"Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. " ~ James 1:2-3

Breast Health

It's been a very long time since I've posted, but I need a place to share the experience I had, since I had a difficult time finding pictures as I was doing my own research a month ago. 

I am 31 years old. My mother was diagnosed with stage 3 breast cancer at her first mammogram at age 39. It was long since recommended to me that I begin mammograms at age 30. As I was still breastfeeding, I waited until my annual ob/gyn appointment post-breastfeeding to request the referral. My midwife, whom I trust and adore, took one look at my family history, and referred me to a surgical oncologist who specializes in breast cancer. This way, each year, my mammograms and breast health will be monitored by a specialist. There is no such thing as being too proactive, when the last three generations of your maternal line have died of cancer.

The Monday after Christmas, I went in for my first mammogram. To say I was nervous is an understatement - I knew my mother's first mammogram came back with cancer, and it's all I could think about. I fought the tears in my eyes.

The tech warned me that first mammograms often result in a "callback" because anything that is not 100% obvious is double checked - so that the doctors understand what is "normal" for you. Each of us has different breasts, different densities, different goofy spots of fibrous tissue. 

It didn't stop me from panicking when I received my own callback. 

Thankfully, when I had my second mammogram (which was much squishier than the first and hurt just a bit), the tech took the time to show me the area of question on the image of my left breast, and then, how that questionable area went away when I got the higher compression scan. 

And a few days later, I received the "all clear."

I was relieved. 

A few weeks later, I had my "Establish Patient" visit at the surgical oncologist, whom we'll call Dr. E. The visit with Dr. E was pretty basic, a bit about my family history, went over my mammogram images, and of course, she did a breast exam. When she was done, she asked if I had any questions or concerns. 

I just had one. For the last few months, I have been noticing that one duct on my right breast (note this is NOT the breast that needed re-imagining) will bleed. Many of my ducts still express milk, though it has been months since I last breast fed, and I check occasionally to see if they've dried up yet or not. Which is how I discovered the single bloody duct. 

My midwife took a culture, said it was a common staph bacteria that often lives on the skin, and offered me an antibiotic. But once I'd finished the medication, that one single duct still expressed blood. So I mentioned it to Dr. E. 

She doubled checked, and was able to also express a very dark red blood from that single duct. And, had I done my research ahead of time (and as a medical researcher, I have a large database at my exposure), I would have known what came next. 

Surgery. 

I walked into a Establish Patient visit and walked out with an outpatient surgery date for 4 days later. Dr. E reassured me that in over half the cases, a single duct bleeding is the result of a papilloma, and it is rarely cancer. When I began to do my research, I realized two things:
  1. A "unilateral, uniductal" bloody discharge is an immediate candidate for surgery, as it comes with a (not quite as rare as I was told) 3-5% risk of breast cancer. 
  2. I could find very little in the way of pictures/experiences, etc from other women who had experienced similar things. 
So despite the anxiety I felt, I was sure to document my experience, in hopes that others might be able to know just a bit more about the procedure, the experience, the healing, and my own own thoughts on the matter.

Below the jump are pictures. They are pictures of my right breast at various stages, which may make them NSFW (Not Suitable For Work), but they are also 100% medical. There is nothing sexual about the following images at all.


So, the reason that surgery was required was this simple image here:


The blood was expressed from a single duct, on just one breast (the right). In every medical text and guideline, this is an immediate indication for surgery (as of 2016). Dr. E made sure that the discharge was indeed blood, because sometimes darker discharge can actually be greenish in nature, which is an entirely different course of treatment.

The surgery, from what I could research (and I'd link the video, but I have access to medical databases that most people don't, so you'd have to pay to see it), consisted of one cut, right at the edge of the areola. They would pull the nipple away slightly, identify the duct that was causing the bleeding, surgically remove it, then sew the nipple and breast skin back together.

The removed duct would then be sent to pathology, where it would be tested for malignancy.

I was required to wash twice beforehand (the night before and the morning of) with chlorhexidine, a typical anti-septic soap to help reduce the risk of a surgical site infection. This was actually a procedure I was familiar with, having had one planned c-section, and also my gallbladder removed about two and a half months prior. 

I was nervous about the procedure, but once it's time to go in, they give you something (propofol, I believe) to help relax you before administering general anesthetic. I woke up later, surgery complete. This is what it looks like, right after surgery:


I was sent home with pain meds and the instructions that the wound may bleed, but if it soaks the bandage entirely, I should call. I woke up the next morning to find that I had some bleeding, but it was not enough to soak the bandage:


 
I'm not sure how well you can tell, but the gauze is covered with what is essentially a big clear sticker, to keep the dressing on. The bleeding never went any further, but you can see where the "sticker" irritated me, and I kept itching. The pain was manageable most of the time, but I did find that I used my pain medications to sleep, since I have difficult time sleeping on my back.



I took to wearing my sports bra, because as a large breasted woman, any "jiggling" caused me discomfort. I kept a close watch on the blood spot, but it never seemed to get any worse, which I was thankful for. 




I was allowed to removed the dressing within the week, but instructed to keep the "brown tape" on until my post-operative visit. I had no idea what that meant, until I was able to remove the dressing:



You can see the bruising, where I imagine that the duct was removed. The brown strip covered the actual incision, but the weird brown outline is also sticky; like the tap had once covered it, and as I moved, some of the skin got free, but still remained sticky. 

Finally, two Tuesdays after my procedure (11 days), I had my post-operative visit. I was told the duct removed was the size of a golf ball, completely benign, and was healing normally. Dr. E told me it was "Ductal Ectasia" which is essentially a fancy word for a blocked or clogged duct. She removed the brown strip of tape, and replaced it with "Steri-strips:"




Eventually the Steri-strips peeled a bit, and after a week or so, I removed them. There is still a bit of hardening scar flesh under the incision, which I will keep an eye on. But current, about three weeks post surgery, it looks like:




It was a trying experience, and stressful. But the surgery itself was simple. I still have some pain if my breast is pressed against, but not to the point of needing any medication, not even ibuprofen. 

I hope this helps someone. Anyone. Because I couldn't find anything on this, so here is my account, in case you have to have something similar done.

I found that the pathology reports had been released to my online medical record. To give you an idea of the size of the duct they removed, here are the dimensions of the mass next to the dimensions given for my gallbladder (which was removed in November). Both measurements were done by the same pathologist:


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