Rough guide to making a nipple

You will need:

1 Black marker pen
1 Piece of felt (in the absence of fake leatherette to simulate the skin)
1 Pair of scissors
1 Violet braided absorbable vicryl suture (alternatively, a needle and thread will do)

Step 1. Using a marker pen, draw the outline of your home-made nipple on the felt. If your rendition resembles a squashed club with a circle in the middle, you're doing well. This is what Mr A calls an aeroplane flap.

Step 2. Cut around all of the outline except the base of the circle in the middle. (You'll have to pretend the sutures aren't there; I had to pull Mr A's work apart to show you this bit.)

Step 3. Hold your aeroplane flap upright. Fold one side-flap behind the circle.

Step 4. Fold the other side-flap behind the circle.

Step 5. Fold the last remaining flap down and suture. (Unfortunately, I don't have the precise suturing instructions on hand and will get back to you on this.)

Step 6. Look, no hands!

The bit where it all comes together

If you have any doubts about the value of orange pedagogy, watch this. Here are some oncofruit pointers to give you a head start.

• The latissimus dorsi (LD), the large muscle in the back which in my case became the basis of my reconstructed breast, is represented by the flesh of half an orange.
• The skin (or orange peel) that is to become the new areola is still attached to the LD flap, which has been harvested - cut loose along with the blood vessel - and is ready to be tunnelled under the armpit.
• The skin envelope (empty breast/a.k.a. hollowed-out orange), is filled by the LD flap at which point the new breast, complete with back-skin areola, comes into existence.

Three OMGs from Kate prove it's a revelation. 

Mastectomy for beginners

I know it was my idea, but flippin' 'eck. The orange workshop was amazing. I think it has the potential to be a brilliant teaching tool for women who want to understand what happens to their body during oncoplastic surgery. Picture this (or better yet, watch the video):

1. Mr A goes and blows another of my theories out of the water, which is that once the areola is removed, the skin of the breast is scored like an orange to make flaps that open wide enough so they can get to the tissue. Not so! Instead, the skin is stretched back and held in place by pin thingies. (I think that is the technical term.) Apparently when you do that, you can see the planes inside and easily separate them: layers of tissue, fat, dermis and epidermis. Alum Bay-style stripes of colour come to mind for some peculiar reason.
2. They don't use a bog-standard scalpel on the breast, other than on the skin when they remove the areola. They use an electric knife of sorts. But not like the one my mum used to carve the roast with briefly in the eighties, obviously. She soon went back to manual. But as far as breasts are concerned, harmonic scalpels are the preferred sort. They vibrate about 5000 times a second or something. You'll have to watch the video eventually, because I probably got that wrong. Good job Mr A likes fact-checking.
3. Mr A tells stories about breast surgery of different kinds and the various approaches surgeons take. Of course, much of this discussion takes place off camera. Mr A has one way of doing reconstruction; his cohorts have another. And of course, each woman's result is entirely unique. More proof that it's more art than science in my mind. 

Frankenstein's monster, me?

Before you go any further, you should know that this post contains a medically graphic photo of muscle, tissue and skin. I had to look at it regularly, but you don't. (It's all better now, by the way, the tissue and skin having been regenerated with the help of the anti-bacterial wonder-food, manuka honey. It's true; my three year old daughter still thinks I've got honey on my boobs.)

As I said. If you're at all squeamish, please don't look.

*****

Another friend, Nic, who came to the orange mastectomy and reconstruction workshop courtesy of Mr A, has written to me to tell me what she thought of the evening with my surgeon. We've talked about my surgery many times, and more than once she's brought up Frankenstein. (Despite that, we're still friends.)

"As you know I was pretty amazed by the whole evening (thanks to you) and felt honoured to sneak a peek into the world of a surgeon and his orange boobs - witnessing the processes and knowledge behind the knife. I felt a little concerned for the oranges but they were transformed from mere fruits into models of scientific genius. Quite eye popping really. Watching the orange-bodies being moved about and adapted by human hands as though it were living flesh, listening to him explain how they take parts from the back around to the front to make a better version - it all conjured up memories of Frankenstein being made, and I can see how a complex relationship could form between surgeon and patient - almost like the creator and his creation. But this is different. How incredible that a human being can save your life through his knowledge, skill and attention to perfect detail. Humans rock xx"

I'm intrigued by Nic's references to the relationship between creator and creation, surgeon and patient. If there is any analogy, I think it is this. Frankenstein's monster feels abandoned and lonely; he recognises that he isn't like everybody else. I felt lonely, and frankly a little abandoned, after my mastectomy; after it's over, you're on your own and you just have to get on with it. When I looked down at myself after my operation I felt reduced, hurt and ugly. It was made worse by the extensive necrosis that made part of the reconstructed breast turn black. I was unlucky; this was apparently another unusual complication. The dead tissue had to be cut away, and what lay underneath was quite horrifying. Oddly, though, the manuka honey treatment made me feel kind of special (god I'm weird), and I think that, along with my rapport with the nurses and especially Mr. A, got me through. 

Even so, it took some time for me to turn that sense of the monstrous around, and it's still a work in progress. The necrosis is completely healed, though my surgery isn't over yet. But as time goes on, the scars fade, and I get closer to the finished breast, I find myself returning to the world feeling whole again. A lot more attractive. And a lot less lonely.