Breast Cancer - Surgery

This post follows my initial post about Sewing a gown for breast cancer surgery

and my previous post talking about breast reconstruction

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

Pre-Admission and another scan

One week exactly before my surgery day, I had to attend a Pre-admission appointment. This involved seeing a nurse to have my height, weight and blood pressure recorded. I then met with the anaesthetist who explained very thoroughly the surgery in terms of the anaesthetic process. She said that the surgery was likely to take 6-8 hours and I would be put to sleep with an injection. During the surgery they planned to put in a drip, a catheter and a ventilator and they would give anti-nausea medication during and after surgery as it is really important not to feel sick. She said I would be monitored by one or two anaesthetists for the whole operation. They would both be there at the beginning and end, but in between would be able to take turns and have a lunch break etc. The surgeon does not get a break! 

I was asked several questions, including whether I consented to receiving a blood transfusion during the surgery (the risk of this is very low). There was no hesitation about me saying yes to that question. The anaesthetist then said that she'd had a patient the previous week who had said he would only consent to a blood transfusion if there was no COVID vaccine in the blood!! What, he'd rather die?? Not me, I'm quite happy to put all my trust in the surgeons :)

In case you are wondering, blood is not screened for the presence of vaccines and anyway, a vaccine is completely cleared from the body after a few days or weeks, leaving the antibodies, produced by the immune system, to fight off an infection.

After that I saw another nurse, who explained all about the day of surgery, where to go and what to expect. That was really helpful.

The following day I had to go to the hospital again. I needed to have a radioactive metal seed (Rollis Seed) placed in the lymph node that was enlarged. During surgery, that particular lymph node containing the seed could be identified using a Geiger Counter and removed. I also needed a CT Scan to check the blood supply in my abdomen. This was to make sure that there were plenty of healthy blood vessels in the tummy fat that would be used for the breast reconstruction. The tummy blood vessels would be cut and then reattached to existing blood vessels in their new position in the breast. This meticulous microsurgery is why the procedure takes so long.

One of the mammogram machines

The radioactive seed was inserted using ultrasound, a local anaesthetic and a large needle that I did not look at! The doctor found the enlarged lymph node using ultrasound and then guided the needle into position by checking the ultrasound screen. The tiny (about 3mm) seed was then injected into the lymph node. It all took about half an hour and wasn't too uncomfortable. Afterwards I had to have a mammogram to check the position of the seed. Then I had to have an x-ray of my shoulder area to check that the seed was definitely there and I was given a yellow card to carry with me until the day of surgery. The reason for all this was that the seeds must all be individually traced from injection to removal to make sure that no radioactive material is left lying around. If I died in a car crash or something before surgery, the card would alert people to the fact that there was a seed present and it would have to be recovered and returned to its rightful place. I thought that was rather interesting.

After that I walked over to 'Nuclear Medicine' for the CT scan. I had been fasting since 6am for this and was getting quite hungry after the morning's activities. I needed the contrast dye injection again, which was done by machine, via a cannula. while I was lying in the scanner. The scan commenced immediately after the injection. The machine told me to breathe in and hold two or three times and then it was done.

So...now I just had to wait another six days until Surgery Day. I actually had a pretty busy week. Australia Day was on the Wednesday and I went down to watch the fireworks, which was nice. I thought I would be feeling more and more nervous as the surgery got closer, but I felt strong and positive. I was ready!

Since finding the lump I have had:

Scans - 4 (Bone scan, PET scan and two CT scans)

Mammograms - 3

Cannulas - 5

Ultrasounds - 4

Biopsies - lots in one session (about 17)

Seed insertion - 1

Detailed arm measurements - 1

Surgeon appointments - 3

X-rays -1

Surgery

Finally, three months exactly from diagnosis, it was surgery day. I managed to get a bit of sleep the night before and was at the hospital at 6.30am. Before the actual surgery I had to have a scan to find the sentinel lymph node, which is the first one that lymph from the breast drains into and therefore the most likely node to contain any cancer that might have spread. The scan involved an injection of radioactive dye directly into the breast, under the skin. It stung a bit, but was over in about 30 seconds. I then lay in the scanner while x-rays were taken of my left underarm area. Apparently it can take between 20 minutes and two hours for the sentinel node to show up. fortunately it only took about 20 minutes for me.

Early on in the surgery, the sentinel lymph node is removed and is immediately checked by a pathologist in theatre. If cancer is found in the node, further nodes may be removed during the surgery. After surgery, all the tissue is thoroughly checked by a pathologist and a full report is generated which is used to make future treatment decisions.

Then it was off to get prepped for surgery. Just before I went into theatre, the plastic surgeon looked at my breasts as I sat up straight and drew lines all over them and on my tummy where he would remove the tissue for the reconstruction. He wanted to match the reconstruction to the size and shape of the breast that was not being removed. He did it all pretty quickly, which surprised me. If I was sewing a copy of something, I would take much longer to work it all out, but he seemed happy with a quick look!

Once in theatre, at about 8.45am, I got a bit overwhelmed by all the people and the thought of what was about to happen. There were a few tears. Luckily the team was all ready to get going and the last thing I remember was seeing the clock showing 9am and the anaesthetist saying she would give me 'champagne bubbles'.....

...next I knew I was in recovery. The clock said 5.45pm. I felt like no time had passed. I was taken to my own room where a nurse was with me for the next couple of hours. I felt really tired and just wanted to sleep. 

The room was heated and I had a 'Bear Hugger' blanket over my breast area. This is like a small, very light, inflatable mattress that has hot air blown into it constantly. The warmth helps the blood vessels to stay dilated and healthy as they heal in their new position in the breast. It was a bit hot and sweaty, but not too bad. I had a pain button containing Fentanyl which I could press as I needed it, but it made me feel sick and caused vomiting, so I didn't use it and just had Panadol. The pain wasn't too bad.

I was checked every 30 minutes for the first 24 hours. This involved having my blood pressure, oxygen and temperature taken and having the breast checked by feeling it and listening to the blood movement using a doppler. Any minute changes in the breast (swelling, redness, hardness, bruising) were reported to the plastic surgery team and a doctor would come and check. Each time they said it was fine, but there was a chance that a change could mean a trip back to theatre to have some repair work done, for example a haematoma removed. The 30 minute checks were exhausting and made the night drag on very slowly.

I had three drainage tubes, one from the breast and one from each end of the tummy scar. This scar goes from hip bone to hip bone. The drains will stay in until the liquid coming out slows to about 20ml in 24 hours. The breast one is a bit uncomfortable as I have to wear a compression bra which presses on it. I also have to wear an abdominal binder, a massive elastic thing, but the abdominal drains feel ok.

Day 2 - Feeling pretty good

It is now Day 2 after surgery. The second night I was only checked every hour, which was much better and it's now down to two hourly. I was able to get out of bed twice on Day 1 and sit in a chair. I was very happy to see my partner for a while (visitors are restricted due to COVID) and chat on the phone to my family. I had some food and felt pretty good. Today I'm very comfortable in a chair writing this blog post. Hopefully the catheter will come out today (it's held in by a balloon apparently!) and tomorrow I may get some drains taken out and be able to have a shower. I'm feeling good, almost pain-free and very happy that the main surgery is done. I'm hoping the news will be good from pathology, but I won't know for about three weeks.

PS the new breast looks pretty good from the angle I'm looking at it. The nipple was not able to be saved, but I'm ok with that as it was a decision made for health and aesthetic reasons. The breast is currently quite swollen so looks huge!! My tummy looks concave. I have my friend Robyn calling me Gisele Bundchen and my sister comparing me to a Barbie doll!

My next post talks about my hospital stay in more detail and when I got to go home.