I felt so poetic last week, talking about how Vinnie’s tattoos were the “The End” to my cancer story. Of course, we all know there are only really two things that come after the words “The End,” an epilogue and a sequel. Luckily, we’re not here to discuss Cancer: Part 2. But I was hoping not to have an epilogue to write. Certainly not a week later.

I have been faithfully wearing my silicone scar sheets since January, when I also had steroid injections to help flatten out my slightly bumpy scars.  Of course, before the injection, we discussed the risks, among them: bruising, skin atrophy, fat atrophy. My doctor said these were rare, and he uses the lowest dose available, which he then dilutes again, to reduce any risks.  I had some bruising and as it faded, the scars have completely flattened and smoothed out, but the skin has retained a pink hue in the area. Wearing the scar sheets except when I’m in the shower, I haven’t spent a lot of time worried about the redness because I never really see it.  But I ditched the scar sheets for my trip to Vinnie’s, and he commented (several times) how thin the skin was in that area. It wasn’t where he was going to tattoo, so it didn’t change my plans that day, but his concern gave me something new to obsess over. Just what I need.

I managed to keep my emotions in check for a day or so, but by the end of the second afternoon, I was somehow convinced that my skin was going to burst apart it was so thin, and then after my implant popped out and landed in the floor, I’d need a skin graft to hold it back in. (Yep, a little dramatic. Cancer has trained my brain to eschew the logical and jump right off the deep end. Stupid cancer.) Luckily I was able to get in to see my surgeon the next morning, and he confirmed that the skin was definitely thinner than he’d like, but I was in no danger of losing an implant if I wasn’t wearing a sports bra to keep it from falling out.  While I was dreading the idea of a skin graft (which I’d completely made up in my head, that probably isn’t even close to an option), I was secretly hoping there was some sort of collagen cream or something (also completely made up) that I could slather on once a day to fix everything.  My surgeon’s suggestion was somewhere in the middle.  More fat grafting. At which point my brain sort of turned off. More liposuction from one site, then injecting the fat under the thin skin near my scar. It won’t grow back any skin, but it would support the skin and make it less susceptible to trauma and leave me with a better cosmetic result. Oh, and that probably won’t take care of the redness.  So then he’ll send me to someone to laser it.

Good grief. I was done two days ago. I. Was. Done. I could not comprehend the idea of more surgery. More compression gear.  More restrictions on my activity. I’m sure it wasn’t a crazy reaction. But I told him I couldn’t make the decision that day. I wanted to be done. He agreed, there was no need to rush, we could watch it indefinitely, and make any decisions later. I knew in my heart that I’d likely agree to it, but that day, I just could not.

I gave myself some time to consider my options, and really, I needed to come to grips with the fact that I needed, no, I wanted, more surgery. Yes, I want to be done. But I want to to finish well. And so I called the office and asked to schedule the surgery sooner rather than later. I’m still waiting on the final date, but am hoping to do it within the next couple of weeks. It will be outpatient surgery, and I’ll be in compression gear (super glam spanx-y bike shorts and the wretched ugly compression bra) for probably four to six weeks. I’m hoping not, but betting it will mean more pain meds and more time on the couch than on the trails.

I remember pre-cancer, thinking how great it was that now women can have a mastectomy and reconstruction at the same time. How cute and naive of me. I knew a lot about breast cancer, but didn’t realize that even in the simplest scenario, there are two surgeries and several procedures involved. Many women who opt for a lumpectomy have multiple surgeries to make sure that they’ve gotten all the cancer, only to end up with a mastectomy, either out of medical necessity or for their own peace of mind.  I didn’t mean for this post to be a downer, but I guess this is just a glimpse of the fact, that even under the best circumstances, breast cancer isn’t easy. I’ll be fine physically, and that’s the most important. And though it will take longer, I’ll get over the fact that I have to go through another round of surgery and restrictions.  Because while I’m not thrilled to be writing an epilogue, I’m really glad I’m not writing a sequel.

OK, guys, just so you know, we’re talking nipples today. No graphic images, but if it’s too much information for you, then tune back in later this week.

I’ve talked about my surgery before, but I’ve mostly talked around the details– like they were somehow too private to put in such a public forum. Yet, I’d tell anyone who asked, and it’s not like you can’t figure out the details with a little googling if you really want to know. So I’ve decided to let it all hang out, as it were.  Like most women facing breast cancer, I had several options when it came to surgery, but I definitely went the more aggressive route. I figured if I was going to survive this and live another forty or fifty years, I didn’t want the anxiety of dreading the annual mammogram. I just wanted to be done with it, once and for all.  Given my age and the aggressive nature of triple negative breast cancer, while my surgeon assured me it wasn’t necessary, she also agreed that a mastectomy wasn’t an overreaction. I chose to have a bilateral simple mastectomy. I now have scars across each breast (strategically placed to be hidden by even a pretty skimpy bikini top) and all of the breast tissue, most of the fat, and even my nipples and areolas were removed. I wasn’t the best candidate for nipple sparing surgery, and it didn’t sound like a great option to me, anyway, so I decided to go the “simple” route and get rid of it all. After my skin was stretched out to accommodate what was lost to surgery, silicone implants were placed under the muscles of my chest wall.

My plastic surgeon is awesome and did a great job, but the obvious downside is that I was left with nipple-less breasts. I have to admit that I’m pretty happy with how I look when I’m dressed– I can totally rock strapless dresses, halter tops, and even a sports bra like nobody’s business!  But it’s pretty hard to think of your shape as “normal” when you step out of the shower if you’re just staring at nipple-less mounds of flesh.

I realize that any story that’s mostly about nipples hardly needs a good hook. But I’ve got one anyway. So, there’s this guy in Maryland named Vinnie, and he has a tattoo shop… (One hundred percent all true.) Plastic surgeons can do a few procedures and even some basic tattooing to replicate the idea of a nipple, but a nurse at Johns Hopkins thought that perhaps a bona fide tattoo artist would bring a little more artistry to the table. She asked Vinnie Myers if he could essentially tattoo a picture of a nipple on her reconstructed breast.  Years later, Vinnie has given up traditional tattooing and has become THE go-to guy for nipple and areola tattooing worldwide. He sees seven to ten women a day, and over three quarters of his clients fly in from across the country and around the world. (Expect to wait up to six months for an appointment!) I feel so fortunate that he’s virtually in my backyard, and I was able to score an appointment right away because I could fill the spot of a cancellation. I managed to get there, tattooed, and back before my kids got off the school bus. That’s a good day.

So for the details:

• Yes, it hurts. But because of the nature of a mastectomy, most of the nerve endings in that area are pretty messed up, so it’s not nearly as painful as a traditional tattoo.  It hurt some while he was doing it, but any soreness wore off quickly.  After just 24 hours, what can only be described as discomfort is barely noticeable. (If you take a friend along, she’ll likely be in more pain watching than you are!)
  
• It was quick. Including the before and after pictures and the prep and post-procedure instructions, I was in the office for an hour. The tattooing took maybe half that.
• It’s in a real tattoo shop, complete with a motorcycle out front and a neon “TATTOO” light in the window. But the office where Vinnie does nipple and areola tattoos is private and reflects his love of art and travel. It is clean and feels hygienic without the sterility of a medical facility, something most breast cancer patients are so over by the time they get to this step. Vinnie is professional and friendly, and his wife is the one who takes the pictures and does all of the care instructions at the end.

  

  

• You have to pay out of pocket. Insurance is supposed to cover it, and they give you a form with the appropriate codes to be reimbursed. I’ll still have to submit it to my insurance company, and I expect I may have to do more follow up than with something done in a medical office, but it should be covered like all my other reconstructive procedures.
• Eat before you go.  We made the mistake of thinking that we’d eat once we got to town and made sure that we had time. But it turns out that Finksburg is a pretty teeny town, and since we weren’t tempted to eat at the gas station/Subway, we ended up eating from one of the only other places we could find.  Also a gas station. It’s a good thing Sally and I are so much alike, not everyone will consider a lunch of cheetos, pringles, and twizzlers as acceptable. So if that doesn’t meet your standards, you might want to stop at the Chick-fil-A on the way.                 
• And yes, it looks real. Even though I’ve looked at more pictures on his website than I care to admit (WAIT– don’t click that link if your kids are reading over your shoulder!), I was surprised by how real the tattoos looked in person. Unless you knew they were tattoos, you’d never even imagine that they weren’t real. And even knowing, I bet you’d still be shocked. While plastic surgeons use only a few pigments, Vinnie uses as many as necessary to give a full, three-dimensional, tromp l’oeil effect.  And since he uses standard tattoo grade pigments (different from those most plastic surgeons use), his tattoos won’t fade over time.

It was a good experience.  It’s amazing how a procedure that takes a half an hour can make such a big difference.  After my final surgery, I struggled with whether I thought my breasts looked normal. I’ve come to really hate that word– what is “normal” anyway? But I did struggle. Being the last surgery, it felt so final, and I worried that I wouldn’t be happy with how I looked. Over the months since then, I have grown accustomed to how I look and am fine with it.  But remarkably, with the tattoos, the reconstructed breasts that once gave me pause instantly looked like, well, real breasts. A trip to Little Vinnie’s Tattoo Shop definitely lends a sense of closure to the whole breast cancer thing, as one friend calls it.  Of course, I don’t ever expect the thought of breast cancer to be too far from my mind. But it’s as if with every stroke of his humming tattoo machine, Vinnie was writing the final words in my cancer story. They definitely look like nipples. But it felt like he was writing “The End” across my chest.

Thanks as always to Sally Brewer for these poignant images.  These images are copyright protected and are not for sale.