Pop Goes the Expander: One Woman’s Experience with a Tissue Expander Leak
06 Aug 2016
For any woman, a breast cancer diagnosis is always a blindside. Many articles, like this one from the American Cancer Society, point out that unhealthy habits increase the risk of breast cancer. Others suggest by living a healthy, active lifestyle the risk of cancer can be greatly reduced. However, there are so many differing factors. The reality is that even healthy women can find themselves sitting in an oncologist’s office making those difficult, heartbreaking decisions surrounding a breast cancer diagnosis. It wasn’t her healthy lifestyle that contributed to Dina Mishev’s cancer or to her tissue expander leak. We caught up with this active woman to learn more about her personal experience with a question that lies in the back of many women’s minds, “What if my expander pops?”
Trouble in Paradise
Jackson Hole, Wyoming is one of the most peaceful and beautiful places to live, but that can’t keep the harsh realities of the real world from creeping in. Dina Mishev is a successful freelance writer and editor-in-chief for Jackson Hole Magazine. Jackson Hole has been her home since 1997, two months after her college graduation. In an article for the Washington Post she wrote Jackson Hole was her choice because “Han Solo lived there”, and she wanted to learn to ski.
Dina takes every advantage of the active healthy lifestyle the beauty of the western mountain range offers. It’s not unusual for her daily activities to include skiing, hiking, or biking. Dina is a woman who loves to challenge herself.
In December of 2014, she received her cancer diagnosis, and she quickly found herself living through rounds of chemotherapy, a double mastectomy, reconstruction with expanders, radiation, and then implants.
Her treatment plan was set, and it started with chemo. Dina began to think about the pending double mastectomy and her breast reconstruction with her final round of chemo. Researching the different procedures, she learned that her post-mastectomy breast reconstruction would be a multi-step process.
Finding the best option involved many emotional ups and downs. Because of her active lifestyle, Dina wasn’t ready to compromise. After learning that some of the procedures would leave her with the loss of muscle and upper body weakness, she knew clearly this was not an option. She was determined to not let cancer interfere with life or lifestyle, and eventually with the help of her mother found a plan that would work for her.
Her choice for reconstruction after her double mastectomy was expanders and implants. This would not involve the loss of any muscle. The surgery took place in June of 2015, and radiation followed six weeks later. Her implants would come six weeks after radiation.
“I didn’t know if you could do reconstruction without expanders. I asked about going straight to implants, but the doctor said that was not recommended,” she said. “He believed they would have better results with expanders.”
After the double mastectomy, and her expanders placed, the experience wasn’t exactly what she expected.
“They felt weird, but weren’t as painful as other women had talked about,” she said.
Now with the expanders in, Dina planned out meticulously how she wanted the next steps to time out. Jackson Hole has beautiful summers, and she feels that she “lost” the summer before because she felt weak from her chemo treatments. She wasn’t going to lose another summer because of radiation and reconstruction.
Although she would be able to swap out the expanders in March for implants, she made a different decision. The swap out surgery would wait until October, because she had a bike race she was looking forward to, and that another surgery would result in at least six to eight weeks of recovery. That would require her to take it easy. No exertion would be permitted. So, she chose to wait until after summer.
“I’ll have a really good summer, then I have the expanders swapped out,” she said.
Tissue Expander Leak: A Different Kind of Adventure
In the meantime, Dina still had some tests leftover from her chemotherapy treatments. One of the chemo drugs she had been given required her to receive regular echocardiograms. During the last echo she had scheduled, her well thought out plan and schedule suddenly went awry.
“I didn’t notice anything as I got dressed after the echo, but then two or three hours later when I got dressed to go hiking, the left breast was wrinkled, not so full,” she said.
She wasn’t concerned in the beginning, and went hiking anyway. Challenging her body is somewhat the norm for Dina. Diagnosed with Multiple Sclerosis in 2006, she doesn’t want to ever give in to the limitations she can face sometimes. Multiple Sclerosis is a potentially debilitating disease that can lay dormant for years. Dina doesn’t want to waste time.
“I don’t ever want to look sick,” she said.
As the day went on the imperfection became way more noticeable, and was becoming hard to ignore.
“I asked my boyfriend for a second opinion,” she said. “Am I imagining things, or do they look a little weird.”
Her boyfriend thought it definitely looked “weird.” To him it looked as though it was leaking. As strange as it sounded, maybe her expander “popped” after the echo.
“I took pictures and sent them to my surgeon,” she said. “And they thought it was more than an “oddity.”
Throughout the next couple days she proceeded to release 250 milliliters of saline solution, that once filled the temporary expander, into her urine.
Her surgeon in Los Angeles, after some back and forth with photos, recommended her surgery for the implants be moved up. Although it wasn’t considered an emergency, the leakage was only saline, but the skin and muscle that were expanded would shrink, and then the implant would not fit. She needed to schedule her surgery and not wait until after the summer.
The expander had popped, along with all the plans she made with her boyfriend for the summer (the bike races and everything, were off table). It was then that Dina discovered she might have been suppressing more anxiety than she realized. So, there were some positives to come out of the “popped expander.” Dina began to feel like she was back in control of her life again.
“When my expander popped and I realized everything that was on the table was now off, I was really sad and disappointed, frustrated and angry for a while, but then like a switch it flipped. I should be treating this trip to L.A. like it’s a vacation. The second day just happened to be surgery. Some part of me just let go and relaxed in a way I had not in a really, really long time,” she said.
Dina recently had the surgery to replace the expanders with implants. It went well, and she enjoyed the time she spent in Los Angeles. Even though she is out of commission from some of the summer activities she loves, it’s the little accomplishments that are pushing her forward.
“I’m not even a week out from surgery, and I’m walking the two miles to the bagel shop. Don’t tell my surgeon that,” she said.
This surgery went much smoother than previous surgeries, and now she can look forward to putting this whole ordeal behind her, and celebrating the little victories.
“Yay! I have to take it easy for four to six weeks, but I didn’t have to take a single painkiller.”
Curious to know how Dina’s doing now? She is sharing her story here in her column in the Jackson Hole News & Guide.
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