Part II: Take these boobs away!

Courtesy of modern anesthesiology, I fortunately can’t tell you much about the surgery itself.  Also, I’m a lawyer by training and any medical knowledge I have comes secondhand from my doctors, my pediatrician brother, TV shows, MayoClinic.com, and that one time I was on the jury for a medical malpractice case. But the relevant (or sometimes just amusing) facts that I do know (or think i understand) are as follows. Be forewarned, this may get a bit graphic.  Nipple talk is coming up very soon.

I arrived at the hospital at 10:30AM on November 7 for my bilateral mastectomy.  Based on the results of an MRI a few days prior, my doctors thought the cancer in my right breast was far enough from the nipple that they were planning a nipple-sparing mastectomy.  Since all of the cancer they could see on my various scans and biopsies were on the right, they would also remove what they call the sentinel lymph nodes on the right side. These are called “sentinel” because they are the the ones cells would reach first if traveling the lymphatic system from the breast. However, every person has a different number of lymph nodes and different ones that are the sentinel nodes. I know you are on the edge of your seat wondering how they identify which ones to remove!?

Modern technology to the rescue!  On the day of surgery, I was wheeled to a special isolated area down a dark hall in the hospital basement. The lights flickering, the wheelchair entered a room with the words “Nuclear Medicine” on the door. Okay, it wasn’t so dramatic.  But it was the nuclear medicine unit and they injected a radioactive substance into my nipple!!  What?!  That substance would then follow the lymphatic system to the sentinel nodes. The surgeon uses a Geiger counter in the operating room to determine which lymph nodes to remove!  Aside from the nipple injection part (ugh), pretty cool, right?  I think the range of sentinel nodes that are typical is between 3 to 10 (or something like that).

Fun fact about surgery- they tell you not to eat or drink after midnight the night before.  Nooooooo!!!!!  I am a person who wakes up hungry.  I could fall asleep with multiple thanksgiving dinners in my belly and I will still wake up ready to eat.  I am also an addict.  I get severe headaches without my coffee. Multiple cups of coffee.  Every single nurse, doctor, aid, technician, probably even the valet parking guys, knew that I was hungry.  “Good morning Ms. Lim!  How are we feeling today?” “I’m hungry.  My head hurts. I need coffee. please help!!!”  Plus, for some reason yet to be explained, my 1:00pm surgery was delayed until about 3:30pm, so.... I was not a pretty sight.

The other fun fact prior to surgery was when the anesthesiology nurse mentioned in passing that I was fortunate to have the “dream team” of surgeons.  She said my breast surgeon and my plastic surgeon were really amazing and did great work together.  Maybe they tell that to everyone, but it is one of the best things to hear just minutes before going under.

During my peaceful slumber, the breast surgeon took the first shift clearing out that killer breast tissue (and doing whatever they do to send it off to be meticulously studied in a lab), using her handy Geiger counter on my lymph nodes and removing the radioactive ones. Then she steps aside and calls my husband for an update on her portion of the surgery. Meanwhile, the second part of my dream team, the plastic surgeon, takes over.  Her approach is to survey the landscape and, based on her expertise, make a game time decision on whether to immediately put in implants or put in temporary expanders.  Most often it’s the expanders.  There is a very good explanation for that but I don’t think I could do it justice.  Regardless of which one she chose, I would almost certainly require another reconstruction surgery down the road and there are advantages to having the expanders while the skin is recovering from the mastectomy.

A few hours later, I woke up and started crying. Some of you know I cry. It’s what i do. Not just at Hallmark commercials, but all kinds of stuff. However, I’m told this was not an uncommon thing when coming out of anesthesia. Fortunately in no time at all (at least no time for a heavily drugged person) they had my husband by my side.  When I was finally clear enough for a normal conversation and had a bunch of saltines and ginger ale in my belly, I got the update. 7 lymph nodes removed and preliminary testing showed cancer on one. Also, my plastic surgeon opted for the expanders. And I had three drains put in.  

That long overly detailed account will have to do for tonight. Stay tuned for our next episode with drain fun, numb boobs, full body itching and heart shaped pillows. Photo above is blah me in the hospital in my new elephant pajamas, courtesy of Amazon Prime during my frantic surgery prep weekend. (Button down shirts and pjs are recommended during mastectomy recovery!)