Must Be Cold Out. I Can See Your Nipples.
As in plural. Nipples with an “s”.
Yesterday the was final stage of my breast reconstruction surgery, nipple creation, and I got to witness it live! Well, I couldn’t see anything, but I did get to hear, feel and, (yipes!) smell everything.
When I arrived, everyone was very excited to see us. We were actually a little early for our official arrival time, but my surgeon was running ahead of schedule, so as soon as I signed the release form, I had my vitals taken and her PA was performing the nipple placement. No lines. No waiting!
Nipple creation, or nipple reconstruction, is exactly what it sounds like. The plastic surgeon creates a nubbin of tissue to approximate the look of a human nipple where the original has been removed due to disease. There are a few different techniques out there – some very complicated involving areola creation and skin grafts – but the method my surgeon uses is more like origami.
But first, let’s talk about nipple placement. There is a kind of golden ratio when it comes to the breasts. Ideally, nipples are equidistant from the clavicle, level with each other, aligned perpendicularly with the center of the clavicle, and positioned just above the point where the breast mound starts to slope down. Imagine an isosceles triangle on your chest.
That’s ideally anyway. Most natural breasts are close to this but depending on overall size and “droop”, the nipples might be further out from center or fall below the crest. Still, usually the overall symmetry usually stays in tact.
Between the reconstruction on the left and the mastopexy on the right, my two breast mounds have different slopes, so applying the nipple placement rules mathematically made the two nipples visually look a little off. After measuring multiple times and not liking the result, my surgeon’s PA basically eyeballed it, then I confirmed her work in a mirror. She used one of those sticky electrodes they use for monitoring to help with placement.
Plastic surgery really is an art as much as a science.
Once I was measured up, I put on a hairnet and non-slip socks. I had a johnny on but I got to keep my pants. Then I said goodbye to my hubby, gave him my glasses and my coat and walked down to the operating room lead by a nurse. Walking into an OR is a lot different from being wheeled in on a gurney all hopped up on wacky sauce. The room is really big, at least compared to the ones they show on TV. I assume this is to accommodate all of the doctors trying to keep you alive while the surgeons work on your insides. My surgery was minor so I only had four people working on me – my surgeon and her PA, one nurse to check on me and one nurse to manage the tools. The room seemed pretty empty.
The surgery I had is often performed in a doctor’s office, not an OR. I think my surgeon just had the room that morning for something more major and decided to tack me on at the end. Hence everyone’s anxiousness to get the show on the road.
I hopped up on the operating table and everyone introduced themselves to me. My surgeon checked the nipple placement, agreed that it looked perfect and then they put a blood pressure cuff and pulse monitor on me, put on some music, and started draping me. First they wrapped me in blankets, then blue disposable paper-cloth drapes. Every part of me was draped except for the breast being worked on, including my face which they made into a little tent over my head. It made a little shadow puppet show out of the surgery.
They cleaned the field with betadine (or some other brownish cleaning liquid) while they were doing the draping. Boy did that feel bizarre.
During mastectomy, I lost sensation in most of that area but when they did the DIEP Flap reconstruction, I ended up getting some sensations back. Not just the brain compensation my surgeon described, or at the borders of the mastectomy, but actual sensations across the breast. They feel weird though, not normal. There is one spot where if I touch it, I’ll feel the sensation shooting across the opposite side of the breast.
Anyway, this loss of sensation usually means no need for novocaine. Not me, of course. So the surgeon had to spend a few minutes poking me, asking me if I felt pain, and numbing up the responsive areas so that I could only feel pressure. Once I was numbed up, the actual cutting took like two minutes. The reconstruction technique she uses is a C-V Flap, which involves cutting out a shape of flesh – long arms and a round cap that can then be folded up into a nipple:
Once the stencil was cut, then came the cauterizing. Blecch.
Cauterizing a wound basically burns the edges to close the capillaries. They warned me that the machine was noisy and smelled bad and they were right. It sounded kind of like an airbrush when it was on, but instead of having a compressor clicking on and off, each “trigger” was preceded by a buzzing tone somewhere to my right. Each time the thing went on, little swirls of nasty smelling smoke crept around the blue shroud. Combined with the pulse monitor beeping behind me, and REO Speedwagon’s “I Can’t Stop This Feeling” hukka chakka-ing out of the overhead speakers, it was a disconcerting symphony of sounds and smells.
All the while, my surgeon and her PA were talking about television shows like they were just hanging out, having coffee.
Once that was done, came the suturing, which played out as a strange shadow play of arms and elbows across the field of blue in front of my face. At one point I thought someone was going to clock me in the face. There was also a lot of pushing and tugging. Nipple surgery is not as delicate as one might imagine.
During this stage of the surgery, the two nurses started talking about a problem they had in an earlier surgery with what I am guessing was an obese patient who was too big to fit in the stirrups on the operating table. I started to try to figure out more about what they meant and then I decided it was best to just zone out to the oldies.
Once the tugging and pulling ceased, they surgeons started unwrapping me while a nurse talked me through the post-op instructions. They turned out to be really wrong. They were written for someone under anesthesia and presumably someone who still has full sensation in her breast. As the nurse read them off, the plastic PA had to correct her so many times that at one point the surgeon and PA debated whether to run back to their office to get a better one. But we were all ready to go home and the problem was that there were simply too many restrictions on the sheet, so in the end they just crossed out everything that didn’t apply. Which was almost everything. I believe the only things left on my sheet were 1) Wear loose clothing, 2) Do not take ibuprofen or aspirin, and 3) Come in for a followup next Wednesday. I think I can handle that.
After that business was resolved, they asked me if I wanted to see it first before they bandaged it up. I declined. I had been warned that they make the new nipples extra large because they usually shrink quite a lot during healing. What’s the point in seeing a bloody wound if won’t look anything like the finished product anyway?
Finally, they patched me up with enough Tegaderm to waterproof a small boat so I can shower normally (Hallelujah!) and sent me on my way.
So, the big reveal will be next week. See you then!
One 30-something's candid account of her Stage II breast cancer treatment, featuring detailed descriptions of gross medical stuff and her neverending search for acceptable accessories.
Currently: Off-treatment and on hormone therapy
The world is a scary place. If you can't find the happy, you'll never survive.
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