S is for ‘Show and Tell’ and ‘Surgery – The Big One’

/ʃəʊ ən ˈtel/
The practice of showing something to an audience and telling them about it.

Ever wanted to spend an evening in close proximity to a group of women who have their breasts out on display and keep encouraging you in for a closer look? Alright I get that for some readers that might sound like heaven but I’m not talking about the red light district of Amsterdam on a dirty weekend.  I’m talking about a clinical ward at my local hospital on a chilly autumn evening.  But it’s probably the first time Hampstead and Amsterdam have ever had quite so much in common.

And the reason for the gratuitous nudity?  It’s ‘Show and Tell’ at the Royal Free.  Or to give it it’s proper title, Breast Reconstruction Awareness Group. Because for all my glibness, there’s a serious point to the night.  It’s a rare chance for women who are facing the prospect of losing a breast and having a form of reconstruction to see how it really looks.  Not drawings in a pamphlet, or photos in a book, but real, living, breathing, scarred flesh.  With stories behind every reformed breast.

So a week before my scheduled surgery (which thanks to an admin cock-up had been booked in without time for any further meets with my plastic surgeon), I dragged a friend (bless you, you star) to the hospital for an evening of delights.  It started with a quick powerpoint presentation from one of the plastic surgeons at the unit, running through the different reconstruction options available (see C is for ‘Choice’) in very basic terms.  Up next was the Plastics Specialist Nurse who proceeded to terrify the fucking pants off me with the ‘what you can expect when you wake up’ speech that was, deliberately, honest and lacking in a sweet, sugar coating. Because none of these surgery options are easy rides, and it’s better to be prepared for how shit you’re going to feel when you come round.  But still, fuck, when you see the reality of the drains, the pain meds, the bair hugger (more on all of these later), you kind of hit peak terror.

After the terrifying talk of truth, it was free explore time.  Now I’m an immersive theatre nut, especially for those shows where you get to free roam a space and stumble across unexpected action.  But not even the craziest cheese-dreams of Punchdrunk could come up with a show where every door you open hides a bevy of bare breasts.  But that’s what you get at BRAG night.  Behind one door is a woman who has had a preventative double mastectomy with immediate implant reconstruction, behind another is a woman with the scars from a delayed DIEP reconstruction, behind another is a lady who had the LD reconstruction, using tissue and muscle from her back.  But the door I’m interested in is the one with ‘Immediate DIEP’ on the label, and inside I find 3 angels with bare breasts.  I think most women with a breast cancer diagnosis have to get their boobs out on display so often that you end up with zero boundaries, but to stand in a room tits out for an hour or so as other patients probe them – not literally but with questions – takes a special kind of strength.  Maybe because they were in the same position themselves not so long ago, and if they were anything like me, drew so much comfort from hearing true tales direct from the horse’s mouth about the surgery, the recovery and the aftermath.

Spending time with these women didn’t alleviate my fears about my upcoming surgery but it did allow me to see that there was light on the other side of the door. Now all I had to do was screw my courage to the sticking plate and kick open that door …

And so on to the ‘Big One’ …

A week after show and tell and I quickly discovered that the grim day surgery corridor of doom (See S is for ‘Surgery’. Part One and Part Two) is actually the grim surgery corridor regardless of your treatment or proposed length of hospital stay. So I was back to staring at the grey peeling walls at the end of November as I faced my third surgical procedure in 4 months.  I had certainly pressed the accelerator pedal on surgery – 45 years and 3 months with zero procedures that required me to be unconscious, then 3 doses of general anaesthetic in 12 weeks.

And my nerves had returned.  This time it was sheer terror as I was staring down the barrel of a 9 hour minimum operation, involving complex micro-surgery and scalpel cuts to three separate parts of my anatomy.  That morning I had again assumed the foetal position on the bathroom floor (see S is for ‘Surgery’. Part One), crying with fear and with the realization that this time I’d be coming home without my entire breast.  Scarred as my boob now was thanks to the previous two lumpectomy surgeries, the tissue inside was still mine and imagining it disappearing into some hospital furnace was not where I wanted my thoughts to wander.

It turns out crying took up an awful lot of my time that morning.  After the, now seemingly obligatory, bathroom floor blub, I moved on to crying in the hospital changing room.  Mostly at my almost entire loss of dignity, changing in what looks/feels like a run down storage closet while being harangued by time-pressured nurses as you try to pull the tightest pair of hospital stockings ever over your voluptuous calves.  Crying duties resumed shortly afterwards as I said goodbye to my brother and were doubled when my well-meaning surgeon hugged me and said ‘you can still change your mind, it’s up to you’.  I appreciate the sentiment love but your timing totally sucks.  All I wanted to hear from you right then was ‘I got ya’.

Because she, and my plastic surgeon, totally did.  The next thing I know I’m on the bed in the anesthesia room, someone takes my glasses away, I’m injected with something warm and I’m off with the fairies.

two person doing surgery inside room
Photo by Vidal Balielo Jr. on Pexels.com

For the next 10 hours I’m unconscious and under the knife.  10 hours is a long time.  For me it passes in seconds, but that’s a full and complicated day’s work for a surgical team.  It never occurred to me to ask how it all actually works – do they take loo breaks? Do they get bored and check their social media feeds? When it’s lunchtime does everyone bring a packed lunch and have a picnic round your body?  It’s probably best that I don’t know the answer to some questions but I’ve since heard that the team will take breaks while you’re out cold and that someone is charged with moving your limbs, head etc while you’re asleep so that you don’t stiffen up entirely, get pressure sores or, as some women do, lose their hair in the space where your head rests on the pillow.  It feels weird knowing that someone is manipulating your body like some benign puppetmaster while you’re asleep but as long as they’re not putting on a show (cue Julie Andrews singing ‘high on a hill sat a lonely goatherd’) I’m good with it.

A DIEP reconstruction is, in short, a miracle of modern surgical science and is mind-blowing when you really stop and think about it.   First up, in an immediate DIEP where the reconstruction happens at the same time as the mastectomy, a breast surgeon will remove the original breast tissue by cutting away the areola and nipple and ‘scooping’ the tissue out through the hole, leaving most of the original skin intact.  Then up steps a surgeon skilled in micro-surgery, so called because the blood vessels they’re working with are often under 3mm in size.  This plastics surgeon will make an incision from hip to hip, and remove fat, skin and blood vessels, including part of the ‘deep inferior epigastric artery’ which provides blood supply to the tissue in the lower abdomen and gives the DIEP its name. This removed flap of tissue is moved up to the chest and the blood vessels in it are reconnected to the blood vessels in the chest (which is where the microsurgery and a really good pair of glasses come in), before the tissue is inserted in through the hole in the breast skin and reformed to make a breast shape.   The skin from the tummy flap fills in the hole in the breast skin and the wide opening in the tummy is pulled together and sewn up.  Because the skin across the abdomen is pulled down during this process, the surgeon has to cut it away from the belly button and cut a new belly button hole which is sewn in place.   The patient is left with three scars – a circular scar on the new breast, a scar around the belly button and a long one running hip to hip across the lower tummy.

(Visual learners might like to look at this short animated video to understand the process – it’s animation only so there’s no blood and gore)

Sounds so simple doesn’t it?  Bit of basic rewiring and replastering?  But in reality the complexity of it is breath-taking and though I wish I’d never had to meet the surgeons who worked on me I will be forever in awe of their skill, commitment, focus and dedication.  I’m never sure what drives people to want to plunge their hands into the gunk, gore and grimness of cut open bodies but I’m glad these guys decided it was their purpose in life.

So 10 hours later and I’m awake.  I have zero memory of my time in the recovery room, which is probably a good thing, and the first thing I can remember is being wheeled onto my ward in my bed with the male nurse asking if I recognized ‘these’.  He was rather fit and wearing a vest top so I stupidly/druggedly assumed he was asking me if I recognized his tattoos.  Brief panic about whether I’d ever had any entertaining encounters with tattooed male nurses.  Then I realized he was asking me if I recognized the bags he was carrying.  My bags, which he’d grabbed from the lockers. Phew.  And yikes, embarrassing.

But any embarrassment was soon forgotten as I headed into post-op recovery.  Quite honestly the toughest time of my life so far … and the topic for the next blog.

So hurry back for bair huggers, bare boobs and bums and me nearly vomiting over the physiotherapists.

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