A patient’s story
On an evening in February/March 2010 while examining my breasts, I felt a lump that I hadn’t noticed before at the top edge of my right breast. The next morning I called my occupational health clinic, told them about the lump, and asked for an appointment with a doctor. I managed to see a doctor quickly, and the initial assessment was that the lump was nothing serious. I was referred for an ultrasound scan, which was done a couple of days later.
At that point I was told that it was only excessive growth of the mammary gland. I was relieved. However, the breast became painful, and I went to see a doctor again after about a month. I was sent to have mammography in May, and at the end of the month I had a doctor’s appointment. The doctor told me that the mammograms didn’t show any abnormalities but wanted to refer me for core biopsy. I had the biopsy taken, and then, just before Midsummer’s Day, Helena called and told me that I had breast cancer.
That piece of news did upset the applecart. I had to digest it on my own for a week before I could tell anyone else, even my husband. It was a bit of a shock; the first thing I was thinking about was the kids since they were still so young. Arttu was four, and the girls six and nine. And I was only 35 years old myself. Why me? My faith in the big guy up there has never been very strong, and it certainly didn’t get any stronger now.
In July I went for another mammography to see if I could have breast-conserving surgery, but since the whole breast was full of cancer cells it was removed in July. It was tough for a young woman. However, I was promised that I could have a new breast after about a year, and that kept my spirits up.
I had my first cycle of chemotherapy treatment in August, and a week later my hair fell out. That was tough too. I was however most worried about losing my eyebrows. What would a person look like without the eyebrows! Well, the eyebrows were the only body hair that I didn’t lose. My eyelashes didn’t fall out until towards the end of the chemotherapy, and within a couple of weeks after I had stopped taking cytotoxic drugs they had already grown back as short stumps.
During the last cycle of treatment my body protested a little and it was really hard to swallow the last tablet. I tolerated the intravenous chemotherapy relatively well. I was always in a daze for two days after it, and I also lost my sensation of taste for a good week but recovered it gradually, one taste at a time, before the next dose of drugs. My diet on those “tasteless” days was quite exciting: pasta with butter, cheese-flavoured crisps and probiotic yoghurt drinks. But I filled myself up when I could actually taste something.
I never really had any doubt that I would make it. And I did make it. I had good support networks, and I could work throughout the treatment in so far as my condition allowed and received partial sickness benefit. The fact that I was missing a breast didn’t cause any relationship problems or other issues. The missing hair caused a few funny incidents though. Once in the swimming pool changing room a little girl was bug-eyed in wonderment when she first saw me bald-headed and then – abracadabra – with long hair. I had a good laugh about it but the girl’s mom found it hard to choose her words in that situation.
In January 2011, I started receiving radiation therapy. I didn’t have time to continue working then but otherwise that phase went really well too. My throat got a little sore during the radiation therapy, that’s all.
And then in autumn 2011, Helena constructed a brand-new breast for me from a piece of tissue that she took from my tummy. The surgery went well and the breast is gorgeous and firm. Sensation of the skin is also gradually returning. In autumn 2012, I had the other breast reshaped because, compared with the reconstructed breast, it looked like an old mitten with a raisin at its tip. A silicone implant was inserted into this breast through my armpit, and that’s the only place where I have scars. The breast with the implant is also gorgeous, and my breasts are now symmetrical.
Immediate TRAM flap reconstruction
In spring 2005, the patient noticed a lump on the outer side of her left breast. Examination revealed it to be an early form of breast cancer (carcinoma in situ). The patient sought treatment with me and I first performed breast-conserving surgery to remove the lump. Microscopic examination of the removed tissue revealed that there were transformed pre-cancerous cells also outside the lump. As the risk of recurrence of the cancer was therefore high, I recommended the removal of the whole breast. She was only 38 years old, and I suggested that a new breast could be reconstructed in conjunction with the mastectomy. Since the patient was slightly plump and had large breasts, TRAM flap reconstruction was the best option for her.
I left the skin of the removed breast intact and the entire abdominal flap was placed under it. The patient had always felt that her breasts were too large and wished to have smaller ones now. I was able to take this wish into consideration. The surgery took almost ten hours, after which the patient stayed in the hospital for a week. She was very tired at the beginning. Her sick leave was extended by two weeks, and after a total recovery period of two months she was happy to return to work. She didn’t need any other treatment for her breast cancer.
Just less than six months after the breast reconstruction, her healthy right breast was made smaller and a nipple was reconstructed on the left breast. Once the incisions had healed, a nurse tattooed an areola around the reconstructed nipple.
The patient said that after the diagnosis she was at first sad and frightened, but had gone fishing for a day with her daughters and gradually calmed down.
At the moment she is happy with her life. The children have grown up and left home and she is studying for a new qualification.
She can now pursue any activity, even jogging, thanks to the fact that her breasts are not oversized any longer. The scars cannot be removed, but they do not disturb her. Memories of the past experience are recalled when she is standing in front of a mirror.
TRAM flap reconstruction
The patient had been diagnosed with breast cancer three years earlier and her left breast had been removed then. Losing a breast is always a tough thing but I had consoled her by promising her that a new breast would be constructed once she had recovered.
Three years after her mastectomy she returned to my office, expecting me to deliver my promise.
We chose the method carefully together. She wanted the breast to be reconstructed with her own tissues. Moreover, her wish was that there would be no scarring on her back since she was a musician. Her healthy remaining breast was beautifully round, and since below her navel there was a suitable amount of tissue, we chose the TRAM flap procedure.
I explained to the patient that tissue would be transferred from her lower abdomen to form a new breast. The blood vessels supplying the tissue in the lower abdomen would also be detached and reconnected with the blood vessels in the chest. I would also reconnect the nerves, so that sensation could be restored in the reconstructed breast as far as possible.
The patient’s breast was reconstructed about three months ago. Everything went well. The patient stayed in the post-operative ward for five days, followed by six weeks of sick leave. After that she returned to work.
The patient visited the clinic recently for the finishing touches. I reconstructed a nipple using a small tissue flap and, once the incisions have healed, a nurse will tattoo an areola around the nipple. The breast will then be completed. Since the healthy breast is symmetrical with the reconstructed breast, there is no need to reshape it.
The patient is happy with the result already at this stage and is able to move on in life.