Surgery Update #2

It is 7:00 a.m the  morning after surgery.  I sit her next to Lisa's bed in the chair that I used for my bed during the night.  I was actually quite surprised how well I slept in this partially reclining, narrow seat.  Though I certainly don't feel perky, I have had worse nice of sleep. 

I will pick up where I left off yesterday. About 1 hour after the surgery commenced, Dr. Tittensor sent a nurse to the waiting room to inform me that they had extracted two lymph nodes, tested them, and that both produced negative results for cancer.  I wrapped up my previous blog entry at that point, because I felt like I needed to quickly share that information with family and friends.  That is one blessing of texting:  instant information can be spread--even faster than email--to a large group of people.

Lisa, 30 minutes before surgery.



The sense of relief after receiving news of the lymph node testing was palpable.   That result was the key indicator I had looked for to define a truly successful day.  It all but guaranteed that the cancer had not spread, as all of the prior external testing (mammograms, MRIs, and ultrasounds) had suggested.

The next key indicator of the success of the surgery will be revealed sometime next week when the pathology report of the extracted breast tissue is completed.  That report examines all of the removed breast tissue to learn if the surgeon was able to extract all cancerous cells plus a large enough margin of healthy tissue surrounding the cancerous region.  The hope is to have a healthy margin of tissue at least 5 millimeters in all directions.  That gives the doctors enough confidence that they removed ALL of the cancer from the breast. Most importantly for us it means that we would have to undergo radiation therapy.

We have reason to believe, however, that we will not be able to avoid radiation, as Dr. Tittensor told us prior to the surgery that due to size of the infected region and its proximity to the borders of the breast that the odds of finding a 5 millimeter margin of healthy tissue (in all directions, mind you) were not good.  Thus, we have prepared for radiation therapy from the beginning, which, of course, sure beats having to do chemotherapy.  With low expectations, we'll be that much more elated if radiation is not needed.

About 45 minutes after the nurse informed of the negative results of the lymph nodes, I was surprised to see Dr. Tittensor in the waiting room.  It was about 3:45 (about 1 hour and 45 minutes after Lisa was carted off for surgery). The surgeon was there to tell me that her work was finished--that the mastectomy was complete, that Lisa responded beautifully, that the bleeding was minimal, and that procedure couldn't have gone better. 

She did mention that Dr. Bishop, one of two plastic surgeons that Dr. Tittensor works with to reconstruct breasts, was held up in another surgery in Orem (we're in the American Fork hospital), and that they were waiting for him to arrive to perform his portion of the surgery.  Thus, Lisa lay in the operating room with an anesthesiologist next to her, wound open, waiting for the next surgeon to arrive. The thought of that made me uncomfortable:  I hated to have her anesthetized  any longer than necessary.  That said, you learn really quickly not get too hyper about the about the various inconveniences of medical treatment.

About 45 minutes later Dr. Bishop arrived.  Just before 6:00 p.m. he came to speak to me and Larae, Lisa's mom, in the waiting room to tell us that he too was finished and that Lisa would be waking up in about an hour. 

The plastic surgeon's role in the process is to insert an 'expander' under the breast muscle.  The expander is filled with water and its purpose is to stretch and prepare the skin in the region of the removed breast for a future implant.  Over time they inject more water into the expander through a needle that somehow finds its way into it through the breast, and they gradually stretch the skin.  According to my limited knowledge of the subject, they very rarely complete breast reconstruction  at the time of mastectomy.  I believe this is for two reasons:  (1) there can be various complications that arise from the mastectomy (swelling, bleeding, infection) and the body may not be ready for an implant at that moment; (2) radiation therapy, which follows a significant amount of mastectomies, can wreak havoc on its targeted area.  It tends to shrink and scar the tissue it treats.  Implants in particular don't do well with the radiation.  If you were to radiate after reconstruction the outcome may not be one that you desired--unless, of course, you're happy with one of your breasts looking like a raisin (or worse, a prune).

In addition to inserting an expander under the breast muscle, the plastic surgeon also closes the incision the Dr. Tittensor makes.  That, of course, makes sense to have the guy who specialises in cosmetics, close the incision to minimize the scaring. 

This discussion does bring up the topic of implants.  Lisa and I have jokingly referred to the side benefit of breast cancer as vain-less and guiltless breast augmentation.  Bill Clinton (and I do find this somewhat ironic considering Bill's appreciation of breasts) signed into law in 1998 the requirement that insurance companies had to not only pay for reconstruction for mastectomy patients but also had to pay to make the non affected breast symmetrical with the newly reconstructed breast.  It wasn't that long ago that the attitude toward mastectomy patients was--"you're lucky to be alive"--and not much thought was given to the cosmetic insecurities that a woman dealt with forevermore.

Two weeks ago, Lisa and I spent the week looking at other women's breasts.  That was not on the list of activities I thought I would ever engage in. Taken out of context, that might sound pornographic.  But trust me, this whole subject matter gets very clinical very fast.  We went to interview the two plastic surgeons that Dr. Tittensor works with to learn which of the two we felt most comfortable working on Lisa.  During those appointments, we looked at multiple before, during and after photos of the whole process.  Lisa wasn't terribly encouraged by any of the photos. I had to remind her that most playboy bunnies and cover girls do not pose for breast reconstruction photos, and that perhaps the photographers retained by the plastic surgeons (their nurses) are not trained to make anything look good, particularly in florescent light!

At one point during the process Lisa and I laughed like a couple of preadolescents when one of the surgeons we interviewed took out his measuring tape and a ring of sizing cards attached to a metal ring and began to measure Lisa: from nipple to nipple, chin to nipple, from belly button to nipple, etc.  It was just too much for either of us to handle.  No, it certainly wasn't the first time in recent weeks that her breasts had been handled by a stranger, but for some reason the measuring tape just put us over the edge. I was trying not to look at Lisa, but I could tell out of my peripheral that she was looking toward me, and like that Death Star tracking beam that sucks in its victims in Star Wars, I was sucked in by her gaze.  The moment our eyes met, we burst our laughing.  We naturally tried to suppress the laughter, which only made the matter worse. Soon we were laughing because we were laughing.   Although the surgeon smiled, he did not seem to be overly amused. The surgeon looked a little surprised, as if instead of talking with two adults mature enough to deal with breast cancer he was in the process of telling two eight year-olds about the birds and the bees.
Perhaps it was out of shame that we chose the other surgeon.  I couldn't bear the thought of laughing every time I saw him or his measuring tape.

Unfortunately, there was too much laughing with Lisa post surgery.  She was in her room by seven, but was mostly out of it.  When she woke up, she felt and increasing amount of pain in the area of her lung and upper back.  I will comment more on that later. For now, I am going to eat breakfast with my wife.

The kids paid a visit to a mostly-conscious mom a few hours after surgery.