Archive for the 'Breast Surgery' Category

Preamble to My Breastfeeding Saga, Part 4

August 15th, 2014 by MamaBear

Part I, Part II, and Part III of the Preamble.

I didn’t know what to do. I wanted to leave, but I didn’t know when I would get another appointment. It was hard to get the one I had. The scan was half done anyway, so I reasoned that I might as well have it overwith. I didn’t ever want to have to go back to that godforsaken place. Also, I was in complete shock, so it paralyzed my thought processes. I looked up at her face, and she was smiling like she’d just won first prize at a bitch contest. This was the first time I saw her smiling, and it confused me even more. What in the world was wrong with her??? How did she ever get hired? How was she able to keep her job? I was instantly reminded of the other ultrasound tech thousands of miles away in a completely different country, almost a decade before, who also mistreated me. I couldn’t help but wonder if the anonymity of the profession made it so that patients were more likely to have a bad experience with an ultrasound technician than with most other health professionals.

I didn’t report her because I figure she’s had a rough day, she’s working on a Saturday after all, and I didn’t want to deal with the hassle. I had bigger problems to deal with. I took the ultrasound films the next weekend to Dr. Enthusiastic.

Dr. Enthusiastic scanned my breasts himself before the procedure, and he told me my breasts are “busy” because they inexplicably create a bunch of tumors. He performed the cryoablation and also aspirates some fluid-filled cysts as well (these are new). He was very competent and his personality is reassuring and kind, but the procedure is nonetheless unpleasant: painful, scary, and humiliating. I had to be awake for it, which is part of why it was painful, scary, and humiliating. It took longer than I thought it would, and it left more scarring, though small scars, smaller than if I had had another biopsy. Unfortunately one of the new scars is now on my left areola.

This new procedure was done in a state-of-the-art facility in the U.S. However, Dr. Enthusiastic, a breast specialist, never once mentioned future lactation. Nor did any of the health professionals that attended me in the context of my cryoablation.

I had another cryoablation procedure done with him a couple of years later. It was about the same, but in this procedure, I had the added discomfort of having a drug representative sit in for it. She wasn’t a health professional; she was a salesperson. I don’t know why she was there, but she was and she got a first-row seat to see my mutilated, hypoplastic breasts, too. I don’t remember consenting to having her in there, but I may have, inadvertently.

Since none of my doctors ever mentioned anything about breastfeeding or lactation, I never thought to ask. I figured they were the professionals and if there was something important to say, they would mention it. It bothers me that out of the dozens of health professionals that came in contact with me in the context of my breast surgeries, nobody mentioned anything about lactation or possible problems in the future. For my part, I took for granted that I’d be able to breastfeed my future children, in part because of what my friend who had the breast augmentation told me, in part because nobody mentioned anything about impaired future lactation, and in part because it never occurred to me that I couldn’t. Also, whenever I would research breast surgery, on the internet or in books, future lactation or possible problems therewith were never mentioned.

I think the reason why lactation is never mentioned is a simple one: nobody thinks about it. Our culture takes for granted that babies get fed with bottles, so that if lactation should fail, there’s an easy safety net. Even if it did occur to one of the doctors attending me to mention lactation and possible future problems, they probably stopped themselves because it probably never occurred to them that it would be so important to me. “She could always feed her kid formula,” is probably what they thought to themselves.

That breaks my heart. As kind as most of the doctors I had were, it breaks my heart that in the end, I was just another faceless customer. No one special or important who wanted to provide the best for her baby. No one needing information which would have made a difference in what kind of care she would have demanded. I wonder how many of them opt to breastfeed their own kids? Probably a fair number of them, given that it’s the best way to feed a baby. Did they use the same high-quality standards for me that they would use for themselves? I don’t think so.

I’m hoping that by writing this out, as painful as it is for me, that I can help someone make better decisions for herself.

If you must have breast surgery and if you have a choice in the matter, talk to your surgeon beforehand, and don’t let the surgeon cut your nipple or areola. Try to make the incision as far away from this area as possible, so as to minimize the damage to your milk ducts and to preserve your future lactational ability. If I can spare even one person the pain I’ve been through by sharing my story, it’ll be worth it.

This is the last part of the Preamble. My Breastfeeding Saga may get written someday, if I have the time.

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Preamble to My Breastfeeding Saga, Part 3

August 14th, 2014 by MamaBear

Please read Part I and Part II first.

Twenty-one years old: I discovered more lumps in both breasts. By now, I was a veteran at this. I scheduled with the same plastic surgeon, Dr. HairPlugs, and anesthesiologist, Dr. Competent, as last time. I had the usual round of ultrasounds again. By this time, it feels like half the country’s health professionals had seen my breasts, much to my chagrin.

Before going to get the surgery done, I spoke with a friend of mine who had had breast surgery herself. She’d never had lumps. She had had a breast augmentation. She told me (and showed me) that her plastic surgeon had placed her implants by making an incision around her areola to reduce the appearance of scars. I thought that was very clever. She furthermore told me that she’d had this surgery after the birth of her first child, who she breastfed, and before the birth of her second child, who she also breastfed. She had two kids after that, too, who she claimed to have also breastfed. I learned all too late that when she said she’d “breastfed” them, that it was only for six weeks, and that the whole time she breastfed them, she was also supplementing them with formula. (If I’d only known then what I know now…)

So, armed with this new “knowledge,” I asked my plastic surgeon, Dr. Hairplugs, to go in through my areola on my right breast to excise the tumor because I didn’t want a visible scar on the breast skin itself. This was stupid for so many reasons in hindsight, and if he had mentioned even once that my breastfeeding ability would be impaired, I would have said no. He never did, though. None of my doctors ever did. So I was acting on the knowledge I had at the time. Every time I think of the memory, it makes me feel a little sick. He seemed to pause a bit, and I told him, “Well, if it’s too much trouble, never mind.” Something about the way he paused made me want to change my mind, especially since I already had a scar where he was about to do the surgery anyway (UGH!!). But then he went ahead and said, “No, it’s no trouble at all.” And that was that. (sigh) That is my biggest regret, and is probably what made the difference between having an adequate milk supply and starving my baby.

So I had surgery, for the third time, to remove breast tumors. My right areola was sliced, but thankfully only the top half. The bottom half was left intact.

Fast-forward a few years. Twenty-four years old: I discovered more lumps. I had a job of my own, was no longer in college, and no longer under my parents’ insurance, so I was essentially on my own. I researched on the internet to find out what the latest in fibroadenoma treatment was. I learned about cryoablation, which means you freeze the fibroadenoma in situ and then let the body reabsorb the dead tumor over time. It’s a minimally invasive procedure, out-patient, and pretty brand-spanking new.

Before I had the surgery, I went to get the requisite ultrasounds done. I was sent to an ultrasound facility somewhere in Houston, scheduled for a Saturday appointment. I showed up and donned the appropriate gown. The technician, a woman in her early twenties, told me to get onto the table. I did everything she asked of me. I was trying to remain lighthearted because I hate hate hate hate hate the pre-surgery ultrasounds. Have I mentioned that I hate the ultrasounds? I disrobed my top half and tried to be as complacent as possible. She started scanning me, and I asked her what she saw. She told me, “Your doctor will tell you that.” I didn’t understand her reply because usually when I’ve asked this question (and I’ve asked this question dozens of times to dozens of ultrasound techs), I was told something vague and then some harmless, time-passing chit-chat usually got started. Confused, I asked her, “What do you mean?” There was no one else anywhere near us, so I guess it made her feel safe in doing what she did next. She gave me a dirty look, raised her voice and said, “I CAN’T TELL YOU ANYTHING. I’M NOT ALLOWED TO TELL YOU ANYTHING. DON’T ASK ME ANY QUESTIONS. DON’T TALK TO ME AT ALL.” Then she smacked me on the breast with the jellied-up wand to continue the scan. There was a horribly uncomfortable silence as she finished. She was, after all, scanning my naked, mutilated breasts and because she decided to be a total psycho, I couldn’t talk to her. Also, let’s not forget: she hit me. On the breast. With the ultrasound wand.

Part IV tomorrow.

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Preamble to My Breastfeeding Saga, Part 2

August 13th, 2014 by MamaBear

Please read Part I of the Preamble first.

Fast Forward a few years. Eighteen years old. I’d been avoiding chocolate and all-things-caffeinated for two years. During a routine breast check ( I started doing those since I found that other lump two years prior) I discover… More lumps. In both breasts, this time. One of them is in the same place the first one was found.

I went to get my ultrasounds. I went to a couple of different places and had different technicians, male and female. I hate hate hate hate hate having ultrasounds. It’s always so cold, impersonal, uncomfortable, humiliating. But I have to do it, so I do. Thankfully, none of the technicians were rude or unprofessional to me this time. Whew!

Dr. Compassionate suggested I consult with a plastic surgeon to do the surgery because she doesn’t want the scarring to affect my already battered self-esteem. The surgery she performed two years prior left a large pink scar across the top of my left breast, and she was hoping the plastic surgeon would clean it up with finer sutures. Also, she didn’t see anything wrong with my ovaries this time, so all I needed were a couple of breast lumpectomies.

I consulted with the plastic surgeon, Dr. HairPlugs. He looks at my breasts (who hasn’t at this point?) and says he can do it. I talk to some people in the hospital about who my anesthesiologist will be. I tell them about my eye-drying experience and about the after-surgery pain I experienced last time. They made sure my anesthesiologist for this up-coming surgery was Dr. Competent.

Just before the surgery, a nurse tried to put an IV in my hand. She picked the thickest, largest, Most Painful-Looking IV Ever and jammed it into the back of my hand. She maneuvered the plastic needle around under my skin while I tried to stay as still as possible so that she could find the vein. After about thirty seconds of this, it was just too painful, so I yanked my hand back. She left the IV halfway stuck into the skin on the back of my hand, told me I was not cooperating, and walked away. Dr. Competent came by, saw my hand and told me, “It’s going to be all right.” He gingerly removed the Horse IV and came back with an IV intended for use on preemies. He was so gentle I didn’t even feel it go in. He smiled as he taped it on, patted my other hand reassuringly, and told me it was all going to be okay.

The surgery went without a hitch. I woke up from the anesthesia with moist, sparkling eyes. Unfortunately, when I come-to, I experienced some pain and confusion and was inexplicably unable to talk. I see Dr. Competent right in front of me. He said, “There, there now. It’s okay,” and injects a small amount of clear liquid into my IV. I went from incoherent pain to drifty bliss in an instant. I became unconscious in a matter of seconds.

The biopsies came back and revealed that on the left side, I had another fibroadenoma (or two, hard to remember). On the right side, I had what’s called “fibrocystic breast disease,” which basically means, “we don’t know what this is, so we’re calling it ‘fibrocystic breast disease.’”

As good as the experience was this time, nobody mentioned anything about future lactation.

Part III tomorrow.

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Preamble to My Breastfeeding Saga, Part 1

August 12th, 2014 by MamaBear

I said I’d talk about My Breastfeeding Saga, so this is the preamble, necessary to understanding the problems I faced when I had BabyBear. It’s a multi-part series, and it’s kind of heavy, so read with caution.

Ever since I was a little girl, I always knew I wanted to breastfeed. I remember seeing women breastfeeding their babies and thinking to myself, without any hesitation or repulsion, that that’s what I wanted to do when I had a baby of my own. As I grew up, I acquired more knowledge about breastfeeding that solidified my opinion: it’s far superior to any artificial milk, it protects the infant, etc. I was a breastfeeding supporter, though an often silent one, for as long as I could remember.

My problems with breastfeeding actually began years before I ever conceived BabyBear. I was sixteen. It was summertime, and I was reading some Stephen King novel that had just come out. I think it was Gerald’s Game. I was laying down in the bed and holding the book above me with my left hand. With my right hand, I reached over to scratch my left armpit. Scratch, scratch, scratch. As I scratched, I noticed something wasn’t right. I felt a… No, it couldn’t be. I felt again. Omigod. It was.

A lump.

I felt again. Yup, it was a lump. Not in my armpit, but in my left breast. The tears welled up. At that time, everyone I’d ever heard of with this sort of problem ended up undergoing chemotherapy. I foresaw the following future for myself: cancer, baldness, death. This was pre-internet and I lived at the time in a third-world country, so I couldn’t reassure myself that there were plenty of other people who had experienced this before and been okay with results from a Google search.

My mom took me to the gynecologist, Dr. Compassionate.  She felt the lump, examined me thoroughly and told me that in all likelihood it wasn’t cancerous. She said it was more than likely a fibroadenoma, a benign breast tumor. To be on the safe side, though, she wanted to remove the lump and have it biopsied. She said nobody knows why some women’s breasts make fibroadenomas, but that I should try and avoid caffeine in all forms (including chocolate) and try to live a healthy lifestyle (exercise, eat fruits and vegetables, etc.)

Apart from the lump itself, the avoidance of chocolate and coffee was the hardest part. I learned, for the first time, to appreciate vanilla and strawberry, among other previously ignored flavors.

An ultrasound was scheduled prior to the surgery. This was in lieu of a mammogram, which wasn’t really feasible given that I was so young and my breasts were so small. While the ultrasound was being done, I began to cry. The room was cold and this strange lady was feeling up my normally chaste breasts with an uncomfortable wand covered in frigid jelly. I looked at the screen and the tears just came out. I didn’t want anyone to see me like this, but I couldn’t stop them from coming.

“What are you crying about?” The technician scowled at me. “Girls younger than you come in here to get scanned for the same thing and they don’t cry about it. Don’t be such a baby.”

This was the first I’d heard of this, though I didn’t feel reassured by the fact that I wasn’t alone. It didn’t change the fact that, for example, nobody I knew had even heard of such a thing, that all my friends (as far as I knew) had normal, healthy breasts and I was the only one I knew who needed to have breast surgery.

Her tone and expression were impatient and devoid of compassion.  My crying had angered her, somehow. Surely she wasn’t trying to make me feel better, was she? I still don’t know what made her react that way. Bad day? Long hours? Having to see people sicker than me all the time made her not-so-compassionate when she saw a relatively benign case? Maybe my ugly boobs caused a revulsion so visceral that she couldn’t hold herself back? Who knows?

Unfortunately, this would not be the last negative ultrasound experience for me. Nor the worst.

During that ultrasound appointment, in addition to the lump in my breast, it was also discovered that I had a multitude of cysts on at least one of my ovaries. Dr. Compassionate told me she could cauterize those with a state-of-the-art (at the time) procedure using video laparoscopy. I was pretty sure that, in 1993, I was unfortunately the only kid in my high school who knew what that procedure was.

I was put under general anesthesia a few days later. The lump was removed, biopsied, and found to be a fibroadenoma, as Dr. Compassionate had predicted. During the same operation I’d had a laparoscopy to cauterize the multiple cysts in one of my ovaries. A tiny video camera had been inserted through an incision in my belly button, and grasping and cauterizing instruments were inserted through two other small incisions located further below on my abdomen. The footage on the video had been recorded, and I was given a copy of the tape for posterity. I have no idea where the tape is now, but I can assure you, other than earning me geek coolness points for allowing me to say, “I know what my ovaries and uterus look like,” it’s about forty minutes of pure boring.

I woke up from the surgery with blurry vision that wouldn’t go away and stinging, dried-out eyes. Also: a throbbing, aching body. The anesthesiologist didn’t bother to close my eyes during the entire operation, nor did he administer any pain medication, apparently. I’m kind of surprised I survived the operation at all with that kind of neglect, actually. Was anyone even monitoring my vitals while I was under?

It took a few hours to get my eyes to focus again once they were remoisturized (by allowing myself to cry freely — not hard at all under the circumstances), and the rest of me recovered eventually (sort of). I was given regular strength Tylenol for the pain.

Nobody, not even Dr. Compassionate, ever mentioned anything about my future lactation.

Part II coming tomorrow.

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Why I Do Not Recommend Using Powdered Infant Formula

October 11th, 2007 by MamaBear

I’ve used powdered infant formula maybe two times in the entire time I have supplemented for my daughter (I have supplemented with formula for over a year, out of necessity due to breast hypoplasia and breast surgeries). The main reason why I was never keen on using powdered formula is because of the theory of free radical damage from using a powdered reconstituted animal product. Now, I don’t know if the ready-to-feed and concentrate forms of infant formula I’ve been using contain reconstituted powder in them. If they do, I’ll probably feel like the world’s biggest schmuck. But the more research I do on the subject, the more I realize the oxysterol powdered-milk theory isn’t the only reason why using powdered infant formula isn’t a good idea.

Powdered infant formula is the most affordable form of infant formula there is. Every other form (concentrate, ready-to-feed cans and bottles) is significantly more expensive. This is why most people who for whatever reason decide not to continue lactation (or who can’t easily lactate because of a physical barrier which impedes it — think adoption or breast surgery) usually decide to buy powdered infant formula. It’s not cheap, but it’s cheaper than the already prepared stuff. Many people who would otherwise be able to breastfeed or pump milk for their babies for a lot less money (the price of renting a hospital grade breast pump can be as little as $35/month, or less; the service of a lactation consultant is often cheaper than the cost of one month’s supply of formula), instead buy the powdered infant formula because it is erroneously perceived to be a “cheap” and “good” alternative. There are many barriers impeding the success of breastfeeding for new mothers, but one of the biggest ones is the fact that it is easier (and less taboo) to learn how to prepare infant formula than it is to learn how to breastfeed or pump (also, figuring out how to prepare infant formula can be done easily in public; figuring out how to breastfeed, topless, for example, is unfortunately not acceptable in most places — and trying to figure out how to breastfeed while wearing clothing is like trying to figure out how to swim by practicing in a bathtub — it’s not very effective). Formula companies exploit this whenever they can, seducing women with the promise that formula is “just as good” for their baby and much easier to figure out than breastfeeding in the middle of the night when holding a screaming, hungry newborn and without anyone to help you.

Unfortunately for most mothers, formula companies don’t actually care (in deed; they always pay lip-service to “caring”) if the product is prepared properly or if it’s even safe before preparation. They feel that’s “not their problem,” legally speaking, so they sleep easily at night, even if infants who use their mislabeled products die.

I do not recommend infant formula use at all unless there’s no other feasible option, but I especially do not recommend the use of powdered infant formula. Powdered infant formula is not sterile. Infants have already died from contaminated powdered infant formula (even when prepared according to the manufacturer’s directions). The United States’ Centers for Disease Control and the Food and Drug Administration advise against the use of powdered formula in hospitals because of the contamination risk it poses. It is impossible to sterilize powdered formula in the factory in the same way that liquid formulas can be. Furthermore, if preparing the powdered formula with boiling water to kill the bacteria, some of the vitamins in the formula may be damaged beyond even what the sterilized liquid formulas undergo.

Even when prepared according to the manufacturer’s directions, however, powdered formula never dissolves completely. You can shake the powdered formula with the proper amount of water in a baby bottle until the cows come home (this is what the directions on most if not all powdered infant formulas say to do — shake the measured scoops and water together in the baby bottle), and you will inevitably be left with undissolved lumps in the resultant liquid mixture. These lumps mean the concentration of formula in the liquid is less than it should be, and the lumps often stick to the sides of the baby bottle and never get consumed like they’re supposed to.

In addition to powdered infant formula not being sterile, the possibility of free-radical cell damage from oxidized cholesterol/fat from the formula powder, and the problem with the formation of lumps upon reconstitution, there is also the very real possibility that the directions on the can won’t be followed properly. Most women in the third world don’t have schooling beyond primary school. Consequently, a basic understanding of weights and measures (like liquid measure and powdered formula scoop measure) is often not understood very well. This sometimes leads to formula being prepared at too high of a concentration if the powder is measured before the water is, or it sometimes results in a too-dilute preparation if the woman in question is trying to save money by using less powder than is called for on the can. A too-concentrated formula can lead to dehydration, renal failure, and death in the infant. A too-dilute concentration of formula can lead to malnutrition and a lifetime of health problems, in addition to the possibility of eventual death by starvation. While it may seem “affordable” in the short-run to provide a third-world woman with “free” formula for a time, in the long-run, the results are disastrous and not worth the true, human, cost. The woman dries up, no longer produces milk with her own body, and becomes needlessly dependent on a far inferior, even dangerous product. It becomes like a drug, then. A woman will do anything to get more of it for her baby, because it’s the only feasible option left to her for nourishing her baby once her milk dries up (her milk will start drying up as soon as she starts supplementing with formula if she does not provide stimulation to her breasts — often the woman is not aware of this consequence because not many people are aware of the supply-and-demand aspect of breastfeeding). Over more than one generation, this dependence on infant formula will lead to a loss of knowledge of breastfeeding for a given society (and increased breastfeeding ignorance), leading more women through the generations to become dependent on an external, purchased product rather than trusting their own bodies. It is unconscionable to provide formula to third world countries for free for these and other reasons. It’s also immoral to encourage people to buy “cheap” powdered infant formula when the truth is that the female body can produce a far superior (and practically free!) product, if only the proper education were disseminated about it.

Maybe if everyone had to pay the price of liquid formulas when choosing to formula feed (which is what would happen if everyone knew just how inferior — and even dangerous — powdered formula was), perhaps then breastfeeding and pumping wouldn’t be seen as “gross” and “too much trouble.” It would definitely incentivate a lot of people who erroneously believe formula and breastmilk are “just as good” as one another to at least try breastfeeding and/or pumping before the “easier” formula-feeding, and it may motivate new moms to stick it through the tough times for longer. At the very least, if no one were to buy the powdered formula anymore, it would incentivate those in the formula industry to charge less for their liquid “premium” products, which would be better for everybody — (except, of course, for formula manufacturers and their shareholders).

Formula does not have to be part of the cost of raising a child. It’s not a necessity like a car seat is (for those people who own a car). It is an artificially created need, artificially created through baby-unfriendly hospital policies, aggressive marketing tactics, and the unofficial endorsement of many health care workers (doctors, nurses, hospital administrators, some midwives, etc.) the world over. This artificially created need causes needless illness and death, and it’s all for the sake of making a buck. It is never about the health and well-being of mother and child.

The use of infant formula (homemade or commercially prepared) should be the option of last resort, to be used after all other (better) options have been exhausted. Breastfeeding should always be the first choice, except for the very rare case of severe galactosemia. Powdered infant formula should just never be used at all — babies have better options no matter where in the world they are; much of the time, it’s just a matter of allowing breastfeeding to succeed. Too often breastfeeding is sabotaged by the inappropriate introduction of formula by health care workers, misinformed and exhausted postpartum moms, or well-meaning but misguided family members.

Due to all the health risks associated with consumption of any type of formula, moreover, it is completely inappropriate for any hospital employee or volunteer to feed newborns infant formula routinely unless the mother of the infant is dead, has abandoned the baby, is HIV+, or does not have functioning breasts. And actually, for extreme cases like that, the infants involved should be fed donor breastmilk whenever it’s available (in the case of an HIV+ mom, the mom can try manually expressing her milk into a clean container and flash-pasteurizing the milk to kill the HIV before feeding it to her infant — it would still be far superior to any formula). Funny that if breastfeeding were considered as routine as formula-feeding is now, more healthy donor milk would be available to feed babies whose mothers cannot… Imagine that: A world where every baby is fed breastmilk, and where no corporation is profiting off the sale of human milk. That would surely be a beautiful thing.

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