The Day After

Hello everyone,

It is now the day after surgery. I slept alot yesterday, and don't remember much about it. Sometime last night the elephant that had been sitting on my chest decided to leave. There is still a great deal of pressure, but I am looking forward to getting up in a little while and walking around. We are now on the road to recovery, and that is where I have wanted to be.

My doctor visited this morning, and said everything was looking good. I have alot of bruising on my chest around the tops of my breasts, and the pressure that I feel comes from the expanders. They placed the expanders under my muscle tissue, and will be streching my muscles out over the next couple of months. So I will feel pressure each time they do this. Katie has told me that the expansion is not as painfull as what I am feeling today.

Overall, I think I am doing very well. I am especially looking forward to my shower in a little while. I wanted to thank all of you for your prayers, and I know God will be helping me through the recovery process too.

the night before.

Well, I am typing this on Cody's iPhone so I am sure I will go back later and make corrections. We are staying the night at the embassy suites in Lubbock. Not quite home but it beats having to be up at 2am to drive in from Amarillo. I can say that right now I am not nervous. We enjoyed a very nice dinner with Dad and Terry and came back to the hotel to visit with my aunt Linda and her friend Tom. Cody was his usual laugh arrowsing self so it was a wonderful evening .

I feel really good right now and I am ready for tomorrow to be over so we can start on the road to recovery. Crazy as this seams I hope to be folding laundry by mid week. I have set goals for myself to make sure that I don't just lay around prolong my down time. Don't worry I will be taking it easy, and I will not overextend myself or push my limits. My goal is not make things harder on myself than it should be. I just feel that if I gradually start using my muscles and continue to strech them daily I will do better overall.

Enough rambling on my part. I am excited about tomorrow for a few reasons. I was contacted about a reasearch study that is being carried out by TTUHSC and Joe Arrington Cancer Center. SPOC is the name of the study. I am not sure what it stands for but will find out tomorrow. The overall idea is that they take the tissue removed from my breasts that will not be sent for pathology and use it. My boobies will be used to help out with a cancer research study!!! Once again, I will find out more about it tomorrow. From the phone conversation I had they will be using my tissue to grow tumors. After the tumor has been grown they will try new treatments to see how effective they are in combating the tumor. I cannot think of a better place for my boobies to go!

There is also another bit of information I talked with my genetic counselor about today, but I am going to keep it a secret for a while longer! Nonetheless though, it is very exciting!!

Well, God Bless all of you, and keep the prayers going for us tomorrow!

Anxiety!

Three days left until we load up the family and head to Lubbock. We have decided to take the kids swimming Thursday evening at the hotel in Lubbock before Gigi (Cody's Mom) picks them up for the weekend. After the kids are off to Gigi's, Cody and I will hopefully have a somewhat peacefull evening. Then, Friday is the day. I expect we will be going to the hospital early Friday morning for the admission process and to get prepped for surgery. If you have not figured it out yet, I will be having my double mastectomy and expander type reconstruction this Friday, March the 12th.

We are at peace with this decision and truly feel that it is for the best to go ahead with the procedure sooner than later. My biggest problem thus far is that I enjoy being in control of maintaining our home. I do not always enjoy all of my chores daily, but overall I would not want anyone else doing them. Even though I like being in control I also have to be realistic. I have arranged for a housekeeper for a little while, and have tried to do my best in instructing Cody as to how I do things. Once again though, lets be realistic Cody will probably do things his way. Depending on others is definietly not my strong suite. Another lesson from God.

My sister, Katie, has been so generous as to give me the ins and outs of what to expect with surgery. She has given me detailed lists for: what to bring to the hospital, what to expect immediatly after surgery, her timeline as far as recovery, and she is even letting me borrow her pillow for the ride home. I think my mind is a bit more at ease beacause I know that I can go to her with any of my questions.

I have purchased 6 books that I hope I will be able to immerse myself into during my recovery. They are all about BRCA mutations and breast cancer. Hopefully I will gain a plethora of knowledge, and will be able to add more to my list of topics already scribbled into my notebook for my blog. Thus far I have enjoyed so very much being able to share the knowledge I am gaining thru this process with all of you.

I am hoping to be able to post some updates, or have Cody post some after my surgery. If I am not able to share everything on my blog immediately, I will be journaling about it and intend to share with you soon. Until then, please keep me, my family, and my doctors in your prayers.

Peace of Mind...

...the advantage of knowledge is this: that wisdom preserves the life of its possessor. Ecc 7:12

"Have faith in God," Jesus answered. Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours. Mark 11: 22, 24

Is any one of you in trouble? He should pray. Is anyone happy? Let him sing songs of praise. Is any one of you sick? He should call the elders of the church to pray over him and anoint him with oil in the name of the Lord. And the prayer offered in faith will make the sick person well; the Lord will raise him up. James 5: 13-15

These are just a few of the versus from the Bible that give me encouragement. Lets be honest here, I am far from perfect. I do not get around to reading my Bible everyday even though I try. There are many days during the week when I do not get around to my prayer journal. With all of that said though, I do PRAY everyday. Often it happens during daily tasks while my body is busy doing chores. I know this is not what God prefers, but I still know he is listening. He hears everything I bring to him no matter when I bring it. He does not mind if I call on him several times throughout the day. God wants me as one of his children to talk to him. He wants me to feel comfortable asking for his help and giving my burdens over to him.

Over the past four years I have grown leaps and bounds in my personal relationship with God, and he has rewarded me for my efforts. I have been given peace of mind. Next to salvation, this is one of the greater gifts in life in my opinion. Knowing that God is on my side is a truly awesome thing. He is always there for me even when others are not able. God is never too busy!

God knows me better than I know myself, and for this reason he has made it important for me to have a support group here on earth. He wants me to grow in my relationship with him, but he knows that I will need help along the way. Over the years he has given me and Cody several Church families to help us in the stage of life we were in. He has provided for us what we needed mentally and emotionally over the course of our marriage. God used each of these Church families to challenge us and help us grow in our marriage as well as in our relationship with him. He has taught us that being present and listening is important, but service for his good is also vital for maturity. I have no doubt in my mind that God has had a hand in every step of our lives thus far. He has opened and shut doors at various times to encourage the changes that have brought us to where we are today.

By being part of such wonderful Church families over the years I have learned that they are there for a reason. They teach you lessons, keep you accountable, help you raise your children, and they pray for you. God has taught me that prayer is so important. Prayer is your way of communicating with God. I know their are differing opinions about prayer, but what could possibly be better than having a direct line to God? He wants me to talk to him, not only for myself but for others too. God also wants me to ask others for prayers on my behalf. He is on my side, and wants me to have the encouragement I need.

Mastectomy & Reconstruction: Part 3

The second category of breast reconstruction is tissue flaps. Your own tissue is taken from donor sites on your body and used to form new breasts. There are different areas on your body that tissue can be taken from, therefore, resulting in a name for each donor site.

Who wants a tummy tuck? TRAM flap reconstruction takes tissue that would be removed in a traditional tummy tuck and uses it to form a new breast. TRAM (Transverse Rectus Abdominus Muscle) can be executed one of two ways. Pidicled TRAM flap involves a football shaped area of skin, fat tissue, and muscle located in the lower portion of the abdominal muscles. Imagine placing a two-dimensional drawing of a football centered over your belly-button. The two points of the football would be touching your hip bones on each side. This gives you an idea of where the tissue for your new breast would come from. In this process the tissue is removed from its original location with blood supply intact and tunneled under the abdominal skin to its new location on the chest. In this method, there are risks for hernia and blood clots.

Free TRAM flap reconstruction has become more popular and is beginning to replace the pedicled flap. In this method the above mentioned football is completely severed from its original position. The flap is then transferred to its new position on the chest. Microsurgery is required to reconnect a blood supply to the flap. By connecting a new blood supply to the flap in its new position there is better blood flow to the tissue. There is still a risk of hernia due to the loss of abdominal muscle.

DIEP flap breast reconstruction is similar to the above methods in the sense that it takes tissue from the same area. The tissue taken is limited to the skin, fat, and teased blood vessels. Meaning that there is no muscle tissue removed, only blood vessels from the muscle. Being able to remove only blood vessels significantly reduces the risk of hernia and also reduces healing time. Microsurgery is once again required to reconnect a blood supply to the transplanted tissue.

SIEA flap has improved further on the DIEP method. It is essentially the same with the exception of completely avoiding the use of any tissue linked to the muscle. Meaning that the blood vessels used are within the skin and fat tissue transferred. The superficial inferior epigastric vessels to be exact. There are very few patients who will be a candidate for this type of procedure.

Well we have completed our tummy tuck, but in some cases only one breast has been produced. So what are our other options for tissue transplant? We have two other options. Latissimus Dorsi flap uses tissue located to the rear of our natural breasts. Take your right hand and reach under your left arm to your back. The tissue under your hand will be partially detached and moved under your skin to the front of your chest. Like in the pedicled TRAM flap the blood supply is not cut. This method does not result in a large breast, so it is commonly paired with implant or expander type construction. You will have scarring on your back, and muscle weakness for a period of time following surgery.

The last area utilized for flap reconstruction is the booty. The GAP (gluteal artery perforator) flap uses skin located in the upper portion of the buttock. This results in a flatter bottom, but a very nice feeling breast. The tissue taken from your buttocks is completely severed and transplanted, therefore, microsurgery is necessary with this method to connect a blood supply to the new breast.

Flap reconstruction uses fat tissue from your own body, so the overall size of your breast will fluctuate with weight gain and loss. You will most likely experience sagging at some point in time because of the stretching of the skin with weight fluctuation. Flap methods are commonly used in women who have had a unilateral (one breast) removed to achieve an asymmetrical look with their remaining breast. It is also popular with patients who do not want the everlasting look and feel of implants. If you would like additional information I would suggest the following sites.

http://www.breastreconstruction.org
http://www.breastflap.com
http://www.alwaysyouthful.com

Mastectomy & Reconstruction: Part 2

If you missed yesterdays blog, you might scroll down and read it before starting part 2. A little review from yesterday. You can choose to have mastectomy and reconstructive surgery at the same time, or you can opt for mastectomy and decide later about having reconstruction done.

There are several types of breast reconstruction available. They fall into one of two categories: implants or tissue flaps. Implant reconstruction typically uses a temporary expander that is placed under the pectoral muscle. Over a period of time saline is added to the expander and the muscle tissue and skin is expanded to a desired size. With this type of surgery the surgeon usually determines the size of the final implant before the procedure begins. There is some room for picking your size, but your available skin plays a large role in how big or small you will be. If you were a small "A" before you may not have enough skin elasticity to become a "D". So please do not go into this with unrealistic expectations. On the other hand though, if you have been wanting to downsize the girls this would be a good time for that. There are a few different methods to choose from if you are interested in implants.

The most common method is the one I have mentioned already. The expander is placed at the time of mastectomy. The overall time needed for expansion is highly variable. Women who have cancer and are undergoing treatment may need more time to recuperate between saline injections. There may be some pain and tension each time an injection is made. I have heard the analogy of having braces tightened or new rubber bands placed equated to this process. Each person will have a different experience. Expansion has been documented anywhere from 6 weeks to many months. After the process is completed a less invasive outpatient procedure will be preformed to replace the expander with an implant. Another decision - Saline or Silicone? (I am planning a full day for this discussion) Once the implant is placed your body is given some time for the implants to settle. If any adjustments need to be made they are done after the settling process is complete. This is the most common implant procedure, but there are slightly differing options.

Direct-to-implant ("One-step") reconstruction is a slightly different method. Not all women will be a candidate for this procedure, and there are not as many surgeons who use this method. First of all, you will need to find a plastic surgeon who will preform this method and go for a consult to see if you are a candidate. This method does not require expansion. In lieu of expansion the one step procedure uses an acellular dermal matrix to help create an instant pocket for an implant. Essentially this is a natural tissue that is stitched to the sides of the muscle. By extending the tissue in this manner there is no need for the expansion process. At the time of surgery the implant is placed, and your breasts are complete. After a few months of settling outpatient surgery can be preformed to achieve symmetry and correct any flaws.

Implants will never give you the feel of natural breasts. By choosing this option you may have less sensation than if you decided on a tissue flap method. On the other hand though, the girls will not be heading south anytime soon. They will remain perky and in place for as long as you have them. Tomorrow I will be discussing the different types of tissue flaps. For more information I would recommend the following.

http://www.breastrecon.com/id27.html
http://breastreconstruction.org/typesofreconstruction
The Brest Reconstruction Guidebook by Kathy Steligo

Mastectomy & Reconstruction...

Both of these procedures have made immense progress since my Mom underwent her first surgeries 15 years ago. At the time of my Mom's procedures she first had a biopsy, then later she had a unilateral mastectomy. This means that she had one of her breasts removed while the other remained. To keep her natural shape and look she chose to use a prosthetic. This was simply a silicone gel type contraption that resembled the shape of a breast. Mom had a bra with a pocket that she slipped the fake breasts into, and she looked as though she had two normal breasts. There were draw backs though. It was heavy, and it tended to move wherever it chose. Imagine trying to run with a gel weight attached to the front of your chest with bra straps. After chemotherapy and a little time for recovery, Mom chose to have the other breast removed and reconstructive surgery preformed. I do not remember for sure exactly how her implants where placed. Either way though, she did undergo an expansion process meaning they slowly inflated the implants to achieve a desired size. Mom's implants were very hard, and she had scars across her chest from the original surgery. Over time the scars would have faded, but the overall feel of her breasts would not have changed much. That gives you a slight idea of what my Mom's were like, now we will discuss the process of mastectomy and reconstruction.

Every case will be slightly different because of personal choice, and what doctor we choose. Katie and I will be using the same doctors for our bilateral mastectomy (both breasts) and reconstructive procedures, but there are still factors of personal choice to be considered. First of all we have an Oncologist, a physician of cancer, who preforms the mastectomy or removal of breast tissue. The second portion of the surgery is preformed by a plastic surgeon who is qualified in the reconstructive process. For Katie's surgery, which was performed in February, her procedures took around five hours. This seems like quite a long time, but the combination surgery is beneficial in many ways. Lets break it down a little to get a better understanding about the options.

There are typically two conditions under which mastectomy is considered. The primary reason being the presence of cancer, and the second, which is being seen more and more these days, prophylactic or preventative mastectomy. When cancer is already present your doctor has a great deal of influence on what choices are made. A biopsy or lumpectomy is usually preformed to determine if cancer is present, and if so what type of cancer it is. This portion of diagnosis is very important, because this is the point at which your doctor gives your their recommendations. Typically when cancer is invasive it is recommended to have the complete breast removed to ensure that all breast cells that could contain cancer are taken out of the body. Lumpectomy, or removal of just the cancer cells and small amount of tissue surrounding them, is preformed when cancers are non-invasive and have clear margins. When a lumpectomy is preformed it is usually paired with radiation to ensure that any other cancerous cells are killed. Even when lumpectomy is an option, you still have the choice of mastectomy. Once a woman has had cancer in her breast she is at a slightly higher risk of recurrence, so the decision to keep or remove your breast tissue is yours. Reconstructive surgery is also available to maintain symmetry after lumpectomy.

Back to mastectomy. There are the three types of mastectomy - unilateral (removal of one), bilateral (both), and prophylactic (removal of healthy tissue). Depending on the doctor you choose, there are also different methods of preforming the mastectomy. The method chosen depends a great deal on your doctor, as well as, your individual case. Simple or total mastectomy includes the removal of the nipple, areola, and all of the breast tissue. Modified radical mastectomy is similar to the total mastectomy, but also involves the removal of lymph nodes for pathological testing. Subcutaneous mastectomy removes all of the breast tissue while leaving the nipple and areola intact. These methods can be skin sparing if the choice is made to preform reconstructive surgery at the same time as mastectomy. Katie had a skin and nipple sparing (subcutaneous mastectomy) paired with lymph node removal. At the time of her surgery they removed as much of her breast tissue as possible, and also placed an expander under her pectoral muscles. Slowly over the next several months she will have saline injections into her expander's to stretch her muscle tissue and skin to eventually fit an implant. If a person knows that they will be having reconstructive surgery this method is a good choice. The other option would be to have a non-skin sparing mastectomy. In this procedure they remove your skin tissue along with the breast tissue. Women who have not made the decision about reconstruction, or have decided not to undergo reconstruction have this procedure. You will still have the option of later on deciding to have an expander process or a flap process preformed.

I have only really mentioned one of the available reconstructive process today, but I think I need to break this up into two days. Tomorrow I will discuss the different processes in more depth. This morning I will leave you with this information. There are many websites available from plastic surgeons who preform reconstructive surgery. If you are interested in seeing pictures I would recommend that you visit a few and see what is available. Understand though, that every persons results will be different and dependent on the individual. If you are not considering the surgery please don't visit the sites. This is a very important decision, and should not be taken lightly.