Category Archives: PBM surgery

Pre-op prep

The awesome Casey Eischen, who is not only a fitness and nutrition expert certified in working with women after breast cancer related surgery or treatment, but also had a prophylactic mastectomy herself in November ’12, has recorded another great video. This one is all about pre-op preparation – how to set yourself up for a successful recovery following breast cancer related surgery. Watch this 8.5 minute webisode for some great tips and tricks to prep for surgery!

Also check out my own preparing for surgery checklist.

Post-op resistance training

Level 3 exercises are here!

I’ve mentioned in a couple of previous posts, that I began doing simple range of motion exercises while still in the hospital bed on the day of the prophylactic bilateral mastectomy. I was following Casey Eischen’s program. Casey is a fitness expert and nutrition coach that is certified in training women who are recovering from breast cancer and related treatment or surgery.

If you have not yet seen Casey’s first video or want to learn more about her, see: Post-op exercises or Foobie Fitness.

Here is the next video in the series with level 3 exercises. It is for those that are at least six weeks out from their mastectomy and includes more stretches plus a great resistance training routine.

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

Back to work

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.

slouchingI 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.

heartsOn 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.

One month later

It has been one month since my prophylactic nipple-sparing bilateral mastectomy. How am I doing? Here’s an update:

  • Mario kartI am now driving and no longer need a chauffeur.
  • Sneezing still hurts.
  • Got clearance to resume aerobic exercise, but no running or jumping.
  • Planning on going back to work in less than two weeks. Eek!
  • I am not a fan of these expanders. They are hard as rocks.
  • Still no expansions/fills. We are waiting for the necrotic area to heal. The large scab is slowly lifting at the edges. I trim it so it doesn’t get caught on clothes.
  • Had the 14th and last hyperbaric treatment today. Not sure how much of the healing can be attributed to the treatments, though. The wound has definitely gotten better, not worse, so it didn’t hurt. My breast surgeon believes that it saved Dusky!
  • Some bruising has developed on my right side, right over the fill port, so I stopped massaging the skin and expanders. Still using the cocoa butter oil with vitamin E.
  • Making progress in getting back full range of motion. I am happy to report a small victory – I can now bring my arms all the way to the floor during the floor/towel exercise at 13:10 in this post-op exercise video. Big accomplishment!Coins
  • Haven’t gotten any bills yet, but I know they’ll be pouring in soon.

Overall my recovery has been going great! The complications I’ve had are relatively minor and I am happy that it has not been worse.

Hyperbaric oxygen therapy

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 chamberHyperbaric 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:

Necrosis progress

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

Necrosis four weeks

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.

2013_7_12 Pigment

Recovery photos

I have finally added some photos! Check out the MY PHOTOS page.

CameraA couple of days before my prophylactic nipple-sparing bilateral mastectomy I took a “before” photo of the girls. Since then, I have been taking daily pictures to document my journey. Take a peek to see how I’ve been doing during my recovery thus far. The pics are of my nude torso, so NSFW/graphic.

Tissue necrosis

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

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.

Necrosis progress

2/22: Scab is slowly lifting up.

Necrosis one month

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

2013_7_12 Pigment