Prevention & Recovery

How to cope when you need a mastectomy

How to cope when you need a mastectomy

Author: Canadian Living

Prevention & Recovery

How to cope when you need a mastectomy

Originally titled "My personal best," from the October 2007 issue of Canadian Living Magazine, on newsstands or click here to purchase online.

Years ago, I became the first news camerawoman in Canada, shooting for CBC National and CTV’s national news. As a woman in a male-dominated industry, I drew a lot of media attention. I was even asked to model for Playboy magazine (which I turned down, though I was a Sunshine Girl for the Toronto Sun).

I’ve always worked out and done bust-firming exercises to maintain my shape. Today, as a businesswoman in my 50s (I co-own a Toronto-based video production and satellite transmission company with my husband, Lawrence Partington), I continue to wear clothes that show off my figure.

But when I received a cancer diagnosis and was faced with the prospect of a mastectomy, I was so shocked to hear I had widespread and life-threatening cancer that I didn’t focus on the loss of my right breast. At least, not at first.

The start of it all
My ordeal began in January 2002, when I found a large lump during my monthly breast exam. A re-evaluation of my old mammograms and a subsequent needle biopsy in my doctor’s office confirmed that I had cancer with multiple sites throughout the breast. Because the cancer was widespread, I needed a mastectomy, which was scheduled in two weeks.

Getting a cancer diagnosis is shocking for anyone but perhaps even more so for me given my family history. On both my parents’ sides, I come from 10 generations of Nova Scotians, most of whom lived well into old age. I remember thinking, Maybe I’m not going to live to be old after all.

Fighting for my life

At the time I was so focused on getting rid of the cancer that I just couldn’t think of anything else. When I met with the surgeon, I was not aware that reconstruction could be done at the same time as removing the cancer, and he didn’t bring up the subject, either. We were both just fighting for my life.

At home, Lawrence worried, too. We’ve been married 22 years and have a son, PJ, 21, and a daughter, Joy, 10. We were scared that the cancer had been caught too late. Losing the breast didn’t seem that devastating.

Page 1 of 4A change of heart
But that soon changed. On the Friday before my surgery, I went to my Pilates class and told a friend there about my diagnosis. She asked me if I’d thought about reconstructive surgery. When she said that someone she knew had had it done right on the operating table after a mastectomy, I was thrilled. I guess I was more upset about losing my breast than I realized.

When I got home, I immediately called my surgeon and asked him. “Yes,” he said, “we could do that.” It meant he would need to find a plastic surgeon available at the same time and book the operating room for a longer period. Soon I had a consultation appointment at Toronto East General Hospital with Dr. Laura Tate, the chief of surgery and a plastic and reconstructive surgeon, who is also assistant professor at the University of Toronto’s department of surgery.

A supportive husband
I know some people wonder why I would go through more surgery just to reconstruct a breast. You can’t always analyze why you make certain decisions but I think you have to go with your gut. I just knew it was important for me to save my breast and continue to look the way I always do.

Lawrence made it clear that it was my decision. We were both rather accepting of the possibility that I might “go pirate” – flat on one side, breast on the other. He said he would go along with whatever I decided, and he came with me to my appointments so he could understand all the options.

Decisions to make

When I went to see Tate, she said I had two decisions to make. I could have reconstruction immediately after the mastectomy or at some point in the future. Also, I could have either a new breast formed using tissue taken from somewhere else in my body, such as the abdomen or buttocks, or I could have a two-stage procedure, in which a tissue expander would be inserted during the initial surgery that would stretch the skin over the area where my right breast had been. Then after several weeks of expansion, a permanent saline or cohesive gel prosthesis would replace the expander.

My surgery was approaching fast; I had only two days to decide. I knew I wanted immediate reconstruction but wasn’t sure which kind. I tried writing out all the pros and cons, which were as follows.
• Using my own tissue: This meant two surgery sites, a longer recovery period and abdominal numbness and tightness.
• The tissue expander: With this option there is a chance of rejection or leakage, or needing a replacement later on.

In the end, I decided on the first option, with tissue taken from my abdomen. I just felt my body would accept my own tissue better.

I felt like myself again

I was so happy to wake up after the six-hour surgery and still have a breast. And I think having the reconstruction made facing chemotherapy easier. You lose your hair, you feel weak and nauseous, but at least you have your breast.

I was happy with the way the breast healed, too. It matched the other side and except for some hard tissue inside, felt soft to the touch. My clothes fit the same as before; I can still wear a low-cut top. Once I got through chemo, I felt like myself again.

Page 2 of 4Another devastating discovery
I had five years without cancer and then, in the fall of last year, a routine mammogram found new cancer in my left breast. Because of my history of multiple cancer sites, I opted to have a second mastectomy.

I could have had a lumpectomy (surgery to remove only the part of the breast containing the tumour and some normal surrounding tissue), but I would then have faced years of mammograms every six months, MRIs and probably more lumpectomies.

Again, I was devastated, and again, I had to make a fast choice about reconstruction. This time, Tate felt that since I couldn’t have another reconstruction using tissue from my abdomen, a tissue expander followed by a gel prosthesis was the best option. It required weekly injections through the skin into a metal port that was incorporated into the tissue expander.

Another procedure
I wasn’t prepared for the amount of pain the port generated, especially at night, and I’m glad that part is over. (A permanent gel pouch was implanted after removal of the dreaded tissue expander.)

We decided to enlarge the breast only to fill a B cup (I had been a C) as it involved a shorter expansion period. Then I had liposuction on the other breast to make them the same size. I actually like the smaller size; frankly, I was getting tired of my blouses gaping. And I feel just as attractive with slightly smaller breasts.

I’m really happy with this second new breast. It looks natural. Once it “settles,” I’ll have nipples and areolas tattooed on both breasts – I never got around to it the first time. That’s just as well, because now it will be easier to make the two symmetrical. I could have reconstructed nipples but that would require another general anesthetic. Going under anesthetic is hard on the body, so I think it should only be used when medically necessary.

Page 3 of 4Knowing your options
I’m telling my story now so that other women will think about what they would want in similar circumstances. When you get a breast cancer diagnosis, you have to make decisions very quickly. I think it’s worth thinking ahead and making yourself aware of your options. As for me, I decided that if I had a chance not to lose part of myself, then I’d seize that chance.

The night before my first mastectomy, I put on a red lace teddy and Lawrence took some pictures of me as a kind of goodbye to my right breast. I’m happy to say I can – and do – still wear that teddy.

Breast reconstruction: A personal choice
When Carol Patterson was first diagnosed with breast cancer, back in 2002, breast reconstruction wasn’t always discussed.

Today, though, a woman diagnosed with breast cancer who receives a recommendation for mastectomy is given an opportunity to discuss reconstruction. Depending on the province, a plastic surgeon is now part of the multidisciplinary team that includes her general surgeon and oncologist.

This change in approach ensures that a woman facing the imminent loss of a breast can make an informed choice about what steps, if any, she wants taken to replace that breast, says Dr. Laura Tate, a plastic surgeon and chief of surgery at Toronto East General Hospital, who performed both of Carol’s breast reconstructions.

A difficult decision

Breast reconstruction is a personal decision, she says. Some women are overwhelmed by the cancer diagnosis and don’t want to make any immediate decision about reconstruction. Some might just want the information on reconstruction to consider at a later date.

Others want to exercise the option of immediate reconstruction, although they may have different goals. Some, for example, want only breast “mounds” without nipples just to be able to fill their bra and be able to lean forward without a prosthetic popping out. Others want fully reconstructed breasts, complete with nipples.

Breast reconstruction is a very complex process that requires considerable skill and experience. Tate considers it one of the best examples of true plastic surgery. She says it’s very gratifying to achieve an esthetically pleasing symmetrical result. “A woman gets her body image back and feels like a whole person again.”

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Prevention & Recovery

How to cope when you need a mastectomy