Tag Archives: Plastic surgery

Here we go again

Got the pre-registration call from the hospital today. Here we go again. I am two weeks away from going under the knife for the fourth (and hopefully last) surgery in this process. Almost six months have passed since I had the last surgery during which one of my implants was removed due to an infection (see: Houston, we have a problem).

Pre-op

My pre-op appointment is on Monday, March 31. I’ll be doing standard lab work and discussing the plan for my upcoming surgery, including:

Nipple symmetry – the left nipple became necrotic and I lost just the tip when the scabs came off. I want to snip the tip of the right one to match. What’s worse than two erect, awkward nipples? ONE!
Pocket closure – the pocket on my right side is too low, so during this procedure I’d like it surgically closed up a bit at the bottom.
Increase in size – since we are going in there on both sides anyway, I’d like to achieve what I originally declared as the right size for me, which is 450ccs (350ccs now).
An implant, not a tissue expander – this! More than anything, I just want to be done.

I have my fingers and toes crossed that I will wake up with an implant and not another expander! Obviously, I don’t want any more issues, so if an expander it is, I’ll suck it up and just deal with it. I’m pretty sure I will have at least one drain. <sarcasm>Yipeee.</sarcasm>. Time to whip out the good ol’ checklist and start getting ready.

Breast Prosthesis

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Guess who has two thumbs and the same number of foobs? This .. gal. No, I haven’t had my reconstruction surgery yet, but I did acquire a new breast prosthesis to compensate for the flatness on my left side. I recently said that if somebody is uncomfortable with my lack of bosom, that’s their problem. Well, my thoughts on that haven’t changed, BUT I did realize that I would soon be in a situation where I’d prefer to avoid having these conversations altogether.

Vacay

Hubby and I are going to visit his family in the Caribbean. It’ll be up-close-and-personal and about 85° Fahrenheit, which means my state will be unavoidable and questioned. If I spoke fluent Spanish, I’d say bring it on, but I don’t, so that leaves all the conversating and explaining to my hubby. I just don’t feel it necessary to do this to him. I’m very much looking forward to spending time with his family and enjoying getting away from everything.

How to acquire a foob

So, where do you even start? I remembered that the awesome Miss Casey Eischen – who is a rock star fitness expert, nutrition guru, and herself had a mastectomy with some complications – recently shared that she had a breast prosthesis in need of a home. I reached out and got the package just a couple of days later. I was excited and couldn’t wait to get it opened! Unfortunately, it wasn’t meant to be: the size and shape just weren’t right.

I dug up the name and number a friend shared with me shortly after my removal surgery for a local boutique that specializes in the needs of breast cancer survivors and individuals in need of image consulting. We scheduled a fitting and I obtained the necessary referral from my plastic surgeon. It took a couple of visits and an overnight shipment for us to get the piece just right, but we did it. Here it is, my new friend. Can you tell? The prosthesis is on the right side of the photo. It looks great in the pocketed bra and even better in clothing! I won’t fool the TSA agent reading the images produced by that airport body scanner thing, but I’m confident that I won’t be fielding and attempting to answer uniboob-related questions in Spanish. Yo no hablo mucho español.

I got the prosthesis and two bras. All of the pieces are covered by insurance, but standard deductibles and out-of-pocket maximums apply. Since my insurance plan year just restarted on January 1st, I have not yet met my deductible, so had to cover the total myself. Not a huge issue, as I will have additional expenses with the April surgery and will have to exhaust my deductible and out-of-pocket maximum then anyway. The damage? Around $400. Not too bad. Breast prosthesis: $300, two new bras: $98, consultation fee: $20, not having to answer awkward questions from distant in-laws about your missing boob: priceless.

Just some “fluffing”

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WARNING: NSFW / graphic content below.

Well, it has been a month since I posted my last status update, because there really isn’t anything terribly exciting going on. I do have a photo for you to show you some “fluffing” I’ve noticed in my right implant, though.

I saw Dr. M for another follow up visit a couple of days ago and we agreed that the infection is no more. I have been redness-free for over a month, so I seem to be in the clear. My next appointment with him is at the end of March, which will be my pre-op visit, with the surgery to follow on April 10, 2014. During that procedure my PS will attempt to replace the implant via a small incision in my armpit, using the TESSA technique (right). If he observes that too much scar tissue has accumulated in that space, he will have to place a tissue expander instead. We won’t know until he gets in there. It’s a log way away, but it’s not too early to start crossing fingers and banking those positive thoughts. Get on it! 🙂

As of today, it has been over three months since my exchange surgery and two months since the infection claimed my left implant (see: Houston we have a problem). The implant on my right does seem to be “fluffling,” meaning there has been a slight change in the perceived shape and size of the implant. What is actually happening is my body is changing around the implant forcing it into a different configuration, thus making it seem like the implant itself is actually changing. It is a gradual redistribution of the volume from top to bottom of the implant. The completion of this process may take from three months to a year. Here is the difference in just one month: left = November 13; right = December 13.

The waiting game

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WARNING: NSFW / graphic content below.

It has been over ten weeks since my exchange surgery and a month since the infection that lead to removal of my left implant. I originally thought that I may have the next surgery just three months after the deconstruction, however some issues linger.

While I was across the pond, spending time with family after my mother’s passing, I experienced a lot of redness on the left side. I emailed photos to Dr. M and was told that the combination of stress, emotional and physical exhaustion, as well as a possible infection were the very likely cause of the inflammation. He instructed me to finish the antibiotic I proactively picked up on my way to the airport. After a few days, the redness went down and hasn’t resurfaced since. This Wednesday I saw Dr. M for a follow up. He did an ultrasound and discovered a couple of small fluid-filled cavities. I am to finish the antibiotic and keep a very close eye on the area, while the serous fluid is reabsorbed and addressed by my body. If the redness returns, the fluid will be aspirated for a culture and a decision on following treatment. I’m 48 hours drug-free and things are looking good.

In any case, my next surgery is scheduled for April 10, 2014. At this point, it is unknown whether a tissue expander will be needed. Nothing to do now, but sit and wait. This is what things look like now. I am not wearing a prosthesis or going out of my way to camouflage my lack of bosom. I’ve come to the conclusion that other people’s discomfort is their problem.

Houston, we have a problem

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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:

One month post-exchange

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WARNING: NSFW / graphic content below.

It has been a month since my exchange surgery and over eight months since my prophylactic bilateral mastectomy. I went from about 184ccs of breast tissue pre-PBM, to 550ccs of saline in overfilled tissue expanders, to 350ccs of silicone gel in my Mentor round, smooth, high profile implants.

Not much has changed in the last month. I was hoping that the pocket on righty would close up a bit on the bottom, but that has not happened. This means I will most likely have a revision procedure this year to do that surgically. The new girls look fine in clothing, but I am not 100% happy when looking in the mirror. In addition to pocket revision, I am still planning on addressing the nipple asymmetry by removing the tip of the right nipple. I hope to wrap this all up by the end of this calendar year.

My scars are not pretty, but I already know I develop “two year” hypertrophic scars, so I am not surprised. I just started using Kelocote on the incision spots; hopefully this will help speed up their softening.

In other news, I just returned from a two week Europe vacation visiting Venice and my family; I’m excited to be participating in the local 2013 Race for the Cure on October 12th as part of Team FORCE (Facing Our Risk of Cancer Empowered – www.FacingOurRisk.org); and I was also recently featured in another article in the Fall 2013 edition of a local cancer magazine. Here’s my excerpt (changing names, because I want to continue to keep this blog anonymous):

“Mogatos says she never thought much about cancer until about ten years ago, when her 28-year old sister was diagnosed with breast cancer. In the intervening years, she’s had a great deal of time to think about it: she lost her sister to the disease, her mother was diagnosed with ovarian cancer, and another sister is undergoing breast biopsy.

Mogatos began having alternating ultrasounds and mammograms every six months to monitor her own breast health. She also had the BRCA test, which was negative. Once in a while she’d have an MRI, just to make sure everything was OK. Her doctor explained some women with breast cancer in their families choose to have a mastectomy, so she knew that was an option. But she was only in her early 20s, and “I was going along the lines of if it ain’t broke, don’t fix it,” she says.

In March of 2012, the time came to fix it. Mogatos picks up the story: “An ultrasound spotted some issues. Three separate masses were present. They had developed in the six months since the last mammogram. The oncologist recommended an MRI screening. Waiting for test results was hell, but when they eventually arrived, they were good – no cancer.

“In June, I felt something unusual during one of my monthly self-exams. The lump was in one of the three spots where the ultrasound found issues.” Another ultrasound confirmed that two of the three spots had increased in size and were now palpable. Mogatos had biopsies done, and again endured the terrible wait for results. There were some abnormal cells but no frank cancer. She was told to continue her self-exams and keep regular screening appointments. “The inconsistency of the messages I was getting was very hard psychologically,” she says. “I didn’t want to go through this again, having to wait for test results, feeling anxiety, then being relieved, and then ‘oops, maybe we made a mistake.’ I just couldn’t go through that again.” She began considering preventive mastectomy.

She was referred to Dr. M. “When I met him, we really clicked,” Mogatos says. “He brought up things no other surgeon mentioned. I talked to some of his other patients. I felt he’d be a great partner to get me through it.”

When the time came for surgery, she was ready. “I’d researched, I’d read, and I knew what to expect.” She was too lean for the DIEP procedure, so Dr. M placed tissue expanders, and a recent surgery replaced those with Cohesive Gel implants. “I’m ready to be done with the reconstruction,” she says. “It’s been sometimes painful, sometimes frustrating, but I’m so happy I did it. When I look at the big picture, the possibility of getting breast cancer and not making it through, like my sister, I have no regrets. It’s totally worth it. I never have to think about breast cancer again.”

Scar and surgery photos

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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.

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.

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.

Exchange surgery aftermath

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WARNING: NSFW / graphic content below.

It 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.

Dr. 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

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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!

And 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

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

We 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.

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!