Boob Under Construction

Yesterday I went to the plastic surgeon for what I thought was just a check-up to make sure everything is still good. Turns out it was for expansion! I have to say: adjustable boobs are not quite as cool as they once seemed.

You may remember from a previous blog that I thought I would go through this expansion piece for the first breast, but I ended up waiting so I could "pump up" both breasts at once. That way I could remain fairly even. I had been pretty nervous about that appointment when I thought I would get pumped up, and had even brought a friend with me to emotionally hold my hand and drive me home in case I needed it. All that build up for nothing.

Well this time, the possibility of getting pumped up wasn't even in my thought bubble, so I went to the appointment alone, and even forgot to take pain meds before. It wasn't until I was having my vitals taken that I learned what was coming.

The PA looked at my surgery site and said everything looked good, and I was ready for expansion if I wanted it. Let me take a moment just to explain, because sometimes I forget that not everyone knows how a mastectomy with reconstruction works (lord knows I didn't until last summer!). At the time of my mastectomy, the plastic surgeon put an adjustable implant in, nestling it under my pectoral muscle, and inflated it with saline as much as he could. Mine was a "skin sparing mastectomy," which means the surgeon sort of scooped out the breast tissue and left the skin, but there was slightly less skin because they took the nipple. (There are also nipple sparing mastectomies - Angelina Jolie had one - but I wasn't a good candidate because my previously radiated skin weakened the skin, and the nipple would likely not get the blood it needed, and would die. Gross, right?) So when all was said and done, my reconstructed breasts both ended up being about 80% their original size.

But skin and muscles both have the capacity to stretch - think of when a woman gets pregnant, how her skin stretches to accommodate. So as everything in there settles down after the trauma of the surgery (moved muscles, cut nerves and skin, foreign body), my body comes to be ready for incremental changes that will move me back toward my original size. This part of the process is no longer about my physical health, but rather, my emotional health. They are trying to get me looking as "normal" as possible (whatever that means), so I won't be reminded of cancer whenever I get dressed or look in the mirror.

So, back to the doctor's office. She said I was ready for expansion yesterday if I wanted. I said if she thought I could handle it, then I was willing to go for it. She said it wouldn't hurt going in (except the initial needle prick), and shouldn't hurt after. Then let's do it!

My adjustable implants each have a little port, situated under my skin sort of near my armpit. The ports have a tube that goes into the implant. Here it is:

So she poked a needle through the skin into the port, and then brought out a couple of huge syringes (let's call them Hans and Franz, there to "PUMP me up"). She said they only hold 2 oz each, and usually an expansion is 2-6 oz at a time. She started with my left, the well healed side. She was right - aside from the initial poke, I couldn't feel a thing as Hans did his job. Then we moved over to the right for the same procedure. Franz hurt a little more - I could feel the saline going in, feeling cold, and I could feel my chest-muscle-turned-boob adjusting to the change. I was already feeling very tight to begin with, like I have a rock strapped tightly to my chest. So this didn't help.

When she was done, I took a breath to focus and relax... but it was when I sat up that it really started to hurt. It was SO tight, that any time I moved my shoulder forward or back, I felt a sharp pain. She said she could take some saline out if I wanted her to, and I said I would sit with this for a few minutes and see if I got used to it. She left me alone, and then Dr. Langstein came in. He explained that this is really a no pain no gain situation. This is a boob under construction. He explained the biology of what was happening (totally over my head), and said we could take some out, but that would ultimately just lengthen the process. No, get it done already! I thought. I asked how long it would hurt, and they both said maybe 24 hours, especially the first few. I decided I could suck it up that long. Good, they said, come back in three weeks. I have to keep coming back until I am the size I want to be (which could apparently be quite large, if I felt so inclined! But I don't.).

I'd like to think I'm pretty strong, and have a high tolerance for pain. But I tell you, that was not comfortable. It hurt enough that I could very easily have come up with some tears, but not so much that I couldn't hold it together... until I got in the car. I really wasn't sure I would be able to drive. I sat alone in my car for a few minutes just whimpering to myself and occasionally shouting, "OUCH!!" and contemplating whom I could call to come drive me home (plus someone else to drive my car home). Finally I decided I could make it the 20 minutes home, and took a deep breath, drove carefully out of the parking lot, and was on my way. Of course my GPS took me through downtown, which required a lot of turning (darn it, why didn't I take the expressway??), so my left hand got quite a workout while my right hand mostly lay idly by. But I made it. Last night was pretty rough, maybe the most pain I've been in yet. But I was able to sleep, and the morning was better. Today is not great - better than yesterday but not as good as pre-expansion. So much for today's to-do list; I don't want to move.