50 Y/o Bilateral Mastectomy with Immediate Reconstruction. Des Moines, IA

I would like to share my story as well as I feel knowledge is power. I was diagnosed with microinvasive ductal carcinoma , stage 3 with a very aggressive cell type in November 2014 by a routine mamogram screening. I am a nurse who is married to a doctor and my only reason for sharing this information is that we knew nothing about breast cancer so like so many I immediately asked "Dr. Google" to educate me. I searched treatment options and weighed lumpectomies versus mastectomies. I went to google images and was horrified by the pictures of bad results. I had an appointment the surgeon the following day and printed off numerous pictures to show him what I did not want to look like. I am a 53 y/o woman, healthy, active, a non smoker, not overweight with a breast size of 34 B-C. This information is important as it directly correlated with my surgical options. I did my homework and was knowledgeable when I walked in the door. I knew with a lumpectomy, treatment involved 5 weeks of radiation, then the lumpectomy which would leave me with damaged skin for the plastic surgeon to work with and the pictures I saw looked like someone would take a melon baller and remove the cancerous cells leaving a divot that could somewhat fixed but not back to what I felt was acceptable. I also did not want radiation. I found that there was a procedure called a skin and nipple sparing mastectomy, so as I was meeting with my surgeon I asked about it. My surgeon was Dr Hamling from Unity Point Health in Des Moines, IA . When I met with him the following morning he sat with me for an hour talking about my options. I cannot say enough wonderful things about him. His compassion and bedside manner were exemplary! He took measurements and thought I would be a candidate for the nipple/skin sparing procedure but the final word would need to come from the plastic surgeon. I would like to note at this time that not all surgeons are created equal. My surgeon consulted with the plastic surgeon to have a joint plan before ever walking into the surgical suite. My plastic surgeon was Dr. Lekkas from The Iowa Clinic and I met with him later that week. I walked into the Plastic Surgeions office with my pictures prepared to tell him what I did not want! He asked me what was most important to me and of course I said getting rid of the cancer but it was also important what I looked like when it was all over. When I showed him the pictures and asked how in this day and age can women look like this....he explained the following... Due to my size and medical hx I would be a candidate for the nipple/skin sparing procedure. If I was large breasted, had damaged tissue due to radiation or been a smoker, I most likely would not have been a candidate. He informed me that some breast surgeons just want to remove the breast to get rid of the cancer not leaving the plastic surgeon much to work with and those were most likely the pictures I was seeing. Due to the coordinated care efforts of my surgical team, the plastic surgeon coordinated with the breast surgeon. Dr Lekkas works closely with the breast surgeons educating them before the first cut is made. He lets them know how he wants the initial incisions made so that he can get the best possible outcome in the end. Dr. Lekkas was a perfectionist and I knew I had the right team! I also cannot say enough about the nurses and care coordinators that were involved in my care! I opted for the double mastectomy with reconstruction. I decided to look at this like I was not just getting rid of my cancer and not have to worry in the future, but that I would have a matched pair of perky girls, a free breast job so to speak! The plan was that Dr. Hamling would start the procedure and Dr Lekkas would come in midway and place the expanders that I would need prior to my final implants. During surgery they would check my nodes and determine at that time if I would need chemo. This part scared me to death! My oncologist informed me that if I needed chemo (I was estrogen/progesterone negative, but HER2 positive) my chemo regime would be very aggressive making me gain weight and lose my hair....AWESOME! This would be my worst nightmare. When I awoke from anesthesia, the first thing I felt for was a port for chemo. I was relieved to not find one, I then had to check out what I looked like. I have to say I was surprised to find it was not so bad. The girls were small with a distorted shape, but not bad. A week or so later, I received the final news that the cancer had not spread! My nodes were clear. I wept with relief! I went through several fills of my expanders. I did not want to be bigger than I was...the expanders were uncomfortable and felt like rocks in my chest. Im not going to lie, they were uncomfortable, but tolerable. I could not wait for the permanent implants. The end of January 2015, I got my permanent implants, 455cc and I am a full C cup. I have to say the step children look pretty good. I will have fat transfer done in the fall to soften some of the edges of the implant. Since there is no breast tissue , the implant is behind the pec muscle and when I raise my arms or do a pushing motion I can see the ripples of the implant. I am now 3 months post op and I still get twinges on the left side of my breast where they had to take some of the pec muscle to get clear margins. I also still need muscle relaxants to stop the tightening or spasms I get when I over do it. I can best describe that sensation as having full painful breasts during your period or very full breasts when you are nursing. I am a bit frustrated that as I do more I am very sore. I haven't quite figured out my new normal yet and hope that in time I can get my golf game back and do my normal activities without discomfort. Simple movements like opening a jar will flair the spasms. ( I think its the pushing movement that involves the pec muscle). I know this is a long comment, but some of the things I have experienced I did not see talked about. It doesn't change anything, but its nice to know.... I know I am very blessed and lucky and that my outcome could have looked very different if early detection and treatment was not done. I had the best care I could have hoped for and was very impressed the the coordinated care I received from Unity Point Health. I hope this information will help someone else who is on this journey!