Reconstruction

My Free Boob Job: Myth or Reality?

Breast Reconstruction Feature Image

Please note that I do not consider the images in this post to be sexual. These images document the medical procedures I have gone through to save my life and I feel they are important to share in order to raise awareness and spread understanding. If you are uncomfortable viewing these kind of images, you can view the PG version of this post here.

The silver lining of cancer that everyone wants to talk about it the ‘breast cancer boob job’. Well unfortunately, I have news for you, that silver lining is something of a myth. The reality is, the breast reconstruction process is a far cry from the Hollywood boob job. I have nothing against women who elect to have breast augmentations and have many friends who went that route, but for comparison sake let’s throw the misconception of this comparison out the window.

If you follow me on social media, you may have seen me complaining about weekly events called ‘fills’, the pain of my expansions and the struggle of my mid-reconstruction body. So what does all that mean? Settle in for your first lesson of Breast Reconstruction 101.

Let’s start with the basics…to be clear, what follows is an over-simplified explanation for comparison sake. When someone (without cancer) goes into a surgeon’s office and elects to have breast augmentation, the implants are added to the original breast. The surgery is usually done as an outpatient procedure and the person wakes up with larger breasts and minimal recovery time.

For us post-mastectomy women, who have no breast tissue to augment and thus we are left with few options – transfer fat from other parts of the body or implants (silicone, saline or gel). For a more detailed comparison of all the reconstructive options, check out this super helpful chart from breastcancer.org. While I would have loved to go under and wake up with implants (immediate reconstruction), that option was not in the cards for me due to a variety of medical factors.  So, I began my trek down the road of delayed reconstruction with implants & expanders. I can tell you from experience this route it has been less than pleasant.

Diagram

The process began in my reconstructive surgeon’s office 2 months before I finished chemo. Reconstructive surgeons, which I will refer to as RS from now on, are plastic surgeons that specialize in reconstructive surgery. At the time it was a pleasant distraction from the chemo and something ‘fun’ to look forward to. We spent the appointment playing with implants, talking through the options and taking a ‘before’ picture of my lonely left boob. We then coordinated a date 4-6 weeks after chemo ended when both my oncology surgeon and RS were available to work together for the surgery.  I planned to go under the knife again for my left breast preventative mastectomy and the reconstruction would begin at the same time. After my oncology surgeon finished the left breast mastectomy he passed the torch to my RS. After expertly cutting my pectoral muscles, she inserted the expanders (similar to a deflated balloons) behind the muscles, reattached the muscles and sewed me back up. This of course is my expert scientific summary. Just kidding, I am a far cry from a doctor. The image above will help provide a sense of the anatomy and placement.

Post Mastectomy #1

When the expanders are placed during the initial surgery they are usually filled with a small amount of saline (30-100cc). The amount of skin you have available post-surgery is one factor which determines how much saline you can have at the beginning. Due to complication during my surgery, I only had 60ccs of saline put in. The extra skin that would have been available was needed to re-stitch my incision after extreme swelling & fluid build up (600ccs of fluid/hematoma).

mastectomy 2 healing

After I had recovered from the surgery and the swelling went down, I  was able to begin the delightful expansion process. So how on earth do they continue to fill the tissue expander after you are stitched up? It’s magical! A little blue magnet is used to find the surgical steel port on the expander. The nurse then marks the spot and uses a butterfly needle to access the expander. Jumbo sized syringes (60ccs each) are then used to fill the expanders with saline. The most saline you can get per ‘fill’ is 120ccs per side, but I was never able to get close to that number. The most I have been able to do was 90ccs. The first 2 fills were a breeze. Imagine you are filling a hole with sand, the first few scoops will fill in the hole before a mound is formed. The same is true with your chest. As you’re back filling the space with saline, you won’t experience much pain as the skin and muscles are not yet being stretched.  Once you hit the 3rd or 4th expansion, most people start to experience increased pain and discomfort. As the process continues, the expanders become harder and harder and push out again your skin and muscles with increased strength trying to escape. Image 4 years of puberty condensed into 2 months. Though your skin recovers quite quickly from week to week, the aching in your chest muscles continues without relief. Everytime you move, roll over or lean on your chest, you are met with the delightful reminder of the hard alien objects protruding from your chest.

So how long do you have to go through this expansion process? Unfortunately, it’s different for each person. Most reconstructive surgeons estimate around 6 months. The largest implants are 800cc and  doctors like to over fill the expanders to allow for  extra skin, so the most fluid in an expander would be 860cc. As the process continues, the pain increases and many women experience complications, infections or other issues that delay the process. The expansion process continues until you reach the desired size, which is extremely hard to determine since the expanders appear as odd shaped blobs spreading up and out across your chest wall. Do not fear, though this may look extremely strange at the time, the placement and appearance of your final implants will be corrected by your surgeon to give a natural and even appearance. I hope to finish with the expansion process soon (maybe 2-3 more fills). Most surgeons will suggest women complete one more fill after reaching their desired size to allow for a little extra skin. You can always decide to get smaller implants after living with larger expanders, but you can’t change the other way around. Then comes the waiting… at least three months of waiting is required to ensure your chest muscles and skin fully adjust to the expanders and your body forms a cavity for the permanent implants.

After the required three months (or longer) wait period, there is what many call a ‘switch’ or ‘exchange’ surgery. This part of the process is the most similar to a cosmetic breast augmentation. The surgery is done as an outpatient procedure and the expanders are switched out for ‘permanent’ implants. The recovery from this surgery is minimal (or so I hear) compared to the mastectomy experience. After 3 months of healing many women will end up having a few additional surgeries: nipple reconstruction, fat grafting, or other minor cosmetic adjustments.

Right now I am in the thick of the expansion process, struggling through. A few weeks ago the pain hit me so bad after my fill that I had to stop driving and my husband had to come get me. I’ve been a little apprehensive after that experience, so I have skipped the last few weeks of expansions. Though I want to get the process over with, I can’t stand the pain and discomfort. I was back in the chair this week for another fill. This time we decided to go with 30cc. We’re looking for that perfect number that won’t cause me too much pain and will allow me to manage weekly fills. Based on how I feel this morning, I think this this that golden spot. I was exhausted and uncomfortable last night but today I managing the pain without pain pills.

To help you get a sense for the process and the appearance, I have included a few images and a video below.

Expansion Timeline

Expansion Timeline part 1

Expansion timeline Part 2

Expansion Video

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23 Comments

    jan ward

    May 23, 2016
    Reply

    My daughter recently finished chemo and is about to go through all this. Reading the information about the surgeries and expansions that the doctor provided didn’t give me much of a real understanding of the process and what she’ll experience. This has helped me a lot. Thank you for sharing your experience.

      Anna

      May 23, 2016
      Reply

      I am so glad to hear that this provided some insight for you and your daughter. I found myself feeling the exact same way going into surgery.

        Patricia

        June 21, 2020Reply

        I have recently have undergone a mastectomy and have started the tissue expander fills. I find them very painful, I was not prepared for the first one 50 ccc and then we reduced the second to 30 cc. Number three was 40 cc then the fourth was 60. I find myself feeling ill the next two day after each fill. This week I will talk with the dr and ask for less as I have a busy week ahead need some feel good time. It is a process and each week I learn something new. I am so grateful for these chats because the drs don’t explain a lot. Unless you got through this process it’s hard to really know what it feels like. After The first tissue expander when I went for my second I told the dr I woke up feeling like a brick was on my chest. He questioned whether I thought I was having a heart attack! I wasn’t prepared for the hardness of tissue expander. Too bad I wasn’t informed of the entire process ahead of time. Would of been nice to go through a class to educate me. I’ve learned more on the internet than from my dr. Don’t get me wrong he’s a great plastic surgeon, but I will suggest a class to walk women through this process. Thanks for listening have great day. Hang in there. We are survivors!

          Anna

          June 22, 2020
          Reply

          I can totally understand what you’re going through. Sending love.

          e Aimee Amolsch

          October 18, 2020
          Reply

          I underwent my right mastectomy Sept.28th of this year with expander placement. I have not even started the fill process yet and I’m not in no hurry this alone is weird and it already is tight and heavy feeling.This whole process is just got me wondering why I even went with this seriously.

    Jessie Bishop

    May 24, 2016
    Reply

    I remember when you were diagnosed and we were learning all the things we never wanted to know about breast cancer.

    While this was an important part of the process, it was less important (to me) than your upcoming fight (at the time) and I didn’t fully grasp everything it would take!

    Your free boob job has NOT ended up being “free” in the least and you continue to amaze me with your resilience and grace.

    There really aren’t words for me to describe the reverence with which I view you.

    Your boobs (and all others who choose to do reconstruction) will be the most well earned ones on the planet. My boobs will be in awe of your hard-fought ta tas.

    I’m so glad that your blog is here to help and support others who are going through this overwhelming process, as a person with breast cancer, a caregiver, a friend, or a family member.

      Porschia Holmes

      June 8, 2016
      Reply

      Wow, the perception is nothing like you described. Thank you so much for sharing, it is no way i could have imagined this process being this complicated. But i applaud you for being as patient as you can and accepting the steps to recovery. For most ppl lets say they get injured or even cancer, They have the surgery and have a healing process. In your case not only have you gone thru that stage, going thru this stage, but your also prepared for more recovery phases. Pain and all you are my rock-star, because through it all you still have that pretty smile lighting up every room.

      THE BEST EVER

    Stacey C

    July 18, 2018
    Reply

    I’m in the process of treatment and expansion. I have to say the doctor(Plastic surgeon) makes a difference. I love my Plastic surgeon. She only does breast cancer patients. But I haven’t had any pain from expander yet but I do expect to at some point. But I know I’m in good hands.

    Jay Fils

    October 9, 2018
    Reply

    Thank you for taking the time to do this. This is such an emotional and private process but women like you help me a lot. Like you said, there are few resources for young women. I was recently diagnosed at 35 and I’m almost done with chemotherapy. I’m moving onto my bilateral mastectomy soon with reconstruction and reading your blog is helpful in understanding the things not really expanded (no pun intended) on by others. I feel like emotionally I got to a great place but now I’m back to crying all the time…I guess it’s my mind processing a new mountain that I have to climb. Also, I feel I’m beginning to mourn the loss of my old body even though it’s not gone yet. Just the scar from my port upsets me! I need radiation as well so this is definitely a long process. Thank you again for this blog! God bless

      Anna

      October 9, 2018
      Reply

      I can completely relate to the grief and mourning over losing your body. The emotional moments are hard but are totally normal. Sending you lots of love

    Ashley Parman

    February 6, 2019
    Reply

    I have breast cancer on both sides, dads mom died from it, moms mom beat it, mom is fighting the worst case I’ve ever heard of. The cancer completely ate up her chest and she has open wound now with lynpohdemia, she didnt qant ro do traditional treatment when she first got diagnosed. I have had genetic testing done and have the BRCA gene. What are your thoughts on getting mastectomy and reconstructive as a preventive measure?

      Anna

      February 7, 2019
      Reply

      I am so sorry to hear that! I know many women with BRCA all of whom have proceeded with the preventative surgery. Each person’s decision is so unique but I think if I was BRCA and knew before a diagnosis I would do it too.

    Drea

    October 15, 2020
    Reply

    Thank you sooo much for this post! I just had a bilateral mastectomy 3 weeks ago and had expanders places at the time. In about 2 weeks I will be having my 1st fill and reading your post has given me some insight on what to expect. I was told my fills will be every 3 weeks for a total of 6-8 times.
    The healing process of my mastectomy has not been the easiest and I’m still recovering physically, emotionally and mentally.

    Thank you again for this post

    Julie

    October 18, 2020
    Reply

    I had a bilateral mastectomy in December 2018. After the surgery to remove expanders and put in implants, i asked my doctor when we could begin nipple reconstruction. He said we won’t, your skin is too tght from radiation and we have nothing to work with. He suggested i see a tattoo artist to tatoo fake nipples, but that option doesn’t appeal to me. Almost 2 years later my non-radiated side implant has sagged compared to the radiated side. I’ve been trying for a year to do another revision surgery, but everytime i do pre-op tests i have pnuemonia. Doctors don’t know why and i can’t have surgery with pnuemonia. So my “free boob job” is still in progress and the finished job will be far from the “Hollywood ” breast augmentation. I am so thankful to be cancer free almost 2 years later. I just wanted to share my experience to show every person who goes through this has a unique experience. May God bless and heal you all!

    LoriAnne Nighswonger

    September 6, 2021
    Reply

    I am waiting to get my implants in. I have finished the fills. Thank God! I have a very high pain tolerance but that about did me in. I had my first surgery on June 3, 2021 and had to go back in on June 19th because of a bacterial infection. They had to take out my tissue expander and put a new one in. My left breast is
    is where the cancer was and the infection. My left breast always hurts more. I have 2 different tissue expanders in because they could not find the same one. I almost had to have 3 surgeries because of this! This process is not fun. Free boob job that’s a joke !!! I have never felt so exposed in my life! I pray every night for women like us that if they do get told they have cancer that they know you can be a survivor. Please do your mammograms and your MRI’s if recommended. I did that and mine was caught before it had time to go to my lymph nodes. To all my cancer sisters I pray for you all every night. We are strong and we can move mountains! Love you all! ❤️

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