Nipple Ripples

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.

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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.


Silver lining

Everything comes down to attitude. It’s the only thing anyone has any control over in their life. The rest is unpredictable. Health, relationships, circumstances. A positive outlook or attitude benefits everyone. So this is my positive take on today in point form.

Brushing your hair, pulling up your undies or taking a t-shirt off are incredibly difficult after armpit and breast surgery. I am learning to graciously accept the help of others in situations like this. So if you see me walking naked in the street (except for my t-shirt) please stop and offer assistance. Just gently and very slowly lift it over my head. Don’t be concerned about the drain coming from my chest and the bag of blood. Many thanks in advance.

The landscape driving through the granite country south of our awesome city and the apple growing region always puts on a spectacular display, with sunlight and clouds stretching over rolling hills which are either yellow or green depending on the season. I love this landscape.

All the time in cars we have spent in recent weeks without our children has been good for our relationship and for strengthening our communication. It is great to connect with my partner after many weeks of us just treading water. Little people do their darnedest to make it all about them (and rightfully so).

Melbourne has some beautiful parks and streetscapes and it is nice to be visiting her frequently after living regionally for fifteen years.

It is nice to see members of my medical team again. I like them, so much so, that I would arrange a dinner party if I wasn’t just another one of their 3000 patients they see every day. I could potentially get depressed, more from the finish of treatment than from having had cancer, as they won’t be a regular feature in my life anymore. So I’ve decided to throw dinner parties for random strangers just to fill this void.

Once you go through an experience of multiple surgical treatments for something like breast cancer, (and in a similar way the exposure and dignity loss accumulated from the experience of childbirth), pulling the curtain shut for countless adults at breast inspection times seems really unnecessary. It’s not like they haven’t seen my breasts before. Don’t worry, you won’t see me topless on St Kilda beach anytime soon (unless the implants look amazing).

My husband is really hot. The surgeon took a double take at his gorgeous, cyclist shaved, brown legs today and made comment on them. I pretended I didn’t notice. Unfortunately he did. As if I haven’t seen him admiring his legs enough!

I am really good at talking to the surgeon and taking pictures of her shoes at the same time. See…

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It’s always about the surgeon and her shoes.

After the initial cancer diagnosis and the crazy shock of it, results are just more of the same. Good and bad. They really are just results. A bit more news. I’m a bit numb to it. Even when there is good in it. This indifference is great as it stops me obsessing and stressing unnecessarily.

Why is the hospital cafe food full of the same stuff that is sold at airports? Every time we walk into this hospital I’m looking for a check in gate and wondering where I’ve put my boarding pass.

I might be a candidate to participate in an international trial called “The Supremo Trial” to see if there are any benefits of post mastectomy radiotherapy on breast cancer patients with aggressive cancer. I love it when they name these things after pizza.

I’m keeping the nipple so far. There was no cancer behind it. So that is one less body part to remove. Yay! Although I shouldn’t be too premature with my celebrations, as with the trauma from surgery my nipple may be at risk of tissue necrosis where the tissue dies from lack of oxygen. I have always wanted to visit Antarctica. So I’m viewing this as a kind of ode to frostbite and Shackleton. But so far so good. Breathe nipple, breathe!

If it does turn black, surgeons will remove it and it could be replaced with a nipple tattoo. (Cue music for Embarrassing Bodies, Episode 54) I’ve never liked the idea of tattoos. But if I have to have one, a nipple sounds way cooler than a tribal tattoo, a dolphin or misspelling my husbands name. Imagine getting a nipple tattoo on your bicep? Now that would be super!

A second mastectomy of breast number two, and another sentinel node biopsy of the other armpit is now a given. This will happen post chemo later in the year. Oh joy! The things a mother has to do to get her kids a tour around a fire-station! Hopefully the results of that won’t mean more chemo in 2014. Imagine the jokes I’ll have to create if I have to go through all of this a second time!

The removed breast revealed more patches of pre cancer changes (DCIS), not including the original invasive ductal carcinoma tumour (IDC) and the ductal carinoma in situ (DCIS) that was removed in the first lumpectomy operation. All of these acronyms make it sound like an episode of NCIS. It is hard for me to fathom all of this cancer activity in the space of my tiny 148 grams of breast tissue. On the bright side, at least with a double mastectomy, I will at some point have a set of matching breasts. It will be nice to have some 18 year old looking, perky body parts after all these years.

I think I’m falling in love with a girl called Endone.

‘Chemo’ and ‘dreamo’ rhyme. My chemotherapy might go for 6 months and this is so much better than 10 months! Ain’t no chemo gonna ruin my Christmas lunch. It will be of the ‘Third-generation’ variety which is a bit more cutting edge they tell me. I need some time to recover from these two February surgeries. It will start in roughly three weeks time. This means it won’t start till after the kids and my birthdays. Winner winner chicken dinner! So baldness might not be a feature till April or May now. ‘Bout time I had a new hairstyle anyway. We worked out in 37 years I have only been to a hairdresser 7 times.

The familial/genetics clinic is booked to help search for any potential mutant DNA and troubled genes. This excites me as I love family tree research!

In two operations there have now been a total of 21 nodes removed. Only 1 of these was cancerous. Which is great news but there are no guarantees. Breast cancer is a sneaky bastard and plucks off unsuspecting women at random, even with small tumours and no nodal involvement. Indiscriminate and unpredictable in nature. But in spite of that, 1 node out of 21 is really the BEST news we could have received today!

The Exudrain lady is unfortunately returning home to the country with me today. So a few more days of carting her around. Never mind, it is quite a nice floral bag she sits in. The glances at the shops have been interesting.

There were no tears today. Could have worn mascara after all!

People have offered so much practical and emotional support it’s awesome! We love ‘youse’ all (said in Australian bogan voice)!

There was definitely a silver lining on that cloud I photographed this morning. I just had to look closely enough to see it.


24 hours from the surgeon’s scalpel

A strange calm is hanging over me. There are so many unknowns ahead but the immediacy of the removal of the cancer takes priority.

I have no idea how I will process what lays ahead. My fertility window has just been slammed shut. We were trying for our third child this year and I can’t even connect with what this will mean to me or my husband in the months and years to come. It never occurred to me that the couple of years I still had to add to my family might evaporate into thin air, but it has. At nearly 38, this diagnosis means I’ll be on hormone drugs till I’m 44 and pregnancy hormones feed this cancer. So future pregnancy would be beyond the realms of sensibility.

How will I feel about my changed breast? A lumpectomy, although a small procedure, will pretty much remove half of what I have as there wasn’t much to begin with. I have decided to have this minimally invasive procedure first, (lumpectomy and sentinel node biopsy) then treat the cancer asap, and then decide what to do later on with mastectomy and reconstruction or radiotherapy. Statistics for survival are the same with lumpectomy versus mastectomy. With young children a mastectomy would be quite a feat to recover from with groping arms and cuddles and lifting. And we don’t want any complications that would delay chemotherapy from starting. Women can still get breast cancer after a mastectomy, but it tends to be much earlier detected. The surgeon tells me I can keep my nipples, but that one will point under my armpit post surgery. How exciting!

The surgeon has also suggested I have a 30 percent chance of the cancer turning up in my other breast. And that a double mastectomy might be on the cards. The pros for this being I would have “a set” that look the same if I chose to have reconstructive surgery, and I might also get out of having radiotherapy if both breasts are removed. There are some rare cases coming through in research studies where women under 40 who have radio for breast cancer are turning up with radio caused chest, lung, liver and bone cancers in their fifties. Yippee!

How long will all of this it take to heal? How long will it be till I can continue on my distance running quest? Will I ever get to finish a half Ironman Triathlon?

I had so many goals for myself this year. Cancer was not in my plans.

Will they get it all out and what will the pathology results be? Will the nodes be involved? What if they are? What will chemotherapy do to me? Who will look after my kids? Will my husband cope?

I’m hurtling towards some challenging times.