Breastfeeding and Breast Cancer Blog

From breastfeeding to being diagnosed with breast cancer and then back to breastfeeding. This is an account of my experiences.

Wednesday, February 7, 2007

The First Surgery

The First Surgery was my first surgery.  The hardest part of this cancer journey was the fact that I had a nursing child in my life.  I'm sure cancer on it's own is not easy, but knowing that things going with my body were also having an impact on my child made it harder.

I had decided to back off my nursing on the one breast.  I figured that less milk for the surgeon would be a welcome thing.  Also if my breast was going to be very sore after surgery, I probably wouldn't want to nurse on it.

Before surgery, radioactive dye is injected into the breast surrounding the tumor.  It needs to go in at least four hours before surgery.  The dye travels the same path as the cancer might and goes toward the lymph nodes.  The surgeon looks for the “hot spots” and removes those nodes.  Many surgeons like to give the radioactive dye the day before surgery, except if surgery is scheduled for Mondays.  I hung onto that concept and even though mine was on a Wednesday, I opted to have the dye placed that morning.  The amount of dye is very small, but I was cautious about the drug being in my body and nursing Sydney.  One half life is six hours and I didn’t want that interfering with going to bed the night before surgery!  After all the details were worked out for surgery, drugs, timing…we were set to go!

I arrived at about 8:30am at the hospital for the radioactive dye.  They were aware that I was breastfeeding and “reminded” me that I should abstain for three days.  I attempted to argue with the tech because I feel that information is not correct and certainly didn’t jive with the information I had gleaned from my research.  Finally I decided not to argue, but did feel pretty upset about the encounter and it was not a great way to start the day.  I received five injections of dye at different angles around the tumor.  I had read that it burns receiving the dye and it does, but it was ok.  They were impressed with my performance and sent me on my way.

The Breast Clinic was my next stop.  At different stages my lump was more palatable than others.  The last time I saw the surgeon I was in the process of weaning from that one side and it was feeling a little funny.  The surgeon could not easily find my lump, so he asked that I have a wire inserted into the lump pre-surgery and left inside for him as a marker.  At the day of surgery, the lump felt more like marble than the dried pea it had started out as, but we went ahead and used the wire – there would be no mistakes in removing tissue.  I saw the radiologist and tech who I’d seen before at my many visits to the breast clinic.  Using ultrasound the lump was found and did appear bigger than before.  They were going to use the anesthetic lidocaine for the insertion.  I knew for my surgery I was getting lidocaine and there is a limit a person can have.  I asked if it was really needed and maybe it wasn’t.  So I opted for no lidocaine and the wire was inserted.  It is a fine almost soft wire that could be bent over and taped against my skin.  Afterwards I had a gentle mammogram to document the wire.  After the tissue is removed, it is x-rayed again and the wire position is verified again.

Immediately afterwards we’re off to the hospital!  My nursing toddler and husband had accompanied me to my morning appointments, so first we needed to drop my toddler off with my parents.

At the hospital I was hurried into an exam area.  Apparently my surgeon often runs ahead of schedule and he was that day also.  I have a friend who is an anesthesiologist and offered to be at my surgery.  He was waiting for me and made many aspects of the day more pleasant.  I had felt early on that I did not want general anesthesia for the surgery.  I had been poked and had core needle biopsies, fine needle biopsies, had more mammograms than I care to admit…and now they wanted to remove some tissue from the same area and put me under? I didn’t want that.  So my surgeon thought, ok, we can try this, but I don’t think he felt confident about me being awake.  The anesthesiologist had suggested a block for the surgery and at the time that sounded like a great idea.  Unfortunately, the block did not work for me and even gave me some strange side effects.  It is likely the entire procedure was done using local injections of lidocaine. 

I had a pregnancy test, blood work, IV inserted, blood pressure a couple times, temperature….

I was brought into surgery and asked to move onto a very narrow “bed.”  I got up and started to climb over and everyone freaked out!  The anesthesiologist assured them that I hadn’t had any sedation.  I guess they were worried about me falling.  I got into the right position and the surgeon told me he’d have to watch what he said because I was awake.  I wondered what kinds of things are normally discussed…  Some propafol was on hand in case I changed my mind about sedation and wanted to leave on some level.  I was assured that there are many different levels of sedation and I didn’t need to be totally out with a breathing tube. 

I had asked the surgeon to only use blue dye for the sentinel lymph node biopsy if necessary.  If the radioactive dye did its job, he wouldn’t need the blue dye for extra verification.  The blue dye often stays in the blood stream for 24 hours or more.  I just couldn’t find enough information about it to feel good about nursing with that in my system.

After being draped and cleaned and having my arm wrapped in a funny way they were ready to start.  My arm was wrapped so the surgeon could hold onto it easily and drape it up, down, on him and other ways I’m not even sure!  It felt like it was being supported most of the time.  I couldn’t see much because there was a blue drape in my face, but I could look to the side and see the anesthesiologist and also the door to surgery.  The door actually has a window in it, so I could look out and see people moving about the hallways.  The door was even opened a bunch of times and one nurse came and went.  The anesthesiologist had brought music for me to listen to and he also chatted with me the whole time.  I could ask about what was happening and he gave me updates too. 

The first procedure is the sentinel lymph node biopsy.  Two “hot spots” were located with a geiger counter from the radioactive dye.  He noted I had a very active lymphatic system.  I hope that’s a good thing!  The cutting is done with a cauterizer and it stinks.  There’s a burning smell and smoke.  At one point the surgeon coughed and coughed.  The anesthesiologist told me that using the cauterizer/cutter is like smoking for the surgeon.  That part was not so bad.  I felt some pulling and discomfort, but I was pretty well numbed.

After opening and removing the first lymph nodes, the surgeon moved onto the breast.  He had seen the wire and also marked me up.  Instead of a simple line, he had made a wedge shape which would change my procedure from a lumpectomy to a partial mastectomy.  The cutting and removal went pretty well.  There were a couple times that I actually jumped because a nerve was hit.  More lidocaine was injected.  At one point they needed to go and get more and calculated how much more I could actually get.  Too much can be toxic.

The breast tissue was taken off to radiology for the x-ray.  The nodes I did see.  They were like little balls of pink tissue.  

2 weeks post op
I was than sutured up.  I needed more lidocaine at the armpit (where the lymph nodes were removed) during suturing.  When everything was done, a nurse walked towards me with a large ace bandage.  I asked her what it was for, thinking it was to bind my breasts.  Quickly I informed her that I couldn’t have my left breast bound.  She hurried off to speak with the surgeon and never spoke to me about it again.  I think normally this would occur while a patient was under anesthesia.

After surgery I went back to recovery.  They took my blood pressure and I went to the bathroom.  I got juice and graham crackers, ice packs, tylenol and waited around for someone to tell me I could go.  They didn’t really know what to do with me.  I hadn’t had sedation, just a bit of benedryl to stave off any histamine reactions to surgery.  So after a very short time we left.  My husband had been brought right in to see me after surgery and the surgeon came by to tell us together that everything had gone well.  The surgery took about 1 ½ hours and the whole surgery experience took about 3 ½ hours.  This doesn’t count the pre-surgery running around.  That took about 3 hours.

Often a quick frozen section test is done on the lymph nodes removed during surgery.  If there is cancer found in those lymph nodes, more lymph nodes are taken.  I didn’t want to risk having more lymph nodes taken, especially because the frozen section test isn’t as reliable as the paraffin section tests.  I guess there aren’t too many false positives, but there are some false negatives.  I just wanted things done right the first time.  So I would wait for the test results.

My husband and I drove to my parents to get my daughter and I called my mother-in-law who had picked my son up from school and had him at our house.  At my parents house I did pump a bit of milk for comfort and also to have less milk available for my daughter because of the radioactive dye.  After a meal and some visiting, we headed home to see my son.  I had been icing the two areas and taking Tylenol.  I did feel some discomfort, but it was all pretty tolerable.  My daughter did resume nursing regularly after the surgery on the unaffected side until chemo decisions were being made.

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