Fill 'er Up, Part One: Reconstruction

Since I wasn't going to need chemotherapy after my mastectomy, my doctors allowed me to have my breast reconstruction started during the same surgery as my mastectomy. This means that immediately after my general surgeon removed my breast tissue, my plastic surgeon scrubbed in and placed expanders in my chest. By pairing these surgeries, it meant one less surgery/anesthesia overall, so I was glad to have the option. 

I should state that you don't need to have breast reconstruction after a mastectomy. There are a lot of women out there who decide that they might as well live their life without breasts. Once everything is healed up, it leaves a flat chest. A lot of women are proud of their flat chest and all the shit they've gone through. There is no good or bad option, you decide what is best for your comfort and confidence. You can always go back and change your mind later, just speak to a plastic surgeon about what the best way to go about it is.

Reconstruction surgery varies on what your priorities are, how you want your breasts to look, and your body and skin type (which affects your ability to heal). The first option when you think about having breast reconstruction is if you want to have implants or if you want to use your own tissue only. You can elect to use only your own tissue, which means there isn't anything artificial placed in your breast long term. In order to do this, the surgeon would make a large flap of skin from your belly or from your back and bring it up over to cover your breast incisions- they have to use a skin flap because there's not always enough skin there to pull your chest back together after the surgery if you want a breast shape, especially if the nipples have been removed. To fill out the shape, they can take your own fat and tissue from a different area of your body and put into your breasts. Not always an option for thin girls, you need enough fat to spare. The main reason a lot of people choose this option is because the entire reconstruction process uses your own tissue, so there's less risk of reaction or implant failure. However it does come with its own risks. Due to the extra tissue movement and the flaps of skin, there's a much longer recovery time.  There is a risk of the skin or tissue dying once it has been moved. There is also a risk for a hernia, which means you could develop a hole in an area where tissue was moved if it hadn't healed as strong as the surrounding tissue. These tears usually need to be surgically repaired. I'm very active in my job, I'm walking around all day squatting, kneeling on the floor, picking up large animals. I knew that doing the skin flap wasn't an option for me. My plastic surgeon went over the option with me anyway, and said if I decided to do it that way he could refer me to a surgeon, he personally wasn't trained in how to perform that surgery.

Reconstruction with expanders means rebuilding the shape and look of your 'breast' with implants. Some women refer to them fake boobs, shortened to foobs, I still don't know what I want to call mine. I chose for the reconstruction process to start at the same time as my mastectomy. Some women are not allowed to have the expanders placed during mastectomy surgery, depending on their cancer treatment. You have the option to hold off on reconstruction if you cant decide. If you wait, you will need two surgeries: one to place the expanders, and another to replace the expanders with implants.

The first part of reconstruction is having expanders placed under the skin in your breast area, one for each breast. After the surgery, where often a large area of skin and nipples are removed, there isn't enough skin to place an implant of a good size. It is like trying to wrap a present with a small amount of wrapping paper. Due to my mutation, I elected to have my nipples removed, but I knew that I wanted to have some type of breast shape, and I wanted to be about the same cup size that I had always been. Therefore, expanders were the plan.

Expanders are basically little pouches that go underneath the skin. The skin needs to slowly stretch to fit whatever the desired size implant, the same way that a woman's belly will stretch slowly during pregnancy, or how anyone's skin stretches as they gain weight. Some plastic surgeons prefer to put the expanders underneath the chest muscle, while other plastic surgeons simply put it underneath the skin. This seems to be a topic that has had some changes recently in terms of which option is better, so I won't weigh in too much on that. My sister had her expanders placed under her muscle, mine were just under my skin. It seems to be a bit influenced by plastic surgeon preference. I recommend talking to your doctor, seeing what they recommend, and what the pros and cons would be for your body type and activity level. My expanders were in place when I woke up from my mastectomy surgery. After the surgery, I had to schedule weekly 'fill appointments'. My plastic surgeon, or his nurse, put a small amount of fluid into the expander on a regular basis until the expander was about size that I wanted my implants to be. 

A picture of my chest after 2 fills, the surgical tape still covering my incisions. Above each foob is a small mark over the fill injection site. You can see the healing areas of skin where the drains had been located, one underneath and one to the side of my foob.

My questions was: how the hell do you inject fluid into the expander without it leaking out or bursting? I'll share the answer. Quick shout out to the nurse I saw for my weekly fills, she was always enthusiastic about answering all my questions. Each appointment, I would go into the exam room, take off my shirt, and put on a robe backwards. I would lay back on a table raised at a 45 degree angle so I was still sitting up. The nurse ran a small tool which had something like a magnet in it over my skin on the upper area of my 'breasts' (I'm going to have to come up with a word that isn't foob, because at this point there wasn't even a foob it was just skin over a wrinkly expander), and the tool would be pulled down to identify the exact spot of the port for the expander. The port is underneath the skin as it is part of the expander. The nurse marked the spots with a washable marker, and quickly scrubbed the area with betadine to disinfect the skin. She held a pre-filled syringe with a tube and a small needle at the end, and inserted the needle through the marked location. She injected 60 milliliters (also called cc's) into each expander at each fill appointment. They don't want to put too much fluid in during a fill, because then the skin would stretch too much, and risk pulling too much on the incision.

A small bandage was placed over the needle poke, I removed the bandage as soon as I was back at home. There was minimal bleeding from each spot, and a stridex pad easily removed the marker and betadine. The appointments were quick and relatively painless. The real pain came with my later expansions.

To be continued... *insert dramatic sound effect* dun dun dunnnnnnn