As many of you may remember, I was planning a prophylactic bilateral mastectomy with total hysterectomy when I discovered I was BRCA2+ in January of last year. Now, a year later, almost to the day, with a cancer diagnosis thrown into the mix, I am actually going through with the mother of all surgeries.
A lot of you have asked what my surgery will be like, if I will have reconstruction, if I am still getting the hysterectomy now that I have the big C, etc, so I thought I would devote an entire post to going through it step by step.
Disclaimer: I will be using terms like "nipple" and "breast" and maybe even "vagina", so if those words make you squeamish 1. grow up and 2. this post may not be for you. If you are hoping for pictures of real boobs, you will be out of luck. Move along son.
Now that the legalities are out of the way, lets get on with it....
Day before day of surgery (Sunday)
This day may actually be worse than surgery day. I have to report to the hospital bright and early (0730) and check in to receive a radioactive shot right to the nipple. POW.
I'll bore you the anatomy lesson, but lymph nodes are responsible for draining fluid around your body. They work together in a group, much like a gang. The sentinel node is the queen bee, or the leader that drives the chain of nodes. My surgeon is on the hunt for her and her closest cronies, because if they are cancer free, it is safe to assume the others are as well.
In order to determine which node is the leader of the pack, a radiologist has to inject radioactive dye into my breast and that dye drains out of the area through the lymph system. As it leaves the breast area, it concentrates the most in the first node of the chain, then lesser so in those nodes following until it is no longer detected in the nodes at the end of the chain.
So in case you missed it, I will repeat for emphasis. "a radiologist has to INJECT radioactive dye INTO MY BREAST." This means nipple meets needle, FOUR.TIMES. Tomorrow morning I will be injected at 12, 3, 6, and 9 o'clock around my nipple, just to make sure enough dye gets in to make it glow like a glowstick*.
*I am told it is actually a very low dose of radioactivity. It does make me feel a little bad ass though to say I'm radioactive.
Then the following day, my breast surgeon will scan me to find the most radioactive nodes and promptly take those suckers out. More about that later in this post.
So after my super awesome morning wakeup call, I then get to come home and begin my bowel prep for surgery. I start out with an appetizer of magnesium citrate, or a very effective saline laxative, followed by a full day of only clear liquids, which means oreos are off the menu. What is on the menu is a variety of gatorade, water, soup broth and jello. I know you are all so jealous, you can hardly contain yourselves. This treatment is prescribed to ensure I am cleaned out prior to surgery.
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| Clear liquids, with a side of poop emoji. My kind of Sunday. |
Day of Surgery (Monday)
Now that I am prepped physically, although maybe not emotionally, I will head to the hospital just after 5 am to check in for surgery. I'll get an IV, sign a crap ton of papers and have my last moments with the breasts that fed both of my babies for almost 2 years combined and the uterus that provided them with a comfortable home. Mentally, I want to go into surgery with a positive attitude, so I plan on listening to some dance music and staying up beat. If that doesn't work, watching George Dubya put on a poncho just might do the trick. They will walk me back to surgery around 0700.
Surgery 1- Robotic total hysterectomy (removal of uterus, tubes, ovaries and cervix)
After I am good and asleep (and airway secured!), we will begin with my hysterectomy. After making one abdominal incision, my Gyn doctor uses a robot, as an extension of his arms, to remove all the parts listed above.
That's right, a robot is taking out my uterus. Maybe that would be a good suggestion for a future FRC challenge?? Perhaps not...
This will take approximately 1-1.5 hours to complete, and then my Gyn surgeon will hand off to my breast surgeon.
Surgery 2- Sentinel lymph node dissection (taking out the queen bee and her posse)
This is where the previous day's procedure is important. While the picture below isn't entirely accurate (I said peace out to my tumor a while ago courtesy of adriamycin, cytoxan and taxol), it gives you the idea of the procedure. Using a probe, my surgeon will identify those nodes that glow the brightest in the chain and promptly take them out and send them to pathology. She will then proceed with my mastectomy and wait for the preliminary pathology to return before my procedure is over. I'm not sure how long this part of the procedure takes, I'm guessing around an hour or less.
Surgery 3- Nipple sparing, skin sparing bilateral mastectomy (bye bye boobs)
Now the serious work begins. My breast surgeon will make an incision in my "inframammary folds" (greek lesson- infra = below, mammary = boobs) and begin removing breast tissue under my skin. She will remove every ounce of tissue she can find from my ribs up to my collarbone and over to my armpit. All of this tissue will be sent off to pathology and scrutinized for cancer with the hopes of an all clear at the final report. Removing all this tissue will take approximately 3-4 hours and at that time, the preliminary pathology report should be back on my nodes. If there is concern for more cancer in the nodes, then my breast surgeon will remove more.
Surgery 4- Direct to implant, over the muscle breast reconstruction (hello new boobs!)
My breast surgeon has now earned her lunch, and she will tap out and allow my plastic surgeon to finish the job. I want to mention that many plastic surgeons all over the country chose to do reconstruction differently. The most common method is to create a pocket beneath the pec muscle to hold an eventual implant. Because this pocket does not naturally exist, expanders are put into place to stretch that pocket gradually until it is large enough to hold an implant.. This means slow, painful fills to stretch that muscle, in addition to muscle spasms and an additional surgery to swap them out for implants. While this technique is not wrong and may actually be preferred in some cases, my surgeon prefers to do it a bit differently.
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| This is the best image I could find to describe the two options,, just ignore the mammary gland in the photo, mine will be removed |
Whew, I'm tired just writing this all out and I have to go through it all physically in about 36 hours. My entire surgery should last around 7 hours, although to me it will just feel like a really long nap! I hope this post helped explained a little bit of what Monday will look like for me. I hope to blog more frequently while I am off and I will do my best to update Monday night once I am somewhat coherent.
Prayers are always welcome, specifically for clear minds and steady hands for my surgeons, healing for my body and absence of infection in the days to come. I would also welcome prayers for Mitch and the girls, that they can adjust to me being less available for a while and that Mitch has peace while I am in surgery.
Thank you to ALL of you for your support and love, I couldn't have gone through all of this without you. Much love, ~Linds
