In the Rearview Mirror: Post Mastectomy Body Image and Challenges
06/11/21 • 21 min
In the rearview mirror...What I wish I had known about post mastectomy challenges.
When you are diagnosed with breast cancer, what’s probably foremost in your mind is to expedite surgery and treatment options to rid your body of the cancer. In another blog, I talk about how to prepare for a mastectomy in a practical way by getting the supplies you will need for physical recovery. What I didn’t discuss in that podcast, and what is most often not discussed, was how I would emotionally feel about the loss of my breasts. In my book, A Teacher’s Journey...What Breast Cancer Taught Me, I recall the morning of my mastectomy when I looked in the hotel mirror after showering. I felt the need to verbally say goodbye to my breasts.
Suddenly, I was filled with emotion and terror with visions of how I would look when they were gone. Not that they were great, mind you, I had nursed both my sons, and they were fifty-three years old and saggy. Doubts surfaced and I thought do I really know what I’m doing? I then burst into tears. My husband John, always my rock, hugged me and reassured me it would all be ok. After taking a Lorazepam that my surgeon had prescribed to settle my nerves, I felt better and ready to go. Well, did I really have a choice anyway?
No matter how you feel about your breasts, whether they are too small, too saggy or too large, you WILL grieve them. They are part of you. They are part of your femininity, sexuality and a large part of love making. You have a history together...which are now only memories. I had been told that I could possibly have some minor sensation after recovery, but there were no guarantees. My mastectomy was a skin sparing with expanders placed during surgery, but my nipples would not be spared. Since I had extensive LCIS and DCIS, my medical team could not assure me there weren’t cancer cells in the nipples. At this point, there was no sense taking a chance.
Although I was resolute in my decision, and certain it was the right choice given the information and options at hand, I was still tormented. That fateful morning in the hotel before leaving for the hospital when I cried, it was a foreshadowing for all the tears I would shed in the coming months.
When I first woke after surgery, there were ace bandages wrapped tightly around my chest. The pressure was intense and I thought it was from these bandages. The reality was it was the expanders. Nothing can prepare you for the “iron bra” feeling of expanders. They are extremely uncomfortable and getting used to them is a huge part of the first few months of healing. They are hard, immoveable, and unforgiving when attempting to get comfortable for sleep.
Many of my breast cancer friends, were able to choose DIEP flap reconstruction. This was not an option for me with the plastic surgeon I selected. Her expertise was limited to using the stomach area for the tissue needed. I didn’t have enough tissue available in that area. What I wish I had known is that there are specialized surgeons that are trained to harvest tissue from other areas such as the buttocks, thighs or hips (I would have loved to use that area). This may have involved travel for this expertise, but I would have SO done that to have natural tissue as my new breasts in lieu of implants.
Although I was so fortunate as to not require chemo due to my low oncotype score, I was not prepared that the healing process and completion of the reconstruction would require a long twelve months of procedures, check-ups, surgeries and mental coping. I used yoga, meditation, counseling, and walking to decompress, but I wish I had been more mentally prepared. Most medical teams, or at least mine only volunteered information in small doses. If you don’t ask a lot of questions
In the rearview mirror...What I wish I had known about post mastectomy challenges.
When you are diagnosed with breast cancer, what’s probably foremost in your mind is to expedite surgery and treatment options to rid your body of the cancer. In another blog, I talk about how to prepare for a mastectomy in a practical way by getting the supplies you will need for physical recovery. What I didn’t discuss in that podcast, and what is most often not discussed, was how I would emotionally feel about the loss of my breasts. In my book, A Teacher’s Journey...What Breast Cancer Taught Me, I recall the morning of my mastectomy when I looked in the hotel mirror after showering. I felt the need to verbally say goodbye to my breasts.
Suddenly, I was filled with emotion and terror with visions of how I would look when they were gone. Not that they were great, mind you, I had nursed both my sons, and they were fifty-three years old and saggy. Doubts surfaced and I thought do I really know what I’m doing? I then burst into tears. My husband John, always my rock, hugged me and reassured me it would all be ok. After taking a Lorazepam that my surgeon had prescribed to settle my nerves, I felt better and ready to go. Well, did I really have a choice anyway?
No matter how you feel about your breasts, whether they are too small, too saggy or too large, you WILL grieve them. They are part of you. They are part of your femininity, sexuality and a large part of love making. You have a history together...which are now only memories. I had been told that I could possibly have some minor sensation after recovery, but there were no guarantees. My mastectomy was a skin sparing with expanders placed during surgery, but my nipples would not be spared. Since I had extensive LCIS and DCIS, my medical team could not assure me there weren’t cancer cells in the nipples. At this point, there was no sense taking a chance.
Although I was resolute in my decision, and certain it was the right choice given the information and options at hand, I was still tormented. That fateful morning in the hotel before leaving for the hospital when I cried, it was a foreshadowing for all the tears I would shed in the coming months.
When I first woke after surgery, there were ace bandages wrapped tightly around my chest. The pressure was intense and I thought it was from these bandages. The reality was it was the expanders. Nothing can prepare you for the “iron bra” feeling of expanders. They are extremely uncomfortable and getting used to them is a huge part of the first few months of healing. They are hard, immoveable, and unforgiving when attempting to get comfortable for sleep.
Many of my breast cancer friends, were able to choose DIEP flap reconstruction. This was not an option for me with the plastic surgeon I selected. Her expertise was limited to using the stomach area for the tissue needed. I didn’t have enough tissue available in that area. What I wish I had known is that there are specialized surgeons that are trained to harvest tissue from other areas such as the buttocks, thighs or hips (I would have loved to use that area). This may have involved travel for this expertise, but I would have SO done that to have natural tissue as my new breasts in lieu of implants.
Although I was so fortunate as to not require chemo due to my low oncotype score, I was not prepared that the healing process and completion of the reconstruction would require a long twelve months of procedures, check-ups, surgeries and mental coping. I used yoga, meditation, counseling, and walking to decompress, but I wish I had been more mentally prepared. Most medical teams, or at least mine only volunteered information in small doses. If you don’t ask a lot of questions
Previous Episode
Prevention Strategy 9: Medicinal Mushrooms
Various varieties of mushrooms have long been used in Traditional Chinese Medicine (TCM) for immune support. Several of these medicinal mushrooms have been found to have estrogen suppression effects and are highly beneficial for estrogen sensitive breast cancers. These immune boosting mushrooms are readily available in supplements or can be incorporated into the diet regularly to obtain these benefits.
Next Episode
How Does Breast Cancer Evade the Immune System and How Does Chemotherapy Work
Our immune system is the “clean up crew” which constantly surveys for foreign invaders such as bacteria and viruses. These harmful substances are called antigens. Our Immune surveillance system identifies these invaders, marks them, and calls out the cavalry, the T cells, to destroy them. Macrophages are large white blood cells that are an important part of the immune response. The word macrophage literally means “big eater”. Its job is to clean our bodies of microscopic debris and invaders. It’s an ameba like cell that patrols out bodies and “eats“ intruders. Macrophages are able to pull apart enemy cell proteins and present (identify them) them to T cells as invaders. So what are T-cells? They are cells produced in the bone marrow which spend some time maturing and developing in an organ in the chest called the thymus—this is why they are labeled T-cells, which stands for thymus-derived cells. Once they are mature, T-cells are released into the blood and lymph nodes to start work. When a T cell is presented an invader by macrophages, it then will call out the cavalry (antibodies) to eliminate the diseased cell or invader. Specific types of T cells have particular functions, with helper cells activating other cells of the immune system while cytotoxic T cells directly kill foreign cells (cancers) and viruses. How cancer cells evade the immune system has puzzled scientists for decades. When cells are/or become abnormal, macrophages are supposed to consume and destroy them. So how do these diseased and abnormal cells evade this important checkpoint designed to keep us healthy? How are these cancer cells allowed to fly under the immune system’s radar? To put it in simple terms, cancer cells somehow send out a “don’t eat me” signal to macrophages by expressing certain proteins on their cell surfaces therefore, “disguising themselves” and tricking the macrophage. These surface proteins expressed by the cancer cell bond to other proteins on the surface of the macrophages paralyzing their ability to destroy or consume the cancer. The result is they are not presented to the T cells for an immune response. Since the immune system (T cell) does not identify the cancer cell as an enemy, it does not generate an immune response and allows other cells like it to continue undetected. So, if cancer can evade our brilliant immune system, how can chemotherapy identify and kill cancer cells? The honest answer is ... it can’t. Chemotherapy works simply by killing cells that are rapidly dividing like cancer cells. Cancer cells need lots of glucose or sugar for the energy to divide. Every cell in your body uses blood sugar (glucose) for energy. But cancer cells use about 200 times more than normal cells. Chemotherapy is often administered in a glucose solution to entice cancer cells to absorb the treatment. Since they are hungrier and more aggressive, they “eat” the chemo first which is the objective of the treatment. The problem is that as well as killing cancer cells, chemotherapy also kills normal cells that are rapidly dividing like in the mouth, stomach and bowel (gut), skin, hair and bone marrow. Damage to these normal cells cause the side effects of chemotherapy. However, unlike cancer cells, normal cells can repair the damage and can recover. This is a total simplification of the complex immune response, but I hope it makes it understandable.
How Do Breast Tumors Evade the Immune System? - PHD Version by Dr. Vincent Tuohy, Immunologist. Please visit my website for the full transcript. https://www.sisters4prevention.com/post/how-does-breast-cancer-evade-the-immune-system-and-how-does-chemotherapy-work
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