Cancer Lesson #75: Tittoo Defined

Cancer Lesson #75: Tittoo Defined
Warning: This post may be a little TMI for some readers.
Tittoo: [ti-too]  verb, –tooed, -tooing, noun, plural -toos
verb: to color a reconstructed nipple by puncturing the skin and infusing dyes.
: 1. procedure used to color the nipple on a reconstructed breast,
2. reconstructed nipple that has been colored by puncturing the skin and infusing dyes.

Sample Sentences
Verb: Part of the physician’s assistant’s job was to tittoo the breast cancer patients who had undergone reconstructive surgery.
Noun: Wow! My tittoo didn’t hurt at all — not like the tramp stamp I got in Vegas when I turned twenty-one.


Cancer Lesson #73: Being Treated for Breast Cancer Expands Your Undergarment Wardrobe.

Cancer Lesson #73: Being treated for breast cancer expands your undergarment wardrobe.

Sorry, guys. I’m not talking Victoria’s Secret. Think Bridget Jones’s granny panties.

You see, while having tissue relocated from stomach to chest leaves a flatter stomach (Yay!), it also weakens the abdominal muscles (Boo!)

Hence, the temporary need for support knickers, aka “granny panties.”

For several weeks – or was it months? – these lovely undies were accessorized by a cotton contrivance of a brassiere with thick straps and Velcro closures. Sexy, this bra was not.

For a long time, even wearing a sports bra was painful because of my scars so I resorted to camisoles, and not the alluring lacy ones the word calls to mind. Mine were more like tank tops with lycra. Not bad, but definitely not the come-hither attire of a siren.

Then I had my “reconstruction revision procedure.” How’s that for a medical euphemism? (See Cancer Lesson #43 “A Glossary” for more and #57 “Sets Don’t Have to Match” to add to your breast vocabulary.)

Happily, the anesthesiologist knocked me out for the procedure. Unhappily, I work up wearing yet another surgical bra.

Sigh. I put on my big girl panties and got on with it.

Addendum: I would be remiss if I closed without sharing a link to “Otto Titsling” sung by Bette Midler. If you’ve never heard this paean to the subject of female support, click through and enjoy.

Cancer Lesson #24: A day you can’t remember could become one you’ll never forget.

Cancer Lesson #24: A day you can’t remember could become one you’ll never forget.

Though I missed most of April 27, 2011, it’s a day I’ll always remember.

I can recall looking out the window as we drove to the hospital, wondering if surgery would go as planned, if my tumor would be as expected, and how I’d feel afterward.

Once we arrived, things moved quickly. We were shown into a small room, where I was visited by what seemed like every employee on duty, all asking my name, birthday, and reason for being there (Kimberly Lucas, 2/1/61, right mastectomy with TRAM reconstruction).

My plastic surgeon, Dr. K2, used a permanent marker to draw lines where Dr. S, my breast surgeon, needed to make her incisions. A nurse started an IV, and another introduced the anesthesiology team, advising me to be nice to them since they were responsible for making sure I felt no pain.

They did a good job. One of them hooked me up, and I was gone.

“Mrs. Lucas, you’re all done. Wake up.” A gentle voice roused me to consciousness.

“I lived?”

Funny, until that moment, I’d have sworn it hadn’t occurred to me that I might not.

“Yes,” the nurse agreed. “You lived.”

I heard someone else say it was eight o’clock.

Eight o’ clock! I’d been in surgery for more than twelve hours, which meant my family had been at the hospital all day. Apparently sensing my concern, one of the medical team reassured me that my husband and daughter could see me as soon as I got to my room. (Later, I learned they’d been encouraged to go home, where the hospital kept in contact via phone.)

I closed my eyes and dozed, barely conscious of being rolled through a hallway, and then transferred into a bed. When I woke, The Engineer and our daughter were standing in the doorway.

Although I didn’t realize it at the time, my appearance must have been quite a shock. Compression bindings encased my lower legs, whirring every few minutes as they massaged blood upward to prevent clots. A stunningly attractive hospital gown hid a midriff layered in gauze and overlaid by an elastic truss. Tubes led from incisions in my stomach, right breast, and underarm, to grenade-shaped drains, which were safety-pinned to my bindings. An oxygen meter was clipped to one forefinger, an IV ran through the back of one hand, and a small Doppler system was attached to my breast. I had a catheter too, and what looked like a fanny pack full of morphine with a pump I could push for pain relief.

I managed to stay awake long enough to reassure my family I was fine, and was surprised to discover it was true. Sure I felt pretty crappy, but I’d expected to feel like I was dying, or maybe to experience pain bad enough to make me wish I was. Instead I just felt sore.

Very, very, very sore. Sore enough that when the nurse told me I needed to get out of bed the next day to sit in the chair, I almost laughed.

Then I realized she was serious and, with a lot of help, managed to move the six inches or so that was necessary to accomplish this task. A day later, I was walking.

Actually, it was more of a shuffle, across the hall and back, bent over like an old crone because I couldn’t stand straight. My stomach was too tight.

Certainly no one was more amazed than me when I walked down the hall to the lounge a couple days later.

The human body is a wondrous thing, able to withstand much more than most of us realize, and an immediate TRAM reconstruction after a mastectomy is one of those things.

This type of surgery is a big endeavor, especially when paired with an axillary dissection. It involves taking tissue from one part of the body – in my case, my stomach – and using it to form a new “breast.”

Two surgeons work together, seamlessly moving from a breast surgeon-performed mastectomy through reconstruction by the plastic surgeon. (For a complete description of the procedure from the American Cancer Society website, go here:

My body remembers that day though I do not. The faded but still visible scars, occasional abdominal tightness and weaker right side all give testament to the trauma my muscle and tissue have endured. These effects will continue to wane, but they will never disappear, and though I don’t remember the hours that changed my life forever, April 27 was a day I will never forget. 


Cancer Lesson #21: This could get complicated.

Cancer Lesson #21: This could get complicated.

As with any surgery, a TRAM flap can result in complications. Being I am a hopeless nerd, I researched the ramifications of every possible choice before deciding to pursue this type of reconstruction immediately after my mastectomy.

My plastic surgeon responded to this request by providing a detailed explanation of the surgery. Then he described the possible side effects up to and including death. We also discussed other procedures and their possible complications.

I had to fight the urge to giggle though I know it wasn’t funny. It just seemed odd to be considering the possibility of death via reconstruction when I was walking around with a cancer time bomb in my breast.

Besides, death is a possible complication of practically every medical procedure you can name, including many we think of as routine.

For that matter, death is more or less a complication of living.

I could deal with the <1% chance of death by TRAM flap. It was the possible side effects of chemo – puking in particular – that worried me. And the needles. The idea of the needles scared me spitless.

Still, if you’re considering a TRAM, you should be aware of the possible complications, which are listed here:

As always, I am not a member of the medical community, and nothing I say should be construed in any way as medical advice. Any decisions about your care should be made by you and your doctor. Yada, yada, yada, I know, but I don’t want  anyone thinking I can provide guidance about their treatment.

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Cancer Lesson #17: An Equation

Cancer Lesson #17: An Equation

As mentioned in Cancer Lesson #6, my cancer was ductal, one of the most common varieties of breast cancer. After all the scans and blood draws, it seemed to be just as it appeared – with a single site that had spread to at least one lymph node.

I was lucky. My doctors told me since I was “young” (ha) and “fit” (double ha), I had choices, which I wrote into an equation that looked like this: (R + L + C) = ([M + {r1 or r2}} + C)

R is radiation, L is lumpectomy, and C is chemotherapy. M is mastectomy, and r1 and r2 were my options for reconstruction using implants or a TRAM flap. Of course, there was also the option to not do a reconstruction and wear prosthesis for the rest of my life, a choice many women make.

What was not an option was avoiding surgery altogether. And since my cancer was already in a lymph node, a sentinel node biopsy – where they remove only a few lymph nodes to verify the cancer hadn’t spread – wasn’t advisable. I needed a axillary lymph node dissection, which meant Dr. S would remove as many lymph nodes as she could find to see how many were affected.

The first part of the decision was easy. I’m small-breasted (read “flat”), which meant even a lumpectomy would be noticeable. Plus, I didn’t want to have radiation.

I could have had a bilateral mastectomy, removing both breasts and thereby considerably lowering the chance of recurrence, but that seemed like overkill. Also, if I decided on a TRAM flap reconstruction, I didn’t have enough stomach or back tissue (fat) to make two new breasts. (Too bad they don’t use thigh and bum fat!)

So, a single mastectomy it would be, but with what kind of reconstruction?

Choosing implants meant my new breast could be any size I wanted, and the plastic surgeon would make the other one match. A TRAM came with size limitations, but without the possible later complications involved with implants. (As WebMD says, “Breast implants are not designed to last a lifetime.” See here for the rest of the article:

The decision, in my mind, came down to this: Did I want to have look like more like Barbie or like me?

I got a lot of comments on that blog post and the accompanying Facebook status, ranging from “Go for it!” to “Women aren’t beautiful because of their breasts; they’re beautiful because who they are.”

One friend, who shall remain nameless, commented that he’d always had a fondness for the airport in Salem, Ohio (airport identifier: 38D). Having pretty much settled on a TRAM by that time, I replied that I would probably continue to have a lot more in common with Laurens County, South Caroline (airport identifier: 34A).

Interestingly, the “go for it” and the “you’re beautiful just as you are” comments were equally divided between women and men.

The Engineer wisely didn’t state a preference. Finally, in a fit of self-pity (using my most pathetic voice), I asked him, “Will you still love me when I don’t have a real boob anymore?”

His reply? “I’ll just have to love you somewhere else.”

It was the perfect answer.

Note: I would never presume to imply that the choices I made are right for everyone. Every option comes with complications, and only you and your doctor can decide what is best for you.