Image - Donna -- Free flap, nipple construction, tattoo



Age 39 at diagnosis (1998)
Age 41 in reconstruction
photos (2000)

I had been having routine mammograms for about five years. My breast exam was normal during my annual GYN visit. I scheduled my mammogram for a month later. After I had the mammogram, I was called on Saturday morning by the technician who told me the radiologist wanted me to come back on Monday for additional views. I naturally worried for the rest of the weekend. I went back, had additional mammogram views, an ultrasound, and went home after the radiologist told me he was going to show the films to some of his colleagues. He called on Friday and told me I needed to see a surgeon for a biopsy. This just enhanced my fear, especially when the radiologist left his home phone number on my answering machine in case I had questions regarding the biopsy. I picked up my films on Monday to take to the surgeon's office and, being in the medical field, just HAD to read the report—mistake! Throughout the report, written over and over again, were the words "highly suspicious of malignancy."


Bilateral Free flap with nipple construction

I went to the surgeon on Veteran's Day. He did a needle biopsy in his office and told me to go get some lunch and come back in an hour. It was the longest hour of my life. The biopsy was positive for lobular carcinoma. My world fell apart.

I had a hard time deciding whether to go with a lumpectomy or mastectomy. I knew there was at least one tumor which the surgeon estimated at 3 cm. as well as another suspicious lump. I worried about how I'd look, what my husband would do, how my child would react, whether they'd get it all with a lumpectomy, etc., etc. I finally decided on a modified radical mastectomy because I didn't want to have additional surgery. And I thought it would get me out of having radiation. (It didn't.) It was a very good decision anyway since I had two cancerous tumors, one that was 5 cm. and one that was 1.3 cm. Most of the breast was involved. The pathology report was grim. The cancer was ductal with lobular tendencies, fourteen of fifteen lymph nodes were cancerous as was all the tissue around the nodes. I was terrified that the cancer had spread. Luckily, it was localized.

I really thought I'd be horrified when I saw the scar but I was very surprised to realize it wasn't "gross." I actually thought the large droopy breast that was left was gross!

Because of the tumor size and the extensive lymph node involvement, I started an aggressive treatment regimen. I started chemotherapy three days before Christmas. I had eight rounds of chemotherapy—four each of Adriamycin/Cytoxan and Taxotere. I then had thirty sessions of radiation to the chest wall and axillary region. I'm on Tamoxifen for the next five years. Although I felt pretty miserable during the chemotherapy I think radiation was more difficult because I got progressively more tired with each session. I was trying to be superwoman—working, being mom to a six-year-old, a good wife—and the radiation took its toll. It took months after I finished until I had even a slight amount of energy.


Bilateral Free flap with nipple construction

I decided to have reconstruction about a year after my diagnosis. I'm really glad I waited to have the reconstruction until after I finished all my treatments. It gave me time to do research, to get a couple opinions and to find an outstanding plastic surgeon who specializes in Free flap reconstruction. I decided to have a prophylactic mastectomy on the left side because every self-exam was too grueling. Every normal lumpy bump sent me running to the doctor. I decided I couldn't live like that. Plus, given that my remaining breast was large and sagging, it would need serious work to obtain a symmetrical appearance with a new breast. I was on the operating table for about eleven hours for the prophylactic mastectomy and bilateral deep inferior epigastric perforator Free flap reconstruction. The new breasts were made using the fat and tissue from my abdomen.

The blood vessels were disconnected in the abdomen, the fat and tissue were relocated and then the vessels were reconnected under the microscope. Since no muscle was taken out of my abdomen I don't need to worry about herniation. The surgery has caused me pain for longer than I anticipated. My abdomen is still sore after four months. But the result is worth it. I had a second surgery three months after the initial reconstruction to put nipples on and to do some contouring to make the new breasts symmetrical. This surgery took a couple of hours. The nipples were made by gathering the skin together.


Tattooing

This was a lot more appealing to me than grafting the nipples from another part of my body. About two months after nipple reconstruction I had the areolas tattooed on and now I'm done with my "makeover." For the first time in my adult life I can go without a bra...it is terrific. A heck of a thing to have to go through to get nice breasts and a flat stomach!

Partner's observations:

My initial concern was for my wife's health and long-term survival, both physical and mental. The diagnosis of cancer was devastating and the uncertainty connected with all the associated issues put a lot on the plate for me and my wife. There were also thoughts about, "Why me?" and feelings of denial. They were short-lived and anger and frustration set in. All these emotions were present in one way or another.


Tattooing

This was all before surgery and sometimes the feelings were directed at the surgery which, upon reflection, was misplaced. Surgery is not the enemy—cancer is. Now that the surgeon's job is finished and all the reconstruction is completed, those feelings mostly have gone away. There may be some lingering uncertainties but mostly I look forward every day—and not back—in an attempt to get on with the rest of our lives. Having experienced this disease second-hand doesn't change my perceptions about cancer. Cancer is a sneaky, insidious and hateful disease. There are feelings about guilt, punishment for past bad acts, and other wild things, but they pass over time.

I have attempted to compartmentalize my wife's cancer history into several phases. It is easier than trying to do it all at once. After the initial shock of diagnosis and prognosis and surgery the follow-up was an immediate concern. She had to find an oncologist she was comfortable with and who had the appropriate chemistry to deal with a hard-charging independent woman. The doctor also had to be knowledgeable regarding treatment options and which were do-able.

Daily I am reminded how lucky I am to have a spouse who is up-and-at-'em. Her good nature and energy for living are astounding. I am grateful for her strength and awed at the same time. The surgery did not change me or my spouse. I have tried to be supportive and positive but, most of all, I have tried to keep my wife laughing. If I can keep her amused or smiling then her attitude is better and so is mine. I have also tried to do better with household chores and in caring for the kids. I will continue to help with both of these items and more as they occur. I love my wife and respect her deeply. My feelings for her grow daily as well as my respect for her strength and wisdom. She has handled this adversity with amazing strength and good sense. She has some internal reserves that even she was unaware of. I count my blessings regarding my wife and I am grateful for the opportunity to grow and mature as a person and in our marriage as a result of this disease.


Tattooing

If there is anything positive to say about cancer, it is that it will provide people with the chance to grow. I view my wife differently now; she is much more resilient and mentally tough than ever before and I draw from that strength every day. I will do my best to maintain my constancy and will continue to provide humor and spirit in our relationship. I feel good about my wife, I enjoy her company, and I want to keep enjoying it more for a long time.

 

Photos courtesy of Show Me (2nd Edition), A Photo Collection of Breast Cancer Survivors' Lumpectomies, Mastectomies, Breast Reconstructions and Thoughts on Body Image, published by Penn State Hershey Medical Center in Hershey, PA. This book is now out of print.

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