Category Archives: Exchange Surgery

Scar and surgery photos

WARNING: NSFW / graphic content below.

Had another follow up appointment on Friday. Dr. M refreshed the tape that’s holding up my right foob. We are going to keep doing this for a few more weeks in hopes that it will be enough for the scar tissue to form at the bottom of the pocket and close it up, BUT I may need another surgery anyway. We compared the two sides size-wise and found that we may need to swap out my right implant for a larger one. Plus, I still need to do something about this missing nipple, so yes, more OR time in my future.

He removed the strips covering my incisions, so I can now inspect them closely. They look 3049813476 times better than after the PBM. No necrosis in sight! I have a spot that looks a little bit like the start of a stitch abscess, so I will be watching it. Here’s what my scars looked like pre-exchange and what they look like now, 12 days post-op. Different lighting, but you can see that at the bottom that they are no longer angry red and keloid-ish.

Scars on righty   Scars on lefty

I also got a copy of my surgery pictures! It is really cool to see the changes from this angle. From left: 1. 184 g/ccs removed during PBM surgery (1/22/2013), 2. Expanders at exchange (9/3/2013), 3. One out, one to go, 4. Mentor round, smooth, high profile silicones in 350ccs.

PBM  Exchange 2 expanders  Exchange 1 expander  Exchange implants

So I think this is why my right foob seems smaller than the left one, even though the implant size is the same at 350ccs: I am concave/the hole in my chest is deeper on this side, so the implant sinks into the cavity more. We can’t do anything about it right this moment, though.

Concave front view   Concave side view

Exchange surgery aftermath

WARNING: NSFW / graphic content below.

Easy peasyIt has been five days since the exchange surgery that swapped out my rock-hard tissue expanders for soft and squishy silicone implants. I must say that as I was told beforehand, this surgery really was a breeze compared to the original prophylactic bilateral mastectomy I underwent in January.

My husband took the day of surgery (Tuesday) off from work, but I was home alone the next day and onward. I spent the majority of that day napping, but was pretty mobile while awake. As I already mentioned (see: From the other side), I didn’t experience very much pain. Took my last Norco right before Wednesday’s follow up appointment, during which my drains were removed. This time around it hurt like a b#%$@! I’d say around an 8.Pain Scale

The second follow up appointment was on Friday. This is the day I started driving. During my appointment I got my handy dandy medical device ID card. I’m flying internationally in two weeks, so I’ll make sure to have it with me, but I hope I never have to use this thing.

Kinesio tapeDr. M removed the ACE bandage and bra to examine the girls. He agreed that righty is hanging lower than lefty and used some kinesio-type tape to mold it into the proper position. I was told to continue to wear a tight bra and return on Monday morning.

Hubby was out of town the whole weekend, so I spent it home alone taking it easy. I had to keep reminding myself that even though I feel 100% fine, I’m not. I was wrestling with a pickle jar earlier and finally thought: these pickles are good, but a complication-free recovery is better and had my veggie burger sans pickles. It was still yummy.

The reveal

WARNING: NSFW / graphic content below.

Saw the PS this afternoon for my exchange surgery follow-up. Some great news and some not so awesome. First, the good news: the hemovac/pancake drains have been removed. Woo hoo!!! Buh buy, I hope I never see you again!

In other news: during this appointment I got to see the girls in their full glory for the first time. They are smaller than what I was expecting, even with my over-compensation when declaring what the perfect size would be. We discussed doing 400-450ccs and over-filled to 550ccs to accommodate this volume. The implants I have are Mentor round, smooth, high profile silicones in 350ccs. I was very adamant that I did not want to be able to rest a drink on my bosom. Well, I definitely got the natural slope I wanted. No “shelving” in sight!

2013_9_4And the not so awesome news: righty sits lower than lefty. When I had the expanders, it was the other way around: lefty sat lower than righty. The PS had to open up the pocket to make things even. I don’t know if too much tissue was separated or if it is just swelling or if that’s the void from the drain tube that will eventually close down a bit. This is pretty obvious when I put on a tank top. I didn’t really get a good look and notice this until I was at home, so haven’t yet discussed it with Dr. M.

Aside from the asymmetry and being smaller than I anticipated, I think they actually look pretty good. I like the shape, the amount of cleavage, and the natural slope.

From the other side

Thank you to everyone who sent their love, support, and best wishes for today! The exchange surgery was a piece of cake! Nom nom. 🙂

2013_9_3 post-exchangeWe started just after 9am and I was on my way home by 2pm. Dr. M removed my tissue expanders and replaced them with silicone implants. I didn’t see him post-op, so don’t know yet what projection and volume I ended up with. They are definitely smaller than the expanders and are not all the way up to my collar bones. Woo hoo! I haven’t messed much with the dressings and plan on leaving this up to Dr. M.

On the pain scale, I’m at about 2. Really feeling good. I took Norco, stinky antibiotics, and some Arnica Montana to help fight inflammation and bruising as soon as I got home and ate something. This time around the nurse gave me an anti-nausea, behind-the-ear patch. I do have terrible dry mouth, though, so I’m drinking lots of water and eating cough drops like candy. This also means frequent trips to the potty.

Drain reservoir

I am sporting a sexy hospital-issue bra and an ACE bandage as you can see above and dealing with two drains. Yes, this happened. The tubes exit my armpits causing me more discomfort than the chest pains! Once again they are the giant hemovac type reservoirs. I have a follow up appointment Wednesday afternoon, during which the drains are supposed to be removed. Less than 24 hours to go!

Squishy time

Mario finishWell, the day is almost here. Exchange surgery is less than 12 hours away! I’m so happy to finally be here. All that’s left is a good night’s sleep. I feel like Mario when he finally reaches those stairs at the end of the level. 😀

Following the handy-dandy checklist I put together for my prophylactic mastectomy back in January, I have gotten everything ready. Based on all the feedback from the Ladies that have gone through the exchange surgery before me, I expect this to be a breeze. The exchange surgery will only take about two hours and will be an outpatient procedure. I should be home by about 4pm.

Prep for surgery

I didn’t borrow a recliner this time, so I built myself a pillow-fort-kind-of-thing on the bed. I prepped a basket of essentials to keep by my bedside. It will travel with me between the bed upstairs and the couch, as needed. The hospital bag is packed with a few essentials like the tablet, hand wipes, chapstick, cough drops, lanyard (for those stinkin’ drains), medications, and my awesome My Destiny Foundation tiara.

I have been downing prune juice for the past couple of days to get ahead of the constipation. Also bought some snacks and food items that will be easy to prep while I’m home alone this week. I took the rest of the week off and expect to be doing absolutely nothing.

Later gaters. Write to ya from the other side!

Show me the goods!

Only two weeks to go until my exchange surgery! I am so excited. Can’t wait to be on the other side of this thing. I’m looking forward to being finished. I report to the hospital at 7:30am, for a 9:30am surgery, on Tuesday, September 3rd.

Pre-op appointment

Met with Dr. M this afternoon for my pre-op appointment. Discussed a few more details, got my pictures taken, signed the familiar consent forms, got the don’t-take-these-meds sheet, had my blood drawn, and peed in a cup.

Here are a few of my final questions:

  • QuestionWill I be required to wear any type of bra (compressions or underwire) after the exchange surgery? Should I purchase something? No. If any type of compression is needed it will be via ace bandage and dressings or a mastectomy bra that will be issued by the hospital.
  • I have hypertrophic-ish spots on my incision scars from the mastectomy, should I use something special after the exchange to prevent this from happening? The lumpy scar tissue will be removed during the exchange surgery. Since the pockets are already created/expanded, there won’t be as much stress on the incisions going forward. Silicone sheets? That’s an option that will apply pressure to the incisions to keep them flat. We will revisit once they close.
  • What about this ugly, scarred tissue from the area that was necrotic? Depending on how much skin is loose/available after the implants are placed, we may be able to remove the chunk now. Otherwise, a skin graft from the hip area is an option, but that would need to happen at a later time.
  • And the most important question: will I have drains again? Yes. That wiped the smile off my face. Noooooooooooo! I was hoping I would never see a surgical drain again.

For my photo session today, I removed everything except my underpants. This is the third set of full body pics we’ve taken, but it was still weird. While standing on a pedestal I was thinking of this XKCD strip Lannis shared a little while ago and giggling. Where are my beads? I earned them!

Source: xkcd.com

Choosing implants

Saline versus silicone? Teardrop or round? Will high profile give enough projection? Choosing implants has been a popular topic in the Prophylactic Mastectomy Facebook group this week. While reviewing feedback of some of the other Ladies, I found myself questioning the choices I’ve made. After looking over my little list yet again, I reaffirmed that I have made the best decision for me. Here are the winners upvote and the losers downvote.

QuestionDisclaimer: Each person may give different levels of importance to the factors I list below and should discuss their options with their plastic surgeon. It is not my intention to convey that choosing anything different than what I chose is wrong. I am just presenting my logic. Right, wrong, or just plain stupid. 🙂 As always, I welcome your feedback!

Implant type

Factor Saline Silicone
Durability downvote upvote
Incision size upvote downvote
Chance of rippling downvote upvote
Natural feel downvote upvote
Sloshing downvote upvote
Leak detection upvote downvote

All the hoopla about the link between silicone implants and connective tissue disease, breast cancer, or reproductive issues is just that .. hoopla and unproven. It still caused the moratorium on use of silicone implants in the US in 1992, though. Because of this, breast implants are the most tested medical device out there. The moratorium was lifted in 2006. See FDA’s Update on the Safety of Silicone Gel-Filled Breast Implants for more details.

BreastReconstructionGuidebookTab6_1In any case, both types of implants are encased in a silicone shell. The one encasing the silicone implant is solid, but the saline one has a port (salines are inserted deflated and filled with fluid; silicones are pre-filled). Also, salines are more prone to ripple, causing folds in the shell. These two vulnerabilities are the causes of higher failure rates of saline implants. Although they come out on the bottom here, problems with silicone implants are more difficult to detect. Regular MRI screenings for “silent ruptures” are recommended for patients with these types of implants.

On the aesthetic side of the equation, the incisions needed for salines are smaller, but they are firmer and have been reported to produce a “sloshing” noise.

Implant shape

Factor Round Anatomical
Natural appearance downvote upvote
Natural feel/motion upvote downvote
Higher projection upvote downvote
Complication due to turning upvote downvote

From the various photos I have seen, I am not convinced that there is much difference in the aesthetic outcome, but in my head it makes more sense that anatomical (teardrop) implants have a more natural shape, so I gave them the upvote. While both shapes are filled with cohesive gel, the degree of viscosity varies between the round and teardrop versions. Teardrops may look better, but they are firmer due to the gel being more form-stable (read: solid). This consistency is what gives the implants the “gummy bear” moniker.

Whether saline or silicone, implants come not only in different shapes, but also either smooth or textured surfaces, as well as different projections. Due to the distribution of the gel within the implant shell, the same volume of silicone produces a higher projection in a round implant versus a teardrop one. The higher the projection, the narrower the base. With a 29″ rib cage, I need narrow implants and the round version offers the highest projection: ultra high.

And lastly, the fact that corrective surgery is required if the implant turns is a big one for me. When a round implant turns, you can’t tell, but if a teardrop is loose within its pocket, it is obvious. With the current state of my expanders (one sits higher than the other), I am nervous about this possible issue and want to avoid it.

So there you have it: I chose round silicone implants.

Check out this awesome video showing the difference between regular round silicone implants and their anatomical counterparts.

This is a video of me playing with a round implant that has been ruptured. You can see that this type of implant is also cohesive enough to not leak outside of the shell. It retracts just as the anatomical implant in the above video.

Source of Table 6.1: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.