My left breast is in the toilet.

I mean this in the most literal sense possible. Over three days I peed out the 250 milliliters of saline solution that had filled the temporary expander giving my left breast a shape.

The collapsed expander is not particularly painful. (Although maybe it is horribly painful and I just can’t feel it because mastectomies leave patients without feeling in their breasts.)

It is amazingly weird-looking. I’m sure you never did this yourself, even as a curious 8-year-old trying to impress a group of friends, but have you ever seen a slug that has had salt poured on it? That’s my left breast.

Post-mastectomy breast reconstruction is a multistep process. The number of steps depends on the type of reconstruction done. I selected the surgeons I did partially because of the type of reconstruction they performed.

In the spring of 2015, after my third round of chemotherapy, I was starting to think about the double mastectomy and reconstruction that needed to happen when chemo ended. I interviewed a surgeon at the Huntsman Cancer Institute in Salt Lake City. He would reconstruct using implants as well as tissue from elsewhere in my body. For better or worse I didn’t have enough excess tissue on my stomach to use. So he would use my lat muscle.

This surgeon was the first I interviewed, and he presented this method as the way it was done rather than as the way he did it. I burst into tears in the examination room and cried to my friend that I couldn’t give up my lats for breasts. I was fine being 40 and as flat-chested as an 8-year-old as long as I could still do pull-ups.

When I called my mom in tears, explaining that I wasn’t going to have my breasts reconstructed after all, she began doing what the best mothers do in such situations: finding a solution. Within a couple of days I knew there were other ways of reconstructing a radiated breast besides using tissue from a patient’s stomach or her lat muscle.

There are surgeons who do breast reconstruction using only implants. There are pros and cons to that. The Huntsman surgeon doesn’t do the type of reconstruction he does to make it more difficult for patients, but, rather, because he thinks it gives his patients the best outcome. After weighing the pros and cons I decided I wanted implant-only reconstruction.

I interviewed two teams of surgeons that did this type of reconstruction. I picked the team I did over the other because when I asked the question “How many times have you done this surgery?” members of the team couldn’t answer. They had to guesstimate: “Somewhere in the thousands.” Right answer. Traveling to Los Angeles for surgery was an inconvenience, but one I thought worth it for the surgeons’ experience.

Last June 10, when all of my breast tissue as well as a number of lymph nodes in my right armpit were removed, expanders were put beneath each of my pecs. You can think of expanders like balloons. In my case, because I was next getting radiation, the reason for the expanders was two-fold: They expand the skin and muscle so they’re ready for the real implant, and you can’t radiate a silicone implant. So the placement of expanders is the first step of reconstruction.

The second step is expanding the expanders. Starting around three weeks after surgery, the surgeon emptied a giant needle filled with 50 milliliters of saline solution through a one-way valve into the expander. He added another 50 milliliters every three days. The procedure is done in small increments because it can be painful for the muscle and skin to stretch.

Because radiation permanently damages the elasticity of skin, expanders need to be inflated to the final breast size you want before radiation starts.

My boobs were the right size by late last July, and I started radiation shortly after.

Post-radiation, the skin needs to heal for six months before the expanders can be removed and the real implants, which have a lifespan of 10 to 20 years, put in. The end of March marked six months since the last of my 36 radiation treatments.

While the surgery swapping expanders for implants is surgery — I’m under general anesthesia for 90 minutes to two hours — compared with a double mastectomy it’s a cakewalk. Still, after this surgery my doctors do not want me doing much of anything with my arms for six to eight weeks. I’m not supposed to elevate my heart rate during this time either.

Since last summer was a bit of a bust — recovering from chemo and the double mastectomy and getting radiated and all — I wanted to enjoy this summer, to get strong and to race the 206-mile LOTOJA (Logan, Utah, to Jackson) on my road bike. The plan was to have the expander-to-implant surgery in early October so that I recovered during the offseason, not during the best months to play outside.

And then, just as my boyfriend Derek and I were settling back into the idea of being able to make plans several months out, the left expander popped.

I wish there was a good story behind it. I’ve been lifting weights, sleeping on my stomach (my reconstructed breasts are the same size as my natural breasts, a small B cup), doing indoor rowing classes, stand-up paddleboarding, running, biking, skinning, skiing, backpacking and a dozen other things you’d think could pop an expander. Maybe the hard life I’ve put my expanders through did weaken them. But what did it was an echocardiogram I got to make sure one of the chemo drugs I was on didn’t permanently damage my heart.

The expander didn’t really pop. But “pop” sounds better than, “It sprang a leak.” When I dressed immediately after the echocardiogram I didn’t notice anything. It wasn’t until I changed into hiking clothes two hours later that I saw all was not as it was when I had woken up that morning. My right breast was proud and full, but my left breast was lethargic, the skin around the nipple wrinkled. I noted this and then, because it was a beautiful day, went hiking.

When I showered before bed that night my left breast was even more wrinkled. Under the hot water I played with it, pushing around the saline solution inside. At the time, its collapse was still novel and funny, not yet the death knell of the summer Derek and I had planned.

I worked the saline over to the left side of the breast.

“My armpit has a hernia,” I said to myself. Then I massaged it to the right side. “If someone had three breasts, is this where the third one would be?”

It took longer than you’d expect, but eventually I tired of this game and got out of the shower. I evened out the saline solution and then walked topless from the bedroom into the kitchen to show Derek. We’ve had more than a few conversations over the last year that have started this way.

“Am I imagining things or does my left boob look weird?”

Derek said I wasn’t imagining things. I had him take photos of both breasts for me to email to the surgeon the next morning.

Amazingly — and also probably because I took about 15 milligrams of melatonin — I had no problems falling asleep that night. I was still clueless about what the expander’s leak meant.

The awareness came at 11:15 a.m. the next day. A leaking expander, which, after seeing Derek’s photos the surgeon said I definitely had, is not an emergency, but waiting until October to fix it was not an option.

“The skin and muscle that were expanded will shrink, and the implant won’t fit,” the surgeon explained.

The thought that whatever the expander was leaking might be dangerous hadn’t crossed my mind. But before we hung up, the surgeon told me not to worry: “It’s saline. Your body will excrete it over the next several days.”

Derek arrived home from a lunchtime bike ride to find me on the phone with United Airlines, tears of anger, annoyance, frustration, disappointment and sadness streaming down my face. We hugged for a long time; it was the first time in many months I dribbled snot all over his shoulder.

Energized by the hug, I bought plane tickets to LA, began searching AirBnB for a place to stay, checked to see if my mom could fly out, made sure I could get my pre-op checkup and labs done here in Jackson and began rescheduling the work obligations I had between June 2 and 7.

Planning and then accomplishing all of this — feeling like I was back in control — put me in a better state of mind. By that night, when I was going to the bathroom before bed and Derek pointed out I was pissing my left breast away, I smiled.

Dina Mishev is writing about her journey with breast cancer. Tune in once a month for her story and tips for others facing cancer. Write her at columnists@jhnewsandguide.com.

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