What happens during a breast expander fill?

So today was my final breast expander fill following my mastectomy. A few people have asked exactly what happens during the short appointment so I thought I'd share the procedure with you.

Breast Expander Implant

Firstly, left is image of what my expander implant looks like, this should help you understand how the procedure works.
The outer part of the expandable implant is made of of silicone gel and inside is an inflatable, inner chamber. The inner chamber is where the saline collects as you have your fills. The darker part of the expander that you can see on the image is the valve or port. The saline is injected through this valve and in to the inner chamber, stretching the muscle that is holding the expander in place. Once full, the full expander stays in for around 3 to 6 months before its replaced with a full silicone implant.

The fill procedure may be done by your surgeon or the breast nursing team. Usually the first fill is done in theatre when you have the implant inserted the you return every week for a top up. My expander takes a maximum of 400cc of saline. 250cc was added during my surgery and this will be my third 50cc injection at the clinic.

So here we go, here's what happens during a breast expander fill appointment...

Once in the consultation room I head behind the curtain and remove my clothing - just everything on my top half - no full nudity required! Your nurse will give you a gown to cover up and once you have it on you can lie down on the bed.

Get comfy and relaxed, you don't want to have to move midway through the process.

Once your comfortable the nurse will use a special device called a 'Magna-Finder' to locate the valve in your expander.

Locating the breast expander port

The nurse will move the Magna-Finder across the breast and as she does the vertical magnet will be pulled towards the magnet in your expander. When it is completely vertically straight, its in the correct place. The nurse or surgeon will then mark up the injection site - usually using a biro!

A larger needle is used to draw the saline

Next the nurses will prepare the syringe. Everything is sterile and is laid out on a trolley. To fill the syringe with the saline, the nurses use a large needle. Do not worry about the thickness of this needle! This is just the needle that is placed in to the saline solution and then as the nurse pulls up the syringe plunger the saline is drawn in to the syringe.

The needle they use to fill the syringe is much wider than the needle that goes in to your body during the procedure. In fact the nurse told me the needle they use is just the same width as a needle they use to give immunisation jabs.

Once the syringe is filled with the correct measure (this final fill was 50cc for me) the nurse will switch the to the finer needle and you're ready to go.

Lining the needle up to the pre-marked area, the nurse injects the saline directly in to the implant. The fill takes less than two minutes and for those or you that aren't queasy, you can watch the clip I recorded of my final fill below.

What To Pack In Your Mastectomy Hospital Bag

Now that my surgery is over thought it might help for me to share the things that I needed during my stay in hospital.

Try to remember that after your operation your arm movement will be really restricted and you'll have drains in place. Here are my top takes:

For the Hospital

Slippers - make sure these are non slip. The last thing you need is a fall when you've just come round from anaesthetic.

Dressing Gown - in the UK you are usually asked to wear your dressing gown to walk to theatre before your operation.

Underwear - an obvious one I guess but if you are having DIEP flap surgery then big Bridget Jones knickers that go over your tummy scar are best.

Front Fastening Post Surgery Bra - It is virtually impossible to wear a backwards fastening bra after surgery because of your restricted arm movement. In the UK your breast cancer nurse will provide you with one front fastening bra the day after your surgery. I've found this the most comfortable post surgery bra I have and I sleep in it every night at the moment as it supports the weight of my expander.

Button Up Pyjamas - as soon as I woke up in my hospital gown I wanted to get changed. There was blood on my surgical gown and I needed it off. I waited for Chris to arrive and help but again, ensure its front fastening and button up so you can get in and out of them yourself. I bought a pair a size up as I knew that I would be swollen and carrying my drain around. Elasticated waist is a must too so that you can pull your pants up and down easier.

Drain Pouch Bag - Literally THE best thing I had in my bag. I've heard so many stories of women having to pin their drain bags to their tops, their bras etc but I researched and got myself a Drain Dollies bag. I just had a single mastectomy so I only needed one but if your having a bilateral mastectomy then get two - one for each side.

Mastectomy Pillow - When I came round after my op I was quite uncomfortable under my arm - possible due to having the sentinel node biopsy. Luckily I had ordered a FREE mastectomy pillow from Jen's Friends. Again I only needed one but if your having a double mastectomy then get two.

Snacks - If you've read my Mastectomy Day Diary then you'll know that I had to wait for ages to be fed after my operation. Pack some healthy snacks in your bag so if you're feeling peckish outside of hospital meal times you don't have to wait on someone else. Make sure they're individually wrapped if you can - for hygiene.

Straws - lifting a cup to your mouth is hard so straws are a must. The hospital will probably have some but I packed some in case.

Medication - always take any regular medications with you and hand them to your medical team so they can ensure you are taking everything you need to whilst you are in their care.

Toiletries - again seems like an obvious one but the things you are most likely to forget! Toothbrush, toothpaste and wash things. I took face wipes so I could freshen up through the day.

Make Up - Some of you might thing this is daft but I wanted to feel more like myself for visitors and for the journey home.

Mobile Phone & Charger - I took my own portable charger in case there were no sockets available. I hate being out of contact with my family so my phone was a must.

For Heading Home

Front Fastening shirt - again this is for ease - to assist with your drains and with your arm movement. It's impossible to pop anything over your head because you cant lift your arms. Again I bought oversized because of swelling,

Elastic-Waisted Pants or Leggings - do not make the mistake of taking button up jeans. It's impossible to do up the buttons and pull up the zip! Elastic pants are easy to get into and out of and wont have you splitting your stitches.

Slip-on Shoes - avoid laces and anything that needs effort to pull on. Bending is hard and sore so the easier to put on the shoe, the better.

Pillow - I took a normal bed pillow to put over my front and fastened the seat belt over that to protect myself. I could feel every single bump in the road as we drove back.

When You're Home

Pillows, pillows, pillows - I had to sleep upright for two weeks post surgery and for some people its longer. It can be really difficult to get comfy. Thankfully my painkillers knocked me out most nights. What pillows are best is really down to you. Some people prefer v-shaped pillows to prop them up. I personally used two really firm memory foam pillows vertically behind my regular two duck feather bed pillows.

Prepared Meals in the Freezer - you must remember to eat to stay strong. Having some meals already stocked up is a winner as you won't be able to lift and cook as usual.

Medication - I kept all my meds close to me in a toiletry bag next to my bed. It's worth remembering that you are unlikely to be able to open anything with a child proof cap so try and transfer anything in to an easy access container.

UK Benefits - What Can I Claim if I'm only on SSP?

As if worrying about your health isn't bad enough when you're diagnosed, we then find ourselves in a constant state of worry over our finances. For me it was a huge burden because I am the sole income earner in the family. I have a great job but having 3 surgeries means I've been signed off for a few months and unfortunately being new to my job means I'm only receiving SSP.

First of all I found a great website called Turn2Us that allowed me to calculate what benefits we might be entitled to. Still I was worried because I would still be employed just on a very low income so I wasnt sure if we could even claim for benefits.

Luckily following my Dad's illness I was aware that Macmillan had a help line that would be able to assist and give me some guidance. The helpline is fantastic, it offers help and support on everything from your illness and treatment through to employment law and finances.

 Macmillan Helpline: 0808 808 00 00 

Macmillan took all of our details and as we were in a qualifying area for the Universal Credit roll out, we would be able to apply.

You can find out if you’re eligible by using the Citizens Advice eligibility checker

The application process was relatively simple for us as we're online savvy. Just head to the Universal Credit site and click start. You'll be asked loads of questions about your circumstances, your earnings, savings, number of children etc. If it's a joint claim then at the end of your application you will be given a reference number so that your partners application can be linked to yours. They will need to complete the same questions and their income and earnings will also be taken in to consideration.

The amount of Universal Credit you receive will be made up of a standard allowance and any extra amounts for children, disabilities or health conditions and if you need help paying your rent.


STANDARD ALLOWANCE

ALLOWANCE FOR CHILDREN

ALLOWANCES FOR DISABILITIES & HEALTH CONDITIONS








You may also be able to claim money to help with housing costs - it's all dependent on your age and circumstances but it can cover rent, mortgage interest, some service charges and interest on loans secured against your house.

The final step you must do to complete the process is verify your identity. This was the only thing that really caused us issue as we had to have our Passports and Driving Licences available to photograph. Chris had lost his passport and I couldn't find my driving licence so we both used different apps to verify. I used the Post Office Gov.UK Verify app whereas Chris used the Experian Verification.

Once you (and your partner if its a joint claim) have completed your online application you will then need to call the Universal Credit helpline on 0800 328 9344 to arrange a face to face meeting at the Job Centre. This appointment is for you to have your ID checked again and you will each be given a claim number.

Each time you receive an updated sick note (now known as a 'fit note') from the doctor you will be required to log it on the Universal Credit website and then physically take it in to your local job centre for them to verify and approve. You must do this otherwise your claim may not be processed. Once you have been your online journal will show as complete. I took mine to our initial meeting they just check it and then hand it back, then you'll need to send it in to your workplace so you still get your SSP.





It takes around 5 weeks for the first payment to come through and was paid direct in to the bank. Our Job Centre advisor was lovely and explained that if we needed help to pay our bills or cover any other costs while we were waiting for our first Universal Credit payment then we could do that with him.

In addition you can also apply for free school meals for your children and a council tax reduction while you are claiming Universal Credit. To apply you will need to contact your local authority. It's worth noting that claims are only backdated to the date you apply to try to do this as soon as you apply for Universal Credit.

If you have any questions at all just leave a comment below and I'll get back to you straight away.

Mastectomy Results Day

I wake up apprehensive and still tired. Our appointment isn't until 3.10pm which just prolongs the agony. We arrange for Grandma and Grandpa to pick the children up from school and head off. It's a strange journey. Chris and I hardly speak, we just listen to The Greatest Showman CD for most of the journey. When 'This Is Me' come on the lyrics hit me.

I've learned to be ashamed of all my scars
Run away, they say
No one'll love you as you are...

These past few months have been so tough. I've piled on weight which hasn't helped but more importantly I've lost myself. I feel different, less confident and despite my positive and bubble personality, I hate what I see when I look in the mirror.

Soon enough we arrive in the car park, we hold hands as we walk in to the hospital. I give my name in at the desk and head to the usual waiting room. My heart begins it's usual pounding. I hate the waiting, its agonising. For me not knowing is worse than knowing. I hate the unknown.

Despite our usual hour in the waiting room, today we are called out of the packed waiting area after about 10 minutes - this never happens.

"Leanne Nash"

I real of my date of birth and head in to see Mr M. Today as well as my consultant and two nurses there is another man in there, he's introduced as the Lead Registrar. I'm asked firstly to head behind the curtain and take my top clothes off. It seems daft that they pull the curtain over so Chris - my actual husband - is the only one that can't see my baps!

Mr M says everything is looking good. They had added 250cc into the expander during surgery. Today he would add 50cc more. The needle is huge, so much so that Mr M makes a joke about it being like the needle from Pulp Fiction.

Looking at that image though, Id say my syringe was definitely bigger. Don't panic though ladies - the needle itself is no bigger than the needles they use to take blood.

It's a strange sensation as the saline goes in. The expander moves around inside as it's filled, it's uncomfortable but it's nothing compared to what I've been through so far. My heart is still pounding, wondering the outcome of the results so the syringe moves up and down as my chest moves.

Once complete I get dressed and head back out beyond the curtain. It's time.

"Ok, we've got the histology results back. There was more DCIS in your breast - another 10cm - so in fact it was basically right through your entire breast...

...BUT... (I cling on to this 'but' for what feels like an age, awaiting my fate)

...we have managed to get it all. We've discussed your case in the MDT meeting this morning and because no invasive cancer was found and the lymphnodes we took were clear, you will not need and radiotherapy or chemotherapy."

THANK GOD. SCREAM IT FROM THE ROOFTOPS. DING DONG THE CANCERS GONE.

He continues to tell me I definitely made the right decision having the mastectomy. There was always a chance that there would be no further disease at all and that my breast could have been saved but in my case my whole left boob had been riddled.

The only remaining treatment -  should I decide to take it is a tablet called Tamoxifen. Mr M tells be approximately 13 times that one of the main side effects is vaginal dryness. No word of a lie - they are pretty much the only words I remember from that discussion. And, whilst vaginal dryness is certainly no laughing matter, I did struggle to contain my giggles.

Rather than deciding what to do straight away, I'm given a leaflet to take away and decide over the week what to do.

For now though, with my aching filled up boob, we head home with the best news we've had in 6 months.

Another Sleepless Night

I can't sleep... again. Tomorrow is results day. I find out what histology has come back with from my bad boob and my lymphnodes. There's every chance it could come back completely clear but there's always a chance that they find something nasty - an invasive cancer. Even if it's clear there's still a way to go with treatment - maybe radiotherapy but definitely tablets for 5 or 10 years since my cancer is fed by Oestrogen.

I feel sick to my stomach but I'm really trying to stay positive. Hopefully I will get some sleep tonight.