Fin!

WARNING: NSFW / graphic content below.

Alright boys and girls .. I think we did it! I think we’ve finally arrived at the end. My exchange surgery was on Thursday, September 11. I had pocket revision on my right side and a swap from tissue expander to implant on my left.

SunriseWe arrived at the hospital at 6:30am for the 8:30am procedure. It was a beautiful morning! The surgery lasted three and a half hours – longer than we expected. I woke up bundled up in a tight compression bra and ACE bandage wrapped about my chest. The biggest and most wonderful surprise: NO DRAINS!!! I couldn’t believe it. Spent a bit in the recovery room and then hightailed it home to my comfy bed.

On Friday, we drove out to Dr. M’s office for my follow up appointment, which is when I got to see them for the first time after surgery. Things are looking good! I do have some swelling, which is to be expected, but aside from that they look to be the same size, are even on my chest wall, and my nipples line up. Woo hoo! I know it’s early, as it takes up to a year for things to settle, but I am just ecstatic!

Post exchange

Dr. M explained what he found while he was in there. It appears that at some point since my last surgery in April I ripped apart the pocket revision he did then and this is why the right side was bottoming out again. This could’ve happened as I bumped into something or fell or had some other physical strain or trauma. Hub pointed out that it may have something to do with me painting. Yes, I admit, I did more than I should have. I’m an idiot. This time around I am doing N O T H I N G. Absolutely nothing. For at least a month. And no excuses!

On my left side, Dr. M made the incision underneath the nipple, where the original was, rather than going in through my armpit again. He had to do some work on that side to make sure symmetry was achieved, hence a bit more swelling there. He did not do any fat grafting, which made me happy and I did stay with the same implant size and projection I had previously: Mentor round, smooth, high profile, silicone in 450ccs.

I am feeling amazing! I think the girls look great and physically I am not in too much pain. I am to wear this compression bra for two weeks straight, with the exception of showering. This will ensure everything heals in place as it should. Next appointment: September 25.

Fitness

I can’t wait for this surgery to be behind me! Only a few days left. At 1½ years, this process has taken much longer than I expected and I’m so ready for it to be a distant memory.

One of the things that I have stayed away from during this adventure has been my regular workout routine. I miss it and am eagerly awaiting to be cleared by my plastic surgeon to get back to it. After my last exchange in September ’13, I got that clearance a month out. About the same time I began using the silicone scar-reducing gel and we all know what came next. Ever since then I have been scared to overdo it, so I just haven’t done anything.

I’m not planning on seeing my good ol’ buddy Tony Horton the day after surgery, but I do plan on seeing Casey! Casey Eischen is a fitness expert and nutrition coach that is certified in training women who are recovering from breast cancer related treatment or surgery. She created a great post-mastectomy exercise program that I did after each one of my surgeries (see below). Casey also founded Foobie Fitness as a guide to help women not only prepare and recover from treatment or surgery, but also to educate us on how we can all make small improvements to help live a cancer-free lifestyle. Today I got my Foobie Fitness tank. I am ready!

Foobie Fitness tank


As with starting any diet or exercise program, always consult with your doctor.

Projection waffles

waffleI am such a waffler! Why is this so hard? I already decided that I am not swapping the implant I have for something else! Yet here I am, still thinking about it. I remember this .. this is how the whole “should I keep my nipples” thing went. Remember how that turned out? I think I made the wrong decision then. I want to make the right one now.

At my pre-op appointment last week I signed consent forms*, gave blood, got prescriptions for Norco and Cipro, and played around with some implants. Here are two silicone implants that are both 400ccs. The left implant is high profile, the right one is ultra high profile. The ultra high profile version is narrower at the base, and has more projection.

implant profiles

So last time: do I keep my Mentor round, smooth, high profile, 450cc silicone implant and match it on the other side or do I go for an ultra high profile version? As I said in my last post, I am not disappointed with what I have, but we could improve on projection. Here are some more answers that helped me come to the FINAL final decision:

  • QuestionWill replacing the existing implant increase risk of capsular contracture? Even if we choose to keep the current implant, it will be removed to resolve the issue causing bottoming out. Either way, it is coming out and then something is going back in. Risk unchanged. (I didn’t realize this. I thought we’d fix it without taking the implant out.)
  • Current implant has zero rippling (woo hoo!). Will a higher profile create that issue? It is impossible to predict this. Many factors come into play. Unknown.
  • Will any pocket revision be needed? Goal would be to choose a UHP implant size with the base width close to current implant, so that no pocket tightening is needed.
  • So how much difference in projection can we achieve with a swap? Depends on what size implant we choose. We went to the Mentor product guide to check dimensions.

This is what I have in now:

HP 450 dimensions

The UHP implant with the closest base width is 590ccs! That is just not going to happen. I don’t want the “done” look. My tissue expander is at 550ccs and it is already too much for my taste. I wouldn’t mind a little more projection, but that will come with overall increase in volume = bigger foobs. I am not comfortable with that idea. The options are:

UHP dimensions

We could do a 480cc or 535cc UHP implant, but the increase in projection is minimal (1cm at most, which is about the length of a finger nail) and I like my size now. So while yes, we’re going in there and the implant is coming out anyway, I love the fact that I have no ripples and that I know what I will look like on the other side. Let’s do only what we really have to and hope for the best! Fingers crossed surgery #5 will be a huge success and I will be DONE!


*Carefully read your consent forms before you sign them. You do have the option to strike out or refuse some of the things you may not agree with. I do not consent to medical students/residents, fellows, or visiting surgeons performing any part of my procedures. I understand the need for teaching opportunities, but my plastic surgeon is the only one I want touching me (with the exception of his regular surgical assistants and OR staff).

Last expansion of round 2

WARNING: NSFW / graphic content below.

For the second time now, I am excited to declare that I am done with expansions! Yes, I’m celebrating just like I did last year when I finished the process then. We added 50ccs to the expander on my left (right in pic below), for a total of 550ccs. I now wait until September 11 for my exchange surgery. Time to bring back the calendar countdown thingie!

During my appointment, I had an opportunity to discuss the upcoming procedure with my plastic surgeon. I wanted him to eyeball things, make sure everything is OK, and confirm that all we are doing is taking out a tissue expander and placing the Mentor round, smooth, high profile, silicone implant in 450ccs.

Well, it looks like the implant on my right is making the trek south again – bottoming out. This means that during the exchange surgery, Dr. M will have to go in on my right side and close up the pocket from the bottom. This is what he did in April, so I’m concerned about whether or not this will hold. He explained that this time he will do the vest-over-pants (overlapping) closure, which should hold tight. I sure hope so, because I’m counting down to surgery #5 and now at 1.5+ years into this thing. I do not want any more surgeries!

We also discussed the current implant and whether I am happy with its size and the shape. I’m not unhappy, let’s just say that, but I did ask about the difference between high and ultra high profiles. Dr. M will look into the specific measurements and we will discuss when he returns from vacay. If there was something to improve on, projection would be it, but after discussing with the hub I am thinking that I don’t even want to go there. He agrees.

This is a 450cc silicone implant on the left of pic and a 550cc tissue expander on the right.

2014_7_31

Nippies

After my prophylactic bilateral mastectomy in January ’13, the left breast became necrotic from the incision up to my nipple. The scab that formed as the area healed eventually fell off taking my left nipple tip with it. Just the tip. It never grew back so I have one full nipple on the right and just the areola on the left. This makes for some awkward headlight moments.

What’s more awkward than two hard nipples?

Well, ONE! Although the remaining nip isn’t 100%, meaning I don’t have full sensation as I did pre-PBM, it still responds to stimuli. Every time I drive, for example, the seat belt rubs in just the right spot, so when I get out of the car, the right nipple is always “on.” If I was wearing bras, this wouldn’t be an issue, but I’m not, so I am usually sporting one headlight. I know .. it’s not that obvious and not everybody will notice, but I know it’s there!

One headlight

In an old post I went through the options that I face if I want to do something about the nip:

  1. Do nothing
  2. Get a 3D tattoo
  3. Reconstruct the lost nipple via skin graft or skate flap
  4. Remove the other nipple

I want to do something and it looks like it’ll be #4. My plastic surgeon can to this during an in-office procedure, but we will wait until I am healed from my next and hopefully last surgery in September. I am aiming to be finished by end of 2014.

In the meantime, he recommended I try Bristol Six Nippies. I have seen other women recommend this product on the various message boards and now I am recommending it too. These things are awesome! They are silicone nipple pasties that can be either inserted into a bra or cami or worn directly on the skin. I have the latter version, which is coated with an adhesive and sticks right where you put it, for many hours. Nippies Skin are seamless rounds that come in light, medium, and dark tones that blend into the skin. The medium version is pictured below.  The also come in other colors and designs, including tassels!

Bristol Six Nippies Skin

This is what they look like under the shirt. Yes, jerk cat IS judging you.

Bristol Six Nippies Skin

Are my breasts uneven?

WARNING: NSFW / graphic content below.

Two months after my most recent surgery I now have the same volume in my tissue expander as I do in my implant. We added 50ccs to the expander, for a total of 450ccs. Even though they are the same, they are uneven. I am at the perfect point to show the difference between the look of expanders versus that of implants.

Are my breasts uneven?The tissue expanders are hard, sit high up on the chest wall, and have more projection. Implants are soft, pliable, and more natural. Women who have been through the process and had their exchange surgery often say they are disappointed with size. In a 1-to-1 volume swap, the differences between these two types of devices are to blame.

Here I am as of today: 450cc tissue expander and 450cc implant (Mentor, round, smooth, high profile, silicone). Can you tell which side is which? The one with the lighter areola is the expander. From the front, they don’t look that much different, but from the side or top you can see that the expander is narrower and sticks out further than the implant.

Implant vs expander

When I was going through the expansion process after my prophylactic mastectomy, I reached my happy point at 400ccs. Having read and heard that women are often disappointed with their size post-exchange, I gave myself a cushion and declared that I wanted 450cc implants. That’s what I ultimately got (took a while to get there, but I’m there) and I’m glad that I decided to do a little extra. I am very happy with the implant size.

My plastic surgeon overfills by 100ccs, so I have two more expansions to do. Then I wait a couple of months for my exchange surgery on September 11. This is going to be a weird summer with high temperatures, skimpy tops, and two different size boobs. Oh well. I already spent six months with a single boob, so how bad could this be, right? :D

FoobieFitness.com

You’ve seen me mention the amazing Casey Eischen and her post-mastectomy exercise program, I’m sure. I’ve done it more than a couple of times. Foobie Fitness, which started with Casey’s YouTube channel and a community page on Facebook, recently became an official non-profit! Today Casey and her team launched FoobieFitness.com aiming to help not only women navigating breast cancer-related journeys, but anyone interested in disease prevention, nutrition, yoga, and the overall cancer-free lifestyle. Who isn’t interested in saying NOPE to cancer?!? Make sure to visit this awesome resource!

FoobieFitness.com

 

My feedback featured as a Success Story on FoobieFitness.com:

 “The Coach Casey post-mastectomy exercise program is was what really helped me make a speedy and successful recovery after my prophylactic mastectomy and tissue expander reconstruction over a year ago. I knew that my range of motion and mobility were going to be severely impacted by the traumatic procedure, so I began searching for the right program that I could begin right away and would help me in my recovery. I found just that in Casey’s videos.

I started doing wrist bends while still in my hospital bed and I slowly progressed through additional exercises in the following days. Each time I played that YouTube video I was doing better than the day before and I attribute that to this program!  I talk about and recommend it whenever the opportunity presents itself. I still do it as of the day I write this, having had additional reconstructive surgery just four weeks ago! Casey has always been positive, encouraging, and willing to offer additional advice and tips. She even created a clean and simple nutrition plan to supplement the exercise regimen. Thank you Coach Casey for helping me and countless other women get through this!” – Nope2BC.com

On a side note: I had my second fill today bringing the expander to 400ccs. I have also moved my exchange surgery out a few weeks to September 11. The story continues.