Dear Doctor, I need to have a mastectomy! What does it involve?

“ When I was told I had breast cancer I just assumed I was going to have a mastectomy. In my mind it wasn’t an option not to have one. I just wanted to get rid of this cancer! If that meant having a mastectomy fine! It didn’t bother me, I just looked at it as an unfortunate thing that had happened in my life and I just had to deal with it. I’m one of those people scars don’t bother me, and I was told I was going to have a reconstruction at the same time. If anything, I don’t think I would have coped as well if they were going to do just a mastectomy. For me the reconstruction after the mastectomy was most important. I guess it’s to do with my age…at 29 you still feel like you should have a decent pair of breasts! I definitely needed to wake up with something there. 

I did wonder for a second how horrible I might look. I kept seeing myself as someone with a disability. I could feel the tumour in my breast, it was big. I wish somehow I could just save the nipple and it would just look normal after. I tried but it wasn’t an option. Me and M went for an appointment to see my new surgeon who then started saying to do chemotherapy first to try and dissolve or shrink the cancer. Then whatever is left of the small lump, if anything is left at all, it could be removed with a small operation. No, I wasn’t having any of this my mind was made up I wanted to get rid of this cancer straight away not wait for it to slowly shrink.

After the appointment I decided to go shopping with my friend, the last day of having a normal body I thought. I got a phone call from my sister, are you ok? she asked. Yes fine. You do understand you are going to wake up looking different! At that point I got annoyed and felt angry. I didn’t choose for this to happen to me!! Obviously I knew I was going to wake up not looking the same! I just wanted to act normal though. I was angry, but looking back on it now I understand my sister was just trying to prepare me for the difficult time ahead.

The operation was an early morning one. I didn’t sleep the night before, I spent time packing an overnight bag for the hospital. Now I know how under-prepared I was, I had packed things like books thinking I would be bored. The pain I might face didn’t even cross my mind, as I have a high pain threshold. My brother drove us to the hospital early that morning and I planned to meet my friends there. My mum was worrying so much, her breathing became difficult and she hadn’t brought her asma pipe. I was so worried about her, my mind wasn’t even on my operation. 

I was called into a room where they were going to do my pre-op assessment and consent for the operation. The room had several big blue leather comfy chairs and everyone was being so nice. I imagined this is what it would feel like at chemo. I spoke to several people, all asking the same questions over and over again. I was so stressed about my mum that my temperature went really high. I was slightly beginning to panic about everything! I had to tell myself to calm down. I took a few minutes to myself put my phone away and just tried to relax. It worked temp went down. I was ready to get dressed for theatre and go. 

If you would like to say bye to your family the nurse said. I walked out, I felt really emotional but held back the tears. I have to go now Mum, I said and gave her a hug. I told my brother to let my friends know, I didn’t think they would make it. I walked into the changing room and got into my theatre gear,  it felt so strange. At this point I truly felt so alone! For the first time through this process I was so scared. My friends burst into the room! They weren’t even allowed to be in there but they certainly were not going to miss me! I told them I’m too hot, take off your gown they kept saying. Just help my mum I told them. They gave me a hug each and told me they would be waiting at the other end. As they left I saw my Mum and brother sat there I gave my Mum one final wave, she smiled back. And then it was time for me to go. 

I followed the nurse down a corridor, I was desperate to see my surgeon, just a familiar face, but no one. The nurse sat me down I spoke to several other people, same questions and answers once again and then it was time. I walked into the room probably with about eight people all looking at me, I felt shy. Hiii! I said, nobody really responded, they were so busy sorting out themselves and the equipment and it was all so busy, it was like watching a movie! And I was going to do some acting. I was told to get on the bed and sit up whilst they put a load of stickers on my back. Then I lay down, how are you feeling somebody said, nervous I replied, I kept thinking where is my surgeon? I wanted to see her.

Ok we will give you some calming meds to relax you. I lay down a needle went in though the top of my hand, medication pushed in and that was it I began to feel sleepy. The last thing I heard was, try to stay awake. 

I woke up feeling sick! What have they done to me? I thought. I was recovering half conscious, my mouth was dry, my throat felt sore, my eyes felt like they had tons of Vaseline on. I lay there on the trolley, I looked at the clock, 2:00pm. I was down there at 9am in the morning. I couldn’t think straight I didn’t feel pain I just felt sick and numb. Then I told them I am going to be sick! I puked up in a bowl a nurse bought. Would you like some water? I couldn’t make up my mind because I wasn’t with it, after 10mins debating out loud, I decided yes. I drank some water and  lay flat on the bed, I was beginning to come round. I tried to turn, then I felt the pain it’s as if someone had beaten me up hard! I tried to get in a comfier position but was unable to. I was getting agitated. All I kept hearing was some nurse shouting we need to get her a bed, she needs a bed, and apologising to me. 

I looked at the clock again nearly 4pm finally a familiar face, my surgeon, Are you ok? Yes I said. Have you been crying? No I said, she looked at me for a second and off she went. I felt a little angry at her. I just wanted her to be there!

Finally! They began moving me. I was off to a bed. I needed it, the trolly was so uncomfortable. I always wondered how people felt when they were on a trolly bed being wheeled to a bed. I just looked at the ceiling all the way, it all felt a bit surreal.

The thought of having a mastectomy is scary for any woman. It’s as though someone is taking away part of your woman hood. We spend years unsatisfied with our breasts until one day someone says you need to get rid of them. Suddenly your perspective completely changes. 

What does a mastectomy involve?

A simple or total mastectomy is the removal of all the breast tissue and the nipple. 

A modified radical mastectomy includes a removal of the breast tissue and the lymph nodes in the armpit. 

A radical mastectomy is the most extensive with removal of nodes and the muscles under the breast.

What reconstruction options are available?

You have a choice whether you want to have no reconstruction at all, reconstruction at a later date or reconstruction at the same time as the mastectomy. There are different options available for reconstruction. This was something that my friend struggled with. She wanted an immediate reconstruction so that she would still wake up from the operation with a breast. 

The main options are,

– Mastectomy with an implant fitting

– Mastectomy with reconstruction using muscle and fat taken from the tummy or back

The options very much depend on your breast shape, size and your available fat on your body. You have appointments with the specialist nurses to see pictures and see the different options.

What does the operation itself involve?

It is done under a general anaesthetic, so you are fully asleep. It usually takes a few hours. After the operation you will have dressings over the scar and possibly a drain in (a thin plastic pipe that drains left over blood or fluid). Most people stay in hospital overnight and if all is well can go home the next day. You are usually on painkillers and antibiotics for 1-2weeks and district nurses will check your drain at home if you have one. The dressings are removed after a week when you have your follow up with the consultant. 

What will my breast look like after?

This does depend on what type of operation you have. However the majority of women will have their nipple removed and a thin horizontal scar across the breast. The breast itself most often looks very similar to the natural breast. There is the option of 3d tattooing a nipple at a later date. From what I have seen, when a bra is worn it is almost impossible to tell which is the affected breast. 

What advice would I give to someone making decisions about cancer treatment?

First of all don’t be embarrassed to ask questions. I have noticed a lot of the information given is medical jargon that most people might not fully understand. The health professionals will assume you know what they mean if you don’t ask. When asking questions, make sure you clarify anything you don’t understand. Also ask what the risks and benefits are for each option because that will help you to weigh them up. 

Don’t feel pressured into making a decision just because a specialist seems to be pushing you that way. Of course their opinion is vital and valid but make sure you do what is right for you. And finally involve your family and friends, there will be people in your circle whose opinion you trust and who know you better than any doctor or nurse does. 

But at the end of the day this is your treatment so make sure you get all the information you need to decide to do what feels right for you.

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