tummy tuck

Breast cancer lesson number 27: We make our choices and then our choices make us

Decisions, decisions, decisions! When faced with ‘the big C’, every meeting, every booklet, every phone call demands a decision – and usually not a small one. Basically, a day without a potentially life-changing choice in it, feels like a day off cancer. Trust me, there aren’t many of those.

In the first few weeks following my diagnosis, my colleagues were constantly amused by the way in which I would turn up at my desk, do some work, decide about freezing embryos, drink tea, have a meeting, talk about major surgery, drink more tea, write some emails and then weigh up the pros and cons of losing my hair. It was like life was suddenly on fast forward and as long as I could tackle a few major decisions a day, I was just about keeping up (I thought I’d only have to work and plan out a wedding guest list this year).

However big, most of my decisions have been met with nods of approval and sympathetic smiles. I think there is one decision though that requires a bit more of an explanation. A few concerned friends have asked me why, when I could have had a more traditional silicone boob job, did I choose to have my tummy cut open and glued back together (a DIEP flap). It’s something I’ve glossed over in earlier blogs, but I can see why, on the face of it, I must look a little like a bit of a pain junkie or a glutton for punishment. Is a tummy tuck on the NHS really worth the effort?

The short answer is yes, absolutely. The decision to hand myself over to the surgeon and his scalpel may seem brave (or just a bit stupid), but having been armed with the facts, it was the only surgery I wanted to consider (hence the extreme chocolate eating).


Here’s a quick insight into why my tummy fat is now masquerading as my right boob:

1)    Immediate reconstruction or delayed reconstruction?
The ultimate no-brainer. I don’t have much up top as it is, so to be made flat chested on one side at the age of 32 was never really a consideration. I didn’t like the idea of wearing a breast prosthesis and really wanted to keep my cleavage (especially for a wedding dress). Immediate reconstruction apparently leaves less scarring than other types and the results are usually better. Tick, tick and another tick for good measure! The only really downside I can see (and the main reason people may wait I guess) is that radiotherapy may change the appearance of the reconstructed breast (let’s see shall we?!). I also had to wait a bit longer for the two teams of surgeons to be available to operate.

2)    To flap or not to flap?
A slightly more complex conundrum, but I hope you’ll see why the tummy was right for me.

a)    I’m very healthy (apart from the obvious) and have a lot of looking-in-the-mirror time left. Basically, I am not limited due to my general condition.
b)    Implants give a less natural look. Perky boobs would be more attractive if I was having both done. Trouble is, if you have one done, you open yourself up to the possibility of more surgery down the line just to keep you balanced (especially if you put on – or lose – a lot of weight). I like the idea of something that can grow with me and age gracefully.
c)     Implants don’t feel as soft or warm as a breast formed using your own tissue. Never really fancied a vampire boobie myself.
d)    Implants don’t last forever. That means more surgery down the line!
e)    Radiotherapy and implants are not great bedfellows.
f)     An implant is a foreign body that may fail, if your body rejects it. I was next to one woman in hospital who had had problems with two implants and had opted for the DIEP surgery as the last resort. Yes, there is a 2% chance of the tummy fat failing, but that’s good odds in my book.
g)    I know I can cope with pain.
h)    Tummy fat is always an unwanted addition to the body. I’m a great believer we all need our moment in the spotlight. Now, it can feel useful.
i)      Microsurgery is amazingly complicated. Humans wouldn’t have invented such a thing if it weren’t to create great results!

3) Tummy, bum, inner thigh or back flap?
What would you rather? A) A bum with a gap that reminds you of cancer every time you sit down B) Shoulder weakness C) An oddly-shaped inner thigh that makes cycling a bit tricky OR D) a flat stomach. Hmm! Tricky! Not such a dilemma in my book.

Ok, so I’ll admit this is a bit one-sided. Yes, it was major surgery. Yes, there may be more complications down the line. Yes, implants can look amazing. Yes, I have a patchwork of scars across my body. And yes, it hurt A LOT! (and the recovery will take time). But, all things considered, at 32, the short-term-pain-long-term-gain option was always going to win.

I have no regrets. I’d made my decision before I’d left the cancer surgeon’s consulting room and long before the plastic surgeon had had the chance to draw a diagram of my tummy and explain the lengthy list of complications.

My tummy is as flat as a pancake.  My boobie is warm and as real as it will ever be (albeit without a nipple for now). When I am rubbing aqueous cream into my scars (a must-buy for anyone with breast cancer), I don’t think about the lengthy surgery or the complications. I just smile and thank the surgeons for saving my life and giving me another reason to feel thankful when I look in the mirror.

For anyone having to make this decision in the future, good luck! Listen to your body, listen to your heart and I hope you have many more happy moments in front of the mirror.

Next decision for me? What to wear to my fertility meeting tomorrow. Do I have a skirt that can fit over my corset without it riding up and looking like a belt? Pretty complex stuff!

Breast cancer lesson number fourteen: Prepare yourself for the big reveal… It hurts

Today marks the start of my return to independence. I have already wiggled my slippers on, waddled slowly to the toilet without a supportive arm and managed to wash my face. My moving mattress is now just foam, so there won’t be any more late night parties. I have also conquered the stairs without my wound feeling like it’s ripping apart. That means I am pretty much ready to go home.

Today has been an unexpectedly big day. Not because I can now pull my big knickers on. Not because I am getting my third drain taken out (leaving me with just one to take home with me tomorrow). No, today was the day I saw myself in the mirror for the first time. And, the worst bit is, I wasn’t prepared.

Looking down certainly doesn’t prepare you for looking in the mirror. I had accepted the challenge of washing myself independently and, before I knew it, I was sitting facing the scars and trying to make friends with my new flap. I had believed the nurses and doctors when they said it looked amazing (and it does in medical terms). It’s just that a scar from hip to hip, a new belly button, a large swollen lump in place of a cancerous boob (with no nipple) and a very swollen arm from the lymph node removal is quite a lot to take in. I may be healthier right now and I should be rejoicing about that, but I just feel a bit like an alien. Until I love these new body parts, how can I expect any one else to love me?

There is a small blessing in all of this. I have never been a woman defined by my looks. I’ve had spots, I’ve been overweight many times, my style is what could only be described as timeless (because it pretty much never changes, not because it’s stylish) and my walk is unique to say the least. I grew up being teased for the way I look and walk and I am strong enough now to know that it’s not a bit of body tissue that makes you who you are. It’s the person you are beyond the scars that matters.

A lovely nurse said something beautiful to me yesterday. She said: ‘disease makes us beautiful’. By this, she didn’t mean there are a queue of people dying to get stitches and surgical bruising. What she meant was, every obstacle we face reminds us of the important things in life and gives us the space to work out who we really are and what we really want. Each scar is a reminder that life is hard, but every time you recover, you learn to see more beauty in both yourself and others. We can be beautiful in other people’s eyes because we can see the pain others can’t and we can be the shoulder or support when others’ backs are turned. Put it this way, if beauty were defined by the amount of hurdles we face in life, I’d be Kate Moss.

While I will never be beautiful, I hope that my scars (once I have learned to love them), will give me the strength to support others and help them find the beauty within.

So tomorrow is the beginning of the real post-surgery recovery at home. There is only one thing I will miss from this first stage other than the beautifully smooth mashed potato – and that’s the view. London, with its bright lights, busy streets and Big Ben alarm clock – is pretty good company when you can’t sleep (and I’ve had what feels like about three hours in total in hospital). Walking by the river on operation day felt like a different kind of London. Away for the usual crowds and commuters, it was preparing for the day, with workers sweeping up, switching on and keeping the city’s heart beating. Looking out over the water at night, it feels like another world driven by bus timetables and lone wanderers, not blood pressure machines and drain bottles. It may be the city that never sleeps, but in the early hours even the centre can feel like the quietest place on earth.

There’s only one thing I have to do now before they let me go tomorrow – and that’s have a poo. Easier said than done…

Breast cancer lesson number thirteen: Time is a great healer… and morphine helps too

So, Friday was an interesting day. It started in the darkness of the early hours with a short train ride and a relaxing stroll along the Thames. It finished in the darkness of the night with a bucket load of morphine, a dedicated nurse, a giant monitoring chart and a view of the river (along with the London Eye). It started out with the cancer trying to take charge. It finished up with an army of amazing doctors and nurses (ten in theatre alone) all determined to make sure the cancer didn’t stand as chance.

I am happy to report, there is life after surgery. When it comes to life in hospital, however, the day asleep on the slab was the easy part. I won’t sugar coat it. The last few days have been hard (very hard). I woke up in recovery and was in pain (and shivering uncontrollably). We knew the tummy tuck would be tight. It actually felt like my stomach would rip open if I moved. I lay in bed clutching it tightly and crying through the morphine. No one could help me. Not even Mr morphine and his magic cocktails.

As with everything, however, the writhing agony has subsided and I am now left with a rather trendy abdo binder corset holding it all in (not forgetting my friend the big knickers). My right arm is limp and swollen from the lymph node clearance, my four drains are down to two and still draining into sports type bottles (all held up in the most beautiful handmade drain bags in the hospital) and my body looks at bit like it has been savaged! (Tip for those about to go through this, there are very few dressings used in plastics, so you see pretty much everything, including the glue). But, you know what, the boob is alive (complete with a bit of stomach skin), the tummy tuck was worth it, and I am still me (just a more well-thought through version).

Time can do wonders to heal and erase the memories, but if you think hospital is the chance for a decent rest, then think again – even the bed is timed to move around, so when you think you’re comfy, it sets you off guard again.

Three days is a long time in body recovery terms – although you know you’ve already been here too long when they are struggling to find a vein (the good arm is now out of bounds for life). I won’t talk you through the tests, the hourly checks, the pain, the pills the detail of the flap that is now my breast (being referred to as the flap in bed 11 is a bit weird). What I want to talk about is the positive side and, most importantly, progress.

Here are the highlights and the I-cannot-believe-this-is-really-happening lights:

1) NHS mashed potato is still pretty special: not sure I should be ordering it for lunch and dinner, but when something is that good, it is rude not to. Not sure I’ll be going in for seconds of the milk jelly though.
2) The beds are alive: nobody warns you of this and it was the cause for some amusement when I got a bit worried and explained I thought the bed was eating me. I think the guy looking after me in recovery thought I was hallucinating. At least I have been burning a few calories from the mashed potato while sleeping. It’s a special mattress for preventing pressure sores. Just wish I could have a proper ‘still’ mattress now.
3) Some drugs, when flushed through a cannula, feel like they are flooding your hand. Again in recovery too, I screamed out that I thought I was leaking. The nurses looked alarmed until it happened an hour later and they realised what I meant.
4) The recovery room was like the stuff of dreams: this feeling had little to do with the drugs or the general anaesthetic and a lot to do with the fairy tale castle and doodles on the walls. If you’re wondering why, it used to be a children’s ward. I just thought they’d consulted the wrong decorators and were attempting to transport us far from our bodies.
5) Blanket-warming machines are a revelation: they look like glass fridges and they produce the most wonderful warm blankets for theatre. If only they were available on the high street. I would buy shares.
6) I think my flap might be pregnant: flap testing involves running an ultrasound probe over the breast to check for a pulse. It’s often disconcertingly loud and the heartbeat sound it produces makes you feel like there is more than just fat up there.
7) It is possible to eat a roast dinner with one hand: a lymph node clearance makes the arm feel a bit useless (and tingly), so being faced with a lump of meat in gravy for lunch yesterday was a bit challenging. Undefeated, I worked away with one hand and managed to complete the challenge in about 40 minutes. Those who know how much of a fast eater I am will find this amusing.
8) I have a new belly button: apparently it would be too far down south if my old one hadn’t been relocated. This should go some way to explaining just what they took out.
9) Showering in a chair is so relaxing: while my new body will take some getting used to, this new way of cleaning is completely therapeutic and comforting.
10) Expect the unexpected in the consulting room: when my surgeon arrived to talk me through the operation, he did some drawing to explain – on me. To say I was a human doodle by the end of it, is an understatement. Think my parents got a bit more than they bargained for.

The strangest thing about this whole experience is the fact I am under plastics. I didn’t meet my cancer surgeon at all on the day, the surgeons I do meet are focused on new boobie, the ward is all plastics (skin grafts and skin flaps) and no one has mentioned the ‘C’ word. I think people might actually think I am a little bit vain with my boob and tummy tuck. My surgeon joked today that people elect to have tummy tucks. I grimaced and replied: ‘I guess they usually have something to remove in the first place.’ Should have had just a few more cakes, although it is nice to think my boob is part Hotel Chocolat treats and part apple and banana cake!

The one thing I miss the most? Being able to make a cup of tea. Three cups a day just doesn’t touch the sides.

The road to recovery may be a bit bumpy, but it’s the right road and I am happy to be on it at last.

I’ll be out once I am down to just one drain. Watch this space and thanks for the messages of support.