Breast Cancer - talking about reconstruction

This post follows my previous post about my full diagnosis of breast cancer. 

You can find all my breast cancer posts by clicking the tab at the top of the blog.

Please note that this is my personal medical story. There are details of medical procedures. I am not a medical doctor. 

PET Scan

At the end of my last post I was waiting for the PET scan to check my lymph nodes and for an appointment with the plastic surgeon. 

A PET scan uses a radioactive tracer to detect areas of the body with high chemical or metabolic activity. Cancer cells can have a higher metabolic rate than normal cells so will show up as bright spots on the scan. My surgeon wanted to see, in particular, whether any cancer had spread to my left underarm lymph nodes.

On the day of the PET scan I had to fast for 6 hours but fluids were allowed. I drank lots of water which again helped with having the cannula inserted. The radioactive tracer they use is bonded to glucose which will travel to the 'hungriest' cells in the body after fasting to see where there is most cell activity. 

Once the cannula was in, I was seated in a reclining chair in a cubicle with thick walls and was given a hot blanket, which was lovely. The nurse stood on the other side of the wall and fed the injection tube through a small hole in the wall so she wasn't exposed to the radioactive substance. I could hear the clicks of the Geiger Counter measuring the radioactivity. Once injected, I had to sit and relax for an hour in the dark so the tracer could travel around my body. I was not allowed to use my phone or read as that would apparently make my fingers and brain 'light up' too much in the scan! 

When the hour was up, I was directed to a special toilet to empty my bladder as urine contains high amounts of excreted tracer. There were signs on the loo instructing everyone to be seated to avoid radioactive splashes! I then had the scan in a big machine.

Afterwards I was given a sandwich and cup of tea (most appreciated) and told that I should not come into close contact with anyone for the next few hours. For the trip home I was told to sit on the back seat of the car on the passenger side for the safety of the driver!! For all these precautions, apparently the level of radioactivity is considered safe for the patient and I'm not going to think too much about it for now. 

It was more than a week before the results arrived. Unfortunately nothing had apparently showed up at all on the scan. I was told that none of the cancer had 'lit up' because it was not a 'hot cancer'. It was disappointing to have no further information from that procedure.

Ultrasound

Since the PET scan yielded no results, I was sent for an ultrasound on the lymph node of concern. The plan was to put a 'clip' on the node so it could easily be found using ultrasound, scans etc. 

Waiting for the ultrasound

The clip turns out to be a tiny wire ring, less than 0.5cm across. It was a relief to see how small it was. I'm not sure how it goes on to the lymph node, as I didn't end up needing it, but according to the nurse it isn't a big deal and doesn't hurt afterwards. The radiographer decided that it was easy to find the lymph node as it is enlarged, so the clip wasn't necessary. They will put a radioactive 'seed' in it just before surgery though.

The offending lymph node

Plastic Surgeon Appointment

This was the big one. Finally I would learn whether I could have a reconstruction after the mastectomy and what kind of reconstruction would be possible.

Masks were required due to a positive COVID case in the Perth community. I am hoping that we can stay COVID-free at least until my surgery is done. I know cancer surgery would still be a priority, but an influx of COVID cases and possible cancellation of elective surgeries really worries me. It would not be good for anyone needing a hospital. I am now triple vaccinated and hope that will keep me safe while I wait.

Back to the plastic surgeon. You may remember that I was hoping to have a breast reconstruction at the same time as the mastectomy to minimise the number of surgeries required, to enable the skin and nipple to be kept and for emotional reasons. I feel that it would be less of a shock if I can wake up from surgery with two breasts. This is a very personal decision and is just what I would prefer. Everyone needs to make the right decision about whether to have reconstruction based on their own circumstances.

My hope was that I would be able to have a DIEP reconstruction where tissue is taken from the tummy to form a breast and the blood vessels are reattached in the new location by microsurgery. It is a long procedure, generally 10-12 hours of surgery and a long recovery time, including an average of five days in hospital, but you end up with living tissue in the breast and hopefully little or no further surgery is required. There are several other options for reconstruction, such as a variety of breast implants or tissue from other areas of the body and I was open to discussing all of them.

The plastic surgeon was very professional. He had a look at my breasts and tummy and said that I looked to be a good candidate for DIEP reconstruction. He got me to lie down to check whether I had enough tummy fat to make the breast. He did this by pressing his open hands on either side of the breast and then on either side of the tummy muffin-top. Yep, they seemed about the same size so it was looking good! I had expected a more technical approach, but that was pretty much it! He said he would need to take all the tissue possible from the tummy, so it would be very 'tight' and flat and my breasts would appear bigger as a result (OMG!). I would be walking hunched over for a while as it healed. 

I then spent some time with another doctor while the referrals were made to book the surgery and for another CT scan to check blood supply in the abdominal area. A good blood supply is important for the blood vessel microsurgery side of things so the tissue doesn't die after the procedure. Apparently smokers are unlikely to have a good enough blood supply. Women who have had previous major abdominal surgery are also not good candidates for a DIEP. I have an appendix scar from 30 years ago that's about 8cm long, but luckily I gave birth naturally so no C-section scars. This should mean that it's all systems go!

A few days after the plastic surgery appointment I received my surgery date. Not long to go now. I feel a LOT better now I know what will be happening with the surgery and when it will be. It is a huge relief to know I can have the surgery I wanted and that I'll be waking up with the cancer gone and two breasts. The tummy tuck is an added bonus. I am trying to focus on how things will be in about three months' time and not think too much about the major surgery and long recovery I am facing in the immediate future.

I am spending the next little while getting my bag packed for hospital (the list here is helpful) and getting the house cleaned and arranged for when I get home. I am increasing my exercise to make sure I'm feeling fit and well going into hospital. My Dad has had several major surgeries over the years and is convinced that being fit is the key to success. I'm hoping for the same! I'm trying to do something enjoyable every day. 

Next time I will report on the outcome of surgery.