Prophylactic Mastectomy - Should I keep My Nipple?

So last week I went back to see my surgeon. We're really happy with the scarring and the overall shape I have with the expander in and Mr M says I'm ready to have the exchange surgery to switch from the hard bulky expander to an implant. At this point I raise the fact that I still want to go ahead with the prophylactic surgery on the 'healthy breast'. 

I can tell my my consultants face that he's against this and re-iterates the fact that it's not necessary. I explain that from Day 1, back in December when I got my diagnosis, I have always asked for them to take both breasts. It just isn't worth the risk for me. I have 2 children, I live for them, I'm not risking it. No way. Mr M says I will need to see the psychologist agan to get final approval. I explain I have already spent sometime with him and I know he will approve it.

Because I'm opting for the second mastectomy, the exchange surgery will need to wait. I now have a number of options to consider for the mastectomy surgery:

1. Lose the nipple
- this would mean I have to go through exactly the same process as before. When you have your nipple removed you have to have an expander to enable the skin to stretch. If I go ahead with this then I'll have mastectomy with expander,weekly fills up to 450cc as on the left side and then once complete and rested the exchange to implants will happen together to allow a better match.

If I go ahead with this option then there are more options of what I can do to look like I have nipples again. 3D areola tattoos, prosthetic 'stick on' nipples and I can even have flesh taken from elsewhere to make a nipple shape in place of those that I have lost that can be tattooed over too to give a realistic colour.

An example of customised nipple prosthesis.
Image: www.feelingwholeagain.com

2. Keep the nipple on the right breast
- this would leave me with 'odd' boobs and looking pretty much like I do now. One breast with a nipple and one without. I already know that this isn't the option for me, I want uniformity. I want to match both sides regardless of whether I have nipples or not.

3. Share the nipple
- this is something that I had actually read upon myself and decided to ask about. So, if I went ahead, I would keep my right nipple. It would remain in place after the mastectomy but at a later date (probably after the exchange surgery and during another day case under anaesthetic) my nipple would be split it in two and made in to two nipples. Half will remain on my right breast and the other transplanted and 'shared' on to the left side.

Keeping the nipple does leave me with a slight risk as there will still be a small amount of breast tissue that remains but given that my right breast is healthy, I am torn. There is a lot to think about. I just need to consider all of the options and do what is right for me.

Mr M explains that once Ive been approved my the psychologist he will go ahead an complete the operation for me. With regards to my nipple, I can just let him know my decision on the morning of the operation. I'm likely to be on the waiting list for 6 months to a year. Thank god I'm getting what I want finally!

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.