Breast Reconstruction Revision

Many breast cancer patients who have reconstruction end up having revision surgeries.  You are warned about that at the beginning of the process (or you should be).  It might be as simple as a scar tweak here or an adjustment there, or it could be more involved, like cleaning out contracture.   Implants have a median shelf life of ten years, and sometimes need to be replaced.    People with one natural (aging) breast often have surgeries to keep the twins matching.

I knew all along that many more surgeries would be in my future - me and Joan Rivers, we have our plastic surgeon on speed dial.

So, now I am planning my first revision.

But, it's not really a revision.  I'm starting all over.

I know, right?  You are shocked.  You remember how happy I was with my post-surgery results and are wondering what kind of foolish, Joan-esqe body dysmorphic dysfunction is going on with me.

No dysfunction here, unless my plastic surgeon has it too. Once the swelling went down and the implant settled into its spot, the results look quite different.   It's kind of amazing how much post-surgical swelling there is - and how natural it looks, not like swelling, but kind of like a breast.  Once that's gone, you see the final result.

Like Joan on her birthday, I'm less than pleased.

My plastic surgeon, who I saw last week, also is not pleased.  I have no inframmary fold, which we knew would happen, although I couldn't really picture what that meant.  It means I have a mound on my chest rather than anything that even resembles a breast.  There is puckering in the scar and some odd lumps along the cleavage, so wearing anything that shows cleavage also reveals I had cancer.  (The good news is at 53 with grey hair, nobody is really checking out the cleavage anymore.)  Also, the implanted side has odd bulges at the bottom, like a water balloon squeezed in half.

The reconstructed size is also smaller than the real side.  It will always be flatter - they can't make them pointy like real Material Girl  breasts. But, it's kind of shrunk in on itself now and I have an empty  space in the tip of  my bra.  In clothes, you can't really tell so I am relatively satisfied.  But, as time goes by, it is becoming more noticeable, and in tank tops this summer, if you know to look, you'll see the bottom of my "breast" looks odd - the clothes will hang a different way, although you'd have to be super-observant to notice that.

My plastic surgeon says I got the minimum desirable result, which is that in clothes, they look even.

He suggested that we start all over again.  Take out the implant, put in the expander and redo it.  That would mean more drains, more expansions, another hard lump in my chest for months.

One of the problems was the original expander had rotated in me and didn't expand the proper places.  When he first suggested a redo, back when he first became my plastic surgeon, (and after I had had the expander in for an entire year), I was opposed to it.  I really didn't care what my result was going to be, as long as I could get dressed normally, could look decent in clothes and get that hard rock out of my body.

Now, a  few months down the road, I guess the memory of the expander has faded and my attitude is different.

And, you know, now I have to look at the results every day.  I couldn't imagine it before - now it's reality.

So I am going to try again.

He has promised me one thing and one thing only:  it won't look worse than it does now.  He is not certain it can get better - that the fold can be created or that the lumpiness will be removed.  But, it's worth a try.

I'm going to wait until the end of summer and then plan the surgery.  I would like one summer or normality - it's been a few years.  If I'm going to have the expander again, I want to be wearing winter clothing and jackets, and not tank tops.

I also need to wait for my shoulder to heal before I have another surgery.  Given my slow progress there, it might be 2012 before I can think about it.

Speaking of reality, if you want an example of what I'm talking about, you can find it here:  Scar Project.  It is sad and beautiful.   You will see both unreconstructed and reconstructed women.  A few of the reconstructed women have much better results than I have, and I'm really happy for them - they look almost normal.

My results most resemble the lovely woman with the brown hair sitting in front of the bathtub with Christmas lights draped on them - she has what appear to be newly grafted nipples. (I didn't do nipples because the two breasts don't match and I thought it would be grotesque.)  As you can see, in her right breast she has lots of lumpiness and not much inframmary fold either.  The other women who has results similar to mine is the woman with long brown hair sitting between the two chairs.  She has no inframmary fold either and the kind of bulging I was talking about.

I"m really proud of those brave women who show the truth of mastectomy.  If my job wasn't sensitive, I would show too.  And, if you look, you will see why revisions and tweaks become important.

All of that said, I'm still extremely glad I didn't take off my healthy breast for the sake of symmetry. The numbness and "feel" of the reconstruction is unpleasant.  Because I have no breast tissue, it feels like there is something pressing against my chest wall all the time -  I can feel it moving against my ribs.  Of course, the skin is completely numb and that is quite annoying - I'm glad it's only one side, I really think it would drive me batty to have my entire chest numb.  Finally, that crazy maddening itch I've had since the mastectomy - well, it's still there.  I thought phantom pain and itching eventually went away but so far, no luck.  It is unbelievably frustrating having an itch you simply can't scratch.  I still try but I can't feel anything so there is no relief.

When the doctor takes out the implant, I'm going to tell him to scratch around in there but good.  Dig in.  Maybe he can get it.

So, my first revision?  A complete re-do   Just like Joan's face.

I hope it comes out a bit more natural..  .