Tag Archives: BRCA

Ovarian Cancer Awareness Month

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.

Fitness

Projection waffles

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I 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.

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:

Will 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:

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:

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).

Last expansion of round 2

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WARNING: NSFW / graphic content below.

For the second time now, I am excited to declare that I am done with expansions! Yes, I’m celebrating just like I did last year when I finished the process then. We added 50ccs to the expander on my left (right in pic below), for a total of 550ccs. I now wait until September 11 for my exchange surgery. Time to bring back the calendar countdown thingie!

During my appointment, I had an opportunity to discuss the upcoming procedure with my plastic surgeon. I wanted him to eyeball things, make sure everything is OK, and confirm that all we are doing is taking out a tissue expander and placing the Mentor round, smooth, high profile, silicone implant in 450ccs.

Well, it looks like the implant on my right is making the trek south again – bottoming out. This means that during the exchange surgery, Dr. M will have to go in on my right side and close up the pocket from the bottom. This is what he did in April, so I’m concerned about whether or not this will hold. He explained that this time he will do the vest-over-pants (overlapping) closure, which should hold tight. I sure hope so, because I’m counting down to surgery #5 and now at 1.5+ years into this thing. I do not want any more surgeries!

We also discussed the current implant and whether I am happy with its size and the shape. I’m not unhappy, let’s just say that, but I did ask about the difference between high and ultra high profiles. Dr. M will look into the specific measurements and we will discuss when he returns from vacay. If there was something to improve on, projection would be it, but after discussing with the hub I am thinking that I don’t even want to go there. He agrees.

This is a 450cc silicone implant on the left of pic and a 550cc tissue expander on the right.

Nippies

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After my prophylactic bilateral mastectomy in January ’13, the left breast became necrotic from the incision up to my nipple. The scab that formed as the area healed eventually fell off taking my left nipple tip with it. Just the tip. It never grew back so I have one full nipple on the right and just the areola on the left. This makes for some awkward headlight moments.

What’s more awkward than two hard nipples?

Well, ONE! Although the remaining nip isn’t 100%, meaning I don’t have full sensation as I did pre-PBM, it still responds to stimuli. Every time I drive, for example, the seat belt rubs in just the right spot, so when I get out of the car, the right nipple is always “on.” If I was wearing bras, this wouldn’t be an issue, but I’m not, so I am usually sporting one headlight. I know .. it’s not that obvious and not everybody will notice, but I know it’s there!

One headlight

In an old post I went through the options that I face if I want to do something about the nip:

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

I want to do something and it looks like it’ll be #4. My plastic surgeon can to this during an in-office procedure, but we will wait until I am healed from my next and hopefully last surgery in September. I am aiming to be finished by end of 2014.

In the meantime, he recommended I try Bristol Six Nippies. I have seen other women recommend this product on the various message boards and now I am recommending it too. These things are awesome! They are silicone nipple pasties that can be either inserted into a bra or cami or worn directly on the skin. I have the latter version, which is coated with an adhesive and sticks right where you put it, for many hours. Nippies Skin are seamless rounds that come in light, medium, and dark tones that blend into the skin. The medium version is pictured below. The also come in other colors and designs, including tassels!

This is what they look like under the shirt. Yes, jerk cat IS judging you.

Are my breasts uneven?

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WARNING: NSFW / graphic content below.

Two months after my most recent surgery I now have the same volume in my tissue expander as I do in my implant. We added 50ccs to the expander, for a total of 450ccs. Even though they are the same, they are uneven. I am at the perfect point to show the difference between the look of expanders versus that of implants.

The tissue expanders are hard, sit high up on the chest wall, and have more projection. Implants are soft, pliable, and more natural. Women who have been through the process and had their exchange surgery often say they are disappointed with size. In a 1-to-1 volume swap, the differences between these two types of devices are to blame.

Here I am as of today: 450cc tissue expander and 450cc implant (Mentor, round, smooth, high profile, silicone). Can you tell which side is which? The one with the lighter areola is the expander. From the front, they don’t look that much different, but from the side or top you can see that the expander is narrower and sticks out further than the implant.

When I was going through the expansion process after my prophylactic mastectomy, I reached my happy point at 400ccs. Having read and heard that women are often disappointed with their size post-exchange, I gave myself a cushion and declared that I wanted 450cc implants. That’s what I ultimately got (took a while to get there, but I’m there) and I’m glad that I decided to do a little extra. I am very happy with the implant size.

My plastic surgeon overfills by 100ccs, so I have two more expansions to do. Then I wait a couple of months for my exchange surgery on September 11. This is going to be a weird summer with high temperatures, skimpy tops, and two different size boobs. Oh well. I already spent six months with a single boob, so how bad could this be, right? 😀

Updates galore

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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.

Anti ode to the surgical drain

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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

Pain in my a…xilla

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WARNING: NSFW / graphic content below.

No, it wasn’t all a bad dream; yes, I did get a tissue expander 😦

During my follow up appointment with Dr. M we discussed the reason for this: with nothing separating the pec muscle and my ribs, the tissue on my left breast adhered to them. This wasn’t a surprise, but Dr. M had to do some extra work to prep the pocket again. He went in through my armpit to avoid messing with the incision site that gave us necrosis and later the breakdown that caused an infection. He shared photos he took during the procedure illustrating the adhesion and how he separated and cauterized it:

This helps explain why my left side hurts so darn much! In addition to the internal sculpting, I also have a large incision and the drain tube in my armpit. Doing my best to not move my left arm! I’m still Norco-ing it up every six hours and the drain has been kicking out close to 100mL/day. I went in on Friday with the expectation that I’d be leaving it behind, but at this rate, I’m not sure we’ll be able to remove it when I go back on Monday.

Next steps?

So now what? Well, the right side looks great! The pocket closure and bump in size to 450ccs seems to have done the trick. The other side needs a lot of work to catch up, though. We must wait a few weeks for things to heal before we begin the expansion process. The tissue expander has 300ccs of saline and our goal is 550ccs (Dr. M over-expands). Last year’s expansions were in increments of 50ccs, every other week. Then we wait four weeks until the exchange, which puts us out to sometime in August. Here’s to another awkward summer!

Now some good news …

I have been downing Sunsweet Prune Juice, oatmeal with flax, and lots of water in an effort to avoid that dreaded post-op constipation. I also tried Smooth Move tea for the first time. I am happy to report: I pooped today! 😀

pooping