Category Archives: Complication City

Houston, we have a problem

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:

Hyperbaric oxygen therapy

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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

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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.