Robo Boobs

As previously mentioned, I had known for 14 years that I carried the BRCA 2 gene mutation prior to my mastectomy. Living with this information for so long is both a blessing and a curse. It was troubling to know I was essentially 'doomed' (or that's how I looked at it); women with a BRCA mutation have up to an 85% lifetime risk of getting breast cancer. However, knowing the origin gave me access to be proactive with screenings, allowed me to be aware, and more able to research and begin the acceptance. This ultimately allowed me to apply more practicality to my decision-making. Of course emotions still played a role; becoming a mother in the last 4 years made it even more important to speed the preventative measures along. I wanted to remove as many risks as possible to feel more confident that I could be there for my children. I felt blessed, actually, that I had known as long as I did. I know not all people are that fortunate and the news is sprung on them quickly. It's harder to feel confident in your decision-making when it is rushed.

I began the arduous process of monitoring my breast health at the age of 23. It was recommended to begin this 10 years prior to the youngest family member's diagnosis that was my aunt Cindy.

The monitoring eventually played a key role in thinking more seriously about prophylactic surgery. Every 6 months I alternated having an MRI and mammogram/ultrasound. It gets quite exhausting (and expensive) and especially at that age, with denser breast tissue, there are a lot of false positives. I had to chase down a few biopsies, which take an emotional and physical toll. I believe recommendations have evolved now and mammograms aren't really recommended until after age 30 due to tissue exposure.

About 7 years prior to my surgery (and before kids), I did some thorough research on a prophylactic mastectomy. At that time, I was now a young adult, living independently, but also not yet a mother. I figured it was time to start taking some things seriously and getting a handle. I live in the Dallas/Fort Worth area so I also had the benefit of being in a larger metro area with plenty of healthcare choices. I went through several different breast oncologists who referred me to plastic surgeons to get an understanding of the ultimate results. I met with a lot of doctors and I must admit, what I saw did scare me off a bit. I had to take a break. Mastectomy photos weren't exactly comforting and the emotional guidance I received from various doctors; some encouraged me to push forward right then with the surgery, others encouraged that I waited until I had a family (if that was in my plan) and then pursue. I didn't like what I had seen, I wasn't ready to make the choice and I still hadn't had a family yet - and that was my husband's and my plan. I'm grateful I had the opportunity to wait. There are so many factors that showed me I truly wasn't ready. I'm grateful I was able to wait (even though I definitely have FOMO about getting all of this done much earlier/younger). When I picked it up again, it was absolutely amazing the advancements that have been made in that 7 years; so much so, that I had the benefit of a robotic procedure!

Calendar Tip for Timing: My plastic surgeon suggested having the procedure towards the beginning of a calendar year, as that would allow me the most time to take advantage of meeting my insurance deductible. I thought this was great advice, and knowing what I know now (3 surgeries later) that proves true. It's also a good time of year to recover (for the first surgery, anyway); it's typically more cold and dreary out so it just mentally and emotionally feels better to be cooped up then.

From a BRCA perspective, unfortunately the monitoring on other areas of the anatomy continues. I had originally planned to have my Fallopian tubes removed during this initial surgery (to fend off ovarian risks prior to planned hysterectomy at 40), but given the robotic element, opted to delay this. So, tackled that surgery along with additional fat grafting later in the year (again, because I've met my deductible). I will begin monitoring my pancreas, due to an increased risk there as well. All good things to knock out while I'm covered, and because Its 2020 (ha, didn't know what that year was going into all of this).

I can't stress enough the importance of selecting the right team of doctors. I did go through quite a few in just the monitoring phase. Being a previvor can be a bit different to navigate in a medical setting to make you feel like YOU need a call to action. You need doctors who respect the risks of hereditary cancer, but also understand what this mutation means and make you feel heard. I did lots of research prior to making a choice. Finding a doctor that is well informed with heredity breast cancer can make all the difference. I found many of my breast oncologists didn't necessarily have a strong familiarity with the mutation. They were well versed but didn't always come prepared with providing recommendations. I wanted a doctor that could recommend the right resources given my specific scenario. Someone that was on the cutting edge of research and advancements in the breast cancer arena and that of hereditary breast cancer, and so on. That led me to my ultimate destination at UT Southwestern!

I could immediately feel the difference in care and I finally felt like I was being truly monitored by a cohesive team. The breast surgeon/oncologist, in my particular case, is the lead and primary doctor that provides the comprehensive view. He or she orders and advises the monitoring of your breasts (and supplements to other organs). The breast oncologist maintains a regular regimen of mammograms, ultrasounds and MRIs (mine alternated every 6 months). These specialists make up your hereditary viewpoint and is obviously key to them reaching out in each of these fields. I also had similar monitoring done in my pelvic area (pelvic ultrasound), which also required coordination with an obstetrician. As you can see, it can turn into quite a few doctors. But, you need a lead. In my case, all of this funneled up to my breast surgeon/oncologist. Again, this is the doctor that provided a comprehensive view of the overall changes in your breast and/or other organs. In the past, this chain of command didn't seem well coordinated, but now it was more smooth.

My original breast surgeon at UT Southwestern (Dr. Rao) was actually not who ultimately did my surgery! I had seen her for a few years and together we had come up with a plan that I would have my surgery around age 35, when I had the 2 children I had planned and was finished breast feeding. Unfortunately, she was recruited to another hospital. That was a bit unnerving, but everything happens for a reason. She referred me to Dr. Farr, who completed my surgery and is now my breast surgeon (more on that, later). Thankfully our timing aligned perfectly, as I hadn't been monitored heavily in almost 4 years due to having my 2 girls. So when I returned, it was game time. I immediately clicked with Dr. Farr. I felt this sense of a natural connection. Dr Farr is so incredibly passionate about patient care and she introduced me to a possibility, something I hadn't heard yet. She told me about this robotic element and shared with me her research. I was immediately intrigued. That natural sense of connection with her obviously played a key role in allowing me to feel safe in my future decision. I wanted to choose her; we were a team and with that I took the plunge. Dr. Farr goes above and beyond to support her patients and their families and honestly, if I'm being fully transparent here, I love that she is a female!

This was my exact thought when my surgeon, Dr. Farr, introduced me to the robotic mastectomy option. I was curious and she was definitely excited about this innovative approach. She shared her research presentation with me, and I was fascinated - but then I learned I would be the first in the US to have this specific single-port procedure. That was scary, but I believed in her expertise.

Robotic mastectomies originated in Italy and have been conducted for several years using the da Vinci robot with multi-ports. However, using this robot for breast mastectomies in the US was relatively new. The FDA had issued a statement in February 2019 about multi-port robotic mastectomies needing further study. That's where UT Southwestern in Dallas, TX comes in - they are leading the national charge in advancing robotic breast mastectomy procedures.

When Dr. Farr explained the research and the potential advantages of the robotic approach, I was intrigued. The benefits include better visualization, precision during surgery, single-port access meaning minimal scarring, and potentially faster recovery with less tissue trauma. The cutting-edge technology aspect was incredible.

Yes, being "first" was scary, but I believed in Dr. Farr's expertise and the technology. The fact that I could have such minimal scarring with a single-port approach was a huge advantage.

The mental preparation was honestly the hardest part. I read many others saying the same thing. The anticipation for the surgery (not even the robotic part, just the idea itself) was honestly the worst part for me.

I was fortunate to have support from family, friends, my husband Michael, and my two daughters. Having my "why" - my girls - made the decision clear even when I felt nervous. I'm so glad I took the risk and pushed through the anticipation.

I had my surgery February 1, 2020 (thankfully before COVID-19 hit the US hard). I think the results are astounding! My incision is approximately 1.5 inches long on each side - a tiny scar compared to traditional mastectomy. I opted to do tissue reconstruction with a goal size of being a small C (420-450 ccs). The initial surgery went well and was just under 6 hours. I was happy with the results that very same day - even with just expanders! I had minimal bruising, it was really quite incredible. I was in the hospital for one night (which is still typical). My overall recovery went quite well. I had my drains removed and completed filling my expanders to the desired size within the first month. The downside is that sensation never returned to my breasts, as hoped.

I had my second surgery in mid-May to swap out the expanders for breast implants. At that time, I also had fat grafting done to add around the implant area to make this look more natural and minimize the rippling appearance that you can see from the implants.

All in all, I'm incredibly happy I took the risk. The anticipation for the surgery was honestly the worst part for me. I read many others saying the same thing. I'm so glad it's behind me and now I can just look forward! There are of course some downsides but I'm working through accepting these. As I've said, I have 2 little girls (ages 4 and 2), parts of the recovery were tough as I wasn't able to hold them for a total of 2 months (weight restrictions). I was so grateful to have a super supportive family that helped me get through all of this both physically, emotionally and mentally.

My surgery was scheduled for 7:00 am, we had to arrive at the hospital 2 hours early for check-in. My husband, Michael, and my mom were there to help me and give me emotional and mental support all morning. My dad was in the waiting room as well - it actually looked like a ghost town in there! Typically, surgeries are not scheduled on a Saturday; they had purposely scheduled mine for a Saturday to minimize the number of people around, being that this would be the first robotic procedure. The nurse who checked me in was named Carol and she was exactly what I had hoped! She was bubbly, light, cheery and got me all set up in my room where I changed and was asked several more questions. I anxiously watched the clock. It kept getting closer and closer to 7 am (my surgery time) and I couldn't believe how calm I looked like a ghost town in there! but alas, the lady screws up my IV and it doesn't go correctly in my hand, so she has to do it a second time in my forearm... see, I do have a reason to be scared of those!! So far, I'd been relatively putting on a brave face, smiling, joking, but the anticipation and anxiety were becoming pretty overwhelming. I just tried to remember to stay positive. I just wanted to smile and keep my head level and not succumb to crying. I mean, I even managed to smile for a picture.

My doctor, Dr. Farr, finally came in to greet me. I'll never forget she had goggle marks on her face. I'll find out later that she got minimal sleep and was already up practicing for hours, hence the goggle marks. She reviews the procedure again and gives me more paperwork to sign specifically regarding the clinical trial. I had been asking about this for a week or so, trying to avoid reading it the DAY OF SURGERY. Sure, there are risks in being part of a trial and clinical trial... First off, I was confident in the process. I was confident that saying yes was best, but there's clearly something about being told you're a part of a trial and there are risks... but then she uttered something I had not heard yet. "You will actually be the first patient in the world to have this procedure"... excuse me, come again?!

So, the 'world' comment obviously threw me, scared me and it made me cry a little. I was aware I was their first patient, but not the first one in the world. I don't know who I was trying to be brave for: Michael, my mom, Dr. Farr or even myself, but I just kept telling myself not to cry! So, a few chin quivers later and once I said, "excuse me, I'm just a little scared... OK, not computing right now, lets just do this..." I eventually learned more context from Dr. Farr (covered in the why I chose robotic section). I realize the irony that I apparently didn't realize that key factor going into all of this. However, I was already confident in the robotic option. So, so be it.

Dr Haddock, my plastic surgeon, then had his turn. He also had me sign a consent form. Then it was time to mark me up! Whew, things were just getting more and more real. He had me stand up and drew with dark marker around my breasts to create a map for both him and Dr. Farr.

After this, the anesthesiologist team came in and introduced themselves. They were two quite young people. They gave me the anti-anxiety medicine at that time - it was needed! I think it was just about 7:00 am on the dot when they rolled me back.

I only briefly remember the actual operating room. The nurse told me she would take good care of me and they told me I had pretty eyelashes (aww, thanks!) and that was it! I would be asleep for the next 6 hours.

Recovery in the hospital was smooth. I had wonderful nurses and was able to see my family. The support made all the difference in my recovery.

I had quite a bit of energy that first day home. I was surprised how well I could get around. I was able to go upstairs; I was game to watch the Super Bowl (came home Super Bowl Sunday!) but I didn't have much of an appetite for all of the snacks. Things were looking up though!

Michael continued to be a fantastic nurse and supporter. There were several medicines we had to balance and time, especially for the first several days. We also had to empty my drains and time them properly. He was so good at creating a routine to stay on schedule with my medicine on time and drains emptied properly. That is something you underestimate at first, too. You are just not in the mental state to care about what to take, when and how and he really helped me with that. We determined we could empty my drains every morning and every night and it went super smooth! He could empty them every day, which was also good for consistency. I had him empty my drains for me until day 3 or so; I got the hang of it and had the mobility to empty them myself.

On Monday, my second day after surgery, was the roughest day. I think more of the aches set in at that point... but the biggest factor wasn't necessarily the pain, but the by-product/side effects of taking the pain medicine. I was very mentally cloudy, nauseous, confused, and TIRED. I ended up getting ginger cookies to help with the nausea but decided to see what it's like WITHOUT the pain medicine going forward. I think all hospitals/doctors can do a better job of this... advising to see how you can manage pain on the first few days WITHOUT pain medication. From my standpoint, its easy to underestimate what your body is actually capable of handling. In the hospital/doctor's defense, the medication does say take 'as needed.'

This was also the first day I took a shower, which did feel very nice (hot water heater fixed, by the way :)). Michael did have to help me as I couldn't move my arms too much. I was shocked I could take one so early, and was anticipating a much longer time (I'd read a lot worse from other blogs, like weeks?). I was told that I could take a shower 48 hrs after surgery, they just attached waterproof tape over the entire incision and all around where the drains entered my sides, so that too was essentially protected from the shower water. I found that it was more trouble to remove everything and I was given an extra belt, which I transferred to after the shower, to the dry belt. Both of my actual incisions were quite small. I hadn't seen them earlier yet the first few days so I was a bit apprehensive, about the length of the incision. The incision seemed to have considerable scars already healing on each side. There was also waterproof tape all around where the drains entered my sides, so that too was essentially protected protected from the shower water. I found that I did live in button down pajamas for the majority of the first week.

By day 4/5 I just took ibuprofen. Things seemed so much better after this. I wasn't as groggy or nauseous. Honestly, the pain was quite fine and at first I was just ibuprofen or of the meds but eventually prescribed twice a day (didn't need to take it. And sure enough it was OK. From a mobility standpoint I could do quite well. I got around the house fine and didn't want or need to stay in bed. Matter of fact I preferred to sleep sitting up from the beginning (but I would still like mentioned, some pillows. I also don't like to feel left out). I did need a lot more help to get in/out of bed the first few days. It was hard to reach and hard to use my abdomen to get up because I guess it also requires a lot of chest muscles too? Another bummer thing that happened is I figured out a few days in that I was allergic to the antibiotic they had me on. I did some research and found it was quite common to have this side effect to the medication, so my doctor switched me to a different antibiotic. Great, dealing with all the regular discomfort and now an itchy rash on top of it! At least I could address it now. Michael noticed bumps and something just didn't seem right. I did some research and found it was quite common to have this side effect. Great, and now an itchy rash on top of it! At least I could address it now.

I did enjoy the relaxation elements over the first few days though. Michael would sit with me and comfort me and the girls would sometimes come in and cuddle and watch movies. I actually really enjoyed it! I even had my mom come in and watch Mary Poppins for a little bit with Cora and I in bed and it was sweet. So there were some good bonding moments. I was so worried that the girls would be 'afraid' of me... sometimes kids get scared of big booboos and I had never been ill or injured but I never felt that show them that they're not twins I was surprisingly never an issue and they were always very loving and supportive. I had a strategic plan about how to talk to the kids about all of this, which I outline in Quick Tips.

Day 6 was my first official day out of the house. Again, I'd been moving quite well within the house but it was time to feel some sunshine! Michael and I went on a little day outing to Torchy's Tacos (one of our favs) and enjoyed some tacos, queso and a margarita (hey I wasn't on pain meds anymore :)) It was lovely. We still used a pillow to protect my chest but everything seemed fine and went well. I had to find quite a bulky sweater to wear to hide my drains. Michael still had to help me get in and out of the car and buckle but I could nearly reach and do most myself.

For the most part I had good energy but did take my time doing things.

I was looking forward to this day as I had follow-up appointments scheduled with the plastic surgeon's nurse, Tina (hoping to get drains out) and with Dr. Farr, the breast oncologist/surgeon. By this point, I had decent mobility in my arms, and could pretty much reach my arms all the way up. I was not regularly taking anything throughout the day at this point, and could pretty much sleep throughout the night. Sleep wasn't always great in the early days as well as not being able to move all night did cause me to wake up at least once a night and would feel pain at this point. Because of this, I would take a stronger pain pill each night just prior to bed (acetephetamine + codeine = Other brand name example) to help calm down some nightmares. Once I stopped and wasn't as groggy, I slept a bit better and without issues. I continued to not particul up until at least first week or two. It's hard to reach and hard to use my abdomen to get up because I guess it also requires a lot of chest muscles too? Another bummer thing that happened is I figured out a few days in that I was allergic to the antibiotic. I wouldn't as groggy or nauseous. I didn't take as much help to get in and out of bed (still no lifting) and again, was nearly my normal self! At 3 weeks out, I went to the gym for the first time and did the elliptical and stair climber. Both felt fine and it was nice to get some cardio going again! I had asked my doctors in advance if this was acceptable and they agreed. I also did light weights.

Plastic Surgeon Appointment: I was able to take 2 of the 4 drains out on this day. Good news, but not exactly what I was hoping for. Nurse Tina confirmed that Dr. Haddock had said all went well and that she'd been told/seen a picture of the incision prior and were all shocked at the results. (my official appointment with Haddock was on Thursday, in a few days). Having the drains pulled out was not painful, but an odd feeling. And just like with everything else, the anticipation is worse than the actual, so it wasn't as bad as I was anticipating. I still had to keep up my drain recordings and emptying twice a day for the remaining two drains for almost 2 weeks before I get these out.

Dr. Farr appointment/Breast Surgeon/Oncologist: This was a great appointment. Again, I had been looking forward to speaking with her all day, to get her perspective on the procedure. From the first time I'd met Dr. Farr I did feel a connection. I did really like her. And I think all of that led us to the path we were on. So, as soon as she walked in the room she said, "Oh my gosh, I have been so excited to see you ALL day." It was a refreshing thing to hear, actually. You automatically feel when surgeons to sometimes act like robots or to be fairly non emotional (which also isn't fair), well from a patient standpoint this is definitely. But in a good way, I found her honestly to be so refreshing.

So, I asked her how she felt about everything and how the surgery went from her perspective. She said it really did go great but that she's glad this first one's behind her! That's again a little shockingly honest to hear "I said, yea me too but gee, thanks!!" And she told me she really was quite nervous. Sometimes you forget its their first time too. She also told me she was unable to sleep the night before (ugh, that makes me one nervous, glad I didn't hear that, that morning!) Again, I flashed back to seeing her right before the surgery that morning and her distinct goggle marks on her face, so she had been preparing. She reviews with me, again, about the nature of the clinical trial. I suppose she gave me more context of the robot type and FDA approval. The goal of the clinical trial is to have approximately 70 total patients which should reach through 3-5 years and are on the review process that will be reviewed by the FDA (I hope I'm reading this correctly, but this is basically the goal!)

About 2 weeks prior to the surgery I was obsessively trying to research more about robotic mastectomies. I found a few previous US occurrences, these however were never approved by the FDA. I also found the statement by the FDA about not sanctioning these at all (released in Feb. 2019). This was a bit scary, I'll be honest, but I was already so deep into this process. Also, I knew I was on board this time, and that's what had me convinced to move forward. I had not known about the nuanced part about the multi port vs single port, so that's why some of the information was a bit shocking. Again it was amazing to hear added context of the trial and the fact that I truly was the first in a way I hadn't imagined. I'm glad in a sense that I didn't totally grasp this aspect before the surgery, but since I passed the mental hurdle I'm all set now! So weird, but feeling good and almost nervous.

I did mention I would have lightening like, shooting pains within my breasts over the past week. She said this was normal and they were phantom breast pains. She took a look at my breasts and seemed very happy with the results (as was I). I had overall good movement and minimal bruising. She did ask about sensation, and unfortunately, once again, I don't have as much as I think there'd be considering the procedure. So, almost being told looking at the appointment. We all hugged, and Michael too, and we all had a good closed loop for me (and hopefully her) and I look forward to following up with her more. I hope there's more in our future. I hope I can somehow share more with others about this trial and get the word out. This actually helps jumpstart this website as more of a start!

Dr Haddock Appointment (13 days): I had my first post-op appointment with Dr Haddock. I was anxious to hopefully get the last 2 drains out on this visit... but unfortunately, even though I tried to sell it, it was a no-go. They still weren't ready. Have I mentioned enough yet what a DRAG these are?! Two atleast are a lot easier to hide under clothing (with that belt) than 4, though. I also asked for the perspective on his experience with Melissa Dr. Farr's... well not so much. And, let me be clear, there's nothing wrong with that. I too, felt a connection with Dr. Haddock and knew he was the right plastic surgeon for me as well. But, he is far more direct, straightforward and serious. I suppose it's a nice balance. He did confirm the surgery went smoothly and was roughly 5 hours. They thought it would take longer and also anticipated more blood loss than there ended up being (which is great). I did have a sharp pain deeper in my chest behind my tissue expander. I did ask about that and they said it was likely a suture attaching the tissue expander to my chest wall and that it was normal. So it was comforting in the sense that I knew what it was. I still would have this pain from time to time over the next week or so. They suggested using the muscle relaxers to help with that, which I hadn't really been using up to that point. The final step of this appointment was to do my first tissue expansion. At surgery, I was filled to 300 cc's. I told him I wanted to be a small C, which would put me in the 420 cc range, but he pushed out on reaching 420. He felt with the expanders I would get a different level of actual implant fill and he felt even be different (like 450 ccs) to achieve the same look I would be getting from the expanders. They typically add 60 cc's to each breast with each expansion, meaning I would need a total of 2 expansions. There are a few logistics around expansion, it has to be a few weeks after surgery (which I was) and doesn't have to be too far apart and it wouldn't be too far apart because they'd want to get you through expansion to get to the 420 cc's. I would just need one final expansion to get me to the 420 cc's. I assumed with these expanders there was going to be some big crazy or ugly port somewhere. But there is not! The 'port' is located under the skin and they use a magnet to find and pinpoint it and then they simply inject saline right into each breast/tissue expander. The one benefit of no feeling in your chest is that you don't feel the huge looking needle and liquid that's about to go into your body! There is a sensation of pressure, especially towards the end as all of the liquid fills into the expander. They mentioned I would probably have some tenderness and pain over the next few days (which I did). I made my next expansion appointment (also hoping to finally have my last 2 drains removed), pre-op appointment and official surgery appointment for my second actual breast implants. One expansion down, one to go!

We had a changing of the guard at two weeks out. My parents headed back home (to Kentucky). I was sad to see them go; I was getting pretty spoiled with all the help! By this point, I really felt fairly independent to do most things. However, I still had some limitations, mainly I wasn't supposed to lift anything for 4 weeks - that's pretty limiting when you have 2 kids that are 4 and 2! So, my inlaws arrived soon after to continue to support us through the end of the month.

Day 16: I had my second nurse appointment with Dr Haddock's office. At this point, I knew my numbers were solid for the last 2 drains to be removed (less than 20 ml total over 24 hours per drain)! I also wanted to maximize my time and get my final tissue expansion (the drive is an hour away, so may as well knock it out if I could). They'd told me previously it would be OK (this would be a week apart) but up to my comfort level. I was now up to 360 cc's and expansion would put me at 420 CC's. My last expansion was a tiny bit longer on this one and it lasted a few days. Towards the end of the week I developed a similar deep, sharp pain between my armpit and breast on my right side. I assumed this was similar to the prior pain (under right breast) and caused by the expansion and things shifting around a bit. It still comes and goes over the next week or so.

I was quite active within this week and resumed some smaller chores, started taking the kids to school with help (still no lifting) and again, was nearly my normal self! At 3 weeks out, I went to the gym for the first time and did the elliptical and stair climber. Both felt fine and it was nice to get some cardio going again! I had asked my doctors in advance if this was acceptable and they agreed. I also did light weights.

2020 was a special year for Michael, too (again this is pre COVID!) It's a Leap Year and his birthday is February 29th! So, we got to celebrate his actual birthday this year. We received a very special treat from his parents and the opportunity to stay in Dallas for a night at the fancy Statler hotel. It was a much needed retreat for both of us! We enjoyed the rooftop patio, a nice dinner and dancing!

Things moved along quite well. I was done with my expansions, I had my second surgery scheduled for the implant exchange, I was able to lift my children again and exercise. All was well and life pretty much resumed to normal (well except for COVID-19, but hey - I'm only looking forward and not back.

Overall, the tissue expanders are quite an odd feeling. I told the doctor it sometimes feels like I'm not in my own body. They are very hard to the touch and just feel tight. When you push on them, I can feel the pressure from the inside but do not have sensation on my skin/outside of breast/chest area. It feels odd to hug people and sadly to hold my children. I feel like there is this big block or barrier in front of me. I'll sum up the second surgery later, but I will say it does feel a bit more 'normal' with implants. It will never be the same, but it will always be better than any alternative and something I'll just have to get used to.

I am very pleased with my breast size and look. From an expanders standpoint, they are more outright and less settled into the body so it looks a lot more 'fake' and quite risque (to put it nicely!) My doctor also assured me that the implants will have a slightly more natural look, which what I'd prefer (spoiler alert - they do). I really don't look too much better). The incision has healed very well. I really don't have anything to complain about as far as appearance/look. The stitches are/were and will continue to dissolve on their own. I'd also asked at that time about using over the counter scar cream; he told me to wait as he'd be using this same incision to insert the implants, so I will use that after the second surgery is complete (also detailed later).

I'm happy its behind me. The recovery was honestly easier than I expected both physically and emotionally. There were of course some difficult moments (mostly when I actually let my guard down and had some sad moments when I realized it won't exactly be the same), when I realize that it won't exactly be the same, but when I realized that I won't feel my chest muscles. I feel like there is loss of sensation is very odd. But that sacrifice was absolutely worth it... for me. I'm so glad that I don't have to worry anymore, I'm so glad the opportunity was given to do this more forward-looking technique that will probably made a ton of future mastectomy patients feel much better about their decision. I was happy to be a part of this. I have been so humbled all along. I'm so glad I don't have to worry about my future and the anticipation of all of it is the hardest, so the more you can learn from others hopefully the more ease you will feel.

This process does require patience. It will be the better half of the year, if not the whole year until I'm 'done' with it all. But once again, I'm only looking forward and not back.

My goal is to be a resource and a voice. I want to help others by sharing my story because I read other people's stories and it helped me so much. Even the smallest of details. Once again, the anticipation is the hardest, so the more you can learn from others hopefully the more ease you will feel.

COVID-19 sure did shake things up a bit. I was originally scheduled to have my exchange surgery 3 months after the initial surgery (June 1). I could have had it slightly sooner (actually was offered a 4 month timeline at the time of my initial surgery) but I declined that trip slot and thought the original 3 month timeframe would be great. Well due to COVID, that changed and the trip got cancelled. So, fortunately for me, I was able to move up my surgery to mid-May. Thankfully the hospital was still able to conduct this surgery! I was relieved, as it's not fun to have tissue expanders, so the sooner I could get those babies out, the better!

This surgery involved 2 elements:

• Removing my tissue expanders, that had stretched my skin to the appropriate size, and inserting an approximate 450 CC size C silicone breast implant.

• Fat grafting - liposuction of my abdomen area and using this fat to supplement tissue on top of the implant. Because there is no longer breast tissue, it is easy to see the actual breast implant (and its rippling) through the skin. This added fat helps to minimize this.

Unfortunately, the limitations are similar and I was not supposed to lift anything for another 4 weeks. I had to ask my parents to come back once again to help. They were so gracious to support once again, especially given the deteriorating environment of the nation due to COVID. This was an outpatient surgery and takes roughly 2 hours. Such a stark contrast to the previous that I felt like this was going in for a check-up. So, the big positive is that I wasn't nervous at all... after what I had already been through, this was nothing. Well, kind of :).

Well, now I feel like an old pro at this. My 3rd (and hopefully final surgery) was scheduled for October. This surgery involved 2 elements:

• Fat grafting - liposuction of my thighs area and using this fat to supplement tissue on top of the implant. After the first round there were a couple of areas of 'hollowing' in some areas (right breast chest/center and left breast) that needed additional tissue, so this is why we're even doing another round.

• Fallopian tube removal - my previous two bikini-area incisions from abdominal liposuction were used in addition to my belly button to have this removed. Fallopian tubes were also sent to pathology to ensure no signs of cancer.

This would be conducted by two different surgeons. My plastic surgeon, Dr. Haddock, as well as my obstetrician surgeon, Dr. Carlson. The decision to remove my Fallopian tubes was another step towards minimizing risks where possible. My doctors didn't quite agree on the necessity, however I felt that while I was on this journey I may as well do what I can. My breast oncologist firmly recommended it, she had sited some emerging research and baselines about the harm in doing it vs not? I tended to agree. My obstetrician oncologist said there was not yet firm research to solidify that helped, but he was happy to oblige if that's what I wanted. This was yet another outpatient surgery and took roughly 2 hours.