Amazing how time flies, right? The days are long, but the years are short. For probably the fourth time this year, I have been tapped to counsel a friend of a friend that has fallen into this sisterhood of warriors.
It's easy to just go about my life with these scars and experiences and memories, just as we all do. With the passage of time, my story stays with me in my heart and in my narrative, but until I have to dust it off and present it to a new audience, so to speak, it seems far away.
I couldn't sleep last night. Maybe an hour or so. This state of hyper awareness, when you can hear every breath (mine, husband, dog), every movement, every kick on or off of the A/C, also gives way to a stillness. I have fired up my still hyper awareness, and then fired off a very long email to this poor lady who was just asking me why I chose implant reconstruction. I don't think she was expecting to read the dissertation that is awaiting her in her inbox.
An excerpt:
As an LMT/PTA with an emphasis on lymphatics, I knew for sure that I did not want radiation, if I had a choice in the matter. And if I did have to have radiation, I did not ever want to irradiate a live tissue flap reconstruction. I was fully aware of the range of motion and strength deficits with all of the different types of reconstruction, as well as postural impairments with abdominal, DIEP, and lat flap repairs. I wanted the least possible offsets to muscle moment arms in my chest, as well as any other potential donor sites. (This is in regards to muscle contraction and available strength.. once the moment arm changes, the effectiveness of muscle contraction is diminished. When you perform any reconstruction, this is going to happen in some way.)
I would rather surgically excise the malignancy, disturb as little as possible, and call it a day.
I'm not afraid of surgery, not afraid of chemo, but I didn't want radiation unless it was required to save my life. It can cause lifelong lymphatic and immune issues, and I just wasn't in the mood to deal with all of that in addition to whatever else was going to be happening.
Implants can always be switched out, if there is an issue. I've only had one patient (out of hundreds) whose body flat out rejected the implant, and I've also seen that with knee replacements, lumbar fusion hardware rejection, etc.). I did have a second reconstruction in the summer of 2020, but only because I had textured implants, which have a higher risk of developing lymphoma. Because I play a ton of tennis, that creates friction over the textured implant, so I switched them out for smooth. I also have celiac disease, which can put me at a higher risk for developing lymphoma, so I just opted out of that whole potential scenario with the smooth implants.
My first implants were positioned behind the pec major, and I was pretty uncomfortable for a long time. I also felt pretty weak, chest-wise. I couldn't do a pushup or a pike-type exercise (moment arm issue). When I elected to get the smooth implants, they were placed above the muscle, which made a HUGE difference for me. I am stronger now than I have ever been. I have almost full range of motion, I can do pushups, pikes, chaturanga (yoga), arm balancing poses, etc. that I could never have done before that last revision.
Everyone has a different set of challenges with their breast cancer journey. The most important thing, in my opinion, is to identify what type it is, make a plan, have a team, and get organized.
I was estrogen & progesterone +, HER2 -. I was supposed to take Tamoxifen for 10 years because of the age at which I was diagnosed. I could only take it for 3.5 years because of some manufacturer/distribution issues (I had severe reactions to the Mylan version).. This caused a whole lot of uterine/endometrial issues that I had to deal with for a few years... What I'm trying to say essentially is that I'm glad that I went the route that I chose, because sometimes your cancer journey drags on and on and on, and for some people it never ends. I just wanted to make things as simple as possible for as long as possible so that I could be as strong as possible. I have an almost 17 year-old son who has always been my primary focus... being here for him.
What I didn't include was that I had to have a revision of the right breast, four months later. I also didn't include the fact that I had a fat graft the following summer, due to a ripple deformity on the right side. I didn't include the fact that my right quad and left hip have a couple of remaining numb spots secondary to the liposuction "harvest" for the graft. I didn't include the fact that my skin is still very thin and whose integrity can become compromised relatively easily... Eh, details.
I also didn't tell her that my life today is still better than I had ever imagined it could be. I am strong, healthy, play golf and competitive tennis, and probably look pretty damn good for my age. I have a loving and supportive husband who is really, incredibly sweet and generous to me. My son is off at camp, attacking the Blue Ridge Mountains in North Carolina and becoming one hell of an amazing young man.
This journey and all of these choices we make regarding reconstruction (or not) can be exhausting in the moment, yet they offer perspective in the rearview mirror. I suppose my motivating factor or desire the entire time was "strength," but I wouldn't have been able to properly articulate that until right now, though it may seem simple by reading these posts.
XO,
Whipper
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