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Hi Debbie

I had what was called a subcutaneous mastectomy, axilla clearance and insertion of tissue expander! He said at the time that if I needed radio it would be fine with the tissue expander (at the time we didn't know the status of my lymph nodes).

 I had never heard of it and asked if it was new and he said he had been doing it for 10 years.  He was not happy with me having a reconstruction at the time of the surgery as the recovery was longer and the risk of infection was higher thereby delaying the start of chemotherapy (something he didn't think we should do). I was happy with a radical mastectomy as I just wanted the cancer out but he felt that the benefits of the skin expander outweighed any potential negatives.  I did ask after how it was done and what if they hadn't got everything and he said that during the surgery had things looked worse (like the cancer leading up into the skin or in the blood vessels) they would have changed their strategy. The pathology checks that everything is out with a clear margin anyway.  

Essentially at the moment, 2 1/2 weeks post op I look like I have a boob - though there is not an ounce of breast tissue in there.  I have no nipple and the expander is only half full.  The expander is inserted under my chest muscle - it is uncomfortable but getting better every day.  This week I imagine I will have a fill up!  there is a lot of saggy skin puckering around where my nipple used to be.  My surgeon said some women are happy with the expander (It's basically a silicon and saline implant) and never have a tissue reconstruction - but when I decide much further down the track on reconstruction I have my own skin to work with for the reconstruction and my scar is very small - about 5cm across where my nipple was.  I am happy with this and the options that it leaves me.  I actually have no idea why it is not more common but I am sure that there are reasons.  My cancer was a grade 3 (aggressive) but the largest tumor was 2.2 and there was no sign of it leading up to the skin.

I don't think that a plastic surgeon was involved in the surgery (I haven't got a bill for one! lol - there was an assistant surgeon).  I am so happy with my surgeon, he has not only considered eradicating the disease but how I will feel about my body when I have this disease beaten.  I will see a plastic surgeon further down the track regarding reconstruction but for now, the outside world wouldn't know I've had a mastectomy.  Today I wore a t-shirt and while I'm lopsided I felt no need to top up with the prosthesis and come Wednesday I imagine I will be more even when the expander gets filled up a little more.  I think one of the main downsides is how tight you feel in your chest while everything is stretching - I won't lie and say its a walk in the park but it is not too hard to endure.  We did laugh about how "pert" that boobie will be while my other one has a natural "droop" - again something that can be dealt with at reconstruction time.  

They did tell me how the surgery was done if you want to know - let me know - perhaps not for everyone - I just wanted to be sure they got everything.

It is so hard making these decisions - ask questions and get your answers it's your body afterall!

Good Luck,

Amanda