Thursday, August 20, 2015

Cancer Bombs: The Land of Tweaks

Once upon a time there was a woman who figured her story was over...

How naive, eh?

Yep, I got the call in February of 2015 from Dr M. After a year and a half of radio silence, I have to admit I was startled. She wanted to see me.

And the girls.

Cut to me sitting on her exam table, swinging my feet in yet another cotton surgical gown, waiting to flash my boobs. Again.

Now you see, things are good. Really good. Not perfect. No, not perfect. Gah, is anything in life ever perfect?

(I know, I know, less philosophizing, more bewbs. I got it.)

So. In comes Dr M, in her pristine lab coat and her sunny disposition, rubbing her hands all ready to check out her handiwork. After the standard pleasantries, she politely asked I doff my gown and let her have a peek.

“Okay,” I said. “But let it be known my quality of life is 100%.”

Dr M’s eyes narrowed. “Why are you apologizing? Again?!”

Left side? A touch higher than the right. Still. After a year and a half. Despite scar massage, despite wishing, praying, willfully ignoring and living my life, the left side still hadn’t dropped.

I know. That boob's a jerk, am I right?

So I dropped my robe to let her see.

Dr M tilted her head and clucked her tongue. “No, that’s not going to do...” She grabbed the girls one at a time, running her hand over their shape, tsking under her breath. “Nope.”

When I told her Lefty is an asshole for not joining the party down low with Righty, she told me that actually, Righty had dropped too far—to the point of bottoming out (read: problem). Lefty was sitting pretty thanks to scar tissue from a previous drain site keeping her in place, but Righty was on a slow trek elsewhere. And she wasn’t going to stop without surgical intervention, specifically Dr M cutting in and tacking that damned implant in place.


And this is where I discover that my journey through genetic testing and prophylactic mastectomy has taken me someplace I never thought I’d be...

The Land of Tweaks

As it turns out, the most gifted plastic surgeon can wield their talents and utilize all the skill in their arsenal, but they, all of them, are uniformly handicapped by the same ephemeral variant, and it’s a variant they can never anticipate.

Namely: chaos the way a patient’s body heals post-surgery.

But wait: I thought plastic surgery was permanent! Why be a perma-patient? Raise your hand if you were thinking the same thing. Go on, admit it.

Dr M’s chuckling at you, too.

Her response to my naive comment regarding plastic surgery being more permanent: “Yes, what I do is permanent, but what your body does with my work is not.”

Healing. Scarring. Aging. These elements alter the delicate work a surgeon has done.

And in my the odd case undoes it entirely.

So. Righty’s bottoming out, an issue that will not disappear without surgical intervention and will only get worse with time. Flash forward to August 2015 (read: today), and I’m already sitting here at seven weeks post-op, having had Righty pinned up and both implants swapped for silicone rounds instead of teardrops to correct some implant rippling.

(It’s been discussed that if this rippling returns there will be liposuction and lipo-filling/lipo-shaping to correct it. LIPOSUCTION. Oh lordy.)

Yes, I was once again T-Rexing it with my arms pulled close (one week); with no heavy lifting (four weeks); no crushing of the girls (read: sleeping on my back only, no chiropractic or massage therapy appointments for six weeks); and absolutely on pain of popping an implant into my abdomen death no raising my arms (read: SIX WEEKS STRUGGLING TO MAKE A GODDAMN PONYTAIL AND WASH MY HAIR).

Suffice it to say it’s been a looooooooong summer.

Next week is another post op appointment with Dr M, and I’m 99.9% sure she’s going to be frustrated. Looking in the mirror, Righty’s too high—she’s climbed a good 1.5cm above the incision line, similar to what happened to both sides after my mastectomies in 2012.

(To be honest, I’m looking forward to hearing her mutter her version of, “Motherfucker.” Always entertaining. Heh.)

In her defense, I am not knocking her skill. Hours after surgery I was regarding her work in a mirror before swelling truly set in, and everything looked perfect. Six weeks later and Righty’s shifted.

We’ve discovered through these surgeries that my body heals too well.

I’ve scarred through incision sites more thoroughly than other patients, gluing skin to ribcage. I’ve shrunken Alloderm in an attempt to absorb it into my body, launching implants absurdly high beneath my pectoral muscles. I’ve had record-breaking nerve regrowth (seriously: this last surgery’s recovery held far more pain than anyone had anticipated because my body has done in two years what most patients are lucky to regrow in four to ten years).

And now my infamous scarring has struck again, gleefully attaching this implant higher (as requested, to be sure) to my ribcage.

Can you blame it? It’s like Righty was replying, “Oh, you want it HIGHER again? You should make up your mind. But no problem sweets, consider it handled. DONE LIKE DINNER!”

(What an asshole, eh?)

In short: I’m pretty sure Dr M’s going to want to go back in.

At one appointment I asked, belatedly, that if I refused any of her recommendations whether I would be (gulp) discharged from her care.

Dr M laughed and said that first off, I am never discharged from her care. It’s a damn good thing we get along so well because she says we’re in this for the long haul. I can expect to hear from her likely every two years until, well, we both retire (since we’re contemporaries).

But yes, if I ever get pissed at her prodding weary of her pursuit of perfection, I am welcome to tell her to bug off.

And everything boob-related is covered by government healthcare.

As Dr M put it, I signed up for perfect, cancer-free boobs. Until she and I are content that I have perfect, cancer-free boobs, we can go in and tweak until our hearts are content.

That’s how this show rolls.

That’s also how I arrived to this new place, this Land of Tweaks. I am three surgeries into what should have been a single swap-and-replace mastectomy and reconstruction surgery. Listening to the previvor community at large, it would seem that this is the norm—a daisy chain of tweaking surgeries to perfect our bodies’ directionless healing—

No, “directionless” is the wrong word: our bodies are given direction, but nature refuses to be directed easily. Yet I know the correct word to describe my right breast at this moment would be disfigured. (No, I'm not just being picky.)

Though I still consider myself lucky. I know of one brave previvor blogger who has undergone eight surgeries since 2013, including losing two separate implants at two separate times thanks to complications (read: undergoing unexpected surgery resulting in sporting a single breast for months before once again beginning the painful process of expansion and implant swap. Mogatos, I tip my hat to you, madam. A toast to your unending strength).

And that’s why I finally decided to write this post. Not because I wanted everyone to know my business (again), but it followed the spirit of the original series—giving people a resource for understanding what’s involved when they undergo a prophylactic mastectomy thanks to BRCA mutation.

It felt disingenuous to omit this continuation, this unexplored Land of Tweaks.

That said, I expect this to be the last post. This is the cosmetic side of the journey, and the details of which will be completely different for each patient. Also, in breaking the news of more surgeries to someone, I was met with disbelief that I should even consider going under the knife again. To be sure, this person wasn’t attempting to be unsupportive, rather it was a moment of sheer honesty—a friend who knows they need not censor their true opinions from me.

(For the record, anyone living with this disfigurement would understand considering these lighter, tweaking surgeries. I am not looking for absolute perfection, only something that appears more natural. And I am confident it is within Dr M's grasp, regardless of how fucked up my body's sense of humour may be.)

Though the point was made: blogging each step in what amounts to cosmetic surgery, despite necessity or lack thereof, involves a flag-waving, poor me, attention-seeking attitude of which I’m not a fan.

Thus this single post serves the purpose for anyone reading in preparation for their own prophylactic journey. This is the place no one mentioned to me beforehand, this unexplored Land of Tweaks, and I feel compelled to ensure others are aware it exists.

As always, regardless of the lay of this new territory, I prefer it here over the alternative: being forced to wander endlessly through a wasteland with a pair of cancer bombs strapped to my chest.

For me, this journey is still worth it.

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