8/23/19: Double Mastectomy (DMX) Surgery

Here's a recap of my surgery experience. All the gory details!

First off, I feel fine! The pain is much less than I anticipated, so I am grateful for that. I assume there are lots of factors that are making my recovery easier than what I had expected as the worst case scenario. I did not have reconstruction (immediate reconstruction entails additional surgery); I did not have chemotherapy prior to surgery; I don't smoke (smoking ages skin prematurely, which can make for more difficult recovery); and I'm well below the median age of breast cancer patients (62), so maybe I have fewer health issues in general.

The night before surgery, my nerves got the better of me. I was up around 2:30 AM, and couldn't fall back asleep. I took my shower with Hibiclens, took 2 Tylenol before leaving the house as instructed, and we arrived at the hospital at 6:30 AM as scheduled.

I have to say, I really feel I got high quality care at the hospital. Everyone was competent and compassionate.

Ken came in with me to the pre-op area. I gave a urine sample. A pre-op nurse took my vitals and asked me lots of questions. Two anesthesiologists came by, and one put an IV into the back of my left hand for the general anesthesia. The IV in my hand felt kind of weird, it took getting used to.

Throughout the process, I was asked multiple times to confirm my name and the procedure I would be undergoing, in my own words. It turns out, it was not enough to say, "double/bilateral mastectomy"; it was important that I also state "bilateral sentinel lymph node biopsy".

I changed into a hospital gown, and they took me in a wheelchair down to the Breast Center for my nuclear medicine appointment. Ken stayed behind because much of the Breast Center is a women-only area. I met with a nuclear medicine person and a radiologist. I'm pretty sure the radiologist was the one who performed my first ultrasound, but she showed no signs of recognizing me. The two of them together decided where to inject me with the blue radioactive dye that would show the path from my breasts to the sentinel lymph nodes, which would be removed for biopsy. I got 6 injections in each breast. That's 12 injections total! Ouch. 4 injections on each side went into the breast tissue. The remaining 2 on each side were subcutaneous, and hurt a bit more.

I was brought back to the pre-op area. We met with the breast surgeon, and I really have to say, he just filled me with confidence with his calm, professional, and reassuring demeanor. I confirmed with him one last time that I was sure I did not want reconstruction, I wanted to be flat, with no excess skin; I wanted non-skin-sparing surgery.

The anesthesiologists came back around and gave me two injections in my back for a nerve block (regional anesthesia) that would numb my whole chest area.

Then it was time.

I said goodbye to Ken, and teared up. One of the nurses pushing my hospital bed talked to me with calm, compassionate, and reassuring words. I stared up at the hospital ceiling, holding back the tears, while they pushed me around corners and down halls to the operating room. I was moved onto the operating table, and they must have administered the general anesthesia via the IV around that time. I remember counting 5 people busily working around me, and that's it.

The next thing I knew, I was waking up, and it was done.

I went into surgery at 9:45 AM as scheduled. I'm told I came out at 1:10 PM, so that's just about 3 1/2 hours in surgery. I woke up around 1:30 PM. They called Ken to come to the post-op area.

The nurse told me the breast surgeon was "really happy" with the results. The breast surgeon came by and said everything had gone smoothly. I think I was still pretty out of it.

The post-op nurse talked to me about pain management, and she used the words "tolerable pain". I appreciated her perspective, because I was apprehensive about taking addictive narcotics. She said we could start with the lowest possible doses and ramp up only if necessary. She did recommend that I take oxycodone when the block anesthesia was expected to wear off, which would happen in about 8-10 hours after it was administered.

I really had to pee, so two nurses helped me up and walked me to the restroom. My post-op nurse warned me that because of the blue dye, my pee would be green! And so it was. I made a mental note to tell my son, who I knew would get a kick out of that.

I was moved to my room around 2:45 PM. They put leg compression wraps on both my calves to help prevent blood clots. The wraps automatically compressed each leg alternatingly. It felt great, like I was getting a constant leg massage. (I would periodically take them off when my legs felt too warm.)

Any time a nurse took my vitals, the blood pressure cuff was placed around my leg calf instead of my arm. I think this was to prevent lymphedema (swelling in the arms) after lymph node removal. I will need to ask the surgeon during my follow-up visit if I will always need to have blood pressure measured from my leg, or can it be measured in my arm after I'm fully healed?

At 6:00 PM I took 5 mg of oxycodone. The nurses regularly gave me 1000 mg of Tylenol on schedule, every 8 hours. I also got antibiotics via the IV, a shot in the belly of blood thinner (also to help prevent blood clots), and Colace and Senna to help with bowel movement.

Ken went home in the late afternoon to pick up the kids and bring them to the hospital. They visited for about an hour, and then Ken brought them back home. He had dinner with them, and then the kids stayed home with Ken's mom while Ken came back to spend the night with me in the hospital, in a reclining chair in my room.

It was a long, emotional day. I am glad to have the procedure behind me, and am happy to focus on recovery. I am not quite as relieved as I thought I would be, because I am still anxious about the pathology results.

I will get a call on Monday to schedule a follow-up appointment with the breast surgeon.