On Friday morning, Mr Cool drove me 2 hours to the big smoke specialist cancer hospital, and despite arriving on time, I waited in the waiting room for another 2 hours for a 12 minute breast clinic consult.   I was quite annoyed, especially since a friend of mine who had a later appointment was seen before me and I sat for another hour. Of course, when I went in my breast surgeon apologised for the delay and I gave her a piece of my mind I didn’t mind, cause she is mesmerisingly impressive worth waiting to see. So all was forgiven.

In the small consult room we gathered, myself, the breast surgeon, the plastic surgeon and the breast care nurse.

After dutyfully stripping off, the plastic surgeon took a close up picture of my breasts with his iPhone doing my best breast pose. Naked from the waist up and with my hands on hips I nearly said cheese as he snapped away. Luckily I’ve been practising in the bathroom mirror for months.

I love the feeling of being photographed topless by a 60 something, hairy faced, balding plastic surgeon and this photo then sitting in his iPhoto collection along side thousands of other breast pics. I’m hoping he doesn’t leave his phone on a table in some random cafe. These pics I assume, will be safely guarded and used as a reference in surgery.

In four weeks, I will be having my preventative prophylactic mastectomy. Tests show no cancer in my right breast. But the risk of recurrence or new cancer is quite high and right from the diagnosis I made a decision to have the second breast off. If my tiny breast can have as much cancer as it did, then I don’t want any breast tissue on my body. Especially since the cancer is strongly Estrogen positive. This decision has not wavered since the January diagnosis.

At the time of this second mastectomy, they will put in a silicone implant and make a dermal flap to hold it in place and stop it from bulging out the top of my pectoral muscle which is pulled off the ribcage to make room for implants to sit behind. In the same operation, they will remove the tissue expander from my left breast that has been there for 6 months, and replace it with a silicone implant. I might ask if I can keep the tissue expander as a souveneir. Could be used as a paper weight or something. After a hostile start, we have become friends, the little Asian sized expander that was never expanded.

Working together, the breast surgeon will perform the nipple and skin sparing mastectomy and a possible sentinel node biopsy, they will turn the nipple inside out and scrape and freeze some cells and hurry them off to pathology and wait for the result in ten minutes.  I’m not sure what they will do while waiting.  A quick round of Candy Crush perhaps?  If the result is negative for cancer I get to keep the nipple.  The plastic surgeon will then take over and build the breast with my new implant and give me a bit of hollywood shoozhing.  I will be in hospital for 3-5 days and will come home with Exudrains again. You can see a picture of what they looked like last time I had them here. And again a nurse will visit me daily to check the dressings and drains. For a month I will sleep sitting upright in bed as I can’t lay on my sides or stomach. And like last time, I wont be able to run for about 5-6 weeks, perhaps longer given I’m so low from chemo and I will have already commenced radiotherapy 2-4 weeks after this surgery.

They are very happy with the work they did on the left Shittytittie cancerous breast back in January and February. It has healed well and looks nice and perky and radiotherapy should take care of any cancerous cells that may have been left lingering.

With the exception of nerve damage to the breast and arm from the mastectomy and full axilla clearance back in February, I love my new breast, and am quite happy with the 3 o’clock nipple. (Refer to Diagram B below) But in this meeting the plastic surgeon and breast surgeon had a little conversation between themselves while I sat bare chested and listened…

BS : What are we going to do about that nipple?

PS : What do you mean? How far to the left side and how high it is?

BS : Yeah. We definitely need to fix that!

Me : Oh thats okay I have always had nipples that point sideways.

BS : No we really should do something about it.

PS : If she is happy we can just leave it and make the other one the same when we do the mastectomy and insert the new implant with a dermal flap.

BS : Or you could just move it slightly to the centre with another incision.

My Plastic surgeon nodded while closely studying my left breast.

PS: I’m more concerned with this swollen scar tissue at the surgical incision line at the side of the breast. It is very tight. We’ll need to free it up a bit. We could drag it round to make the side of the underarm more streamlined, and that would change the position of the nipple.

Me: What about the top of the breast? It’s very tight when I raise my arm.

PS: Oh don’t worry about that we will loosen that up in the next operation.

The plastic surgeon left the room.

Legend:

  • BS = Breast Surgeon with the amazing shoes and largest diamond I have ever seen on her ring finger.
  • PS = Sincere Plastic Surgeon with the hairy face.
  • Me = Me with the wonky arsed nipples.

So there is just this small dilemma of the nipple placement. For 37 years I thought my nipples were you beaut perfect. Turns out, the surgeons think they out of the ordinary. Extraordinary even. I have never had front on “beamers” (For those not in the know, Beamers refer to hard nipples, visable through one’s shirt) My lights have always shone out to the sides. Always. But with a lumpectomy and mastectomy and with a tissue expander inserted, my nipple is considerably higher than it once was and it points to the side – like to 3 o’clock if you get my drift. (Refer again to diagram B). The yet to be renovated breast has a nipple that currently points to 8 o’clock so there is considerable work to happen to achieve symmetry. Symmetry is everything in the plastic surgery world. I am a geographical person also, so another description of nipple orientation might include compass points. My left nipple sits east north east and my right nipple currently points south west and the perfectionist breast surgeon would like to see them even and centred. I’m not sure I even care.

For your amusement, below are some annotated diagrams outlining the dilemma. I’m a visual person and I like pictures, but I’m not putting photos of my breasts on this website. Just letting you know now. So below is as good as it gets.

Image003

Diagram A: Pre cancer nearly 40 something boobs that have breastfeed two children. These were my “Rocks in Socks”. But they were good rocks, in good socks and they were mine. Before cancer moved into the building.  

Diagram B: Post cancer lumpectomy, mastectomy and tissue expander insertion. Here the left breast is perky and larger than the original even though it was never filled or expanded, with  a 3 o’clock pointing nipple. Right breast (my right) still the original.  I have always liked 3 o’clock, it’s a great time of day.

Diagram C: August planned prophylactic (preventative) right breast mastectomy with immediate reconstruction with silicone implant, making breasts the same with a 3 and and 9 o’clock nipples. Cue circus music. Hideous, someone cover her up! (I thought they would look great!)

OR

Diagram D: August prophylactic (preventative) right mastectomy with immediate reconstruction with silicone implant, making breasts the same with extra incisions to move both nipples more to the centre of breast so that they look like beamer headlights (point forward). (Yawn, can’t be bothered, I thought I looked good already. Mr Cool will find other reasons to leave me than my outward pointing nips.)

Now I am left feeling a little confused by the options for my wonky nipples. Is it really a problem? I can’t have people sniggering at my high and sideways pointing nipples when I go topless on St Kilda Beach after all of this is said and done. Maybe I need a tummy tuck too? My stomach points to the sides as well. Can they do that at the same time? I’m guessing I’ve got two weeks to decide whether I want them touching and moving my nipples when I next meet them and sign consent forms for the surgery. These first world problems get more ridiculous as we ‘advance’ as a society. Advance being a highly debatable word.

For this fortnight, that concludes the great nipple position, freak show, circus saga.

On a more serious note, I will be back to the big smoke in two weeks to see a psychologist about undertaking my prophylactic mastectomy. Apparently anyone who has one must see a psychologist first. Not to approve or deny the mastectomy, but just to talk though the issues around the taking of a breast that doesn’t yet have cancer in it. Do I see it as an amputation of a body part? Will there be any adverse psychological effects of this decision? I had a breast removed already, and I am very ready to let the other one go as well once chemo is complete.

My pathway through treatment has been complicated. After I was initially not likely to require radiotherapy, post mastectomy pathology revealed I probably should have it (Multifocal, grade three, one node, tumour close to chest wall, want to live as long as possible, have young kids etc) which has put a bit of a spanner in the works for how we move forward.

I am presently unable to have an MRI on my breast because I currently have a tissue expander with a metal magnetic port in my chest. Being in a MRI machine would be a bit like sitcking a ball of metal in the microwave. I have had mammograms and ultrasounds of the second breast. They have come back clear. Yet the surgeon has twice raised the prospect of doing a Sentinel Node Biopsy (SNB) to be sure to check the lymph nodes. She said I would be very unlucky to have cancer in the lymph nodes of my right arm given I am on chemo at the moment , but it does happen even when no cancer is detectable in a mammogram or ultrasound. Once the mastectomy occurs, diagnostically they cannot do an SNB because that involves injecting the breast with both radioactive contrast and blue dye and imaging it prior to surgery and then removing the nodes involved to check for cancer (see my previous post “Blue Dye” for a description of this procedure), but there is a risk of lymphodema occurring in the right arm, and I’ve already had all of the nodes removed from the left arm. So having two arms at risk of lymphodema is not a great prospect. The alternative is to take a chance and do nothing with the nodes. So another decision to make as well.

Of course, I am wondering if the surgeon’s picture will be used in some hideous nipple placement photographic presentation at some plastic surgeon’s circus convention. Roll up, roll up to see the lady with the mismatched 3 o’clock and the 8 o’clock pointing nipples! To be fair though, someone who was wearing designer 6 inch fluorescent pink stilettos (kicking myself I didn’t get a picture) has created this uncertainty about my nipples in my mind and it wasn’t my hairy plastic surgeon. To move or not to move. It’s not like I have any breast sensation left post mastectomy anyway.

Just call these growing waves of unsettled thoughts I have to make decisions about my “Nipple ripples”.

Cue circus music now.