The Aftermath

I woke up from a planned, double, nipple sparing mastectomy with straight to implant reconstruction to find out that I had cancer in three of my lymph nodes, and they had performed a left axillary lymph node dissection as well. Positive nodes hadn’t been visualized in any of my imaging scans before and made the situation significantly worse. Once it’s in your lymphatic system, you are at a higher risk of recurrence, and chemo and radiation become part of the recommendations. But this surprise would become one of many for me along this journey.

In 2014, putting the implants under the muscle in implant reconstruction was standard. This isn’t so much the case anymore because the way the muscle would contract over and animate the implants caused a lot of dissatisfaction in patients. It was uncomfortable, and it could inhibit range of movement, plus it looked terrible anytime you had to reach for or lift something. I had had a long meeting with both the breast surgeon who was to perform the mastectomy, and the plastic surgeon who would do the reconstruction. They did their due diligence in explaining what was going to happen and outlined the risks for me. I asked questions to the best of my layperson’s knowledge, but I didn’t know what I didn’t know until afterward. Unfortunately, this left me with a result that was unfortunate and not right for me as an active woman. When I had previously consulted with surgeons at City of Hope, I was told they would perform something called an “anchor scar”, which is essentially an incision around the outside of the areola that jets out toward the armpit only about an inch. They said it wasn't visible in clothes or bathing suits. At the time, differences in scar placement between surgeons didn’t register in my head. So when I underwent the procedures at USC and they told me the scar would be on the side of the breasts, I didn’t realize that was different than what COH had told me. I woke up with 4 inch long scars that jetted into my armpit on both sides. It was worse on the left since they had to remove my axillary fat pad, but it was shocking to see it, and sadly, everyone else could see it too in a tank top or bathing suit. On top of that, one of my nipples died during the procedure. The areola was fine, but the protruding part of my nipple turned black and fell off. When I realized I couldnt feel anything on my boobs at all, I was suprised and asked the doctor when the feeling would come back. She gently reminded me that she explained I would lose feeling, and that’s true; she did tell me that. But I didn’t realize it was permanent. I thought they preserved the nerves to the nipple since I was keeping them, and the feeling would eventually come back. I was incorrect.

Waking up from that procedure was hard. Because of the node involvement, the surgery was 9 hours instead of 4, and I threw up coming out of the anesthesia. I felt like I had an elephant on my chest; I couldn’t take a deep breath, and I was in incredible pain. Having both procedures at the same time, with the implants put UNDER the muscle, is the reason this was so extreme. I had large breasts naturally, and I was an avid power yoga practitioner, so the surgeon had a difficult time detaching and lifting my pec muscles enough to place the larger implants. From what I understand, a mastectomy by itself hurts, but patients recover quickly. But when they remove the fat pad in the armpit, perform a mastectomy, AND reconstruction, it’s a lot.

Pain medication is a monster of its own breed. You need it to take the edge off the pain, but it causes other problems that are arguably worse. I only took those pain meds for about a week and started weaning myself off. But in the meantime, because of the pain medication, I developed a bowel impaction that nearly sent me to emergency surgery. There’s nothing like the humbling experience of picking shit out of your own ass with the pointer finger of your only good arm, while being doubled over in a frog position on the bathroom floor, after having your tits cut off. At this point, any fantasy I had about being a self-possessed and graceful woman went right out the window. My illusions of my self-image were shattered. From the cold linoleum floor of that pink bathroom in my tiny one-bedroom apartment in Venice, CA, I met my ego, and she fled the room. It’s a really good thing I was flexible, and thank god I didn’t die.

The surgeon who performed the mastectomy kept my left arm above my head for too long during the procedure, and since I wasn’t awake to tell her that my arm was asleep, she didn’t know, so she never moved it. She damaged my scapular nerve during this process, which inhibited me from raising my arm. Coupled with all the surgery in my armpit, it took me about 3 months to be able to lift my left arm to shoulder height again. All of these developments were deeply disappointing and hard to accept emotionally. I didn’t like the scars, and my right breast looked weird without the nipple. The lack of feeling in my breasts and nipples severely impacted arousal for me, which is something I didn’t anticipate but emerged as a major problem in my relationship and sex life. I couldn’t use my left arm, so I couldn’t do yoga or work out my upper body. Even though I’m right-handed, I still used my left hand at work, so I had to find ways to compensate. Lucky for me, I’m tenacious. I found ways around everything, but I was distraught that my doctors offered little explanation for these issues and certainly no solutions. I seemed to know more than they did about the body and rehabbing it. I started walking around the block within a few days of coming home, and using Chinese medicine, ayurveda, and homeopathic medicines and techniques to support the damage in my shoulder nerves and general surgery recovery. Within a month, I was stretching and moving my lower body. With the help of a friend who worked in physical therapy, I developed my own physical therapy routine because I was determined to regain my range of motion in my arm and get back to moving my body. As I began to recover, the discussion about next steps was looming over me like a cloud. I needed to get educated on their recommendations: radiation, maybe chemo, and tamoxifen. Then, as I was preparing for these decisions… My right implant fell out and slid into my armpit.

I mean what the hell?