While the chemotherapy is done, I'm not quite finished with everything yet, and the question that everyone has been asking is "so...what's next?" Here's the plan right now, as well as some info on the prognosis after a follow-up with the oncologist.
You may recall from last October that I originally had a tissue expander placed when I got my mastectomy. The idea at the time was to have the tissue expander in place throughout chemotherapy, filling it every week or every other week, so that when chemo was done I would be ready or within a few weeks of being ready for my final reconstructive surgery. Unfortunately my body had different ideas, and after refusing to heal with the tissue expander (even after two more follow-up surgeries to try and clear out some of the dead skin that wasn't healing), we eventually had to take it out so I could move on with chemo.
Now that I have finished with chemotherapy, it's time to try again with the tissue expander. There are essentially two options:
- Just try to put in the tissue expander again with no additional surgical tricks and see if my body will allow it to heal this time around. In this case the only area of my body that will be affected by the surgery is the site of the mastectomy where they will place the expander again.
- Put the tissue expander in and at the same time bring a portion of my lat muscle around from my back (leaving it attached to the muscle in my back), wrapping it around the area of the mastectomy in an effort to bring some additional blood flow to the area. In this case I will require some additional recovery because it will involve both the mastectomy site and my lat muscle.
When the mastectomy is performed, they remove a significant amount of tissue and leave behind only a small flap of skin. All the nerves and blood vessels are also removed at the time, which means that it can sometimes be difficult for the incision area to heal because you have very little blood flow in the area.
We still don't know exactly why my body wouldn't heal with the tissue expander in place (although we do know that it didn't appear to be related to an infection), but the doctor's best guess is that it was because of the lack of blood flow. For that reason he was pushing me toward option #2. The down side to this option is, of course, that my range of motion and strength will be affected, which will have an impact on a lot of my hobbies, including CrossFit, triathlons (swimming), and Olympic weightlifting. For that reason, I have chosen to go ahead with option #1 and my surgery is scheduled for June 27.
I fully understand that if things don't work out with option #1 again it will mean another surgery, and I will have to do option #2 anyway, but I really feel like I don't want to have those limitations unless it is an absolute last resort, and the only way I will know that it is a last resort is to try the other way first. In the end I will accept the limitations if required, and just work really hard to get back to where I was physically before all of this happened--heck, maybe I'll even try to get better than I was before.
Step 2: Filling the Expander
No matter which option ends up working in the end, once the tissue expander is in place they will fill it over the course of about 8-12 weeks, stretching the skin until it is slightly larger than my other boob that was left intact. This is pretty straightforward, so not much to expound on here.
Step 3: Reconstructive Surgery, or "the boob job"
Once we get the skin stretched to a size that I like, the next step is to get the final reconstructive surgery. I will actually have an implant placed in both sides, the one at the mastectomy site will fill the whole breast and the one on the other side will just be big enough to make them even. The main reason for this is that it's difficult to get a reconstructed breast to look just like the real one, and an implant in both sides will make them look more similar. Depending on how long it takes to stretch the skin, I'm anticipating this surgery to be sometime in September/October.
Step 4: Follow-Ups
Of course, during and after all the reconstructive stuff there is the follow-up work to be done. I have already been in to the oncologist for my first follow-up appointment; he said that my blood work looked good and there was nothing abnormal about it. At that time he also prescribed Tamoxifen, an anti-estrogen drug that will help to keep my estrogen levels low for the next five years, which has been shown to help in curing breast cancer and preventing it from coming back. Since it's blocking estrogen chances are it will put me into menopause, but the oncologist thinks since I am so young I will likely come back out of menopause again after I'm done taking the pills.
I will continue to get follow-up appointments about every three months for the first year, then they will go to every six months and eventually to once a year. I'll have annual mammograms on the boob that I still have left, and we'll keep an eye on all kinds of things to make sure that I'm still healthy for many years to come.
I'll continue to keep you all updated as the surgeries progress.
