I feel I’m on a long road. I thought I could see the end. But, it’s not over yet.
Last week, on Thursday the 21st April, which is exactly four years and two months to the day since I was diagnosed with breast cancer, I was in hospital for what I hope is my last surgery for breast cancer. My seventh operation. A nipple reconstruction. This will be the third plastic surgery operation, and I am feeling the usual combination of nerves and excitement. Because mostly surgery is about taking things away, but these reconstructive surgeries are about giving me something back. But I am strangely more nervous than any of my other surgeries, because this one is ‘only’ a local anaesthetic. That means I’ll walk into the operating theatre, I’ll see all the staff and the equipment, and I feel nervous about that. But I’ve been pretty low key during the run up to the surgery saying, ‘Well, you know it’s only a local.’
So it’s ‘only’ a local, it’s ‘only’ a nipple, it’s ‘only’ minor surgery. Well, I think I’m coming to realise that nothing is ‘only’ in cancer treatment.
Since I was last there the hospital have moved into a brand new building. It’s clean, modern, the ward is spacious. The windows are open to the lovely spring day and it feels exactly like healthcare should feel. Ronnie leaves me and I sit and wait.
The usual round of checks happen. But they are much less than my other surgeries, for a general anaesthetic. I tell the nurses that I feel nervous. I’m given my gown and then my surgeon’s registrar, Kate, comes to see me. We spend a long time with a tape measure and a pen marking out the exact placement of the nipple and I feel fine about that. Except I am now sweating profusely, I have to go and wipe myself with a towel. And I still feel nervous. I distract myself playing Osmos on my iPhone.
Ken Graham, my surgeon comes to see me, I am totally confident in him and it’s good to see him. He checks the position we’ve agreed and then, using my silicone nipple as a template, confidently draws in black pen the edge of my nipple. The silicone nipple is marked with black too, but it doesn’t matter I think, because I won’t need it after today.
And then it’s time and a nurse comes and walks me down to theatre. We walk in to the pre-theatre room and I am handed over to my surgical team. I still feel extremely nervous. They are smiling and friendly, obviously this is just a normal day for them. This is as far as I’ve been before, I’ve always had an anaesthetic here, and then woken up in a recovery room.
As I am shown through the doors into the theatre my head is practically swivelling in all directions. The room is enormous. I mean really, much bigger than I had imagined. And ‘theatre’ is the right word, there are a cast of players, all suited up in blue, all busy doing things in different parts of the room. ‘I’ve never been in a theatre before,’ I say in amazement.
I get up onto the bed and lie down. They cover me with a blanket and start, it’s an extremely well choreographed and well rehearsed routine they have. They chat to me, but nothing is making me feel any more relaxed. ‘Is this music OK?’ asks Kate. ‘I can’t hear any music,’ I say. The lights above the bed are bright but not glaring, shiney collections of silver, blue and green balls, like Christmas baubles. And above me and around me all these pairs of eyes, with surgical masks and hats.
They continue very politely chatting to me. My breasts are uncovered, and my right breast is doused in that cold brown liquid, and then the anaesthetic is prepared. I see the needle, which is huge, and look away and clutch onto the hands that have appeared next to mine at the edge of the bed. It doesn’t hurt, it’s just seeing the equipment is vaguely terrifying to me.
Then they proceed to cover up the rest of me with sterile blue sheets, leaving just my right breast exposed. I’m trying not to look, trying to disengage myself. I can feel hands on my body placing things down. And finally a folded sheet is placed across my chest under my chin and then pulled up like a concertina so that I can’t see the surgical area. And it’s suddenly too much. I make a sound, I’m not even sure what noise it is and my whole body feels absolutely rigid.
I hear Ken speaking from behind the screen. ‘Sarah do you want to stop now and I can do this next week with a general anaesthetic?’ He has sensed my anxiety. My answer? I can’t speak, I just burst into tears. Not just a ‘trickle from the corner of my eye rolling onto the pillow’ type crying, but deep heavy sobbing that leaves me unable to speak. That is obviously answer enough, and the next thing I know everything surgical disappears and I am lying as I was under the white cotton blanket.
Ken is standing next to me, touching my shoulder. ‘I’m sorry,’ he says, ‘I should have realised that you were so nervous. I didn’t want you to be upset. I’m sorry.’
Everyone is so nice to me, so concerned. They say it happens, that some patients just can’t do this without a full anaesthetic. I try to put my legs onto the floor. ‘I can’t,’ I say. I look at my legs, and they are shaking. Ken asks someone to arrange a ‘chair’ for me. So I am wheeled back to the ward, clutching my notes, feeling like a complete failure.
Three people from my surgical team come to see me again, they are now in ‘normal’ clothes and I nearly don’t recognise them. No masks or hats. I say that I know other women have had this surgery and they actually watched it being done. ‘But they aren’t you,’ they reassure me. ‘You’ve been through so much, this was just not right for you.’ They tell me that it’s OK and that they will see me next time.
I started the day weary, but mildly excited that I was nearly at the end. How did it get from that to a sad Sarah in a surgery gown trying to clean off the black pen from my silicone nipple using an alcohol wipe? My right breast now bruised from the needle, and that’s how I feel. A bruised and delicate failure.
But now, I realise, trying to find something good out of the situation, now I have a choice. Knowing that I was ‘only’ having a local anaesthetic, I had opted for the nipple reconstruction that involved using skin on the breast mound, which creates a nipple bud, but then needs tattooing at a later date to add colour and an appearance of the areola. There are other ways to reconstruct a nipple which use skin from a donor site, usually the inner thigh, but it didn’t really appeal to me with a local anaesthetic. However, if it were done that way the skin would be darker, and I might not then need the tattoo, and also possibly repeated tattoos if the colour fades. Having seen my reaction to this ‘minor’ surgery, I can’t now imagine how I would react to the many needles of getting a tattoo done.
So. Another choice. I’d really like to hear from any one with their experiences of a surgical nipple and which option you chose. I’m also particularly concerned about the pain in the donor site, the inner thigh, and how that healed. It would be great if you could tell me about your nipples…. sorry but that’s the only way to ask really.