has anybody seen my boob?

As anyone who has ever been to my house can attest, the place tends to be a total disaster pretty cluttered. We lose stuff all the time, only to find it months or even years later, after it's already been replaced.

But I have to admit that never in my wildest dreams did I ever think I'd find myself typing this sentence: 

I can't find my prosthetic breast.

We've actually been making some inroads in terms of beating back the clutter. But some rooms are getting worse before they get better. And our bedroom is complete tip.

Now admittedly, I don't wear my prosthesis all that often. But there are days when I want to fly below the radar. There are clothes that just look better when they're symmetrical. And I haven't seen my fake breast for weeks.

Could I have absent-mindedly stuck it in a drawer that I haven't checked?

Could it have become mixed up in the bags of clothing destined for donation?

Could it be under the mounds of clothes yet to be sorted?

Could I have left it somewhere?

It's a mystery.

If you find it, please let me know. 

Or just leave it in my mail box.



Update May 26: We found it! It was in a suitcase. In our bedroom. From a trip on which neither I nor the boob were in attendance. I think I took it off one night and too lazy tired to put it away, popped my bra with the boob still in it, in the open suitcase. Then, the suitcase was closed and left. Three weeks later, when my love finally unpacked - he found my prosthesis. Mystery solved.

Texas Bill Mandates Breast Reconstruction Discussion Before Breast Cancer Surgery

Currently only 30% of breast cancer patients are informed of their breast reconstruction options before mastectomy or lumpectomy.

New legislation is being proposed in Texas that aims to significantly improve that abysmal statistic for breast cancer patients. Texas House Bill 669 would mandate that doctors inform all breast cancer patients about their breast reconstruction options BEFORE having surgery for breast cancer. The bill was drafted based on similar legislation in the state of New York.

PRMA Plastic Surgery is proud to announce that a former patient, Tammy Carrington, is the team leader behind this Bill.  She proactively sought out her state representative, James White, to begin drafting proposals.  The Bill was drafted and submitted January 14, 2011.  If approved, this statute will take effect the following year.

Tammy Carrington knows firsthand what it’s like to be diagnosed with breast cancer and receive limited treatment options.  After being diagnosed in June of 2009, Tammy was given two options: a lumpectomy with radiation or a unilateral mastectomy.  Tammy didn’t want either.

Tammy wanted to decrease the risk of breast cancer in the future in the other breast too. After intensely researching her options on her own she learned she could have bilateral mastectomies and immediate reconstruction. Ultimately she traveled to PRMA in San Antonio and underwent bilateral mastectomies with immediate DIEP flap breast reconstruction using her own abdominal tissue.  All the procedures were covered by her health insurance.

Not surprisingly, Tammy feels very strongly about this Bill since she so easily could have chosen something she feels would have been the wrong option for her.

"My nature is to research things completely so that I can make informed decisions. I am the mom to a severely brain injured little boy… I’ve spent lots of time over the years looking for information on how to help him get better… After getting over the shock of hearing the 'C' word,... I went into research mode”, Tammy recalls.

“HB 669 isn’t mandating any particular treatment. It's not mandating any surgery. It's just mandating education. Women have the right to be told about their options so they can make truly informed decisions about their own health. Unfortunately, right now only 30% are even told breast reconstruction is an option”, she says.

PRMA Plastic Surgery is proud to support HB 669 and is calling on breast cancer patients, physicians, and all those touched by breast cancer throughout the state of Texas to offer their support by calling their representatives.

Please call your State Legislator and urge them to co-author HB 669. Your state representative’s contact information can be found HERE.

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PRMA Plastic Surgery in San Antonio, Texas, specializes in advanced breast reconstruction using the patient's own tissue. Procedures offered include the DIEP flap, SIEA flap, GAP flap, and TUG flap. We are In-Network for most US insurance plans. Patients are routinely welcomed from across Texas, out-of-state, as well as from outside the USA. Connect with other breast cancer reconstruction patients at www.facebook.com/PRMAplasticsurgery

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Breast Reconstruction: New Video Discusses Latest Breast Reconstruction Options

Breast reconstruction surgery restores something that nature has provided but cancer has taken away.

Unfortunately, most American women with breast cancer do not even realize they have the option of breast reconstruction after mastectomy or lumpectomy.

Breast reconstruction is not a cosmetic procedure.... it is every woman's right: it restores something that nature has provided but cancer has taken away. It is also covered by insurance thanks to a Federal Mandate passed in 1998.

Despite this mandate, studies alarmingly show that only 30% of women facing mastectomy are even offered the option of breast reconstruction.

Women have many reconstructive options after mastectomy or lumpectomy. These range from breast implants to "autologous" techniques which use the patient's own tissue to recreate a more "natural", warm, soft breast. The nipple and areola (the darker area surrounding the nipple) can also be recreated.

a lapse in judgment

In the last couple of weeks, I have received two emails from Rethink Breast Cancer, an advocacy organization aimed at younger women. The messages urged me to by tickets for the Rethink Romp, a Toronto fundraiser and party.

I like a party as much the next girl and the idea of a superhero themed party made me smile. I love superheroes.

I eagerly clicked through to check out the "Shazamer", an interactive site where I could make my own superhero. At that point, the fun came to a screaming halt, as I read the words: "Show of your six packs and your great racks in support of Rethink Breast Cancer".

It's a great site, with some really cool interactive features but the model is built like Barbie and the "Superheroes" title bears the sub-head "with a great rack comes great responsibility."

The idea that a group of diverse, smart breast cancer advocates sat around a table and decided that this was a good idea is just inconceivable to me. Even more shocking is that this idea went from that table to a high profile, glossy campaign without someone shouting, "Hey wait a minute! Don't you all think this is a little insensitive?"

Yesterday, I sent Rethink this brief email:

Has no one complained to you about this?

A breast cancer organization talking about "great racks"? What if you only have half a rack or none at all? Can I still be a superhero if I'm not white [I did discover after I sent the note, that you can change the skin colour of the model, once you get inside the game but both the male and female superhero start as fair and light-haired] , with big boobs and able-bodied?

I love the idea and I love the spirit of fun and celebration to which you are clearly aspiring. I just don't understand how a group of breast cancer advocates sat down together and agreed that this is the best imagery and wording for this event.

So disappointed.

I haven't heard back yet. Rethink Breast Cancer has a great mandate and does good work. I love the spirit of fun they try and inject into their work. With this campaign, though, the organization has displayed a serious error in judgment.

super me
a one-breasted warrior
with really great boots
a rhea belle top
and some seriously funky accessories (thanks to Babz for that suggestion)
generous hips (the better to shoot from)
crows feet
and smile lines
honest
smart
strong
and always compassionate
but ready to kick ass
when she needs to.

10 to do in May

For the last few months, I've been playing along with a group of folks over at BlogHer who've formed a group called "List Lovers Unite." I'm a sucker for "to do" lists and I've found the practice of making monthly to do lists to be rather compelling.

Sticking to the list, however, has yielded mixed results. Here's how I did with April's list (as with previous months, completed tasks are in blue, partially done tasks are in green and the tasks I didn't even started in purple):

1. Write a first draft of the short story I've been kicking around. (I wrote an outline)

2. Spend an average of eight hours writing per week. (Not even close)

3. Do strength training at least once a week and continue with the five hours of cardio per week. (I'm very pleased to have started the strength training, which I did, for at least a few minutes, five times in four weeks. I fell a couple of hours short with the cardio, though. I need to remind myself on rainy days that I'm not made of sugar).

4. Sort through my clothes (carried over from February and March). (I bought some clothes but my closet is still overflowing with stuff I can't or don't wear).

5.Make summer plans for my family. (we are going to Blue SkiesMusic Festival this year and have tentatively planned another couple of trips but I have yet to sit down with a calendar and nail it all down)

6. Brush my big (shedding) dog once a week and my smaller (non-shedding, tangling) dog every other day. (I brushed the big dog once and the little one twice. I did take Lucy to the groomer on Tuesday, though. She's been shorn now, so now I really only have ears and tail to brush for a while)

7. Update my Ravelry project page.

8. Finish another scarf.

9. Make soup twice. (the jambalaya in the slow cooker when I wrote last month's post was the only soup I made. It was a good one, though)

10. Get a hair cut. (Done. And I feel much better with shorter hair)

I did get something done that had been on my previous month's to do list. I bought a bathing suit. And then I wrote about it for BlogHer and even posted a photo of myself.

I'm still reeling from that one.

Around the middle of the month, I realized was feeling very grumpy. I figured out that I was unhappy because, while I wasn't necessarily getting anything done, I also wasn't having any fun. I had to remind myself that, as I'm the one attempting to give my life more structure, I'm also the one who needs to give myself permission to be flexible.

When I drew up my goals for this month, I decided to incorporate time to read, relax and be creative (a bit ironic, I know) and to set aside time to specifically attack this list.


Things to do in May:

1. Spend an average of eight hours writing a week (I'm already behind. Sigh. I have started to edit the first draft of my novel, though, so that's something).

2. Do strength training at least twice every week (Did it once last week, so I'm behind there too).

3. Do an average of five hours of cardio every week (On track. Yay!)

4. Make soup twice (I've already made and eaten a big batch of sweet potato, red lentil and spinach soup).

5. Sort through my clothes (carried over from February, March and April - but I really do want to get this done).

6. Finish making summer plans for my family.

7. Go to at least one bike store and do some test rides (That should be fun. Also, my bike has started to make some pretty scary noises when I pedal or change gears).

8. Spend one afternoon every week doing something fun or relaxing (Last week, I spent part of Mothers' Day finishing Water for Elephants, which I loved reading. This week, I'll spend Thursday afternoon either reading or knitting. I need to make the space in my life to do the things that restore my energy and my creativity).

9. Finish one knitting project (I made a bunch of dish clothes and a dish towel for a friend and gave them to her, so this one's done already).

10. Spend one afternoon per week just dealing with this to-do list (last week it was Wednesday and this week it will be Wednesday, too).

Anyone else out there still working on the monthly list? How's it working for you?

i bought a swimsuit

And I posted about it for BlogHer.

I won't say the search wasn't traumatic:

I rejected suits that didn't cover my scars, that were two big, too small or both at the same time. I worked up a sweat trying to get tangled bathing suit straps over my shoulders, often resulting in a look that was reminiscent of a wrestling uniform. I cried a little bit. Regular suits left me feeling too exposed and mastectomy suits bagged on the chest when I was not wearing a breast form.

You can read the rest of the post here. I even posted a picture of myself, wearing the swimsuit.

I didn't get to far on my to-do list this month but these are accomplishments (the doing and the writing) of which I am proud.

10 things to do in april

This month, I actually wrote up my 10 things and posted them over at BlogHer on April 1st. And then, I let chemo and the long Passover/Easter weekend sidetrack me. I seem to be somewhat lacking in motivation on the blogging front these days. 

I have lots to say but I don't always feel like saying it.

Perhaps blogging should be on my list of May 'to-do's.

For now, though, here is how I did in March (completed in blue, partially done in green and not even started in purple):

 

1. Finish re-reading the draft of my novel (carried over from February). I discovered when I reached the end of the document that I had just stopped writing when I'd written the required 50,000 words. The story has no end. And needs some serious editing. That will be a goal for a future month.

2. Organize my clothes and my closet (carried over from February).

3. Graft the toes on the socks I'm knitting for my sister (carried over from February). It barely took an hour to finish these suckers. Should have done it ages ago. Now my sister will  have some nice wool socks, just in time for summer.

4. Do an average of 5 hours of cardio exercise every week (Revised from February).Really, this should almost be in blue. I fell short by less than an hour, so I'm pretty pleased with myself.

5. Make soup once. Sweet potato, spinach, red lentil. It was a recipe from my nutrionist (see below) and it was yummy.

6. Spend an average of 10 hours writing per week. I permitted myself to write this in green because I did do some writing in March but I didn't even come close to reaching my goal. I blogged 10 times and wrote in my journal with reasonable consistency but that was pretty much it.

7. Make and keep an appointment with a nutritionist to work out a plan to improve my diet, then follow it. I did do this one and have begun to make some changes to my diet. And, although I fell pretty much completely off the wagon over the long weekend, that was in April so it doesn't count.

8. Get my bike back on the road. It's been tuned up and ridden. When the weather is nice, I am going to continue to make my bike my main form of transportation.

9. Mend/wash/block my hand knit scarves. There are five of them. Three are mine and one is an unfinished present. None of them should take very long and it would give me a tremendous sense of accomplishment. Update: After stepping away from this and considering what I have on my plate, if I get two scarves done, I will be happy. I finished one. Now it needs to be delivered to the recipient.

10. Buy a swimsuit that fits (ugh). I tried on a couple of swimsuits but didn't find any that comfortably fit my long torsoed, plus-sized, one breasted body. I initially thought I would carry this one over to April but have changed my mind. This one's traumatic and will be a longer term project.

 

So that makes (more or less) 5 finished tasks, 4 partially completed and one not yet begun.

 

I'm really enjoying this process. I'm getting things done that I might not otherwise. It's gving me a sense of structure and accomplishment. 

 

Here is my list for April:

 

1. Write a first draft of the short story I've been kicking around (I have a writing buddy now, who's going to give me feedback. I have promised to deliver something for her to read by the end of the month).

2. Spend an average of eight hours writing per week (I'm already behind but it's not too late to catch up).

3. Do strength training at least once a week and continue with the five hours of cardio per week (I am on track with the cardio but have done one set of situps exactly once, so I need to get moving on the strength training).

4. Sort through my clothes (carried over from February and March).

5.Make summer plans for my family.

6. Brush my big (shedding) dog once a week and my smaller (non-shedding, tangling) dog every other day (the little dog has been brushed twice, which is probably twice more than she was groomed in March).

7. Update my Ravelry project page.

8. Finish another scarf.

9. Make soup twice (I have a jambalaya stew in the slow cooker right now).

10. Get a hair cut.

It's not too late to play along!

soup and the missing muse

I made three soups in January.

Red lentil and carrot from Cooking with Foods That Fight Cancer

Broccoli cheddar from Looneyspoons: Low-fat food made fun!

Jambalaya from Weight Watchers (heavily modified: I substituted white fish for shrimp, used more liquid and had sausage on the side, so folks could choose their level of spiciness. And I didn't use chicken. And I used different spices. This for me, was a wildly adventurous departure).

If I don't run out of time today, I plan on making a pre-chemo Sweet potato and roasted garlic soup from the The Eat-Clean Diet Cookbook: Great-Tasting Recipes That Keep You Lean!
A friend gave this one to me. I recall it being time consuming but delicious..

I have had a post on the tip of my fingers about my current highly ambivalent feelings about my life, identity and treatment but I can't seem to bring myself to write it.

In fact, I can't seem to bring myself to write much these days.

Maybe, later this week, as I recover from chemo.

Tomorrow is Groundhog Day. And the four year anniversary of my mastectomy.

Growing Breasts from Fat Stem Cells: the Future of Breast Reconstruction

A new form of breast reconstruction that allows women to re-grow breasts from their own fat stem cells after a mastectomy could be offered to British and Australian breast cancer patients for the first time in 2010.

A human trial of the new technique is being planned by plastic surgeons at a London hospital. The trial will study whether fat cells can be induced to multiply and fill a breast-shaped mold implanted under the chest skin to recreate a breast after mastectomy. Australian scientists also recently announced that they would start similar treatments on women within six months, following animal studies involving mice and pigs that successfully re-grew breasts from fat.

If the human trials are as successful, this new technique could transform breast reconstruction surgery, offering an alternative to breast implant reconstruction and more complex tissue transfer techniques requiring significant down-time.

The technique is expected to take about eight months to grow a breast. Initially it will only be used to reconstruct breast cancer patients who have been cancer-free for at least 2 years. Eventually it may also be used for cosmetic breast augmentation allowing women to achieve a significantly larger breast size without needing saline or silicone implants.

The Australian team is led by Professor Wayne Morrison of the Bernard O’Brien Institute of Microsurgery in Melbourne. After a decade or so of working on this project he has now obtained ethical approval for a trial involving a handful of women.

I had the pleasure of listening to a presentation by Dr Morrison at the American Society for Reconstructive Microsurgery in 2008. The technique involves using liposuction to remove some of the woman’s own fat cells. The concentration of stem cells within this fat is then boosted in the laboratory. A biocompatible scaffold is then implanted under the patient’s skin, to create a cavity that matches the shape of her remaining, natural breast. The stem cell-enhanced fat solution is then injected into the scaffold. Over time, the scaffold is filled by the multiplying fat cells which obtain the necessary nutrients from blood vessels surgically wrapped around the scaffold.

The first trials will likely require that the scaffold is removed at the end of the reconstruction process though there is some talk of making the scaffold absorbable in the future so this extra step can be avoided.

Right now the focus remains on growing a breast made completely of fat, without breast glandular tissue, milk ducts or nipple-areolar tissue. The nipple and areola will therefore still need to be reconstructed as an additional step.

These developments are very exciting. I am sure this is the direction breast reconstruction is going in. The most advanced techniques currently available, like the DIEP flap for instance, already use the patient's own fat to recreate a very natural breast. In the case of the DIEP flap, this tissue (fat and skin) is taken from the lower abdomen, providing the benefit of a tummy-tuck at the same time.

While DIEP flap breast reconstruction only takes a few hours (as opposed to eight months), it does involve major surgery and the creation of scars on another part of the body (lower abdomen). In addition, women still need a second surgery for "fine tuning" and nipple reconstruction. In essence then, the reconstruction process can still be fairly drawn out and take several months. I am sure many women will be eager to avoid major surgery and scarring for what could be a very similar end result once this new technique is optimized.

*****

Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction and scar healing. Keep up to date with the latest news in breast cancer reconstruction at The Breast Cancer Reconstruction Blog. Also join us on Facebook and Twitter!

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Breast Reconstruction Report: "I wanted to heal my way"

By Lisa Bernhard

I was 29 years old when my gray-haired surgeon looked at me from across his desk and said, "I'd recommend a mastectomy." My dad, seated to my left, exhaled hard. To my right, my mom sat in silence. Family history had repeated itself: My grandmother underwent a mastectomy at age 39. Now it would be me. But in the four days since my diagnosis, I had researched and stumbled upon a choice my grandmother never had.

"It's OK," I said to my dad. "They can rebuild me."

They did. In one nine-hour procedure, a cancer surgeon performed a skin-sparing mastectomy, removing the nipple and tissue inside my right breast but leaving most of the skin intact. Then a plastic surgeon performed a free-flap reconstruction, extracting a portion of my stomach skin and fat and microscopically reconnecting it to my chest. Later, he reconstructed the nipple. The result was a breast that looks and feels like...my breast.

In the 14 years since, my reconstructed chest has seen me through highs and lows: confident in an evening gown while reporting from the Oscars as a TV correspondent; sorrowful, at times, when standing naked under bright bathroom lights, the faint scars tracing my areola reminders of invading disease and scalpels. Yearly screenings send my heart pounding, but my surgery has helped me be hopeful about the future.

Of course, some women don't want any kind of reconstruction, sometimes due to health reasons or as a matter of preference. But women who do choose it report significant, lasting psychological benefits, in a way that transcends physical beauty, according to a study by Amy K. Alderman, M.D., assistant professor of plastic surgery at the University of Michigan Medical School in Ann Arbor. "Women tell me they feel whole again and more able to put cancer behind them," she explains.

Which is why I'm alarmed that many women don't know that options like the one I selected exist. Nearly 70 percent of women eligible for reconstruction aren't informed of their reconstructive options, according to a 2007 study by Dr. Alderman. Almost 65 percent of general surgeons said they believe patients lack interest in reconstruction, and less than one in four consistently refers breast cancer patients to plastic surgeons.

Meanwhile, plastic surgeons often limit the time they devote to cancer patients, because they tend to lose money treating them. Insurance reimbursements—which are roughly based on what Medicare pays—are paltry. In the case of free-flap surgery, plastic surgeons can charge $7,000 to $25,000 per breast; the average Medicare reimbursement in 2007 was $1,737. As a result, some doctors won't accept insurance for reconstructive surgeries, forcing patients to pay out of pocket. Others steer patients toward more profitable types of reconstruction, regardless of what's best medically, says Mark Sultan, M.D., my reconstructive surgeon and chief of the division of plastic surgery at St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center in New York City. Insurers reimburse implant reconstruction at roughly the same level as a flap, but surgery takes only about an hour. "Doctors may think, Why do a six-hour operation when I am paid the same amount for a one-hour implant?" Dr. Sultan says. "They may convince themselves, consciously or unconsciously, that the patient is a better candidate for an implant."



Comment by Dr C:

I completely agree with Dr Sultan and I strongly encourage all women considering breast reconstruction to research all their reconstructive options. Unfortunately, some patients will have to consider traveling for some of the more advanced procedures. A major consideration for most people is obviously cost. Patients must be aware of the practice of balance billing which can add thousands of dollars to the out-of-pocket expenses.


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Keep up to date with the latest news in breast reconstruction at The Breast Cancer Reconstruction Blog. Also follow us on Twitter!

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Breast Cancer Reconstruction And Health Care Reform - What Does It Mean For You?

By Sharon Lacey

What does health care reform mean for patients with breast cancer and how will it affect you?

Well, it could mean...

Even though you or your loved one could benefit from advanced breast reconstructive surgery after mastectomy (like the DIEP flap procedure for example), your plastic surgeon might well have to say “no”.

While this may sound extreme to many of you, this would happen if comparative-effectiveness research rules that the benefits of the surgery for the average patient just don't justify its price tag, especially when compared with yesterday's treatments (like tissue expanders for example).

Unfortunately, medical advances and "cutting-edge" procedures do come at a price. Though this does mean certain procedures are more expensive, it has also ensured the United States has stayed at the leading edge of health care in the world, at least until now.

In an enormous break with tradition, such cost considerations based on averages will be factored into medical practice guidelines. These will function as an invisible hand that puts a brake on the more expensive procedures even though they benefit certain patients.

Standardized practice guidelines will be evident everywhere, even embedded into your doctor's government-certified computer: as described in the Obama budget, computer pop-ups will appear to help your doctor make decisions. (And through the same systems, his or her choices can be monitored for consistency with the guidelines.)

More uniform care will certainly improve weak performing doctors, but many experts worry about intruding on the seasoned judgment of the good physician. It remains to be seen how government micromanaging—if not rationing—of care, driven by reasons other than patient well-being, will go down,… particularly when that patient has a face.

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Keep up to date with the latest news in breast reconstruction at The Breast Cancer Reconstruction Blog. Also follow us on Twitter.

*****

free to a good home (part 2)

A few weeks ago, I wrote that I had an almost new prosthesis that I was seeking to re-home. This is what happened next:

Julia consulted other directors of Breast Cancer Action, who suggested that there might be a program to send prostheses to developing countries. She also called the social worker at the cancer centre who told her that Canadian Cancer Society takes donations (1745 Woodward Dr., Ottawa, ON K2C 0P9. 613-723-1744). I am so grateful to her for doing this.

Throws Like A Girl , who is part of our group at Mothers With Cancer, suggested that we need "a prosthesis relocation program."

Imstell jumped in with the following:

"Maybe we [Mothers With Cancer] could just host a bulletin board where people could post their needs:

FREE TO GOOD HOME Single 36C teardrop prosthesis. Likes to travel. You pay shipping.

WANTED swimming prosthesis. Any size large enough to hide my belly.

These had me laughing out loud but I think we might actually get something like this going.

Finally, Christine told me that she has a friend who lives locally, who was in need of a new prosthesis. It turned out to be a perfect fit.

Thanks to all who commented here, via email and on Facebook. You made me laugh. And you made me feel good about the power of community.

We are off to the maritimes tomorrow (if all goes well-it's a two-day drive with two kids and two dogs). I may be offline until August 12. I feel the withdrawal pangs starting already.

free to a good home

It's not the kind of thing I'd want to advertise on Craigslist or Kijiji.

I can't set it out on my front lawn and hope someone takes it away.

I doubt the Canadian Diabetes Association or the Ontario Federation for Cerebral Palsy would want it as part of their drive to collect use goods for re-sale.

But I have a perfectly good prosthesis, worn only a handful of times that I'm sure someone could use, even if it was wrong for me (and I have replaced it with another one I don't seem to be wearing much).

The government covers about two thirds of the cost of a new prosthesis. That balance must be prohibitive for many who don't have private insurance to take care of the rest.

How do I find someone who can use it though?

Maybe someone at Breast Cancer Action would know.

Of course, I could always use my prosthesis to make art, the way Jacqueline did.

I think my inclinations might be a little more violent, though.

Thoughts?

my new rack

Warning: This post may contain too much information for some readers.


I have not worn a prosthesis for more than two years. Lymphedema and then scarring from radiation made the experience of wearing it excruciating. The last time I tried to wear it, I was on a date with my spouse in Florida. After an hour, I was in tears, it hurt so much.

Out it came and I haven't looked back.

At least not much.

I find that I'm pretty comfortable without a prosthesis. Sometimes I dress to camouflage and others I just don't care. And most of the time, I don't think about it at all.

Lately, though, I've wanted the chance to blend in a little more, to not have to lead with my cancer when I meet people. And although I have some great tops that work with my asymmetrical body, (from Rhea Belle, of course) I do get tired of the limited options open to me (it's hard enough finding funky clothes in larger sizes).

So, while feeling slightly guilty about giving into societal notions of beauty (in hiding my asymmetry, am I implying that I think there is something wrong with it?), I set out to visit Kelly's Mastectomy Boutique.

The entire operation took all of ten minutes ("Oh look! Boobs!" I exclaimed as I tried on prosthesis and bra) and cost several hundreds of dollars (recuperable, thanks to the government and my insurance plan. I wonder though, why do we need a referral from a doctor? Does anyone get a prosthesis for fun? What would they do with it?). I brought it home, stuck it in my closet and didn't wear it for almost a week.

Yesterday, I decided it was time for the prosthetic equivalent of a test drive. I was meeting Sassymonkey for pints and knitting on a sunny patio. It seemed like a low stakes endeavour, in that if I arrived with my boobs pointing in different directions, Sassymonkey was likely to be unperturbed. It was also a good opportunity to put the boob through it's paces, as I would be biking, knitting, eating, sitting in the warm sun and engaging in a social encounter.

My new fake boob is squishier in back and is supposed to be lighter - better for both my uneven chest wall and lymphedema. I wore it under a t-shirt with a picture on it (much harder to wear with an uneven chest) and one that is slightly snugger than I have been wearing lately. I noticed immediately that my waist, gone for ages, seemed to reappear. I also noticed that my posture seemed to improve.

I ran into someone I knew on my way to the pub. She said, "You look different. Have you done something to your hair?"

And after Sassymonkey and I had been sitting for a while, I pointed out my newly symmetrical rack to her. "That's what's different!" she exclaimed.

"You'd tell me if I were unbalanced right?" She assure me that she would (I felt unbalanced, I'm so unused to having this weird mound on the right side of my chest).

All in all, I declare the outing a success. The thing felt odd but there was no pain. I even forgot I was wearing it for a while.

When Sassymonkey and I parted we hugged goodbye (I later repeated this experience with T. Hugging feels very odd, like we are squishing a big pillow between us) and she noted, "You're still balanced."

I said I was glad but that I was going to take it off when I got home. "It's like breaking in a pair of shoes, you know?"

She said that she did.

As I type this, the stand-in for my right boob is nestled in it's box in my closet. I am toying with taking it out for a spin again this evening.

And one last thing: there needs to be more support and encouragement of women who create clothing for the post-mastectomy body. Also, it would be great if the bigger clothing companies would come across, by supporting the work of women like Jacqueline and modifying their own designs. I can't be the only woman who has had a mastectomy, does not love prosthesis and cannot/would not choose surgical reconstruction.

Mammograms after Mastectomy and Breast Reconstruction - Are They Really Needed?

"Do I still need to have mammograms after my mastectomy and breast reconstruction?"

I'm asked this question quite often.

The truth is there's a lot of ongoing debate about this.

Some doctors feel that since there is no "natural" breast tissue left, there is no need to continue monitoring patients. I disagree with this strongly.

Breast cancer can come back after mastectomy - there's a 6.7% chance in fact. Breast reconstruction does not increase or decrease the risk of recurrence at all - the recurrence rate is the same whether women have reconstruction or not.

Since the risk of breast cancer recurrence is a real one, surely we need to continue some sort of monitoring?

Self breast exam is a no-brainer. It's relatively easy to perform and it's dirt-cheap (free). The issue of mammograms is less clear-cut.

The appearance of the mammogram changes completely after breast reconstruction. Even if the breast looks very natural and similar to the way it did before the mastectomy on the outside, the inside of the breast is completely different.

Let's take the following example: a woman who undergoes a skin-sparing mastectomy and tissue (flap) reconstruction like a DIEP flap may look like she has natural breasts that have merely been "lifted". In reality her breast tissue has been completely replaced by tummy fat. Fat and breast tissue look completely different on mammograms so the post-reconstruction mammograms cannot be compared to any taken before the mastectomy. You're essentially starting from scratch as far as the mammograms go.

Some surgeons feel that patients should have 1 mammogram after the reconstruction has been completed just to get a new "baseline". If the regular self breast exams reveal anything new of concern then the mammogram can be repeated. At least now the new mammogram can be compared to the baseline mammogram.

Other breast surgeons take it a step further and recommend a baseline MRI once the reconstruction is completed instead of a mammogram. MRIs are much more sensitive (sometimes over sensitive though) and the information they provide is also more specific. Again, if self breast exam reveals a new area of concern in the future the MRI can be repeated to see if anything has changed.

The issues with MRIs are (1) the additional cost compared to a mammogram, and (2) sometimes they see things that really aren't there - for example, something that is benign is interpreted as worrisome. This in turn leads to further investigations and biopsies that may never have really been needed.

Yet one more viewpoint is that any new breast lumps that appear in the future are going to require a biopsy anyway so what is the point of getting a "baseline" MRI or mammogram at all? Tissue (flap) breast reconstructions can occasionally develop something called "fat necrosis". These are areas of fat in the new breast that become hard and create "lumps". While a biopsy may indeed be planned anyway, there is a lot to be said for the physician and patient knowing this "lump" has been there all along (on the MRI) and the chance of this representing a new cancer is extremely low. The additional peace of mind and information a baseline MRI provides in this situation alone warrants the test in some physicians' opinions.

What do I recommend? At least a mammogram 6 months after the breast reconstruction is completed to get a new baseline and regular self breast exams.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction surgery after mastectomy using the patient's own tissue. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest news in breast reconstruction at The Breast Cancer Reconstruction Blog. Please also Follow Dr C on Twitter.

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Impact of Radiation on Breast Reconstruction

Radiation therapy is often recommended as part of breast cancer treatment. Patients undergoing lumpectomy receive radiation routinely once they've healed from surgery. Some mastectomy patients also need radiation after surgery depending on the characteristics of the tumor.

I think it is fair to say that most reconstructive breast surgeons, myself included, are not particularly fond of radiation because of the way it impacts the patient's tissues (and breast reconstruction in general.) Nonetheless, it is important to remember that "life comes before breast" and in certain situations there is a definite benefit for the patient in having radiation therapy.

So what's the problem with radiation therapy (from a plastic surgeon's perspective)? For starters it can cause toughening (fibrosis) and shrinking (contracture) of the patient's tissue which makes the tissue lose its elasticity and become more tough and rigid. Skin color changes are common, red at first turning more brown over time. Radiation can also cause burn injuries as well as damage to underlying organs such as the lungs and heart. Anyone who is facing radiation therapy must discuss all the potential risks with their their radiation oncologist beforehand.

Women undergoing lumpectomy are often told that most of their breast will be preserved and that radiation is given "as insurance" to decrease the risk of cancer recurrence. What many women don't appreciate is that the breast can end up looking vastly different once the treatment is done because of radiation changes, even though they underwent "breast conservation". Many women end up going to see a plastic surgeon anyway to fix this unforeseen problem, which ironically can include the same reconstructive procedures as for mastectomy.

Radiation after a tissue reconstruction (eg tram flap, diep flap) can cause the reconstructed breast to shrink and harden. Unfortunately, this is a fairly common scenario. Less frequently (with heavy radiation doses), new wounds can develop in the reconstructed breast which need wound care. Patients facing radiation after flap breast reconstruction should know that there is a risk of needing further reconstructive surgery to correct changes caused by the radiation therapy. One study found a re-operation rate of almost 30% in patients receiving radiation after TRAM flap reconstruction.

Tissue expander / implant reconstructions fair even worse with radiation. The complication rates in this setting are much higher than with tissue reconstructions, including complete failure of the reconstruction altogether (and removal of the implant). Some surgeons routinely offer implant reconstructions to patients that are either facing or have already had radiation therapy. There are even articles published in the plastic surgery literature supporting it. I have to respectfully disagree (strongly). In my experience mixing implants with radiation typically ends badly. I will only do this in the very rare instance that there is absolutely no other option.

So what's the take-home message?
1) "Breast conservation" can fall short of the patient's cosmetic expectations.
2) breast implants and radiation do not mix well.
3) If you're facing radiation after mastectomy think twice about insisting on immediate reconstruction. You may be lucky and things may work out just fine. However, there's also a good chance you'll be signing up for more surgery than you bargained for.

Dr C

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Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction surgery after mastectomy using the patient's own tissue. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest news in breast reconstruction surgery and research at The Breast Cancer Reconstruction Blog.

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Texas Plastic Surgeons Offer Innovative New TUG Flap Procedure to Recreate Natural Breasts After Mastectomy

San Antonio, TX (PRWEB) February 23, 2009 -- Plastic, Reconstructive & Microsurgical Associates (PRMA) of South Texas, a leading breast reconstruction surgery practice in San Antonio, is now offering women the Transverse Upper Gracilis (TUG) flap procedure to restore their breasts after mastectomy. PRMA plastic surgeons specialize in breast reconstruction after breast cancer, with particular expertise in advanced microsurgical techniques using the patient's own living tissue.

"Increasingly, women facing mastectomy prefer new breasts sculpted from their own skin and fat, thereby avoiding the problems that often occur with implants," says Dr Chrysopoulo. Breasts shaped from living tissue have a natural look and feel that can't be achieved using implants or temporary prostheses. "While most patients prefer the Deep Inferior Epigastric Perforator (DIEP) flap technique which uses a woman's lower abdominal tissue, it is a technique that may not be an option for those who have had previous tummy tucks, who don't have adequate abdominal fat, or who prefer not to scar their abdomens. TUG flap surgery is a viable option for these women; a way to restore their natural breasts with excellent results."

Both the TUG and DIEP flap procedures are complex, technically demanding microsurgical procedures requiring special skill and experience. During the TUG procedure, surgeons transplant a flap of skin, tissue and muscle from a woman's upper thigh to her chest. The process has distinct advantages compared to other types of natural tissue breast reconstruction: thigh tissue has superior contour, shape and projection; loss of the muscle does not inhibit an individual's mobility or function; scarring is not easily visible, and the procedure produces a cosmetic thigh lift as well as a new breast.

"TUG flap surgery allows a woman to come out of the operating room the same way she went in," says Chrysopoulo. "With nice-sized natural breasts in place." The TUG flap is an excellent post-mastectomy option for women who have mastectomy to either treat or prevent breast cancer.

Candidates for the TUG are women who:
• have small to medium-sized breasts.
• want to avoid an abdominal scar.
• lack sufficient abdominal tissue for DIEP breast reconstruction.
• have had a previous tummy tuck or other abdominal surgery.

PRMA board-certified surgeons routinely offer both reconstructive and cosmetic breast procedures, and perform more than 400 microsurgical breast reconstructions annually for patients from Texas and across the U.S. PRMA surgeons are in-network for most U.S. insurance plans. Visit www.prma-Enhance.com or contact 800-692-5565 to schedule a consultation or for more information about the TUG flap or any other reconstructive breast procedure.

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asymmetry at the songbird branch

I have a post up at The Songbird Branch (a blog started by the brilliant Jacqueline) about my attempt to knit an asymmetrical sweater for my asymmetrical body.

Go check it out and the really beautiful items that have been found and made for the post-mastectomy body.

rants and ramblings on a rainy day

Some things make me very, very angry.

Like every new detail coming out about the needless deaths of Robert Dziekanski and Brian Sinclair. Each man could have been saved so many times by so many different people.

Like the fact that the mayor of Ottawa and the leadership of OcTranspo were guilty of several big whoppers around the transit strike (especially about how much money the city was saving and how long it would take the buses to get back on the road).

Some things make me laugh.

Like making silicone breast prosthesis jokes with my sister last night (you really did have to be there).

And going to see a taping of The Debaters with my son and my spouse.

Some things make me smile.

Like getting an email from a woman I have never met who tells me that she loves my blog and seems to be living a parallel life to mine (right down to the kids five years apart and two dogs).

Like the sound of two dogs snoring as I type this.

Some things make me worry about my faculties.

Like the fact that I bought tickets for a show (the above-mentioned Debaters) and then made child care arrangements for the wrong night (thank goodness for my wonderful sister who changed her evening plans so she could still come and hang out with my youngest son).

Like the fact that I woke up one night in a cold sweat in the middle of the night a week ago and double-checked that I had bought the tickets, yet didn't notice that they were for the wrong night.

Some things are good.

Some things are bad.

Some things just are.

Still working, sometimes, on sorting out the difference.

Breast Reconstruction Surgery - Part II - Muscle Flap Reconstruction

Women interested in breast reconstruction after mastectomy have several reconstruction options to choose from. In Part I of this series we discussed tissue expanders, breast implants and Alloderm.

Though implant reconstruction remains the most common method of breast reconstruction in the US, many women are now steering away from this option, opting instead to use their own tissue for more “natural” results. Muscle flaps have, until fairly recently, been the only choice available for these tissue reconstructions. The most commonly offered muscle flaps are the latissimus and TRAM flap procedures.

Latissimus Dorsi Flap:

The latissimus procedure uses muscle from the back of the shoulder blade which is brought around to the breast mound to help create a new breast. During the procedure a section of skin, fat and muscle is detached from the back and brought to the breast area.

Many patients also need a tissue expander placed under the muscle flap in order to obtain a satisfactory result. The expander is replaced by a permanent implant at a second procedure down the line.

Patients will have a scar on their back shoulder region that can sometimes be seen through a tank top, swimsuit or sundress. The upper back can be numb or sore for a few following this procedure until the nerves grow back and the incisions are completely healed.

Women who are very active in sports should know that this procedure can reduce ability to participate in activities like golf, climbing, swimming, or tennis.

TRAM (Transverse Rectus Abdominis Myocutaneous) Flap:

The TRAM flap was the first procedure to describe use of one of the rectus abdominis muscles (sit-up muscles) for breast reconstruction. This procedure begins with an incision from hip to hip rather like a “tummy-tuck”.

A "flap" of skin, fat and one of the patient's abdominal muscles is typically tunneled under the skin to the chest to create a new breast. This is known as a pedicled TRAM flap. Recovery from the TRAM flap procedure can be difficult and painful and there is a risk of abdominal bulging (or “pooching”) and even hernia. Long-term, the patient has to adapt to the loss of some abdominal strength (up to 20%) which most active patients will notice.

In cases where both breasts are being reconstructed, both abdominal muscles are sacrificed and transferred to the chest (one for each breast). The loss of abdominal strength in these situations is far greater and very significant.

Over the years and with the introduction of microsurgery, the procedure has evolved several times with each modification preserving more and more abdominal muscle. This has made postoperative recovery a little easier and has decreased the potential for abdominal complications somewhat.

The latest evolution in breast reconstruction is  “perforator flap surgery”. These techniques use skin and fat from various parts of the body. Since no muscle is sacrificed recovery is much easier and muscle strength and function are preserved long-term. These techniques will be discussed in Part III of this breast reconstruction series.

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Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction after mastectomy including the DIEP flap and Alloderm one-step procedures. In-network for most US insurance plans. Toll Free (800) 692-5565. Latest news in breast reconstruction surgery and research available at The Breast Cancer Reconstruction Blog.

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