|Updated: March 2009
While Pregnant, Tissue Expanders and AlloDerm®
This patient was diagnosed with breast cancer during pregnancy. Her first mastectomy was completed while she was pregnant while the second was done at a later stage.
Josephine's Breast Reconstruction Story:
My journey began in January of 2006. I was lying in bed and I discovered a hard mass in my right breast. I always had lumpy breasts. During my menstrual cycle, they would feel especially hard and tender, but what I felt that night was something that I knew didn’t belong there.
Five years earlier, I had a similar experience. I felt a lump in my left breast the size of a peanut, and my fear led me to have a mammogram and ultrasound. Neither revealed any abnormalities. I was supposed to follow up every six months, but I never did.
I nudged my husband, who was already fast asleep, and I whispered, “I have a lump in my breast.” He turned around and said, “Where?” I made him feel it, and at first he didn’t say anything. After a minute or so he said, “Go to the doctor and have it checked.” I was worried, but having gone through it before, I figured it was nothing. I was a few days away from my period. I thought if it didn’t go away by the time my period was over, I’d see a doctor.
As it turned out, my period never came. On February 5th, I found out that I was pregnant. My husband and I were ecstatic. I made an appointment to see my Ob-Gyn. I was already going through morning sickness. When I saw my doctor, I told her that I had felt a lump in my breast. She examined me and gave me a prescription for an ultrasound to make sure that there was no reason for concern. One month later, I was back in her office for my second prenatal visit. She asked how I had made out with the ultrasound, but I still hadn’t gotten around to it. She strongly advised me to go and get it checked out, and told me about a former patient who waited, and ended up having breast cancer. I assured her that I would make an appointment as soon as I left.
At this point in my pregnancy, I was physically exhausted, sick, nauseated--you name it, I had it. I would come home from work and go right to bed. Who was thinking about the lump? April came and went, and so did May; then came the month that changed my life forever.
I spent the first week of June house-sitting for my parents who were spending the month in Europe with my brother. By this time, I not only felt better, but I looked better too. Everyone knew that I was pregnant, not just fat. I was glowing, my hair was gorgeous, and I looked great. My husband and I found out we were having a boy. I was planning my husband’s birthday party. Everything was great.
My husband came home from work one night and was pretty down. I asked him what was wrong, and he told me that a friend at work lost his wife to breast cancer. He looked at me and said, “You better go and get that lump checked right away. I’m not kidding! Make an appointment for this Monday.”
Monday was his birthday, I thought to myself. Friday morning I got to work and the first thing I did was look up a radiologist that was covered by my insurance. I picked randomly, and made an appointment for Monday, as I had promised my husband that I would. When I got to the radiology center, it all hit me. I was here to find out if I had cancer. I had the feeling that this wasn’t going to be good.
They called me in and set everything up. I laid back and the technician asked me a few questions. Then she examined me with the ultrasound probe. I looked up at the screen, and when I saw the lump, I immediately understood that it wasn’t a cyst. It was a weird shaped, black mass with some white dots. The technician then said that she’d be right back, and that a doctor was going to come in to examine me. When she left the room, I began to break down, holding my belly, scared for my son. Weeks before, I had begun to feel this life in me, and now so many things were going through my mind. I wasn’t going to live to see my son grow up. Maybe I was already dying and it was too late. Was my baby going to be okay? The doctor came in and I believe someone else entered the room as well. They noticed I was crying. I remember one of the ladies holding my hand. They referred me to a breast surgeon.
When I left the office, I pulled over on the side of the road and called my husband in tears. That’s when the world around us started to crumble. Everything just stopped. I was supposed to go back to work that day but I didn’t. I called one of my co-workers who already knew what was going on. I told her to relay the message to my boss that I couldn’t talk. My husband took the week off from work. The next day I was in the surgeon’s office, getting a biopsy.
On June 14th, my husband got the call with the results of the biopsy. It was cancer. I called him from work, but he didn’t want to tell me what he already knew. I said to him, “I know it’s not good, so tell me.” He said, “You have breast cancer.” After I hung up the phone, I broke down. The report read infiltrating ductal carcinoma, Stage 1b. That’s when my journey with cancer moved to the forefront of my existence. I was 32 years old, and five and a half months pregnant. My husband and I would cry together, thinking of the worst, but hoping for the best. We became so close, closer than I ever imagined. We were married less than two years. Everything was still so brand-new. We were having our first baby, how could this happen to us? We started to see life in a whole new light. We were nicer to each other, loved each other more unconditionally. Everything changed. I was nicer to people. I almost felt that now I finally knew the true meaning of when people would say life is precious. You just don’t really think about it until you are faced with the possibility that you might lose it.
Two weeks went by before I’d get to tell my parents and my brother the news. I didn’t want to tell them while they were overseas. Their reaction was utter disbelief and devastation. They suggested that maybe I was given the wrong diagnosis, and maybe somehow the results were mixed up. I had to explain to them that the results were mine, and that they were correct.
In July of 2006, I had a right mastectomy and sentinel lymph node biopsy, with my Ob-Gyn right at my side monitoring the baby. Until now, every decision I made involved the safety of my child. Now it was in God’s hands. I was not scared for me, but for my baby. I created this life, and now I had to protect it at all costs, even if it meant putting me at risk. It was hard for some people to understand that, but when you feel that baby move inside of you, your life changes forever. You become this person you never thought you’d be.
The surgery was a success. My breast surgeon performed the mastectomy, and my plastic surgeon placed a tissue expander which would be used to stretch my skin for an implant. The expansion would be done over three months. Each month, my plastic surgeon would inject me with about 50-100 cc's of saline using a pretty big syringe. The needle was inserted through a port in the expander, but I didn’t feel it at all. My skin was still numb from the surgery. I still haven’t regained all of the feeling in that area. I didn’t feel any soreness from the skin stretching, just some tightness, which is normal.
There were a lot of risks involved with my surgery because of my pregnancy. Had I not been pregnant, I would’ve opted to have both breasts removed at that time. Because of the anesthesia risk to the baby it could not be done. The margins were clean and there was no lymph node involvement; nothing short of a miracle. Recovery was hard and painful, but after the drains were removed, I felt much better.
My son was born via scheduled C-Section in September of 2006. His birth was scheduled one month early so that I could start chemotherapy. This was yet another miracle. Months earlier, there were discussions of having chemotherapy while I was still pregnant.
In late September, I began chemotherapy fresh out of the hospital with a newborn. I didn’t breast feed for obvious reasons. My mother practically lived with me for two months, taking care of my son while I went for treatments. Losing my hair from chemotherapy felt more devastating than losing my breast. My hair was my identity. Strangers used to stop me in the street to tell me my hair was beautiful. I had long dark brown curly hair, spiral curls, all natural. I asked my husband to shave my head. He said I looked great, but as the days went by, I’d look in the mirror and I couldn’t believe I was still looking at myself. I cried every day. I didn’t want to talk to anyone on the phone. I didn’t want to see anyone. I didn’t want them to see me the way I was. I felt like everyone felt sorry for me. Eventually, I realized that it was me who felt sorry for me, and that I had to do something about it.
My chemotherapy treatments continued as I was going for the expansions. In April of 2007, I had my exchange surgery. This surgery involved removing the expander and replacing it with a breast implant. My plastic surgeon did a great job and my recovery was not very hard. A few months later, I decided to have a prophylactic left mastectomy. I made this decision for two reasons; to lower my risk of cancer, and to achieve better symmetry between both of my breasts. My family stood by me with this decision.
I had the surgery on my opposite breast performed in October of 2007. My recovery was much quicker than it was after my first mastectomy. My hair has grown back slowly and I have already scheduled my next couple of surgeries. I look forward to having the exchange for the final implant on the left side, as well as the nipple reconstruction on both sides.
My breasts look better than they did before all this. I am happy again and I don’t have to wear a bra anymore. I have one more Herceptin treatment left, and then I will take Tamoxifen for five years. I am limited with my right arm because lymph nodes were removed, so I can never have blood or my blood pressure taken from that arm. I am at risk of developing lymphedema, but I am able to lift my son and I am able to carry things. I just have to be careful.
One day, I'd like to put this all behind me, but I think it will always be with me. I’m lucky to be alive today. Had I waited any longer than I did, I might not have been here to write this story. When cancer touches you, you are never the same. Some days I still can’t believe it happened to me, but now I have a healthy baby, and I'm well on my way to completing my breast reconstruction.
Josephine underwent the right mastectomy and immediate tissue expander AlloDerm® reconstruction while she was still pregnant. She later underwent exchange of the right tissue expander for a saline implant. She chose to have a saline implant rather than a gel device. After completing this second surgery, Josephine decided that she wanted to proceed with a prophylactic left mastectomy. She had her left mastectomy and tissue expander AlloDerm® reconstruction followed by an exchange of the left expander for a saline implant and nipple areola reconstruction.
To see photos of a similar reconstruction please refer to Carole's story.
Full name withheld for patient's privacy, edited by our medical board