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Updated: April 2008

Bilateral Tissue Expanders and AlloDerm®

Photo of Michelle's Procedure
Photo of Michelle's Procedure
Before
After

This patient required mastectomies for the treatment of bilateral breast cancer. She is seen here before and after her bilateral mastectomies and staged breast reconstruction. The reconstruction was completed with tissue expanders and AlloDerm® followed later by expander exchange for silicone gel implants.

Michelle's Breast Reconstruction Story:

 

I woke up around six that morning to get the twins out of bed and feed them their bottles. They were just two months old and starting to smile, or pass gas. I am not sure, but they seemed to do it while looking at me, so I preferred to think of it as a morning smile for their mom. We had tried for years to have a baby, with more medical help than I care to remember. Each pregnancy resulted in an early miscarriage. Finally, my doctors began to suggest using a gestational surrogate to carry our biological child. This is what we ultimately did. We found an amazing woman that allowed herself to be implanted with our embryos. She carried our twins full term, giving us the most amazing gift imaginable.

I changed their diapers, played with them for a bit, and then put them back to bed for a morning nap. Once they were asleep, I went into the bathroom to take a shower. In the shower, my hand brushed across my right breast and I felt a hard knot just below the skin. After the shower I felt it some more. What the hell is this? How do I all of a sudden feel this knot, when yesterday I noticed nothing? I went into the bedroom where my husband was still asleep, woke him and asked him to feel the spot. He looked at me and his eyes said, “yup, I feel it too.”

We called my doctor’s office as soon as they opened, and the receptionist fit me in that very same day. My husband went with me to my internist, who recommended I have a mammogram immediately. So many questions filled my mind. I could not believe this was happening to me. My babies were two months old.

I went for a mammogram later that afternoon. Once inside the radiologist’s office, my mood worsened. The technician performing the mammogram did not even glance at me. I was led to a separate waiting area, and one by one the other patients were being told that everything looked great, and that they can come back next year. I was by far the youngest woman in the room, and at 34, I had never had a mammogram, and didn't know what to expect. I sat, and I sat. Twice, the technician called my name, and my hopes of getting the all clear were dashed, with the words, "We just need to get another angle."

The technician came out and said the radiologist wanted to do a sonogram. He rolled the probe from side to side on my right breast, always slowing down as he came to the knot. After the scan he sat me up, and said, "You need to see a breast surgeon. This concerns me, as I’m sure you know." I walked back into the waiting room where my husband and father-in-law were sitting. By now the rest of the office was empty; the receptionists and other patients had all gone home.

The next few days were a blur. I went from one appointment to the next. As surreal as it was, the scans and pathology reports told the same story. I was most likely facing invasive carcinoma in the right breast, and DCIS in the left. Thirty-four years old, no family history, twins at home, and now bilateral breast cancer. The doctors were all in agreement; I needed bilateral mastectomies, followed by chemotherapy and possibly radiation.

I remember the breast surgeon explaining to me that women today could have breast reconstruction right away, as part of the mastectomy surgery. This way, I would awake from the surgery with breast mounds, rather than being completely flat. My surgeon felt that this was psychologically very important, as did I. After all, I had great boobs, with a shapely 34D to be exact. On my small frame, they provided a nice little curve. He explained that I could get temporary breast implants that would later be replaced with more permanent implants. He suggested that I see a plastic surgeon.

I was overwhelmed by the PowerPoint presentation the plastic surgeon showed me. These were not pictures of women with fun implants like I saw in tabloid magazines. These were women with reconstructed breasts, in various stages of healing; some after radiation, others with just one breast done. There were also pictures of women with large scars across their breasts. Things were moving too fast. I felt like I was on a dizzying roller coaster, and I desperately needed to get off.

I proceeded to make some appointments for second opinions. All the while, members of my family bit their tongues. After all, I had cancer. You don’t take your time when you have cancer, you get it out of your body as soon as possible. But I needed time. This was my body, and I was young and attractive. This just wasn't fair. After all, I had already needed a surrogate to carry my children. That was my thing! Infertility was supposed to be my one thing to overcome in life. Now breast cancer! What kind of a women was I? Such a lemon, I joked later. I looked like a good package on the outside, but inside; such a sour mess. Nearly a year later, my friend said to me, “You’ve made such sparking lemonade”, and I cried with pride for my journey.

After getting second opinions, I returned to the original plastic surgeon. My gut told me that I could trust him. Because of my small frame, he suggested using tissue expanders, then exchanging them for saline or silicone gel implants after chemotherapy was completed. The mastectomy and subsequent pathology revealed invasive ductal carcinoma in the right breast with two positive lymph nodes and ductal carcinoma-in-situ in the left. I was HER2-negative and progesterone receptor as well as estrogen receptor positive. Later I would also learn that I was BRCA gene negative.

I awoke from the surgery with small mounds where my breasts once were. They were hidden under gauze and a surgical compression vest. I had known that I would have drains exiting my body to help with healing, but I really wasn’t prepared for the actual sight of them protruding from my body. Clear plastic tubing with a clear bulb on the end emanated from under each pseudo-breast and under each arm pit. It all seemed rather antiquated and crude. However, it soon became evident that they were quite necessary as they quickly filled with fluid and had to be drained and measured to help determine how healing was progressing. I had one drain removed from each side after two weeks, and the remaining drains removed about one week later.

A few weeks after surgery, I went for my first fill up of saline into the breast tissue expanders. There was a small port under the skin, on the top of each expander. My plastic surgeon found each port using a magnet to pinpoint its exact location. Using a syringe filled with saline, he injected directly into each expander. Every two to three weeks I went to be expanded. I usually went the day before chemotherapy, as this was when my resistance to infection was at its best. I was surprised by how little the expansion process hurt. I took Tylenol once or twice to ease the pressure, but I was not able to feel the actual syringe at all.

After chemotherapy ended, we scheduled my implant exchange surgery. I had been expanded to just slightly smaller than my natural size had been, and we decided to use cohesive silicone gel implants. The surgery took less than two hours, and I went home that same day. I took narcotic pain pills for about four days, then Tylenol on occasion after that. I was frustrated with the swelling and pain under my right arm, where I had 29 lymph nodes removed during the mastectomy. Although I had regressed a lot in range of motion, my physical therapist's recommendation of gentle stretching exercises and massage helped me to improve over time.

About eight weeks after my expander implant exchange, I started to feel better about my implants with every passing day. When I turn my body in certain positions, I can see the implants ripple a bit beneath my skin, but this will be fixed during the next stage of my reconstruction, when I have my nipples done. My plastic surgeon will take skin from my abdomen, where I have a scar from a previous surgery, and graft it onto my breasts to help create nipples and areolas. Then all I will have left is tattooing my nipples to give them color and my reconstruction will be finished.

Early in my diagnosis I remember thinking, "Why me?" and "How can I be so unlucky?" Amazingly, when I look back now, I realize just how lucky I am that my experience thus far has been so positive. My family has been incredibly supportive; more than words can adequately express. My chemotherapy treatments were more tolerable than I had expected. My reconstruction is going well, and I know that I will be pleased with the final results. Although I would never have wished for an experience like this, I know that at the end of this journey, I will emerge a stronger more confident woman.

 

Photos and Doctor Commentary

 

Photo of Michelle's Procedure  Photo of Michelle's Procedure

Pre-operative

After bilateral mastectomies and expander AlloDerm® reconstruction

Michelle is seen before and after bilateral mastectomies and expander AlloDerm® reconstruction.

 

Photo of Michelle's Procedure  Photo of Michelle's Procedure

Pre-operative markings for bilateral expander implant exchange

After bilateral expander implant exchange

Before her expander implant exchange, markings were made on her inner breasts to allow positioning of the implants more closely together. An improvement in breast contour is seen after expander removal and placement of cohesive gel implants.

 

Photo of Michelle's Procedure

Pre-operative markings for bilateral nipple areola reconstruction

After healing from her expander implant exchange, Michelle underwent nipple areola reconstruction. Pre-operative markings were made with Michelle standing upright to properly locate her nipple areola position bilaterally.

 

Photo of Michelle's Procedure
Final breast reconstruction

Michelle is seen here one year after her bilateral tissue expander breast implant exchange and eight months following nipple areola reconstruction.