Surgeries

Cancer Surgery

As you’ve gathered from the title of this page, I had to have more than one Surgery.

Having finished the drugs trial 4 days before the first surgery, I’d been poked, prodded, questioned, drawn on, starved, and educated in the art of using a hospital bed controller.  I wasn’t really worried about going in for the operation itself.

First things first that morning, as well as having the tumour removed, the surgeons were going to routinely check the lymph nodes in the armpit area to see if Cancer had spread to them.  The procedure is called the Sentinel Lymph Node Biopsy.

Sentinel Lymph Node Biopsy

How does that work?

I’ll keep it short, I had to go to Nuclear Medicine at the hospital an hour before admission time, to have a small injection of a Radioactive Tracer into the breast near the tumour.

Even typing that now I’m wincing.  And yes it was so bloody painful!!

THEN (and I am weirdly fascinated by this – strange woman) once in theatre, blue dye is injected into the breast at the time of the surgery.

The dye then travels WITH the Tracer, finds the sentinel nodes, staining them bright blue so the surgeon can see them.

These sentinel nodes get removed for further testing and will reveal whether or not cancer has spread from the breast to the lymph nodes.

Smurfette Lymph Node Biopsy

Simple really…!

Oh and as a result, you get blue wee, and you start to turn into a Smurf.  To be fair, the wee colour fades within a day or so – but the smurf boob took 6 months to fade.  And it was VERY blue.

My children thought this was hilarious.  Well I’m all for humour being brought into this when it can be!

Admission Time

Once I’d had the painful jab (I soon learnt that my pain threshold got better, thankfully), and was admitted to Day Case Unit, I changed into the three-armed gown. Which is great once you get it on correctly.

On went the tight surgical stockings, not by me I may add – I couldn’t get the damn things on.  A nurse helped me bless her, vigorously, but successfully.

Then the black marker pen came out.  Arrows were drawn around the tumour site, a huge arrow pointing down from my neck.  Seemed a bit overboard really…surely there is NO WAY the surgeons needed THAT many pointers showing where the tumour was??  But whatever, they’re the experts!

And after going through the procedure again, anaesthetic issues addressed, I was directed to the waiting room to be called down for the operation.  After about an hour I got called through.  Great – I thought.

The thought was short-lived, it was just to discuss medications I was already on.  Back into the waiting room I went.

Two visitors broke the time up a bit actually.  My sister, working in Outpatients at the time, popped up in her lunch-break so I chatted away to her.  I was quite relaxed considering what was about to happen.

The second ‘visitor’ (I use that term loosely), didn’t come up especially to see me.  I was loitering at the entrance of the waiting room when I saw him coming along the corridor – an ex-neighbour of mine, doing his job – an Anaesthetist from the theatres.

We stood there chatting for a while, then this wave of horror came over me.

‘Oh. My. God.  What if he’s MY anaesthetist??  Seeing me lying there with my BOOBS out???

Keep calm woman.  It’ll be fine!  Then he asked me who my surgeon was.  When I told him, he said ‘oh she’s really good, I’m not with her today’.

I think he saw the relief on my face.  We carried on chatting for a bit, and off he went.  Phew.

When my name was eventually called, I imagined being wheeled down to theatre on the bed, or at least a chair.  No, we went for a little walk.  Time to make sure my dressing gown was securely tied!

I remember sitting in a cubicle down there.  My calm disposition turned to a blubbering wreck.  It hit me, what was happening.  I couldn’t stop crying.  I didn’t want to go in.

Then I wanted to get in there quickly, get it over with.  Tears flowed and I don’t think they stopped until I was under their spell.

All Done

As I didn’t go down to Theatre until mid to late afternoon, I came round (eventually!) in the Recovery Room, said two words to someone then fell asleep again.

My Husband was informed that the Operation had gone well but that they’d had to do a lymph node clearance instead of just a biopsy, so I would likely be more uncomfortable than originally planned.

Uncomfortable was a massive understatement.  But as with all surgeries, I knew it was short-term.

However, I was ready to go home that evening and could he come and pick me up.

Was I ready??  I wasn’t waking up very well from the anaesthetic and about 5 minutes before my Husband arrived to collect me, I proceeded to be sick.  Oh I did NOT feel good.

It was 7 pm and the day shift on the unit, were going home.  My Husband walked in and was told again that I could go.  He took one look at me and said ‘well let’s give it a bit longer’.  The day shift left and on came the night shift.

We’d been sat for about 20 minutes and the assistant Surgeon came around to explain that they had indeed removed the tumour which was larger than initially thought, about the size of a fist.  We were both shocked.  And, due to what they saw with regards to the nodes, they made the decision then and there to do a Clearance.

The Surgeon looked at me, surprised, and said that I’d gone downhill since he saw me awake(ish) in Recovery.  The Staff Nurse who had just come on shift walked in, and my Husband asked his opinion.

“Hmmm, she’s not going anywhere tonight I’m afraid”.

So that was that.  I was in for the night and my Husband went on home after a while.

I can’t say that was the most comfortable of nights. But thankfully the next day, drain bottle in hand, I went home…

 

Axillary Lymph Node Clearance

Sometimes, as in my case, at the time of removal of the tumour and the sentinel nodes, the surgeon can see that lymph nodes already look abnormal.  The shape and feel of them at the time of my surgery meant – and this wasn’t on the original plan – they decided to remove what they felt had already been affected.

And I’m glad they did.

Everyone has a different number of Lymph nodes in their body, and under their arms, the ‘bunch’ can vary a lot.  For me, I had 14 removed and that was a clearance.

 

Sentinel Lymph Nodes

 

Recovery

Once I got home, I just couldn’t get comfortable.  Every way I positioned seemed to hurt.  And that bloody drain in my side, attached to a bottle (which in other hospitals you get given a nice tote bag to carry it round in I hear!).  Mine was just transparent.  Nice. So my daughter would take a wide birth of it when I was in the house.

It annoyed me, that drain.  Why?  Because I’d be sat on the sofa, with it out of the way on the floor, go to stand up, forget it was in and cause myself more pain!  Idiot.

Five days of annoyance.  Petty now, but at the time it was one of those things I kept swearing at.  For the 5 days it was in.  I had been told it was going to be REALLY painful when the district nurse would come to remove it.

Why do people tell you that??  Just something else to get worked up about.

So, when the nurses came in to remove it, once the blood and muck had stopped, I was geared up for MORE pain, and just thought – right come on then – let’s get on with it!

I lent onto the table, took a deep breath and …. Come on – do it then…. Oh.  You have!

That didn’t hurt! I’m gonna say it again… Phew!!

Recovery took a while for me after this operation.  I had a lot of pain around my side and had antibiotics to make sure there wasn’t an infection.  Thankfully the stitches were ones that dissolved, and the wound was healing well – I was doing everything they told me to do/or not to do, but this pain was horrible.  I couldn’t lay on that side and I was getting quite impatient after a few weeks.

I’d bought the right type of bras beforehand…all mine were underwired – don’t wear those, REALLY uncomfortable – so non-wired and also sports type bras were the comfortable ones to wear.  I naively thought after a few weeks I could go back to the underwired ones.  Wrong!  My swollen ‘side boob’ made wired bras impossible to wear for more than five minutes.

Don’t worry pretty bras….I will wear you again soon!!  I may not fill you properly one side, but I WILL wear you soon!!

Two weeks after surgery I had my appointment to go back and have the dressing removed and the scar checked over.  I was quite shocked when the nurse removed it.  I’d purposely not looked too intensely at it, other than admiring the multi-coloured bruising mixed in with the blue dye still evident.

They’d removed quite a lot of tissue and I could see there was a dip across the scar which was about 7cm long.  I just had to get used to it being a different shape and I wasn’t asymmetrical anymore.

I used E45 cream on the scar as advised and kept that up so it wouldn’t dry up, and it said on the paperwork that the scar would fade in time.  We will see.  Two years later, the scar is soft and not very pink, but due to the dip across the breast, it’s still visible.

Pre and Post Surgery Advice

The information I had given to me was really good.  Poole Hospital’s in-house Patient Information was simple to understand and for surgeries I had:

Psychological support in cancer care; planned admission for day surgery; Localised Wide Local Excision; Breast Surgery Sentinel lymph node biopsy; Aftercare following breast surgery; Re-Excision.

Exercises

I had strict instructions from the Breast Care Team to make sure after the first week, that I started and kept up the arm exercises.  Everything hurt.  Everything was tight.  I couldn’t put my arm down by my side.  But of course if I didn’t do all these exercises nothing would get easier.  The main aim was that I knew in 6 months or so time, I was going to have Radiation Therapy which would mean laying there with my arms above my head!

And I couldn’t lift to 90 degrees.  But the leaflet given, produced by Breast Cancer Care, was good and clear, and I stuck to that.

I also still couldn’t put my arm down by my side.  It was making sleeping very hard, and just walking/sitting was awkward.

When they called my name at the appointment to get the dressing removed, I stood up and followed the nurse through. ‘Oh you’re having arm issues aren’t you, holding yourself carefully!  Let me give you one of these cushions to put under your arm’.

Ahhhhhhhhh – relief!!  Used it sat at my desk at work, at night to keep it more comfortable… actually I used it everywhere. And still do. They’re made by volunteers locally and donated to the hospital.

Breast Surgery Exercises
Breast Cancer Cushion

Second Surgery

When I went back for my appointment to get the results of the surgery and to confirm ongoing treatment, the Surgeon confirmed that although they removed the tumour, they didn’t get clear margins around it.

When they remove a tumour, they also remove surrounding tissue to ensure no cancer cells are left behind.  The tissue she removed unfortunately still had cancerous cells in it, so they would need to go back in and remove more tissue and hope that that was clear.  If it wasn’t, a third operation would be necessary, and that would have to be a Mastectomy.

There was always a risk of second surgery with Wide Local Excisions, and they did tell me before the first one, what could happen.  So, the plan was to go back in through the original scar in order to remove more breast tissue.  Again a day case operation, and THIS time they would give me some Anti-sickness medication through the cannula during the operation, so that afterwards I hopefully wouldn’t feel as bad as the first time.

Thankfully, this was a much quicker operation as no lymph nodes were touched this time, and I didn’t feel sick after (yay!) so home I went with my bottle of Morphine the same day.

I did recover much quicker too.  Mentally and physically back on my feet quicker.  I didn’t have an annoying drain to contend with this time either.

After Effects

I know I didn’t have a Mastectomy.  But I still have a quarter of it missing.  The hospital have been brilliant, getting me fitted with a prosthesis (Priscilla the Prosthesis I named her… !) so that clothes fit better and I don’t feel as self-conscious.  It helps a lot of time.  But not all of the time.

I wore a dress for my works Christmas do which felt lovely, then ended up fiddling with the neck line all night thinking I was going to fall out!  It wasn’t even that low cut!

On a serious note, I was very close to someone who had to have a single Mastectomy, and she struggled to accept how she looked.  She couldn’t look at herself in the mirror, so she always got dressed before doing so.  She would cry every day.  Unfortunately due to her general health reconstruction wasn’t an option.  I’d take her to the hospital and get her fitted for her prosthesis and bras, and she felt much more comfortable afterwards, but of course it couldn’t replace natural tissue.

A year later, and it was me going through the things I helped her through.  Being more of a curvier woman, I’ve always worn clothes with a v-neck, shown a bit of cleavage – legs can remain covered up as MUCH as possible  – but I always tried to make the top part look nice!

And now I was looking in the mirror, crying at how odd I looked.  Odd scar, odd shape, not symmetrical any more.

I immediately thought, as the Surgeon suggested, that once everything had healed and further down the line, I would opt for reconstruction.  I hated the way I looked – unattractive, unfeminine, un….me.

I did get used to looking at it but mentally I’ve struggled.  Due to other complications during recovery (including a lively gallbladder which is due to be removed imminently – another general anaesthetic) reconstruction is on the back burner for a bit.

I have Priscilla doing her job quite well, for the time being anyway.

Next:  Chemotherapy