Tag Archives: recovery

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.

Back to work

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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.

slouching I 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.

On 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.

Hyperbaric oxygen therapy

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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 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:

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

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.

Recovery photos

Snot delivery

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Having a cold within a week of a bilateral mastectomy is not fun or pretty. I started coming down with something a few days post-op and knew it was going to be trouble. Today, two weeks out, I am still stuffed up and hacking up stuff. I’ve gotten to the point where I feel nauseous from the amount of mucus I have ingested. Did someone order some snot? My nose is raw from trying to avoid that by blowing out whatever post-nasal drip has decided to make an appearance. That’s the “not pretty” part.

The “not fun” part is even worse. Blowing my nose, coughing, and especially sneezing are extremely painful. Each one of those actions causes abrupt movement in the chest/rib cage and is just brutal. My first sneeze took me completely by surprise. Immediately after it came, I screamed out in agony. My husband insists that the coughing and sneezing is good for me, because it forces a stretch. I think he’s talking out his butt and just trying to make me feel better.

Remedies

I got some great advice from the ladies in the FaceBook support groups (see: #1 on my list of Resources). Here’s what I have been doing to make it a bit easier on myself:

Carry a pillow, always. When I feel a cough or sneeze coming on, I gently hug it against my chest to soften the blow.
Water, water, water. I drink plenty of water. Guava juice is also good and tasty! Bolthouse Farms Passion Orange Guava juice is my drink of choice.
I drink a lot of hot tea and eat chicken soup. Although I maintain a whole foods, plant based diet, I put it on hold for the sake of getting some relief. Chicken soup helps!
I take hot, steaming showers.
Use a humidifier.
Get plenty of rest.

Foobie Fitness

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Fitness, nutrition, and your health

Speaking of exercise … post-mastectomy exercises are crucial to a full, healthy, and speedy recovery. I keep mentioning Casey Eischen’s program, because it really is a great one and has been working well for me. Every day I do exercises and every day I get further than the day before.

Click here if you’re interested in learning more or contacting Casey Eischen. This amazing lady 1. is a fitness expert and nutrition coach that is certified in training women who are recovering from breast cancer and related treatment or surgery, 2. she underwent a prophylactic bilateral mastectomy herself in November ’12, and 3. she took some time to provide invaluable feedback for this post. Also, be sure to visit (and like) Foobie Fitness, a FaceBook community page run by Casey Eischen.

Note Post-op workouts are one thing. Preparing your body before the procedure is another, and just as important. It is the #1 item on my preparing for surgery checklist: get in the best physical shape you can manage before the surgery. The healthier the body, the more tolerant it is to trauma, and the faster it recovers. I workout on a regular basis, however, I’m no fitness guru, so I would advise discussing exercise with your doctor and/or a certified trainer.

In addition to physical fitness, nutrition is extremely important to aid healing and keep a hand on inflammation. According to Casey, Inflammation is attributed to the improper functioning of the immune system. Check out this meal plan she designed for Simple/Clean Nutrition.

Something that should go without saying – smoking is a big NO-NO.

Details

The breast reconstruction procedure utilizing expanders, and ultimately implants, wreaks havoc on the pectoralis major muscle. The nerves feeding the muscle are snipped when the pocket is created (note: this was the case with my PBM, but may not be the standard procedure for all plastic surgeons, so please talk to your doctor). This causes the muscle to atrophy and lose some of its functionality. The more developed the pec major, the more difficult (read: painful) the expansion process and following recovery will be. A few months before my prophylactic mastectomy, once I knew it was in my future, I began altering my routine. I stayed away from push ups and flys and instead focused on core and legs. After the procedure, because pec major is traumatized, core and legs must pick up the slack.

I’ve fallen and I can’t get up

Maya

My abs got me out of trouble on day three after the mastectomy. I was sitting on the floor petting a cat and decided it would be a good idea to lay down flat on the floor. That was fine and dandy until it was time to get up. No matter which way I tried to get up, I felt pain. Couldn’t roll over to my side, because I still had surgical drains coming out of me and I couldn’t use my arm to prop myself up if I ever got there. Bending at the waist was not working – my serratus was screaming. I finally wedged my feet under the couch and then used the leverage and my lower abs to bend at the waist.

It was scary as I was laying there helpless, but as soon as I managed to get up, I said to my self outloud: YOU F$@#ING IDIOT! It’s funny now, but wasn’t then. Moral of the story: don’t lie flat on your back three days after surgery, stupid.

Shower time

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Taking a shower after a prophylactic bilateral mastectomy can be a challenge. For the first few days after the procedure, it is not a good idea, because of limits on mobility/range of motion, weakness, and the presence of surgical drains. Some doctors instruct their patients not to shower until the drains have been removed. Until that time, sponge baths are the way to go. I got clearance from my doctor to take a shower four days after my procedure. I almost hugged him when he uttered those words.

The magical day was Saturday (surgery was Tuesday). I waited until about 30 minutes after taking a dose of pain meds, so they had a chance to work their magic. My equipment:

Someone to help
Shower chair or a small cooler with a towel draped over it
Antibacterial soap
Shampoo/conditioner
Regular pouf
Back brush/pouf

The whole process took somewhere around 30 minutes, with most of it spent on undressing and then putting clothing back on in what seemed like slow motion. I wore my underpants and clipped my drains to them (washed my butt last:)). An alternative is to wear a shoestring or a lanyard around the neck and clip the drains to that.

Yoshi: my fav t-rex

I sat on the cooler facing away from the shower head and let the water run down my back rather than directly onto my incision sites and boobies. I insisted on doing the washing, including my hair. It was tough to reach up and scrub – taking it slow and noting when it was too much was the key. The back bush helped with the hard-to-reach places. It was a much needed extension of my t-rex arms. I put antibac soap directly on my hands and gently washed the incision sites, the armpits where the drains exited, and the rest of the chest. After showering, I patted the chest dry with a clean, sanitized towel. This was a much needed refresher!

Sasquatch xing

In one week, I progressed from the sit-down shower or a bath (water level below the chest) to my first real, solo, stand-up shower. The day I wrote this post, nine days post-op, I felt limber enough to shave my legs. Someone release the marching band! My armpits are still a bit sasqutch-esque, because the drain tube holes haven’t completely healed, so I’ll hold off shaving them.

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.

Saying NOPE to Breast Cancer

Tag Archives: recovery

Fitness

FoobieFitness.com

They’re growing – first expansion

Back to work

Hyperbaric oxygen therapy

In a nutshell

Why do it?

Does it work?

Recovery photos

Snot delivery

Remedies

Foobie Fitness

Fitness, nutrition, and your health

Details

I’ve fallen and I can’t get up

Shower time

Day 3 of recovery, infinity, and beyond!

Drain removal

Sleeping

Exercises