Tag Archives: Plastic surgery

Fourth expansion

WARNING: NSFW / graphic content below.

Another fill behind me. We took it back down a notch from 75 and added 50ccs to each expander, for a total of 350ccs/side. I’m not sure that you can see much of the difference in the photo, whic is at the bottom of this post.

I must say that I feel better after this fill than I did after the previous three. Typically I wake up on Saturday and it takes me a while to get going. This morning I didn’t feel much pain at all – no ibuprofen needed. I went food shopping and cleaned the whole house. I hope I don’t regret this tomorrow! Fingers crossed that this continues for the next four fills.

To celebrate my over-the-hump expansion (four down, four to go), I present to you: t-rex. In a previous post (see: Shower time) I joked that I had t-rex arms because of my limited range of motion right after the mastectomy. I could barely scratch my head (or butt) for a few days. I got this shirt shortly after. Enjoy!

Ask me about my t-rex

100 + 50 +75 +75 + 50 = 350ccs

We’re getting there – third expansion

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WARNING: NSFW / graphic content below.

Fill number three is done. We added 75ccs to each expander, for a total of 300ccs/side (pic below). It is about the same on the pain scale as it was last time – nothing initially, but feeling pressure the next morning. I continue to slather these things with cocoa butter oil with vitamin E to keep the skin soft and prevent stretch marks. So far so good. If you missed the scoop on the first two fills, see: They’re growing and They’re back.

Since I still haven’t decided just how big I want to go, while I was in for the fill I checked in with my plastic surgeon to get his feedback (I trust that he has an eye for these things). Another 150ccs or so will be just right based on my body size and shape. Ultimately, it is up to me how many ccs will be the sweet spot, but I do agree that we’re not there yet. So we are going to continue the fills until I’m happy. What then?

Once the desired size is reached, there are two more 50cc fills done. As you see in my photos, the tissue expanders are kind of boxy and sit high up on the chest wall. The additional expansions are done to overstretch the skin and muscle, so that when the final implant is placed it has a more natural shape. When the expansions are done, we wait four to six weeks before we move on to the next step.

Exchange surgery

When we’re done will all of the fills, including the overfilling step, an exchange surgery is performed. This is an outpatient procedure during which the plastic surgeon exchanges the tissue expanders for saline or silicone implants.

I asked how far out they are booking surgeries for Dr. M and quickly realized that I need to get something on the books STAT. The first available date is September 3rd. That is over four months away!!! My (sarcastic) thanks to Dusky, my rebel left nipple. Had I not experienced necrosis (see Tissue necrosis), we would’ve started the expansion process about two months sooner. What can I do about it? Be grateful that necrosis was as bad as it got.

Current plan: three more 50cc expansions + two 50cc expansions to overfill = 550ccs. Here’s to a Dolly Parton-esque summer! Not sure if this is good or bad. Thoughts? I’ll be celebrating my last expansion with July 4th fireworks. On this day last year, I was struggling to enjoy myself while hanging out with friends at the beach. I didn’t get the call that was supposed to come on July 3rd – the results of my biopsies. I spent July 4th entertaining thoughts of tumors, cysts, breast cancer, chemo, and worse, rather than enjoying fireworks and my friends. It was a really bad day. What a difference a year makes.

Anyway, watch my boobs grow!

100 + 50 +75 +75 = 300ccs

They’re back – second expansion

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WARNING: NSFW / graphic content below.

Another expansion done! We added 75ccs to each expander, for a total of 225ccs/side (pic below). I am now just a tad over my size before the prophylactic bilateral mastectomy in January.

I decided to speed things up a little bit – rather than doing 50ccs per expansion, we bumped it up to 75ccs. So far, so good, but it has only been a few hours. The worse of the pain the first time hit me when I woke up on the day after the fill. I felt like I was back in the recliner the first week post-op. I popped an ibuprofen, did some stretching, and moved on with my day. The pressure eased as days passed and I was back to “normal” within a week. Well, here we go again. I imagine it will get worse with each fill, but we shall see.

Breast Reconstruction Guidebook Figure 7.1 For a recap of why/how the expansion process works, see They’re growing or check out the video below, which was shared by fellow PBM-er Trisha on her blog I’m getting my boobs chopped off. By the way, if you haven’t noticed, I list a number of blogs on the right side of the page under Relevant Sites & Blogs. Check them out! Most of those ladies has also undergone a mastectomy; some proactively and some after a breast cancer diagnosis.

100 + 50 + 75 = 225ccs

Source of Figure 7.1: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

They’re growing – first expansion

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WARNING: NSFW / graphic content below.

Goodbye ugly scab, hello first fill!

The scab that has been living on my left boob has finally fallen off! Can I get a “woo hoo”? It has been two full months since my prophylactic mastectomy on January 22 and the start of my adventure with resulting skin/nipple necrosis. Today I had my first fill. 50ccs of saline were injected into each tissue expander, bringing the total to 150ccs/side.

What are tissue expanders, you ask? The type of breast reconstruction I chose is two-staged: tissue expanders first, followed by silicone breast implants. The tissue expanders, which were implanted underneath my pectoralis major muscle during the mastectomy, get filled with saline on a regular basis to stretch said muscle and the skin that covers it, until the desired volume is reached. They are like “pre-implants.” Similar shape, but more rigid, unnatural, and uncomfortable. They have a round magnetic port in the top half, which allows for insertion of a needle, without compromising the expander.

Breast Reconstruction Guidebook Figure 7.1

The process of filling the tissue expanders is pretty quick and uneventful. First the nurse uses a little plastic contraption with a metal pin at the end to find the magnetic port in the tissue expander. Once the center of the port is identified, the nurse sanitizes the area and injects the needle attached to a syringe holding the saline. She then slowly pushes the plunger until all 50ccs of fluid have been injected into the expander. This takes less than one minute. After completing the fill, she places a little round band-aid over the injection site. Same story on the other side.

This procedure is overall painless (based on just the first fill). The only sensation was a brief sting as the needle was inserted into the port through the skin.Three hours later, I feel a little bit of that now-familiar pressure on the muscle and skin stretched over the expanders. As soon as I got home, I popped an ibuprofen, did some stretches, and smeared my chest with Palmer’s cocoa butter oil.

As I look down at my chest, I can see that my foobs are bigger. It is a small difference, but it’s there. It will be interesting to watch these things grow. I can already tell that it won’t be pretty. The expanders didn’t settle exactly the same way: one sits higher and the other one is a bit twisted. The asymmetry seems to be normal based on my plastic surgeon’s feedback and the photos other women have shared. Enjoy the visual!

100 + 50 = 150ccs

The fills will continue every two weeks at 50ccs/side. At this point, I have not yet decided how big I want to go (one of my friends joked: “go big or go home!”). However, I did find out that my breast surgeon removed 184 grams of breast tissue/side, which translates to roughly 184ccs, so one more fill and I will be back to pre-op size. Next appointment: April 12.

Source of Figure 7.1: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.

Recovery photos

Day 3 of recovery, infinity, and beyond!

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Drain removal

This day (Friday; surgery was Tuesday) was one of the first post-mastectomy happy days. Had the first follow up appointment with my plastic surgeon. I was up on my feet by this day, but not yet running laps around the neighborhood. We pulled up to the hospital and a nurse came out to get me with a wheelchair. I wore my beautiful Pink Passion recovery gown.

Drain in right armpit

Dr. M noted that I was recovering nicely thus far. My drain output was very low on the two anterior drains (20ml/day each), so it was time to remove them. The sensation of the tube being pulled out was odd, but not very painful. The little pain I experienced was from the stretching of the hole in my armpit through which the tube passed. [Side note: I know the pic on the right is gnarly, but I gave you fair warning (top right of every page) that I include content that is NSFW/graphic, so deal with it.] The two posterior drain tubes were still kicking out about 60ml/day, so they were left in for a few more days.

The tubes serve a very important role during the recovery process: they remove the extra fluids your body produces as it heals itself around the incision and surgery sites. If those fluids are not taken away, seromas or hematomas can develop.

A seroma is a pocket of clear serous fluid that sometimes develops in the body after surgery. When small blood vessels are ruptured, blood plasma can seep out; inflammation caused by dying injured cells also contributes to the fluid.

Seromas are different from hematomas, which contain red blood cells, and form abscesses, which contain pus and result from an infection. – Wikipedia

Sleeping

Roses from a dear friend

I was expecting to be doing a lot of snoozing because of the narcotics, but was very surprised by how awake, alert, and active I was immediately after my return home from the hospital. I spent a lot of time online – most often in one of the FaceBook groups (See: Resources), keeping friends up-to-date, writing thank you cards, walking around the house, and general random stuff. I found that if I settled in on the recliner and forced myself to calm down and close my eyes, I didn’t have any trouble sleeping, but overall I was not beat by any means.

Exercises

I did post-op exercises from Casey Eischen’s program a few times per day. Each day it was a bit easier and I could do more.

2/1: Check out a more recent post about exercise and nutrition: Foobie Fitness

I was excited about Saturday, because I got clearance from Dr. M to take a shower! He even told me to wash my own hair. Who would’ve thought I’d be that ecstatic about bathing. More on that next.

Day 2 of recovery

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Total hospital stay after my prophylactic bilateral mastectomy was just a tad over two days. I was not up to or interested in any friends/other family visiting while I was there. Sitting up in bed was challenging and exhausting enough.

The morning of discharge, I saw both surgeons, had a few more hospital staff visitors, and got the discharge paperwork. Prior to surgery I made a list of questions we had to get answered before leaving the hospital, so we gathered the info:

How and when do I empty the drains? A nurse demonstrated how to do this properly. The drains need to be emptied at least twice per day.
Do I need to change the dressings? No, leave as is until the follow up appointment and further instructions from the plastic surgeon.
When is my follow up appointment? Friday morning (3 days post-op).
Can I shower? Not right away. Take a sponge bath or use baby wipes, until told otherwise.
Who do I contact in case of emergency or if I have questions after-hours? Call the plastic surgeon’s office. If after-hours, the answering service knows how to reach him.
When do I get the pathology results? They will be available in about a week. Make an appointment with the breast surgeon.

Pink Passion gown

I put on the super-awesome gown that was dropped off by the local Pink Passion Breast Cancer Support Group coordinator. It opens in the front, has flaps on each side of the chest for easy access, and has huge inside pockets to hold the drains. The hubby got the car warmed up and brought it to the front door, where I was taken in a wheelchair by one of the nurses.

Finally home

Borrowing a recliner is the best thing I did to prep for the recovery. It is an electric one, so I don’t have to pull the lever to use it. It is set up downstairs in the living room, with a bunch of the stuff from my checklist spread out around it. I could rest and sleep comfortably without worrying about turning over in the middle of the night.

Bathroom breaks

Prune juice

Getting the medication dosage and timing right took a couple of tries, but once I got it nailed down, I was doing great. The trips to the bathroom decreased since I was off the IV, but I made it a point to try to go every four hours when I woke up for meds. I was conscious of the fact that I hadn’t gone #2 yet, but not freaking out. Since the stool softener (Colace) was the only thing that got me nauseous, I stopped taking it and started downing Sunsweet Prune Juice. This worked! Also, each time I got up, I took at least two laps around the house to get the blood flowing.

Drain management

Emptying the drains was a bit overwhelming at first, but became just a normal thing we had to do. Hubby and I did this two times per day. Gear: rubber gloves, alcohol swabs, measuring cups, note pad, and pen. Each reservoir was emptied, the volume recorded, the port/hole wiped with an alcohol swab, the drain “charged,” and the fluid flushed down the toilet. The drain tubes were interesting (one might also use the word “gross”) to look at. There were clots visible in the lines, but not a problem. The fluids kept draining, so everything was good.

Clot

More fun stuff coming next, but first, an important announcement from Grumpy Cat, a.k.a. Tardar Sauce.

Day 1 of recovery

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Mobility

Although getting in and out of bed got easier, I was still unable to manage a trip to the bathroom in under 15 minutes. A nurse was called in each time I had to go. The feel-good button, the call nurse/TV remote, the oxygen tube, and the finger pulse oximeter clamp had to be removed before I even sat up. The IV bag was attached to the stand, we gathered up all four drains, hubby made sure my naked ass wasn’t completely bare and off we went. By about noon, we were able to do it without a nurse.

I started doing range of motion exercises while still at the hospital. If you haven’t already seen the video from Casey Eischen in my Post-op exercises post, make sure you check it out.

2/1: Check out a more recent post about exercise and nutrition: Foobie Fitness

Drains

Drain

On the day of surgery and day 1 of recovery nurses emptied my drains. They weren’t the typical JP bulb-type ones, but oval hemovac spring evacuators. Each reservoir was labeled left/right and anterior/posterior. The fluid collected was measured and then recorded. Emptying them was not difficult; keeping them untangled was. Rather than coming out of my sides, the tubes exited my armpits. This placement made for a lot of discomfort anytime my arms were moving (= all the time).

Wound dressing

There was gauze and tape in the armpits for the drain tube sites; the incisions were covered by sterile strips; and the whole chest was wrapped in an ace bandage. Due to the meds, I didn’t feel much pain, but did feel discomfort and pressure – like an elephant sitting on my chest.

Dressings

Food

DOs On the day of surgery I was on a liquid diet, but it wasn’t even relevant as I was not hungry at all. I downed crackers and a lot of water. Hall’s Vitamin C cough drops helped with the dry mouth and throat. There was a menu in my room and food service staff came around collecting orders. I was worried about constipation, so I focused on high-fiber snacks and meals. Breakfast of choice was plain, bland, tasteless oatmeal. Lunch: dressing-less garden salad. Dinner: mushroom soup.

Spirometer

In-between meals and trips to the bathroom, I did breathing exercises using the spirometer. It is a plastic box with a tube attached to it, used to get the lungs back up to full capacity and to prevent pneumonia. You inhale through the tube and try to keep the ball in the air. This gizmo came home with me to continue the exercises.

Pain management and discharge

Typically patients return home after one night’s stay in the hospital. The throngs of nurses, residents, coordinators, and doctors (I really lost count) make their rounds in the morning to see how things are going. My breast surgeon determined I was in great shape and ready to go. The nurses started the process to ween me off the morphine and transition to my prescribed narcotics (Demerol). Don’t know who or why the call was made to give me something different than what I would have at home, but they started me on Norco. Pepcid AC and Colace joined the party too. This is about when the morphine itch started. The back scratcher was my best friend.

I just needed to see the plastic surgeon for his blessing to head home. He ended up with a couple of emergency patients and did not make it to see me. After we spoke via telephone I had the option to go home and start on the Demerol or stay another night and get a prescription for Norco filled when the pharmacy opened. I opted to say and not risk being in pain without access to a remedy.

That night was uneventful. On to Day 2 of recovery.

The big day

Final preparations

Note During the last few days before surgery, I made final preparations for the big day. One of them being picking up my dad from the airport. He surprised me the Thursday before surgery by telling me he purchased his ticket to fly in from Europe to spend a month out here and help my husband take care of me. A great relief to have an extra set of hands. It’s nice to have dad here, but I plan on making a quick recovery, so I hope he doesn’t get bored!

I received two separate calls from the hospital the day before the procedure confirming we were still a “go.” I got a lot of detailed information about the timeline and what the day would look like. I confirmed that 1. I would be in a private room (space for hubby AND dad to spend the night) and 2. the hospital has wi-fi.

The night before surgery, I made sure the recliner and area around it were ready for my return home. I gathered all of the things mentioned on my checklist, without exception. I packed my hospital bag with all of the necessities and hit the sack early. I was expecting to have a bit of anxiety in the last few days leading up to the surgery, so I had my doctor write me a prescription for Ativan. The bottle is still full. I was a bit nervous, but not as much as I thought I would be.

The morning of my prophylactic bilateral mastectomy

ID and FALL RISK wrist bands

I was told to be at the hospital by 5:30am, with surgery scheduled to start at 7:30am. We arrived a bit early and waited to get checked in. The receptionist confirmed my name and date of birth and tagged me with my wrist band and the handy-dandy “FALL RISK” warning bracelet.

About 30 minutes later, I was called back by the pre-op nurse. She took my vitals, had me change into a Bair Paws gown (nothing underneath), and asked for a urine sample. We went over all of the paperwork, including consent forms I already signed. I was sure to point out that I didn’t consent to residents or fellows performing any part of the procedure, which was noted. She got my compression socks and booties on and hooked up, another nurse came in and got my IV line in, and then hubby and dad were called in to see me.

Compression socks and booties

Incision markings

A few different nurses, the anesthesiologist, and both surgeons stopped by. I mentioned that I would love to not have any nausea once I woke up and they gave me something. The plastic surgeon marked up my chest wall for the smiley face incisions (with his high-tech Sharpie). BTW, I am 5’4″, 125lbs, and 34A.

I spent a few more minutes with the family and then it was time to roll out. I was wheeled to the operating room where I got to meet a few more of the surgical staff. I scooted over to the operating table, got my arms strapped in and that is all I remember.

The surgery took over five hours: three hours for the mastectomy, two and a half for the expander placement. The fam got regular updates from the operating room (five total) via telephone call into the waiting room. Each surgeon came out to speak with them when their piece was over.

Recovery room

I woke up in the recovery room with a nurse watching my vitals. She made sure I was comfortable and wasn’t feeling nauseous. After an hour another nurse came over to wheel me to my room. While he was there prepping, I had a very sudden wave of nausea wash over me. Got an injection of something and an alcohol swab to sniff (this actually helped) . Once I was OK, we made the trip to my room.

I had a bit of a hard time moving to the bed once in the room. The nurse offered his arm and started pulling me over, but that was painful. We decided to just have his arm available and I would pull instead. I think he got impatient and gave me a little yank at the end. I finally settled in and after about 20 minutes my husband and dad came to my room.

I was hooked up to a morphine drip, which delivered a steady flow of the golden juice. I also had a button I could push for an extra kick that could be added (only every 10 mins). The machine kept track of how often extra meds were requested and how many times it actually delivered. That day I had over 20 requests, but only 12 deliveries, if I remember correctly.

I ate crackers and drank a lot of water. I made my first trip to the bathroom around 7pm. Getting out of bed was rough – needed two people to help to and in the bathroom: one to manage the drains and the other to help on the toilet. Although I felt the need to go, I had a rough time making my body obey. I peed in a “hat” that measured the output which was recorded by the nurse. I made a total of four trips to pee the first night, with each one easier than the last.

It only gets better from here! On to Day 1 of recovery.

Pre-op stuff

Here are some of the pre-op instructions I received from both doctors.

DON’Ts

Don’t use any aspirin or any products which may contain aspirin (acetaminophen/Tylenol is OK), vitamin E, fish oil, herbal medications, or diet pills within 14 days of surgery
Don’t smoke, exercise, or drink any alcoholic beverages for 24 hours
Don’t eat or drink ANYTHING, including water, after midnight
Don’t bring valuables (jewelry, excessive amounts of cash/credit cards)
Don’t wear makeup, perfume, or nail polish

DOs

Do take your blood pressure, seizure, breathing, heart condition, or thyroid (but not diabetes) medications with small sips of water
Do bathe either the morning of or the night before surgery
Do wear proper clothing (top that opens in the front)
Do have a responsible adult with you to drive you home
Do bring your eyeglass case or contact lens case and solution, if needed

I’m anxious and scared, but very excited! Still feel that this is the right decision for me and that I am doing the right thing. Can’t wait to be on the other side.