The deep end

Hello friends, I’m on the other side of surgery now. It was successful, and I am doing ok. Doing today well, actually. I’m so happy to let you know that the pathology from my breast tissue was negative for any malignancy and I have not had any complications.

Thank you to everyone who has reached out to me and my family, and everyone who has held us in your hearts and prayers. I have felt so loved. I have been surprised by how hard it is to string together words in my post-surgery state of mind, and my appreciation for Jen’s gift for writing through the hard times is greater still.

If surgery and breast reconstruction talk isn’t your thing, please skip the rest of this post. I am going to share in some detail the procedure I underwent.

Two weeks ago, I had a Bilateral Breast Skin-Sparing Mastectomy and Bilateral Reconstruction with Free Deep Inferior Epigastric Artery Perforator Flaps. In mastectomy forums and support groups, this is usually referred to as DMX with immediate DIEP flap reconstruction. In simpler terms, it means that after my breast tissue was removed my surgeon used tissue from a donor site on my own body to reconstruct breasts.

My surgery took place at The Christ Hospital in Cincinnati, Ohio. My breast surgical oncologist Dr. Jennifer Manders removed all of my breast tissue while keeping my skin intact. From what I can tell from the surgical notes, Dr. Manders completed the mastectomy within a couple hours. While Dr. Manders was operating on my chest, my plastic surgeon Dr. Bianca Chin operated on my abdomen. She removed skin and fat tissue from my belly (DIEP flaps) and then used that natural tissue to reconstruct breasts, contouring the tissue and fitting it into pockets under my skin on my chest. (Think belly fat instead of breast implants.) Using a microscope, Dr. Chin had to detach blood vessels from my abdomen and reattach them through my chest wall. Before closing my abdomen, Dr. Chin also surgically repaired my diastasis recti—a condition where my abdominal muscles had not healed back together after having babies, common for women who have babies after age 35 (me); women who have big babies (also me); and women who have babies in quick succession (me again). The surgery began before 9 am and I woke up from anesthesia around 5 pm.

I was sent to recovery on 5 South, a post-surgical floor at The Christ Hospital where my Mom, Roz, had spent her nursing career. I wish I had been an easier patient for the wonderful team that looked after me, and I am so grateful for their excellent care. I felt very vulnerable and very confused those first few days, and I hurt. Dane and Mom took turns sleeping in my hospital room; Dad and Katie were right there with me. So much love.

For the first 24 hours in recovery, nurses were checking me every hour to monitor the health of the DIEP flap tissue. Those visits reminded me of ultrasounds during pregnancy, with nurses using a doppler to listen and locate my heartbeat and then our collective relief when we heard the reassuring pulse that confirmed blood flow. Following surgery, Dr. Chin used devices called T-Stats—amazing non-invasive sensors that monitored the tissue health and sent a live feed to her smartwatch. I am so in awe of these gifted surgeons, these dedicated nurses, and the advances in medicine and technology that made my procedure successful.

I was discharged from the hospital after three nights in. I have an incision hip-to-hip, a new belly button, and ‘lollipop’ incisions on my breasts: a circle located where my nipples were and a vertical line down to the crease below my breast. My pain is primarily down the middle of my abdomen where my diastasis recti was repaired and near my sternum where Dr. Chin had to drill through my chest wall to reconnect blood flow to the reconstructed breasts. (As I’ve stopped taking narcotic pain medication over the past few days, some areas feel better and other areas feel worse.) I was sent home with four drains still attached, and a nerve block that injected anesthesia into two sites in my back and was connected to a not-so-fashionable purse that contained the medicine. These post-surgical accessories were removed one or two at a time and my final drain was removed yesterday. When the last drain came out, I told Dad that I was so happy I could skip, except that I definitely can’t skip yet.

Overall, I feel like I’ve been hit by a truck. Funny enough, those are the exact words one of the surgeons I consulted with used to describe this sensation following the DIEP flap procedure. So… expectations managed, I guess?

There were many options available to me for how I approached breast reconstruction—including no reconstruction: the option for aesthetic flat closure of the mastectomy site. I had known about natural tissue reconstruction for many years and had even talked about DIEP flap with Jen when reconstruction was something she was still considering for herself if she had survived cancer. Implants were never an appealing idea for me, one of the reasons is that implants typically need to be replaced every 10-15 years. With this successful, immediate natural tissue reconstruction and with thanks to the very talented Dr. Chin, I don’t expect to have any major subsequent surgeries. It’s typical for DIEP flap patients to have a less intense, outpatient ‘phase 2′ surgery, where I could choose to have scar revision, nipple reconstruction, or adjust the size or lift of my breasts through reduction or fat grafting. That decision will come after I have a few months of healing behind me.

I feel vulnerable sharing these details with you, but I think it’s important to set aside my shy feelings and put this out there. (I come from a family of great communicators or over-sharers… you decide.) I learned so much by hearing and reading others’ stories. My awareness of these types of surgeries evolved into researching options and then to connecting with other individuals all considering the choices for themselves. This has been a highly personal decision that I did not arrive at lightly. I hope that anyone facing a mastectomy is educated about their choices and has the resources and advocacy to see them through.

Two weeks out, I am so happy that I made this choice.

Love,
Meggie