A Mastectomy Is What Exactly?

Somewhere along the line of preparing myself for surgery, I had to start asking the tougher questions about the surgery and come to terms with the answers.  One of those questions is what exactly is a mastectomy?  Many people think its simply the opening of the breast, taking out some tissue from the round part of your breast and sewing you back up.  Well, it's actually, in fact, a lot more than that.  I felt the need to put this information out there as I get questions all the time from those who don't know what I'm about to go through.  Call it education and a way of paying it forward for others to be in the know.  Hell, I had to be educated, and I've been educating myself since 2005!

So, here we are, getting a mastectomy.  The initial incisions all depend on the type of mastectomy you're having.  There's simple or total, radical, partial and nipple-sparing/skin-sparing mastectomies.  I'm having the nipple-sparing/skin-sparing option, which essentially means they will save everything you see on the outside, but get rid of everything on the inside.  My incisions will be under my breasts, in the inframammary creases.  Here's the part that is different from those who have undergone a breast enlargement, and where many don't understand the differences between the two.  Well, besides the difference that I might not come out looking as cosmetically beautiful as someone who is getting an augmentation, because I don't get to keep my tissue.

After the incision is made, the breast tissue is separated from the overlying skin and from the chest wall muscle underneath. All of the breast tissue — which lies between the collarbone and ribs, from the side of the body to the breastbone in the center — is removed. - breastcancer.org

Did you read that carefully?  It's not about putting an implant under your muscle and into your existing tissue and closing you up.  You're not left with your nice cushy breast tissue to round out and smooth out your breast. With a mastectomy, the doctors are trying to save your life.  They take ALL the tissue that is considered breast tissue.  Did you realize how far your breast tissue actually extends?  Up to your collarbone?  Down to your ribs?  And essentially across your entire chest?  After they remove all of that tissue, they will then, in my case, insert an implant under my muscle, use Alloderm to support the implant (read more about it here) and then sew me up.  There's nothing in there anymore to keep things "squishy" or soft.  Some patients complain about the visual effect left when you have an implant pushing on your muscle which is then pushing on your now paper thin skin without that nice layer of breast tissue.  Typically, the one-step is not really a one-step.  Some patients prefer to go back to their surgeons for fat grafting (or lipofilling), which means transferring fat to the breast to fill in dents, muscle rippling, cover ridges and even things out cosmetically.

By Unknown Illustrator [Public domain], via Wikimedia Commons

After the reconstruction phase is finished (total surgery will be approx 4-5 hours), drains will be inserted to collect excess fluid.  These can last up to two weeks, but I'm praying for a rocking body that heals quickly and I get these puppies out sooner than later!  I'll stay in the hospital for two nights, then go "home" for recovery.  Since we'll be in the States, we'll stay two weeks in San Antonio, where I'm having surgery, then head to Houston for a change of scenery.  After a total of four weeks in Texas, we'll travel back to Singapore to complete the healing process.  I'm going to miss the comfort of my own bed, plentiful amounts of pillows, a cozy blanket that's mine and so much more.  The comforts of home, you know?

I think the hardest part of recovery, for me, will be reminding myself to NOT be Supermom.  That's my title given by many.  I feel the need to keep going, taking care of everything and doing everything myself.  I'll need to rely on my husband...A LOT.  Part of recovery is limited arm use during the healing first couple weeks.  No raising my arms up (hello button up shirts and pjs) and no lifting anything over 10lbs for the first six weeks.  There's the expected fatigue for the first few weeks as well, but hey, I'm determined to make it to the Riverwalk and the Alamo while there!  I also need to avoid caffeine and alcohol for 4-6 weeks.  WHAT???  No celebratory champagne or chocolate?  Dr. C. and I are going to have to talk about this one.

One of the things that scares me most is the phantom pains that can occur after surgery.  There might be itches I can't scratch and pains I can't control or ease.  These are due to nerves regrowing.  I just don't like discomfort.  I know, and you're thinking the same thing I am right now...you're having a massive surgery and you don't like pain or discomfort?  Let's just go back to that chocolate thing.  That'll help me through.

I decided I needed to have something to look forward to after all of this is over.  Spending my entire summer having surgery and recovering couldn't be ended by just going back to work.  I'd feel like I didn't get a "break".  So, we're planning a tropical paradise getaway, one where the kids can go to kids club/camp and I can enjoy looking at the ocean and sunsets.  Only fair, right?

I hope this helps some of you understand what the surgery is, the nitty gritty of it.