Tag Archives: Necrosis

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.

Sunrise We 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!

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.

Updates galore

1 Reply

WARNING: NSFW / graphic content below.

Mother’s Day sucked

This was the first US Mother’s Day without my mom, who had ovarian cancer and died in November. Last week was rough. May 8th was World Ovarian Cancer Day and May 11th US Mother’s Day. Seeing everyone posting photos of celebrations with mom was really difficult. I know many of you reading this understand, because you have also lost your mom.

nope2BC is a success!

I spent the weekend doing my best to occupy myself with other things, such as painting, moving furniture, and shopping. I finally did something with the spare room that has been empty since we moved into this house seven years ago: it is now my crafting room.

Did I tell you the FORCE jewelry fundraiser lead me to start my own business? Yup .. nope2BC – Saying NOPE to Breast Cancer. Come see and Like on Facebook. I am making and selling cancer awareness themed jewelry and donating all proceeds to FORCE. I opened an Etsy shop and have also participated in a few local craft fairs and art expos. Over $1,000 has already been raised, which is way more than I expected to make in such a short period of time. I am ecstatic that it has done so well! I have another event tonight and many more coming later this year. I have lost count!

Recap of my reconstruction journey

Moving on to an update of where I am in the breast reconstruction process. First, I’d like to recap my journey for those of you who recently started reading this blog:

01/2013 – Prophylactic bilateral mastectomy with tissue expander placement
100ccs @ PBM, necrosis on left breast, hyperbaric oxygen therapy, fills delayed for two months, lost left nipple tip, expanded up to 550ccs
09/2013 – Exchange surgery
550cc expanders > 350cc Mentor round, smooth, high profile, silicone implants
10/2013 – Infection and left implant removal
Necrosis scar tissue broke down, hole developed, infection followed, implant had to go
04/2014 – Revision surgery
300cc tissue expander on left, swap to 450cc implant on right
08/2014 – Planned exchange surgery

Expansions are a go

Five weeks after my most recent surgery I finally had my first expansion. We added 50ccs to the expander on my left, for a total of 350ccs. Our goal is 550ccs, so four more expansions to go. My exchange surgery is scheduled for August 19. We are going to be cutting it close with only about four weeks between last expansion and exchange. If I wuss out again and need to lower the expansion volume, I will have to push the surgery into September. Just two days after the fill, I am sore, but it is no surprise. Next expansion: May 30.

Here we go again

15 Replies

Got the pre-registration call from the hospital today. Here we go again. I am two weeks away from going under the knife for the fourth (and hopefully last) surgery in this process. Almost six months have passed since I had the last surgery during which one of my implants was removed due to an infection (see: Houston, we have a problem).

Pre-op

My pre-op appointment is on Monday, March 31. I’ll be doing standard lab work and discussing the plan for my upcoming surgery, including:

Nipple symmetry – the left nipple became necrotic and I lost just the tip when the scabs came off. I want to snip the tip of the right one to match. What’s worse than two erect, awkward nipples? ONE!
Pocket closure – the pocket on my right side is too low, so during this procedure I’d like it surgically closed up a bit at the bottom.
Increase in size – since we are going in there on both sides anyway, I’d like to achieve what I originally declared as the right size for me, which is 450ccs (350ccs now).
An implant, not a tissue expander – this! More than anything, I just want to be done.

I have my fingers and toes crossed that I will wake up with an implant and not another expander! Obviously, I don’t want any more issues, so if an expander it is, I’ll suck it up and just deal with it. I’m pretty sure I will have at least one drain. <sarcasm>Yipeee.</sarcasm>. Time to whip out the good ol’ checklist and start getting ready.

Houston, we have a problem

32 Replies

WARNING: NSFW / graphic content below.

Before I tell you about what has been happening for the last few days, I just want to say to those that are considering this procedure, preparing for one, or have already started the process: women who undergo a mastectomy, whether prophylactic or not, don’t always experience complications. Actually, I’d say that most do not, based on my involvement in a few online support groups and interaction with women in my local community. Everybody’s experience is different, because of different doctors, hospitals, body condition, other health issues, activities during recovery, nutrition, etc. There are many factors. Each person should consider their scenario and discuss concerns they may have with their surgical team.

Another thing to keep in mind is that usually the people that have problems are the ones that speak up. You know – the squeaky wheel thing. There are so many women out there that have had a completely complication-free experience and have beautiful results! You can’t tell that they’ve gone through this journey unless they tell you! Those women usually don’t linger in the support groups, stop blogging about it, move on, and just leave it all behind them. They are DONE and don’t have to think about it again.

Okay, Houston, we’ve had a problem here

Unfortunately, I’m not one of them. Upon my return from vacation, I started working out again (cardio) and I also began using Kelocote on my hypertrophic scars, as I mentioned in a recent post. Both of these activities began on Sunday. The following Wednesday I saw Dr. M and things looked good. The next day I noticed a bit of redness around the incision on my left breast. By Saturday there was a small area in the center of the scar tissue from my bout with necrosis that had turned blue. I emailed Dr. M and got this response:

Yes, this is a significant problem. Need to see you tomorrow.

By Monday afternoon, I had a hole. By early evening I had chills, sweats, and a fever of 101.7. Panicked, I called the after-hours service to page Dr. M and he called back immediately. The plan was to continue on the antibiotics, take a couple Tylenol, and sit tight unless the temperature spiked past 103, at which point I’d hightail it to the ER. Within two hours the temperature dropped below 100, but I knew what was coming: the implant had to go.

My surgery was at 5pm on Tuesday, October 15. Dr. M cleaned up the incision and removed the implant. I am left with one breast and another drain! I really REALLY don’t like drains, but who does? What’s next? We have to let everything heal for at least three months before we being talking about restarting reconstruction on that side. I’m am so bummed by this humongous setback!

Why did this happen?

A combination of things may have caused this, but it’s hard to say exactly which was the straw. In Dr. M’s experience, implants are usually (but rarely) lost due to complications from three major things: radiation, smoking, and/or trauma. I fall into the third category. The necrosis I experienced in January produced a lot of scar tissue, which has poor circulation. My use of Kelocote on that scar tissue introduced chemicals into the equation. On top of that, I started working out again. My body protested against the combination of old and new trauma. So here I am, uniboobin’ it for at least three more months! Good thing it’ll be during winter and I can camouflage things a bit. I present a foob and a drain:

Fifth expansion

9 Replies

WARNING: NSFW / graphic content below.

In other news: I had my fifth expansion. 50ccs have been added to each expander, for a total of 400ccs/side. We’re getting there.

184ccs (pre-op) vs. 400ccs

I am very happy with how these things are looking so far. Compared to how expanders usually look on women, mine have a pretty natural shape. A bit lop-sided, with righty higher up than lefty, because of how the internal pockets healed post-op. The right pocket closed up a little bit on the bottom, so the expander sits higher in my chest, but it’s not too bad. This will be fixed during the exchange surgery in September.

I have a few more decisions to make before September. Mainly: will I get silicone or saline implants, what shape will they be, and what am I going to do about my nipples. If you’ve been following me for a bit (or can tell from the photos), you know that I lost one of my nipples to necrosis. I need to figure out what I’m going to do about it. The options are:

Nothing
Reconstruct the lost nipple via skin graft or skate flap
Get a 3D tattoo
Remove the other nipple

I can’t decide what is best. On one hand, I went through all this trouble, so why give up now, but on the other, I just don’t think I’m going to like the aesthetic result if I do nothing or reconstruct/tattoo just one. What’s more awkward than two hard nipples? ONE! I like symmetry. I think I’m going to remove the other one and maybe reconstruct them both. Not 100% on that though. We shall see.

Here are the pics. Big difference between what 100ccs looked like after my mastectomy in January and the 400ccs I have today.

100 + 50 +75 +75 + 50 + 50 = 400ccs

Nipple delay

11 Replies

Wondering what a nipple delay is? I was too! I hadn’t heard of this procedure until Angelina Jolie announced to the world that she underwent a prophylactic double mastectomy and this procedure was part of the process.

Since that announcement, many different articles and opinions have been published. A lot of them positive, but a few negative. That’s another post for another day. A few pieces did provide more information on the nipple delay procedure.

What is nipple delay?

During the nipple delay procedure, the surgeon makes an incision in the skin and severs the breast tissue and blood vessels directly beneath the nipple (it remains attached to the surrounding skin). Due to this, the nipple is no longer dependent upon the blood supply directly beneath it and becomes accustomed to getting its blood supply through the skin. According to the Pink Lotus Breast Center blog, it actually recruits additional blood flow not previously established.

This is an uncommon procedure. If it is elected, it is performed some time before the mastectomy; two weeks for Angelina Jolie.

Why have a nipple delay?

Surgical nipple delay is used to decrease likelihood of nipple necrosis, which can occur because of loss of blood supply and can lead to nipple loss, following a nipple-sparing mastectomy.

Breast skin is fragile after mastectomy. If it’s exceptionally thin after the breast tissue is cut away or is handled too roughly, it may die. The same result may occur if the breast surgeon severs too many blood vessels that feed the skin or uses eletrocautery too aggressively and burns the inside of the skin, which may then blister and die.
– Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

I was not informed of this option prior to my own nipple-sparing mastectomy. My compromised blood flow resulted in necrosis on my left breast and I lost a nipple. If you are interested in reading about my bout with necrosis (including photos) and the hyperbaric treatment I underwent in an effort to thwart it, please read Tissue necrosis.

Related articles:

Surgical Delay of the Nipple–Areolar Complex: A Powerful Technique to Maximize Nipple Viability Following Nipple-Sparing Mastectomy (annsurgoncol.org)
Angelina Jolie’s ‘nipple delay’ procedure, explained (NYmag.com)
A patient’s journey: Angelina Jolie (PinkLotusBreastCenter.com)

Source of Figure 1.1: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

We’re getting there – third expansion

14 Replies

WARNING: NSFW / graphic content below.

Fill number three is done. We added 75ccs to each expander, for a total of 300ccs/side (pic below). It is about the same on the pain scale as it was last time – nothing initially, but feeling pressure the next morning. I continue to slather these things with cocoa butter oil with vitamin E to keep the skin soft and prevent stretch marks. So far so good. If you missed the scoop on the first two fills, see: They’re growing and They’re back.

Since I still haven’t decided just how big I want to go, while I was in for the fill I checked in with my plastic surgeon to get his feedback (I trust that he has an eye for these things). Another 150ccs or so will be just right based on my body size and shape. Ultimately, it is up to me how many ccs will be the sweet spot, but I do agree that we’re not there yet. So we are going to continue the fills until I’m happy. What then?

Once the desired size is reached, there are two more 50cc fills done. As you see in my photos, the tissue expanders are kind of boxy and sit high up on the chest wall. The additional expansions are done to overstretch the skin and muscle, so that when the final implant is placed it has a more natural shape. When the expansions are done, we wait four to six weeks before we move on to the next step.

Exchange surgery

When we’re done will all of the fills, including the overfilling step, an exchange surgery is performed. This is an outpatient procedure during which the plastic surgeon exchanges the tissue expanders for saline or silicone implants.

I asked how far out they are booking surgeries for Dr. M and quickly realized that I need to get something on the books STAT. The first available date is September 3rd. That is over four months away!!! My (sarcastic) thanks to Dusky, my rebel left nipple. Had I not experienced necrosis (see Tissue necrosis), we would’ve started the expansion process about two months sooner. What can I do about it? Be grateful that necrosis was as bad as it got.

Current plan: three more 50cc expansions + two 50cc expansions to overfill = 550ccs. Here’s to a Dolly Parton-esque summer! Not sure if this is good or bad. Thoughts? I’ll be celebrating my last expansion with July 4th fireworks. On this day last year, I was struggling to enjoy myself while hanging out with friends at the beach. I didn’t get the call that was supposed to come on July 3rd – the results of my biopsies. I spent July 4th entertaining thoughts of tumors, cysts, breast cancer, chemo, and worse, rather than enjoying fireworks and my friends. It was a really bad day. What a difference a year makes.

Anyway, watch my boobs grow!

100 + 50 +75 +75 = 300ccs

Back to work

5 Replies

So it has been over six weeks since my prophylactic mastectomy and I feel great. My recovery has gone relatively smoothly and I am enjoying the return of full range of motion, exercising, lifting the kitties, scratching the middle of my back, vacuuming (maybe “enjoying” is a bit too strong of a word for this one), and I’m finally back to work.

slouching I have a desk job, so it isn’t very physically demanding, but I did feel completely pooped after my second day back. Sitting in one spot for most of eight hours is much different than lounging on the couch and it caught up with me. I find that the tightness across my chest, while not painful, is uncomfortable, so my shoulders droop to relieve the pressure and I slouch. Although I’m more comfortable that way, it makes my whole body ache at the end of the day. It’s just awkward. I must admit that I was getting kind of bored at home, though, so the return to work was good for me. I missed the face-to-face interaction with my friends and co-workers.

On the healing end of things: I still have a scab on lefty (about the size of a dime). Expander fills have been delayed until all is well and the scab falls off on its own. My next appointment with the plastic surgeon is scheduled for March 29th, so I am hoping healing will be complete by then and we can begin the expansion process.

Not much else going on in post-mastectomy land.

Hyperbaric oxygen therapy

2 Replies

WARNING: NSFW / graphic content below.

Tissue or skin necrosis is one of the risks associated with a mastectomy (or any surgery), which is typically a result of loss/interruption of blood vessels feeding the tissue. Read more about it in my previous post: Tissue necrosis.

Hyperbaric oxygen therapy, most commonly known to treat decompression sickness related to deep diving, is sometimes used for treatment of wounds or necrosis. I was not familiar with this type of treatment before entering this community and even now, being completely engrossed in it, I don’t see it mentioned often.

In a nutshell

Hyperbaric oxygen therapy (HBOT) involves the breathing of pure oxygen while in a sealed chamber that has been pressurized at 1-1/2 to 3 times normal atmospheric pressure. – American Cancer Society

What that means is: you get into a clear plastic tube that is sealed, the air pressure is raised (while your ears constantly “pop”), pure oxygen is pumped into the tube, and you get to watch two hours of TV while the oxygen works its magic. I renewed my Netflix subscription just for the occasion!

Why do it?

The main benefit to hyperbaric oxygen therapy for wounds is esentially faster healing. Here are some key points from WoldWideWounds.com:

Oxygen used under pressure can assist wound healing
It can be used successfully in wounds such as failing flaps and necrotising soft tissue
HBO therapy provides oxygen needed to stimulate and support wound healing where there may be insufficient supply
It combats clinical infection
It is a relatively safe non-invasive therapy

Does it work?

I had 14 treatments total and can definitely see changes in the necrotic area. I am unsure, however, how much of it can be attributed to the hyperbaric oxygen therapy versus regular rate of healing, diet, exercise, etc. Both my plastic surgeon and the wound care doctor agree that I will still have scarring and “discoloration” of the tissue underneath the necrotic skin, but will not need any skin grafting or other forms of treatment. My breast surgeon thinks that HBOT saved my nipple. So discoloration I can deal with, as long as I can avoid additional surgery and get to keep Dusky, the rebel left nipple!

These are earlier pics of changes in the wound over the first two weeks post-op, pre-HBOT:

This is what Dusky looked like after ten HBO treatments and four weeks post prophylactic bilateral mastectomy:

This is after the scab fell off two months post-op. Unfortunately, I did lose the tip of my nipple. Yup, just the tip. It took another couple of months for the pigment to return.

Tissue necrosis

28 Replies

WARNING: NSFW / graphic content below.

What is necrosis?

One of the risks associated with a mastectomy, or any surgery, is tissue necrosis. This occurs when the blood supply is compromised and the cells aren’t receiving enough oxygen; the skin begins to die. As this happens, it turns black and hardens into a scab. Although the dead tissue can be removed (debridement), it cannot be brought back to life. Hyperbaric oxygen therapy (HBOT) can be used to treat surrounding tissue – more on this in another post: Hyperbaric oxygen therapy.

Breast skin is fragile after mastectomy. If it’s exceptionally thin after the breast tissue is cut away or is handled too roughly, it may die. The same result may occur if the breast surgeon severs too many blood vessels that feed the skin or uses eletrocautery too aggressively and burns the inside of the skin, which may then blister and die.
– Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

My case

Nipple necrosis was one of my big worries when I was struggling to decide whether my prophylactic bilateral mastectomy was going to be nipple-sparing. I did a lot of research and talked to both of my surgeons about it. Check out my earlier posts on the topic: Nipples, pecs,bras, OH MY! and Let’s give them a chance.

Left nipple day of PBM

I had the unfortunate chance to experience necrosis in the area of the left nipple and skin directly underneath it. The day of my surgery, we could already see that there may be a problem. The left nipple looked “dusky.” On day six, the sterile strips covering the bottom of the nip and the incision underneath it were removed and we discovered a bit of a mess there as well. In the next 24 hours, the area turned black. A little panicked, I reached out to my PS for his guidance. I was told to just sit tight, because there really isn’t anything that could be done. I washed the area with anti-bac soap and kept an eye on it.

Over the coming days, the small area of necrosis changed shape a bit, but did not get better. Check out the images below, which show the changes over a two-week period. The day I wrote this post, 18 days after PBM, some of the scabs on the nipple have fallen off, revealing bright pink skin underneath. The larger area of necrosis under the nipple is still covered with a tough, black scab. I have had four hyperbaric oxygen treatments in an effort to minimize the damage. More on that here: Hyperbaric oxygen therapy.

I am told that my nipple will be fine. Worst case scenario = scarring or discoloration in the area below the nipple as the scabs fall off. We shall see. I will post an update when that occurs.

2/22: Scab is slowly lifting up.

7/12: Scab is long gone and the pigment has returned.