Amanda Returns Post Surgery: Here’s What She Wants You To Know
June 4, 2024
Abby Wambach:
Welcome. You do it.
Glennon Doyle:
You do it.
Abby Wambach:
No, no, I did it last time. It was not that great.
Glennon Doyle:
I thought it was great.
Amanda Doyle:
I’ll do it. I deserve to do it.
Glennon Doyle:
You deserve to do it.
Abby Wambach:
Okay you do it.
Glennon Doyle:
You of all people.
Amanda Doyle:
Welcome back. It’s a joy to say welcome back to We Can Do Hard Things.
Abby Wambach:
Why is it a joy, Sissy?
Amanda Doyle:
It’s a joy because I’ve been just army crawling and by that I mean not crawling at all just army me sitting my way through the past little bit and now I feel really good and I’m just so happy to be back in the saddle with the pod squad and y’all.
Abby Wambach:
Okay, so give us a timeline. Where are we in your process?
Glennon Doyle:
Just in case people haven’t listened to the previous episodes, which they shall.
Amanda Doyle:
Okay, so we did a couple of episodes a couple of weeks ago. We’ll put it in the show notes where we announced that I had received a diagnosis of breast cancer. They are episodes 309 and 310. So you can listen to those. And when we did that, it was, gosh, that was three weeks after I had learned about the diagnosis. It was really fresh. It was just three days after I had told anyone about it. And then I think about a week before the surgery and the surgery was a bilateral, which means both, mastectomy. So both of the breasts were removed and what we did was went direct to reconstruction and we can talk about what all of that means.
Okay. Pod squad, we in this episode are sharing a lot about what I’ve been through my diagnosis and surgery and treatment just as an explanation of what we’ve been through and what we have learned and seen. But we are obviously not doctors and none of this should be used to apply to your medical situation because every single person and prognosis is totally different. So we do want you to use this to reach out for good solid medical advice and get several opinions, not just one, but don’t include us as one of your medical opinions. We’re just here to cheer you on and love on you and give you some inspiration to go get your medical opinions.
We love you. Thank you. But as of recording this episode, it is now nine days after the mastectomies and reconstruction and where we are now is still before we have the pathology back that tells us what was actually in there when they removed it because that’s the only way to find out the full extent-
Abby Wambach:
Pathology is what, Sissy?
Glennon Doyle:
Yeah. Tell us what that means. What are we waiting for exactly?
Amanda Doyle:
Right. For some cancers, at least mine and maybe a lot more when they can see that it is there, but when they go into biopsy it’s really only checking one small area and so they can’t be totally sure of what is in all of the other areas of the breast tissue. So you can’t really find out the full extent of what type of cancer is there, how much of it, et cetera, until you actually remove all of the breast tissue, send it to pathologists who cut it up into many slides and really inspect it to say, okay, this is the kind of cancer in this, this is the kind of cancer in that and this is the percentage of the overall breast tissue that was taken over by the cancer. And then that leads to determining next steps.
Glennon Doyle:
Like what?
Amanda Doyle:
So next steps can be, and this can go back into as we talk about what is entailed in mastectomies because I really feel like I want to do this episode because it’s such an overwhelming learning curve and there’s so many different things to know If you’re looking at this process and trying to figure out what’s best for you during what is necessarily an extremely emotional time and it all happens very, very quickly.
So I would love to just let people know a very baseline so that they just feel like they know a little bit going into these conversations and also for people who are supporting people who are going through this because one in six women in America will have this disease and so we all either are going to be that person or know someone we love who is that person.
So anyway, the next steps are if lymph nodes were not removed in your original surgery, possibly removing lymph nodes, either some lymph nodes or all of them, we can get into what that means or radiation may be necessary or chemo may be necessary or some kinds of therapies and medications. So there’s a lot of, depending on if you are estrogen progesterone positive in your cancer, then you can do endocrine therapy, which is basically a pill for five years. It basically blocks the estrogen receptors that are on the cancer and make it less likely to be reproducing.
Glennon Doyle:
Okay, so let’s do what you just suggested. I was so incredibly grateful for the people we would all of our days, just Googling anyone who would tell us what to, who would talk about the mastectomies afterwards and just in service of wanting other people to have a little bit of comfort. It’s an emotional brain scramble and you can’t think and then it’s never been more important that you think clearly.
Amanda Doyle:
Yeah, that’s so tricky.
Abby Wambach:
And it’s very confusing. There’s a lot of elements to it that make it very complicated and to come down to the solution. So can you walk us back to the beginning and doctors types of doctors conversations, just give us the overall lay of the land.
Glennon Doyle:
Without feeling too much stress because we are going to have an expert come on and fill in the blanks for us. So I don’t want you to feel like this has to be the overall, but just whatever you want our people to know.
Amanda Doyle:
Yes, that’s so important to say. We are lining up an expert to talk about all of this, who does this every day of their lives to talk about it all in great detail. But this is the perspective of someone who’s fresh off the battlefield. What do I remember? You’re not going to write this in a textbook, but here’s where we are. So we were out of town when we got the call, the initial diagnosis over the phone, we back into town and the next day you two and Abby in to be with us because the we meeting with a surgeon. That leads me to my first, which I think may be the most important thing that we did in this process, which is making sure to talk to more than one doctor. We had an initial appointment with the surgeon. I am normally, I feel like very good at advocating for myself having a sensor for what could be better.
And we did that first appointment with the surgeon, it was overwhelming, it was scary. We got a lot of information and it was either that night or the next day and I was laying in bed just really, really overwhelmed and you called me, Glennon, and just basically said how comfortable did you feel with that person? What you think about that and you and Abby were both sharing, very gently, that you didn’t think that was the person.
I knew in my heart that that was true and when I got off the phone I just cried with relief because I know that I was in the level of exhaustion, emotional exhaustion knowing that I needed to do this quickly because cancer is not something you sit on and just research for a year to find the perfect person for you, you need to get it out, that’s important. And that I was just completely saturated and would not have been able to feel like what felt like starting over with someone else. And so I am so grateful that you were there for that. And I think when people say bring someone with you for their appointments, that is one of the reasons why that is so important. The emotional support is important. The writing down everything is so important, but having someone there who can be listening at a deeper level and who brings extra energy.
I know you patient don’t have the energy to even consider. It’s taking all of your energy to consider having to survive what they’re telling you you’re going to have to survive. And having to create the additional energy to say “No, wait, now I think I need to research another human who’s going to tell me all the things I need to do to survive”, it just feels like you can’t do that. So when you have people with you who can say, “Let’s take a step back, let’s think through this, do we have all the information? Do we have the right people that we need?” Because my procedure would have been a completely different procedure at every step if we had gone with that original person.
And so I am just so, so grateful that you were there, that you pushed me to get a second opinion and that you cultivated the bandwidth to be like we can do this and to show me that way because I didn’t have the bandwidth to do that.
Glennon Doyle:
If I’m listening right now, I’m thinking what was it that you in your gut, when we said are you sure that’s the right person? And you recognized that as that as true, what do you think it was? Because I think people, it is so hard. It’s like listening to people who are supposed to be experts and then are you even allowed to have your own knowing or your own opinion? So what was it?
Amanda Doyle:
It was a few levels of it. Some of them were more in black and white, some of them were just the feeling of, there was a couple times in the conversation where I would say, well what about X? And then the doctor would say, “Well actually that’s a good point. Maybe we should do X.” And it completely panicked me at the deepest level of me because I was like, I need to be able to be the patient. I can’t be the patient and the doctor and the lawyer for the patient who’s representing the doctor in me. I need to be able to be, I know I have to be a patient and an advocating for myself patient, but I can’t think that I am in any way directing this.
Glennon Doyle:
Exactly.
Amanda Doyle:
I need to have one of my concerns addressed. I need to have one of my questions answered, but I can’t be a co-director of this process. I need to know that you are captaining this ship. That was the kind of feeling about it. But then the black and white issues were later that surgeon had ordered a non-nipple sparing mastectomy off the bat and said that the cancer was too close to the nipple to save it. And I said, okay, I understand. And then we actually ended up meeting with four surgeons. So the three surgeons after that were all clear that we were going to at least try a nipple sparing mastectomy, not clear whether we would be effective in that, in terms of after the fact, after the pathology came back, it might reveal that the cancer was too close to the nipple and it was too risky and we needed to remove it, but that we should certainly start with nipple sparing to see if we could. And so I would have lost both of my nipples if I had just agreed without finding more information.
This is not to be accusatory to this person. This is about if you take one person’s perspective as gospel in a medical situation, you’re just getting one person’s perspective. It’s not just capital T truth. You have to get a selection of truths and then end up where you want to end up there. And then when I brought that back to that surgeon and said, “Well what do you think of this because they’re saying we can do nipple sparing.” They said, “Well, when I said that we couldn’t spare your nipple, you didn’t seem very upset about that. So I just let it go.”
And so that is a problem in the medical world. I was trying to be a mature adult person, handle the information that was processed to me, deal with it and move along. And there may be people that are telling you the way that would be easiest to do and then they’re gauging your response to that to see if that is palatable to you and that is not. You need to be with someone who their priority is to save all the parts of your body unless it’s absolutely necessary that you lose them and not be deciding do you get to save the parts of your body based on whether that really, really upsets you or not.
Glennon Doyle:
It’s really something. It’s really something, that was very upsetting.
Amanda Doyle:
Yeah, so I think both of those made it totally clear that wasn’t what we were doing.
Abby Wambach:
And for you to have gone and done all this research to actually get this diagnosis, it’s like you put your trust in this person who helped you discover this thing and then the trust that they have in the next doctor and the next doctor. It was a really hard thing for you to have to manage emotionally saying to your first doctor, “I don’t know if this surgeon is really it”, because it’s like there’s this human thing that happens that if people are non-confrontational, if people just want to go with the flow, get the cancer out as fast as possible, these things are so important. I just want to say how brave it was of you to advocate for yourself and granted you had people like us and we had people in the wings helping us manage this.
This is not just because we thought of this idea. We had people we were talking to. I just want to say that because I think there are a lot of people listening to this that might relate to some circumstance that they’re just going to like, “Well this is what the doctor says and the doctors know everything”, and it’s like you got to feel good and strong and that your doctor has your back.
Glennon Doyle:
And to preface all of this by saying, what we discovered is it’s not like when you get your car fixed. In general, there’s a way that if you take your car to any place, they’re going to fix your carburetor in the same way, there’s some kind of manual and they all just try to stick to the best recent carburetor situation. That is not how this works. We were stunned. Every single surgeon had an absolutely different-
Abby Wambach:
Approach.
Glennon Doyle:
Belief in what was best approach, sometimes drastically different, sometimes contradicting each other. So that’s the terror of this is you have to decide who you believe the most.
Abby Wambach:
Crazy.
Glennon Doyle:
You’re not just finding the best.
Amanda Doyle:
Yes, although it becomes a Venn diagram and you might have one that the circle is not even on the page, but when I started to have a lot of confidence is when the circles overlapped in the middle in the core things I cared about and then you can make, I ended up just making a chart. Here are the key differentiators between these two surgeons that I have narrowed it down to and here’s the three things that differentiates them. Do I care about these things? Asking the oncologist what they thought about these three things and then ending up with the person that you end up with.
But I will say I was very nervous about asking for a second opinion, which I’m embarrassed by how nervous I was. That is not my view of myself, but I’m saying it honestly to say that if I was super nervous and embarrassed, I’ve got to think a lot of people might be just frozen with the idea of doing that. And I have to say that it was received so graciously.
Glennon Doyle:
Yes.
Amanda Doyle:
I was almost like, oh wait, they’re just waiting for you to say this. They know that this is the best thing. All the doctors know that if it were them or someone they loved, they would absolutely be doing a second opinion. So when you ask for it, they’re like, “Good call. You’re one of the smart ones.” There was no balking and if there were to have been some kind of reluctance to allow you to do that, then that should be a key indicator for you, don’t do it.
So when I wrote, I actually wrote something that was basically like if you’re nervous about doing it, you can write it something like this. But it was basically like I really hope you won’t take this anything other than what I feel like I need to do for what is to me a very scary time, but I am going to request files for second opinion as learn more about this and the surgeries and reconstruction and all of it. It feels like a very big deal and I have always advised everyone I know to in cases of big deals get a second opinion.
So I’m very, very grateful and I just feel like it’s the right thing to do. So I want to make sure you knew that when you saw my request in the chart for all my files so you would know the context. So thank you so much. I did it like that. And they were like, “Absolutely, of course I totally support second opinions you need to do this.” So then you just write to all your doctors and say, I need all of my files sent to this person, the new person that you’re trying to get.
Abby Wambach:
The second opinion or third opinion or fourth opinion.
Amanda Doyle:
Right, exactly. So that is the number one thing I would say you need to do. Bring people who have emotional sturdiness to the appointment with you who have the capacity to not be so overwhelmed by their fear for you that they can retain a margin to maybe think a little higher up, not in the weeds of it. So you bring people to help support you emotionally, to write everything down. You also in the appointments, record them on a audio on your phone. What’s the app called?
Abby Wambach:
Voice memo app.
Amanda Doyle:
The voice memo app. And no one had any feelings about that. It was like you were recording on a voice memo app so that we can remember the things you say because as much as you have the person writing everything down, you will forget things.
Abby Wambach:
We had to go back and listen a lot and somebody actually told us that 50% of what’s said in a doctor’s meeting is missed.
Amanda Doyle:
And the three of us, we’d come out and be like, “I remember it this way.” “No, I remember it this way.” You’re putting your particular spin in your head on everything that you hear. So it’s really important to have that. So when you go into your appointments emotional support person, person who’s writing things down, one of those people has to have enough bandwidth to be able to take a step back. You also record everything.
Glennon Doyle:
And then if you record everything, if you don’t have somebody there because now I’m just thinking like, oh my god-
Abby Wambach:
The solo person.
Glennon Doyle:
People who don’t have somebody with them. The voice memo can help that because if you’re alone and you go into these meetings, you’re going to be a certain person in that waiting room. You’re going to be scared. You’re going to be not filtering exactly. You voice memo it and then the person with you who’s going to help you think this through and have a different capacity is going to be you, but the next day. So it’s like you can listen with your more fortified self the next day and offer that support to yourself.
Abby Wambach:
Yeah, we referenced the voice memos a lot. I’d just be like, “Oh, what was, okay, let me find it.”
Amanda Doyle:
And if you’re a person can’t be there, but it’s far away, you can send them to them and ask them to listen. Also, your person doesn’t need to be the closest person to you. In fact, I think in some ways if you have someone who cares about you and is willing to go to the appointments but is not emotionally overwhelmed by this, they might actually be a stronger person to be in there and listening with clarity and precision to what’s happening. So it doesn’t have to be your best friend or closest person to you to do that.
The second thing with regard to all of this is you will have likely a lot of radiology, whether they’re mammograms or MRIs or whatever, it’s so old school in a lot of ways that they still have these on discs. You want to ask whoever the radiology department service you’re working with to put all of your images on a disc and you actually want to get a couple of those discs and then you want to go pick them up. Because what often happens is when you’re getting these second opinions, they only send the reports and the reports, in my case also the report did not accurately represent the images that existed. So my second opinions needed to actually see the images themselves and not just the reports. So that is something that we learned pretty late in the process. So during this process, make sure to get all your images, you bring them on a disc, you give them to the person that’s giving you the second opinion, you get it back from them after.
So what we ended up doing, my surgeon ended up being Dr. Lucy De La Cruz who is the Chief of Breast Surgery at Georgetown Hospital in dc. We ended up doing a nipple sparing bilateral mastectomy. So again, there’s so many different kinds of mastectomies and especially when you go into the reconstruction phase, there’s a bunch of different types of reconstruction also. So basically they cut under the breast, which is called an inter mammary flap or whatever. They make the incision right under the breast kind of where an underwire bra would be. They go in, they cut all of the breast tissue out. In my case, they had to go very, very close to the nipple because the cancer was really close to the nipple, which is why some were concerned about the ability to even try to do a nipple sparing. So they cut it all out and they did it on both sides and took out the breast tissue.
In some cases you can’t have nipple sparing and so they will actually cut around the areola and the nipple. In some cases some surgeons are able to, I worked with Dr. Fann for my reconstruction who’s a plastic surgeon. Some surgeons are able to do nerve sparing where they attempt to, and I should back up and say that something that is not talked about a lot, which is because women’s sexuality is so invisible that it’s an afterthought that is sometimes not even mentioned to people before mastectomies, is that you lose all feeling in your breast and your nipple. So some people are totally numb as if you have anesthesia where you can’t feel anything. 80% of people with mastectomies are numb for their lifetime. There’s new work that is being done now, which is nerve grafting where they try to take your existing nerve and use grafting with cadaver nerves to try to reconnect it.
I had that done. It is of limited efficacy. They’re not sure that it is going to work, but it’s advancing all the time. So that is something to ask about and to ask your surgeon as to whether that’s something that they do and what their success has been and it is covered by almost all insurances. So ask about that and make sure that you’re not being upsold as if that is an extra thing you can buy because some surgeons I met with did try to sell it as that, not the surgeons I ended up with.
Glennon Doyle:
And that’s another thing that if you don’t bring that as a priority-
Amanda Doyle:
Exactly,
Glennon Doyle:
They could later say, “Oh, we just didn’t think you cared that much about your sensitivity because you didn’t bring it up.” So I believe fully that if this were a male situation that the feeling, people would not be like, “Oh, we just didn’t know you were the kind of guy that cared if your penis had feeling.” I think that would, but for women, you actually have to be tell them that you care about your body parts and that you care about feeling. Not saying that you’ll get to keep either of them because maybe your situation requires you not to, but what you assume they would assume is not necessarily true. You have to say, “I care about my body parts and sensation.” If you do, if you do.
Amanda Doyle:
And there’s a thousand different types of people and priorities, but nipple sparing, nerve preserving, all of these things are things you just need to ask point-blank about. And also what was a comfort to me is that it felt like my overriding priority is to be as aggressive as possible to get every minute iota of cancer out of my system. And so that, if that’s the overarching goal, you are like, okay, I’m willing to do whatever. I’m willing to do whatever to make sure that that goal is met. And I think what gave me great comfort is when I was meeting with people who are like, yes, that’s absolutely what we’re going to do and we can try to save these things and determine whether they’re actually at odds with each other. Whereas some people are like, “Yeah, get of all of it from go because this is your goal.”
Whereas Dr. De La Cruz was like, yes, we will find out, we’re not getting rid of your nipple just because we fear that it might have cancer in it. What we’re going to do is scrape every bit of surface out and we’re going to test the tissue that is right up against the nipple and if it has any cancer in it, we will then go back and remove your nipple. But if it doesn’t have cancer in it, then we’ve confirmed that keeping your nipple is not at odds with your overarching goal of taking every little bit of cancer out.”
That to me, where you can get to the place where it’s data driven, where there’s the capacity to confirm fear or eliminate fear is where I felt most comfortable, because fear and uncertainty can be a very blunt instrument if it’s used too early. And the doctors that I really relied upon were those that were like, “Yes, and we can confirm whether that is in fact true and then we can make our decisions based on it.” So that was a key part of the surgery. And it also related to another thing that folks who are going through this will run into, which has to do with the lymph nodes. So I had one enlarged lymph node prior to the surgery that was biopsied and did not find any cancer in it, which was so wonderful, but it did not mean that all of the lymph nodes don’t have cancer in them.
Glennon Doyle:
Can you explain to us why? Because now I understand this so well, but a month and a half ago I had no fricking idea why we’d be testing lymph nodes.
Amanda Doyle:
Yes. Okay. So lymph nodes are, they’re basically a drainage system put very, very simply, of your body. So a lot flows through there it drains through. Very, very important part of our whole body. The lymph nodes that are under your armpit are the first drainage site in effect of breast cancer. So as a breast cancer is going to move into the rest of your body, it traditionally flows through the lymph nodes. So that is why it’s like if you think of it as, okay, the cancer’s inside your house, that’s your breast, is it stepping outside and going to infiltrate everywhere else? It’s going down these first steps before it goes out into the world into the rest of your body. So the lymph nodes are those kind of stepping stones in your yard and the first stepping stone is called the sentinel lymph nodes. So in a lot of surgeries they have, it’s called sentinel lymph node biopsy.
That often happens right off the bat in every mastectomy we’re taking the breast and we’re also taking your sentinel lymph nodes. What that means is every woman’s lymph node system is different, but everyone has that first stepping stone and it can either be one lymph node, two lymph nodes or three lymph nodes or more, but the average is one through three. So as it’s draining out of your breast, it starts to either fill up one lymph node or it is filling all three gradually. But that’s the first stepping stone. So there are ways to trace, this is very new technology, which is amazing, they used to have to go in and take out every lymph node, but now they identify during your procedure, identify the sentinel lymph nodes and often a lot of surgeons will just go in and preempt. They just take out those lymph nodes because they know if there’s any threat that it’s coming outside of the breast, we want to just get rid of the sentinel lymph nodes.
Then they can look at the sentinel lymph nodes and say, is there cancer in these? If there is, okay, we’re going back and we’re taking all the lymph nodes, which are called the axillary lymph nodes. So that’s that. The important thing is that once you take out the breasts, you lose the ability to track what are the sentinel lymph nodes and what aren’t. So that’s your one shot to know which the sentinel lymph nodes are. So you either identify them in surgery and you take them out, or you do what I did, which is in the surgery you add this thing called Magtracer, which is a dye that’s put in that identifies the sentinel lymph nodes and says, okay, these are your one, two or three sentinel lymph nodes. It stays dyed like that, identified like that, for up to six weeks so that you can wait until your pathology comes back, find out, okay, how much of invasive cancer are we seeing? Do we feel like it’s likely in the lymph nodes? And then you can go in know which the sentinel lymph nodes are and take them out after.
Both approaches are good and smart and reasonable. And that’s a personal choice. I liked the verify a step at a time. Lymph nodes are again a part of your body and lymphedema happens in 20% of the cases and it’s not awesome. So anyway, that’s what we did. But having the Magtrace in there is important to identify the lymph nodes to know that would be your first step to take out.
Glennon Doyle:
Yeah, so lymphedema is the thing that could happen if you take the lymph nodes out.
One of the things we kept learning was going in and just our first thoughts just do the most aggressive thing possible, get it all out, which I’m sure is a lot of people’s instinct.
Abby Wambach:
Instinct, yeah.
Glennon Doyle:
What we kept learning was that okay, but there’s consequences to every decision. So there’s no obvious most aggressive thing because if you do the most aggressive thing, you might have the most aggressive consequences of that thing. So it’s always a balance and that’s why you liked the verify with data at each point. Now for the pod squad newbies, if it’s not in the lymph nodes, if there’s no trace at the end of the day in the pathology that there’s any of this cancer in the lymph nodes, then that means for sure that this cancer they’ve identified in your breast did not travel outside because it has to go through the lymph nodes. Am I saying that right?
Amanda Doyle:
So different people have different perspectives on that. It’s just minute little cancers that you could miss wherever and invasive cancer has been determined to be a chronic disease. There’s no way to know 100% for certain that that is the case, but this is the way that it’s done. In the case of invasive cancer, there’s always, even if they don’t take out a lymph node because it isn’t found there, they often do endocrine therapy, other therapies to be like, we are just making sure that any little baby cancer’s in there, we are making it the least hospitable environment for them. So it isn’t necessarily totally done, but that’s every case that is different, every case is different. So it’s really hard to, and I want to be careful not to feel like we’re making any blanket pronouncements of this is a really clear decision tree if X, then Y, because it really, really depends a lot on your specifics, your family history, your margins, your age, the type of cancer they find there, how aggressive it is, how nonaggressive it is. It’s very, very different for every person.
Abby Wambach:
So let’s take us back to the different process of deciding, because I know that in the surgery that you had the bilateral mastectomy, you had the ability to go straight to reconstruction and I know not many women do. Can you tell us a little bit about the process?
Amanda Doyle:
Yes, so reconstruction, so the decisions about reconstruction are, there’s a lot of different kinds. You can go flat, you can have all your tissue removed and just have this nice clean, flat situation. If you have seen Tig Notaro’s stand up, you have seen how beautiful that is. And by the way, the last week I have been a total immersion program on Tig Notaro. I’m so obsessed with her. I can’t stop. Anyway, I’ve started being like Stephanie and putting all my hair on one side because-
Glennon Doyle:
Yes, Stephanie.
Amanda Doyle:
I just feel like I have a little bit of Stephanie in me when I put it all on one side. Like this.
Glennon Doyle:
I was texting Tig when you went into your mastectomy.
Amanda Doyle:
Oh really?
Glennon Doyle:
I was texting Tig.
Amanda Doyle:
Oh god, I just loved, I mean their standup that week, they found out about their situation. I listened to it twice.
Glennon Doyle:
Watch the Tig documentary, people. Pod squad. If you don’t know what we’re talking about, watch the Tig documentary.
Abby Wambach:
She’s amazing.
Amanda Doyle:
And the standup is Tig Live.
Glennon Doyle:
Tig Notaro Live.
Amanda Doyle:
Yes. That’s her famous standup. She did the week she found out, and then the documentary is so good. Everything that they do is so good.
Glennon Doyle:
Okay, go ahead. Sorry. It was a Tig digression.
Amanda Doyle:
Anyway, that’s the flat. Then most people have delayed construction with what’s called expanders. So the idea, you go in for your mastectomy, you often go home the same day, which is wild, but you have the mastectomy and then they put in what are expanders, which are essentially like empty implants and what they’re doing is trying to stretch and preserve the skin of the breast because we need to keep the skin alive in order to reconstruct the breast if you are not going flat. So they slowly throughout your checkups, blow up these little implants to expand and prepare the breast for your eventual reconstruction. That is a process that you tend to have three months between your mastectomy and when you would go get your reconstruction. So there’s two recoveries for it. People have different feelings about it. There’s some pros to that, which is that if you’re planning to go with bigger breasts, then you had before the surgery, the expanders can be helpful to that.
You can slowly stretch your skin to accommodate a larger implant, so that’s great. Also, some surgeons, that’s just what they do and they don’t do anything else. You can become a straight to reconstruction candidate if you don’t want to go bigger than what your current skin can accommodate. Straight to reconstruction doesn’t work, and I’m not exactly sure why, if you have larger breasts is my understanding. There’s also a third type of reconstruction, which is using, not implants, but using your own tissue. It’s called deep flap. It’s a more intensive surgery, but it’s cool in a lot of ways because you don’t have a foreign substance in your body. It’s all your own tissue, so you don’t have the threat of, a lot of people have autoimmune responses to foreign substances in their body and it’s all your own tissue. Then your body will react naturally to if you gain weight, your breasts actually gain weight.
If you lose weight, your breasts actually lose weight because it’s your own tissue. So it’s so cool that the body could do that and that often ends up being from people’s bellies and stuff where they end up getting basically a tummy tuck because they take the tissue from their bellies and they put it in their breasts and then they get a tummy tuck and then that’s their deal. I was not a candidate for that because I didn’t have the tissue that they needed to do that. So what they did for me is they took out the breasts and they immediately did the nerve work, put in implants that ended up being the same as my breasts, stitched me up and that was the surgery. Which is crazy town because it was, what was it, like two and a half hours or something?
Glennon Doyle:
Yeah. I’m wondering if you would allow us to stop here because this has been so helpful to get us up to Mastectomy day. I’m wondering if we could stop and then we could start the next episode. Everyone’s going to want to know, I think, what was mastectomy day like and what do you wish people to know and what do you wish people who are supporting people know, all of that. So would you allow us to come back and discuss that?
Amanda Doyle:
Totally.
Glennon Doyle:
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We Can Do Hard Things is created and hosted by Glennon Doyle, Abby Wambach and Amanda Doyle in partnership with Odyssey. Our executive producer is Jenna Weiss-Berman. This show is produced by Lauren LoGrasso, Allison Schott, Dina Kleiner and Bill Schultz. I give you Tish Melton and Brandi Carlisle.
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