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,
11.02.09
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.
09.30.09
Keloid Scars
I may I have covered this topic before but not as it applied to me, personally. I noticed something last night after I took off my bra. There is a two to three inch area on the underside of each of my new breasts that has some keloid scarring. These spots didn’t have tape on them consistently as they are furthest out towards my sides and the tape kept coming off there.
Imagine if skin could simmer like water and then be frozen in that state. That’s what keloid scars look like. Here’s a photo of keloid scars on someone’s chest.
Doctors do not understand exactly why keloids form in certain people or situations and not in others. Changes in the cellular signals that control growth and proliferation could be related to the process of keloid formation, but these changes have not yet been characterized scientifically.
The methods now available to treat keloids are:
- Cortisone injections (intralesional steroids): These are safe and not very painful. Injections are usually given once per month until the maximum benefit is obtained. Injections are safe (very little steroid gets into the bloodstream) and usually help flatten keloids; however, steroid injections can also make the flattened keloid redder by stimulating the formation of more superficial blood vessels. (These can be treated using a laser; see below.) The keloid may look better after treatment than it looked to start with, but even the best results leave a mark that looks and feels quite different from the surrounding skin.
- Surgery: This is risky, because cutting a keloid can trigger the formation of a similar or even larger keloid. Some surgeons achieve success by injecting steroids or applying pressure dressings to the wound site after cutting away the keloid. Radiation after surgical excision has also been used.
- Laser: The pulsed-dye laser can be effective at flattening keloids and making them look less red. Treatment is safe and not very painful, but several treatment sessions may be needed. These may be costly, since such treatments are not generally covered by insurance plans.
- Silicone sheets: This involves wearing a sheet of silicone gel on the affected area for several hours a day for weeks or months, which is hard to sustain. Results are variable. Some doctors claim similar success with compression dressings made from materials other than silicone.
- Cryotherapy: Freezing keloids with liquid nitrogen may flatten them but often darkens the site of treatment.
- Interferon: Interferons are proteins produced by the body’s immune systems that help fight off viruses, bacteria, and other challenges. In recent studies, injections of interferon have shown promise in reducing the size of keloids, though it’s not yet certain whether that effect will be lasting. Current research is underway using a variant of this method, applying topical imiquimod (Aldara), which stimulates the body to produce interferon.
- Fluorouracil: Injections of this chemotherapy agent, alone or together with steroids, have been used as well for treatment of keloids.
- Radiation: Some doctors have reported safe and effective use of radiation to treat keloids.
This is not a very common complication, but it can happen. There doesn’t seem to be a bias. It happens equally in men and women as well as all ethnicities.
06.15.09
It’s More Complicated Than That
Something that isn’t really mentioned much is that eventually many breast implants may need to be replaced. An article released in 2005 by the New York Times reports that up to 93% of silicone implants fail within the first 10 years. http://www.nytimes.com/2005/04/07/politics/07breast.html .Those implants need to be removed and possibly replaced as soon as possible. This is another surgical expense that you will have to cover. Usually these costs must be paid out of pocket. In one study by the New England Journal of Medicine, the complication rate for augmentation was as high as nearly 25% http://content.nejm.org/cgi/content/abstract/336/10/677.
Other things surgeons are unlikely to tell you are that sometimes the skin thins and wrinkles and the silicone shell of the implant become visible. With saline implants, if you push on your breasts, you can hear the implant sloshing around. Ever fondle a breast with a saline implant? It feels like you’re fondling a water bottle. When it comes down to it, saline breast implants are really only good for looks. The other option is silicone implants. Although there is not a conclusive group of studies, it is widely believed that leaked silicone is responsible for, or at the very least, contributes to, autoimmune conditions such as fibromyalgia.
Sex may not be the same either. You have water bottles sloshing around in your chest that feel totally different from your natural breast tissue. Many women also report numbness or reduced feeling in their breasts and especially the nipples after augmentation. Sometimes it’s temporary. Sometimes it isn’t. This is surgery and it can cause permanent nerve damage just as with any other surgery.
Before you sign your paperwork for the surgery, someone in the doctor’s office will go over the list of possible complications. In my case the person stressed repeatedly that these complications were extremely rare. I’m sure that there are women out there who have gone through the procedure with no complications and no issues at all. I would LOVE to talk to one of these women.
The list of possible complications is as follows:
Seroma (pooling of serous fluid)
Hematoma (pooling of clotted blood; risk is 3-4%)
Symmastia
Double Bubble (also known as “double fold”, “snoopy effect”, or “snoopy breast”)
Mondor’s Cord
Bottoming Out
Deflation Photos (approximately 7%)
Capsule Contracture
Traction Rippling & Rippling Photos
Photos of these complications can be found here: http://tinyurl.com/5gz6mc
Other lesser complications include:
Asymmetry
Bleeding
Breast droop
Displacement
Implant leak
Infection (risk is less than 1%; always involves removal of implant)
Interference with mammography
Keloid (heavy scar)
Nerve Damage
Nipple numbness
Pain
Permanent numbness (risk is 15%)
Reactions to medications
Rippling
Rupture of the implant (often due to injury)
Skin irregularities
Sloshing
Slow healing
Swelling
Visible scar
The above are relatively MINOR complications, however. Seroma and hematoma can lead to necrosis because of the pressure on the small blood vessels reducing blood flow to the affected tissues.
Necrosis is the death of tissue. When necrosis occurs, the area must be debrided. This means that the dead tissue has to be clipped out and the remaining, new tissue cleaned. Debridement doesn’t hurt. That tissue is dead which mean there are no living nerve endings. To leave dead tissue is to invite infection. So even though the thought is terrifying (and believe me, it was TOTALLY terrifying when I went through it), it’s better to get it done and over with. Then the body has a clean bed of underlying tissue to grow from.
The complication percentages listed above are reported to be low. Most are under 10 percent according to the statistics I have found. This does NOT mean that surgery of any kind is completely safe. Do not believe that just because your friend had a boob job that went perfectly that you would have the same experience.
Your surgeon and his or her skill level play a big part. So does your body and how it heals. Even though I got a clean bill of health from my pre-surgical physical and blood test, I developed several complications. I had seroma and hematoma that were NOT addressed by my surgeon. I believe those contributed to the development of necrosis. I also talked to a nurse about a year after my complications. From the description of my waist to collarbone bruising, the nurse was completely convinced that something had gone wrong during the surgery that led to the development of the necrosis.
I’d like to stress again that you should be educated about your choice of surgeons. He or she MUST be board certified by a plastic surgery association. ANY doctors can call themselves a plastic surgeon but the ones who are actually educated for that specialty are board certified.
Do NOT try to find a deal. Trust me when I say that cheaper is NOT better. I learned this lesson the hard way. It cost me more than money to learn this.
If something does go wrong, you may not be able to sue. In the state of Florida a plastic surgeon is only required to carry $100000 in malpractice insurance unless they are affiliated with a hospital. By the time your lawyer proves malpractice, most of that $100K will be gone to lawyer’s fees. You will, in all likelihood have little to nothing left for any repair procedures.
Use my story as a cautionary tale. Know your body, know your family medical history, know your surgeon, and know the risks.
05.28.09
Six Weeks
There’s so much to talk about that I don’t know where to begin. Thursday May 27 will be six weeks since my surgery. Everything is looking good. The small opening on my back has scabbed over and is getting smaller every day. The other areas are all looking good. There is still the red spot on my right breast that hasn’t changed and there is still very minor bruising on the left. None of that is a reason for concern. I just find it odd that those things are persisting.
As requested by Dr. Elliott, I showered tonight, washed all the incision sites and re-taped them. I’m still not exactly certain why he wanted those re taped. He IS the expert here though so we deferred to his knowledge. My guess is that he still wants to keep the scarring to a minimum and that’s what the tape does. It keeps the scars flat and prevents them from becoming keloid scars (http://www.medicinenet.com/keloid/article.htm).
Something I noticed after my shower is that the skin on my back is still somewhat tight. It isn’t nearly as bad as it was six weeks ago when I felt like I was bound in a corset. It still feels like there is tape or some kind of light binding even when there isn’t though. I’ve also noticed that in a good portion of my back I still have absolutely no feeling. The only reason I know that I am touching skin is because my fingertips feel skin. I don’t even feel pressure in some places.
My armpits are almost as bad, though there is a little bit of feeling there. My left arm is almost completely back to normal as far as mobility goes. It’s still a bit sore, but it’s much better. The range of motion in my right arm is still limited. I still cannot straighten it directly next to my head. I CAN hold it at about a 60 degree angle though. I think perhaps I need to start working on stretching it. I may start a VERY light exercise routine of stretching to start increasing my range of motion. Before I do that though I’m going to call Dr. Elliott’s office and ask what they think first. No point in messing myself up if he says no. I’m all about avoiding the messing myself up bit.
Speaking of…I had another flashback tonight after I got out of the shower. It’s been a few weeks since the last time. I’m glad those horrific moments are getting fewer and farther between. I’m not thoroughly convinced that I may not be suffering in some small way from post traumatic stress disorder. PTSD isn’t just something that combat troops may have to deal with. Anyone who has been in a long term life threatening situation, whether that’s combat related, health related or even related to a rape, can develop PTSD. Flashbacks are one of those symptoms. For me, hell for anyone it’s completely terrifying to “see” incisions tear open like they did before. That was the first episode in a few weeks though. So that’s getting much better, too.
I’m starting to go out more frequently too. Before we left for my one month checkup I tried to get a hair appointment with my regular stylist because my roots were hideoulsy long. Unfortunately she couldn’t fit me in. So, silly me, I found someone else on the Pravana website and she squeezed me in. I say silly me because I actually expected her to do a good job since she claims she teaches at Brevard Community College in Cocoa. I even told her that for the dye to take properly, my roots have to be at least a gold color.
She screwed up. She lightened them to a medium brown and then tried to dye over that. My roots HIDEOUS. It looked like someone had tried to just dye over them. She promised that she would fix it for free. So against my better judgement I went back today. Somehow she managed to screw it up again. She DID manage to lighten the roots but not to the right shade because now they have an ORANGE tint to them!! I am NEVER going back to her again. I don’t care HOW desperate I am.
Now I have to wait at least a week before I can make an appointment with LeAnn at Belleza in Rockledge. I’m just going to have to call her, explain what happened and see how soon she wants to see me.
The day wasn’t a total loss though. After the stylist was done, Ken and I went out to Norman’s Raw Bar and Grill in Cocoa Village for lunch. While we were there we recorded the first episode of our food podcast “The Chipped Plate Chronicles”. YAY!!
I’m looking forward to Friday. I REALLY want to go see the new Pixar movie “Up”. It looks like it’s going to be absolutely fantastic! The reviews on www.rottentomatoes.com are phenomenal. I’ve also seen all the previews so I’m excited about it.
We have also planned that for our weekly outing to Disney, I am going to try to walk from the car in the Minnie parking lot (Yes, we know a secret) to the gift shop where they rent the wheelchairs. I think I could make it into the park, but by the time I got down to Casey’s, I’d have to have a cast member bring me a chair.
In the next couple days I’m going to release a post called “The Adjustment” that is going to cover more of my mental, physical and emotional adjustments and how I handled them. And how I’m STILL handling some of them so stay tuned!
