Monday, July 29, 2013

Cancer Bombs: Musical Boobs

[Note: The first of this series can be found here. All previous (and subsequent) installments of this series can be found here.]

May 2013.

Slowly, ever so slowly, the fact that I was surgically deformed played on my mind, until I found myself a deflated puddle lacking in positive body image.

Though I’d originally resolved not to have an opinion on the new boobs until they’d settled into their new home around the six month mark, that same resolve crumbled under the knowledge that what I had taken as swelling was in actuality an implant complication that would require surgical revision to correct.

I was deformed.

And it wouldn’t get better with time. It would only get better with surgery.

Yes, I made do and wore my wonky boobs with a smile. But it grated over time, even on a girl who subscribes to terminal realism.

Sure there are more important things, and I could focus on the daily grind and get through it, but in the quiet moments the sadness crept in. I was clinically deformed, and nothing short of being cut open and dug into again would fix it.

By the time May rolled around my body image was through the floor—despite having had magazine-worthy dress and makeup as a bridesmaid, despite winning a costuming award at JordanCon, despite managing to fit back into the wedding dress I wore almost nine years previous.

I was weary of the image in the mirror, and ready to have Dr M perform a good old swap and replace.

And Mr Lannis—bless him and all he’s put up with—was weary of my snarly attitude. It’s possible he told the hospital staff to surgically remove it (the verdict is out on that one).

The procedure to correct the ugly girls was a simple one. In a “breast mound revision” (::snort::), Dr M would go through the original incisions, release the scar tissue glued to my ribcage, and swap and replace the implants for new ones—a slightly larger pair to help stretch out the Alloderm and scar tissue.

Then she’d sew me up, and send me home. Seriously. It was day surgery, and depending on whom I spoke with, would be anything between an hour and a half and two and a half hours long.

Believe it or not, I managed to make it to my surgery date (May 23rd), though it’s questionable whether the same could be said for my sanity. I was back to breakouts and stress napping, a perpetual depressed and exhausted daily state. It was time.

My surgery was scheduled for 10am, and I needed to check in for 8:30am. Once again I drove us to the city, was poked for blood work, and doodled on by Dr M. I was in good spirits, okay, giddy with nervousness and ready to be rid of my boobs-on-loan.

Climbing up on to the surgical table, the anesthesiologist jabbed me multiple times in search of a vein on my left hand. Dr M’s eyes were wide in silent alarm, quietly asking whether she should say something about the IV, when my nervous babbling took over and I began telling the surgical team that the entire left side of my body was a jerk.

The astigmatism in the left eye, the myringotomy hole that never healed in my left eardrum, the left ear that rejected a piercing, my twisted left tit—it wasn’t the anesthesiologist’s fault for being unable to find a suitable vein, it was the assholery that is my entire left side...

Then I blurted that I hoped they were ready to play musical boobs—because I certainly was—and “Go Team!”

Then I was under, which was good, since I’m pretty sure by that point they wanted me under just to shut me up. I’m fairly certain they found me less entertaining and more batshit crazy.

(An assessment I'm familiar with.)

I woke up in recovery and probably flashed dude in the gurney across the way because I didn’t realize I wore no dressings. Yes, the first thing I did was sneak a peek at my new girls, and in my drugged state moved my gown to discover I was wearing a tensor bandage around my chest—up under my armpits and above my breasts—and nothing else.

Unless you counted the steri-strips on my incisions below my breasts.

Seriously, dude got a show. Though considering that the Jackson-Pratt twins had returned (goddamn them!) it may have been a vomit-worthy show. The JP drains are less than sexy, trust.

After being catered to by some lovely nurses, Mr Lannis showed up to announce I’d been under about three hours, but the surgery took only two. Shortly thereafter Dr M came to visit. Everything was reported as perfect, and she was counting on my stellar healing history to kick in.

The Jackson-Pratt twins were to remain in for a week, and she’d remove them when she saw me for my first post-op appointment. The tensor bandages were the only thing she wanted me to wear. No bras, no other wraps, for at the very least the first week—perhaps longer.

So much for the fancy pants post-breast-surgery bra I’d purchased.

So off we went, me to sleep in the recliner for a week, and unable to drive for a week, but otherwise far more capable than the first go ‘round. This time I was immediately able to take care of my own sponge baths and measuring drain output, but until they came out I had to hit the salon for hair washes. Heavy lifting and arm raising was out, but the mastectomy got the lion’s share of the inconvenience. This time I found myself woozy from the Tylenol 3s with codeine, and dropped to Extra Strength Tylenol on day two post-op (the bonus being the lack of caffeine meant I slept better at night).

The crux this time around was my numbness.

Numbness that stretched from immediately above my nipples down to the incision scars and from sternum to armpit. Yes, my incision scars themselves were sore, but the majority of where Dr M’s handiwork lay had no sensation. There was the transference of pressure to tissues beneath, but no surface sensation to speak of. This meant I could sometimes tell if I was poked in a numb boob because the muscles behind the implant sensed pressure, but a light brush on my skin would go unnoticed.

So Dr M had opened me up, poked around in there to cut out and loosen scar tissue, and here I was three days later with barely a physical reminder that I’d just had surgery.

I suppose the inconvenient JP twins served a purpose—they were the anchor reminding me to be careful.

That seven day post-op appointment had its share of revelations, too. Dr M quickly rid me of the wretched Jackson-Pratt twins, and got down to business.

“So,” she began. “You’ll never believe it. I opened you up, and that left implant was in perfect position. It was never twisted.”

Pardon, cowgirl? Not twisted?

It would seem that mastectomies highlight oddities of boobage. To the extreme.

No two boobs are identical to begin with, and hollowing out all the innards simply reveals every miniscule difference between what might otherwise have been considered a matched pair. Turns out my natural breasts had some discrepancies between them when it came to size and shape, and once their innards had been gutted, my surgeons had been left with two different shaped pockets for the implants.

That was why the left boob appeared so odd.

Okay, I guess that makes sense.

But I'm not sure if that's better or worse as a cosmic euphemism. Sure, I didn't have a twisted tit, but what does it mean if your zombie tits were expressing themselves artistically?

So Dr M and I discussed the revision—everything looked great—and I was to continue wearing the tensor bandage (and only the tensor bandage) for at least the next week. After that I was free to do as I pleased, but if anything seemed weird or I had any concerns, I was to revert back to the tensor bandage across my chest (with the girls free underneath), because that was all Dr M would have me do to correct anything during this early healing phase.

And it turns out that removing those blasted drains is a recipe for instant human. Seven days post-op and I was sleeping in my own bed and reserving Extra Strength Tylenol for bedtime.

It. Was. Awesome.

Yes. That was it. I was sore, but only where the drains had sat, the rest was fine.

Though I ended up wearing the tensor for the entire five weeks until I saw Dr M again. Any time I went without it—even for a few hours—my left pec began to ache. I’d push on the sore muscle near my sternum and rewind the tensor around my chest once again, taping my nipples to hide the perpetual nip-ons.


[An aside: if you’re ever asked to wear tensor bandages constantly, I highly recommend the name brand Tensor bandage from 3M. A dollar more than the store brands, and they lasted much longer. I had three I cycled through, washing and wearing (dryer and line drying, both), and they lasted me five weeks of constant wear. After all was said and done I only pitched one of the three for shot elastic. The store brand tensors lasted me less than 24 hours before the elastic lost its stretch, but the Tensor brand? Weeks of continual wear. A godsend.]

July 3, 2013.

The six week post-op appointment came up quicker than I remembered, though that was probably because I was more capable (and therefore less frustrated) this time around.

After six weeks of healing, Dr M had a better idea of what was going on—before the implant swap, and after. You see, my girls were still... off. Not nearly as much—they looked fabulous naked to the naked eye (heh)—but through a camera lens you could better see that the right implant sat lower than the left (that damn left side again!).

From her perch on the rolling stool, Dr M could see that they were aligned well, but the left side remained higher. The bonus was that now, six weeks after surgery, she knew why.

“You have more breast tissue on this side,” she said, squeezing my left pec.

It wasn’t nearly the eyesore it used to be, but it refused to sink down the way my pec on my right side had. I told her of the ache when not wearing the tensor bandage, and how I thought it might stem from lack-of-use (which she agreed), but now that my body had settled post-surgery, the problem was more evident.

A mastectomy is a tricky thing. No two mastectomies are identical, just as no two breasts are identical. After seeing the drop of my right breast, and being able to squeeze the flesh above my left breast, Dr M was certain the differences stemmed from the mastectomies.

When Dr D hollowed out my breasts she left a thin layer of fatty tissue containing blood vessels to maintain the necessary blood flow to my skin and nipples. It’s something done by hand, and by feel, and by skill—and because of those factors, the results of each mastectomy varies. Dr M suspected that Dr D had left slightly more tissue on the left breast than on the right. The left breast had the slightest more natural insulation to its pocket—mere millimeters more thickness—creating less stretch to the skin. That allowed it to maintain its natural shape more, instead of molding to the shape of the implant, like my right breast was doing. Also, the right breast implant had dropped sooner (an action we wanted to happen) because the thinness of the skin allowed for it to drop easier.

The left breast would get with the program, it would just need more scar massage on the incision and drain area to release the tissues and hopefully let gravity do its job to even out the last little bit.

Overall though? I’m quite happy with the results. Sure, they don’t feel the same as real breasts, but I find they look natural, and they move.

Dr M was overjoyed with the revision results—apparently at the six week post-op mark my incisions had faded and the new girls had softened and shifted with gravity such that I resembled someone at the three month post-op mark. And Dr M said if it were my twelve month post-op appointment, she’d be pleased with the visual assessment.

Dr M remarked that at this point, if I were to take off my top in a locker room, unless someone noticed the small dots of scar that are from the drain sites near my arms, no one would assume I had had surgery. And if they did see those scars, they’d likely assume it was augmentation, not a complete overhaul of the goods.

Yes, they look that great.

Mr Lannis’ opinion? Well, let’s keep it clean and say he’s pleased. (Silly digression: I was wearing a padded bra when I met him. It’s taken thirteen years and a pair of surgeries, but I’ve finally lived up to the wares I was selling that night... heh.)

Are you ready? It’s comparison photo time!

Sorry to disappoint, but they’re not topless pics. (Yeah, because that’s what the Internet needs—more topless photos... ::snort::)

What are you looking at? Well, they’re the before and after shots of my revision surgery—no, not my natural breasts, Mr Lannis and I didn’t have forethought back then. The before photo was taken days before my revision surgery, the after photo at seven weeks post-op.

Disclaimer: I should have straightened my asymmetrical shirt before Mr Lannis took the after photo. Whoops. Hindsight 20/20 and all that.

Left: before corrective revision surgery. Right: after corrective revision surgery.

For whatever reason, the discrepancies between the implant that has dropped (my right side—visible on the left side of the shot) and the one that hasn’t (the left breast, so the right side of the shot) is far more evident in pictures. In person you have to really stare at my chest before you notice it (warning: if you do that, I’m likely to hit on you because I’ll take it as a come on.)

These two collages are identical, but on the second one I added numbers so I could walk you through what you’re seeing—some of the differences are subtle.

Left: before corrective revision surgery. Right: after corrective revision surgery.

Points 1 and 2: my nipples. They moved. Okay, maybe only the swell of implant beneath them changed, but in the before photo they’re pointing south and south-east, respectively. Yeah—pretty. In the after shot they’ve balanced out, and while Dr M would prefer to get in there for a nipple tuck (they’re about 1cm lower than the ideal position, and one naturally sits farther to the outside), there’s no medical need to muck about in there any more (so says I). Besides, their appearance has improved, and I never once had a brush with not-so-fixable complications (like necrosis). As far as complications go, despite needing revision surgery, I had an easy run of it.

Point 3: My bizarre left pec. In the before shot you can clearly see my left pec jutting towards my armpit, making my breast into a top-heavy triangle. Even after surgery it remains bulkier than the right pec, but the difference is negligible.

Point 4: The fit of my shirt. The stretch of the elastic strap on my sport top is a great comparison marker to show how my pecs had bulged outward thanks to the pair of errant implants sitting too high. (Yes, I’m aware I’m not standing identically in each shot, thank you Peanut Gallery. Sheesh.)

Other notes:

Thanks to the shine of the flash in the before shot you can see the swell of my breasts sits uneven and far too high on my chest.

The line underneath my breasts indicate where the fullness—or bottom—of my breasts sit. Here you can see how Dr M released the band of scar tissue effectively lowering where the implants sat on my chest by almost 2”. Her incision lines never budged, and are basically where the line is sitting in the after shot—a 5" long pair of scars that hide in the crease under my breast, virtually invisible.

Overall, I’m thinking not too shabby. Especially since my opinion-making has been forbidden until six months post-op (so says Dr M). That’s late November 2013, if you’re keeping tabs.

So. What’s left of this story? Well, there were a few things I missed in The Nitty Gritty post that I deliberately set aside because, well, they had less to do with the specifics of living post-op mastectomy, and more to do with, well... whining.

Yes, it’s time for downsides.

I’m an avid non-complainer. Ranter, yes. Complainer? I try not to. But this series wouldn’t be complete—the image of how life-changing this journey is—would not be complete if I didn’t highlight a few downsides...

The Complaint Department

- Implants aren’t real breasts. They don’t move like real breasts, or handle like real breasts, and they don’t weigh the same as real breasts. Gravity is an asshole while your body adjusts, trust. Implants are like breasts, but it’s as if the makers of Dr Scholls gel-heels designed them. Yeah... Dr Scholls... the gel-boob edition.

- Numbness. From nipple to incision, stretching from sternum to armpit. And the problem with numbness is that it’s so forgettable. If I bend over the recliner’s ginormous arm to reach something on the floor I get frustrated with my short reach—but unbeknownst to me I’ve hit the arm of the chair with my numb breast. (Oops.) It’s like I’m wearing a super-padded bra—even when I’m not wearing any bra at all. It’s implant.

- Many complications are possible. I was lucky, mine was surgically repairable. Some aren’t as easily fixed (see: necrosis. Aside: never ever ever run a Google image search on tissue necrosis. You've been warned).

- No reaching or raising arms. No angling your arm upward at the shoulder at all. Seriously—this is a complete and utter pain the ass. No ponytails for six weeks. Sounds easier than it is, trust.

- No heavy lifting. And the definition of “heavy” kept changing. Immediately post-mastectomy that meant a can of pop—I could barely carry my purse because my arms would drop it (as in: this is not a conscious choice, it’s a physical impossibility). Immediately post-revision surgery I could carry no more than 5lbs, but it was far better than after the first surgery. It’s a sad day when you’re ecstatic you can pick up your cat—especially when your cat weighs less than most newborn babies.

- Sleeping on the recliner post-surgery. After the mastectomy I slept there for six weeks, after the revision surgery it was only necessary until the drains came out. Envisioning rolling mid-slumber, tangling myself in tubing and popping biohazard fluid-filled bulbs gave me nightmares. Now you can share them. You’re welcome.

- No driving. Another pain in the ass for anyone use to using a driver’s license for independence. I was curbed for four weeks post-mastectomy, and seven days post-revision surgery. Every second sucked my soul.

- Drains. The Jackson-Pratt twins are a necessary evil, and the worst fashion accessory ever.

- Deformity. It goes under complications, yes, but the psychological effects ran deep, in part due to having made the conscious choice to undergo a prophylactic mastectomy (second-guessing a life-altering surgery takes a toll on your psyche).

- Waiting for swelling to go down. It can be a long road, and much like when you begin painting a room and wonder “what the hell was I thinking?!” the swelling, bruises, incisions and scabby nipples all look far worse than you can imagine before they begin to take on their new appearance. Patience is a virtue, and also a rare find. Just breathe.

- Permanent nip-ons. Yes. They’re permanent. As in: always there to some extent. Yes, my nipples react to cold/touch/whatever-odd-element-that-makes-nipples-decide-to-cut-glass-out-of-nowhere, but they never go as flat as they used to pre-mastectomy. That’s okay: nipple stickers exist for a reason.

- No hugs. Possibly the worst downside ever. I was unable to hug my children post-mastectomy. Post revision surgery it was tentative hugs only. But post-mastectomy it was at least three weeks before it was okay. And you feel like the shittiest mother ever when you can’t hug your boys on Christmas day. Offering them a thigh to squeeze isn’t the same thing, though it lightens the mood...

- It hurts to laugh (obviously this disappears slowly post-mastectomy). On Christmas Day, while watching Swiss Family Robinson with the family, Mr Lannis and I enjoyed acting as the Peanut Gallery, picking apart the less-than-gender-equal Disney classic (what?! They discover she’s a girl and suddenly she can’t walk down a hill and needs help? Are her legs are broken?!). I would not recommend this activity. Your pecs will not appreciate it.

- Forever feeling like they’re not mine. Nope. They’re no longer my boobs—my boobs are gone—and they took whatever ownership I once had with them. It’s a freaking miracle I’m wearing a sports shirt in those pics. Thank Mr Lannis for that. These boobs are government-funded, and arguably owned by anyone who pays taxes in Ontario... heh.

- Sub-muscular implants do tricks. Truth. When my pecs clench the implants are pulled up, lifted in a way that resembles when guys clench their pectorals. This also means that whenever I do any activity that clenches my pec muscle, the implant lifts—so raking the lawn? yeah... an observant bystander might wonder what is up with my freaky tits—haha!

- Sneezing sucks immediately post-op. If you’re lucky enough to get a heads up, cross your arms and hold on to the girls tight. Even with that your sternum will probably be sore for a few days afterwards. This gets better the longer you’ve healed after surgery. At six-weeks post op it’s gone.

- Strangers. Get used to a number of people manhandling your goods. The people who touched my breasts (who weren’t Mr Lannis) from May 2011 to May 2013 are as follows:
  • Dr H, our family doctor (1)
  • mammography technician (2)
  • ultrasound technician (3)
  • Dr A, general practicioner through the genetics department (4)
  • two MRI technicians (5, 6)
  • Dr D, the general surgeon (7),
  • Dr M, the plastic surgeon (8),
  • two hospital nurses (9, 10),
  • at least three home care nurses (11, 12, 13),
  • a handful of surgical attendants for two separate surgeries. 
 Conservative estimate puts the tally into the late teens now, but who knows...?

Once again—and never to be forgotten—regardless of the downsides listed, regardless of the length of the list, regardless of the fact that I got to second base with a remarkable number of people (heh), considering the upside is dropping my genetically predisposed as high risk of breast cancer to less than any woman walking this Earth’s natural risk of breast cancer... well...

I tally this a win.

[Note: The next installment of this series can be found here.]

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