Tag Archives: Prophylactic mastectomy

Projection waffles

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.

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.

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

Yup, tissue expander

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Darn it! Yes, it’s a tissue expander. There was too much scar tissue in there, so we are playing it safe. I’m OK with that … I like safe. Also, yes, I do have a drain and yes, I still hate them!

On my right side, we were able to go up to 450ccs and alter the pocket. From what I can see so far, things are looking OK. I will take photos tomorrow after my dressings are off and this pesky drain is out.

The procedure took about four hours and I only stuck around for a little bit after. The Tiddy Bear came in handy for the ride home. I ❤ these things! My throat is sore and my chest does hurt, especially on the left side where I have the tissue expander. No surprise there. No showering until tomorrow after I see Dr. M for my follow up. Until then I look as if I was choked by an Oompa Loompa, because of the pre-surgery scrub on my neck :).

Thank you all for the massive amount of positive energy and prayers sent my way. ❤ ❤ ❤

Hubby has been taking really great care of me. I just took delivery of a green smoothie to drink with my Norco. He keeps reminding me to stay on my ass and take it easy. We don’t want a repeat of last year. Nope! My two kitties have not left my side since we got home. You can’t see the other one, because she is under the blanket, spooning my leg. LOL

Recovery buddy

Box o’ recovery crap

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Counting down the hours! My surgery is scheduled for 8:30am on Thursday and should last about three hours. We are doing reconstruction on my left/flat side and pocket revision plus implant swap on the right side. I’m excited to finally get here after the six-month wait, but I’m also very nervous. Not knowing what is waiting for me is uncomfortable.

My bedside box o’ recovery crap is ready! I used my PBM checklist to gather the essentials:

Water
Back scratcher
Tissues
Tiara (of course!)
Digital thermometer
Scissors
Tape
Measuring cup
Alcohol swabs
Chap stick
Phone and charger
Rubber gloves
Snacks
Medications
Camera
Lanyard (I will very likely have a drain or two)
Hand sanitizer
Lotion
Cough drops
Note pad and pen
Kindle

I think I’ve got it covered. Don’t you? Now I just need to pack my hospital bag. I expect to be home in the afternoon, so this should be quick. Wish me luck! Talk to you later ‘gaters.

No whining

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Whambulance It looks like it will be a tissue expander after all. Waaah! Not what I wanted to hear. Somebody call the whaaambulance, STAT!

Dr. M and I discussed this yesterday during my pre-op appointment and unfortunately, he will likely be inserting an expander rather than an implant. There is a chance that one will not be needed, but as I mentioned, that is unknown until he goes in there, so planning on an expander. What a disappointment! I am hoping this won’t happen, but definitely not counting on it. Major bummer.

kik Deflated = this is how I felt when I left Dr. M’s office. It means surgery #5 is in my future and probably not until some time in August. Another summer with a tissue expander, more appointments, many more uncomfortable moments :(. BUT I got over it after reading the text my husband sent me in reply to my rant. I took a deep breath and exhaled all those thoughts out of my system. Expander fills suck and can be very uncomfortable, BUT chemotherapy side effects are much more uncomfortable. Doing this, all of this, is worth it.

So NO MORE WHINING! It is what it is and I trust Dr. M will make the best decision after assessing the state of my tissue and skin. And yes, it will be over before I know it. What I know I don’t want is more complications as a result of trying to rush things.

In addition to talking about this, we discussed the low pocket and implant size. During the procedure the pocket will be closed up a bit and I will get a larger implant on my right side – we are shooting for 450ccs. There’s a chance of fat grafting around the implant. Not sure where the donor site will be, but I know this means lots of bruising and more pain.

Less than two weeks to go! I leave you with a short video of me playing with a busted cohesive silicone gel implant while waiting for my appointment. Even if ruptured, the gel stays within the silicone capsule, unless pressure is applied. It returns to the capsule when released:

Here we go again

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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.