Let's talk about breast reconstruction

 

I was diagnosed with Stage 2 Grade 3 Pleomorphic Lobular Carcinoma (PLC) of the right breast in August 2019, after a routine mammogram in July 2019. My cancer also tested positive for hormone and HER-2 receptors. It means that the hormones my body produce (estrogen and progesterone) and a protein called HER-2 act as food that feeds the cancer cells and make them grow. 

My treatment regime

It is important to remember that each breast cancer patient's treatment regime is different. I highly recommend that you consult at least two oncologists and consider the best treatment option for you.

The first step in my treatment was to remove the tumours from my breast. Because of the aggressive nature of PLC, my surgeon recommended a double mastectomy with direct-to-implant reconstruction. Step two was chemotherapy, followed by step three, a year-long treatment to block the HER-2 receptors. I am now busy with phase four of my treatment - hormone-blocking therapy - that will last for 10 years. 

Breast reconstruction is a lengthy process

When I heard that my medical aid's oncology benefit pays for breast reconstruction, I was over the moon! I always dreamt of saving enough money for a breast-lift. The one positive of breast cancer was that I'm getting new boobs. Little did I know that it is not simply one surgery. So far, I've had seven surgeries - six of them were related to reconstructing my breasts. 

A general surgeon performed the first procedure - a surgical biopsy of the tumour at the beginning of August 2019. Later that month, a specialist oncoplastic surgeon performed a nipple-sparing bilateral (double) mastectomy and direct-to-implant reconstruction. The average recovery time after a mastectomy is three months. The healing process can take up to one year. 

In September 2019, the surgeon hospitalised me for debridement of the wound because I developed necrosis. Debridement is the removal of dead (necrotic) or infected skin tissue to help a wound heal.

But the wound did not heal. In November 2019, the surgeon removed the implant because the infection spread to the prosthesis's surface. Once again, I had a three-month recovery period. 

Six months later, in May 2020, the wound was healed, and my body ready for another attempt at inserting an implant. Because the surgeon had to remove a fair amount of skin with the previous procedure, he inserted a tissue expander. A tissue expander's role is to slowly stretch the skin over time to prepare it for the permanent prosthesis. Again, the procedure demands three months to recover. 

I visited the surgeon every few weeks to slowly fill the tissue expander with saline solution for six months. And finally, in December 2020, the surgeon replaced the tissue expander with a permanent silicone implant. By this time, the left breast was fully healed, and the surgeon extracted fat from my belly with liposuction to fill up the breast. The fat-fill is used to give the breast a more natural appearance. Yet again, a recovery period of three months lay ahead of me.

Nipple reconstruction is not minor surgery

Two weeks ago, in March 2021, the surgeon admitted me to the hospital again. This time, the procedure is a nipple and areola reconstruction. It may sound like minor surgery, but believe me, it is not! 

When the surgeon removed the prosthesis in November 2019, he also removed my infected right nipple. To build a new nipple and areola, the surgeon removed the skin from my lower belly - in essence, a mini tummy tuck - and uses that skin to create the new nipple and areola. The cut on my lower abdomen is from hip to hip. He also performed liposuction again to complete the shaping of my left breast and start shaping my right breast. And guess what? Yes! Another three-month recovery period.

Keeping fit and in shape during the breast cancer treatment

Between 2016 and 2018, I worked really hard to get back in shape. I lost 20 kg, reached my goal weight, started building muscle again. I felt good and looked great. 

I managed to maintain my weight after getting to my target weight until my diagnosis. Each three-month post-operative recovery time set me back. Chemotherapy left me so exhausted that I could not walk to the bathroom, let alone exercise. Also, one of the chemo side effects that I experienced was an increased appetite. The hormone-blocking treatment induced the early onset of menopause. Lower estrogen levels are linked to fat storage in the lower abdomen. 

My body is being re-wired, and in the process, I gained back the 20 kg that I lost four years ago. The oncologist referred me to a clinical dietician, and we are working towards a healthier, fitter, and slimmer me.

If I can offer one piece of advice: don't wait until after you start treatment to consult a dietician. Make the dietician a part of your core medical team from the start.

What's next?

I cannot imagine that I've come to the end of the breast reconstruction journey. I am not sure what the rest of the breast reconstruction journey entails. Another fat fill on the right breast? Areola tattoos to get them both the same colour and size? But, unlike a few years ago, I don't really care what is next. It is what it is, and I must focus my energy on getting better.