11.06.09
The Calm
After the second surgery there was actually a brief time when I thought that everything might be alright after all.
I should have known better.
I don’t know HOW I should have known better, unless past experience told me that the HiQ had no real idea what he was doing and the man was/is a menace and a disgrace to the medical profession.
I had just hoped that the worst was over.
And for a little while everything WAS okay. I actually had a period of about 12 days when everything looked like it was going to work out. Sure I was going to need one more surgery but at least I didn’t have to deal with the necrosis. I just changed the gauze over the surgical tubing drains and changed dressings like I was told.
Little did I know what was ahead of me.
11.04.09
Check Up Part 3
I forgot to include something in yesterday’s post. Dr. Elliott had mentioned that he wanted to make sure that my breast tissue has become softer. For the first few weeks right after surgery, my new boobies were really hard and stiff. They were actually very hard. It reminded me of how hard my breasts were after the initial implant surgery.
I pointed out a place across the top of my left breast that, to me, felt harder that the rest of the breast tissue. After gently prodding at it a bit in examination Dr. Elliott explained that the harder area is the top of the muscle flap. He also explained that in comparison to what HE meant my hard it was actually very soft and pliant.
Something that I found to be extremely bizarre is that where I thought had keloid scarring, upon examination, appeared to have nothing of the sort. I am chalking this up to a slightly poor fitting Caique bra from Lane Bryant. It is just a little too small and it makes the scar line feel a little lumpy after a whole day of wearing that type of bra.
That’s one more reason to have a proper bra fitting done. Even if you think it’s been done properly, sometimes it hasn’t. Even though their customer service is really, REALLY bad,
11.03.09
Check Up Part 2
Dr. Elliott is EXTREMELY pleased with how well the Twins are doing. He’s thrilled with how much they’ve softened and how well the scars are fading. He’s also pleased with how my back looks.
While he was looking and “groping” (forgive me Dr. Elliott, I don’t know what else to call it when you check to see how they feel) we talked about the things I was curious about. First, I found out the reason my back has that plasticky feeling like someone set down a layer of plastic wrap across a wide section of my back.
The reason for that is that he basically disected my back, probably doing more surgical maneuvering back there than in my chest. The crackly feeling is where scar tissue has formed in kind of a sheet. It will probably take another six months or so for that to release. He gave the same prognosis for the numb areas, although those could take even longer.
We also talked about how subjective the term “recovery” is. You “recover” in the recovery room. You “recover” in the hospital. You “recover” after the surgery and that can take over a year dependent on which aspect of healing we’re talking about. For instance it took me about six months to get my endurance level back to where it was. Some people take more time. Others take less.
It’s subjective.
We also discussed nipple reconstruction. I told him it probably wouldn’t be until this time next year. He said it didn’t matter. We could do it tomorrow, next week or five years from now. Personally *I* was just relieved that he wasn’t planning to retire any time soon.
Another thing we touched on was doing a breast lift. His concern is that there wouldn’t be much point to it because as heavy as the Twins are, they would end up right back where they are in no time at all. I would have to lose at least 30 pounds before it would become feasible.
My big issue with that is around that point the Twins will start getting smaller. As I’ve written before, to watch them shrink away is like watching my original breasts rot away. I just can’t handle that right now. I just can’t. As i sit here typing I can feel the panic rising and the tears filling my eyes. I CAN’T lose them again.
Okay, okay, I know logically that I’m not losing them. They’re a part of me and I love them dearly. I’m just SO not ready for that. And for the first time in my life I’m content to weigh 218.
We also discussed the two little places on my sides that look like little handles. he called them puckers I think. (Dr. Elliott, if you read this please leave a comment and correct my verbage). He said they were normal and occurred as part of the surgery. We could do a little lipo to lessen them but to tuck the skin would require another incision. Dr. Elliott didn’t seem very keen on another couple of incisions on me and I’m really quite okay with that. He explained that when you do the tummy tuck type breast reconstruction you get the same thing at the hip bone area.
Dr. Elliott made a point of mentioning that he was SO happy we had gone with the latissimus flap reconstruction rather than the tummy tuck. We both had been extremely concerned about possible complications. The tummy tuck procedure simply carries more risk and more risk was the LAST thing I needed.
So all in all the Twins are doing great. He wants to see me again Aprilish for my one year check up. In the mean time I REALLY hope that he checks in. He seemed really interested in my blogs.
And in case I haven’t said it enough, he’s an amazing doctor. Every woman who has to go through reconstruction for ANY reason should go see Dr. Elliott at Atlanta Plastic Surgery (http://www.atlplastic.com).
11.02.09
Seven Month Checkup
Today I’m going to see Dr. Elliott for my seven month check up. Normally it would be six months but he cut me a little slack because life has been a bit insane lately with Ken’s new job, me taking over our business, school and general family issues.
I’m sure he’s going to say everything is okay. There are some things I want to cover with him though. First, a wide swath of my back still feels like it is covered in plastic wrap. I wish I had some other way to explain it. It just feels like a big square of my back has had a cracky plastic coating painted over the top. Or maybe like someone laid down wide strips of packing tape. I really hope he understands this analogy.
I also still have numb spots in places. The other night my right armpit itched abominably but I have no sensation in that area. You wanna talk weird? Try itching someplace that’s numb. THAT’LL throw your brain for a loop.
I also want to get his opinion on the small area of keloid scarring. Please see the entry on 9/30/09 for more about this topic. It’s not much but I think he ought to know.
I also need to tell him that we won’t be able to afford my nipple reconstruction surgery until around this time next year. Then I want to ask him what he thinks about the Japanese practice of inserting pearls under the skin for nipple protrusion. Unfortunately I cannot find a reference to that at the moment. As experienced as Dr. Elliott is though I’m sure he’s heard of it IF it’s something that is actually done.
Until recently about 2/3 of all nipple reconstructions failed. Dr. Elliott has gone to incredible lengths to reassure me that with current techniques that won’t happen. It IS normal for there to be some shrinkage though.
I’ll report more on this later.
11.01.09
Surgery #2
As my regular readers know I developed necrosis two weeks after the October 2nd breast augmentation and lift surgery in 2007. After several weeks of Hell I was scheduled for a second surgery on November 2. This surgery was for the purposes of removing the implants and the remaining necrotic tissue. We showed up in the afternoon at the surgical center – which we had to pay the fee for – I was prepped and before I knew it, part two of my nightmare had begun.
When I was able I looked at what had been done. It seemed, in retrospect, Frankenstinian. The line of vertical sutures looked like someone had whip stitched the skin together. I also found out that, on the left side, there had been a half inch spot left open.
I also found out that over 300 ccs of serous fluid had built up in each pocket. The implants were both intact. That explained the pressure and the bubble under my flesh. Fortunately this time the HiQ put in what passed for really crappy drains. He had inserted open-ended surgical tubing. The outer ends were covered in gauze to absorb the leaking serous fluid that my body produced. Compared to the closed-system drains I had after my reconstruction, these things were positively primitive.
I was also an A cup now down from a DD cup and before that a C cup. This wasn’t nesecarilly a bad thing. I finally had the ski slope breast shape I had been after from the beginning. By ski slope I mean the breasts that are heavy and rounded on the bottom and on the top the breast gently slopes down to be capped by a pert, rosy nipple.
I was just missing the nipple.
The HiQ assured me that after i had healed, we could do reconstruction. At this point I was already starting to have my doubts. But I’ll talk more about that later.
For those of you joining me from NaNoBloMo and reading my blog for the first time, please go read the first post for more information about what BoobCast is all about.
10.24.09
Debridement
It sounds scary. I was terrified when the HIQ said that at the next appointment he was going to “remove the dead tissue”. I anticipated pain. I even had a panic attack. As if I wasn’t enough of a basket case as it was. I didn’t even get an explanation as to how it would be done.
By this time I was crying at least once a day. It had finally sunken in that things were really bad. I had lost both nipples and areolae. The tissue was completely dead. The tissue itself was blackened and rubbery. In some places it crackled when I pushed down on it. So it had to be removed.
Dead tissue is a breeding ground for infection and if it wasn’t removed, it would have caused infection that would have gone systemic and eventually killed me. So debriding, even though it sounds terrifying, is actually a good thing.
When we came back for the next appointment, the HiQ STILL didn’t explain exactly what would be going on. Thankfully his nurse did. She explained that this wouldn’t hurt because the tissue he would be removing was dead so the nerve endings were dead too. Because the nerves were dead, there wouldn’t be any sensation except for a pulling sensation.
I sat down and kept my eyes closed the entire time. I do know that he cut the tissue off with surgical scissors because I saw the instruments before the procedure. All I felt was pressure and tugging. No pain aside from the emotional grieving of having lost an intimate part of myself. I grieved for the loss the same way an amputee or breast cancer survivor would.
It still freaks me out some that he was cutting tissue off my body. It sounds like something out of a horror movie, doesn’t it? Just the concept was enough to freak me out. Yet through all of this I explained calmly and in clinical terms to Hubby what was going to happen. He was, again, not allowed in. I refused to expose him to it and I was determined that I would do my best to maintain a facade of normalcy.
I failed about half the time by this point. But I tried, by damn. I tried.
The most important thing to take away from this post is that if you have to endure debridment, it is NOT painful. It sounds scary but what’s scarier is what will happen if you do NOT have it done. So have it done and do something really nice for yourself afterward.
10.15.09
What Is The Sound Velcro Makes?
This is going to be a slightly more graphic than usual post about wet to dry dressings and what necrosis looks like as it develops. So those without strong stomachs are cautioned. I will do my best to inject humor into this as I go. Humor and my support system are really the only way I survived this in the first place.
That, and I rediscovered the analytical part of myself. I mentally separated myself from the situation at hand. I used the phrase “THE breasts” as opposed to “MY breasts” and I never looked at myself in the mirror. So I dissociated to some extent while I was changing the wet to dry bandages.
Initially I didn’t really understand HOW wet the gauze was supposed to be. I was told by the nurse that the gauze should be damp. *I* thought that meant it should be dripping just a little bit. After a couple days I noticed there was little to no progress with the wet to drys. Progress would mean the removal of dead tissue. I was pulling off the occasional fleck here and there but nothing meaningful.
Let me explain a bit more about wet to drys. Once the gauze has been dampened in sterile saline solution, it is laid flat in one or two layers over the area to be debrided. It is molded to the body part so when it dries it is a bit like plaster. A successful pull makes a soft sound akin to velcro being pulled from its fuzzy moorings.
When I went back in for the next check up a couple days later the HiQ complained that there was not enough progress. I explained what I had done and was given the moisture level corrections. It seems that instead of dripping slightly, the gauze should be just slightly damp. Previous to this I had done what is called “packing” where the area is kept moist with wet salined gauze. Thus my confusion, I suppose. We’ll go in to packing later when things have gotten REALLY bad.
Once I had been given better information I was sent home for a couple more days. I was also told that I should only be changing the wet to drys one to two times a day. I HAD been changing them 3-4 times because that was what I had done when I was packing. No one told me to do anything different as far as changing went. Isn’t it amazing how nothing changes when there is no communication?
With the new changes I was getting more dead tissue off. When I pulled off the dried gauze it was definitely pulling away the blackened tissue. The HiQ had me do that for about a week and a half. In that time I still forbade Ken to come in during bandage changes and showering. No one should have to be exposed to that.
I had started crying at least every other day at this point and I was really depressed for obvious reasons. Pulling bits of dead flesh off your own body tends to do that. I was angry because I couldn’t get a straight answer out of the HiQ. The man had all the bedside manner of Dr. Mengele. Which was pretty evident by the “don’t scream” comment when he was sewing cadaver skin onto me and telling me that it was an extremely expensive treatment.
Really folks that all I can manage for today. Come back tomorrow and I’ll tell you the Valium story.
10.14.09
Pins And Needles
During the first few weeks after the initial surgery, there is another incident that stands out strongly in my mind. Personally I think that I spent the first 2-3 weeks after the initial surgery in shock. Like the kind of shock they talk about on ER or House, MD. That and the fact that I really don’t want to remember, might have something to do with this.
So why am I doing this if I don’t want to remember? I’ve talked before about how silent people are when it comes to botched plastic surgeries. People need to know and understand that even with an amazing surgeon, things can go wrong. Plastic surgery isn’t an instant fix even when it DOES go right.
So here I am, talking about it.
It was the appointment after the HiQ gave me a cream that was supposed to improve circulation. I left Ken in the waiting room because I was bound and determined that I wasn’t going to expose him to what was going on unless I absolutely had to. Quite honestly I was also terrified that if he saw what was happening to my body, he would leave me and I would be alone because I had insisted on having this done.
I still have a small part of me that blames myself for the entire snafu as regular readers know. Even two years after the fact I carry a part of that blame. I don’t know if I will ever shake the idea that, on some level, this was all my fault.
I remember sitting in the exam chair. The HiQ took a long needle from a steripack and stuck it directly into the blackened nipple tissue on my right breast. It didn’t hurt. I didn’t feel anything. I also didn’t really understand what was going on. The HiQ never said why the needle stick. All he said was “I’m sorry.”
I understand now that the reason for the stick was to see if the necrosis was just topical or if it had affected the underlying tissues as well. If the necrosis was topical, there would have been a droplet of blood from the stick. There wasn’t anything.
I didn’t understand what was going on. I wasn’t being told anything. I didn’t know what questions to ask because of all that. So I was just my usual, kind, cheerful self. It’s amazing what ignorance can do. It’s also amazing how rapidly the old defense mechanism of avoidance popped in. For the last 10 minutes I have been looking at how to create a website on iWeb so that I can finally get the BoobCast website up and running.
That may not seem like avoidance from your perspective. Trust me. It is. I was avoiding talking about what happened at the HiQ’s office that afternoon.
I checked my photos and unfortunately I don’t have anything for the four week span between October 9th and November 11th. I wish I had taken some pics during that time period. That way I could have better chronicled this story.
See? I’m doing it again.
So… Here I go. After the needle stick, I THINK that’s when the HiQ first mentioned debriding. That thought terrified me. I kind of knew that it meant having tissue cut off, and I anticipated a great deal of pain. I’ll talk more about it soon. It’s emotionally really rough but physically there isn’t any pain at all.
He said that he wanted me to start doing wet to dry bandages. He didn’t say why though. I had to figure that out on my own. Wet to dry bandages gently pull off dead or dying tissue. What you do is you take a gauze bandage and pour saline solution on it. Then you squeeze it out so that it is damp and spread it on the area to be debrided Then you put dry gauze over the top so that you don’t get your clothes wet.
I did that all on my own for a week. I forbade Ken from being in the bathroom when I was changing dressings or showering and I ALWAYS wore a surgical bra when I was around him. To my mind, I was not ever going to expose him to that as long as I could help it. Unfortunately, that would come back to haunt me in about a month.
10.13.09
Nipples Revisited
This weekend Ken and I drove down to Disney’s Vero Beach Resort. They have this great little second story restaurant that overlooks the ocean. We like to go out there, watch the ocean, enjoy the breeze off the water and get a little something to nibble on.
Saturday afternoon as we were getting ready to leave a couple came up from the water and sat down. She must have been cold because her nipples were fully extended through her swimsuit.
Up until that moment I was completely satisfied with the reconstructed breasts I have. Please understand that I love my Twins. The square-ish corners have evened out nicely. They’ve got a really nice rounded look to them now. They’re also finally soft and pliable while still being somewhat firm. Even without all those changes I would still be happy beyond words to have them.
I was really startled to realize that a part of me still doesn’t feel complete. I’m definitely not mentally ready to have another surgery. Even a minor one that only involves topical tissues. If I WAS ready we can’t afford it for a while yet. The nipple reconstruction will end up being around $9,000. About $7K for the surgery and the rest is the fee for the outpatient surgical facility.
Dr. Elliott always said that I would know when I was ready to have the first surgery. He said (paraphrased) that there would come a point where the feelings I had about the mangled wreckage that once was my chest would outweigh the fears I had and I would know when I was ready.
It is the same with nipple reconstruction. I know I am not ready for another surgery yet, financial situation aside. Having that moment of realization that I miss having nipples, however, is the first step in that direction.
10.08.09
Nope. Still Not Ready.
October 2nd was my two year anniversary. I keep trying to write posts about the first two weeks. Every time I get to the point that I start talking about the pressure, I look back on things I wrote back then and I start to tear up. I still don’t know exactly how I muscled my way through the ordeal. I guess I’m just tougher than I look, eh?
I also spent a good deal of time trying to block out and forget the things that happened. I didn’t keep written records and I wish i would have taken photos in the first two weeks. But I didn’t. Even Hubby’s memory is pretty sketchy.
Neither of us can remember if the following incident is in the second or third week after the initial surgery. It DID happen some time within the first three weeks though.
One night I felt a great deal of pressure in my chest, as though there was a very heavy someone standing on a board across my chest. Hubby called the HiQ’s answering service because I was having problems breathing. The only thing that seemed to relieve the pressure was to take off the surgical bra and lay on my back. Even then that only worked for a little while.
Hubby had to call the answering service TWICE before the HiQ called back. When the HiQ called, Hubby explained the problem. I was promptly told NOT to lie down and to put the surgical bra back on. It was also suggested that Hubby get me a Valium and that nothing was wrong and I was just having an anxiety attack.
And that’s enough for now.
