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.
10.29.09
Misty Watercolor Memories
The human memory is an odd creature. Or at least mine is. I have been trying to remember incidents from the first four or five weeks after the initial lift and implant insertion surgery. I’ll try to zero in on that time and then my mind will slip sideways as though the memories had a silicone shield. Everything just slides right off. Non-stick memories.
I’m guessing this happens because I tried so hard to repress and not think about what was happening WHILE it was happening. I just dealt with one second at a time, did what I had to do and cried about it afterward. I was on what amounts to auto pilot. Either that or I detached and focused on the anatomical details. Although that really started more after the second surgery.
I wonder how much of this is a coping mechanism. Avoidance used to be a major part of my modus operandi. From what I learned when I was (briefly) a psych major, avoidance isn’t considered a healthy way of coping. Though I’m not so sure I WAS avoiding. I was changing the wet to dry dressings twice daily and going to my regularly scheduled doctor appointments with the HiQ.
I have to wonder how clearly people remember incidents of severe trauma. Does our brain initiate a response that allows us to be protected from the harshness of those memories? Is it some sort of conscious mechanism in which we tell ourselves that “this gets filed back here and we’re not going to remember this any more”. Rather like sticking our fingers in our ears and yelling “LALALALALALA I CAN’T HEAR YOU LALALALALALA!!”
***WARNING – VIVID DESCRIPTION AHEAD***
And then…sometimes I get some vivid memories back. Like one of the times I was pulling off one of the wet to drys and a big chunk of flesh the size of a quarter came away with the necrotic tissue and I felt like Imhotep from “The Mummy”. Or a Zombie.
I actually spent a moment or two trying to put it back in the spot. You know…like when you’re a little kid and you break your favorite toy. You try to put it back together and it won’t go but you just can’t figure out why it won’t go back together.
Yeah, I think I was a little insane for a while.
10.28.09
Packing Up
Even after the debridement the HiQ still had me packing the area with saline soaked wet-to-dry bandages. Every time I asked why this happened his reply was the standard “I don’t know”. When I asked him what was next, his standard reply was “We’ll just have to wait and see.”.
After the debridment I told him that “I don’t know” is no longer an acceptable answer. I let him know that I would accept “I don’t know but I’ll find out” and that I would expect an answer at my next appointment. When he DID finally give me an answer it amounted to “Sometimes these things just happen and we really don’t know why”.
Emotional meltdowns were a regular occurence. Ken still wasn’t allowed in with me. I wasn’t going to expose him to the horror I saw twice a day.
After the debridement there was just raw fatty tissue and flesh. Granular tissue started filling in some of the areas. granulation tissue the newly formed vascular tissue normally produced in healing of wounds of soft tissue, ultimately forming the cicatrix. A Cicatrix is a scar resulting from formation and contraction of fibrous tissue in a flesh wound So I was starting to heal.
Since the HiQ had removed all the necrotic tissue that he could, the next step was the other bad news. There was no way the implants were going to stay. They had to come out. So they scheduled me for the second surgery on November 2nd 2007. And lucky me, I got to pay for the cost to use the surgical center. Yes. You read that right.
In the next post I’ll talk about the shocking reality of law suits for malpractice.
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.
07.08.09
The Check Up
This afternoon I’ve got an appointment with Dr. Guy, the local Uber plastic surgeon. She’ll be checking on the progress of the tissue overgrowth on my back in that one spot. According to Hubby, who can actually SEE what’s going on back there, it’s closing up FINALLY. I’m still going to hold off on wearing bras for a few more weeks though. Just to give that spot time to FULLY heal.
I’ve also found a way to make these shelf bra camis more supportive. There’s a bra-maker supply shop here (http://www.bramakerssupply.com) that has everything I need to replace these flimsy straps with wider ones. The elastic under the breasts is pretty wide already so i won’t have to replace that. All I have to do is hand dye the new shoulder straps to match and sew them in. VOILA! New, supportive cami shelf bras. Since I live in Florida, wearing two tops in the middle of summer is just too hot. So this solves both the problem of support and the heat issue. I’ll post pics when they’re done.
The *other* checking up thing I have to do is call Patti at Dr. Elliott’s office. She was supposed to call me about where I could get silicone prosthetic nipples locally. Since I don’t have an existing nipple to be cast and copied I may not have to see someone to be fitted. But then as large as the new Twins are, I may. I have NO idea ho that works really.
That’s one more thing I’ll have to report back on one I know something. I REALLY want to have the prosthetics in time for DragonCon. I’m still REALLY not in a head space for another surgery yet. Even if I COULD afford it right now, the last thing I’m looking forward to is being cut on more even if it IS just minor, in-patient surgery.
I’m afraid I can’t find any photos of the star flap nipple reconstruction. I did put up a link in an earlier post though. I’ll dig around and see what I can find and edit this post if I can find an appropriate image.
07.01.09
Emu Oil
A couple months ago I mentioned that I was starting to use something new to try to speed healing of that lovely little troubled spot. I had read that Emu Oil works wonders for many people. I’m here to weigh in on the subject.
Yes, it works. It speeds tissue growth. The problem for me was that it speeds tissue growth in the wrong places. Instead of allowing the skin to grow over the wound from the edges of separation, it grew new tissue in the middle of the wound that actually IMPEDED wound closure. So now we’re doing wet to dry bandages. I’ve explained that process in a previous post.
My conclusion: Emu oil works but you’ve got to be aware of precisely how it is applied.
06.25.09
The Non-Infection Infection
I had my appointment with Dr. Guy’s people this morning at 11:15. There is good news afoot dear reader. According to Dr. Guy’s PA, the troublesome spot on my back is NOT infected. The white stuff is simply “flesh”. That IS a direct quote.
Unfortunately the flesh is inhibiting healing, so we’re back to doing wet-to-dry bandages. I have a follow up appointment in two weeks to check the progress. Hopefully by then the area will FINALLY be closed up.
For those not familiar with wet to dry bandages, I’ll explain. I believe I may have mentioned the profess in an earlier post but I’d hate for you to have to dig for it. When there is a fairly shallow wound in need of debreiding, the least painful ad least invasive way to do it and keep it relatively sterile is to use a wet-to-dry. Here, you take a piece of sterile gauze ad soak it thoroughly with saline. Then you pack it lightly into the wound so that it covers every bit of it, even into the corners. The wet then gets covered with dry gauze and taped. When it dries, the gauze adheres to the biological matter to be removed. When you pull it out to change it, it takes some of the matter with it. Then the process is repeated until the wound is clean.
Our bodies heal from the inside out. Following this process gives your body a clean bed from which to grow new flesh and eventually skin. It can be tedious and somewhat frustrating. Sometimes it only pulls off a little bit. I just keep focusing on the good news that it’s not infected.
10.17.08
Batshit Crazy
I was hooked up to a portable V.A.C. machine (http://www.kci1.com/35.asp), from December 7th 2007 until January 24th 2008 24 hours a day, 7 days a week. Except for the few hours every three days that my husband spent pulling the specialized foam from the open wounds in my chest, cutting new pieces and putting the plastic and suction tubes back on, I carried this thing around with me as it slowly healed my chest.
It uses low level vacuum pressure to close the wounds and pull out dead tissue and fluids. In all honesty I think it saved my life. Up until the point that the surgeon’s nurse suggested it, I had been packing the open wounds with saline-soaked gauze three times a day. Even though i was grateful for the machine, it still made a soft clattering sound that was a constant reminder that I had made this choice and it was my fault that this was happening to, not only myself, but my husband and my sons.
During those months, I became even more depressed than I previously was. I think that I’m still suffering from what is called “situational depression”. I don’t like going to bed because during the day and evening there are so many distractions. When I go to bed, though, the distractions are gone and I’m left alone with my thoughts. Sometimes I can’t fall asleep until 3 am. Then I sleep until 11 and the cycle perpetuates itself.
I recognize depression in myself because there was a time when I loved cruising eBay. Now, I have little to no interest. I mean, I *could* look, but what’s the point? I’m not totally depressed. I still love my work and I’m excited about BoobCast. It just seems like some of the flavor has been taken out of the world.
I’m not the type to pin happiness on a situation. Such as, I don’t say things like “I’ll be happy when I get ________________”. I think I’m making an exception though. I’ll be happier when I don’t look at my chest in the mirror and feel mangled.
In the mean time…I’m batshit crazy.
