Breast reconstruction

Post-surgery Check In

/ D.B. Sieders / Leave a comment

It’s day 13 of National Breast Cancer Awareness Month! Today, I’m taking a break from the usual programming to talk about my breast reconstruction journey, which I hope is (finally) over. I had the misconception that breast reconstruction was relatively simple, one or two procedures and done!

Image Source Here. Also has information about different types of reconstruction!

Yeah, that was before I got breast cancer. Oncoplastic reconstruction (lumpectomy followed by reduction and lift) was a one and done, as is (or can be) aesthetic flat closure (going flat). But building new breast(s) after mastectomy is complex and involves multiple surgeries/procedures to achieve symmetry and an aesthetically pleasing result. That’s where I’m at in the process.

I talk about this in Talking to My Tatas, and include pictures of where I was in the process as of 2021, but it might be useful to include a timeline and description of the various procedures I’ve had. Everyone’s reconstruction process is unique and tailored, but it should give you an idea of how involved the process can be and often is for people who’ve been diagnosed with breast cancer.

June 2018 – Tumor removal from left breast by lumpectomy and oncoplastic reconstruction

September 2018 – Radiation therapy on left breast

February 2020 – Diagnosed with residual disease in the left breast (at the beginning of the Covid-19 pandemic)

May 2020 – Unilateral mastectomy to remove left breast and to implant expander

(Involved several intervening procedures like 3X saline fills for expander and physical therapy to regain mobility after mastectomy, which was compounded by radiation damage to the skin over my left breast and breast tissue)

November 2020 – DUG flap reconstruction (grafting of thigh and muscle/skin tissue from right thigh to build foundation of left breast plus mastopexy (reduction and lift) on right breast

(Required lots of at home massage therapy on irradiated tissue to soften it)

February 2021 – Liposuction and fat grafting into left breast + more tweaking on the right breast

(Required lots of at home massage therapy on irradiated tissue to soften it)

July 2021 – Liposuction and fat grafting into left breast

(Required lots of at home massage therapy on irradiated tissue to soften it)

December 2021 – Liposuction and fat grafting into left breast and scar revision on right breast

(Required lots of at home massage therapy on irradiated tissue to soften it)

October 2022 – Liposuction and fat grafting into left breast and minor scar revision on right breast

Image Source Here. Also has information on thigh flap reconstruction procedures.

That’s seven procedures, not counting biopsies and a lumpectomy from 2016 to remove a benign papilloma, in two years since residual disease detection. It’s a LOT! I count myself lucky to have a brilliant surgeon who has worked with me at my pace to get symmetry between a mostly natural right breast and reconstructed left breast, which is no easy task. And I have a great support system. But it’s a LOT. Each surgery involves recovery from anesthesia, incisions, bruises a plenty (lipo is brutal) and the mental and emotional impacts (which included depression and hypervigilance that made me feral). That required therapy, another part of the process.

Is it worth it? For me, the answer is yes. I’m almost back together and beyond amazed and pleased with how I look and feel. I am whole. Not the same, never the same, but whole. It’s a process. Remember that when you’re checking in with your survivor friends who may be waiting for follow-up procedures, tattoos or surgical nipple-building procedures, trimming of excess skin around incision areas, etc. It’s a process. Be kind. If you’re a survivor in the thick of reconstruction, remember to be kind to yourself and that YOU ARE WORTH IT!

(Hopefully) Wrapping Up My Breast Reconstruction Journey

/ D.B. Sieders / Leave a comment
Photo Source Here.

It’s the fourth day of National Breast Cancer Awareness Month 2022!  Today, I’m undergoing my eighth breast surgery, seventh in a series of procedures related to cancer. In May of 2020 I had a single mastectomy to remove my left breast after we found residual cancer. In November of 2020, I began the process of reconstruction starting with a Diagonal Upper Gracilis (DUG) Flap procedure in which my surgeon removed tissue from my right thigh and grafted it to my chest, forming the foundation of a new breast, along with a reduction and lift of my right breast to start the process of making my boobs symmetrical.

It’s been a long, involved, two year process.

Part of the challenge is symmetry. Since I chose to keep my right breast, it’s harder to build a new breast with the same general size and shape. As one of the surgical residents once told me, they’re twins, but they’re going to be fraternal, not identical. I can live with that, especially since I can still feel and enjoy my right breast.

I got this awesome meme here!

The quest for volume and symmetry has involved a series of fat grafts, transferring fat from my flank, left thigh, hips, and my back on this next round to my left breast. It’s working! Each time we get a little closer to a matching pair that look pretty freakin’ good. Yes, I have scars and always will, and yeah, my nipples point in different directions, but after the last procedure, I was comfortable in a T-shirt for the first time in since my mastectomy.

I’ll take it.

I’m going into this with a mixture of excitement and trepidation. Once again, I’ll be going under anesthesia and under the cannula if not the knife. I’ll be putting my body through the ringer again, going through the process of healing from wounds and bruises, both internal and external, as well as whatever psychological reaction I experience post-surgery. Bandages and binders, aches from having an IV needle jammed into my left hand as I cry silent tears and kick myself for doing this. I owe my body a big apology. I question my decision and wonder if its worth it.

Then, I take a deep breath and remind myself that I’m still here, surviving and thriving. Cancer took a lot out of me, but I won’t let it steal my joy or rob me of my resolve to get my body put back together in a way that works for me. At the end of the day, that’s what matters.

So, wish me luck, and I’ll see y’all on the other side!

Surgery Made Me An A-hole

/ D.B. Sieders / 5 Comments
Photo Source

First off, I’m doing GREAT nine days after autologous (fancy term for my surgeon using my own fat and tissue to build a new boob) breast reconstruction! The procedure went very well, and the graft took. My amazing surgeon, Dr. Galen Perdikis (and his team, including the surgeon who assisted with the microvascular attachment work), took muscle and tissue from my right thigh and made a very nice left breast by grafting it under the skin he saved following my mastectomy back in May. The official medical lingo for this type of reconstruction is diagonal upper gracilis (DUG) flap reconstruction. I’ll blog more about the specifics and the experience later, but right now, I want to talk about something else.

I want to talk about a bit of an epiphany I had.

Photo Source

Disclaimer – I have NO scientific or medical data to back me up on this, partly because I couldn’t FIND IT on Google or PubMed. This could be a search strategy issue (the closest thing I did find was Post Intensive Care Syndrome, PICS), and I hope it is, because I’ll be super disappointed if no one has studied the phenomenon I’m experiencing right this very moment—a phenomenon that I’ve decided to call Wounded Animal Asshole Syndrome, or WAAS.

This should TOTALLY be included in the DSM. And I fully expect credit for it.

Here’s the deal. The first time I left the house on my own after surgery, which was yesterday, I was, for lack of a better word, a RAGING asshole. Now anyone who knows me will tell you that I can be a Grade A asshole on any given day under the right set of circumstances, but this was something else. Something visceral and deeply animalistic. I was angry, suspicious, and viewed every other human around me as a potential threat. Like a wounded animal, I gave off a heavy dose of don’t-fuck-with-me vibes that fell just short of low, guttural growls.

By the time I reached the Breast Center for my appointment, I was a little worried about the safety of those around me.

Photo by Aleksandr Burzinskij on Pexels.com

Then, it hit me. I am—quite literally—a wounded animal. Yes, I volunteered to undergo the procedure that left me with the healing surgical incisions I was subconsciously guarding. Yes, my rational mind knew that the arguably weird man in Walgreens wasn’t out to snatch me and throw me in his trunk. And yet, I was experiencing the same level of heightened awareness and suspicion of strangers around me that I felt shortly after the birth of each of my children—a time during which I was still sore, bleeding, and physically vulnerable.

That fed into the horrible postpartum depression (PPD) episodes I experienced, but that’s a story for another time…

I have no idea if this is a common thing or a me thing (I suspect it’s a common thing because I’m not special, no matter what my mom told me growing up), but it is both fascinating and disturbing. It happened again today when I took my son to the zoo and we encountered a crowd at the entrance. In addition to generalized COVID anxiety (note: the Nashville Zoo is SUPER cautious, mandates masks, and limits the number of daily visitors like a responsible organization), I was freaked the fuck out and felt the urge to turn in a circle and hiss to keep people away from me and my cub, er, I mean, son. It was weird. It doesn’t happen when I’m out with my mate (husband) or when I’m in in a small herd (of socially distanced friends)—only when I’m alone or with a child (who is almost as tall as me, which makes it weirder).

Photo Source

The only reason I can think of for this bizarre behavior is that it is a throwback from ancestral human days when we were running from cave lions, saber toothed cats, and wooly rhinos. Hide pain, conceal wounds, show no weakness, and act so aggressive that the big scary predator won’t bother with you and will instead seek an easier meal.

Maybe it’s a manifestation of generalized anxiety disorder (GAD), but honestly, I’ve been managing that very nicely with medication and therapy—or so I thought.

Anyone else out there have this? Drop me a note in the comments. We’ll call it an informal survey.

Reconstruction Surgery and Resilience

/ D.B. Sieders / Leave a comment

With so much uncertainty in the world, it’s nice to be fairly certain about one thing: tomorrow, I will get a new left breast. It’s a mixed bag of emotions for me, but the strongest are relief and hope.

When I wake up tomorrow afternoon from anesthesia, Covid will still be ravaging the planet. We may or may not know who will be the next president of the United States. I have no idea whether or not my latest research grant will be funded, nor do I know what will happen to my quest for tenure in 2021. But, if all goes well, cancer’s reshaping of my body will end.

A wise friend once told me that the only certainty in life is uncertainty. I’ve found that to be true in my almost forty eight years of living. For someone who suffers from anxiety, it is a difficult truth to face. I’m the type of person who thrives on stability, on knowing what to expect, and on consistency. There has been precious little of those comforts for me since April 19, 2018, and especially since February 2020. Discovering that I still had residual disease in the form of a 6 mm tumor remaining in my left breast pulled the rug out from under me and stole my illusion of safety.

That’s one lesson I learned from cancer—there is no such thing as safety or certainty.

So how do I cope? How can we as survivors cope? Building Resilience.

Diagram of Resilience

For me, one strategy has been to let go of the illusion of control. Or, to really refine the concept, I’ve been working hard to catalog the things I can control, like staying as healthy as possible with diet, exercise, regular health screenings, medication, and yoga/meditation. These measures may or may not prevent a recurrence, but they will help me live a better, healthier life. There’s no downside.

Other things I can control include the effort I put into taking care of my family. I can love them, feed them, create special moments and memories that nothing can take away, not even cancer. I can take pleasure in the small, daily moments that I used to take for granted. For example, I spent about thirty minutes this morning watching birds at my feeders. We have so many birds, from tit mice (snort) to a red-bellied woodpeckers, and chickadees to sparrows! I’ve always found solace in nature. Other small moments like a cup of tea enjoyed sitting on my deck with a chill in the air and the sun caressing my face bring me joy. I’ve had the BEST time cooking with my kids. Potstickers with my daughter and meat and rice bowls with my son have sustained us physically and emotionally. Again, there’s no downside to savoring the small moments of joy in everyday life.

I cannot control whether funding agencies select my research grants for support, but I can control the quality and integrity of my research. Funding is even more uncertain today than when I entered the field, but it is still an exciting and hopeful time to be a scientist! There are many exciting avenues of breast cancer research open for me to pursue, and if I have to leave the field (or, more likely, switch from tenure track to research track) in a few years, I’ll leave behind a body of work that I can take pride in, and I can and will continue to work in other avenues, like education and outreach. I can control how I adapt to career challenges.

The best I or any of us can do is to live every single day to the fullest. We can choose kindness, positivity, and follow our paths to making the world a better place, starting with ourselves and our community. Every day is a gift, and tomorrow’s gifts are yet unknown but so inviting. I look forward to being physically whole. I look forward to getting back to regularly scheduled life with a newly restored body, building strength and resilience.

I look forward to hope, which is something I can rely on.