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Knowledge is Power

Updated: Oct 3, 2021

Or so I keep telling myself.

Hewitt Genes

So this man Alan Harrison Hewitt (my grandpa) was the carrier of the gene. (we don't know if he got it from his mom or dad cause neither got cancer and they had both passed away before he even became an adult, and he passed away at 65 suddenly on a Cruise in Grease) I'll add a family tree later so if you happen to be part of my family tree you can go to your doctor and tell them to test you for PALB2 c.2052del

ScrewUCancer - is a mini series, about a lady in her 20's who has lost many family members to cancer, and who finds out she has the BRCA gene mutation and does preventative mastectomy. The mini-series is wonderful, albeit terrifying. Only terrifying because I don't have my mommy to nurse me back to health like she did following both my c-sections. I KNOW I'll be alright and my husband and friends and even kids will try to be helpful, but there's nothing as helpful as mom staying with you, and forcing you to do your exercises, eat, sleep take pills on-time. All while doing all your regular chores and loving the crap out of your kids. She's the only person I don't feel I'd be burdening with this. So now, on to burden some peeps. Gosh friends, you're so lucky to have me. Bahhh haa. I totally want the shirt she is wearing as a tee or even tee-shirt dress or tank top but I can't find it anywhere.

So random things I've found out this week (some in the book, some random places).

Your body makes extra fluid cause it's used to supplying your breasts with fluid, and that's why you need drains after surgery. Also the drains don't hurt cause there's no feeling in your boobs.

Expanders are tight and uncomfortable, and the purpose is to stretch your pectoral muscle away from the bone so that they can put the implant under the peck muscle so there isn't just a thin layer of skin on top of implant.

I wont be able to shower, like forever (2 weeks) and should get dry shampoo, body spray, and a billion baby wipes, and light a lot of candles.

Also I need to clean the drains and it's like milking a cow.

So I just wanted a one and done surgery but apparently several factors determine whether a patient is a good candidate, or even eligible for a direct-to-implant breast reconstruction:

  • Patient must be willing to have reconstructed breasts be the same size, or often smaller than the original breast size (yep me)

  • There must be enough remaining breast skin following mastectomy relative to the desired volume of the breast reconstruction. Often, this limits eligible patients to those able to undergo a nipple-areola sparing-,

nipple sparing-,( I won't be nipple sparing cause my nipples have breast tissue and it still leaves like 4% chance controversy remains over whether or not the procedure is appropriate for women with mutations, who can have a breast cancer risk of 50 to 60 percent by age 70 and up to 80 percent over a lifetime) or skin-sparing mastectomy (pictured here)

  • The remaining breast skin must be healthy. (I think mine is) Patients with underlying medical conditions like lupus or diabetes or who smoke cigarettes or use other recreational drugs are more predisposed to wound healing problems and are rarely candidates for direct-to-implant breast reconstruction.

  • Absence of previous radiation. (I didn't have any radiation) Previous radiation, for example in patients who had a lumpectomy and radiation, developed a recurrent breast cancer and now require mastectomy are not usually good candidates for a direct-to-implant breast reconstruction due to concerns over tissue quality and wound healing problems.

  • Use of acellular dermal matrix. The supportive components of the breast tissue are removed following a mastectomy. In order to support, pad, and control the position and shape of a breast implant placed at the time of a mastectomy a material known as an acellular dermal matrix is used. The use of alloderm, (AlloDerm tissue is sewn to the chest muscle to provide a hammock-like support for the implant. The AlloDerm tissue is essentially making the chest-muscle space larger, allowing a permanent full-sized breast implant to be inserted without having to use a tissue expander)

OMG I feel like I'm studying for exams, and lets be honest, I never want to write another exam. I'm so over school, is this the universes way to tell me to keep learning? Exhausted, between all the house cleaning, and grief and learning, and covid burn out. I think I would be happy just finding an empty patient bed and sleeping all day at work, unfortunately I think i'd likely get fired, but my house is basically spotless for the first time in 9 years. (maybe my family should leave once a year just so I can spend a week cleaning)

So Coles notes here. You can go direct to implant if you go ontop of the muscle, or if you're explanting an old implant, or if you use AlloDerm. Also Saline feels more firm than silicone. Textured leave more room for problems (but also if you get a tear dropped shape, textured keeps it from flipping or turning)

Subpectoral - means under the muscle

Part of the chest muscle is usually cut or divided so the implant can be placed under it. The surgeon may sew a material called acellular dermal matrix (a soft tissue substitute made from human or animal skin) to the tissue at the bottom of the breast to create a pocket that helps hold the lower half of the implant in place.

Advantages of subpectoral implant placement include:

  • lower risk of implant rippling or wrinkling; the chest muscle on top of the implant can help prevent the outlines of the implant from being visible through the skin

  • capsular contracture may be less likely to occur

  • the skin is better protected while it’s healing

Disadvantages of subpectoral implant placement include:

  • possibly more discomfort during recovery from the surgery and, in some cases, chronic pain, tightness, and weakness (because the chest muscle was cut and/or divided during the procedure)

  • higher risk of dynamic distortion (or animation deformity), which makes the breasts move in unnatural looking ways when you flex your chest muscle (flex my chest muscle...yah I don't plan on caring if it looks weird when I flex, but you do you, boo)

Prepectoral (also called over-the-muscle) implant placement means the breast implant is placed directly under the skin, on top of the chest muscle. The implant isn’t covered by as much soft tissue as it would be if placed under the chest muscle. The surgeon may wrap the implants in acellular dermal matrix material and sew the material to the surrounding tissue. This helps provide support for the implants, helps keep them in place, and makes them less visible through the skin.

Advantages of prepectoral implant placement include:

  • less pain, tightness, and weakness during and after recovery

  • lower risk of animation deformity or dynamic distortion - not a selling point for me... I don't plan on flexing much.

Disadvantages of prepectoral implant placement include:

  • a potential risk of implant rippling and wrinkling showing through the skin if the implant is not covered by enough soft tissue

  • a slightly higher risk of developing an infection around the implant compared to subpectoral placement

  • a possible risk that the implant shifts out of the correct position over time, if your breast skin is thin ... um no thanks

Mirena birth control is linked to breast cancer but don't worry... just a bit (WTF) The package insert for Mirena states that if you have or have had breast cancer, or even suspect you might, you should not use hormonal contraception.

It also acknowledges “spontaneous reports of breast cancer,” but says there’s not enough data to establish a link between Mirena and breast cancer. That said if you're just one of my friends or family reading this and don't have a history of breast cancer that same study found a lower-than-expected incidence of these cancers:

  • endometrial

  • ovarian

  • pancreatic

  • lung

So it's great to not worry about getting pregnant, (I do know 2 people with IUD babies, so I mean it doesn't always protect against babies) and I'm loving not having a period these last 3 years, but also I have one friend who expelled hers by accident, one with it imbedded, and another waiting at emerg cause her's BROKE inside her and she's in tremendous pain. Mine will be coming out, but I'm just gonna wait till summer is over, one last period free summer pre menopause.

Also learned that the cancer that killed my mom (Triple Negative) usually affects, people who are

  • Are African-American or Latina

  • Are under 40

  • Have what your doctor will call a BRCA mutation, especially the gene BRCA1

To Summarize.

I am still waiting on an MRI appt, however my family doctor has referred me over to Guelph General Hospital with that. Once I get a date, I will call them and let them know that, Hey I'm across the street from the Hospital so call me anytime someone doesn't show up for an MRI and I'm your person.

I am still waiting on my consult with the plastic surgeon to find out what he recommends. He being Dr.Avram

This is one of his patients. Prior to surgery and 7 days after.

Breast Augmentation with Round, Smooth-Walled, Moderate plus Profile Silicone Implants; Right -370cc & Left 350cc

This is what I want. Make me look like this, look up your surgical notes dr.A and put me in. One question though where are her drains? Do you have drains if you don't cut your knockers off?

That said on Dr.Avram's website it says there's an extensive wait list and patients on the waitlist for a two stage Breast Reconstruction (expanders to implant) could wait 2 years just for an appointment. So that's disappointing. But if that's the case I guess I have a LONG time to do my research, stay tuned.

Mom, Aunty Mena, Aunty Julie

So anyway, step one.

MRI appt.

Miss you mom.

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