Category Archives: Exchange Surgery

Happy ending?

WARNING: NSFW / graphic content below.

One week after exchange surgery, during which my right tissue expander was replaced with an implant, I am feeling fantastic! My recovery has been going very well and I like what I see. The surgery took a few hours; I was home by 2pm. I left the hospital in a bra and with a drain exiting my right armpit. I suspected I would have one, so while still a big bummer, it was not a surprise. The pain level was low overall (maybe a 3). The following days were uneventful. I spent the weekend home alone, mostly reading and sleeping.

Pain Scale

Drain tubeAlthough my level of activity was low, drain output was 80mL for the first couple of days, so it had to stay in a bit longer. During my second follow up appointment, on Monday, the drain was removed. About a foot of tubing, which was placed in the pocket around the implant, was pulled out (see pic on right: from the black stitch just under the hand, all the way down!). This is usually not painful, just weird. Good riddance! Feeling so much better with that thing out of me. Dr. M declared that things were looking good and ordered a follow up a week later.

So, how are things looking? You tell me!

2015_7_30

Mentor round, smooth, high profile, silicone in 450ccs. Left in pic: 1 week, right: 10 months.

IMG_3901I am still swollen and bruised (Arnica helped), but the result is pretty darn good, considering the circumstances. I’m hesitant to celebrate, however. With my history, I have a few more weeks to go until I can breathe a little easier. The issues I experienced after my last two exchange surgeries (see: Houston, we have a problem and Déjà vu) both happened about a month out. So, fingers crossed that this is my happy ending! I can’t wait to move on with my life.

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T-minus

WARNING: NSFW / graphic content below.

The final countdown has begun. T minus seven days until my exchange surgery! That’s right, just one week left. This will be surgery #8 in the mastectomy and breast reconstruction process, which started January 22, 2013. The goal is to replace the tissue expander on my right with a squishy implant. On one hand, I am very excited about this surgery, as it should be my last one. However, I am also incredibly anxious. This process was supposed to take about eight months and two surgeries. Here we are 2.5 years later with #8 on the horizon. I’ve experienced a few complications that have drawn it out and caused me a lot of grief. In any case, this time next week I will be home and it will be behind me. I can focus on healing and moving on with my life!

Surgery prep

As I prepare for next week, I think about what supplies I need to gather. I’m dusting off the good ol’ Checklist that has helped me get my stuff together each time. I’ll be using the abbreviated version from my Box o’ recovery crap post, which lists the things I keep on the night stand:

  • MedicationsRecovery aids
  • Lanyard (I will very likely have a drain)
  • Measuring cup
  • Rubber gloves
  • Alcohol swabs
  • Scissors
  • Tape
  • Digital thermometer
  • Back scratcher
  • Tiara (of course!)
  • Tissues
  • Chap stick
  • Cough drops
  • Water
  • Snacks
  • Hand sanitizer
  • Lotion
  • Note pad and pen (to track meds and temperature)
  • Camera
  • Kindle
  • Phone and charger

That should do it.

Status update

Yoda fucksI haven’t posted a photo since the tissue expander placement, six months ago. Slacker! My expansions went OK. That side is a different shape and size than my implant, of course, but not too bad. We stopped expansions at 450ccs, which is the volume of the implant on my left. There are a few things off at this point, like my nipples not being “level” and some weird divot in my cleavage, but honestly, at this point, I’m almost all out of fucks to give about these details.

So here I am, On the left in photo I am sporting a tissue expander in 450ccs. On the right I have a Mentor round, smooth, high profile, silicone implant in 450ccs (10 months after exchange).

IMG_3801

A few months after surgery I’ll evaluate the state of things and decide how much the details are bothering me and if there is anything else to be done. Maybe that divot will fill out (it’s OK in a bra) and the nipple-level thing won’t be as bad. Things will be different with an implant and maybe they’ll be symmetrical and just right.

One thing I know will definitely follow is a tattoo by Amy Black. I still haven’t decided if it will be just a 3D nipple fill or something artsy fartsy and covering more of my chest wall. We shall see!

Bra shopping

WARNING: NSFW / graphic content below.

My exchange surgery was on September 11. We swapped out the tissue expander on my left and made a pocket revision to correct the implant bottoming out on the right. The follow up appointment was two weeks later. Everything feels and looks relatively good. Some twinges of pain here and there, but that is to be expected. As far as my results: small issue, but it’s still early as things will change and settle for a while. My next follow up is at six weeks.

Compression braI have been wearing this sexy little hospital-issued number almost 24/7 and was hoping to hear that I could ditch it. Well, I can burn that one, but I do need to continue wearing something. It should be wire-free, but have a tight band. I set out bra shopping this weekend and quickly became frustrated! The first two stores didn’t even carry a 32. I ended at Victoria’s Secret, where I should have started, but that was tiring too. It seems that out of the 23049814 bras VS carries, only a few are wire-free.

First tried on the Perfect Comfort Demi Push-Up in 32DD. Too much padding, I’m still spilling out (no DDD), and the VS girl didn’t know her shit – it has an underwire. I went home with two of the Sexy Tee Wireless Bra in 32D. It truly is wire-free and has no extra padding.

VS bras

photoUpdate: I also went to Nordstrom Monday. My location does not work with United Healthcare, but they offered to provide the paperwork and I can file it myself for UHC to review and decide on.

I didn’t mention this option originally, but should have. As Joyce wrote in the post comments, Nordstrom has fitters and works with most insurance companies for post-mastectomy bra needs. They will find the right bra and file paperwork for the insurance company to cover the expense. Appointment required.

I bought How Perfect by Wacoal in 32D. It is super soft! Love it.

The results

As I mentioned things are looking pretty good, but I do see a small issue: asymmetry. Prior to this surgery my right implant had bottomed out and was lower than the left. Now I am seeing the opposite, although not as much of a difference. I also have a sneaking suspicion that my right side is getting tighter, which may be a sign of capsular contracture, but I don’t want to panic just yet and continue to massage like Dr. M advised.

It is still early and things will continue changing. This may be a non-issue in a few months or it may be worse .. we shall see. In any case, I am just pointing out what I see now. I have not lost sight of the big picture and reason for all of this: I said NOPE to breast cancer! In the words of the wise Casey Eischen: “Prevention, not perfection.” 🙂 ❤

These things really don’t look like a D naked, but you know bras are like jeans: there are multiple ways to measure and it seems like every brand does it their own way. The bras I bought will serve for the next month. After that I hope I can go bra-free.

Reminder: Mentor round, smooth, high profile silicone implants in 450ccs.

2014_9_27 front

 

2014_9_27

 

 

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).

Anti ode to the surgical drain

A week after my revision surgery, I am happy to say that the drain is finally gone! Out of eight drains that I’ve had to endure, only two have caused me pain when being pulled out. This one was brutal. Tears-in-my-eyes, screaming-on-the-inside, get-this-thing-out-of-me type of pain. I felt every inch of it coming out. The pain was about an 11. Good riddance!

Pain Scale

Things are healing well and looking great. I am very happy with my right side and the volume we ended up with. Also glad to say that there is no necrosis in sight and bruising is at a minimum. I will keep an eye out for a seroma, now that the drain is gone, but don’t expect an issue. Antibiotics have been refilled for another week and my first expansion appointment is scheduled for May 14. I leave you today with my anti ode to the drain:

Surgical drain, o surgical drain
You are a necessary evil
But you cause much pain
Like a device that’s primeval

Waking up with you attached
Is more than a disappointment
You truly were a nuisance
Your level of awkwardness unmatched
I hated all the discomfort
I felt like a mutant

Your home was my armpit
You stayed way too long
You were my hate’s target
You really just din’t belong

You caused me much anger
And a lot of disgust
Anxious to rid of you
You felt like a dagger
You, I have freely cussed
Very happy to say adieu