ductal Carcinoma In Situ (DCIS). Sometimes the medical personnel try to make that sound less scary by saying the cancer was surrounded by pre-cancerous cells. They are trying to simplify the difference between the invasive cancer and the non-invasive, but they're not fooling me.
My grandmother had a double mastectomy to remove DCIS. Hers was not invasive, but still warranted removal. Anyway, treatment choices for the remaining DCIS (which is microscopic) include either radiation, or further excision. Based on my own feelings, and the recommendations from my tumor board, we are going with further excision. Dr. J, the plastic surgeon, will use the same incision line they used to remove my tumor to cut out just a little bit more tissue. The DCIS remaining was like a tail, or a feeler, extending toward my sternum. I am pleased to avoid the radiation!

     Within half an hour prior to my surgery, Dr. J. came to visit me practically skipping. He was excited that Dr. T. planned on saving my nipples! Ha! He was more excited about it than I was by far, but his enthusiasm was encouraging. I didn't really view the changes to my body until I got home, though I did pay some attention as the nurses and Doctors checked my incision sites. I ended up with bruising covering the lower half of my left breast, and a scab over my left nipple caused by a small disruption of blood supply as my body started figuring out how it was supposed to function without my breasts. I also had some skin puckering or dimples.

I had two drains, one for each side. A tube, sticking out of my body, connected to a plastic bulb shaped about like a grenade. The drains collect excess fluid to reduce swelling. Gone were the breasts that had fed four children. They had expanded and retracted so many times they were no longer perky. They were no longer full. They were so small, they were also (fortunately) not saggy. I earned those imperfections. They were mine. Looking in the mirror at home - at my skin beaten up and stretched over the expanders - I observe the new perkiness and mourn the loss. Is it weird to miss something imperfect? To trade imperfection for something most women desire - and feel like you got short-changed?
     A long time ago in my youth I was obsessed with my body image. I tried so hard to create a body that was not mine. I starved myself. It took many years before I realized why I had been sinning. During my time teaching young women in the church, I shared with them the story of my journey, and the testimony I gained about loving our bodies because they are God given. He doesn't create mistakes. I learned to accept my body and my perceived flaws because those very flaws are a gift to me from God. I no longer mocked His design. I was grateful for it. I changed my psychology. And now, my figure more accurately reflects what society says women should look like. It disturbs me.
     When I first discovered my breast cancer I was unaware of the congressional act that mandates insurance company coverage of breast reconstruction for policies which cover lumpectomy or mastectomy. I anticipated attending my classes with one breast, as I knew it would be unlikely I would be able to tolerate a prosthetic for several months after the surgery.

Mastectomy Swimsuit Fashion
I love the empowerment in these pics.

I was okay with that, but I knew it would be difficult at times, and that no matter how much I tried to 'gear myself up for it', I would mentally struggle with the implications. I was relieved to find out about the act of Congress in response to my personal situation. Upon further research, I discovered the act was passed based on research into patients' psychological well being post-mastectomy, with or without reconstruction. The evidence heavily supports healthy psychological outcomes for reconstruction, and especially for younger women. I am also grateful that each woman can choose what is right for her personal well being. I would completely support a woman of any age desiring to forego reconstruction. So why did I choose reconstruction? It's complicated. I didn't mind being small, but I have to admit, part of my self identification as a woman includes my breasts. Beyond that, I considered the effect on my family.  My husband is tremendously supportive of me making whatever decision I want regarding my own body. He wants me to be happy, and I have to speak with him at length before he expresses even the hint of an opinion. Still, he is a man, and he admits he enjoys breasts. I considered our intimacy. I thought about my children. I'm still uncertain regarding the lessons my children would have learned from either outcome, but felt strongly that my youngest ones would have had a much harder time without the reconstructive surgery. I struggle with my culture's view on women's breasts. I have for many years, but my breast cancer brings the topic to my mind often.

Are you kidding me?
That's the biggest syringe I've ever seen!

     My expanders were 'filled' for the first time today. 100 mL of saline were pumped into each side. The procedure itself was not painful, but the same places that have been causing me discomfort this week have hurt more since we left the doctor's office. It reminded me of water balloons being filled. My husband thought it simply erased some of the skin dimples and puckers that had resulted from the surgery, and didn't see any size difference. They will expand them one more time than what I feel is 'my size' so that the implants do not damage my skin. What is 'my size'? I don't know. I all ready feel more blessed by the extension of my life than I deserve. I all ready feel more perky than I would like to be. I all ready have more... fake breast (?) ... than I started out with! Does it even matter? I suspect I could have made my way through life without breasts and still been just fine. My own psychology confuses me. Oh, and you can feel the unnatural nature of the expanders underneath my skin. It is very... weird! I try not to think about how alien the expanders are because I don't want to convince my body to reject them! Even other people can feel the expanders - they are a little creeped out by the unnatural feel of the plastic underneath my skin.
     I started doing physical therapy on my own before receiving clearance from the doctor. I was ready! I'm glad I will see her again this Tuesday because I want to start doing yoga again. I miss the gym!