Mastectomy and Reconstruction Q&A

I’ve received quite a few questions from friends related to my double mastectomy and delayed reconstruction (also known as the expansion process). Since clear information for non-patients is surprisingly lacking in this arena, I thought I’d do my part to remedy that.

1. Since your surgery was in April, you’re feeling stronger with each day, right?

Unfortunately, no. I get expansions every Thursday. I need to go home from the doctor afterward and take it very easy. I’m still in a lot of pain when I wake up on Friday through Saturday. By Sunday, the pain starts to gradually abate a little each day until the next expansion starts. I haven’t yet had a day without limitations or pain.

2. What does expansion entail?

My reconstructive surgeon placed mounds under my skin after the mastectomy. These mounds are called “expanders.” Most women require expanders after mastectomies since they have had radiation, lumpectomies and/or chemotherapy. (All of those compromise the viability of the skin, thereby increasing the risk of infection after the mastectomy surgery.)

During the expansion process, the doctor numbs the area where the nipple used to be and then injects saline into a port under the skin. The breast increases in size before your eyes. Depending on the woman, expansion can last for a few weeks or months.

The fact that expansion is very painful doesn’t receive a lot of attention. Some women use a numbing cream before the procedure. Others take ibuprofen or pain medicine before and after.

3. Are you done with expansion yet?

Right now, I have 400CCs of saline in my breasts. On my frame, that comes out to a DD cup. My old breasts weighed 600CCs. My doctor believes that I should be 500CCs. That’s bigger than I wanted to go, but I appreciate her concern for the aesthetics. (My skin would be a little saggy if I didn’t go bigger.)

Fingers crossed, I’m hoping that today is my last expansion.

4. How do your breasts look?

There wasn’t any bruising after the first week, which is amazing. There are thin scars across the middle of both breasts. Some of the areola on the right breast was spared, but the left breast has no areola. My nipples were taken since breast cancer can start in the milk ducts. I will have surgery next year to restore the nipples, but for the time being, I have boobs that look like a Barbie doll.

5. You said your mastectomy wasn’t that painful. My friend had a horrible time with the surgery. Do you have a high pain tolerance?

Mastectomies aren’t a one-size-fits-all surgery! Depending on how scarred or burned the skin of a woman’s breast is, she might require skin and tissue to be taken from her back or abdomen to rebuild her breast. That makes the surgery and recovery much more complicated.

I have been told that I have a high pain tolerance, but I think it’s wrong to compare one person’s experience to another. We all hopefully do the best we can with what we have to deal with. Taking pain medicine or talking to your doctor about pain management shouldn’t be viewed negatively.

6. Are you doing more this month than last?

Yes, thankfully, but it’s all relative. I’m so happy to be able to walk a lot like I used to. (I'm not walking as quickly and I need to be holding my arm over my breasts for support, but I’m okay with that.) I did participate in the Komen 5K two weeks ago, and I was proud to walk with my survivor sisters.

My upper body is very weak, though, and I’m in physical therapy. I have trouble raising my arms over my head so I can’t wash my own hair. I don’t have the strength to walk my dog or drive yet. And, it’s still tough to lift more than a couple of pounds or reach out to the side. I’ll get there, though.

A light touch against my breast is very painful. While dining with friends, someone accidentally bopped into my arm in a way that it lightly hit my right breast. I instantly had tears in my eyes and was in the bathroom getting sick within two minutes. (And, for what it’s worth, throwing up makes my breasts hurt more, as does sneezing.)

7. What’s next?

I will complete the expansion this month. I’ll continue with physical therapy to improve my strength and mobility through July. And, then, on July 31st, the surgeon will reopen the incisions on my breasts to remove the expanders and put in the real implants. There are many things that this process is, but short isn’t among them!

Did you learn anything new?

Have you or a loved one gone through the expansion process?
 

The Pain of Anal

Question: My boyfriend is very big. I started to try anal, but it really hurt. What should I do, City Girl?

Answer: Communication and patience are your friends! This is why I don't recommend having casual anal sex. If you are in a relationship with someone, you should be able to talk about things openly and in advance. There needs to be an understanding that anal sex can't be rushed. Thrusting hard might feel good for him, but if you are in pain, it's doubtful that anal will be part of your sexual repertoire for very long. Think slow and steady.

Pick a night to introduce a finger or two into the mix. Focus on the clit and pussy first, and then ease on into the ass. Have a good lube on hand. Start with a finger or two on the outside of the anus, and then slowly put one finger inside. The goal here shouldn't be for you to orgasm or for the finger to simulate a cock, but rather, to get you more accustomed to anal play.

After you feel comfortable with fingers, try a small anal plug or bead inside your ass. Again, the emphasis is on using the toy to supplement the experience. It helps if you have already cum clitorally or vaginally before you pull out the beads so you will be more relaxed.

When you are ready to have anal sex for the first time, follow the tips that I laid out for you in my Anal 101 post. To reiterate one of those suggestions, I do not recommend having anal sex on a full stomach. That just increases the discomfort and chance that you will feel nauseous or have to go to the bathroom.

After you have reached orgasm with some pussy stimulation and have prepped the ass a bit with a finger or toy, have your man put a handful of lube on his cock and in your ass. Then sit on top of your man with your back facing his chest. That should work no matter his height, weight or "size," and is also the most natural position for your body to relax your anal muscles.

With you on top, you also have more control in terms of how much of his cock you take in and the pace of the thrusts. Remember that both can be gradual and in a manner that is enjoyable (or at least tolerable) to you. If it starts to hurt, take some deep breaths for a minute and then see if it still hurts. If so, stop, ask your man to release his cock, and go to the bathroom.

"Why the bathroom?" you might be wondering.

Well, sitting down will help your muscles relax. There also can be a feeling at the beginning of anal sex that you have gas or have to go to the bathroom. (I'm not trying to gross you out here. This is just the anatomy of things.) Heading to the ‘loo will give you more privacy on the chance that there is any "activity" in that region.

Upon returning to the bedroom, try again. If the act is still painful after a minute or two, then try a different position. What feels comfortable for you will depend on your body and your partner's body. (When I refer to "body," I mean height, weight, how tight your ass is, and how large his cock is.) Be sure to communicate with your partner if you feel any discomfort. Most guys will not be able to tell that you are in pain, unless you speak up! Your partner also needs to know that if you say, "Oww" or "Stop," that he should release his cock from your ass immediately.

As you are becoming comfortable with anal play, know that the sex doesn't have to lead to orgasm – initially or ever. If anal sex is painful or makes you feel like you have to go to the bathroom, don't continue it. Release his cock from your ass, go to the bathroom, grab a washcloth on the way back to the bedroom, wipe his cock down and then enjoy some oral or traditional sex. It's okay to save anal sex for another time. I won't say that the act is like riding a bicycle, but your body and muscles will become more acclimated to it.

There are women who do not enjoy anal sex at first, but after several attempts, find that they not only enjoy it, but also get a lot of pleasure from the act. Likewise, there are those women who don't find the act pleasurable and never want to try it again. Whatever mode works for you and your partner is the right one!

Are Three Break-Ups Three Too Many?

I’ve been remiss in answering readers’ questions from Formspring. Let’s start to remedy that today!

Question: My boyfriend and I broke up three times. This third time has been the longest. It’s been a week since we have been broken up. He said loves me a lot, but he needs time to flirt and to be single before he wants to be with me again. What do you think?

Answer: I’m sorry that you’re experiencing such relationship turmoil. It’s clear from how you’ve phrased the question and your patience about the situation that you love your boyfriend a lot.

Your boyfriend appears to be taking advantage of your feelings for him and your patience. He’s found a way to have his proverbial cake and eat it, too. When he wants to enjoy the benefits of being in a serious relationship, he does. When he wants to break up so that he spend time with other women, he can. When he wants to return back to the security of his relationship with you, he's able to do so.

The real question here is how much of his behavior you’re willing to tolerate. Your limits are for you and you alone to determine.

As you decide what’s in your best interest, it's worth asking yourself what you’re looking for from a significant other. How secure do you feel about this relationship, knowing that your boyfriend can use an easy-out clause at a moment’s notice? Does this relationship provide you with the level of trust and commitment that you would like?

How do you define “love,” and how different is that from how your boyfriend defines it? Break-ups are by their nature heartbreaking. Going through that three times in one relationship might be too much for some people to bear emotionally. If your boyfriend truly loves you a lot, I wonder how he views love and commitment and why it doesn’t break his heart to hurt you.

In addition, what does your boyfriend mean by being “single” again? I don’t think you can assume that he’s just casually flirting with other women since he doesn’t need to be single to do that. Whether or not we’re in a relationship, we all encounter people with whom we have a connection or feel an attraction. That’s human nature. The key, however, is recognizing that our love for our significant other outweighs our need to act on that attraction.

Are you comfortable with your boyfriend having sex with other women while you're on these breaks? When he comes back to you after this time apart, do you talk candidly about whether he was with anyone else and if so, whether or not he used a condom? Please make sure that your heart and your health are protected!

Whatever you decide, I hope that you find the peace you’re looking for and the love that you deserve.

Readers, what advice would you give this young woman?
 

Five Weeks After My Double Mastectomy

How am I doing five weeks after my double mastectomy?

In the very good news column, my drains are all out! I can now wear clothes that don't button or zip up and take a proper shower! Since last Friday, I've also found myself with more energy and able to be out of the house a few hours a day.

In the not-so-good news column, I was surprised to experience significantly more pain in the third and fourth weeks after my surgery. I barely required any pain medication the first two weeks, and yet I found myself reaching into the medicine cabinet on numerous occasions in the later half of the month. Why was that?

 

For those of you who live in the DC area, yes, I'm the girl who walks with her arms in front of her breasts. I'm doing so in part because the more my chest jostles, the more pain I'm in. I also am trying to guard against anyone bumping into me or trying to hug me. (Both hurt a lot!) It might be an odd sight, but I have to place my comfort over others' confusion. I look forward to a day in the not-so-distant future when I can hug freely again! xoxo

Digital Detox

Is Social Media ruining our minds?

That’s the question that Assisted Living Today posed in an infographic, an excerpt of which is posted below:

In my Sexuality and Social Media class, my students and I discussed whether we, as a society and as individuals, are becoming too connected to our smart phones and computers. Specifically, we evaluated the findings contained in the infographic in light of the following:

  • How much do we prioritize our time online?
  • Can we disconnect long enough to take a tech-free day?
  • How often do we check our phones when we are out with others? What are the rules of etiquette in the age of social media?
  • Who sleeps next to their phones? Is this healthy?

Over the past two years, I’ve learned how to keep my laptop closed at least one day a week. I've found it wise to limit how wired I am to give my brain a chance to rest. I must admit, though, that I would have had a harder time doing that if I wasn't able to easily respond to emails via my BlackBerry.

As I socialize with others, I’ve also started letting each person or group be my guide as to whether I keep my phone in my hand or on the table. If my friends have their phones out of sight, then I’ll try to do the same. If I need to keep my phone out for any reason, I’ll let the person know why. Do I succeed in being 100% present with others at all times? Of course not. But, I’ve gotten better about it, and I’ve learned to acknowledge to myself and my friends when I’m feeling distracted and why that is so.

Although I’ve limited my connectivity, I’ve still found it difficult not to check my phone several times a night. I’m a light sleeper, and I don’t have a clock in my bedroom. So, my telephone became my clock. As I'd roll over throughout the night, I’d click on my phone to check the time. If there was a notification of an email, I'd open my email folder. If a text message came in late at night, I’d read and respond to it, and then I’d look to see if I had any emails. If I was up for longer than three minutes, I’d go on Twitter and respond to a few Tweets. It was a slippery digital slope!

I realized that as light a sleeper as I am, it wasn’t healthy to be spending so much time on my phone in the middle of the night. How much was my sleep disrupted by this? How urgent were any of these matters? And, what message was I sending to The Man about how I prioritize him and my time online?

On Friday night, I started my digital detoxification. My BlackBerry remained in the living room, while I was in the bedroom. Over the past several days, life has gone on without me checking my emails and responding to friends and colleagues at 2:00am. (Note sarcasm.) I’ve also noticed that I fall back asleep faster since I’m not up for as long. I have a feeling that this digital detox is here to stay!

How connected are you? Are there regular times when you consciously choose to be tech-free? Do you have any rules about cell phones when you are out with others or asleep?

Are Bloggers in the Public Eye?

Yesterday, I received the following comment via my website contact form:

Name: K

E-mail Address: citygirlblogs (at) gmail

Question/Comments: Hi there – I met you a couple months ago at a PR networking event and tried to make conversation. You had a terrible expression on your face, responded to a couple of my questions in a painful/ abrupt manner, and then left the event. Someone who knew you said to me, don't worry – she doesn't like public, crowded events. Why put yourself in the public eye with your blog if you can't communicate in person? I'm not trying to criticize; I'm just pointing this out. I wish our correspondence had been different and appreciate what you're doing on your blog. Best of luck. I hope you have a speedy recovery.

***

Dear K,

You raise some interesting points. Since you chose to input my email address, rather than your own, I assume that you aren’t interested in a response or two-way conversation. However, I advise my students, fellow bloggers and several nonprofits to acknowledge criticism and then let it go. It would be uncharacteristic for me not to do the same in this case.

To address your comment point-by-point:

I met you a couple months ago at a PR networking event and tried to make conversation.

So, we met in March or thereabouts, but you only decided to reach out to me now? If our interaction affected you this much, I wish that you had contacted me earlier.

You had a terrible expression on your face, responded to a couple of my questions in a painful/ abrupt manner, and then left the event.

I have absolutely no poker face. When I’m really sick, it shows. I’ve suffered from chronic migraines since I was a teenager, averaging two a week for the past decade. I also have Post-Concussion Syndrome, and noises, crowds and lights can be very disorientating for me. My most recent concussion was in March, and that was my third in eight months. My neurological conditions cause me to get nauseous and dizzy on an almost daily basis. I throw up more in one week than most people do in a year.

Nonetheless, I try to do as much as I can. It’s important for me to support my friends with their endeavors, as well as certain DC organizations, charities and businesses. Sometimes, that causes me to push it or do more than I should. If the pain becomes too severe or I can’t stop vomiting while out in public, I’m definitely anti-social, and I try to leave as quickly as I can.

Other times, I'm waiting for my migraine medicine to work its magic so I can feel better. I threw up three times before this year's Fashion For Paws and didn't talk a lot to people backstage. Four hours later, after my migraine medicine had kicked in, I did my best to rock that charity runway so that no one could tell.

Photo Credit from Fashion For Paws 2012: The Washington Lobbyist

Someone who knew you said to me, don't worry – she doesn't like public, crowded events.

I actually do like most events, but since the complications from my neurosurgery in 2006, my health doesn’t always allow me to enjoy events. Either that person doesn't know me well or she responded to you generally out of respect for my privacy.

Why put yourself in the public eye with your blog if you can't communicate in person?

I didn’t realize that a person with a blog is in the public eye! The words on a blog are public by virtue of how the Internet operates, but the people who write blogs are not public figures. (In fact, quite a few bloggers use pseudonyms on their sites.)

I'm a writer, a professor and an advocate. When I speak on panels or attend an event, that's something that I choose to do. I don't work in news, entertainment or politics.

I fully admit that it’s difficult for me to hold a conversation when I feel ill. On a good day, I’m also not a fan of networking events since they often create a disingenuous and self-serving environment. And, I try to be nice to people, but I’ve never promised to be nice to everyone I meet. (Can anyone promise that?)

With respect to my ability to communicate in person when I’m not sick or in pain, I’ll let my resume speak for itself or my friends speak for me in the comments.

I'm not trying to criticize; I'm just pointing this out.

You clearly are trying to criticize me, but that’s fine. I’m comfortable enough with myself to handle it.

I wish our correspondence had been different and appreciate what you're doing on your blog.

Since this affected you enough to write me a couple of months later, I wish you had reached out sooner. Our interaction might have been different, if you had done so from your own email address. As I’m sure our paths will cross again, I hope you’ll come up to me at a future event.

Best of luck. I hope you have a speedy recovery.

Thank you, Stef

What are your thoughts, readers? Are bloggers in the public eye? How do you feel about networking events? How do you interact with others when you’re sick or having a bad day?

Is It Wise to Share Your Location Online?

Do you use the check-in feature on Facebook or have a Foursquare account? Are your Tweets linked to your location? How much do you post online about your whereabouts?

As a single female who blogs about sex, I’ve been loathe to provide a lot of information about my location. I don’t have a Foursquare account. I never check-in anywhere on Facebook. And, I’ve disenabled the geotagging feature on my Twitter account. I also feel a bit uncomfortable when I see Tweets from my friends in advance of our get-togethers that reveal where we plan to go in the future.

When I began blogging anonymously, I didn’t want people connecting City Girl to Stef Woods. Now that I blog openly, I’m more private than you might expect about where I am and who I’m with. If I acknowledge my whereabouts online, I try to do so as I’m leaving a given location, rather than when I’m there.

I’ve been blessed to have amazingly supportive readers and virtual friends. I don’t want to be disrespectful of that, but I also can’t assume that every reader and every Twitter follower is a good-hearted person. I still cringe every time I see Creepy Apology Man in my neighborhood. Do any of us really know who is paying attention to us – online or off – and whether that attention is harmless?

This topic has been on my mind since I read the blog of one of my Sexuality and Social Media students, Sharon Shih. In a post on "Common Location-Based Social Media Features," she writes:

[It’s] important to point out other applications that may reveal a little too much information about the user. Some social media websites such as Facebook.com provide the option of sharing your location. This can be done on a smartphone or on a computer and now Facebook even includes a map of your exact check-in location with a space to add text and the ability to tag the people you are with. Twitter has a similar feature that allows locations to be added to tweets. While this might seem like a good way for individuals to document where they have been, this also provides sexual predators with a lot of information that can be used to harm.

Another similar application is Foursquare.com, which actively encourages its users to check in their locations on their phones to connect with other friends who might be in the area. The problem is that Foursquare can be linked to other social media sites such as Facebook or Twitter so unless all accounts are completely private, there is a chance that someone who is not a “friend” will see your location.

While these features may seem fairly innocuous, they also hold the possibility of alerting predators to your location. Facebook literally provides a map of where you are, which practically leads an assailant right to your exact current location. As of May 2011, 17% of the U.S. population had checked-in using an app on their mobile device (Hargreaves, 2011). 90% of people who have checked-in have done so using Facebook Places and the top check-in destinations were restaurants, coffee shops/cafes, hotels, and bar/clubs (Hargreaves, 2011). Out of those statistics, the most concerning is probably the amount of people who check in at bars/clubs because of the added factor of alcohol and lessened inhibitions. It is important that the people using these services realize how easy it can be for this information to be used against them, especially if they are not alerted to the dangers. It is necessary for individuals to be aware that what they put out on the Internet can translate to real life in a negative way.

Sharon’s project explores “the utilization of social media by sexual predators to locate and target potential victims. Due to the proliferation in the use of social media, more people are able to be 'connected.' However, these connections can be dangerous if users are not authentic and social media is being used as a tool to connect with potential victims. For this reason, [her] research question is:

Has social media made it easier for sexual predators to find potential victims?

This is a highly important and relevant issue in our society and more awareness needs to be brought to this subject matter. With younger generations beginning to use social media, a new medium to reach potential victims has become available for sexual predators. In order to prevent more violent acts, parents and children should become informed of ways in which to safely use social media. In general, all social media users should become aware of this issue in order to protect themselves from sexual predators because children are not the only ones who are targeted.”

Read more about Sharon's research findings here.

So, do you acknowledge your whereabouts on Foursquare, Facebook or Twitter? Why or why not?

Preparing for Your Mastectomy Surgery

Back in March, my double mastectomy surgery was looming over my head. I was on edge about everything, even commenting on Twitter that I was suffering from PMS (Pre-Mastectomy Syndrome). A week later, tears replaced my ire. I cried for seemingly no reason, although deep down, I knew why I felt so raw. I was sad. I was scared. And, I wanted my surgery to be over and done with.

In early April, something switched inside my head. I let go of what I didn’t have control over and focused on what I could control. I talked openly with both surgeons about their expectations and my anticipated restrictions. Then, I set up a calendar with what I needed and who was helping on what days with which items. The more I organized my schedule, the more empowered I felt.

What suggestions do I have for others preparing for a mastectomy or a similar procedure?

1. Talk to your doctor openly in your pre-operative appointment. Ask your surgeon any or all of the following questions:

  • What laboratory tests are required pre-surgery?
  • Do you need to pre-register before your surgery with the hospital or your insurance company?
  • Is it expected that tissue and muscles will be taken from your back or abdomen? If so, how will that impact your recovery?
  • How limited will you be when you wake up? (Some of my survivor sisters were unable to move their arms to the side or over their shoulders for weeks.)
  • How long will you be in the hospital?
  • What prescriptions will you need to take once you are out of the hospital? Ask your doctor for the prescriptions in advance of your surgery so you can fill them beforehand.
  • How many drains will you have, and how long will they need to stay in?
  • What type of assistance will you require once you are able to go home? Should you hire a nurse?
  • How long will it be before you can shower? Shop for groceries? Return to work? Drive? Have sex? Make your children dinner? Walk your dog?
  • How often will you need to visit the doctor after your surgery? Make your appointments and arrange transportation before your operation.

2. Stock up on surgical bras. For at least one month, you’ll be advised to wear a surgical compression bra 24 hours a day. Get several in advance so you’re not dependent on the hospital for providing one or a loved one for doing your laundry.

3. Purchase and install a detachable shower head to allow you more options for bathing. You might also want to get a shower chair.

4. Talk with your doctor about shaving and deodorant restrictions. (At my 10-day follow-up appointment, I found out that I was allowed to use an electric razor and Crystal Deodorant. I wish that I had known that earlier since I fear that I offended many a caregiver and visitor.)

5. Do you have loungewear and pajamas that button or zip up? If not, purchase a few items of clothing that are easy to put on and take off. Don't expect to have enough range of motion in your arms to put on a round neck sweatshirt.

6. Set up a calendar to make sure that you have assistance during the first two-three weeks. Send all of your caregivers an email with relevant names, phone numbers, addresses, dates and tasks. Be as detailed as possible with your caregivers before surgery.

7. Accept help. A lot of us want to do everything ourselves, but that won’t be realistic after surgery. People will approach you before you head to the hospital with offers to help. Figure out who you feel comfortable with having at the hospital and in your home and take them up on their kind offers!

I’ve found that I do better with help those first few weeks after surgery, rather than just company. (I don’t have the energy to show well-intentioned visitors where things are in my place.)

I'm thrilled to report that my double mastectomy surgery on April 25th went very well. It wasn’t that painful, and I was able to get out of bed, use my phone and hold a small cup once with ease. I’m also incredibly thankful that I surrounded myself with such a wonderful support system – all of whom took the time to read the five-page email that I sent them before surgery and gladly assisted me with whatever I needed!

So, readers, did I miss anything? What tips do you have for future patients?